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112 Cards in this Set
- Front
- Back
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Acute onset of chill, cough w/ rusty sputum, lobar consolidation, g+ lance diplococci
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Pneumococcal pneumonia
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What are signs of bad outcome?
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bacteremia, hematogenous spread (meningitis), more than 1 lobe, type 3 serotype, very old/young
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Walking pneumonia
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Mycoplasma pneumonia
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Pneumonia that spreads by inhalation of infected aerosol
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Mycoplasma pneumonia
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No productive cough, mild difference in leukocytes, bullous myringitis, bronchopneumonia
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Mycoplasma pneumonia
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Contaminated in water supply/air conditioning
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Legionella sp.
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Recurrent chills, diarrhea, relative bradycardia for deg. of fever, silver/DFA stain
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Legionella sp.
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COPD, alcoholics. Looks like acute bronchitis/pleuratis w/ gram- cocobacilli
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Hemophilis influenzae
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Abrupt onset and bulging fissure on CXR (lobar pnuemonia)
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Klesiella pneumoniae
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Often necrotizing and rare in CAP w/ high mortality
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gram - pneumonia
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Sick eldery recovering from recent flu w/ cavitary lesions/destruction + pleural complications
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Staph aureus
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Alcoholic with four rotting teeth carried to the ER with impaired consciousness
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Anaerobic pulmonary infections (fusobacterium, bacteroides, peptostreptococcus)
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In CXR of an alcoholic with rotting teeth, you see lung abscess, necrotizing pneumonia and empyema
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Anaerobic pneumonia
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SW USA, northern border of mexico, valley area of California; soil as arthrospore so dangerous to construction workers
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Cocciodiomyocosis
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A Filipino construction worker in California positive then negative skin test for Coccio along w/ + IgM/IgG
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Possible dissemination, w/ IgG high titer = high chance of dissemination
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A guy travelled to a cave in Mississippi faced an epic battle with bats comes down w/ fever
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Histoplasmosis
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A girl travelled to the Great lakes has come down with abrupt fever w/ productive cough. Culture shows broad based budding yeasts
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Blastomycosis
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Faced with aspergillus, cough, dyspnea, fever and chills
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Hypersensitivity peumonitis
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w/ long standing asthma worsening w/ eosinophilia, + skin test for aspergillus
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allergic bronchopulmonary Aspergillosis (ABPA)
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colonizing pre-existing cavity from TB etc.
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Aspergilloa (fungus ball)
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In an HIV + pt w/ aspergillus infection
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invasive aspergillosis
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A popular protozoan in HIV pts
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Pneumocystis carinii
(Pneumocystis jirovecii) |
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Alpha receptor
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vasopressor effect in the upper airway improving decongestion
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beta1 receptor
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myocardial conductivity thus increasing HR/contractile F
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beta2 receptor
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relaxation of bronchial smooth muscle, inhibition of inflammatory mediators
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epinephrine
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beta2,1 and alpha
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ephedrine
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beta2,1 and alpha
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isoproterenol
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beta2 and 1
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What happens when beta1 and alpha used together?
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for pts w/ CAD or HTN, can cause myocardial stress and MI
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MOA of beta2 receptors
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increased adenyl cyclase > increased CAMP > antagonism of bronchoconstriction
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short acting beta2 agonists
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albuterol, levalbuterol, pirbuterol
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onset and duration of short acting beta2?
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onset for 3-5 min and last for 4-6 hours
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common adrx of short act. beta2?
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tachycardia, tremor, hypokalemia
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dosage of levalbuterol compared to albuterol?
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at half mg dose to provide bronchodilation that albuterol produces
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what are long acting beta2 agonists?
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Salmeterol, Formoterol, Arformotrol, Albuterol (Volmax), SR (Vospire) and Indacaterol
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Usual onset and duration of long acting beta2?
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onset from 5-30 min and last for 12 except for the new drug (Indacaterol for 24 hrs)
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Salmeterol
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long acting beta2, partial agonist, tachycardia, tremor, hypokalemia
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Formoterol
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long acting beta2, full agonist, rapid onset (5min), prolonged QTc
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codons 16 and 27
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polymorphisms that lead to desensitization of beta2 receptors
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Salmeterol alone for persistent asthma?
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NO, worse outcome used alone (only used as adjunct to med dose of corticosteroids)
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Ipratropium
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Anticholinergic; reduce vagal tone of the airway and dry pulmonary secretions
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Atrovent
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branch name for Iprotropium
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Pts w/ soy lecithin or peanut allergies?
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Iprotropium is NO GO
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Tiotropium
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long acting anticholinergic; blocks M1-M3 for up to 24 hrs >> dysphagia
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montelukast, zafirlukast
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antileukotriene agents; comp. inhibit cys LT1 receptor
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Zileuton
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5-Lipoxegenase inhibitor
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montelukast
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no specific adverse effects
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zafirlukast
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reversible/irreversible hepatitis
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zileuton
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elevated LFTs (liver function tests) and reversible hepatitis
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how do corticosteroids work?
