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AGACNP Board Review > Pulmonary Medicine > Flashcards

Pulmonary Medicine Flashcards

Review of common Pulmonary disease and disorders (310 cards)

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1
Q

What is Asthma?

A

Enhanced resposiveness to stimuli in the trachea and bronchi

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2
Q

What is the pathophysiology of Asthma?

A
  1. Widespread narrowing of the airways
  2. Hypertrophy of smooth muscle
  3. Mucosal Edema
  4. Hyperemia
  5. Thickening of the epithelial basement membrane
  6. Hypertrophy of mucus glands
  7. Acute Inflammation
  8. Plugging of airways by thick, viscid mucus
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3
Q

Etiology of Asthma

A
  1. Dust Mites
  2. Pets
  3. Cockroaches
  4. Indoor Molds
  5. Exercise
  6. Cigarette Smoke
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4
Q

Name 5 S/S of Asthma

A
  1. Respiratory Distress at Rest
  2. Difficulty speaking in sentences
  3. Diaphoresis
  4. Use of Accessory Muscles
  5. Respiratpory rate of >28
  6. Pulse >110
  7. Pulsus Paradoxus >12 mmHg
  8. Hyperesonance
  9. Cough
  10. Chest Tightness
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5
Q

What are the ominous signs of Asthma?

A
  1. Fatigue
  2. Absent breath sounds
  3. Paradoxical chest/abdominal movement
  4. Inability to maintain recumbency
  5. Cyanosis
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6
Q

Laboratory/Diagnositics for Asthma

A

CBC
PFT
ABG

Leukocytosis, Respiratory Alkalosis, PF is <60 lpm

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7
Q

Agents for Asthma and COPD

A
  • Short-Acting Beta Agonist (SABA)
  • Long-Acting Beta Agonist (LABA)
  • Short-Acting Muscarinic Agonists (SAMA)
  • Long-Acting Muscurinic Agonists (LAMA)
  • LABA/ICS
  • LABA/LAMA/ICS
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8
Q

Mechanism of Action of SABAs

A

Binds to BETA2 adrenergic receptors in the airway. This leads to activation of adenyl cyclase resulting in increased levels of cyclic-3’,5’-adenosine monophosphate (cAMP). Increases in cAMP inhibits phosphorylation of myosin and decrease intracellar calcium. Decreased intracellar calcium relaxes smooth muscle airways.

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9
Q

Indication of SABAs

A
  1. Bronchospasm
  2. Asthma
  3. COPD
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10
Q

Therapuetic effect of SABAs

A

Bronchodilation

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11
Q

Side Effects of SABAs

A

Chest Pain
Palpitations
Nervousness
Restlesness
Tremor

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12
Q

Contraindications of SABAs

A

Cardiac Disease
Hypertension
Diabeties
Seizure
Excess inhaler use

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13
Q

SABA Agents

A
  • albuterol (ProAir)
  • levabuterol (Xopenex)
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14
Q

Mechanism of Action for LABAs

A

Produces accumulation of cyclic adenosine monophosphate at BETA2 adrenergic receptors

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15
Q

Indication for LABAs

A
  • Concomitant therapy for asthma uncontrolled with ICS
  • Prevention of bronchospasm in COPD
  • Prevention of exercise-induced bronchospasm
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16
Q

Therapuetic Effect of LABAs

A

Bronchodilation

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17
Q

Side Effects of LABAs

A

Headache
Palpitations
Tachycardia
Trembling
Paradoxical Bronchospasm

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18
Q

Contraindications of LABAs

A
  • Acute attack of Asthma
  • Not taking a long-term asthma control medication
  • Patient is currently controlled on a low- or medium-dose ICS
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19
Q

LABA Agents

A

salmeterol (Servent Diskus)
formoterol (Perforomist)
olodaterol (Striverdi Respiramat)

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20
Q

Mechanism of Action for SAMAs

A

Inhibits cholinergic receptors in bronchial smooth muscle. This results in decreased concentrations of cyclic guanosine monophophate (cGMP). Decreased levels of cGMP results in bronchodilation.

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21
Q

Indication of SAMAs

A

Maintenence therapy of reversible airway obstruction due to COPD, bronchitis, emphysema
Management of asthma induced bronchospasm

