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Nayla Pharm > 3- LRI > Flashcards

3- LRI Flashcards

1
Q

What is the MCC of acute bronchitis

A

Lower respiratory viruses (self limited)
Adenovirus, influenza virus
(Kids: also Parainfluenza)

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2
Q

IF bacterial, what are MCC of acute bronchitis

A

Mycoplasma Pneumoniae

Normal flora contamination with: S. Pneumoniae, Staph, Haemophilus

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3
Q

When would suspect a bacterial etiology in acute bronchitis

A

previously healthy pt. with persistent fever
respiratory Sx for 4-6 days
Immunocompromised/predisposed

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4
Q

How do you treat acute viral bronchitis

A

Symptomatic for fever, malaise, lethargy; IBO, Acetaminophen, fluids
-Avoid abx, rarely use cough suppressants

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5
Q

How do you treat Acute bacterial bronchitis

A

Abx therapy aimed towards likely pathogen (S. pneuma and M. pneumoniae)- AZITHROMYCIN (macrolide)
-Fluoroquinolone as alternate

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6
Q

What is the single most common reason patients seek medical attention

A

respiratory tract infections (major cause of morbidity from acute illness)

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7
Q

What are the most common LRI

A

Bronchitis
Bronchiolitis
Pneumonia

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8
Q

What is bronchitis

A

inflammation of the walls of bronchi/bronchioles causing narrowing
affects large elements

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9
Q

What is bronchiectasis

A

widening of the bronchi with excess mucus causing narrowing

affects small elements

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10
Q

How is bronchitis classified

A

Acute: all ages
Chronic: usually adults

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11
Q

What are symptoms of bronchiolitis (infancy)

A

cough, coryza, vomiting, diarrhea, noisy breathing, labored breathing (grunting, flaring, retractions)

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12
Q

What are Acute bronchiolitis findings

A

Tachy, RR 40-80 (retractions), wheezing, INSP rales, mild conjunctivitis
Normal WBC
ABN ABG’s (hypoxemia- rarely hypercarbia)

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13
Q

What is the MCC of acute bronchiolitis

A

RSV (self limiting)

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14
Q

How do you treat healthy acute bronchiolitis babies

A

treat fever, oral fluids, observe for labored breathing

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15
Q

How do you treat severe babies

A

oxygen therapy, IV fluids

+/- bronchodilators and Ribavarin

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16
Q

Who would you give Ribacvarin to

A

acute bronchiolitis patients with bronchopulmonary dysplasia
congenital HD
premature
immunodeficient

17
Q

What is prophylaxis for RSV

A

Pavilizumab (preferred) or RSV immunoglobulin

-Should be given to those with underlying heart/pulm disease monthly during peak season (late fall-early spring)

18
Q

What are S/E of palivizumab

A 
fever
rash
antibody formation
anaphylaxis
thrombocytopenia
19
Q

What causes chronic bronchitis

A

inhalation of noxious agents + env. factors + bac/viral info

20
Q

What is the definition of chronic bronchitis

A

chronic cough, excess sputum, and organisms in expectoration for >3 months for 2 years

21
Q

How do you treat an acute chronic bronchitis exacerbation

A

Chest physiotherapy/ humidified air (mobilize and increase expectoration)
Bronchodilators (albuterol)
+/- Oxygen therapy and Abx

22
Q

What are common pathogens in chronic bronchitis

A

H. Influenza
M. Catarrhalis
S. Pneumoniae

23
Q

If needed, what abx are preferred in chronic bronchitis

A 
Doxycycline
Ampicillin
Amoxicillin
Augmentin 
Levo/Moxifloxacin
24
Q

What will you find on chronic bronchitis PE

A

inspiratory rales/rhonchi, exp. wheezing
Hyper resonance, decreased BS
obesity, clubbing, barrel chest

25
Q

What will chronic bronchitis labs show

A

Erythrocytosis

decreased vital capacity, prolonged exp. flow

26
Q

What are PNA PE findings

A

Dullness to percussion, increased tactile remits, decreased BS, crackles, retractions
tachycardia, tachypnea

27
Q

What will PNA lab findings show

A

Leukocytosis

28
Q

PNA symptoms are

A

Abrupt onset fever, chills, dyspnea, pleuritic CP, productive cough (rust sputum)

29
Q

RF for CAP

A 
65+ y/o
DM
cardio/pulm/renal/liver disease 
smoking, alcohol 
(asplenia)
30
Q

RF for HAP

A 
60+ y/o 
aspiration, COPD, ARDS, coma
antacids, ppi, H2 antagonist 
head trauma, ICP
NG tube/enteral ntr
reintubation/tracheostomy
IV abx w/in 90 days (MDR risk)
31
Q

RF for VAP

A

all HAP RF +

MDR risk w/ septic shock, acute renal replacement therapy, 5+ days of hospitalization

32
Q

What is the MCC of PNA in adults

A

Strep Pneumo

33
Q

What is the MCC of PNA in kids

A

RSV, parainfluenza, adenovirus
(if bacterial, S. Pneumo)
(older children, M. pneumoniae)

34
Q

What is “adjunct therapy” for PNA in adults

A

humidified O2 for hypoxemia
bronchodilators if w/ bronchospasm
rehydration fluids
chest physiotherapy

35
Q

What is Grade 1A PNA prevention

A

Pneumo vaccine and flu vaccine

Flu meds as prophylaxis or w/in 48 hours of Sx onset

36
Q

What is Grade 1B PNA prevention

A

Macrolide (azithromycin) if in close contact with pertussis

Use SINGLE dose aerosol meds

Nayla Pharm (12 decks)

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