Lung Drugs & Bugs Flashcards
(104 cards)
1
Q
What are some signs and symptoms of an infection of the lungs?
A
- Cough
- Chest pain
- Fever
- Fatigue
- Dyspnea
- Increased tactile fremitus
- Egophony
- Tubular breath sounds
- Wheezes
- Dullness
- Elevated WBC
- Abnormal chest imaging
2
Q
Nosocomial pneumonia is defined as a pneumonia that begins _ hours after admission
A
Nosocomial pneumonia is defined as a pneumonia that begins 48 hours or more after admission
3
Q
Ventilator-associated pneumonia is defined as a pneumonia that begins _ hours after intubation
A
Ventilator-associated pneumonia is defined as a pneumonia that begins 48 hours after intubation
4
Q
Name the defense mechanisms in the airways/lungs that pneumonia must overcome
A
- Mechanical filtering (nose and upper airways)
- Mucociliary clearance and cough
- Antimicrobial substances (IgA, lactoferrin, lysozymes, defensins)
- Cellular immunity (macrophages, T cells, PMNs)
5
Q
Infection of the lung can take one of three routes of entry:
A
Infection of the lung can take one of three routes of entry:
1. Aspiration (pathogens colonizing the oropharynx, GI)
2. Inhalation (droplets or particles in the air)
3. Hematogenous (ex: Staph that gets in via IV drug use)
6
Q
Aspiration pneumonia is most common in _ population
A
Aspiration pneumonia is most common in individuals with altered mental status
* Aspiration pneumonia is the reason that we can’t eat before surgery
7
Q
Explain microaspiration vs gross aspiration
A
Microaspiration is a minor aspiration event where individuals aspirate pathogens colonizing the oropharynx without even noticing
Gross aspiration involves contents of the mouth or GI tract
8
Q
This is _ pneumonia
A
This is lobar pneumonia
9
Q
This is _ pneumonia
A
This is bronchopneumonia
10
Q
This is _ pneumonia
A
This is interstitial pneumonia
11
Q
What type of pneumonia?
A
Bronchopneumonia
12
Q
What type of pneumonia?
A
Lobar pneumonia
13
Q
A pneumonia caused by _ may be confirmed with urine antigens
A
A pneumonia caused by Legionella may be confirmed with urine antigens
14
Q
A pneumonia caused by mycoplasma may be confirmed by _
A
A pneumonia caused by mycoplasma may be confirmed by mycoplasma
15
Q
_ is the most common cause of pneumonia in an immunocompromised host; however, _ are also possible
A
Streptococcus pneumoniae is the most common cause of pneumonia in an immunocompromised host; however, possible to have:
* Atypical mycobacterium
* M tuberculosis
* Pneumocystis jiroveci
* Crytococcus
* Histoplasma
16
Q
The most common cause of community-acquired pneumonia is _
A
The most common cause of community-acquired pneumonia is streptococcus pneumoniae
* It is also a cause of childhood otitis media, sinusitis, conjunctivitis
* It colonizes the upper respiratory tract
* Spreads via respiratory droplets
17
Q
Strep pneumoniae is _ hemolytic, has _ shape, is catalase _ and optochin _
A
Strep pneumoniae is alpha hemolytic, has diplococci shape, is catalase negative and optochin sensitive
18
Q
“Rusty sputum” is usually pathoneumonic for
A
“Rusty sputum” is usually pathoneumonic for strep pneumo
19
Q
Strep pneumo has 4 important virulence factors:
A
Strep pneumo has 4 important virulence factors:
1. Polysaccharide capsule to hide from phagocytosis
2. Adhesins to bind host cells
3. Pneumolysin a pore-forming toxin
4. IgA protease which cleaves mucosal IgA
20
Q
We can take advantage of the _ structure of strep pneumo to vaccinate individuals < 2, > 65, and chronic medical conditions
A
We can take advantage of the polysaccharide capsule of strep pneumo to vaccinate individuals < 2, > 65, and chronic medical conditions
* We now recommend the conjugate vaccine Prevnar
21
Q
What makes conjugate vaccines so effective against bacteria with polysaccharide capsules like strep pneumo?