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22
Q

Therapuetic effect of SAMAs

A

Bronchodilation
Decreased Rhinorrhea

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23
Q

Side Effects of SAMAs

A

Hypotension
Palpitation
Dizziness
Headache
Bronchospasm

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24
Q

Contraindations of SAMAs

A

Acute Bronchospasm
Hypersensitiity to atropine, belladonna alkaloids, bromide

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25
SAMA Agents
ipratropium solution (Atrovent)
26
Mechanism of Action of LAMAs
Acts as a anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways
27
Indication of LAMAs
Long-Term maintenance of COPD and Asthma Reduce exacerbations in COPD
28
Therapuetic Effects of LAMAs
Decrease incidence and severity of bronchospasm in COPD and Asthma
29
Side Effects of LAMAs
Dry Mouith Tachycardia Bronchospasm Glaucoma Urinary difficulty
30
Contraindications of LAMAs
Concurrent ipratropium
31
LAMA Agents
tiotropium bromide (Spiriva), glycopyrrolate (Lonhala), aclidinum (Tudorza)
32
Mechanism of Action of ICS
Potent, locally acting anti-inflammatory and immune modifier
33
Indication of ICS
Maintainence and Prophylatic treatment in Asthma
34
Therapuetic Effect of ICS
Improves asthma symptoms Decreases frequency/severity of asthma attacks
35
Side Effects of ICS
Otis Media Headache Bronchospasm Adrenal Suppresion
36
Contraindications of ICS
Acute attack of asthma or status asthmaticus
37
ICS Agents
Budesonide (Symbicort) Fluticasone (Advair)
38
LABA/ICS
Symbicort & Advair
39
LABA/LAMA/ICS
fluticasone furoate/unmeclidinium/vilanterol (Trelegy Ellipta)
40
mMRC Grade 0
Dyspnea with mild exercise
41
mMRC Grade 1
Dyspnea when hurrying or walking up a slight hill
42
mMRC Grade 2
Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace
43
mMRC Grade 3
Stops for breath after walking 100 yards (91 m) or after a few minutes
44
mMRC Grade 4
Too dyspneic to leave house or breathless when dressing
45
GINA: Track 1, Step 1
Symptoms less than 4-5 days a week Low dose ICS-formoterol
46
GINA: Track 1, Step 2
Symptoms less than 4-5 days a week Low dose ICS-formoterol
47
GINA: Track 1, Step 3
Symptoms most days or waking > 1 week Low-Dose maintenence ICS-formoterol
48
GINA: Track 1, Step 4
Daily symptoms, Waking greater than once a week, or low lung function Medium-Dose maintenence ICS-formoterol
49
GINA: Track 1, Step 5
Persistent symptoms/exacerbation despite good adherence w/ Step 4 Add LAMA, Consider Phenotypic assesmmet, Consider high-dose maintenence ICS-formoterol
50
GINA: Track 1, Reliever
PRN low-dose ICS-formoterol
51
GINA: Track 2, Step 1
Symptoms less than 2 timess a month ICS taken whenever SABA used
52
GINA: Track 2, Step 2
Symptoms greater than 2 times per month but less than 4-5 days/week Low-dose maintenence ICS formoterol
53
GINA: Track 2, Step 3
Symptoms most days or waking greater than one week Low-Dose maintenence ICS-LABA
54
GINA: Track 2, Step 4
Daily symptoms, Waking greater than one week, Low lung function Medium-High dose Maintence ICS-LABA
55
GINA: Track 2, Step 5
Persistent symptoms/exacerbation despite good adherence w/ Step 4 Add LAMA, Consider Phenotypic assesmmet, Consider high-dose maintenence ICS-formoterol
56
Inpatient Management of Asthma
1. Supplemental low-flow 02 2. Inhaled SABA: Albuterol (MDI or Nebulizer 3. Inhaled SAMA: Ipratropium (MDI or Nebulizer) 4. Systemic Glucocoticoids: Methylprednisone (IV or PO) 5. Magnesium Sulfate 6. Suspected anaphylais? Epinephrine (0.3-0.5 mg SQ) 7. Mechanical Ventilation as needed
57
What is Status Asthmaticus?
Severe acute asthma presenting in an unremitting, poorly responsive, life-threatening manner
58
Inpatient Management of Status Asthmaticus
1. Supplemental Oxygen 2. IV D5 1/2 NS 3. Inhaled and Parenteral sympathomimetics 4. Methylprednisolone 60-125mg or Hydrocortisone 300 mg 5. Atrovent 6. Monitor REspiratory function 7. Monitor ABG every 10-20 minutes 8. Intubate
59
What is COPD?
Chronic Bronchitis and Emphysema
60
What is Chronic Bronchitis?
Excessive secretion of bronchial muscus manifested by productive cough for three months
61
Name 4 S/S of Bronchitis
* Mild to Moderate Dyspnea * Onset after age 35 * Copius sputum production * Stocky, Obese * Chest A-P Diameter Normal * Percussion Normal * Hyperinflation of Chest on CXR * Hematocrit Increased
