Antibiotics, J Kinder, Lec Flashcards Preview

Year 2 Resp Exam 2 > Antibiotics, J Kinder, Lec > Flashcards

Flashcards in Antibiotics, J Kinder, Lec Deck (112):
1

what patients do not fall into community acquired pneumonia Tx guidlines

immunocompromised
solid organ bone marrow or stem cell transplant
chemo
long term high corticosteroids
congenital or acquire immunodeficiency
HIV

2

What is the evaluation of Illness severity Score

CURB-65
Confusion
Uremia (BUN>19)
RR >30
BP SBP65)

3

if CRUB score is 0-1 how do you Tx
if score >3 how do you Tx

0-1: outpatient
>3: admit to ICU

4

What is minor mriteria for ICU admission

low WBC
low platelets
low core temperature

5

what are the absolute indications for ICU admission

mechanical ventilation
septic shock

6

What si required fro Dx CAP

demonstrable infiltrate on CXR

7

what are common bacteria causing CAP

Spneumonia
H influenza
Moraxella

8

What bacteria can you not pick up on a gram stain that cause CAP

mycoplasma pneumoniae
chlamydophila pneumoniae
legionella spp

9

most likley infecting organisms for outpatient

s pneumoniae
mycoplasma pneumoniae
haemophilus i
chalmydophila pneumoniae
viral

10

what are common infecting organisms that we Tx inpatient non-ICU

S pneumoniae
M pnuemonia
C pnuemonia
H influenzae
Legionell spp
Aspiration
Respiratory viruses

11

What are common infecting organisms for Px that we Tx in ICU

S pneumoniae
S aureus
Legionella spp
Gram neg bacilli
H influenzae

12

What are pathogens that exist with chronic oral steroids or severe underlying bronchopulmonary disease, alcoholism, frequent antibiotic use

enterobacteriae
Pseudomonas aeruginosa

13

what are common viruses that cause CAP

influenza
RSV
adeno
parainfluenza

14

not so common viruses that can cause CAP

human metapneumovirus
HSV
Varicella zoster
SARS associated coronavirus

15

Drug Resistant S penumoniae is seen in what cases

beta lactam use within previous 3 mo!!!
age 65 y.o
alcoholism
immunosuppresive illness or Tx
Exposure to child at day care

16

for a previously healthy Px what is outpatient Tx for CAP

macrolide (azithromycin PO)
Doxy PO

17

Outpatient recommendations for at risk DRSpneumo

respiratory fluoroquinolones (levofloxacin)
Beta lactam PO (high dose amoxicillin, amoxicillin-clavulanate) alternates: (ceftriazone and cefurozime)
+ macrolide!!!

18

outpatient rec for Px in high rate (>25%)region of macrolid resistant S penumoniae

consider alternatives

19

What is rec for inpatient non ICU with CAP

Respiratory FQ IV or PO (levofloxacin)
Beta lactam IV (ceftriaxone)+ macrolide IV (azithromycin)

20

What is rec for inpatient ICU with CAP

B lactam IV (ceftriaxone) + azithromycin IV or Resp FQ (levofloxacin)

21

What is Tx for patient with beta lactam allergy

FQ

22

What are risk factors for pseudomonas

structural lung disease
repeated COPD exacerbations
prior antibiotic therapy

23

Tx for at risk pseudomonas CAP

anti-pseudomonal B lactam IV (piperacillin-tazobactam, cefepime) + cipro or levofloxacin

or B lactam + aminoglycoside (gentamycin and azithromysin)
or B lactam + aminoglycoside & anti-pseudomonal FQ

24

What are risks for CA-MRSA

end stage renal disease
injection drug abuse
prior influenza
prior antibiotic use (FQ)

25

Tx for MRSA

vancomycin IV or linezolid
panton-valentine leucocidin nectroizing pneumonia: add clindamycin or use linezolid

26

When do you switch from IV to oral

imrpoving clinically. hemodynamically stable
tolerating oral meds
normal functioning GI
normal mental status

27

Describe duration Tx for CAP

minimal 5 days
must be afebrile 48-72 hrs
no more than 1 CAP assoc sign

28

how long duration does pseudomonas

15 days

29

When does hospital acquired pneumonia begin

48 hrs after admission
increases length of stay 7-9 days

30

What is HCAP

health care associated penumonia

31

common hospital acquired pathofens

P aeruginosa, E coli, K pneumoniae, Acinetobacter Spp, MRSA

32

what are the oropharyngeal pathogens with hostpial acquired CAP

viridans group strepcocci
coagulase neg staphcocci
neisseria spp
corynebacterium spp