A
In these vaccines, the polysaccharides are covalently conjugated to carrier proteins that will engage the help of T cells
22
Q
What color will strep pneumo be when plated on blood agar plate?
A
Green- alpha hemolytic
23
Q
Pseudomonas aeruginosa has gram _ rods and is _ hemolytic and _ positive
A
Pseudomonas aeruginosa has gram negative rods and is beta- hemolytic and oxidase positive
24
Q
“fruity odor”
A
Pseudomonas aeruginosa
25
Pseudomonas has a _ pigment when plated due to its _
Pseudomonas has a **blue-green** pigment when plated due to its **pyocyanin**
26
Pseudomonas can be found in _
Pseudomonas can be found in **soil, water, human throat and stool**
27
In healthy individuals, Pseudomonas can cause _ or _
In healthy individuals, Pseudomonas can cause **hot tub folliculitis** or **otitis externa** (swimmer's ear)
28
We primarily worry about pseudomonas in immunocompromised patients like patients with _
We primarily worry about pseudomonas in immunocompromised patients like patients with **burns, CF, AIDs, diabetes, neutropenia**
* Often cause hospital acquired infections (VAP, CAUTIs)
29
Pseudomonas virulence factors include:
Pseudomonas virulence factors include:
* **Alginate/biofilm formation**- encapsulated
* **ExoA**- inhibits host cell protein synthesis
* **ExoS**- disrupts the host cytoskeleton
* **Elastase**- disrupts the ECM
30
Pseudomonas has two exotoxins;
ExoA _
ExoS _
Pseudomonas has two exotoxins;
ExoA **ADP ribosylates EF2 and inhibits host cell protein synthesis**
ExoS **disrupts host cytoskeleton**
31
Gram-negative coccobacilli, non-hemolytic, aerobic, twitching motility via pili
Gram-negative coccobacilli, non-hemolytic, aerobic, twitching motility via pili: **Acinetobacter baumannii**
32
Acinetobacter baumannii is found in _
Acinetobacter baumannii is found in **in moist environments; colonizes human skin and RT**
* It is an opportunistic pathogen that causes VAP
33
The smallest free-living organism that only infects humans is _
The smallest free-living organism that only infects humans is **mycoplasma penumoniae**
34
Bacteria that has a "fried egg" appearance when plated
Bacteria that has a "fried egg" appearance when plated: **Mycoplasma pneumoniae**
35
Mycoplasma pneumoniae cannot be gram stained because _
Mycoplasma pneumoniae cannot be gram stained because **it lacks a cell wall**
36
_ is the most common cause of community-acquired "atypical" pneumonia
**Mycoplasma pneumoniae** is the most common cause of community-acquired "atypical" pneumonia
37
Mycoplasma pneumoniae does not have any known toxins; instead it secretes _ to cause damage
Mycoplasma pneumoniae does not have any known toxins; instead it secretes **H2O2** to cause damage
38
_ bacteria lives within amoebas in freshwater and often causes pneumonia in people who are exposed to contaiminated water in AC units and water towers
**Legionella** bacteria lives within amoebas in freshwater and often causes pneumonia in people who are exposed to contaiminated water in AC units and water towers
39
Legionnaires disease occurs when _
Legionnaires disease occurs when **Legionella colonizes the lower RT and alveolar macrophages phagocytose the bacteria** --> pneumonia
40
_ is a flu-like infection that is caused by legionella (not pneumonia)
**Pontiac fever** is a flu-like infection that is caused by legionella (not pneumonia)
41
Legionella must be stained using _ stain and it requires _ to grow
Legionella must be stained using **silver stain** and it requires **charcoal yeast extract agar with iron and cysteine** to grow
42
The groups most at risk of legionella include _
The groups most at risk of legionella include **smokers, > 50 yo, COPD patients**
43
_ is a common electrolyte abnormality associated with Legionella
**Hyponatremia** is a common electrolyte abnormality associated with Legionella
44
