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Drugs for respiratory infections Flashcards

(112 cards)

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1
Q

CURB-65

A

confusion
uremia (BUN>19)
respiratory rate (>=30)
BP low (systolic =65

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2
Q

CURB-65 scale

A

0-1 treat outpatient
2-admit
3-ICU

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3
Q

minor criteria of admission

A

WBC100,000

temp <36

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4
Q

absolute indications for ICU admission

A

mechanical ventilation

septic shock

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5
Q

CAP CXR

A

infiltates required for Dx

if neg but CAP strongly suspected start antibiotics and repeat CXR in 24-48hrs

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6
Q

CAP culutre

A

need to know what microbe to Tx to decrease mortality

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7
Q

CAP UA

A

legionella

pneumococcal

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8
Q

atypical bacteria

A

mycoplasma penumoniae
chlamydophilia pneumoniae
legionella

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9
Q

common infecting organisms for outpatient

A 
S. penumoniae
M. pneumoniae
H. influenza
Chlamydophilia pneumoniae
respiratory viruses
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10
Q

in-patient non ICU organisms

A 
S. penumoniae
M. pneumoniae
Chlamydophilia pneumoniae
H. influenza
legionella
aspiration
respiratory viruses
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11
Q

ICU organisms

A 
S. penumoniae
S. aureus
legionella
gram - bacilli
H. influenza
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12
Q

underlying bronchopulmonary disease

A

H. influenza
M. catarrhalis
S. aureus

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13
Q

chronic oral steriods, severe underlying bronchopulmonary disease, alcoholism, frequent antibiotic use

A

enterobacteriaceae

pseudomonas aeruginosa

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14
Q

anaerboes

A

classic aspirations in alcohol/drug overdose
seizures w/gingical disease
esophageal motility disorders

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15
Q

common CAP viruses

A

influenza
RSV
adenovirus
parainfluenza

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16
Q

other CAP viruses

A

human metapnumonvirus
HSV
varicella-zoster
SARS associated coronavirus

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17
Q

2-3% incidence

A 
M. tuberculossis
chlamydophilia psittaci
coxiella burnetti
F. tularensis
B. pertusis
endemic fungi
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18
Q

drug resistant S. penumoniae (DRSP)

A 
65
B-lactam use w/in previous 3 yrs
alcoholics
immunosupressed
exposure to child at day care
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19
Q

outpatient in previous healthy

A

macrolide- azithromycin
doxycycline
both PO

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20
Q

outpatient at risk for DRSP

A

respiratory fluoroquinolone- levofloxacin
B-lactam- amoxicllin +macrolide
all PO

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21
Q

inpatient non ICU

A

respiratory fluoroquinolone- levofloxacin (PO or IV)

B-lactam- ceftriaxone + macrolide IV

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22
Q

ICU

A

respiratory fluoroquinolone- levofloxacin

B-lactam- ceftriaxone + macrolide IV

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23
Q

pseudomonas risks

A

structural lung disease
repeated COPD exacerbations with frequent corticosteroid and/or antibiotic use
prior antibiotic therapy

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24
Q

Tx for psudomonas

A

anti-psuudomonal B-lactam IV (piperacillin-taxobactam, cefepime) + either cipro or levofloxacin
or
beta lactam + gentamicin and azithromycin
or beta lactam + gentamycin +anti-psudomondal fluoroquinolone