61
What is Emphhysema?
Abnormal, permanent enlargement of the Alveoli
62
Name 4 S/S of Emphysema
* Progressive, constant dyspnea * Onset of symptoms after age 50 * Mild sputum * Thin, Wasted Body * Chest AP Diameter increased * Percussion hyperresonant * Hematocrit normal * Total lung capacity increased
63
How to confirm COPD
PFT stating FEV1/FVC ratio is less that 0.7
64
GOLD One
FEV1 >80% of predicted value
65
GOLD Two
FEV1 50-79% of predicted value
66
GOLD Three
FEV1 30-49% of predicted value
67
GOLD Four
FEV1 less than 30% of predicted value
68
Treatment of COPD: Category A
No or 1 moderate exacerbation that does not require hospitalization per year mMRC between 0-1 CAT less than 10 Bronchodilator
69
Treatment of COPD: Category B
No or 1 moderate exacerbation that does not require hospitalization per year mMRC greater than 2 CAT greater than 10 LABA+LAMA
70
Treatement of COPD: Category E
Greater than 2 moderate exacerbations or greater than 1 leading to hospitalization per year LABA+LAMA
71
COPD Assessment Test
Scale symptom severity with 1 being the lowest and 5 being highest * Cough * Phlegm * Chest Tightness * Breathlessness * Activities * Confidence * Sleep * Energy
72
What is TB?
Systemic disease caused by M. tuberculosis
73
Name 4 groups at risk for TB
* Incarcerated * HIV (+) * Diabeties Mellitus * Chronic Kidney Disease * Malignanacy * Malnutrition * Immunosupressed
74
Name 3 S/S of TB
* Fatigue * Anorexia * Dry cough * Weight loss * Fever * Night Sweats
75
Laboratory/Diagnostics for TB
* Cuture of M. tuberculosis x3 * Small Homogenous infiltrate in upper lobes by CXR * Acid-Fast Smears * Purified Protien Derivative (PPD)
76
Management for TB
* Notifiy local health department * Hospitalization not required
77
Antituberculars
Rifampin 600mg Isoniazid 300mg Pyrazinamide 1.5-2.0g Ethambutol 15mg/kg ## Footnote Typical treatment is for 6m. 9m for immunocompromised
78
MOA of Rifampin
Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms
79
Indication for Rifampin
Active TB Broad Spectrum ABX
80
Therapuetic Effect of Rifampin
Bactericidal action agaisnt: Mycobacterium S. Aureus H. Influenzae L. Pneumophila N. Meningitidis
81
Side Effects of Rifampin
* DRESS * SJS * TEN * Hepatotoxicity * Red Discolaration of Urine * NVD
82
Contraindications of Rifampin
Concurrent use of: atazanavir, darunavir, fosamprenavir, praziquantel, saquinavir, tipranavir, or ritonavir-boosted saquinavir.
83
Drug Interactions for Rifampin
Decreases effect of ticagrelor, digoxin, warfarin, contraceptives, and numerous other drugs Increases effect of clopidogrel, bactrim
84
Mechanism of Action for Isoniazid
Inhibits mycobaterial cell wall synthesis
85
Indication for Isoniazid
1. TB 2. TB prevention
86
Therapuetic Effect of Isoniazid
Bacteriostatic or Bacteriocidal action against mycobacteria
87
Side Effects of Isoniazid
* Hepatitis * DRESS * TEN * Pancreatitis * Peripheral Neuropathy
88
Contrindications of Isoniazid
Acute liver disease History of Hepatitis Pregnancy
89
Mechanism of Action for Pyrazinamide
Lowers the pH of the mycobateria envirment by converting pyrazinoic acid in susceptable strains
90
Indication of Pyrazinamide
TB
91
Therapuetic Effect of Pyrazinamide
Bacteriostatic action against mycobateria
92
Side effects of Pyrazinamide
Hepatotoxicity Hyperuricemia Arthralgia Photosensitivity NVD
93
Contraindications of Pyrazinamide
Liver Impairment Preganancy
94
Mechanism of Action of Ethambutol
Inibitis growth of mycobacteria
95
Indication for Ethambutol
Additive antitubercular agent with active TB
96
Side Effect of Ethambutol
Hepatitis Optic Neuritis Peripheral Neuritis Confusion Pulmonary infiltrates
97
Therapuetic Effect of Ethambutol
Tuberculostatic effect agaisnt susceptable organisms
98
Contraindications of Ethambutol
Optic Neuritis
99
TB Monitoring
First 6 weeks- Weekly sputum smears and cultures, then monthly
100
TB Baseline Labs
LFT CBC CMP Visual Acuity Red-Green Color Preception
101
PPD 5mm
Positive in HIV infected and the immunocompromised
102
PPD 10mm
Positive for healthcare workers, immigrants, and the incarcerated
103
PPD 15mm
Positive for the general public
104
What is Pneumomonia
Pathogens gain access to the lower respiratory tract through aspiration, inhalation causing inflammation of the respiratory tract
