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Pharmacology (Dale Turley) > Respiratory (Pneumonia) - Exam 4 > Flashcards

Respiratory (Pneumonia) - Exam 4 Flashcards

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1
Q

CAP defined as?

A

an acute infection of the pulm. parenchyma in a patient who has acquired the infection in the community

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2
Q

HCAP definition?

A

healthcare-associated PNA - is acquired in other healthcare facilities, such as nursing homes, dialysis centers, and outpatient clinics

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3
Q

The rationale for the separate designation of HCAP was that patients with HCAP were at higher risk for ___________________ organisms

A

multidrug resistant (MDR)

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4
Q

CAP is a common and serious illness and is associated with morbidity and mortality, especially in _____ & patients with _______________.

A

older

comorbidities

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5
Q

Determining whether a patient should be admitted or treated as an outpatient is essential before what? And what is the determining factor in making this decision?

A

it is essential before selecting an ABS regimen

Severity of illness is the most critical factor in making this determination

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6
Q

CURB-65 helps with the decision of the site of care for CAP and uses what 5 prognostic variables?

A 
Confusion
Urea - BUN - > 7 mmol/L
Resp. rate - > 30 
BP - <90/60
Age - > 65
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7
Q

_______ (___) is primarily ordered to help determine if someone has lactic acidosis, a level of lactate that is high enough to disrupt a patients pH balance, and is a great predictor of sepsis and degree of illness.

A

Lactate (LDH)

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8
Q

CAP is most commonly caused by what bacteria?

A

Streptococcus pneumoniae

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9
Q

What is the Gold Standard for diagnosing pneumonia (CAP) when clinical features are supportive?

A

the presence of an infiltrate on plain chest radiograph

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10
Q

Other frequent isolated pathogens for CAP are ?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
respiratory viruses (parainfluenza, influenza, RSV)

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11
Q

Less common isolated CAP pathogens?

A

Legionella

H. Flu

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12
Q

What pathogens make patients typically sicker and require admission to the hospital - CAP?

A

Staph
Enterobacteriaceae
Pseudomonas

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13
Q

CAP primary treatments?

A 
Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Erythromycin (E-mycin)
Levofloxacin (Levaquin)
Doxycycline (Vibramycin)
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14
Q

Macrolides MOA?

A

inhibit synthesis at 50 S ribosomal unit

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15
Q

Macrolide clinical uses?

A

CAP believed to be caused by penicillin-sensitive STREP or H. Flu or any atypical pathogen

can be bactericidal or bacteriostatic depending on the susceptibility and conc.

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16
Q

Proceed with caution in using macrolides in?

A 
elderly
hepatic impairment
renal impairment
QT prolongation
torsades de pintes hx
MI
CHF
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17
Q

MOA of Levofloxacin (Levaquin) Fluroquinolones?

A

inhibit microbial nucleic acid metabolism

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18
Q

what ABS does resistance vary geographically?

A

Levofloxacin

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19
Q

Levofloxacin (Levaquin) BBW?

A

disabling, potentially irreversible serious reactions

tendinitis/tendon rupture

Prolonged QT syndromes

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20
Q

Doxycycline (Vibramycin) MOA?

A

Bacteriostatic; binds to 30S and possibly 50S ribosomal subunits, inhibiting protein synthesis

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21
Q

Doxycycline class?

A

tetracyclines

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22
Q

Serious reactions with Doxycycline (Vibramycin)

A

photosensitivity
superinfection
C.Diff associated diarrhea

avoid use during pregnancy and lactation

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23
Q

AKA walking pneumonia?

A

Atypical Pneumonia

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24
Q

Are there any distinguishing clinical or radiological manifestations between CAP typical and atypical ?

