Wolff cardiopulm infection - crossword Flashcards by Morgan Mcbride

notable among the “cefs” for being ~only agent eliminated by the liver rather than the kidneys

ceftriaxone

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common reason for adding vancomycin or linezolid to pneumonia, both during empiric therapy and lab-guided therapy; ceftaroline also has activity

MRSA

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4th gen cephalosporin meaning it has greater gram negative outer membrane penetration, active against psudomonas

Cefepime

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macrolide-like with 15-aom ring, does not block cytochrome P450 and has unusual pharmacokinetics in that a single dose becomes concentrated in cells, especially phagocytes, and is then solwly released at bacteriostatic levels over several days to give it a half-life of 3-4 days

Azithromycin

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Risk of this is increased by some cephalosporins

Bleeding

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Neuraminidase inhibitor effective against influenza A and B, administered IV and having a longer half-life, it can reduce the severity and duration of the flu by 1-2 days if administered within 48 hrs

Peramivir

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3rd gen fluoroquinolone, “respiratory” activity but also useful against Pseudomonas

Levofloxacin

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Important consideration when toxic drugs requiring monitoring are administered IV over short periods of time (30 min); in the case of gentamicin with irreversible effects on bacterial ribosomes, the concentration needs to be high enough to reliably exert those effects but then low enough as indicated by this to allow for the toxic drugs to exit the host cells (eg proximal tubules, vestibulocochlear hair cells) where they can exert deleterious effects

Trough

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Overgrowth of this anaerobe can occur in GI tract when broad spectrum abx are administered, leads to severe diarrhea, can be a major problem in healthcare facilities, and has a worrisome mortality rate

C. difficile

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Characterized as an extended spectrum penicillin because of its activity against P. aeruginosa, used in both CAP and HAP when pseudomonas is a concern

Piperacillin

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An orally active and inexpensive ergosterol synthesis inhibitor, and drug of choice for yeast infections; has no activity against molds

Fluconazole

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Aminoglycoside used to treat community-acquired pneumonia in hospitalized pts with severe beta-lactam allergy and in those who acquired pneumonia in hospital (eg VAP or HAP) when there is concern for multi-drug resistant gram-positive and/or gram-negative infections

Gentamicin

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Gram-positive cause of endocarditis more commonly than cause of pneumonia, vancomycin is indicated if the endocarditis does not respond to beta-lactams

Enterococcus

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A penicillin-binding protein drug notable for having useful activity only against gram-negative aerobic pathogens including Pseudomonas; a monobactam held in reserve for treating more serious infections such as HAP and VAP

Aztreonam

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A 4th gen “respiratory” fluoroquinolone

Gemifloxacin

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Crucial bacterial enzyme preferentially blocked by 1st and 2nd gen fluoroquinolones and is arguably the main target that makes fluoroquinolones active against susceptible gram-negative infections

DNA gyrase

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Acronym for the multidrug resistant bacterial of greatest concern, members are responsible for ~80% of ventilator-associated pneumonia

ESKAPE
E. coli
Staphylococcus pseudintermedis/schleiferi/aureus
Klebsiella Pneumonia
Acinetobacter Baumannii
Psuedomonas Aeruginosa
Enterococcus Faecalis/Faecium

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minimum number of drugs required to treat multi-drug resistant TB

Five

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Getting the annual version of this vaccine is the best protection against the virus

Influenza

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Among the respiratory pathogens for which there is no preventative therapy

Adenovirus

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An orally administered 2nd gen cephalosporin

Cefaclor

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Development of a candida infection here

Prosthetic valve

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Notable among the 3rd gen cephalosporins for having activity against Pseudomonas

Ceftazidime

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Can rupture during fluoroquinolone therapy, especially in the young, old, and in others who subject them to significant stress

Tendons

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Also exhibited by erythromycin, further extends its spectrum of potential drug interactions

P Glycoprotein

Used in first-line treatment cocktail for active TB and sometimes for tx of latent TB