105
Name 4 S/S of Pneumonia
* Fever * Rigor * Purulent Sputum * Lung Consolidation * Malaise * Increased Fremitus
106
Abnormal Labs in Pneumonia
* CBC * ABG * CXR * Sputum Cultures * Blood Cultures
107
What scales help predict morbidity and mortality in CAP?
1. Pneumonia Severity Index (PSI) 2. Patient Outcomes Research Team (PORT) 3. CURB-65 Criteria
108
PORT Class I-II
Score: Less than 70 Risk: Low Mortality: Less than 1% Treatment: Outpatient
109
PORT Class III
Score: 71-90 Risk: Low Mortality: 3% Treatment: Brief Inpatient
110
PORT Class IV
Score: 91-130 Risk: Moderate Mortality: 9% Treatment: Inpatient
111
PORT Class V
Score: Greater than 130 Risk: High Mortality: 30% Treatment: ICU
112
CURB-65 Criteria
**C**onfusion b**U**n greater than 19 **R**espiratory Rate greater than 30 S**B**P<90;D**B**P<60 **65 **years old or older
113
CURB-65: Low RIsk
Score: 0-1 Consider home treatment
114
CURB-65 Moderate Risk
Score: 2 PCU Admission
115
CURB-65: High Risk
Score: Greater than 3 ICU Admission
116
Empiric Therapy Outpatient CAP: Nonsevere
Amoxicillin 1g or Doxycycline 100mg BID or Azithromycin/Clarithromycin
117
Nonsevere Outpatient CAP Pathogens
C. pneumoniae M. pneumoniae S. pneumoniae H. influenzae M. catarrhalis
118
Empiric Therapy Outpatient CAP: Severe
Augmentin or Cephalosporin + Macrolide/Doxycycline or Fluroquinolone
119
Viral PNA Treatment
Oseltamivir Zanamivir Remdesivir (COVID-19)
120
Severe Outpatient CAP Pathogens
Multi-Drug Resistant S. Pneumoniae
121
Empiric Therapy Inpatient CAP: Nonsevere
Beta-Lactam + Macrolide or Fluoroquinolone only
122
Macrolides
Azithromycin Clarithromycin
123
Fluroquinolones
Levofloxacin Moxifloxacin
124
Beta Lactams
Ceftriaxone Cefotaxime Ceftaroline Ampicillin-Sulbactam
125
Empiric Therapy Inpatient CAP: Severe
Beta Lactam + IV Fluroquinolone or IV Azithromycin
126
Inpatient Nonsevere CAP Pathogens
S. pneumoniae M. pneumoniae C. pneumoniae H. influenzae Legionella
127
Inpatient Severe CAP Pathogens
S. Pneumoniae S. Aureus Legionellla Gram-Negative bacilli H. influenzae
128
What is the definition of HAP?
PNA that occurs 48h after admission
129
Nonsevere HAP Empiric therapy
Piperacillin/tazobactam or Cefepime or Levofloxacin or Imipenem or Meropenem
130
Severe HAP Empiric Therapy
All in nonsevere or Ceftazidime or Ciprofloxacin or Azetreoname + Vancomycin or Linezolid
131
Lethal HAP Empiric Therapy
All in severe or Amikacin or Gentamicin or Tobramycin
132
Definition of VAP
PNA that presents in mechanically ventilated patients 48 post-intubation
133
MRSA VAP
Vancomycin + Linezolid
134
Gram Negative ABX w/ Beta-Lactam Activity
Piperacillin/tazobactam Cefepime Ceftazidime Imipernem Meropenem Aztreonam
135
Gram Negative ABX w/o Beta-Lactam Activity
Levofloxacin Ciprofloxacin Amikacin Gentamicin Tobramycin Colistin Polymyxin B
136
What is a Pneumothorax?
Gas infitrated into the pleural space increasing pressure resulting in a collaspe
137
Name 5 S/S of a Pneumothorax
* Chest Pain * Dyspnea * Cough * Hyperresonance on affected side * Diminished breath sounds on affected side * Diminished Fremitus on affected side * Medianstinal Shift toward unaffected side * Hypotension
138
Laboratory/Diagnositics
CXR ABG
139
Pneumothorax Management
1. Chest Tube, 4th of 5th ICS and MAL 2. Needle thoracostomy (Emergency), 2nd ICS and MCL
140
What is Sarcoidosis?
A condition of unknown etiology causing interstial lung disease and noncaseating granulomas
141
S/S of Sarcoidosis
* Progressive Dyspnea * Nonproductive Cough
142
Laboratory/Diagnositics
* CXR * PFT * CMP * ABG * Bronchoscopy with biopsy
143
Sarcoidosis Management
Corticosteroids
144
What is a Pulmonary Embolus
An emboli in the lung parenchyma
145
Risk Factors for PE
* Prolonged immobility * Venous Statis * Hypercoagulable states * Oral Contraceptives * Surgery * Cardiac Thrombi
146
Virchows Triad
* Prolonged immobility * Venous Stasis * Hypercoagulable states
147
Name 5 S/S of PE
* Usually occur abruptly * Unexplained dyspnea and tachycardia * Chest Pain * Hemoptysis * Low Grade Fever * Hypotension * Cyanosis
148
Laboratory/Diagnostics for PE
1. V/Q Scan if no CT Angio 2. ABG 3. Spiral CT 4. DDimer 5. CT Angiography
149
PE Management
1. Oxygen 2. IVF 3. Possible intubation 4. Heparin 5. Fibrinolytics
