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57 Cards in this Set
- Front
- Back
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Bacterial pathogens for CAP.
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- S. pneumonia
- H. influenza - atypical pneumonia |
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Which antibiotic recommendation for CAP?
- previously healthy, no use of antibiotics within the past 3 months |
- macrolide
- doxycyclin |
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Which antibiotic recommendation for CAP?
- presence of comorbidities - immunosuppressed - antibiotic use within the previous 3 months |
- respiratory fluoroquinolone
- beta-lactam + macrolide |
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Which antibiotic recommendation for CAP?
- in regions with high rate of infection with macrolide resistance (eg. Dayton) |
- respiratory fluoroquinolone
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Is this considered severe CAP?
- multilobar inifltrate - confusion/disorientation - respiratory rate > 30 |
Yes.
3 out of 9 minor criteria |
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Is this considered severe CAP?
- invasive mechanical ventilation - septic shock with the need for vasopressors |
Yes.
major criteria |
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What is the antiobiotic recommendation for CAP?
- inpatient - non-ICU |
- respiratory fluoroquinolone
- beta-lactam + macrolide |
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What is the antiobiotic recommendation for CAP?
- inpatient - ICU |
- beta-lactam + azithromycin or respiratory fluoroquinolone
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What is the antiobiotic recommendation for CAP?
- when pseudomonas is suspected |
- beta-lactam + ciprofloxacin or levofloxacin
- beta-lactam + aminoglycoside + azithromycin - beta-lactam + aminoglycoside + fluoroquinolone |
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What is the antiobiotic recommendation for CAP?
- when CA-MRSA is suspected |
add vancomycin or linezolid
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Bacteria associated with HAP.
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- GNB: late onset
- S. aureus: early and late onset - S. pneumonia (penicillin and multidrug resistant): early onset - H. influenza: early onset |
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What is the next step when you suspect VAP/HAP?
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Assess risk factors for MDR pathogens
- if yes, use broad spectrum antibiotic - if no, use limited spectrum antibiotic |
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What is the antibiotic recommendation for this HAP/VAP?
- early onset - any disease severity - no risk for MDR |
- ceftriaxone (cephalosporin)
- 3rd or 4th generation fluoroquinolone - ampicillin/sulbactam - ertapenem (carbapenem) |
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What is the antibiotic recommendation for this HAP/VAP?
- late onset - any disease severity - risk for MDR |
- cephalosporin
- carbapenem - beta-lactam,beta-lactamase inhibitor (pipracillin-tazobacatam) + fluoroquinolone - aminoglycoside + linezolid or vancomycin |
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Risk factors for MDR pathogens.
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- previous antibiotic therapy
- current hospitalization or ICU stay - high antibiotic resistance in the community - immunosuppressive disease |
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Pathogens of HCAP.
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- MRSA
- pseudomonas aeruginosa - acinetobacter species - klebsiella (GNR with beta-lactamase) |
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Mechanism of amphotericin B.
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complexes to ergosterol disrupting plasma membrane of the fungus
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Distribution of amphotericin B in the body.
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- liver, lungs, kidneys
- less so to pleural, peritoneal, synovial fluid * free drug highly protein bound |
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Uses of amphotericin B.
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life-threatening, progressive fungal infections.
- aspergillosis - cryptococcus - histoplasmosis |
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What is this anti-fungal drug?
- need test dose 1mg - infusion related problems |
amphotericin B.
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Aderse effect of amphotericin B.
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- nephrotoxicity
- hypokalemia - hypomagnesaemia - anemia - renal tubular acidosis |
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List 4 azoles.
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- fluconazole
- itraconazole - voriconazole - posaconazole |
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Which azole is this?
- required dose reduction in renal failure - does not treat aspergillus |
- fluconazole
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Which azole is this?
- need to take with high acid food (ie classic coke) - side effect: rash, headache |
- itraconazole
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Which azole is this?
- side effect: steven-johnson syndrome, hair loss, electrolyte disturbance, CV effects, visual disturbance - pregnancy category D |
- voriconazole
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Which azole is this?
- does not treat sporotrhix and penicillium - side effect: fever, abdominal pain, neutropenia, elevated liver function test |
- posaconazole
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What type drug are these?
- anidulofungin - caspofungin - micafungin |
echinocandins
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Mechanism of echinocandins.
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- cell wall (1,3-beta-glucan)inhibitor
- against aspergillus and candida |
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Treatment choice for candida.
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anidulofungin (echinocandins)
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Side effects of anidulofungin.
