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Pulmonology > 08.19 - Drug Tx of Bacterial Infections (Sweatman) - Questions > Flashcards

08.19 - Drug Tx of Bacterial Infections (Sweatman) - Questions Flashcards

(78 cards)

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1
Q

Unproductive cough in pneumonia suggests

A

Viral or mycoplasma etiology

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2
Q

Most important factor in successful treatment of pneumonia is

A

early intervention

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3
Q

2 most common causes of nosocomial pneumonia

A

S Aureus; P Aueruginosa

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4
Q

Most common cause of pneumonia in DM or Alcoholic

A

Klebsiella Pneuminae

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5
Q

Most common etiology of pneumonia in 18-40 yo

A

Mycoplasma Pneumoniae

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6
Q

Tx of Legionnaires

A

Azithro or Carithromycin

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7
Q

Respiratory Quinolones

A

Levofloxacin, Cirpofloxacin, Moxifloxacin

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8
Q

Who gets Legionnaires

A

Men >50; Smokers/Chronic Lung Dz; Immunocompromised

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9
Q

Abx for Outpatient, no modifying factors

A

Macrolide or Doxycycline

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10
Q

1st gen macrolide? 2nd? 3rd?

A

Erythromycin, Clarithromycin, Azithromycin

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11
Q

For aminoglycoside, you should think

A

Gentamicin

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12
Q

Abx for Outpatient, COPD, no steroids or abx in 3 months

A

2nd gen Macrolide or Doxycycline

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13
Q

MOA for Macrolides

A

50s ribosomal inhibitor: Blocks translocation

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14
Q

MOA for Tetracyclines

A

30s ribosomal inhibitor: Blocks protein synthesis

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15
Q

MOA for Fluoroquinolones

A

DNA Gyrase inhibitor: Prevents DNA replication

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16
Q

MOA for Penicillins

A

Block cell wall cross-linking

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17
Q

MOA for Carbopenem

A

Blocks cell wall cross-linking

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18
Q

MOA for Cephalosporins

A

Inhibit cell wall cross-linking

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19
Q

MOA for Aminoglycosides

A

30s Ribosomal inhibitor

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20
Q

Resistance mech for Macrolides

A

Ribosomal methylation and mutation of 23S rRNA; Active efflux

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21
Q

Resistance for Tetracyclines

A

Decreased entry and increased efflux; Target insensitivity

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22
Q

Resistance for Fluoroquinolones

A

Mutation of DNA Gyrase; Active efflux

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23
Q

Resistance for Penicillins

A

Drug inactivation (b-lactamase); Altered PBPs; Decreased permeability of gram positive outer membrane; Active efflux

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24
Q

Resistance for Cephalosporins

A

Drug inactivation (b-lactamase); Altered PBPs; Decreased permeability of gram positive outer membrane; Active efflux