33

what can lead to pseudomonas R and what drugs is it becoming R to

mutlitple efflux pumps
decreased expression of outer membrane porin channel
piperacillin, ceftazidine, cefepime, imipenem, meropenem, aminoglycosides, FQs

34

What are the gram neg pathogens that are acquiring R and to what antibiotics

Klebsilla- ampicillin, cephalosporins and aztreonam
Enterobacter- cephalosporins

35

What does antibiotic carbapenem attack

the plasmid mediated AmpC-type enzymes (ESBL)

36

What is mech for MRSA

penecillin binding proteins have reduced affinity for B lactam
still R to linezolid, inc R is rare

37

What is mech behind DRSP

altered penicillin binding protein
still susceptible to vanco and linezolid

38

Dx for Drug Resistant CAP is what

radiographic infiltrate that is new or progressive
fever, purulent sputum, leukocytosis, decreased O2 sats

39

What is empiric Tx for early onset HAP

ceftiaxone OR FQ
OR ampicillin
or ertapenem

40

What are potential pathogens for late onset HAP

P aeruginosa
K pneumoniae
Acinetobacter
MRSA

41

Tx for late onset HAP

Antipseudomonal cephalosporin
or
antipseudomonal carbapenem
or
B lactam + antispeudomonal FQ or aminoglycoside (gentamycin)
+ linezolid or vanco if think MRSA

42

What is drug of choice for non-resistant S pneumoniae

penicillin G, amoxicillin

43

What is drug of choice for resistant S pneumoniae

cefotaxime, ceftriaxone, levofloxacin, moxifloxacin, vanco, linezolid

44

What is drug of choice for H influenze

non B lactamase producing: amoxicillin
B lactamase producing: 2nd or 3rd generation cephalosproin, amoxicillin/cluvulanate

45

what is drug of choice for Mycoplasma pneumoniae or chlamydophila pneumoniae

Macrolide, tetracycline

46

What is Drug of choice for legionella

FQ, azithro or doxy

47

What is drug of choice for eneterboacteriae

3rd or 4th generation cephalosprin, carbapenem (if ESBL producer)

48

what is drug of choice for pseudomonas

antispeudomonal B lactam + cipro or levo (FQ) or an aminoglycoside

49

what is drug of choice for anaerobic pathogens like bacteroidesm fusobacterium and peptrostrep

B lactam/B lactamase inhibitor, clindamycin

50

What is drug of choice for staph aureus

methicillin sensitive: penicillin (nafcillin, oxacillin, dicloxacillin)
methicillin R: vanco or linezolid

51

adverse effect of clinda

diarrhea

52

What is drug of choice foe pneumocystic jiroveci

trimethoprim/sulfamethoxazole

53

Drug of choice for bordetella pertussis

azithromycin, clarithromycin

54

what is drug of choice for influenza virus

oseltamivir, zanamivir

55

What is drug of choice for coccidioides spp

no Tx necessary if normal host
otherwhise azoles

56

Tx for histoplasmosis and blastomycosis

itraconazole

57

Where can antibiotics target

cell wall synthesis, cell membrane synthesis
synthesis of 30S and 50S ribosomal subunits
nucleic acid metabolism
function of topoisomerases
folate synthesis

58

How do beta lactams work

covalently bind penicillin binding proteins inhibiting the last transpeptidation step in cell wall synthesis

59

what leads to beta lactam synthesis

structural differences in PBPs
decreased affinity
drug destruction and inactivation!!
active efflux pumps

60

adverse effects penicillins

allergic reactions
anaphylaxis
interstitial nephritis
nausea, vomiting, mild to severe diarrhea
Pseudomembranous colitis

61

What are adverse effects cephalosproings

cross reactivity to penicillins
diarrhea
intolerance to alcohol

62

adverse effects to carbapenems

nausea/vomiting
seizures
HS

63

MOA vancomycin

binds terminal end of cell wall precursor units

64

Resistant mech vanco

alteration ot D-Ala D ala target to something else so binds poorly

65

Adverse effects to vanco

macular skin rash, chills, fever
red man syndrome (histamine release) extreme flushing, tachy and hypotension
ototoxicity, nephrotoxicity

66

MOA FQ

concentration dependent that binds bacterial DNA gyrase and topoisomerase IV
prevents relaxation of + supercoils

67

Resistant mech FQ

mutation in genes encoding DNA gyrase or topoisomerase IV
active transport out of cell