150
What is Acute Respiratory Distress Syndrome?
ALI due to multifactoral insults to the lung
151
S/S of ARDs
* Severe Dyspnea * Respiratory Distress * Cyanosis * Tachycardia * Rales/Wheezes
152
Laboratory/Diagnostics
CXR ABG
153
ARDs Management
1. Mechanical Ventilation 2. Treatment of underlying disease
154
Equation for reccomended Tidal Volume
4-6mL/kg to ideal body weight
155
What is Control Mode?
Machine ventilates the patient. TV and RR are preset
156
What is Assist-Control mode?
Machine ventilates the patient, but the patient can activate the machine resulting in delivery of a preset TV.
157
What is SIMV/IMV Mode?
Machine ventilates the patient, but the patient can breathe inspiring their own TV
158
What is CPAP?
Continours positive pressure during spontaenous breaths
159
What is BiPAP?
Continous positive pressure during inspiratory and expiratory breaths
160
What are the Key Ventilator Settings?
1. The Mode 2. FiO2 3. Tidal Volume 4. PEEP 5. RR 6. Pressure Support
161
Obstructive Pulmonary disease causes what on PFT?
Reduced Airflow Rates
162
Restrictive Pulmonary Disease causes what on PFT?
Reduced Volumes and expiratory flow rates
163
Airflow Rates in PFT
FVC FEV1 FEV25-75 PEFR
164
Volume Rates in PFT
TLC FRC RV
165
What is FVC?
Forced Vital Capacity Volume of gas forcefully expelled from the lungs after maximal inspiration
166
What is FEV1?
Forced Expiratory Volume in 1s Volume of gas expelled in the first second of the FVC
167
What is FEV25-75?
Maximal Mid-expiratory rate
168
What is PEFR?
Peak Expiratory Flow Rate Maximal airflow rate achieved in FVC maneuver
169
What is TLC?
Total Lung Capacity Volume of gas in lungs after inspiration
170
What is FRC?
Functional Residual Capacity
171
What is RV?
Residual Volume Volume of gas remaining in lungs after max expiration
172
What is a Pleural Effusion?
Transudate or Exudate in the plueral space
173
Exudate Pleural Fluid
* Pleural fluid protien to serum protien ratio is greater than 0.5 * Pleural fluid LDH to serum LDH ratio is greater than 0.6 * Pleural fluid LDH greater than two-thirds the upper limit of normal serum LDH
174
Transudate Pleural Fluid
* Pleural fluid protien to serum protien ratio is less than 0.5 * Pleural fluid LDH to serum LDH ratio is less than 0.6
175
Name the 4 types of Pleural Effusions
1. Transudates 2. Exudates 3. Empyema 4. Hemorrhagic
176
Name 5 Physiologic Changes in the Elderly
1. Lungs are stiffer 2. Pulmonary strength is weaker 3. Rigid chest wall 4. Vital capacity decreases 5. Residual volume increases 6. Increased AP diameter 7. Hyperresonance to percussion 8. Alveolar Surface Area decreased 9. Reduced oxygen uptake 10. Aveoli collaspe easeier 11. Inreased mucous 12. Decreased response to hypoxia and hypercapnia
177
Normal Pulmonary Laboratory/Diagnostics in the Elderly (Reference)
1. Reduced pulmonary function reserve 2. Dyspnea on Extertion 3. Exerise Intolerance 4. Decreased chest/lung expansion 5. Less effective exhalation 6. Decreased mucus clearance 7. Increased risk of ateletais 8. Increased risk of Respiratory Infection 9. Increased risk of Bronchospasm
178
Pneumonia in the Elderly
* Classic signs may be absent * Weakness * Decreased ADLs * Anorexia * Poor Appetite * Confusion * AMS
179
Most Common Pathogens of PNA in the Elderly
* S. Pneumoniae * Gram-negative Bacilli * Staph Aureus
180
MOA of Amoxicillin
Binds to bacterial cell wall resulting in cell death
181
Indication of Amoxicillin
H. Pylori Skin Infection Respiratory Infection Genitourinary Infection HEENT Infection ## Footnote Endocarditis Prophylaxis
182
Therapeutic Effect of Amoxicillin
Broad Spectrum bactericidal action
183
Name 5 bacteria that Amoxicillin is active against
* Streptococci * Pneumococci * Enterococci * Haemophilus influenzae * Escherichia coli * Proteus mirabilis * Neisseria meningitidis * N. gonorrhoeae * Shigella * Chlamydia trachomatis * Salmonella * Borrelia burgdorferi * H. pylori.
184
Contraindications of Amoxicillin
Penicillin Allergy Beta-Lactam Allergy
185
Name 5 S/S of Amoxicillin
* GEP * DRESS * SJS * TEN * CDAD * NVD
186
MOA of Doxycycline
Inhibits protien synthesis at the level of the 30S bacterial ribosome
187
Indication of Doxycycline
Gonorrhea Syphyllis Chronic Bronchitis Acne Anthrax-Post Exposure ## Footnote Malaria prophylaxis
