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PDAT6 ID > 13 - CAP > Flashcards

13 - CAP Flashcards

1
Q

DOSING + ADR

B-Lactams
(+Macrolides or Doxycycline or Respiratory Fluoroquinolone)
for
INPATIENT CAP Non-ICU

A
  • *CEFTRIAXONE**
  • *1g IVPB qd**
  • *Cefuroxime**
  • *0.75-1.5gm IVPB q8**
  • *Ertapenem**
  • *1gm IVPB qd**
  • *Ampicillin/sulbactam**
  • 3gm IVPB q6h (**QID too often)*
  • *RENAL ADJUSTMENT - except cefTRIAXone**
  • Rash + Diarrhea*
  • *ERTAPENEM = RARE SEIZURE**
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2
Q

DOSING + ADR

Aztreonam
(+respiratory fluroquinolone)
for
INPATIENT CAP ICU** w/ **PCN ALLERGY

A
  • *Aztreonam**
  • *1-2gm IVPB q8**
  • *RENAL ADJUSTMENT**
  • Rash*
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3
Q

Special Populations for CAP

A

Cystic Fibrosis
need to cover for pseudomonas

Bronchiectasis
LONGER duration

HIV

Legionella –> 7-10 day treatment

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4
Q

Signs & Symptoms
CAP

A

Cough / Fatigue / Fever

Tachypnea (Rapid Breathing) / TachyCardia

Lung Sounds
Rales & Rhonchi // Dullness to percussion

Infiltrates on CXR
Chest Xray

Chest Discomfort

Chills / Rigors / Nightsweats

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5
Q

Comorbid Conditions

that warrant for step-up therapy for outpatient CAP

A

Recent AB use or comorbid Conditions:
Respiratory Fluoroquinolones OR Macrolide+B-Lactam

Chronic: Liver / Heart / Renal / Lung Disease

Diabetes / Malignancy

Diabetes / Asplenia / IMS disease-drugs

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6
Q

When to SWITCH from

IV -> ORAL

for CAP

A

AFEBRILE for 24-48 hours

&

GI tract is Intact

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7
Q

DOSING + ADR

Clindamycin
for
Outpatient CAP - ASPIRATION (mouth)

A
  • *Clindamycin**
  • *300mg q6** or 450mg q8
  • *7-14 days**
  • no renal adjustment*
  • Rash*
  • *COLITIS -** pseudomembraneous
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8
Q

Outpatient CAP Treatment

ASPIRATION
mouth

A

CLINDAMYCIN
300mg q6 or 450mg q8
or
AUGMENTIN
500mg q8 or 875mg q12

  • *7-14 days**
  • *legionella = 7-10 days**
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9
Q

INPATIENT CAP Treatment

ICU + PCN ALLERGY

A

RESPIRATORY FLUOROQUINOLONE
Levofloxacin + Moxifloxacin
+
AZTREONAM
1-2gm IVPB q8

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10
Q

INPATIENT CAP Treatment

NON-ICU

A

B-LACTAM
cefuroxime / ceftriaxone / ertepenem / amp-sulbactam
+
MACROLIDE** or **DOXYCYLINE** or **RESPIRATORY FLUOROQUINOLONE
levofloxacin / moxifloxacin

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11
Q

Outpatient CAP Treatment

No recent AB therapy
<90 days

A

MACROLIDE** or **DOXYCYCLINE

  • ZPAK (500mg x1day -> 250mg x4days)
    • 5 days, stays INSIDE cellls
  • Azithromycin XR Suspension 2gm
    • one dose
  • ​Clarithromycin 250-500mg BID or XR 1gm daily
    • no renal adjustment
    • GI upset / Ototoxicity / 3A4 inhibitor
  • DOXYCYCLINE 100mg q12h
    • 7-14 days
    • no renal adjustment
    • Teeth discoloration / GI Upset
    • antacids / magnesium / iron / calcium
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12
Q

Body’s Defenses to CAP

A

Anatomy:
Nose / Throat / Nasal Hair
MuscoCiliary System:
Mucous / Cilia / pH

COUGH + GAG reflex + Stomach Acid

Humoral Mechanisms:
IG’s / TNF / IL’s / Complement

Cellular Mechanisms:
Alveolar Macrophages / PML’s

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13
Q

Diagnosis of CAP

A

Determines if hospital or not:
CURB-65 or PSI (port Severity Index)

Sputum Culture
technique & timeliness is important
>25 WBC & <10 Epi’s

CHEST X-RAY

Blood Cultures / CBC +diff / Chemistry

Thoracentesis / Pathogen specific test

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14
Q

Why do Pneumonias Occur?

