Bacterial Infections Of The Lung

Front 1

What is pneumonia? Symptoms? The most important factor in successful treatment?

Back 1

Front 2

Wat are the four major types of pneumonia?

When would you most likely see each?

Back 2

Front 3

Define pneumonia. What are some common symptoms? Are drug/sputum cultures important? What is THE MOST important factor in successful treatment?

Back 3

Front 4

Most common causes of pneumonia by age:

0-6 weeks

6 weeks - 18 years old

18years old - 40 years old

40-65 years old

>65 years old

Back 4

Front 5

Most frequent cause of each:

Nosocomial infection

Diabetics or alcoholics

Can anaerobes be gram + or gram -? Part of normal what?

What are the viruses in ages 6 wks-18 years?

Back 5

Front 6

Look over Legionaire's disease.

Back 6

Front 7

Does legionella cause pneumonia?

In what sex and ages is it more common?

Is smoking a risk factor?

What about immunocompromised patients?

What two ABs used most commonly?

Good alternatives?

What about for severely ill patients? Drug interactions?

Back 7

Front 8

Look over

Back 8

Look over

Front 9

What is the first generation macrolide?

What are the 2nd generation macrolides?

3rd generation?

Draw the decision treat for treating CAP.

Back 9

Front 10

Most common used drugs:

Macrolides

Mechanism?

Back 10

Erythromycin (1st gen)

Azithromycin (3rd gen)

50s ribosomal inhibitor blocking translocation

Front 11

Most commonly used drugs:

Tetracyclines

Mechanism?

Back 11

Doxycycline

30s ribosomal inhibitor blocking protein synthesis

Front 12

Most commonly used drugs:

Floxacins

Mechanism?

Back 12

Levofloxacin

DNA gyrase inhibitor preventing DNA replication

Front 13

Most commonly used drugs:

Penicillins

Mechanism?

Back 13

Amoxicillin + Clavulonic acid

Piperacillin + Tazobactam

Block cell wall cross-linking

Front 14

Most commonly used drugs:

Carbonpenem

Mechanism?

Back 14

Meropenem

Blocks cell wall cross-linking

Front 15

Most commonly used drugs:

Cephalosporins (CEFs or CEPHs)

Mechanism?

Back 15

Cefazolin (1st gen)

Cefurozime (2nd gen)

Ceftriaxone (3rd gen)

Ceftazidime or Cefepime (both 3rd gen with antipseudomonal activity)

Inhibition of cell wall cross-linking

Front 16

Most commonly used drugs:

Aminoglycosides

Mechanism?

Back 16

Gentamicin

30s ribosomal inhibitor

Front 17

MOR:

Macrolides

Back 17

Ribosomal methylation & mutation of 23S rRNA active efflux

Front 18

MOR:

Cyclines

Back 18

Decreased entry into and increased efflux from target insensitivity

Front 19

MOR:

Fluoroquinolones

Floxacins

Back 19

Mutation of DNA gyrase

Active efflux

Front 20

MOR:

Penicillins

Cillins

Back 20

Drug inactivation (B-lactamase)

Altered PBPs (target insensitivity)

Front 21

MOR:

Cephalosporins

CEFs or CEPHs

Back 21

Decreased permeability of gram -ve outer membrane (altered porins)

Active efflux

Front 22

MOR:

Aminoglycosides

Back 22

Drug inactivation (amino glycoside modifying enzyme)

Decreased permeability of gram -ve outer membrane

Active efflux

Ribosomal methylation

Front 23

Look over

Back 23

Look over

Front 24

Nosocomial pneumonia:

Is an etiologic agent sometimes established?

With loss of oropharyngeal fibronectin there is a shift to include ______________________. When is gram + more common?

What is the prevalent pathogen?

Back 24

Front 25

What are the indicated drugs for nosocomial pneumonia? Alternative? What do all except vancomycin have activity against? What is vancomycin reserved for?

Back 25

Gram negative

Treatment of MRSA (IV)

Front 26

What two things causes aspiration pneumonia? When does it occur? What helps to diminish incidence? What are half of all hospitalized patients (bacteria)? Medication indicated and alternative?