_ is Legionella virulence factor and it is able to replicate within _
**T4SS (Dot/Icm)** is Legionella virulence factor and it is able to replicate within **macrophage vacuoles** (the bacteria survive by inhibiting phagosome-lysosome fusion)
* It uses nutrients from the host cell and evades host immunity
* It causes damage via macrophage cytokine release and inflammation
45
Bordetella pertussis is an aerobic gram _ , _ (shape)
Bordetella pertussis is an **aerobic gram-negative , coccobacilli**
46
"100 day cough"
"100 day cough" : **Bordetella pertussis**
* It is highly transmittable via respiratory droplets
* Causes the whooping cough
47
The highest risk group of bordetella pertussis is _
The highest risk group of bordetella pertussis is **unvaccinated infants**
48
B pertussis has _ virulence factor which enables it to bind to ciliated respiratory epithelial cells
B pertussis has **pili (Fim)** virulence factor which enables it to bind to ciliated respiratory epithelial cells
49
Virulence factors _ and _ help B pertussis with adhesion
Virulence factors **pertactin** and **filamentous hemagglutinin** help B pertussis with adhesion
50
B pertussis has three toxins:
B pertussis has three toxins:
1. Tracheal cytotoxin
2. Adenylate cyclase toxin
3. Pertussis toxin
51
Tracheal cytotoxin causes _
Tracheal cytotoxin causes **ciliary paralysis**
52
Adenylate cyclase toxin causes _
Adenylate cyclase toxin causes **increased cAMP** --> inhibition of PMN function
53
Pertussis toxin causes _
Pertussis toxin causes **AB toxin that ADP-ribosylates G proteins** --> causes the systemic pertussis symptoms of fever and increased WBC count
54
The _ vaccine protects against B pertussis
The **DTaP and Tdap booster** protects against B pertussis
55
_ and _ are two gram-positive branching, filamentous beaded rods that can cause pneumonia
**Nocardia** and **Acinomyces** are two gram-positive branching, filamentous beaded rods that can cause pneumonia
* They almost look like fungus-like hyphae
56
(Nocardia/ Actinomyces) can be distinguished from its counterpart by being weakly acid-fast
**Nocardia** can be distinguished from its counterpart by being weakly acid-fast
* It is an aerobe, while Actinomyces is anaerobic
57
Actinomyces can be found in _ so is often associated with _
Actinomyces can be found in **normal oral flora** so is often associated with **cervicofacial abscesses**
58
_ forms "molar tooth" colonies on plates
**Actinomyces** forms "molar tooth" colonies on plates
59
Actinomyces has low virulence but is known to form the characteristic _
Actinomyces has low virulence but is known to form the characteristic **yellow sulfur granules**
* Composed of bacteria, immune cells, calcium phosphate, and pus that drains through the sinus tracts
60
Nocardia is found in the _
Nocardia is found in the **soil**
61
Nocardia causes pneumonia that is characterized by _
Nocardia causes pneumonia that is characterized by **abscess formation** and cavity formation --> can spread to cause brain abscesses
62
Nocardia: forms **dry, chalky, wrinkled** colonies on plates & **fluffy, "cotton balls"** under dissecting scope
63
Nocardia virulence factors
1. **Cord factor**: inhibits phagosome-lysosome fusion
2. **SOD**: detoxifies oxygen radicals
3. **Catalase**: detoxifies oxygen radicals
64
Name some of the common causes of community acquired pneumonia
*Streptococcus pneumoniae* G+
*Hemophilus influenzae* G-
*Moraxella catarrhalis* G-
*Mycoplasma pneumoniae* Atypical
*Staphylococcus aureus* G+
*Legionella pneumophila* Atypical
**Initial empiric treatment for CAP must cover G+ G- and Atypical bacteria**
65
Patients with CAP and no other risk factors who are treated outpatient may receive _ , _ , or _
Patients with CAP and no other risk factors who are treated outpatient may receive:
