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58 Cards in this Set
- Front
- Back
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Treatment for an output patient with community acquired pneumonia, with no complications:
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Macrolides and Doxycycline are good choices
If you're in a region with macrolide resistant Strep, consider using Fluoroquinolone or a beta lactam plus macrolide |
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Treatment of an outpatient with community acquired pneumonia who has comorbidities:
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Respiratory fluoroquinolone or (beta lactam plus macrolide)
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Treatment of patients with community acquired pneumonia who find themselves as in-patients in the hospital (but not ICU).
(Hint: It's the same Rx as outpatients with CAP w/ comorbidities) |
Fluoroquinolone or (beta lactam plus macrolide)
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Treatment of patients with community acquired pneumonia who find themselves in the ICU
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Beta lactam plus one of the following:
Azithromycin or fluoroquinolone If patients are allergic to penicillin, you can use aztreonam instead of beta lactam |
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Name 4 beta-lactam antibiotics that are antipseudomonal:
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Pipercillin-tazobactam
Cefepime Imipenem Meropenem |
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Treatment for a patient with community acquired pseudomonas
(This one is kinda tough) |
Antipseudomonal beta-lactam (see other flashcard in this set) plus either cipro or levofloxacin OR
Antipseudomonal beta-lactam AND (aminoglycoside AND azithromycin) OR Antipseudomonal beta-lactam AND aminoglycoside AND Antipneumococcal fluoroquinolone |
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If you are worried about community acquired MRSA (CA-MRSA), what would you add to your antibiotic regimen (2 drugs)?
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Either vancomycin or linezolid
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What percentage of hospital acquired pneumonias are ventilator related (VAP) ?
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80-90%
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When it comes to hospital acquired pneumonias, if a patient has either strep pneumonia or H. Influnzae, would be more likely that the patient caught early on or later in their hospital stay?
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These are early hospital infections
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When it comes to hospital acquired pneumonias, if a patient has either a Gram-negative pneumonia like Pseudomonas, would it be more likely that the patient caught the infection early or later in their hospital stay?
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More likely to be caught later on.
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Name five risk factors for a patient to catch multidrug resistant ventilation acquired pneumonias:
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Previous antimicrobial therapy
Current hospitalization or ICU stay High frequency of antibiotic resistance in the community or in the specific hospital unit Presence of risk factors for health care associated pneumonias Immunosuppressive disease or therapy |
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List four antibiotics that you could use to empirically treat a patient with early-onset hospital acquired pneumonia:
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Use one of the following:
Cerftriazone Third or fourth generation fluoroquinolone Ampicillin/sulbactam Ertapenem |
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Are multidrug resistant pathogens more likely to be picked up early on, or later on in a hospital stay?
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Later on
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Treatment for hospital acquired multi-drug resistant pathogens:
(This one is tough!) |
In general, need 2 drugs for pseudomonas and 1 drug for MRSA.
For MRSA, use Linezolid or vancomycin For Pseudomonas, use one (or more) of the following: Antipseudomonal cephalosporin like cefepime or ceftazidime Antipseudomonal carbapenem (imipenem or meropenem) Beta-lactam + Beta-lactamase inhibitor AND antipseudomonal fluoroquinolone Aminoglycoside |
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This type of pneumonia refers to penumonia that occurs prior to hospitalization, and usually occurs in the context of immunosuppression, or recent hospitalization, or living in a nursing facility, or being on dialysis:
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Health Care Associated Pneumonia (HCAP)
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List four bacteria that are associated with health-care associated pneumonia (HCAP)
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MRSA
Pseudomonas Acinetobacter Extended sprectrum beta-lactamase producing gram negatives (Klebsiella) |
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Treatment of health care acquired pneumonia:
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Same as for hospital acquired multi-drug resistant pathogens! (Here's the answers for review):
In general, need 2 drugs for Pseudomonas and 1 drug for MRSA. For MRSA, use Linezolid or vancomycin For Pseudomonas, use one (or more) of the following: Antipseudomonal cephalosporin like cefepime or ceftazidime Antipseudomonal carbapenem (imipenem or meropenem) Beta-lactam + Beta-lactamase inhibitor AND antipseudomonal fluoroquinolone Aminoglycoside |
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How is the CSF penetration with Amphotericin-B?
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Poor
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(T/F) Before administering a full dosage of amphotericin-b you should try a test-dosage of 1 mg to see if there will be any serious problems
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True
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This medicine is key for treating life-threatening progressive fungal infections like aspergillosis, cryptococcus, and histoplasmosis
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Amphotericin-B
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This version of amphotericin-B is more expensive, but it comes with fewer side effects
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Lipid complex amphotericin-B
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(T/F) All azoles are readily available and widely used.