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25
CA-MRSA risk
end stage renal disease injection drug abuse prior influenza prior antibiotic use
26
CA-MRSA Tx
add vancomycin or linezolid IV
27
panton-valentine leucocidin necrotizing pneumonia
add clindamycin or use linezolid
28
IV -> PO
``` hemodynamically stable normal temp and HR RR 90 SAO2 >90% normal mental status tolerating oral meds normal fnx of GI ```
29
duration of therapy
min 5 days, usually 7-10 must be afrebile for 48-72hours no more then 1 CAP associated sign of clinical insatbility
30
duration of psudomonas therapy
15 days to prevent relapse
31
HAP
occurs 48hrs or more after admission 2nd most nosocomial infection in US increases hospitalization 7-9days
32
VAP
arises in 48-72 hours after endotracheal intubation | occurs in 9-27%
33
HCAP
associated w/Hx of hospitalization or exposure to healthcare setting
34
HAP, VAP, HCAP onset
early onset <4days | late onset 5+ days
35
HAP, VAP, HCAP aerobic gram neg
P. aeruginosa E. coli K. pneumoniae Acinetobacter
36
HAP, VAP, HCAP gram pos cocci
MRSA | more common in DM, head trauma, and ICU
37
HAP, VAP, HCAP oralpharyngeal pathogens
viridans group strep coagulatse neg staph neisseria corynebacterium
38
Multi-drug resistant pathogens (MDR)
``` psudomonas aeruginosa klebsiella enterobacter serratia MRSA DRSP ```
39
psudomonas aeruginosa
``` resistance caused by multiple efflux pumps decreased expression of outer membrane porin Ch increasing resistance to piperacllin ceftazidime cefepime imipenem meropenem aminoglycosides fluroquinolones ```
40
klebsiella
intrinsically resistant to ampicillin and can acquire resistance to cephalosporins and aztreonma -> ESBL production
41
enterobacter
high frequency of developing resistance to cephalosporins during Tx
42
klebsiella, enterobacter, serratis
carry plasmid mediated AmpC-type enzymes (ESBL) which are carbapenem susceptible, but concerned about reisitance
43
MRSA
>50% of ICU infection PBPs w/reduced affinity for B-lactams concern for linezolid resistance, but still rare
44
DRSP
altered PBP | all MDR strains in US currently susceptible to vancomycin and linezolid
45
empiric therapy early onset
ceftiaxone or FQ or ampicillin/sublactam or ertapenem
46
empiric therapy early onset pathogens
S. pneumoniae H. influenza MSSA sensitive gram neg E. coli, Klebsiella, enterobacter, proteus, serratia
47
empiric therapy late onset pathogens
P. aeruginosa Klebsiella acinetobacter MRSA
48
empiric therapy late onset
``` antipseudomonal cephalosporin or antipsudomonal carbapenem or beta lactam/bata lactamase inhibitor + antipseudomonal FQ or aminoglycoside + linezolid or vancomycin ```
49
VAP duration of therapy
7 days, unless P. aeruginosa -> 15
50
non resistant S. pneumoniae
Penicillin G | amoxicillin
51
resistant S. pneumoniae
``` cefotaxime ceftriaxone levofloxacin moxifloxacin vancomycin linezolid ```
52
H. influenza
non-B-lactamaase producing: amoxicillin | B-lactamase producing: 2nd or 3rd generation cephalosproin and amoxicillin
53
M. pneumoniae
macrolide | tetracycline
54
C. pneumoniae
macrolide | tetrocycline
55
C. Psittaci
doxycylcine
56
legionella
fluoroquinolone azithromycin doxycycline
57
enterobacteriaecease
3rd or 4th genreation cephalosproin | carbapenem
58
Psudomonas
antipseudomonal B-lactam + ciprofloxacin, levofloxacin, or an aminoglycoside
59
S. aureus methicillin-sensative
antistaphylococcal penicillins nafcillin oxacillin dicloxacillin
60
MRSA
vancomycin or linezoid
61
pneumocystis jiroveci
trimethoprim/sulfamethoxazole
62
Bordetella pertussis
azithromycin | clarithromycin
63
influenza virus
osteltamivir | zanamivir
64
coccioidioides
no treatment necessary if otherwise healthy | if needed itraconazole, fluconazole
65
histoplasmosis and blastomycosis
itraconazole
66
B-lactams MOA
stuctural analongs of D-Ala-D-lAla covelently bind benicillin-binding proteins (PBPs) inhibit cell wall synthesis
67
resistance B-lactams
structural difference in PBPs decreased PBP affinity for B-lactam inability for drug to reach site of action active efflux pumps drug destruction and inactivation by B-lactamases