**Amoxicillin**
**Macrolide** (Azithromycin)
**Doxycycline**
*Note that amoxicillin does not cover atypical bacteria*
66
Amoxicillin MOA:
Amoxicillin **inhibits bacterial cell wall synthesis** by binding one or more of the **penicillin binding proteins** (PBPs)
67
Macrolide MOA:
Macrolides like azithromycin **bind the bacterial 50S ribosomal subunit** causing the cessation of bacterial protein synthesis
68
Doxycycline MOA
Doxycycline is a tetracycline so it **binds to the 30S ribosomal subunit**
69
For mild inpatient cases, where the local macrolide resistance is high we may give a combination of _ or _
For mild inpatient cases, where the local macrolide resistance is high we may give a combination of
**Amoxicillin + Macrolide**
**Amoxicillin + Doxycycline**
70
For patients with severe inpatient pneumonia we might give a combination of _ or _
For patients with *severe inpatient pneumonia* we might give a combination of
**Amoxicillin/ Clavulanic acid + macrolide**
**Amoxicillin/ Clavulanic acid + doxycycline**
71
If patient has had recent amoxicillin use or cannot have amoxicillin, we might give _ drug on its own to treat mild or severe inpatient pneumonia
If patient has had recent amoxicillin use or cannot have amoxicillin, we might give **fluoroquinolone** on its own to treat mild or severe inpatient pneumonia
* Alternatively we can combine 3rd generation cephalosporin with a macrolide or with doxy
72
Fluoroquinolone MOA
Fluoroquinolone impairs DNA replication by **targeting DNA gyrase and topoisomerase IV**
73
Cephalosporin MOA
Cephalosporin work by **binding to penicillin binding proteins and interfere with cell wall enzymes**
74
Fluoroquinolone treatment for CAP must be a respiratory pneumonia like _
Fluoroquinolone treatment for CAP must be a respiratory pneumonia like **levofloxacin, moxifloxacin, gemifloxacin**
* Note that ciprofloxacin is not a respiratory fluoroquinolone because it is not effective against *Strep pneumo*
75
Antibiotics for hospital acquired pneumonia need to cover _ and _ specifically
Antibiotics for hospital acquired pneumonia need to cover **Pseudomonas aeruginosa** and **Staph aureus** specifically
76
In simple cases of HAP against drug sensitive strains we can give _ antibiotics
In simple cases of HAP against drug sensitive strains we can give:
* **Piperacillin-Tazobactam**
* **Cefepime**
* **Levofloxacin**
77
If we are worried about MRSA, we must treat HAP with:
* **Piperacillin-Tazobactam**
* **Cefepime**
* **Levofloxacin**
PLUS
* *Vancomycin* or
* *Linezolid*
78
If we are worried about MRSA and drug resistant pseudomona aeruginosa then we must give a combination of three drugs:
* **Piperacillin-Tazobactam**
* **Cefepime**
* **Levofloxacin**
PLUS
* *Vancomycin* or
* *Linezolid*
PLUS
* *Ciprofloxacin* or
* *Amikacin*
79
Amikacin MOA
Amikacin is an aminoglycoside so it works by binding the **30S ribosomal subunit**
* Recall that the aminoglycosides (-mycin) and the tetracyclines (-cyclin) target 30S
* Macrolides (-ithromycin) target 50S
80
Linezolid works by targeting _
Linezolid works by targeting **50S ribosomal subunit**
81
Recall that vancomycin is a common drug used against MRSA, it works by _
Recall that vancomycin is a common drug used against MRSA, it works by **binding the D-ala-D-ala terminus and inhibiting cell wall synthesis**
82
Name an example of each
83
Ro represents _
Ro represents the **number of people that a single infected person can be expected to transmit that disease to**
* Dependent on transmission efficiency, how long a person is infectious, number of susceptible people exposed
84
_ is a member of the orthomyxovirus family and is enveloped and has a helical capsid
**Influenza** is a member of the orthomyxovirus family and is enveloped and has a helical capsid
85