Rifampin

Negatively impacted in the weight-bearing joints of immature animals by fluoroquinolones, the potential for damage to it is a reason to avoid fluoroquinolones in children if possible but case-by-case benefits may outweigh risks

cartilage

Prototype of recent echinocandin antifungal drug class, it weakens fungal cell walls by blocking glucan crosslinking

Caspofungin

Well-known adverse effect of aminoglycosides, can be exacerbated by other drugs such as furosemide

Ototoxicity

Refers to multi-drug resistant strains of enterococcus that will still hopefully respond to linezolid

VRE (vancomycin-resistant enterococci)

5th gen cephalosporin, spectrum much like 3rd gen with addition of activity against MRSA

Ceftaroline

In addition to rare but serious CNS adverse effects including psychosis, seizures, and memory loss, levofloxacin has a black box warning due to its potential exacerbation of _______

Myasthenia Gravis

Principal cause of tricuspid valve endocarditis, creates a population of patients that is especially challenging to treat

Injection drug use

Well known adverse effect of tetracyclines, but fluoroquinolones and voriconazole are among other agents that also cause this

Photosensitivity

Drug class preferred for addition to beta-lactam antibiotic for treating community acquired pneumonia

Macrolide

Syndrome caused by infusing vancomycin too fast, generally does not cause hypotension, shortness of breath, etc but draws attention

Redman

Metabolizes a number of abx and many other drugs which therefore predisposes to many unwanted drug interactions

CYP3A4

characteristic of Mycobacterium tuberculosis growth that makes it hard to kill

slow

Ideal status of respiratory fluoroquinolones in the treatment of CAP

Reserve generally more effective than tetracyclines or macrolides for pneumonia, but should be reserved to minimize appearance of tolerance – use is discouraged in ambulatory patients with CAP unless: • comorbid conditions • recent antimicrobial use • high prevalence of high-level macrolide-resistant S. pneumoniae in the local community – fluoroquinolones continue to be given, often inappropriately, for CAP

Acronym used for nosocomial pneumonia; ie, that acquired in hospital where multiresistant strains of microbes are more prevalent and the leading cause of infection-related death in hospital

HAP

Orally administered 1st gen cephalosporin, this class has better gram-positive activity than 2nd gen

Cephalexin

Organ adversely affected to varying degrees by many abx drugs including macrolides, fluoroquinolones, azole antifungals and several anti-tuberculosis agents

Liver

Ergosterol synthesis inhibitor with activity against aspergillus, blastomycoses, and histoplasmosis along with other fungal infections, has a black box warning due to its negative inotropic effects that can precipitate/worsen heart failure

Itraconazole

Can occur in topoisomerases to render them insensitive to fluoroquinolones, a reason abx stewardship is so important for this class of drugs

Mutations

Among the safest abx, allergic reactions are the biggest problems

Penicillins

Orally-administered penicillin, an agent of choice for CAP and multiple other infections

Amoxicillin

Enzyme inhibited by linezolid, responsible for rather unusual adverse effects for and abx including serotonin syndrome

MAO - monoamine oxidase

Susceptible to treatment by newer agents posaconazole and isavuconazole but not to voriconazole

Mucormycosis

Has high affinity for ergosterol leading to pore formation in fungal cell membrane, standard treatment for many severe invasive fungal infections but multiple significant adverse effects

Amphotericin b

At least 4 ____ must pass with daily drug administration for most endocarditis treatment regimens

weeks

Initial indication was for its antiviral activity against influenza A (not B), no longer recommended but likely to still show up in textbooks; now used primarily to treat Parkinson disease

Amantadine

S. pneumoniae vaccine administered to newborns at 2, 4, 6 and 12-15 mo, and sometimes to those >age 65

Prevnar 13

Among the "biggest guns," stable against beta-lactamases and having a wide spectrum of gram-positive and gram-negative activity, abx stewardship dictates that it is kept in reserve for use against microbes cannot be killed with narrower spectrum abx (ie, microbes that are multi-drug resistant)