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- hypotension
- vomiting - headache - constipation - nausea - fever - seizure - hypokalemia |
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What is this drug?
- treatment choice for candida - side effect: hypotension, headache, constipation, fever... - no drug interaction |
anidulofungin (echinocandins)
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Side effects of caspofungin.
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- facial swelling
- increased liver function test - thrombophlebitis |
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Drug interactions of caspofungin.
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- efavirenz, nelfinavir, carbamazepine, dexamethasone, phenytoin, rifampin
- cyclosporin (hepatotoxicity) - reduces serolimus, tacrolimus |
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Drug interactions of micafungin.
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- increases nifedipine, sirolimus
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Side effects of micafungin.
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- acute renal failure
- anaphylaxis - diarrhea, leukopenoia |
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Which echinocandin?
- should not be used for UTI, cryptococcus, zygomyces. |
caspofungin
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Which echinocandin?
- should not be used for cryptococcus, zygomyces. |
- caspofungin
- micafungin |
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First line drugs for TB.
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- INH (isoniazid)
- RIF(rifampin) - ETH (ethanbutol) - PZA (pyrazinamide) - streptomycin |
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Mechanism of INH.
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- disrupts cell wall formaiton by inhibition of mycolic acid.
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INH is active againist ___ (intra- or extra-cellular) oraginisms.
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both
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Rate of metabolism of INH depends on ____.
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level of acetylators: high level cause fast metabolism of INH.
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Side effects of INH.
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- allergic reactions: fever, rash, drug induced lupus.
- hepatoxicity: can be fatal - increase transaminase - peripheral neuropathy: B6 deficiency - pregnancy category C. |
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Mechanism of RIF.
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inhibit RNA synthesis by binding to DNA-dependent RNA polymerase
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What is this anti-TB drug?
- bactericidal - penetrates into phagocytes - penetrates into abscesses - hepatic metabolism - treats TB and atypical mycobacteria |
RIF
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Adverse effects of RIF.
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- orange discoloration of body fluids
- hepatotoxicity - multiple drug interaction: induce P450 - GI distress - pregnancy category C |
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Mechanism of ETH.
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ethanbutol
- disrupts enzymes responsible for cell wall formation - enhances lipophilic drug entry (RIF) |
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What is this anti-TB drug?
- both hepatic and renal excretion - pass BBB with inflammation - good against both typital and atypical mycobacterium. - adverse effect: optic neuritis (loss of visual acuity, red-green color blindness), pregnancy category B. |
ETH
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What is this anti-TB drug?
- unknown mechanism - cross BBB with inflammation - renal excretion - adverse effect: hepatotoxicity, GI distress, hyperuricemia, pregnancy category C. |
PZA
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What is this anti-TB drug?
- IM/IV - penetrates cell poorly - best against extracellular organism - renal excretion - treats TB, plague, tularemia |
streptomycin (aminoglycoside)
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Mechanism of streptomycin.
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inhibits protein synthesis at the 30s subunit
- treats TB, plague, tularemia |
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Adverse effects of streptomycin.
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- nephrotoxicity
- ototoxicity - neuromuscular blockade - pregnancy category D. |
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What is this antiviral drug?
- inhibits DNA synthesis (irreversibly binds to DNA complex terminating replication) - PO and IV - renal excretion - treats HSV and HVZ - side effects: GI distress, renal insufficiency, neurologic toxicity(delirium, tremors), pregnancy category C. |
acyclovir
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Mechanism of acyclovir.
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- inhibits DNA synthesis: irreversibly binds to DNA complex terminating replication.
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What is this antiviral drug?
- inhibits various enzymes in RNA synthesis - inhaled - renal excretion - treats RSV, measles, hentavirus, SARS. - side effects: bronchial/conjuctival irritation, bronchospasm - depression and anemia if taken IV or PO - pregnancy category X. |
Ribavirin
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What is this antiviral drug?
- PO only - inhibit viral mRNA synthesis, disrupting RNA synthesis - renal excretion - treats and prophylax influenza A - side effects: GI distress, CNS(nervousness, tremors), pregnancy category C. |
- amantadine
- rimantidine |
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What is this antiviral drug?
- inhaled - neuramidase inhibitor - high local concentration - no systemic absorption - treats and prophylax influenza A and B - adverse effect: bronchospasm, pregnancy category B |
zanamivir
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What is this antiviral drug?
- PO - neuramidase inhibitor - good oral absorption - activated in liver - treats and prophylax influenza A and B - against H1N5 bird flu - side effect: GI distress, pregnancy category C. |
oseltamivir
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