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Pulmonology > Sweatman Bacterial Infections of the Lungs > Flashcards

Sweatman Bacterial Infections of the Lungs Flashcards

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1
Q

what constitutes lower respiratory region

A

respiratory bronchioles, alveolar ducts, alveoli

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2
Q

symptoms of pneumonia

A 
fever
cough with our without sputum
dyspnea
chest pain
infiltrates on radiograph (diagnostic)
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3
Q

unproducitve cough=

A

viral or mycoplasma

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4
Q

most important factor is successful tx. of pneumonia

A 
early intervention
(mortality decreases when you wait even 8 hours)
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5
Q

4 types of pneumonia

A

CAP
nocosomial
aspiration
immunocompromosed host

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6
Q

define nocosomial/hospital acquired

A

appears within 48 hours of arrival/admission without evidence of existing prior to arrival

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7
Q

most common agent 0-6 weeks for CAP

A

group B strep

E coli

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8
Q

most common agents 6 weeks-18 yrs for CAP

A

viruses (flu, RSV, rino, parflu, adeno)
Myco pneumonia
chlamydia pneumonia
Strep pneumonia

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9
Q

most common 18-40 yrs for CAP

A

Mycoplasma pneumonia

strep pneumonia

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10
Q

most common 40-65 cor CAP

A 
Strep pneumonia
H flu
anaerobes (bacteroides, fusobacterium)
viruses
mycoplasma pneumonia
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11
Q

most common >65 yrs for CAP

A 
Strep pneumonia
Viruses
Anaerobes
H flu
Gram +ve rods
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12
Q

most common causes of nococosmial pneumonia

A

S. aureus,

P aeruginosa

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13
Q

Most common cause of Pneumonia in Dm and Alcoholic pt.’s

A

Klibsielle Pneumonia

currant-jelly sputum

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14
Q

Pt.’s with Dm should get

A

annual Flu vaccine and pneumococcal pneumonia–> DM inhibits the protective proteins in airways…very susceptible to Flue and its effects….worse immune system as well

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15
Q

is there vaccines againts staph

A

no

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16
Q

is there vaccines against pneumococcal pneumonia

A

yes–> strep. pneumonia

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17
Q

transplant pt.’s are also susceptible to

A

CMV infection

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18
Q

gram negative aerobe that thrives in water environment

A

legionella pneumophilia

–> atypical causative agent for pneumonia

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19
Q

name the respiratory quinolones

A

levofloxacin
cipro
moxifloxacin
*acheive good levels in lung tissues

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20
Q

commonly employed for legionella

A

azithromycin, clarithromycin

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21
Q

method for tx of penumonia

A

catergorize based on demographics
treat with broad spectrum pending labs
(take into account individual pt., resistance, local microbe info)