68

adverse effects FQ

GI: nausea, vomiting, abdominal discomfort
CNS: mild HA, dizziness
rash photosensitivity, achilles tendon rupture (don't give in children)

69

What antibiotics inhibit 30S subunits

aminoglycosides and tetracyclines

70

adverse effects aminoglycosides

ototoxicity, nephrotoxicity, NMJ toxicity

71

adverse effects tetracyclines

GI, superinfecitons with C difficile
photosensitivity, teeth discoloration
do NOT give to peds

72

What antibiotics inhibit 50S subunits

Macrolides
Clindamycin
Streptogramins
Linezolid

73

What are adverse effects macrolides

GI, heptotoxicity, arrhythmias

74

adverse effects clindamycin

diarrhea, C difficile, skin rash

75

adverse effects streptogramins

infusion pain and phlebitis

76

adverse effects linezolid

myelosuppression, HA, rash
anemia, thrombocytopenia
do NOT use with serotonin inhibitor usually

77

How long is incubation for influenza

1-4 days

78

When is viral shedding influenza

day after Sx 5-10 days after illness onset

79

Sx influenza

abrubt
fever, myalgia, HA, malaise, non-productive cough, sore throat, rhinitis

80

When do Sx resolve in influenza

3-7 days uncomplicated
cough and malaise can last >2 weeks

81

the hemagglutin protein on virus binds what on cell lining

sialic acid

82

What are the neurominidase inhibitors

oseltamivir PO and zanamivir INH

83

How do neurominidase inhibitors work

analogs to sialic acid so interfere with release of influenza virus from infected host cell

84

adverse effects oseltamivir

nausea, vomiting, abdominal pain, HA< fever, diarrhea, neuropsychiatric
approved for children >1 yr

85

adverse effects zanamivir

cough, bronchospasm, dec pulm function, nasal throat discomfort, not rec in underlying resp disease
children >7 yrs

86

How does R occur with neuroaminidase inhibitors

point mutation in viral hemagglutinin or neuraminidase surface proteins

87

Tx use neurominidase inhibitors

influenza prophylaxis, influenza Tx

88

What Tx influenza A

M2 channel blockers
amantadine PO and rimamtadine PO

89

how do M2 Ch blocker work

block M2 proton ion channels or virus inhibiting uncoating of viral RNA within host cell

90

adverse effects M2 ch blockers

GI, CNS dizziness, severe behavioral changes, delirium, agitation seizures from affect on dopamine transmission

91

How does R to M2 Ch blockers occur

point mutations

92

What antivirals are used for HSV and VZV

acyclovir (PO and IV and topical)
valacyclovir (PO)

93

MOA of cyclovirs

3 phosphorylation steps for activation, first via virus specific thymidine kinase.
inhibit DNA synthesis
chain termination following incorporation into viral DNA

94

What are the cyclovirs used to Tx

genital herpes, varicella, HSV encephalitis, neonatal HSV Tx

95

adverse effects cyclovirs

nausea, diarrhea, HA

96

What antivirals are used for CMV

ganiclovir and valganciclovir

97

Hwo do the ciclovirs work

acyclic guanosine analog that requires activation by triphosphorylation before inhibiting DNA polymerase

98

uses of the ciclovirs

CMV retinitis and CMV prophylaxis

99

Adverse effects ciclovirs

myelosuppression, nausea, diarrhea, fever, peripheral neuropathy

100

what are the fungi of clinical interest

candida albicans, histo capsulatum, crytpto neoformans, coccidioides immitis, aspergillus spp, blastomyces dermatitidis

101

how do azole antifungals work

inhibit gunal cytocrhome P450 reducing the production of ergosterol

102

what is ergosterol

cell membrane of fungi instead of cholesterol

103

use azoles

wide spectrum fungi

104

what are adverse effects azoles

minor GI upset, abnormalities in liver enymes

105

major drug interactions of azoles

statins
anti convulsants
warfarin--- bleeding!!

106

adverse effects voriconazole

visual changes and photosensitivity

107

What is amphotericin B

polyene macrolide antibiotic that binds ergosterol and puts pores in cell membrane

108

Tx use amphotericin B

broadest epctrum used in life threatening infections

109

adverse effects amphotericin B

infusion related fever, chills, vomiting, HA and cumulative toxicity in kidneys

110

What are echinocandins

caspofungin, micagundin
inhibit synthesis B(1-3)glucan which disrupts fungal cell wall

111

Tx use in echinocandins

candida and aspergillus, only IV

112

adverse effect echinocandins

minor GI, flushing