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Pulmonary Block > Pharmacology Bacterial Infections/Lung Cancer > Flashcards

Pharmacology Bacterial Infections/Lung Cancer Flashcards

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1
Q

Treatment of Legionnaires

A

Azithromycin or Clarithromycin
Alt: quinolones (levofloxacin, ciprofloxacin, moxifloxacin)
Severe: Rifampin

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2
Q

Outpatient treatment for uncompliaction CAP

A

Macrolide or Doxycycline

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3
Q

Outpatient treatment of CAP with COPD

A

if recent steroids/abx - Fluoroquinolone or Augmentin, or Clarithromycin and Cephalosporin

no recent steroids/abx: Clarithromycin or Doxycycline

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4
Q

Nuring home CAP Treatment

A

Fluoroquinolone or Augmentin, or Clarithromycin and Cephalosporin

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5
Q

Hospital ward treatment CAP

A

Fluoroquinolone or Augmentin, or Clarithromycin/Azithromycin and Cephalosporin

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6
Q

ICU treatment CAP

A

3rd generation cephalosporin +/- macrolide or piperacillin/tazobactam or fluoroquinolone

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7
Q

Macrolides nomenclature and MOA

A

“MYCINs” 50s ribosomal inhibitor blocking translocation

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8
Q

Tetracyclines nomenclature and MOA

A

“CYCLINEs” 30s ribosomal inhibitor blocking protein synthesis

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9
Q

Fluoroquinolones nomenclature and MOA

A

“FLOXACINs” DNA gyrase inhibitor preventing DNA replication

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10
Q

Penicillins nomenclature and MOA

A

“CILLINs” block cell wall cross linking

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11
Q

Carbopenem nomenclature and MOA

A

meropenem - blocks cell wall cross linking

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12
Q

Cephalosporins nomenclature and MOA

A

“CEFs or CEPHs” inhibition of cell wall cross-linking

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13
Q

Aminogylcosides

A

gentamicin 30s ribosomal inhibitor

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14
Q

Macrolide resistance mechanism

A

ribosomal methylation and mutation of 23S rRNA; active efflux

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15
Q

Tetracyclines resistance mechanism

A

decreased entry into and increased efflux from; target insensitivity

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16
Q

Fluoroquinolones resistance mechanism

A

mutation of DNA gyrase; active efflux

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17
Q

Penicillins resistance mechanism

A

Drug inactivation (beta lactamase); altered peniciilin binding proteins (target insensitivity)

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18
Q

Cephalosporins resistance mechanism

A

decreased permeability of gram negative outer membrane (altered porins); active efflux

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19
Q

Aminoglycosides resistance mechanism

A

drug inactivation (amino glycoside modifying enzyme); decreased permeability of gram negative outer membrane; active efflux; ribosomal methylation

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20
Q

Drugs indicated for Nocosomial pneumonia

A

Imipenem/Cilastin, Aztreonam, Cetazidime, Vancomycin (IV only for staph aureus)

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21
Q

Alternative drugs for Nocosomial pneumonia

A

Meropenem, piperacillin/tazobactam, Cefepime

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22
Q

Drugs for Aspiration Pneumonia

A

Primary - clindamycin

alternative - ampicillin/sulbactam

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23
Q

Clindamycin MOA and Resistance

A

50s ribosomal inhibitor blocking translocation; resistance - methylation of binding site, enzymatic inactivation

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24
Q

Vancomycin MOA and resistance

A

binds D-alanyl-D-alanine terminus of the peptide precursor units, inhibiting peptidoglycan polymerase and transpeptidation reactions; resist - replacement of D-ala by D-lactate