A

Impaired Body Defenses

Virulent organisms or excess inoculum
overwhelms body defenses

Colonization of URI

HEMAtogenous spread = Staph Aureus

Microorganisms gain access as follows:

  • *Aerosolized particles** = TB
  • *Hematogenous / Aspiration**
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15
Q

CAP Definition

A

Clinical Symptoms
or
Infiltrate Presence = CXR
does NOT rule out pneumonia
or
Ausculatory Findings

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16
Q

DOSING + ADR

B-Lactams
(+Macrolides or Respiratory Fluoroquinolone)
for
INPATIENT CAP ICU

A

Same Doses as NON-ICU,
except for: Ceftriaxone can be q12

CEFTRIAXONE
1g IVPB qd or 1g IVPB Q12

  • *Cefuroxime**
  • *0.75-1.5gm IVPB q8**
  • *Ertapenem**
  • *1gm IVPB qd**
  • *Ampicillin/sulbactam**
  • 3gm IVPB q6h (**QID too often)*
  • *RENAL ADJUSTMENT - except cefTRIAXone**
  • Rash + Diarrhea*
  • *ERTAPENEM = RARE SEIZURE**
17
Q

DOSING + ADR

B-Lactams (+Macrolides)
for
Outpatient CAP w/ comorbid conditions
or recent abx use <90days

A
  • *AUGMENTIN**
  • *500mg q8** or 875mg q12
  • *Amoxicillin**
  • *1gm q8**
  • *Cefuroxime**
  • *500mg q12**

Cefpodoxime
200mg q12

  • *RENAL ADJUSTMENT**
  • Rash + Diarrhea*
18
Q

Which CAP drugs require RENAL ADJUSTMENT?

A

LEVOFLOXACIN + Gemifloxacin
Respiratory fluoroquinolones, except MOXI

-BETA LACTAMS
Augmentin / Amoxicillin / Cefuroxime / Cefpodoxime
IV:
ERTAPENEM + Cefuroxime + Ampicillin/sulbactam
except cefTRIAXone

AZTREONAM
for PCN allergy with respiratory fluoroquinolone

19
Q

Pathogenesis of CAP

Factors that can
Impair Lung Defenses

A
  • *Neuromuscular Disorders**
  • *GB / MS** / Seizures

Cystic Fibrosis

CV Disorders
MI / Stroke

Altered Sensorium
Narcotics + Alcohol

Viruses that Impair Alveolar Macrophage Function
HIV

Depressing Mucociliary Transport
Narcotics + Alcohol + Smoking

Colonization

20
Q

INPATIENT CAP Treatment

ICU

A

B-LACTAM
cefuroxime / ceftriaxone / ertepenem / amp-sulbactam
ceftriaxone could be dosed 1gm IVPB q12
+
MACROLIDE** or **RESPIRATORY FLUOROQUINOLONE
levofloxacin / moxifloxacin, same doses

21
Q

Common Organisms (6)
CAP

A

“SMH - MILC”
SMH = Same as AOM

STREPtococcus PNEUMoniae

M. Catarrhalis

H. Influenzae

Legionella + Influenza

Mycoplasma + Chlamydophilia

22
Q

Which CAP drugs require you to avoid

ANTACIDS / MAG / IRON / CALCIUM?

