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CF Flashcards

1
Q

clinical presentation

A

increased cough
increased sputum production
SOB
chest pain
loss of appetite
weight loss

decreased FEV1
decreased FVC

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2
Q

Common pathogens of CF

A

pseudomonas aeruginosa**
strenotrophomonas maltophilia
MRSA**
acchomocter xylosoxidans
burkhoderia cepacia complex**
nontuberculosis mycobacteria

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3
Q

initial antimicrobial selection

A

typical pathogens for age
recent culture data
recent outpatient antiimicribial use
previous abx that result in clinical improvement
allergies
advere effects

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4
Q

mucoid

A

slimy or viscous consistency of bacterial colony

caused by the adaptation that assist the bacteria with resisting antibiotic

seen w persistent pseudomonas infections

aggressive therapy in CF

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5
Q

antibiotic selection for pulmonary exacerbation

A

no clear consensus what should be prescribed

target most common organism in respiratory tract

quarterly sputum collection for empiric therapy

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6
Q

pulmonary exacerbations =

A

respiratory symptoms + decline in lung function

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7
Q

two antibiotics

A

decreased resistance
higher cost
toxicity risk

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8
Q

one antibiotic

A

increased resistance
reduced cost
reduced toxicity

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9
Q

most centers us a two antibiotic regimen for CF exacerbations to target what

A

Pseudomonas

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10
Q

what is the outcome of using two different mechanism of action

A

synergistic activity in vitro

ex: AMG+ beta lactam

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11
Q

when is acute inpatient management indicated

A

severe exacerbations
resistance to oral antibiotics
failure to resolve exacerbations

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12
Q

antibiotic selection for acute inpatient is based on

A

sensitivities
microbial culture
renal function
previous clinical response

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13
Q

routes for acute pulmonary exacerbations

A

oral
IV
aerosolized

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14
Q

first treatment options for Pseudomonas

A
  • tobramycin, amikacin
    -cirprofloxacin
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15
Q

second treatment options for Pseudomonas

A

-piperacillin/tazobactam
-ceftazidime, cefepime
-carbapenem, meropenem, imipenem

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16
Q

treatment option for stenotrophonas maltophilia

A

-sulfamethoxazole/trimethoprim
-levofloxacin
-ceftazidime
-piperacillin/tazobactam

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17
Q

treatment option for MRSA

A

vancomycin ***
linezolid **
sulfamethoxazole/trimethoprim
ceftaroline
clindamycin

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18
Q

if MSSA treatment

A

may use beta lactase except ceftazidime (poor coverage)

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19
Q

treatment option for stenotrophomonas maltopilia

A

-sulfamethoxazole/trimethoprim
-levofloxacin
-ceftazidime
-piperacillin/tazobactam

20
Q

treatment option for burkholderia cepacia complex

A

-sulfamethoxazole/trimethoprim
-doxycycline
-ceftazidime
-meropenem

21
Q

How long are CF drugs administered and what are the drugs commonly used for pseudomonas

A

longer period of time

beta lactams
-cepfepime
-ceftazidime
-imipenem
-meropenem
-piperacillin/tazobactam
-

22
Q

PK of CF

A

larger volume of distribution
faster clearance
larger antibiotic doses and shorter dosing intervals
therapeutic drug monitoring and necessary dosage and regimen adjustments are critical

23
Q

dosing strategies of AMG

A

high doses, extended interval doses

monitoring: random only
less doses and TDM
lower is of toxicity

higher doses=higher peaks

extended intervals=lower troughs= lower troughs =lower toxicity

24
Q

TOPIC study Conclusion

A

IV tobramycin had equal Efficacy given one vs three times a day for CF
once a day is less nephrotoxic

25
Q

what is the guideline Recommendations dosing for AMG for cf pulmonary exacerbation

A

once a day dosing

26
Q

what is the long time consequence of AMG in CF?

A

INCREASED RISK FOR VESTIBULAR LOSS (HEARING LOSS)

27
Q

Is it sufficient to recommend an optimal duration of antibiotic treatment of an acute exacerbation of pulmonary disease?

A

No, but most centers treat 10-14 days

28
Q

monitoring during pulmonary exacerbations

A

FEV1 to normal baseline, if possible
symptoms improvement
c-reactive protein
procalcitonin

29
Q

AMG monitoring

A

peak, trough, or random
renal function panel twice weekly
CBC with differential weekly ‘vestibular testing (annually or those with frequent toobramycin

30
Q

beta lactam monitoring

A

CDC with differential weekly
renal function panel weekly
liver functiobtest and bilirubin baseline and when therapy > 14 days (pip.taz, ceftriaxone, imipenem, meropenam

31
Q

vancomycin monitoring

A

Target AUC: 400-600 mcg*hr/L
random level and trough before dose when patient reaches steady state
renal function panel twice weekly

32
Q

Fluroquinolones monitoring

A

avoid use with QT prolongation

33
Q

linezoid monitoring

A

CBC with differential weekly
liver function tests
serotonin syndrom

34
Q

other considerations for CF pulmonary exacerbation

A

bronchodilator
mucoytic
enzyme mucolytic inhaled
inhaled antibiotic

35
Q

chronic management of CF

A

inhaled antibiotic
Tobramycin

36
Q

Tobramycin dose

A

300 mg INH BID x 28 days on , alternated with aztreonam

37
Q

ADR of tobramycin

A

discolored sputum, altered voice, hearing loss

38
Q

when is tobramycin recommended ?

A

> =6 yo with mild to severe lung disease w peresistent pseudomonas in sputum culture

39
Q

when is aztreonam recommended ?

A

> =6 yo with mild to severe lung disease w peresistent pseudomonas in sputum culture

40
Q

aztreonam dose

A

75 mg INH TID x 28 on, alternated with tobramycin

41
Q

ADR of aztreonam

A

coughing weezing

42
Q

anti-inflammatory therapy of CF

A

AZithromycin

43
Q

when is azithromycin recommended in CF

A

> =6 yo w persistent p. aeruginosa infection

utilized for antimicrobial (may decrease p. aeruginosa) and anti-inflammatory (decrease neutrophils) properties

44
Q

what do patients need to be screened for to prevent resistance before taking azithromycin

A

non tuberculosis mycobacteria

45
Q

what does the guideline stronly recommend for the prevention and eradication of initial p.aeruginosa

A

the use of inhaled tobramycin 300 mg BID for 28 days

46
Q

when is prophylactic antimicrobial therapy used in CF

A

generally reserved for persistent p. aeruginosa infections and is recommended last during chronic pulmonary clearance therapy

ID (27 decks)

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