Drugs for Tx of Respiratory Infections, J Kinder, DSA Flashcards Preview

Year 2 Resp Exam 2 > Drugs for Tx of Respiratory Infections, J Kinder, DSA > Flashcards

Flashcards in Drugs for Tx of Respiratory Infections, J Kinder, DSA Deck (37):
1

what are the common outpatient respiratory microbes causing CAP

S pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Chlamydophila pneumoniae
Respiratory viruses

2

What are the common hospitalized respiratory microbes causing CAP

S pneumoniae
M pneumoniae
C pnuemoniae
H influenzae
Legionella spp
Aspiration
Respiratory viruss

3

What are the common intensive care unit respiratory microbes causing CAP

S penumoniae
S aureus
Legionella
Gram - bacilli
H influenzae

4

with use of chronic oral steroids what microbes are more common with CAP

enterobacteriaceae
Pseudomonas

5

what are common viruses causing CAP

influenza, RSV, adeno, parainfluenza

6

What are risk factors for drug resistant streptococcus penumoniae

B lactam withing previous 3 mo!!
age 65 yrs
alcoholism
immunosuppressive illness or therapy
exposure to child at day care

7

what is empiric Tx CAP for outpatient prevoiusly healthy individual

Macrolide(zpak) or doxy
both PO

8

empiric Tx CAP for outpatient at risk for DRSP,

respiratory FQ PO(levo or moxi)
or
B lactam PO (amoxicillin) + macrolide PO

9

empiric Tx CAP for inpatient, non-ICU

Respiratory FQ PO
or
B lactam IV (ceftriazone, cefotaxime or ampicillin) + macrolide IV

10

empiric Tx CAP inpatient ICU

B lactam IV + azithromycin IV
or
B lactam IV + respiratory FQ

11

Risk factors for pseudomonas aeruginosa infection

structural lung disease
repeated COPD exacerbations
Prior antibiotic Tx

12

Tx for pseudomonas

Anti-pseudomonal B lactam IV (piperacillin-tazobactam, cefepime, imipenem, meropenem)
+ cipro or levo
or
B lactam + AG + zpak
or
B lactam + AG + antipseudomonal FQ

13

What are risk factors for community-acquired methicillin-resistant Staph aureus

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

14

Tx community acquired MRSA

vanco IV or linezolid
Panton-Valentine leucocidin necrotizing pneumonia (add clinda or use linezolid)

15

How long do you Tx CAP

minimum 5 days (most 7-10)
afebrile 48-72 hours
exception: Pseudomonas- 8 day course led to more relapse compared to 15 day course

16

What are common infecting organisms for HAP

Aerobic gram - : pseudomonas, E coli, Klebseilla, acinetobacter spp
gram + cocci: MRSA
oropharyngeal: viridans, coagulase - staph, neisseria, corynebacterium

17

What are the R mechanisms of pseudomonas

Multiple efflux pumps
decreased expression of outer membrane porin channel
chromosomal induction of B lactamases

18

Pseudomonas is gaining R to what

piperacillin, ceftazidime, cefepime, imipenem, meropenem, aminoglycosides, FQs

19

how is MRSA gaining resistance

reduced affinity of penicillin-binding proteins for B lactams

20

early onset HAP pathogens

S pneumoniase
H influenzae
MSSA
sensitive gram - : E coli, klebsiella, enterobacter spp, proteus spp, serratia

21

Tx for HAP early onset

Ceftiazone
or
FQ
or
ampicillin/sulbactam
or
ertapenem

22

what are the late onset HAP pathogens

Pseudomonas, klebsiella ESBL+, acinetobacter, MRSA

23

Tx for late onset HAP

antipseudomonal cephalosporin
or
antipseudomonal carbapenem
or
B lactam
++++++
antipseudomonal FQ or AG
++++++
Linezolid or vanco

24

Duration therapy for HAP

ventilator acquired- 6 days
usually short around 7 days
pseudomonas needs minimum 8

25

What are the neuroamidase inhibitors that we use for CAP

oseltamivir PO

26

how does oseltamivir work

analog of sialic acid, interferes with release of progeny influenza virus from infected cell

27

adverse effects oseltamivir

nausea, vomiting, abdominal pain, HA, fever, diarrhea, neuropsych
approved in children >1 yr

28

therapeutic use oseltamivir

influenza prophylaxis, influenza Tx

29

What are the M2 channel blockers

amantadine, rimantadine
only effective against influenza A
** not in red

30

What are the antivirals for HSV and VZV

acyclovir and valavyclovir

31

Adverse effects of acyclovir and valavyclovir

nasuea, diarrhea, HA

32

therapeutic use of acyclovir

genital herpes, varicella, HSV encephalitis, neonatal HSV Tx

33

What are the antivirals for CMV

ganciclovir and valganciclovir

34

What are the antifungals used to Tx CAP

fluconazole PO IV
itraconazole PO
voriconazole PO IV

35

MOA antifungals Tx of CAP

inhibit fungal cytochrome p450, reducing production ergosterol

36

adverse effects antifungals

minor GI upset, abnormal liver enzymes

37

what is therapeutic use of antifungals

wide spectrum of activity against Candida spp, blastomycosis, coccidiodomycosis, histoplasmosis and even aspergillus