Imipenem

MRSA and metronidazole-resistant C. difficile infections are reasons to use this abx, but IV and orally, respectively

Vancomycin

Well known adverse effect of aminoglycosides, can be exacerbated by other drugs

Nephrotoxicity

Not a substitute for vaccination, this generally well-tolerated antiviral with activity against influenza A and B exerts its effects by blocking an ednonuclease that is required for the viral gene transcription

Baloxavir

Inhaled neuraminidase inhibitor that can hasten recovery from flu if administered within 48 h of symptom onset

Zanamivir

Lacking in mammalian cells but constructed from peptidoglycan in bacteria, the crosslinking component of its synthesis is blocked by beta-lactam abx making it essential for their efficacy

cell wall

Should not be consumed with tetracycline drugs because of precipitates that form in the GI tract and disrupt drug absorption

Milk

Common invasive fungal mold infection, especially in neutropenic patients where it can manifest as fever, chest pain, shortness of breath, etc. OR just fever with imaging evidence of pulmonary nodules? can cause a chronic slowly progressive pulmonary disease with pulmonary infiltrates and cavities

Aspergillus

Name given to bacterial pulmonary infections that develop secondary to viral infections or when there is an overgrowth of selected bacteria that are not susceptible to broad spectrum abx

Superinfection

AKA penicillinase, clavulanate, tazobactam, and sulbactam are among the agents added to abx therapies to inhibit this

beta lactamase

Refers to formulation of amphotericin B in which the drug is administered in 100 nm phospholipid vesicles in an effort to minimize its adverse effects

Liposomal

acronym that means the pneumonia developed after the pt required mechanical ventilation

VAP

Component of first drug cocktail used to treat active TB and the typical agent used prophylactically in those with latent TB

Isonazid

Target of multiple drugs with antimicrobial selectivity, also means a cell wall is not required for it to work

Protein synthesis

Macrolide with less epigastric pain than erythromycin, but does block cytochrome P450

Clarythromycin

Adding activity against these bacteria is what makes ampicillin and amoxicillin "broad spectrum" penicillins

gram-negative

This for a cultured bacterial pathogen to abx is determined either by a disk diffusion assay or by 1:2 dilutions of abx in a 96-well plate

susceptibility

Reason gram-negative cells are gram-negative and serves as a barrier to many abx

outer membrane

Responsible for the elimination of many abx that often do not undergo metabolism such as beta-lactam abx, for example, as well as some drugs that have undergone metabolism; insufficiency of this organ frequently necessitates changes in drug dosage

Kidney

A 2nd gen cephalosporin given parenterally and also orally as its "axetil" prodrug

Cefuroxime

Metabolized to a pyridine analog that disrupts

Flucythosine

Broad spectrum orally available class of drugs with activity against gram-neg bacteria; current agents now also target gram-pos bacteria

Fluoroquinolones

Category of abx that generally should not be administered at the same time as bactericidal drugs, but happens when doxycycline and beta-lactams are combined to treat pneumonia

Bacteriostatic

Macrolide that is a frequent substitution for penicillin can cause epigastric pain and is a "classic" inhibitor of CYP3A4 and p-glycoprotein meaning that it has many drug interactions

Erythromycin

Refers to micro-organism strains that are resistant to all abx that might otherwise be used against them, so totally reliant on immune system to clear from body

Pan-drug-resistant

3rd gen cephalosporin administered as a pro-drug that can be used for outpatient therapy of community acquired pneumonia

Cefpodoxime

Often does not require adjustment for ceftriaxone when there is kidney or liver failure because it undergoes elimination by both organs

dosage

Orally active and also administered parenterally, this bacterial protein synthesis inhibitor agent is orally active against most gram-pos pathogens including methicillin-resistant staphylococcus and vancomysin-resistant enterococcus

Linezolid

2nd gen cephalosporin, a cephamycin administered parenterally, not in notes but cephamycins tend to have better activity against anaerobes when compared to other cephalosporins