188
Therapeutic Effect of Doxycycline
Bacteriostatic action against susceptable bacteria
189
Name 3 Pathogens on the Spectrum of Doxycycline
1. Some Gram + Activity 2. Some Gram - Activity 3. Mycoplasma 4. Treponema pallidum 5. Chlamydia 6. Rickettsia 7. Borrelia burgdorferi.
190
Contraindications of Doxycycline
Pregnancy Lactation
191
Name 5 S/S of Doxycycline
* DRESS * SJS * EM * ED * TEN * CDAD * Hepatotoxicity * Pancreatitis * NVD
192
MOA of Azithromycin
Inhibits protien synthesis at the level of the 50S bacterial ribosome
193
Indications for Azithromycin
1. URI 2. LRI 3. HEENT Infection 4. Skin Infection 5. STI
194
Therapuetic Effect of Azithromycin
Bacteriostatic action against bacteria
195
Contraindications of Azithromycin
Allergy to Macrolides Hepatic dysfunction QT prolongation Hypokalemia Hypomagnemia Bradycardia
196
Drug Contraindications for Azithromycin
* Quinidine * Dofetilide * Amiordarone * Procainamide * Sotalol ## Footnote Quick, Dogs, Always, Play, Safe
197
Name 5 S/S Effects of Azithromycin
* Cardiac Death * TDP * GEP, DRESS, SJS, TEN * Hepatotoxicity * CDAD * NVD
198
MOA of Clarithromycin
Inhibits protien synthesis at the level of the 50S bacterial Ribosome
199
Indication of Clarithromycin
* RTI * MAC * Skin Infection * HEENT Infection * H. Pylori ## Footnote Endocarditis prophylaxis
200
Therapeutic Effect of Clarithromycin
Bacteriostatic Action
201
Name 3 Pathogens on the Spectrum of Clarithromycin
**Gram +/- aerobic bacteria ** Staphylococcus aureus, S. pneumoniae, S. pyogenes (group A strep) Haemophilus influenzae, Moraxella catarrhalis. ## Footnote Mycoplasma, Legionella, H. pylori, M. avium
202
Contraindications of Clarithromycin
* Macrolide Allergy * Hepatic dysfunction * QT prolongation * Hypokalemia * Hypomagnemia * Bradycardia
203
Drug Contradiction of Clarithromycin
* Quinidine * Dofetilide * Amiodarone * Procainamide * Sotalol * Lomitapide * Lovastatin * Ergotamine * Simvastatin * Pimozide ## Footnote Quick, Dogs, Always, Play, Safe; Let, Love, Everyone, SimPly
204
Name 5 S/S of Clarithromycin
* TDP * GEP, DRESS, SJS, TEN * CDAD * Hepatotoxicity * QT interval prolongation
205
Action of Clavulanate Acid
Clavulanate resists action of beta-lactamase, an enzyme produced by bacteria that is capable of inactivating some penicillins.
206
Indication of Oseltamivir
Influenza
207
MOA of Oseltamivir
Inhibits the enzyme neuraminidase, which may alter virus particle aggregation and release.
208
Contraindications of Oseltamivir
ESRD and not on dialysis
209
Name 5 S/S of Oseltamivir
Seizure Confusion Insomina Nausea Vomiting
210
Indication of Zanamivir
Influenza
211
MOA of Zanamivir
Inhibits the enzyme neuraminidase, which may alter virus particle aggregation and release.
212
Therapeutic Effect of Zanamivir
Reduced duration or prevention of flu-related symptoms
213
Therapeutic Effect of Oseltamivir
Reduced duration or prevention of flu-related symptoms
214
Contraindications of Zanamivir
Lactose Allergy
215
Name 5 S/S of Zanamivir
1. Seizure 2. Bronchospasm 3. Agitation 4. Delirium 5. Hallucinations
216
MOA of Remdesivir
Remdesivir is metabolized to Remdesivir triphosphate (RT). RT acts as a ATP analog that competes with ATP for incorporation into RNA chains by SARS-CoV-2 RNA-dependent RNA polymerase which delays and terminates RNA SARS-CoV-2 replication
217
Indication of Remdesivir
COVID-19
218
Therapeutic Effect of Remdesivir
Reduced recovery time in COVID-19 Reduced mortality in COVID-19
219
Contraindications of Remdesivir
Hypersensitivity
220
Name 5 S/S of Remdesivir
* Respiratory Failure * Nausea * Hyperglycemia * Increased LFTs * AKI
221
MOA of Levofloxacin
Inhibits bacterial synthesis by inhibiting DNA gyrase enzyme
222
Indications of Levofloxacin
* UTI * HAP * CAP * Respiratory Infection * HEENT Infection * Skin Infection
223
Therapeutic Effect of Levofloxacin
Death of susceptible bacteria
224
Contraindication of Levofloxacin
* QTC Prolongation * Hypokalemia * Hypomagnesmia * Bradycardia
225
Drug Contraindications of Levofloxacin
* Quinidine * Disopyramide * Amiordarone * Procainamide * Sotalol ## Footnote Quick, Dogs, Always, Play, Safe
226
Name 5 S/S of Levofloxacin
* Aortic Dissection * TDP * QT Prolongation * SJS, GEP * Nausea * Elevated ICP * Seizure * Suicidal Thoughts/Behaivors
