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

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Flashcards in 08.19 - Drug Tx of Bacterial Infections (Sweatman) - Questions Deck (78):
1

Unproductive cough in pneumonia suggests

Viral or mycoplasma etiology

2

Most important factor in successful treatment of pneumonia is

early intervention

3

2 most common causes of nosocomial pneumonia

S Aureus; P Aueruginosa

4

Most common cause of pneumonia in DM or Alcoholic

Klebsiella Pneuminae

5

Most common etiology of pneumonia in 18-40 yo

Mycoplasma Pneumoniae

6

Tx of Legionnaires

Azithro or Carithromycin

7

Respiratory Quinolones

Levofloxacin, Cirpofloxacin, Moxifloxacin

8

Who gets Legionnaires

Men >50; Smokers/Chronic Lung Dz; Immunocompromised

9

Abx for Outpatient, no modifying factors

Macrolide or Doxycycline

10

1st gen macrolide? 2nd? 3rd?

Erythromycin, Clarithromycin, Azithromycin

11

For aminoglycoside, you should think

Gentamicin

12

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

2nd gen Macrolide or Doxycycline

13

MOA for Macrolides

50s ribosomal inhibitor: Blocks translocation

14

MOA for Tetracyclines

30s ribosomal inhibitor: Blocks protein synthesis

15

MOA for Fluoroquinolones

DNA Gyrase inhibitor: Prevents DNA replication

16

MOA for Penicillins

Block cell wall cross-linking

17

MOA for Carbopenem

Blocks cell wall cross-linking

18

MOA for Cephalosporins

Inhibit cell wall cross-linking

19

MOA for Aminoglycosides

30s Ribosomal inhibitor

20

Resistance mech for Macrolides

Ribosomal methylation and mutation of 23S rRNA; Active efflux

21

Resistance for Tetracyclines

Decreased entry and increased efflux; Target insensitivity

22

Resistance for Fluoroquinolones

Mutation of DNA Gyrase; Active efflux

23

Resistance for Penicillins

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

24

Resistance for Cephalosporins

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

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