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25
Antibiotics with biliary elimination
azithromycin, doxycycline, erythromycin, ceftriaxone (+renal), clindamycin (+renal)
26
Amoxicillin and Ampicillin toxicity
cross reactivity with penicillin sensitivity; GI distress; maculopopular rash
27
Azithromycin toxicity
cholestatic jaundice; QT prolongation
28
Cefazolin, Cefepime, Ceftazidime, Ceftriaxone toxicity
complete cross reactivity with cephalosporins, partial cross reactivity with penicillin hypersensitivity; GI distress
29
Clindamycin toxicity
GI distress
30
Doxycycline toxicity
GI distress; teeth discolored; photosensitivity; decreased bone growth
31
Erythromycin toxicity
CYP3A4/pgp inhibitor; cholestatic jaundice; QT prolongation
32
Gentamicin toxicity
nephrotoxicity; ototoxicity; neuromuscular paralysis
33
Imipenem toxicity
Partial cross-reactivity with pen/ceph hypersensitivity; seizures
34
Levofloxacin toxicity
Tendon rupture in adults; cartilage damage in young children
35
Linezolid toxicity
bone marrow suppression; non specific MAO inhibitor
36
Meropenem toxicity
partial cross reactivity with pen/ceph hypersensitivity; seuizures
37
Piperacillin toxicity
partial cross reactivity with ceph hypersensitivity; decreased coagulaiton
38
Vancomycin toxicity
nephrotoxic, ototoxic; Red Man's syndrome
39
Antibiotics to avoid or caution with breastfeeding
clarithromycin, linezolid, metronidazole, piperacillin
40
Sulbactam, Clavulonic acid, Tazobactam MOA
used in combination with penicillin derivatives; these are all irreversible inhibitors of bacterial beta-lactamases
41
Cilastin MOA
used in combination with Imipenem; it is a reversible, competitive inhibitor if renal dehydropeptidase-1 (DHP-1), an enzyme that breaks down imipenem to inactive but nephrotoxic metabolites
42
Reason for not using Daptomycin for lung infections
It distributes to the lungs, but is inhibited by pulmonary surfactant so is ineffective against pulmonary infections
43
Antibiotics for treatment of bronchitis
First line: Amox + Clauv, azithromycin, clarithromycin, doxycline (oral or IV) Resist: Ciprofloxacin (oral or IV)
44
Antibiotics for treatment of Lung Abscess
Clindamycin (esp. against Bacteroides); Metronidazole and Ceftriaxone for nocosomial infections
45
Mechanisms of TKI resistance
Mutation in ATP binding site for TKIs, polymorphisms in apoptosis genes, downstream activation mutations (KRAS, BRAF)
46
Lung cancer mutations more common in nonsmokers
EGFR, EML4-ALK fusions, HER2, hMSH2
47
SCLC Treatment plan
metastasis occurs early so chemotherapy with radiation is only option
48
NSCLC treatment plan
surgical resection if there has been no metastasis, can use adjuvant/neoadjuvant chemotherapy
49
Standard chemotherapy for SCLC
Etoposide and cisplatin or carboplatin
50
Standard chemotherapy for NSCLC
Cisplatin and paclitaxel, gemcitabine, docetaxel, vinorelbine, irinotecan, or pemetrexed Add targeted therapy for those with targetable mutations
51
Indications for Bevacizumab
patients with non-squamus, no brain metastases, no hemoptysis NSCLC
52
Carboplatin and Cisplatin MOA
forms DNA intrastrand cross links and adducts
53
Cyclophosphamide MOA
pro drug of active alkylating moiety
54
Docetaxel MOA
microtubule stabilized inhibiting depolymerization
55
Doxorubicin MOA
intercalator, free radical generator, topo II inhibitor
56
Etoposide, VP-16 MOA
DNA-topo II complex stabilized
57
Gemcitabine MOA
DNA polumerase inhibitor via incorporation of triphosphate form during DNA synthesis
58
Ifosfamide MOA
intra and inter strand cross linker