Cefotetan

Tetracyclines turn them gray/brown while developing

teeth

Member of the newer echinocandin class of antifungal agents with excellent activity against invasive yeast infections, it also has few adverse effects especially when compared to amphotericin B

Micafungin

Careless use of abx here has contibuted to the development of abx resistance

Agriculture

approaches 100% when aspergillus mold is the cause of endocarditis

Mortality

infection for which UpToDate recommends monotherapy with voriconazole as the initial therapy

Invasive aspergilliosis

Was a drug of choice for aspiration pneumonia due to its spectrum of activity that includes most anaerobic bacteria (eg abundant in oral cavity); frequent cause of C. difficile colitis on exam questions

Clindamycin

Active against aspergillus mold and fluconazole-resistant yeast, this ergosterol synthesis inhibitor has some unique adverse effects for the class including a propensity for causing flashes of light in many at lower doses and visual hallucinations at higher doses

Voriconazole

Yeast that is the most common fungal cause of endocarditis; initial therapy is liposomal amphotericin B +/- flucytosine or a high does of an echinocandin

candida

the only route by which fixed-charge drugs such as gentamicin and large abx such as the glycopeptide vancomycin can reach the bloodstream? but can be a convenient/quick route when patients are hospitalized

Parenteral

Parenteral 1st gen cephalosporin, this class has better gram-pos activity than 2nd gen

Cefazolin

Type of pneumonia seen more often in the very young, elderly, and - in its more severe forms - those who are immunocompromised

viral

Beta-lactam-containing abx divided into 5 generations

Cephalosporins

Component of 1st drug cocktail used to treat active TB, it is the only agent in the cocktail that does not have hepatic injury as a worrisome adverse effect

Ethambutol

A tetracycline useful in combination with a beta-lactam for CAP in those who cannot tolerate a macrolide, its low pH can cause local damage - esophageal ulceration

Doxycycline

Refers to a large group of commensal gram-pos streptococci that are alpha-hemolytic, producing a green discoloration on blood agar plates? these critters can cause endocarditis that responds to IV ampicillin of ceftriaxone over 4 weeks unless/until there is abx resistance

viridans

Arguably the primary target of 3rd and 4th gen fluoroquinolones that expands their coverage to include gram-pos bacteria (makes them "respiratory" fluoroquinolones)? this enzyme is crucial during bacterial cell division for separating their replicated circular DNA (ie newly replicated rings are cross-linked)

Topoisomerase IV

Penicillinase-resistant penicillin

Nafcillin

Used in 1st line tx cocktail for TB, exact mechanism of action is unknown? and is hepatotoxic

Pyrazinamide

Vaccine against a broader range of S. pneumoniae serotype, but does not elicit a satisfactory immune response in those younger than age 2 yrs? Recommended for those over 65 and younger people who smoke

Pneumovax 23

Among the 3rd gen abx administered orally to treat community acquired pneumonia, also is among the cephalosporins that increases INR

Cefditoren

At least 6 of these are required to pass with regular drug administration for successful treatment of TB, contributes to adherence challenges

6 months

A 4th gen "respiratory" fluoroquinolone

Moxifloxacin

A pleuromutilin with that unique mechanism of action, its only indication is CAP in patients with normal lung when other drugs are not effective

Lefamulin

Neuraminidase inhibitor effective against influenza A and B, it can reduce the duration of the flu by 1-2 days if administered within 48 h of the onset of influenza symptoms and be used prophylactically by those exposed to people with the flu

Oseltamivir

Regularly issues reports on the biggest abx resistance threats and guidelines for abx stewardship

CDC

Generation of cephalosporins that is especially useful in CAP bc of its wide spectrum against gram-pos and gram-neg bacteria and stability in the presence of beta-lactamases

Third

Component of mycobacterium tuberculosis cell wall that contributes to their resistance to disinfectants, detergents, common abx, dyes, stains, osmotic lysis, and lethal oxidation? Queue classic Monty Python line from "Frenchman" at top of the castle

Wax

Wolff cardiopulm infection - crossword Flashcards

(108 cards)