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Respiratory II > Pharmacology- Caldwell > Flashcards

Pharmacology- Caldwell Flashcards

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1
Q

This type of evidence is obtained from at least one properly designed randomized controlled tria

A

Level 1

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2
Q

Describe Level III evidence

A

Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees

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3
Q

Which type of evidence is better, Level I or Level III

A

Level I

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4
Q

Name 3 antibiotics with level I evidence for S. Pneumoniae in outpatient setting with no risk factors

A

MACROLIDES

Azithromycin, clarithromycin, erythromycin

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5
Q

Name 3 antibiotics with level I evidence for S. Pneumoniae in outpatient setting with comorbidities

A

RESPIRATORY FLUOROQUINOLONES

Moxifloxacin, gemifloxacin, or levofloxacin

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6
Q

What is an alternative treatment route for S. Pneumoniae in outpatient setting with comorbidities

A

Beta-lactam plus a macrolide

Preferred: Amoxicillin or amoxicillin-clavulanate (can substitute ceftriaxone, cefpodoxime, and cefuroxime)

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7
Q

What is the monotherapy with level I evidence for inpatient, non-ICU, CAP?

A

Respiratory fluoroquinolones

Moxifloxacin, gemifloxacin, or levofloxacin

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8
Q

What is the combination therapy with level I evidence for inpatient, non-ICU, CAP?

A

Beta-lactams (cefotaxime, ceftriaxone, ampicillin-ertapenem) & a macrolide

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9
Q

If the patient is allergic to penicillin, what do you substitute the beta-lactam for?

A

Fluoroquinolones

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10
Q

Why isn’t ciprofloxacin used for CAP?

A

It doesn’t cover S. Pneumonia (most common cause of CAP)

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11
Q

What category of antibiotic with level I evidence is used for CAP in the ICU?

A

Respiratory fluoroquinolones

Moxifloxacin, gemifloxacin, or levofloxacin

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12
Q

What are the 2 drugs used initially for acute sinusitis

A

Amoxicillin and TMP-SMX

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13
Q

What bugs are amoxicillin less effective against?

A

H. influenzae and M. catarrhalis

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14
Q

What bug is TMP-SMX less effective against?

A

S. Pneumoniae

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15
Q

List the agents effective against chronic sinusitis

A

Amoxicillin clavulanate (Augmentin), cefuroxime, clarithromycin, azithromycin, clindamycin, cefpodoxime, cefprozil

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16
Q

What is the IM antibiotic used for Streptococcus pharyngitis?

A

One dose of penicillin G

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17
Q

What is the oral antibiotic used for Streptococcus pharyngitis?

A

Penicillin V for 10 days

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18
Q

What do you give for Streptococcus pharyngitis if the patient is allergic to penicillin?

A

Erythromycin: Estolate or ethylsuccinate

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19
Q

Antibiotics for COPD?

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A

TMP-SMX, doxycycline, azithromycin/clarithromycin

20
Q

What do you give for pneumonia caused by highly penicillin-resistant S. Pneumoniae?

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A

Doxycycline, clindamycin, levofloxacin

21
Q

What antibiotics are used for pneumonia caused by Legionella?

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A

Azithromycin and fluoroquinolone

Can also use tigecycline

22
Q

4 specific antibiotics for CAP in patients older than 60?

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A

2nd gen cephalosporins:
Loracarbef and cefuroxime axetil
3rd gen cephalospoorins:
Cefpodoxime and ceftriaxone

23
Q

What do you need to be careful with in H. influenza and Klebsiella pneumonia in choosing an antibiotic?

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A 
It needs to be beta-lactamase stable
These ones are...!
2nd gen cephalosporins:
Loracarbef and cefuroxime axetil
3rd gen cephalospoorins:
Cefpodoxime and ceftriaxone 
(They also cover gram + and gram -)
24
Q

What are the 3 antibiotics used against HAP caused by MRSA?

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A

Linezolid or vancomycin

Also tigecycline

25
What are 4 reasons mycobacteria are intrinsically resistant to most antibiotics?
1. Slow growth (anything active against growing cells won't work with this) 2. Can be dormant 3. Their lipid-rich cell wall can be impermeable 4. They are intracellular and inaccessible to drugs that can't penetrate macrophages
26
What are the 5 first line drugs used for TB?
Isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin
27
Which two TB drugs are the most active?
Isoniazid, rifampin
28
MOA of isoniazid?
Inhibits synthesis of mycolic acids
29
MOA of rifampin
- Inhibits DNA-dependent RNA polymerase | - Blocks RNA production
30
MOA of Pyrazinamide (PZA)
- Not fully understood | - Converted to active pyrazinoic acid in macrophage lysosomes
31
MOA of Ethambutol?
-Inhibits mycobacterial arabinosyl transferases (involved in polymerization rxn. Of arabinoglycan – essential in cell walls)
32
MOA of Streptomycin?
Binds to S12 ribosomal subunit → prevents bacterial protein synthesis
33
Clinical Indications of isoniazid?
- 1st line for TB - Tx of latent infection (single drug) - Less active against other mycobacteria
34
Clinical indications of rifampin?
- 1st line for TB - Atypical mycobacterial infections - Eradication of meningococcal colonization, Staph. infections - Prophylaxis for H-flu
35
Clinical indications of pyrazinamide?
- “Sterilizing” agent used during 1st 2 mths. Of therapy | - Allows total duration of therapy to be ↓ to 6 mths.
36
Clinical indications of ethambutol?
- Given as 4-drug initial combo. Therapy for TB until drug sensitivities are known - Atypical mycobacterial infection
37
Clinical indications of streptomycin?
- In TB when injectable drug is needed or desirable | - Tx of drug-resistant strain
38
AE of isoniazid?
- Hepatotoxicity - Peripheral neuropathy (give pyridoxine to prevent) - Fever - Skin rashes
39
AE of Rifampin?
- Rash - Nephritis - Thrombocytopenia - Cholestasis - Flu-like Sx - Turns body fluids orange (harmless)
40
AE of Pyrazinamide?
- Hepatotoxicity - Hyperuricemia - N/V, drug fever
41
AE of Ethambutol?
-Retrobulbar neuritis → loss of visual acuity & re-green color blindness
42
AE of Streptomycin?
-Nephrotoxicity • ototoxicity
43
Resistance to Isoniazid?
-When used as single drug in Tx of active infection -Mutation → overexpression of inhA, depletion of katG, overexpression of ahpC, or kasA
44
Resistance to Rifampin?
-When used as single drug in Tx of active infection -Mutation in rpoB
45
Resistance to Pyrazinamide?
- Impaired uptake | - Mutations in pncA (impaired conversion to active form)
46
Resistance to Ethambutol?
When used as single drug in Tx | -Mutations → overexpression of emb
47
Resistance to Streptomycin?
-Non-TB Mycobacteria (except MAC & M. kansasii) -Mutation in rpsL or rrs

Respiratory II (8 decks)

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