59
Irinotecan MOA
DNA topo I complex stabilized
60
Paclitaxel MOA
Microtubule stabilizer inhibiting depolymerization
61
Pemetrexed MOA
DHFR inhibitor
62
Topotecan MOA
DNA-topo I complex stabilizer
63
Vincristine Vinorelbine MOA
Microtubule inhibitor, tubules disintegrate into spiral aggregates/protofilaments
64
Carboplatin Toxicity
allergic (platinum) reactives; dose related myelosuppression; cumulative anemia; N/V, blood chemistry dyscrasia, increased hepatic enzymes, BUN, creatinine
65
Cisplatin Toxicity
Allergic reactions to platinum; dose related nephrotoxicity, myelosuppression, N/V. Siginificant Ototoxicity in children
66
Cyclophosphamide Toxicity
Blood dyscrasias leading to anemia/infection; renal compromise, hemorrhages cystitis (take mesna for protection), N/V, rash, Amenorrhea/infertility, pulmonary fibrosis, secondary malignancies
67
Docetaxel Toxicity
increased mortality in SCLC; edema (treat w/ steroids); contra with increased bilirubin/ALK/phos/SGOT/SGPT; neutropenia, dose limiting sensory neuropathyr
68
Doxorubicin Toxicity
Myelosuppression, CHF, hepatic disease, secondary malignancies, extravasational necrosis, N/V
69
Etoposide, VP-16 Toxicity
Myelosuppression, infection; dose limiting hematologic toxicity, N/V, diarrhea, alopecia
70
Gemcitabine Toxicity
Myelosuppression, infection, arthralgia, drowsiness, fatigue, N/V, alopecia, snesory peripheral neuropathy
71
Ifosfamide Toxicity
Alopecia, N/V, blood dyscrasia -> infection, neurotoxicity, heamturia renal failure
72
Irinotecan Toxicity
Myelosuppression, diarrhea, asthenia, fever pain, weight loss
73
Paclitaxel Toxicity
Taxane hypersensitivity, myelosuppression, myalgia and arthralgia
74
Pemetrexed Toxicity
Myelosuppression and GI toxicities, especially with Cisplatin for NSCLC; elevated LFTs and serum creatinine
75
Topotecan Toxicity
Myelosuppression and GI toxicities, hyperbilirubinemia
76
Vinblastine and Vinorelbine toxicity
myelosuppression, neuropathic toxicity (less w/ vinorelbine); neutropenia (less w/ vinorelbine); intrathecal administration of vinca alkaloids is fatal
77
Erlotinib MOA
Reversible inhibitor selective for EGFR; CYP 3A4 substrate; oral administration on empty stomach; smoking increases clearance
78
Erlotinib Toxicity
Diarrhea, intersitial lung disease-type events, liver and or kidney problems, stomach/intestinal perforation, bleeding, corneal perforation/ulceration, conjunctivitis, hypertrichosis, rash
79
Afatinib MOA
covalent inhibitor of EGFR, HER2, HER4; oral admin on empty stomach; Pgp substrate and inhibitor
80
Afatinib Toxicity
Diarrhea, rash, pulmonary toxicity (~1% but 2% in Asians); less toxic than erlotinib
81
Crizotinib MOA
reversible multi-kinase inhibitor, including ALK; oral admin on empty stomach; cyp3A4 substrate and Pgp substrate and inhibitor
82
Crizotinib toxicity
GI issues, edema, QT prolongation, visual disorders, neutropenia, hepatic dysfunction, respiratory dysfunciton, uncommonly rash
83
Bevacizumab MOA
humanized antibody that binds to VEGF preventing receptor activation; given by IV infusion
84
Bevacizumab Toxicity
HTN, arterial thromboembolism, alopecia, GI issues, hemorrhage, asthenia, dizziness, HA, renal proteinuria, dyspnea, upper respiratory infections, Fistulas of GI, vagina, bladder, bronchopulmonary
85
Treatment for adenocarcinoma with EGFR mutation
Erlotinib or Afatinib
86
Treatment for adenocarcinoma with EML4/ALK translocation
Crizotinib
87
Treatment for adenocarcinomas without known genetic subtype
Standard cytotoxic chemotherapy

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