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Pharmacology > Pulm: Drugs for Pneumonia (CAP, HAP, VAP) > Flashcards

Pulm: Drugs for Pneumonia (CAP, HAP, VAP) Flashcards

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1
Q

Identify the bug: rust colored sputum

A

strep pneumo

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2
Q

Identify the bug: currant jelly sputum

A

Klebsiella

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3
Q

Identify the bug: cultured on chocolate agar

A

Haemophilus and Neisseria

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4
Q

Identify the bug: smells like grapes

A

pseudomonas

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5
Q

Identify the bug: Flowery smell

A

E. coli, H. flu

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6
Q

Identify the bug: semen like odor

A

Moraxella catarrhalis

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7
Q

Identify the bug: Yeasty

A

Candida

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8
Q

Identify the bug: dirty gym socks

A

Acinectobacter baumannii

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9
Q

Identify the bug: rotten chicken soup, or chocolate cake

A

Proteus

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10
Q

Identify the bug: earthy, musty, dirt

A

Actinomyces, streptomyces, nocardia

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11
Q

Identify the bug: very bad breath

A

Gram (-) anaerobes

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12
Q

Identify the bug: Very young or old pts

A

viral

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13
Q

MOA and coverage of vancomycin

A

inhibits cell wall synthesis by directly binding D-alanyl- D-alanine oligopeptides

Gram (+) (especially MRSA)

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14
Q

MOA of B-lactams

A

Binds to PBP and prevents cross-linking of bacterial cell wall

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15
Q

MOA and Coverage of Aminoglycosides

A

bind irreversibly to the 30S ribosomal subunit, inhibiting formation of initiation complex

Gram (-)

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16
Q

MOA and coverage of tetracyclines

A

bind reversibly to the bacterial 30S ribosomal subunit

Broad Spectrum

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17
Q

MOA and coverage of Macrolides

A

acts on the bacterial 50S ribosomal subunit, inhibiting translocation

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18
Q

MOA of lefamulin

A

Blocks elongation of the bacterial proteins
-specifically for CAP w normal lungs

low resistance=works when others don’t

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19
Q

MOA of Floroquinalones (for gram (+) and (-))

A

Gram (-)=inhibits DNA Gyrase (topo II)

Gram (+)=inhibits topoisomerase IV

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20
Q

How would you treat CAP in someone without comorbidities and without a PCN allergy?

A

Amoxacillin+Macrolide (preferred) or Doxycycline

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21
Q

How would you treat CAP in someone with comorbidities and without a PCN allergy?

A

Amoxacillin-clavulonic acid+Macrolide (preferred) or Doxycycline

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22
Q

How would you treat CAP in someone w PCN allergy?

A

3rd gen Cephalosporin (ceftriaxone)+ macrolide or doxycycline

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23
Q

How would you treat CAP in someone w PCN allergy and cannot use cepholosporins?

A

Respiratory floroquinolone or lefamulin

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24
Q

How would you treat CAP in someone who has structural lung disease and a PCN allergy and cannot use cepholosporins?

A

Respiratory floroquinolones

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25
When is lefamulin contraindicated?
In a pt with structural lung disease | -only for healthy lungs
26
Adverse reactions to penicillins?
Allergic Rxns | -contact dermatitis, urticaria, rash, fever, prutitis
27
What penicillinase resistant penicillin is great for Staph aureus?
Nafcillin
28
What are the broad spectrum penicillins that are great for gram (-)?
Ampicillin/amoxicillin | -not effective against pseudomonas
29
What are the extended spectrum penicillins that are good to treat P. aeruginosa?
Piperacillin, ticarcillin
30
What are the penicillins combined with, to increase activity?
Beta-lactamase inhibitors | -clavulanate, tazobactam, sulbactam
31
Adverse reactions to Amoxicillin+clavulanate?
Anaphylaxis | Superinfection (C. diff)
32
What is amoxicillin-clavulanate effective agaisnt?
Gram - and +, but NOT pseudomonas
33
What is piperacillin+tazobactam effective agaisnt?
Gram - and +, including pseudomonas**
34
Clinical applications for piperacillin+tazobactam?
CAP and HAP/VAP
35
Adverse rxns to piperacillin+tazobactam?
SJS and other hypersensitivities | Superinfection
36
1st gen cephalosporins + coverage
Cefazolin, Cephalexin Gram (+)
37
2nd gen cephalosporins + coverage
Cefotetan, cefoxitin Gram (-)
38
3rd gen cephalosporins + coverage
Ceftriaxone, cefpodoxime Gram (-)
39
4th gen cephalosporins + coverage
Cefepime Gram (+) and Gram (-)
40
5th gen cephalosporins + coverage
Ceftaroline Gram (+) and Gram (-)
41
What is noteworthy about Ceftriaxones elimination compared to the other cephalosporins?
It is not eliminated by kidney, so no dose adjustment if renal issues
42
Which four cephalosporins cause bleeding issues?
Cefmetazole, cefoperazone, cefotetan, ceftriaxone
43
What are the parenteral cephalosporins?
Ceftriaxone (3rd) | Cefepime (4th)
44
What are the oral cephalosporins?
Cefditoren and Cefpodoxime (3rd)
45
Which antibiotics are great for bacteria without a cell wall?
Tetracyclines | -mycoplasma pneumonia
46
What is an issue with prescribing tetracyclines in kids?
Deposits into teeth and bones, causing gray discoloration
47
What can impair absorption of tetracyclines?
Dicationic metals | -Mg, Ca, Al, Fe
48
What antibiotics are great for atypical pneumonia (legionella, mycoplasma, chlamydia)?
Macrolides | -azithromycin or clarithromycin
49
Which macrolide does NOT inhibit CYP450?
Azithromycin Erythro and Clarithro do!
50
Which macrolide causes pretty bad GI pain?
Erythromycin
51
Which macrolide can be given as a single dose, slow release?
Azithromycin
52
What drugs are the respiratory floroquinolones?
Levofloxacin, Gemifloxacin, and Moxifloxacin Broad spectrum, reserved last resort
53
What toxicity is important for fluoroquinolones?
Achille's tendon rupture
54
Which drug is great for MRSA and MRSE, but can cause Red-man syndrome?
Vancomycin
55
MOA and coverage of Linezolid
binds 23s RNA of 50S subunit Gram (+)-Great for VRE
56
Adverse effects of linezolid?
Blocks monoamine oxidase, so can have increase in serotonin (serotonin syndrome) Lactic acidosis, thrombocytopenia, peripheral neuropathy, hypoglycemia in diabetics
57
MOA and Coverage of Aztreonam
Penicillin-Binding-Protein (PBP) that blocks bacterial cell wall synthesis Gram (-)
58
MOA and Coverage of Imipenem
Penicillin-Binding-Protein (PBP) that blocks bacterial cell wall synthesis Broad spectrum -last resort!
59
Adverse effects of imipenem?
CNS effects: seizures, confusion
60
MOA and coverage of gentamicin
bind irreversibly to the 30S ribosomal subunit, inhibiting formation of initiation complex Mostly Gram (-), but also staph (+)
61
Adverse effects of gentamicin?
Nephrotoxicity, Neurotoxicity, Ototoxicity
62
What are the hard to kill bugs? ESKAP(e)
``` Enterobacter S. aureus Klebsiella A. baumannii P. aeruginosa ``` Have post-translational modifications that provide resistance

Pharmacology (50 decks)

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