227
MOA of Moxifloxacin
Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme
228
Name 5 Pathogens on the Spectrum of Levofloxacin
Gram + pathogens Gram - pathogens including Pseudomonas Aeruginosa H. influenzae E. Coli E. Cloacae Legionella P. mirabilis Staph Strept Mycoplasma ## Footnote HEEELPSS
229
Name 5 Pathogens on the Spectrum of Moxifloxacin
Gram + pathogens Gram - pathogens H. influenzae E. Coli E. Cloacae P. mirabilis Staph Strept Mycoplasma
230
Contraindications of Moxifloxacin
* QTC prolongation * Hypokalemia * Hypomagnesemia * Bradycardia * MG
231
Drug Contraindications of Moxifloxacin
* Quinidine * Dosipyramide * Amiordaron * Procainamide * Sotalol ## Footnote Quick, Dogs, Always, Play, Safe
232
Name 5 S/S of Moxifloxacin
1. Aortic Dissection 2. TDP 3. QT prolongation 4. SJS 5. CDAD 6. Elevated ICP 7. Seizures 8. Suicidal Thoughts 9. NVD
233
MOA of Ceftriaxone
Binds to the bacterial cell wall membrane causing cell death
234
Name 5 Indications of Ceftriaxone
* Skin Infection * Bone Infection * Respiratory Infection * Genitourinary Infection * Gastrointestinal Infection * HEENT Infection * Meningitis * Septecemia
235
Therapeutic Effect of Ceftriaxone
Bacteriocidal action against susceptable bacteria
236
Name 5 Pathogens on the Spectrum of Ceftriaxone
Acinetobacter Enterobacter H. influenzae H. parainfluenzae E. Coli K. pneumoniae M. morganii Neisseria Proteus Providencia Serratis Moraxella catarhalis | DO NOT use for MRSA, MRE ## Footnote 3rd GEN Cephalosporin
237
Contraindications of Ceftriaxone
Allergy to cephalosporin Allergy to penicillin Neonates
238
Name 5 Side Effects of Ceftriaxone
Gallbladder Sludging Cholelithiasis Pancreatitis CDAD NVD Seizure IV Site Pain Phelbitis
239
MOA of Cefotaxime
Binds to bacterial cell wall membrane causing cell death
240
Name 5 Indications for Cefotaxime
* Integumentary Infection * Osseous infection * Geniturinary Infection * Pulmonary Infection * Gastrointestinal Infection * Septicemia * Meningitis * Lyme Disease
241
Therapeutic Effects of Cefotaxime
Bactericidal action against susceptible bacteria
242
Name 5 pathogens on the Spectrum of Cefotaxime
Acinetobacter Citrobacter Enterobacter Haemophilus influenzae (including β-lactamase-producing strains) Haemophilus parainfluenzae Escherichia coli Klebsiella pneumoniae Morganella morganii Neisseria gonorrhoeae and meningitidis Proteus Providencia Serratia Moraxella catarrhalis Borrelia burgdorferi ## Footnote No MRSA activity
243
Contraindications of Cefotaxime
Allergy to cephalosporins Allergy to penicillins
244
Name 5 S/S of Cefotaxime
1. CDAD 2. NVD 3. Seizure 4. Pain at site 5. Phelbitis
245
MOA of Ceftaroline
Bind to bacterial cell wall membrane causing cell death
246
Indication of Ceftaroline
1. Skin Infection 2. CAP
247
Therapeutic Effect of Ceftaroline
Bacteriocidal action agaisnt susceptable bacteria
248
Name 5 Pathogens on the Spectrum of Ceftaroline
Staphylococcus aureus MRSA Streptococcus pyogenes Streptococcus agalactiae Escherichia coli Klebsiella pneumoniae Klebsiella oxytoca Streptococcus pneumoniae Haemophilus influenzae
249
Contraindications of Ceftaroline
Allergy to cephallsporin
250
Name 5 Side Effects of Ceftaroline
1. CDAD 2. Seizure 3. Encephalopathy 4. NVD 5. Hemolytic Anemia
251
MOA of Unasyn ## Footnote ampicillin/sulbactam
Binds to bacterial cell wall, resulting in cell death; spectrum is broader than that of penicillin. Addition of sulbactam increases resistance to beta-lactamases, enzymes produced by bacteria that may inactivate ampicillin.
252
Name 3 Indications of Unasyn ## Footnote ampicillin/sulbactam
* Intugermentary Infection * HEENT Infection * Abdominal Infection * Respiratory Infection * Genitourinary Infection * Meningitis * Septicemia
253
Therapuetic Effects of Unasyn ## Footnote ampicillin/sulbactam
Bactericidal action
254
Name 5 Pathogens on the Spectrum of Unasyn
Streptococci Pneumococci Enterococci Haemophilus influenzae Escherichia coli Proteus mirabilis Neisseria meningitidis N. gonorrhoeae Shigella Salmonella Bacteroides fragilis Moraxella catarrhalis
255
Contraindication of Unasyn
Hepatic dysfunction Renal Dose Renal Impairment
256
Name 5 Side Effects of Unasyn
1. EM, SJS, TEN, GEP 2. Hepatotoxicity 3. CDAD 4. Seizure 5. Pain at injection site
257
MOA of Zosyn