Influenza has _ type genome and replicates in the _
Influenza has a **negative sense ssRNA segmented genome** and replicates in the **nucleus**
86
Most other negative sense ssRNA viruses replicate in the _
Most other negative sense ssRNA viruses replicate in the **cytosol**
* Influenza is an exception because it carries its own RNA-dependent RNA polymerase
87
_ is a influenza's glycoprotein that binds to the host sialic acid for attachment
**Hemagglutinin (HA)** is a influenza's glycoprotein that binds to the host sialic acid for attachment
88
_ is influenza's enzyme that cleaves sialic acid for release
**Neuraminidase (NA)** is influenza's enzyme that cleaves sialic acid for release
89
M2 channel is a proton ion channel that _
M2 channel is a proton ion channel that **maintains proper pH for membrane fusion to endosomal membrane and virus uncoating**
90
_ is the accumulation of point mutations that change the HA/NA sequence each year and requires us to get yearly flu vaccinations
**Antigenic drift** is the accumulation of point mutations that change the HA/NA sequence each year and requires us to get yearly flu vaccinations
91
_ is the reassortment or swapping of genome segments in type A viruses that causes pandemics every 10-40 years
**Antigenic shift** is the reassortment or swapping of genome segments in type A viruses that causes pandemics every 10-40 years
92
Respiratory syncytial virus is a member of _ family
Respiratory syncytial virus is a member of **paramyxovirus** family
93
Describe the features of RSV
RSV:
* Enveloped
* Helical capsid
* Negative sense RNA genome
* Carries its own RNA-dep-RNA polymerase
94
RSV is the most common cause of _ in infants
RSV is the most common cause of **bronchiolitis** in infants
95
RSV has a G protein (glycoprotein) that _ and fusion protein (F) that _
RSV has a G protein (glycoprotein) that **binds cilitated cells (RT)** and fusion protein (F) that **mediates membrane fusion for viral entry**
96
_ is a member of the coronavirus family that is enveloped, +ssRNA, with a helical capsid
**SARS-CoV-2** is a member of the coronavirus family that is enveloped, +ssRNA, with a helical capsid
97
SARS has _ proteins that allow it to bind to the host receptor _
SARS has **spike proteins** that allow it to bind to the host receptor **ACE2**
* ACE2 is expressed on epithelial cells of the oral cavity, nose, lung, intestines, kidney, blood vessels
* Airway inflammation is driven by pro-inflammatory cytokines
98
_ is a nucelotide analog drug that can be used to treat RSV; howevever, it is not commonly used due to its _
**Ribavirin** is a nucelotide analog drug that can be used to treat RSV; howevever, it is not commonly used due to its *narrow therapeutic window*
99
Ribavirin works as a _ to disrupt the action of _
Ribavirin works as a **nucleotide analog** to disrupt the action of **viral RNA polymerase** in a number of ways
100
Ribavirin blocks host _ and therefore is a pregnancy x drug; it is also known to cause _
Ribavirin blocks host **DNA replication** and therefore is a pregnancy x drug; it is also known to cause **hemolytic anemia**
* It is stored in RBCs and has a very long half life of 40 days
101
Amantadine is a flu drug that inhibits _
Amantadine is a flu drug that inhibits **M2**; it blocks virus uncoating
102
Oseltamivir, zanamivir, and peramivir are all release inhibitors; they inhibit the action of _
Oseltamivir, zanamivir, and peramivir are all release inhibitors; they inhibit the action of **neuraminidase**
103
Nirmatrelvir is a _ that can be used to treat SARS; it is often paired with _ in order to slow the metabolism
Nirmatrelvir is a **protease inhibitor** that can be used to treat SARS; it is often paired with **ritonavir** in order to slow the metabolism
104
Ritonavir is a CYP3A4 _
Ritonavir is a CYP3A4 **inhibitor**
