Pneumonia and TB Review Flashcards
What drugs can you treat outpatient CAP with? (in general)
Macrolide > Azithromycin or Clarithromycin(acute hypersensitivity reactions)
Respiratory fluoroquinolone > Levofloxacin, Moxifloxacin
3rd generation cephalosporin > cefotaxime, ceftriaxone, cefpodoxime;
A beta-lactam > Amoxicillin; amoxicillin-clavulanate; Ampicillin
Doxycycline (which is a tetracycline)
What type of organisms typically cause CAP?
Strep pneumoniae
Mycoplasma pneumoniae.
Chlamydia pneumoniae
What medication would you give to previously healthy patients who have not taken antibiotics within the past 3 months? (to treat outpatient pneumoniae with CAP)
- Macrolide (azithromycin or clarithromycin)
2. Doxycyline
What medications would you prescribe to patients with comorbid medical conditions or use of antibiotics within the previous 3 months. (Outpatient CAP)
- Levofloxacin, moxifloxacin
- 3rd generation Cephalosporin
- Macrolide plus a beta-lactam
What are all the drugs you can use to treat inpatient pneumonia with for treatment of CAP?
Antipneumococcal beta-lactam > cefotaxime, ceftriaxone, or ampicillin-sulbactam, aztreonam
Antipseudomonal beta-lactam > piperacillin-tazobactam, imipenem, meropenem
Aminoglycoside > Amikacin
Azithromycin
Levofloxacin, Moxifloxacin, as a single agent
Vancomycin
Linezolid
What drugs are used to treat inpatient CAP who are allergic to beta-lactam antibiotics?
Moxifloxacin or Levofloxacin plus aztreonam
What are some drugs used to treat inpatient s with CAP for patients that are at risk for Psudomonas infection?
An antipneumococcal cephalosporin
Antipseudomonal beta-lactam (piperacillin-tazobactam, imipenem, meropenem
Ciprofloxacin
What are drugs used to treat inpatient CAP in cases were you need to treat ventilator-associated pneumonia (VAP)
Imipenem or Meropenem, piperacillin/tazobactam or cefepime;
Gentamicin; and
Vancomycin or linezolid (MRSA)
Be able to reproduce this chart.
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Be able to reproduce this chart. Fluoroquinolones
Reproduce this chart
What is the MOA of Anti pneumococcal agents like Penicillins and cephalosporins?
Bind penicillin-binding proteins(PBPs)
Prevent transpeptidation
Inhibit cross-linking of bacterial cell wall
Give the mechanism by which there is resistance to penicillin and cephalosporins
Degradation by bacterial penicillinases (beta lactamases)
Mutation of PBP
Down regulation of porins channel(gram –ve)
Upregulation of efflux channels
What are the adverse effects of Penicillins and cephalosporins?
Adverse effect:
Hypersensitivity reactions,
Cross reactivity rxns
GI distress and maculopapular rash (ampicillin)
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Reproduce chart.
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Know things in red
Give MOA, characteristic of drug and AE charted out in these drugs.
Reproduce charts
What is the way to treat nosocomial pneumonia in which there is a low risk for multiple drug-resistant pathogens?
Ceftriaxone, Gemifloxacin, Moxifloxacin, Levofloxacin, Ciprofloxacin, Ampicillin-sulbactam, piperacillin-tazobactam, Ertapenem
What is a way to treat nosocomial pneumonia in which there is a higher risk for nosocomial pneumonia?
- Antipseudomonal coverage
Cefepime, Imipenem, meropenem, piperacillin-tazobactam,
Penicillin –allergic patients>aztreonam - A second antipseudomonal
Levofloxacin, gentamicin, tobramycin, amikacin - Coverage for MRSA
Vancomycin or linezolid
What are the medications of choice of anaerobic pneumonia and lung abscess?
Clindamycin or amoxicillin-clavulanate.
Penicillin (amoxicillin) or penicillin G plus metronidazole
What are some signs that may show that a patient may have a history of predisposition to aspiration?
poor dentition
foul-smelling purulent sputum (in many patients)
Infiltrate in dependent lung zone, with single or multiple areas of cavitation or pleural effusion
Who should a polyvalent pneumococcal vaccine be given to?
Age 65 years or older or any chronic illness that increases the risk of CAP
How does having a polyvalent pneumococcal vaccine benefit a patient with pneumonia?
contains common strains of S pneumoniae and has the potential to prevent or lessen severity of majority of pneumococcal infections in immunocompetent patients
How is the seasonal influenza vaccine beneficial?
effective in preventing severe disease due to influenza virus.
How is seasonal influenza vaccine administered (frequency) and to what groups of people?
administered annually to persons at risk for complications of influenza infection
age 65 years or older,
residents of long-term care facilities,
patients with pulmonary or cardiovascular disorders etc
What are the drugs used to treat Influenza A and Influenza B
And Just influenza A
Influenza A and Influenza B -> Oseltamavir or Zanamavir
Influenza A -> Amantadine or Rimantadine
Reproduce this chart on TMP/SMX MOA, Dosage, clinical use, and adverse events.
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Jeopardy Round. What type of pathogen is describe by the following characteristics?
1. Acid-fast bacilli Slow growing(intracellular), Can become dormant Rapidly active (wall of cavitary lesion).
- Mostly reside inside macrophage, not all drugs reach.
- Cell wall is made of mycolic acid, its impermeable to many drugs.
- Develop resistance (more if single or two drugs used).
- Combination therapy needed (usually 3-4 drugs).
- Slow response, treatment requires months to years (Usually 6 or 9 months, or up to 2 years for TB bones).
- Poor compliance due to prolonged treatment, cost & symptomatic relief.
What are some major characteristics of mycobacteria TB?
What are some first line anti-TB drugs?
Isoniazid(H)
Rifampin(R)
Pyrazinamide(Z)
Ethambutol(E)
TB+ HIV
Rifabutin
Less CYP Interaction
Rifapentine
What are some second-line anti-TB drugs?
Cycloserine
Ethionamide
Streptomycin(S)
Amikacin
Capreomycin
Clarithromycin
Ofloxacin
Levofloxacin
Moxifloxacin
What is the MOA of Isoniazid?
Prodrug activated by catalase-peroxidase (coded by Kat G).
Activated metabolite inhibits the enzyme ketoenoylreductase (coded by inh A), required for mycolic acid synthesis.
Blocks synthesis of Mycolic Acids for mycobacterial cell wall.