Binds to bacterial cell wall causing cell death and inhibits beta-lactamase
258
Indication of Zosyn
Appendicitis Peritonitis Skin Infection Gynecologic Infection CAP HAP
259
Therapeutic Effects of Zosyn
Death of susceptible bacteria
260
Contraindications of Zosyn
Renal Impairment
261
Side Effects of Zosyn
GEP, DRESS, SJS, TEN CDAD Seizure Pain Phlebitis at the IV site
262
MOA of Cefepime
Binds to bacterial cell wall membrane causing cell death
263
Indication of Cefepime
Skin infection Bone infection UTI RTI Abdominal Infection Septicemia
264
Therapeutic Effect of Cefepime
Bactericidal action against susceptible bacteria
265
Contraindication of Cefepime
Hypersensitivity of penicillin
266
Side Effects of Cefepime
Rash CDAD Encephalopathy Seizure Phlebitis at IV site
267
MOA of Imipenem
Enzyme resistance Binds to bacterial cell wall, resulting in cell death
268
Indication of Imipenem
RTI UTI Abdominal Infection Gynecologic infection Skin infection Bone infection Bacteremia Endocarditis
269
TE of Imipenem
Bactericidal action against susceptible bacteria
269
Contraindications of Imipenem
Sensitivity to penicillin and cephalosporin
269
Side Effects of Imipenem
Rash NVD CDAD Seizure Phelbitis
269
MOA of Meropenem
Enzyme resistance Binds to bacterial cell wall, resulting in cell death
269
Indication of Meropenem
Skin Infection Abdominal Infection Meningitis
269
TE of Meropenem
Bactericidal action against susceptible bacteria
269
SE of Meropenem
DRESS, SJS, TEN CDAD Seizure Apnea NVD
269
MOA of Ceftazidime
Binds to the bacterial cell wall membrane causing cell death
270
I of CEftazidime
Skin infection Bone infection UTI Gynecological Infection RTI Abdominal Infection Septicemia Meningitis
271
TE of ceftazidime
Bactericidal action against susceptible bacteria
272
C of Ceftazidime
Hypersensitivity to penicillin
273
SE of Ceftazidime
Rash CDAD Seizure Pain Phlebitis
274
MOA of Ciprofloxacin
Inhibits bacterial DNA synthesis by inhibiting the DNA gyrase enzyme
275
TE of Ciprofloxacin
Death of susceptible bacteria
276
I of Ciprofloxacin
Skin infection Bone Infection Abdominal Infection UTI RTI Bacterial Sinuitis Bacterial Prostatitis
277
SE of Ciprofloxacin
Aortic Aneurysm/Dissection Hepatotoxicity CDAD Elevated ICP Seizure
278
MOA of Aztreonam
Binds to the bacterial cell wall membrane causing cell death
279
I of Aztreonam
Septicemia Skin Infection Abdominal Infection Gynecologic Infection RTI UTI Pseudomonas aeruginosa
280
TE of Aztreonam
Bactericidal Action against susceptible bacteria
281
C of Aztreonam
Lactating Mothers
282
SE of Aztreonam
CDAD Seizure Congestion Nasopharyngeal Pain Cough Wheeze
283
MOA of Vancomycin
Binds to bacterial cell wall, resulting in cell death
284
I of Vancomycin
MRSA Endocarditis Meningitis Osteomyelitis Pneumonia Septicemia Soft Tissue Infection
285
SE of Vancomycin
GEP, DRESS, SJS, TEN Ototoxicity Nephrotoxicity Phlebitis Vancomycin flushing syndrome
286
MOA of Linezolid
Inhibits bacterial protein synthesis at the level of the 23S ribosome of the 50S subunit
287
I of Linezolid
Nosocomial Pneumonia CAP Skin infection VRE
288
TE of Linezolid
Bactericidal agianst streptococci Bacteriostatic against enterococci and staphylococci
289
SE of Linezolid
TEN CDAD Serotonin Syndrome Elevated LFTs SIADH
290
MOA of Amikacin
Inhibits protein synthesis in bacteria at the level of the 30S ribosome. Resists the action of the enzymes known to inactivate aminoglycosides
291
TE of Amikacin
Bactericidal action against susceptible bacteria
292
I for Amikacin
MAC Serious infections unresponsive to less toxic antiinfectives
293
SE of Amikacin
Ototoxicity Nephrotoxicity
294
MOA of Gentamicin
Inhibits protein synthesis in bacteria at the level of 30S ribosome
295
I of Gentamicin
Serious gram-negative infections Serious Infections
296
TE of Gentamicin
Bacteriocidal Action
297
SE of Gentamicin
Ototoxicity Nephrotoxicity Ataxia Vertigo
298
MOA of Tobramycin
Inhibits protein synthesis in bacteria at the level of the 30S ribosome
299
I for Tobramycin
Serious Infection Gram-negative
300
TE of Tobramycin
Bactericidal action
301
SE of Tobramycin
Ototoxicity Nephrotoxicity CDAD Paralysis
302
Miscellaneous Dangerous Antibiotics
Colistin, Polymyxin E Polymyxin B

AGACNP Board Review (5 decks)

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