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22
Q

Outpatient no other modifying factors

A

Macrolide of doxycycline

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23
Q

Outpaitient with COPD, no steroids of Antibiotics in 3 months

A

2 gen macrolide

(clarithromycin) or doxycyline

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24
Q

Outpaitient, COPD, steroids or antibiotics in three months

A

floraqunolone, or augmentin, or clarithromycin (2nd gen.) +/- cephalosporin

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25
Nursing home
floraqunolone, or augmentin, or clarithromycin (2nd gen.) +/- cephalosporin
26
Hospital Ward
floraqunolone, or augmentin, or clarithromycin (2nd gen.) or azithromycin (3rd gen.) +/- cephalosporin
27
ICU first option
3rd gen cephalosporin+/- macrolide or piperacillin (broad)/tazobactam or floroquinilone
28
zosyn
piperacillin/tazobactam (beta lactamase inhibitor)
29
ICU with risk of P aeruginosa
antipsuedomonal florquinolone (cipro) + beta actam or macrolide + 2 antipseudomonal agents
30
why adjust for recent seroid use
pt. assumed to have realignment of local flora
31
MOA for macrolides
50s ribo blocker-->prevent translation
32
MOA for tetracyclines (doxycycline)
30s ribosomal blocker--> inhibts protein synthesis
33
MOA for floroquinolones
DNA gyrase inhibitor--> prevents DA repication
34
Penicillin MOA
block cell wall cross linkage
35
MOA for carbapenem
blocks cell wall cross-linkage
36
MOA for cephalosporins
inhibit cell-call cross-linkage
37
3rd gen cephalosporin with anti-pseudomonal activity
cefepime
38
MOA for aminoglycosides (gentamicin)
30s ribosomal inhibitor
39
resistance mech. for macrolides
mutation of 23s rRNA, ribosomal methylation, active efflux
40
tetracyclines restance mech.
decreased entry/increased efflux, target insensitivity
41
resistance mech to floroqiunolones
mutation of DNA gyrase, active efflux
42
resistance mech. to cephalosporins
dereased permeability of gram negative outer membrane (altered porins), ective efflux
43
resistance mech for aminoglycosides
drug inativation (aminoglycoside modfying enzyme) dec perm of gram negative outer membrane active efflux ribosomal methylation
44
most common nocosomial organism
Staph aureus, p aeruginosa
45
drugs indicated in NOCOSOMIAL pneumonia
1. imipenem/ cilastin--> meropenem 2. axtreonam--> zosyn 3. ceftazidime--> cefepime 4. vancomysin (IV)
46
carbapenem with less side effects
meropenem
47
drug reserved for cetazidime resistant
cefepime-> 4th gen and anti-pseudomnal
48
50% of isolate for pt.'s with aspiration pneumonia are...
gram negative bacteria - 16% anaerobes - 12% staph aureus
49
risks factors for aspiration pneumonia
Unconsiousness--> loss of protective reflexes long term intubation foreign body gastric acid semi-recumbant positioon and unable to expectorate material in airway
50
indicated in aspiration pneumonia
clindamycin--> ampicillin/sulbactam
51
tx for aspiration pneumonia must include protection against
anerobes such as H. flu
52
MOA for clindamycin
50s ribosomal inhibitor blocking translocation
53
resistance mech for clindamycin
meythlation of binding site, enzymatic inactivation
54
Vancomycin MOA
Bind D-ala-D-ala terminus of peptide precursor units, ihibiting peptidoglycan polymerase and transpeptidase reaction (cell wall proliferation inhibitor)
55
resistance to VANC
replacement of D-ala by D-lactate
56
Vancomycin only works on
gram positive bacteria
57
dosing route consideration for Ab's
oral for mild infections (no Gi problems, adherent, other chelating drugs)--> parenteral is severe--> may swithc to oral when controlled
58
Ab's with highest oral bioavailability
Florquinolones and doxycycline
59
three major relationships to consider when choosing a medication for pneumonia
1. AUC/MIC 2. Cmax/MIC 3. T>MIC
60
dosing parameters for concentration dependent drugs
large doses relative to MIC at long intervals relative to serum half life
61
example of concentration dependent drugs and their dosing
once daily aminoglycosides 2g of have with pt.s in normal renal function
62
time dependent dosing parameters
dosed more frequently, with emphasis on the need to maintain serum drug level above MIC for 30-50% of dose interval
63
example of time dependent meds
constant infusion of beta lactams to ensure maximal T>MIC
64
T>MIC greatest consideration for
penicillins, cephalosporins, carbapenems
65
24 hour AUC/MIC greatest consideration for
aminiglycosides, floroquinolones, tetracylines, vancomycin, macrolides, clindamycin
66
cMAX/MIC greatest consideration for
aminiglycosides. floroquinolones
67
which drugs DO NOT REQUIRE DOSE ADJUSTMENT FOR RENAL IMPAIRMENT (entirely billiary or renal/billiary)
azithromycin, ceftriazone, clindamycin, dxy, erythromycin, linezolid (all others do require adjustment)
68
drug with renal metabolism not just exceretion
imipenem
69
ab's metabolized by liver cyp's
linezolid
70
Major toxicity for amoxicillin
cross reactive with penicillin sensitivity,
71
ampicillin toxicity
maculopapular rash
72
azithromycin toxicity
QT prolong, chelestatic jaundice
73
cefazolin cross-reactivity
complete cross reactivity within cephalosporins, penicillin cross-reactivity
74
doxycylcine toxicity
teeth discoloration, dec bone growth, photosensitivity
75
erythromycin toxicity
cyp 3A4/pgp inhibitor, QT prolong, cholestatic jaundice
76
gentamicin toxicity
nephro and ototoxicity, neuromuscular paralysis
77
imipenen toxicity
cross-reactive with penicillin, cephalosporin toxicity
78
levofloxacin toxicity
tendon rupture in adults, cartilage damage in young children
79
linezolid toxicity
non-specific MAO inhibitor
80
meropenem toxicity
cross-reactive with pen/ceph
81
piperacillin toxicity
cross reactive with ceph, decreases coagulation (bleeding tendencies)
82
vancomycin toxicity
neophro and ototoxicity, Red Man's syndrome
83
cross reactivity related to...
presence of beta lactam ring that is rpesent in multiple drug classes
84
augmentin
amoxicillin/clavulonate
85
zosyn
pieracillin/tazobactam
86
unasyn
ampicillin/sulbactam
87
benefit of conjugating with a bactam/clavulonic
increases the duration of the effect of the beta lactam antibiotic by irreversibly inhibito the beta-lactamases
88
primaxin
imipenem/cilastin
89
Cilastin MOA
Reversible, competitive inhibitor of renal DHP-1, an enzyme which breaks down imipenem to inactive but nephrotoxic metabolites
90
antibiotic not used for pulmonary infections
daptomycin (cubicin)
91
why is daptinomycin not used for pneumonia
though it distributes to lung tissues...this drug is inhibited by pulmonary surfactant
92
Bronchitis in young people
viral
93
Bronchitis in elderly patients with other comorbitities
bacterial
94
common bugs that cause acute bronchitis in the elderly
Mycoplasma pneumonia, strep pneumonia, H flu, Moraxella catarrhalis and Bordatella pertusis
95
most common cause of acute bronchitis in smokers
H. influenza
96
indicated drugs in acute bronchits
1. augmentin--> ciprofloxacin if resistance 2. azithromycin 3. clarithromycin 4. doxycycline
97
Lung Abcesses most likley cuased by
Anaerobes + gram negative cocci + gram positive bacilli
98
nocosomial lung abcesses
gram negative bacilli
99
community acquired lung abcesses
gram positive cocci
100
treatment for lung abcesses
1. clinda mycin (better than penicillin vs. bacteroides) | 2. metronidazole + ceftriaxone (for nocosomial infections)
101
gram negative lung abcesses
metronidazole + ceftriaxone
102
gram positive cocci lung abcesses
clindamycin
103
List the tx for CAP in order of preference
Macrolide or respiratory quinilone or amoxicillin/clavulonate
104
treatment for abcess and aspiration pneumonia should cover for
anaerobes

Pulmonology (10 decks)

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