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25
Resistance for Aminoglycosides
Drug inactivation ; Decreased perm of gram neg outer membrane; Active efflux; Ribosomal methylation
26
No etiologic agent in ___% of nosocomial pneumonia
50%
27
3 indicated drugs for most nosocomial pneumonia
Impipenem/Cilastin; Aztreonam; Ceftazidime
28
When should Vancomycin be used
MRSA
29
50% of isolates in hospitalized patients with aspiration pneumonia are
Gram negative enteric bacilli
30
Abx for Aspiration Pneumonia
Clindamycin
31
MOA of Clindamycin
50S ribosomal inhibitor
32
MOA of Vancomycin
Binds D-alanyl-D-alanine terminus of the peptide precursor units, inhibiting peptidoglycan polymerase and transpeptidation reactions
33
Resistance for Vancomycin
Replacement of D-ala by D-lactate
34
Oral bioavailability in Doxycycline and Fluoroquinolones
High, so easy to administer orally
35
3 important parameters for defining drug activity
AUC/MIC, Cmax/MIC, T>MIC
36
Characterize AUC/MIC, Cmax/MIC, T>MIC
Concentration-dependent: AUC/MIC, Cmax/MIC; Time-dependent: T>MIC
37
Concentration-dependent means that increase in abx conc leads to more
rapid rate of bacterial death
38
Time-dependent means that reduction in bacterial density is proportional to
time that concentrations exceed MIC
39
Concentration-dependent drugs are often given
in large doses at long intervals relative to serum half-life
40
Time-dependent drugs are often given
more frequently, with emphasis on need to maintain serum drug level above MIC for 30-50% of dose interval
41
Renally eliminated drugs (adjust for renal impairment)
Amoxicillin, Ampicillin, Cefazolin, Cefepime, Ceftazidime, Gentamicin, Imipenem, Levofloxacin, Meropenem, Piperacillin, Vacomycin
42
Toxicity of Amoxicillin, Ampicillin
Maculopapular Rash
43
Toxicity of Azithromycin
Jaundice; QT prolong
44
Toxicity of Cephalosporins
Cross-reactivity with penicillin hypersenstivity
45
Toxicity of Doxycycline
Teeth; Photo; Decr bone growth
46
Toxicity of Erythromycin
Same as Az + CYP3A4 inhibitor
47
Toxicity of Gentamicin
Nephro and Ototoxicity; Neurmuscular paralysis
48
Toxicity of Imipenem
Pen/ceph hypersensitivity; Seizures
49
Toxicity of Levofloxacin
Tendon/Cartilage
50
Toxicity of Linezolid
Bone marrow suppression; MAOi
51
Toxicity of Meropenem
Pen/ceph hypersensitivity; Seizures
52
Toxicity of Piperacillin
Decr coagulation
53
Toxicity of Vancomycin
Nephro and Ototoxicity; Red Man's Syndrome
54
Abx with developmental dysfunction toxicity
Doxycycyline
55
Abx with unusual organ dysfunction toxicity
Gentamicin, Vancomycin, Erythromycin; Imipenem, Meropenem; Levofloxacin
56
Other classes, besides penicillin, with beta-lactam ring
Cephalosporin, Carbapenem
57
Abx caution with breastfeeding
Clarithromycin, Linezolid, Metronidazole, Piperacillin, Doxycycline
58
Teratogenic Abx
Clarithromycin, Doxycycline, Erythromycin, Gentamicin, Levofloxacin, Linezolid, Metronidazole, Trimethroprim
59
What is paired with Amoxicillin
Clavulonic Acid
60
What is paired with Piperacillin
Tazobactam
61
What is paired with Ampicillin
Sulbactam
62
What is paired with Imipenem
Cilastin
63
Function of Cilastin
Reversible, competitive inhibitor of DHP-1, which breaks down imipenem to inactive, nephrotoxic metabolites
64
Reversible, competitive inhibitor of DHP-1, which breaks down imipenem to inactive, nephrotoxic metabolites
Function of Cilastin
65
Why is Daptomycin not used for pulmonary infections
Inactivated by surfactant
66
Most episodes of bronchitis in young patients are
Viral
67
Etiology of bronchitis in most older patients
Bacterial
68
Most common etiology of bronchitis in smokers
H. Influenzae
69
4 abx indicated for bronchitis
Amoxicillin, Azithromycin, Clarithromycin, Doxycycline
70
Lung abcesses resolve with tx within
2 months
71
Gram positive cocci in lung abscesses are usually ___-aquired
Community
72
Gram negative bacilli in lung abscesses are usually ____-acquired
Nosocomial
73
Abx for community acquired lung abscess
Clindamycin
74
Abx for nosocomial-acquired lung abscess
Metronidazole + Ceftriaxone
75
Clindamycin is superior to penicillin vs
Bacteroides
76
For CAP, a ___ or ___ is appropriate 1st choice
Macrolide or Respiratory Quinolone
77
Alternative option for CAP
Amoxicillin/Clavulanate
78
Tx for abscesses and aspiration pneumonia should cover
Oral Anaerobes

Pulmonology (31 decks)

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