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Pharmakologie (Subject) / alles (Lesson)

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  • Wo liegt die Cushing-Schwellendosis 7,5 mg Prednisolonäquivalent
  • Medis zum Alkoholentzug Clomethiazol (NW: Atem- und Kreislaufdepression, bronchiale Hypersekretion, Abhängigkeitspotential) Benzodiazepine
  • initiale Therapie der ambulant erworbenen (schweren) Pneumonie Amoxicillin/Clavulansäure (Augmentan®) oder Cefuroxim (Zinacef®) oder Ceftriaxon (Rocephin®) oder Cefotaxim (Claforan®) Bei einer schweren Pneumonie sollte diese Therapie kombiniert werden mit einem Makrolidantibiotikum
  • Therapie der Legionellenpneumonie Makrolidantibiotikum oder Fluorchinolon der Gruppe 3/4
  • Antibiotikatherapie bei ESBL? Welche Erreger gehören zu den ESBL? Carbapeneme! → Imipenem, Meropenem Ampicillin/Tazobaktam   ESBL-bildende Erreger: Klebsiella pneumoniae Klebsiella oxytoca Escherichia (E.) coli Citrobacter spp. Enterobacter spp. Morganella morganii Proteus spp. Providencia spp. Salmonella spp. Serratia spp.
  • Wirkstoffe und Wirkmechanismen der Antiobiotika <!-- /* Font Definitions */ @font-face {font-family:"Courier New"; panose-1:2 7 3 9 2 2 5 2 4 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Wingdings; panose-1:5 2 1 2 1 8 4 8 7 8; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 0 65536 0 -2147483648 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Cambria; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; 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  • Wirkspektrum Penicillin V, G, Propicillin und Depotpenicillin Gram posititve Kokken Gram negative Kokken Spirochäten: Treponema, Borrelien, Leptospiren Gram positive Anaerobier: Clostridien   NICHT: penicillinasebildende Staphylokokken Enterokokken Listerien Bakteroides
  • Wirkspektrum der Aminopenicilline Gram pos und Gram neg Keime inklusive Haemophilus E.coli Listerien Shigellen Salmonellen NICHT (hierfür Breitspektrumpenicilline wie Piperacillin, Mezlocillin): Pseudomonas Proteus Klebsiellen Enterobakter
  • Welche Antiobiotika können in der SS eingesetzt werden Penicilline Cephalosporine Makrolidantibiotika (Roxi-, Erythro-, Clarithro-, Azithromycin)
  • Wirkspektrum der Cephalosporine Gruppe 1: ambulant erworbene Infektionen      Gram pos. und einige gram neg. wie E.coli, Klebsiellen, Proteus Cefazolin i.v. Cefaclor p.o. Gruppe 2: Infektionen des Respirationstraktes      β-Lactamase-stabil, Besser wirksam geg gram neg. Cefuroxim i.v., p.o Gruppe 3: schwere Inf mit gram neg   sehr gut gegen gram neg. , Ceftazidim auch gegen Pseudomonas Cefotaxim Ceftriaxon Ceftazidim
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  • UAWs der Cefalosporine Allegien, Kreuzallergien Nephrotoxisch Neurotoxisch
  • Wirkung der Carbapeneme Betalaktamase-AB gram positive und gram negative Keinme, ausser Ertapenem auch Pseudomonas Imipenem Meropenem Ertapenem
  • Wirkstoffe der Monobaktame Tobramycin Streptomycin Getamicin Neomycin Spectinomycin
  • Wirkspektrum der Aminoglykoside Staphylokokken und gram neg Keime inkl Pseudomonas Kombi mit beta-Laktamantibiotika (Penicillin, Cephalosporine, Monopaktame, Carbapeneme)!!!! Streptomyin: Kombitherapie bei Tuberkulose Neomycin: lokale Infektionen der Haut oder des Darms
  • Wie werden Penicilline eliminiert unverändert renal über tubuläre Sekretion!!!!!!! (Aminoglykoside werden glomerulär filtriert)
  • Charakteristika der Makrolide Erythromycin Roxithromycin Clarithromycin Azithromycin sehr gut verträglich, können bei SS und Kinder angewandt werden. AW: alternative bei Penicillinallergie Helicobakter pylori Eradi Bei Mykoplasmen oder Clamydieninfektion Erythromycin: Prokinetikum
  • Tetrazykline Wirkstoffe Anwendung UAWs Tetrazyklin, Doxyzyklin, Minozyklin AW: Pneumonie, Syphillis, Borreliose, Clamydien und Mykoplasmeninfektion UAW: Zahnveränderungen, ossärer Wachstumsstopp, Fototoxisch
  • Ciprofloxacin gehört zu wecher Gruppe? UAW Flourchinolone UAW: Knorpelschäden Senkung der Krampfschwelle
  • Charakteristika der Glykopeptidantibiotika IND Reserveantibiotikum bei Infektionen mit multiresistenten Bakterien Pseudomembranöse Colitis, p.o. Drug-monitoring!!! WI: nur gram positive UAW Nephro-, Ototoxisch, Allergien  
  • Wirkspektrum von Metronidazol Entamoeba histolytika Trichomonas vaginalis Giardia lamblia Bacteroides fragilis Gardnerella vaginalis - Aminokolpitis
  • Welche AB wirken bakteriostatisch? Makrolide (Erx, Roxi, AZi, Clari) Tetrazykline (Doxy) Clindamycin
  • Endokarditisprophylaxe Richtlinien Einmalgabe vor dem Eingriff “One dose fits all“ -> 2 g AmoxycillinBei Allergie: Clindamycin oder Clarithromycin Nur noch echte Hochrisikopatienten Herzklappenprothese Endokarditis in der Vorgeschichte Angeborene Herzfehler Herztransplantierte
  • Schwere Infektionen - typische Kombipartner Beta-Lactam Antibiotika und Gyrasehemmer (2/3) (Moxifloxacin) Beta-Lactam Antibiotika und Aminoglykosid (Tobramycin oder Gentamicin) Beta-Lactam Antibiotika und Metronidazol Beta-Lactam + Beta-Lactam Vancomycin + Rifampicin
  • Pharmakotherapie Tuberkulose mit wichtigsten Interaktionen und NW Isoniazid    - funkt. Vit B6 Antagonismus, Langsamacetylierer, hepatotox. Rifampicin    - Enzminduktion (CYP) in der Leber, hepatotoxisch +Pyrazinamid - hepatotoxisch, Gicht ggf.Ethambutol - Optikusneuritisoder Streptomycin (Aminoglykosid) - oto- und nephrotoxisch
  • Therapie resistenter Keime Methicillinresistente Staphylococcus aureus (MRSA) = Oxacillin-resistente Staphylococcus aureus (ORSA)Tx: Vancomycin, Linezolid, Daptomycin, Fosfomycin, (Tigecyclin), Rifampicin, Cotrimoxazol Glycopeptid-resistente Enterokokken (GRE) Vancomycin-resistente Enterokokken (VRE)Tx: Linezolid, Daptomycin, Tigecyclin, Qunopristin/Dalfopristin Extended- Spectrum Beta-Lactamase produzierende Gram-negative Erreger (ESBL) wie E. coli und Klebsiellen Tx Fosfomycin, Imipenem, Meropenem, Tigecyclin, Nitrofurantonin
  • Antibiotikatherapie in der SS Beta-Lactame (auf Zulassung der Einzelsubstanz achten) Makrolide (auf Zulassung der Einzelsubstanz achten) Clindamycin Fosfomycin Vancomycin Metronidazol ab 2. Trimenon ZidovudinAciclovir