A

RESPIRATORY FLUOROQUINOLONES
Levofloxacin / Moxifloxacin / Gemifloxacin
RENAL ADJUSTMENT - except MOXI
Kids / tendon rupture / QTC prolongation / hypoglycemia

DOXYCYCLINE
100mg q12h f7-14 days
Teeth Discoloration / GI upset

23
Q

DOSING + ADR

Respiratory Fluoroquinolones
for
Outpatient CAP w/ cmorbid conditions or Recent ABx

A
  • *LEVOFLOXACIN**
  • *750mg QD x5d** or 500mg QD x7-14d
  • *Moxifloxacin**
  • *400mg QD**
  • *Gemifloxacin**
  • *320mg QD**
  • *RENAL ADJUSTMENT** - EXCEPT MOXI
  • *KIDS / tendon rupture / QTc prolongation / hypoglycemia**
  • ANTACIDS / MAG / IRON / CALCIUM*
24
Q

Outpatient CAP Treatment

Recent AB therapy (90days) or Comorbid Conditions

Chronic: Liver / Heart / Renal / Lung Disease

Diabetes / Malignancy

Diabetes / Asplenia / IMS disease-drugs

A

RESPIRATORY FLUOROQUINOLONE
Levofloxacin / Moxifloxacin / Gemifloxacin
or
MACROLIDE + B-LACTAM
Zpak or Clarithromycin
Augmentin / Amoxicillin / Cefuroxime / Cefpodoxime

25
Q

DOSING + ADR

Respiratory Fluoroquinolones
(+ Beta Lactam)
for
INPATIENT CAP ICU

A

SAME AS *NON-ICU*

  • *LEVOFLOXACIN**
  • *500-750mg IVPB QD**
  • same as PO*
  • *Moxifloxacin**
  • *400mg IVPB qd**
  • same as PO*
  • *RENAL ADJUSTMENT** - EXCEPT MOXI
  • *KIDS / tendon rupture / QTc prolongation / hypoglycemia**
  • ANTACIDS / MAG / IRON / CALCIUM*
26
Q

Risk Factors
CAP

A

AGE

Alcoholism / Smoking

COPD / CVD / Diabetes

Immunocompromised:
HIV / Hematologic Malignancy

27
Q

CURB-65

Score:
0-1 = Outpatient
2 = Inpatient
> 3 = ICU

A

20 - 30/60/90

Confusion

Uremia = BUN > 20mg/dl

Respiratory Rate > 30

Blood Pressure < 90/60 mmHg

Age > 65

28
Q

CAP Treatment

Length of Therapy

A

7-14 Days total
except for zpak (5days) / levofloxacin (750mg 5days)

Legionella = 7-10 days

29
Q

DOSING + ADR

Macrolides
(+B-lactam)
for
INPATIENT CAP Non-ICU
or
INPATIENT CAP ICU

A

ICU and NON-ICU same dose

Azithromycin
500mg IVPB qd
or same dose of outpatient if ORAL

  • no renal adjustment*
  • *GI upset / Ototoxicity / 3A4 inhibitor**
30
Q

DOSING + ADR

Respiratory Fluoroquinolones
(+ Beta Lactam)
for
INPATIENT CAP Non-ICU

A
  • *LEVOFLOXACIN**
  • *500-750mg IVPB QD**
  • same as PO*
  • *Moxifloxacin**
  • *400mg IVPB qd**
  • same as PO*
  • *RENAL ADJUSTMENT** - EXCEPT MOXI
  • *KIDS / tendon rupture / QTc prolongation / hypoglycemia**
  • ANTACIDS / MAG / IRON / CALCIUM*
31
Q

DOSING + ADR

Macrolides
for
Outpatient CAP w/o recent ABx
or
Outpatient CAP w/ comorbid conditions
(+ B-Lactam)

A
  • *Z-PAK**
  • *500mg x1d -> 250mg QD f4d**
  • *Azithromycin XR suspension**
  • *2gm 1 dose**
  • *Clarithromycin**
  • *250-500mg q12** or XR @1gm QD
  • no renal adjustment*
  • *GI upset / Ototoxicity / 3A4 inhibitor**
32
Q

DOSING + ADR

DOXYCYCLINE (+B-lactam)
for
INPATIENT CAP NON-ICU

A
  • *Doxycycline**
  • *100mg IVPB q12**
  • same as PO*
  • no renal adjustment*
  • *Teeth discoloration / GI UPSET**
  • antacids / mag / iron / calcium*
33
Q

DOSING + ADR

DOXYCYCLINE
for
Outpatient CAP w/o recent ABx

A
  • *Doxycycline**
  • *100mg qd f7-12days**
  • same as IV*
  • no renal adjustment*
  • *Teeth discoloration / GI UPSET**
  • antacids / mag / iron / calcium*

PDAT6 ID (31 decks)

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