Back 26

Front 27

Mechanism of action and resistance:

Clindamycin

Back 27

MOA = 50s ribosomal inhibitor blocking translocation

Resistance = Methylation of binding site, enzymatic inactivation

Front 28

Mechanism of action and resistance:

Vancomycin

Back 28

MOA = Binds D-alanyl-D-alanine terminus of the peptide precursor units, inhibiting peptidoglycan polymerase and transpeptidation reactions

Resistance = replacement of D-ala by D- lactate

Front 29

Oral dosing is simplest and most acceptable route of drug delivery for less severe infections. What is it reserved for? When could absorption be compromised? Look over slide.

Back 29

Front 30

What three PK-PD parameters quantify the relationship? What is it characterized as?

Back 30

Front 31

What does concentration dependent mean?

What does time dependent mean?

What are pharmacologic sanctuaries?

Back 31

Concentration dependent = increase in AB concentration leads to a more rapid rate of bacterial death. (AUC/MIC, Cmax/MIC)

Time dependent = reduction of bacterial density is proportional to the time that concentrations exceed the MIC. (T > MIC)

Microbes in some tissues benefit. Poor penetration, prevailing pH, or local factors leading to increased drug inactivation protect these areas.

Front 32

Which drug classes have time above MIC as the predictive parameter?

Back 32

Penicillins, Cephalosporins, Carbapenems

(Time dependent = dosed more frequently and usually to keep MIC 30-50% of dose interval, sometimes prolonged or constant infusion).

Front 33

Which drug classes have 24 hour AUC/MIC as the predictive parameter?

Back 33

Aminoglycosides, Fluoroquinolones, Tetracyclines, Vancomycine, Macrolides, Clindamycin

(Concentration dep = once daily dosing = given at large concentrations over long intervals)

Front 34

Which drugs have Peak/MIC as the predictive parameter?

Back 34

Aminoglycosides, Fluoroquinolones

Front 35

Which drugs eliminated by the kidney only? Should you reduce the dose in the case of impair renal function?

Back 35

Front 36

For which drugs do you not have to worry about dose adjustment for renal impairment? How are they metabolized?

Back 36

Front 37

Major toxicity:

Gentamicin

Back 37

Nephrotoxicity

Ototoxicity

Neuromuscular paralysis

Front 38

Major toxicity:

Vancomycin

Back 38

Nephrotoxicity

Ototoxicity

Red Man's syndrome

Front 39

Major toxicity:

Erythromycin

Back 39

CYP3A4/Pgp inhibitor

Cholestatic jaundice

QT prolongation

Front 40

Major toxicity:

Imipenem

Back 40

Partial cross-reacivity with pen/ceph hypersensitivity

Seizures

Front 41

Major toxicity:

Meropenem

Back 41

Partial cross-reactivity with pen/ceph hypersensitivity

Decreased coagulation

Front 42

Major toxicity:

Levofloxacin

Back 42

Tendon rupture in adults

Cartilage damage in young children

Front 43

Major toxicity:

Doxycycline

Back 43

GI distress

Teeth discolored

Photosensitivity

Decreased bone growth

Front 44

Major toxicity:

Linezolid

Back 44

Bone marrow suppression

Non-specific MAO inhibitor

Front 45

What will predispose a patient to a similar allergy with cephalosporin or a carbapenem?

Back 45

Front 46

Which drugs are known teratogens? Which should you caution w/ breast feeding?

Amoxicillin, Ampicillin, Azithromycin, Cefazolin, Cefepime, Ceftazidime, Ceftriaxone, Ciprofloxacin, Clindamycin, Imipenem, Meropenem, Vancomycin, Clarithromycin, Doxycycline, Erythromycin, Gentamicin, Levofloxacin, Linezolid, Metronidazole, Piperacillin, Trimethoprim

Back 46

Front 47

What do you combine with each? Why?

Amoxicillin, Piperacillin, Ampicillin

Back 47

Front 48

What do you combine with Imipenem? Why?

Back 48

Front 49

Why is daptomycin not used for pulmonary infections?

Back 49

Front 50

Bronchitis:

Type of episodes in younger patients? Older?

Which bacteria are responsible? In smokers?

Back 50

Front 51

Indicated drugs for bronchitis? With resistance?

Back 51

Front 52

How do lung abcesses respond to medical management? When do they resolve? What are the anaerobes responsible?

Back 52

Front 53

What drugs are appropriate? Why should metronidazole not be used alone?

Back 53