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True
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Many azoles are metabolized by this enzyme
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P450
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With which azole must you adjust the dosage if the patient has renal problems?
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Fluconazole
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Which azole can you NOT use to treat aspergillus?
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Fluconazole
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Which azole is the weakest at treating Histoplasma
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Fluconazole
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This azole is associated with alterations in visual perception (blurring, photophobia).
Also, what should you do to prevent changes in visual perception? |
Voriconazole
Patients who are on the med for longer than a month should have their visual acuity checked |
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Which class of anti-fungals end with the suffix, -fungin ?
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Echinocandins
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What is the mechanism of action for ecinocandins?
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They inhibit the fungal cell wall enzyme 1,3-Beta-D-glucan synthase
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Ecinocandins are especially good at treating which two fungi?
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Candida, and Aspergillus
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Are there many or few drug interactions when using anidulofungin?
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Actually, there are no drug interactions
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This azole is a category D medicine
D for Don't Use in Pregnancy unless you want to get sued |
Voriconazole
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This Echinocandin has a lot of vague side effects and is known to increase the drug levels of nifedipine and sirolimus
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Micafungin
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(T/F) Candida is often a true cause of pulmonary infection, especially in babies
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False - Often it's picked up from the mouth
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List the first line drugs for TB (5)
I would call this a k-n-o-w |
Isoniazid
Rifampin Ethambutol Pyrazinamide Streptomycin |
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This drug is the most active of all TB drugs, although resistance is common over time
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Isoniazid (INH)
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How does Isoniazid work?
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Disrupts cell wall formation by inhibition of mycolic acids
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What determines whether a person is a fast metabolizer (acetylator) or slow metabolizer of INH? Which has higher levels of INH in their body, fast acetylators or slow acetylators?
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Determined by genetics
Slow acetylators have higher levels of the drug in their body |
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The side effects of this anti-TB drug include allergic reactions, hepatotoxicity, and peripheral neuropathy.
Also, it's pregnancy category C |
INH
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What is the mechanism of action for Rifampin?
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Inhibits RNA synthesis by binding to DNA-dependent RNA polymerase
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Which anti-TB drug turns pee orange?
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Rifampin
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If you give rifampin and INH at the same time, what are you putting the patient at risk for?
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Liver toxicity
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This anti-TB drug is associated with optic neuritis
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Ethambutol (ETH)
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We don't know why this anti-TB drug works, but it does. It crosses the blood-brain barrier with inflammation and may provoke gout?
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Pyrazinamide
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This anti-TB drug is an aminoglycoside. It works best against extra-cellular organisms. It's not the most active drug so you hardly ever use it alone.
It's also good for plague and tularemia… although I suppose if a patient comes down with either one they're not doing so well |
Streptomycin
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Which anti-TB drug is NOT associated with hepatotoxicity?
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Ethambutol
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This anti-viral drug comes in an inhaler form, and works by inhibiting various critical viral enzymes like viral RNA dependent RNA polymerase. Side effects include bronchial or conjunctival irritation, bronchospasm, headache, and anorexia
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Ribavirin
Note that it also comes in IV and oral forms. The side effects for those forms include hemolytic anemia and depression |
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Which viruses is ribavirin effective against?
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RSV mainly
Also measles, hantavirus, and SARS |
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This antiviral drug is a pregnancy category X which means don't use unless you want to get eXtra-sued
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Ribavirin
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These two antiviral drugs basically do the same thing. They both inhibit viral mRNA synthesis
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Amantadine and Rimantadine
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What is the mechanism of delivery of Rimantadine and Amantadine?
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Oral only
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(T/F) Amantadine and Rimantadine work mostly on influenza A, and to a lesser extent, on influenza B.
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False - Only influenza A
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What are the CNS side effects you see with Amantadine and Rimantadine?
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Nervousness, concentration problems, and tremors
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What is the difference between the mechanism of delivery with Zanamivir and Oseltamivir?
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Zanamivir is inhaled, while oseltamivir is PO
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What is the mechanism of action in Zanamivir and Oseltamivir?
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Neuramidase inhibitors
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What is the spectrum of activity with Zanamivir and Oseltamivir?
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They work on both Influenza A and B (treatment and prophylaxis) and they work on bird flu
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Which is worse to use in pregnancy, zanamivir or oseltamivir?
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Oseltamivir since it's a category C.
Zanamivir is category B |
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What is the mechanism of viral resistance to Zanamivir and Oseltamivir?
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Resistance is mediated through altered binding sites for neuramidase and hemagglutinin
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