A

NO

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25
The mainstay of therapy for possible M. pneumoniae infection are?
marcolides (zithromax) or a fluroquinolones
26
Erythromycin MOA?
binds to 50S ribosomal subunit, inhibiting protein synthesis bacteriostatic or bactericidal; depending on susceptibility and concentration
27
Erythromycin side effects?
diarrhea, nausea, vomitting, red rash, increased risk of sun burn permanent problems with young children including changing the color of their teeth
28
HCAP common organisms?
``` Staph MRSA Candida albicans Pseudomonas Acinetobacter Stenotrophomonas C.diff E.coli TB VRE Legionnaires ```
29
HAP or HCAP tx? general
``` Ceftriaxone (Rocephin) Cefepime Piperacillin/tazobactam Ertapenem Meropenem Levofloxacin Vanco ```
30
Ceftriaxone (Rocephin) - Cephalosporins MOA?
Cephalosporins bind to PBP's on bacterial cell membranes to inhibit bacterial cell wall synthesis by mechanisms similar to those of the penicillin's bactericidal
31
2nd Generation Cephalosporin is slightly less active against G+ organisms than the 1st gene but it has an __________________?
extended G- coverage
32
what are some G- bacteria?
Salmonella Shigella E.Coli H.Pylori
33
Clinical uses of 2nd gen. cephalosporins?
infections caused by the anaerobe Bacteroides fragilis (cefoxitin)
34
Clinical uses of 4th gen. cephalosporins and examples?
Combines the G+ activity of first-generation agents with the wider G- spectrum of 3rd gen ceph. Cefepime - more resistant to beta-lactamases produced by G- organisms
35
Example of 4th gen cephalosporin?
cefepime
36
Caution in patients with what when prescribing Cephalosporins?
penicillin allergies
37
Cephalosporins MOA?
interferes with synthesis of the bacterial cell wall and thus are bactericidal
38
MOA of Piperacillin/tazobactum sodium (Zosyn)?
Pipercillin inhibits bacterial cell wall synthesis by binding to one or more of the PBP's - more broad spectrum more coverage Tazobactam inhibits many beta-lactamases
39
Class and MOA of Ertapenem (Invanc) and Meropenem (Merrem)?
Class: Carbapenem's MOA: like beta lactase, binds to PBP's and inhibits cell wall synthesis Broader spectrum of activity the cephalosporins and PCN's
40
MOA of Fluroquinolones?
inhibit microbial nucleic acid metabolism
41
When is Vanco used?
serious infections caused by drug-resistant G+ organisms, including MRSA
42
Class of Vanco?
Glycopeptide
43
MOA of vanco?
inhibit cell wall synthesis in G+ bacteria
44
Which organisms does vanco not work against?
G- organsims (E.coli, pseudomonas)
45
Monitor vanco by ___________ to determine correct dosage
blood level (peak and trough)
46
Treatment for severe C. diff colitis?
Oral Vancomycin
47
Common side effects include pain in the area of injection and allergic reactions like ______________.
red man syndrome may have problems with hearing, low BP and bone marrow suppression
48
Trimethoprim + sulfamethoxazole (Bactrim) MOA ?
Trimethoprim- inhibitor of dihydrofolate reductase sulfamethoxazole - inhibit microbial enzymes involved in folic acid synthesis
49
Sulfonamides and trimethoprim are ________________.
antimetabolites and are selectively toxic to microorganisms because they interfere with folic acid synthesis
50
The combination of a sulfonamide with trimethoprim causes a sequential blockade of __________ synthesis.
folic acid
51
Patient education for sulfonamides?
notify clinician if see skin rash no driving drink liberal amount of fluids to prevent crystalluria
52
Conscientious Considerations of Sulfonamides?
watch for SJS watch for G6PD deficiency as can lead to anemia Hypersensitivities can occur up to 12 days AFTER exposure
53
Examples of Respiratory antivirals ?
Oseltamivir (Tamiflu) - primary | Amantadine ( Symmetrel) - fallen by the way side
54
Oseltamivir (Tamiflu) class and used to treat what?
Class: antiviral medication and used to treat influenza A & B and to prevent flu after exposure (Hospitalized immunocompromised patients and pregnancy)
55
Oseltamivir MOA?
it is a prodrug and it is hydrolyzed to the active form, oseltamivir carboxylate (OC)
56
Oseltamivir is hydrolyzed into active for ________________.
Oseltamivir carboxylate (OC)
57
OC inhibits influenza virus _____________.
neurominidase
58
Amantadine (Symmetrel) class?
antiviral agent anti-parkinson agent, dopamine agonist
59
Amantadine is used to treat __________?
influenza A
60
why is Amantadine no longer recommended for the treatment or prophylaxis of influenza A?
Issues of resistance

Pharmacology (Dale Turley) (31 decks)

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