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inhibit phospholipase-A2 and decrease prod. of prostaglandins/leukotrienes + upregulate anti-inflammatory genes
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Beclomethasone
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inhaled corticosteroid
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Budesonide
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inhaled corticosteroid, combo product, high doses > adrenal suppression, osteoporosis, skin thining
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Flunisolide
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inhaled corticosteroid
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Fluticasone
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inhaled corticosteriod
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Fluticasone
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inhaled cortico/low-med doses > decreases growth
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Mometasone
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inhaled cortico/velocity in kids (transient)
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Triamcinolone
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inhaled cortico
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Prednisone
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activated to Prednisolone in vivo; tablet cortico
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Prednisolone
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tablet cortico/hypertension, peptic ulcer, immune suppression, Cushing's, growth suppression, cataracts
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MOA of Methylxanthines
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inhibition of phosphodiesterase > increased cAMP > SM relaxed > mild anti-inflammatory
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Theophylline
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methylxanthine: tachycardia, nausea, vomiting, supraventricular tachycardia (SVT), CNA stimulation, hyperglycema/hypokalemia >> narrow therapeutic window!
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Aminophylline
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methylxanthine: at usual dose > insomnia, GERD, hyperactivity in kids
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Cimentidine vs. Theophylline
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dec metabolism, use famotidine/ranitidine
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Macrolides vs. Theophylline
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dec metabolism, use azithromycin
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Quinolones vs. Theophylline
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dec metabolism, use other antibiotics
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Rifampin vs. Theophylline
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inc metabolism, thus increase dosage
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Smoking vs. Theophylline
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inc metabolism, so stop smokin!
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Cromolyn
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mast cell stabilizer; cough, irritation, bad taste
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Omalizumab
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inhibit binding to IgE/monoclonal antibody >> possible malignant neoplasm
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Alpha-1 proteinase inhibitor
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increased LFT, headache, somnolence
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Roflumilast
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inhibit phosphodiesterase-4 > accu. of cAMP > sup of cytokine release, lung infiltration by neutrophils/leukocytes
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SE of Roflumilast
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diarrhea, weight decrease, insomnia, anxiety, depression
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Combivent
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ipratropium + albuterol
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advair
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salmeterol + fluticasone
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symbicort
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formoterol + budesonide
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dulera
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mometasone + formoterol
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pro-drug activated by mycobacterium cells and inhibits mycolic acids of the walls
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Isoniazid (INH)
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metabolized by liver N-acetyltransferase
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Isoniazid
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slow acetylators and fast acetylators exist, so need to watch out for adverse rxn for the slow
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Isoniazid
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SE of INH
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hepatitis is the most common, asymptomatic minor rises in liver enzymes >> symptoms appear lose the drugs
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peripheral neuropathy at high level due to pyridoxine deficiency
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B6 deficiency b/c excretion of pyridoxine increases so most often INH + pyridoxine given together
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DNA-dep RNA polymerase
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Rifampin
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secretions of orange/red as urine, sweat, tears
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Rifampin
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hepatitis, rises in bilirubin/alkaline phosphatase in hepatotoxcity
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Rifampin
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CYP P450 CA4 inducer
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Rifampin, so HIV drugs or oral contraceptives are at lower active levels b/c of Rifampin
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Not known MOA, but requires activation of yrazinamidase into pyrazinoin acid
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Pyrazinamide (PZA)
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Nausea and vomiting along with dose-dependent hepatotoxicity + teratogenic
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Pyrazinamide (PZA)
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elevation of serum uric acid may exacerbate underlying symptoms of gout if present in pts
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Pyrazinamide (PZA)
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inhibitor of arabinosyl transferases
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Ethambutol
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neuropathies including retrobullar optic neuritis (bilateral blurry vision with impairment of red-green color vision)
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Ethambutol
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aminoglycoside that initially made for TB tx
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Streptomycin
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Renal, auditory and especially vestibular toxicity
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Streptomycin
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Rifabutin
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Rifampin derivative w/ less hepatotoxicity
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Rifapentene
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Rifampin derivative that's for weekly regimen
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levofloxacin and moxifloxacin
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fluoroquinolones for MDR-TB
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inhibition of DNA gyrase
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fluoroquinolones
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CNS toxicity and QT prolongation as well as tendon ruptures
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fluoroquinolones
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50S protein synthesis inhibitor
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Linezolid
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thrombocytopenia and bone marrow suppression dep on its dose/duration
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Linezolid
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Kanamycin and Amikacin
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aminoglycosides
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Ototoxicity
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Kanamycin
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peptide protein synthesis inhibitor
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capreomycin
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blocks mycolic acids production
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ethionamide
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gastrointestinal disturbances frequent that leads to non-adherence
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ethionamide
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D-alanine structural analog that inhibits alanine racemase
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cycloserine
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tremors, convulsions, peripheral neuropathy (possible pyridoxine supplement preventing these effects)
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cycloserine
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inhibits folate synthesis, GI upset/intolerance and hypersensitivity
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Aminosalicylic acid (PAS)
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GI upset in treated TB pts could be presenting symptoms of?
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hepatotoxicity
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AST increased 5x or 3x w/ associated symptoms, then tx discontinued. then what?
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reintroduce medications one by one at one week intervals
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RIPE for 2 months during "initial phase"
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Rimfanpin, Isoniazide, Pyrazinamide, Ethambutol
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Two drugs for "continuation phase"
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Rinfampin and Isoniazide
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When do we go ahead and go onto the "continuation phase" for 7 months?
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sputum culture after 2 months of tx still +, no PZA for the initial phase, once weekly rifampin/iso after two weeks + sputum cultuer
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