68
pencillins adverse effects
``` allergic rxn anaphylaxis interstitial nephritis (rare) GI pseudomembranous colitis ```
69
cephalosporins adverse rxn
1% risk of cross-rxn to penicillins diarrhea intolerance to alcohol
70
carbapenems adverse effects
nausea/vomiting seizures hypersensitivity
71
vancomycin MOA
inhibits cell wall synthesis
72
vancomycin resistance
alteration of D-Ala-D-Ala target | which bind glycopeptides poorly
73
vancomycin adverse effects
``` macular skill rash chills fever rash red man syndrome (histamine) hypotnesion tachycardic ototoxicity and nephrotoxicity ```
74
fluoroquinolones MOA
concentration dependent targets bacterial DNA gyrase and topoisomerase IV active transport out of cell
75
fluoroquinolones adverse effects
GI CNS rash, photosensitivity achilles tendon rupture
76
fluoroquinolones contraindications
kids
77
30s inhibitors
aminoglycosides | tertracycline
78
aminoglycosides advere efects
ototoxicity nephrotoxicity neuromuscular blockade
79
tetracycline adverse effects
GI superinfections w/C. difficile photosensitivity teeth discoloration
80
50s inhbitiors
macrolides clindamycin streptogamins linezolid
81
macrolides adverse effects
GI hepatoxicity arrythmias
82
clindamycin adverse effects
Diarrhea C. dif skin rash
83
streptogramins adverse rxns
infusion pain and phelbitis
84
linezolid adverse rxns
myelosupression HA rash
85
neurominidase inhibitors
oseltamivir | anamivir
86
neurominidase inhibitors MOA
analogs of sialic acid | interfere w/release of progeny influenza virus from infected host cell
87
oseltamivir adverse effects
nausea, vomiting, abdominal pain HA, fever, diarrhea, neuropsychiatric effects children >1yr
88
zanamirvir adverse effects
``` cough bronchospasm decrease in pulmonary fnx nasal/throat discomfort not recommended in underlying airway disease children >7 ```
89
neurominidase resistance
point mutation in viral hemagglutinin (HA) or neuroaminidase (NA) all influenza A and B susceptible H1N1 resistant ot oseltamivir
90
uses of neuroamindase
influenza prophylaxis | influenza Tx
91
M2Ch Blockers
amantadine | rimantadine
92
M2Ch blocker MOA
block M2 proton ion Ch of virus inhibiting uncoating of viral RNA w/in host cell only works against influenza A
93
M2Ch blocker adverse effects
``` GI CNS severe behavioral changes delirium agitation seizures ```
94
other anti-virals
acyclovir valacylovir ganciclovir valgancyclovir
95
acyclovir and valacylovir MOA
inhibits DNA synthesis
96
acyclovir and valacylovir uses
``` genital herepes varicella HSV encephalitis neonatal HSV ```
97
acyclovir and valacylovi adverse effects
nausea diarrhea HA
98
ganciclovir and valgancyclovir MOA
termination of DNA elongation
99
ganciclovir and valgancyclovir uses
CMV retinitis | CMV prophylaxis
100
ganciclovir and valgancyclovir adverse effects
``` myelosuppression nausea diarrhea fever peripheral neuropathy ```
101
antifungal uses
``` candida albicans histoplama cryptococcus neoformans coccidioides adpergillus blastomyces ```
102
Azole antifungals MOA
inhibits fungal cytochrome P450 reducing production of ergosterol
103
Azole antifungals uses
``` candida blastomycosis coccidiodomycosis histoplasmosis aspergillus ```
104
Azole antifungals adverse effects
minor GI abnormal liver enzymes drug interactions
105
amphotericin B
polyene macrolide antibiotic
106
amphotericin B MOA
binds ergosterol and changes permeabilty of cell by forming pores in cell membrane
107
amphotericin B uses
broadest spectrum of activity | useful in life threatening situations, but very toxic
108
amphotericin B uses
``` infusion related fever chills HA vomiting cumulative toxicity ->renal damage ```
109
echinocandins
caspofungin micafungin anidulafungin all IV
110
echinocandins MOA
inhibits synthesis of B-glucan | disrupts fungal cell wall -> cell death
111
echinocandins uses
candida | aspergillus
112
echinocandins adverse effects
minor GI | flushing

Resp II (15 decks)

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