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Pharm > Allergy, Flu, Pneumonia > Flashcards

Allergy, Flu, Pneumonia Flashcards

1
Q

What do you use antihistamines for?

A

Immediate type hypersensitivity reactions

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2
Q

What two kinds of activity to antihistamines have?

A

Anticholinergic

Antimuscarinic

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3
Q

What kind of drugs are antihistamines?

A

Reversible competitive H1 receptor antagonists

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4
Q

What is the affect of antihistamines?

A

Reduce or prevent physiologic effects of histamine release

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5
Q

Do antihistamines affect the pre-released histamine?

A

No

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6
Q

What is an issue with first-generation antihistamines?

A

They produce sedation

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7
Q

What is an advantage of second generation antihistamines and what is the result?

A

They are peripherally selective drugs

They are much less sedating

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8
Q

What is a ethanolamine antihistamine?

A

Diphenhydramine (benadryl)

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9
Q

What is a phenothiazine antihistamine?

A

Promethazine

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10
Q

What are some classes of first generation antihistamines?

A

Ethanolamines
Phenothiazines
Piperazines

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11
Q

What is a piperazine antihistamine?

A

Hydroxyzine

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12
Q

What are some classes of second generation antihistamines?

A

Phthalazinone
Piperazine
Piperidines

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13
Q

What is a phthalazinone antihistamine?

A

Azelastine

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14
Q

What is a piperazine antihistamine? What is it a metabolite of?

A

Cetirizine

Active metabolite of hydroxyzine

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15
Q

What are piperidine antihistamines?

A

Loratadine
Desloratadine
Fexofenadine

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16
Q

What is desloratadine a metabolite of?

A

Active metabolite of loratadine

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17
Q

When is desloratadine contraindicated?

A

In pts hypersensitive to loratadine

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18
Q

When is cetirizine contraindicated?

A

In pts who are hypersensitive to hydroxyzine

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19
Q

Do 2nd degree antihistamines have more or less sedative properties?

A

Less

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20
Q

What activities should pts on antihistamines take caution with?

A

Driving

Tasks requiring alertness

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21
Q

What precautions should be taken with children taking antihistamines?

A

Supervise children in hazardous activities

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22
Q

What substances should you avoid with antihistamines?

A

Co-administration of other CNS depressants (drugs or alcohol)

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23
Q

AEs of promethazine

A

Possible fatal respiratory depression
Lower seizure threshold
Prolong QT interval

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24
Q

Can promethazine induced respiratory depression be reveresed with naloxone?

A

No

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25
Q

When is promethazine contraindicated?

A

Children < 2 years

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26
Q

What is a concern with IV/SQ administration of promethazine?

A

Tissue necrosis

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27
Q

What is key with influenza? What can we do to deal with this?

A

Prevention

Promote annual immunization

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28
Q

What is the MOA of amantadine?

A

Chemoprophylaxis of signs and sx of influenza A

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29
Q

What does amantadine treat?

A

Uncomplicated RTI with influenza a

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30
Q

What is the MOA of oseltamivir?

A

Chemoprophylaxis of signs and sx of influenza A/B

31
Q

What does oseltamivir treat?

A

Uncomplicated RTI with influenza a/b

32
Q

What might decrease the effectiveness of oseltamivir?

A

Emergence of resistance

33
Q

When do you give oseltamivir as prophylaxis?

A

Following contact w/ an infected individual

34
Q

When do you give oseltamivir as tx?

A

W/in 2 days of onset of flu sx

35
Q

What do you give zanamivir for prophylactically?

A

The flu for pts >5 years for flu a/b

36
Q

What do you treat with zanamivir?

A

Flu a/b in pts > 7 years old

37
Q

What is rimantadine used for in adults?

A

Prophylaxis and tx of influenza A in adults

38
Q

What is rimantadine used for in kids?

A

Prophylaxis of flu a in kids

39
Q

When do you start rimantadine?

A

ASAP after sx appear

Preferably w/in 48 hours

40
Q

How long do you give rimantadine?

A

7 days

41
Q

What populations do you reduce rimantadine dosing for?

A

Elderly

Nursing home pts

42
Q

Are community acquired pneumonia (CAP) organisms multi-drug resistant?

A

Generally not

43
Q

What are some common CAP organisms?

A

Streptoccous pneumonia

Haemophilus influenzae

44
Q

What is the pneumonia severity index?

A

PSI -> see slide 46

45
Q

What is the CAP tx algorithm?

A

see slide 47

46
Q

What are the CAP empiric antibiotics?

A

See slide 48

47
Q

What organism is gram positive and has cocci in clusters?

A

S. aureus

48
Q

What should you add for CAP tx if the stain comes back as S aureus?

A

Vancomycin

49
Q

What organism causes CAP and is gram negative?

A

Pseudomonas

50
Q

What should you add if the CAP organism is pseudomonas?

A

Anti-pseudomonal (ex: Tazo, cefepime)

51
Q

What do many WBCs on gram stain indicate?

A

Pneumonia more likely

52
Q

Is pneumonia more likely with more or less organisms on gram stain?

A

Many organisms

53
Q

Is pneumonia more likely with mixed morphology or single?

A

Single morphology

54
Q

Severe CAP empiric tx?

A

See slide 50

55
Q

When do you classify pneumonia as hospital acquired (HAP)?

A

When it is new after 3-5 days as inpatient

56
Q

Is HAP more or less likely to be multi-drug resistant?

A

More likely

57
Q

What drug should you consider to add for HAP?

A

Vancomycin

58
Q

What can you add for broader mutli-drug resistance coverage?

A

High dose Pip/Tazo (zosyn)
Cefepime
Imipenem/cilastatin

59
Q

What dose of Pip/Tazo do you give for MDR? What’s something you have to take into consideration?

A
  1. 45 g q 6-8 hours

* renally adjust

60
Q

What dose of cefepime do you give for MDR? Whats an exception?

A

1 g q 12 hours

2 g q 8 hours for febrile neutropenia

61
Q

What dose of imipenem/cilastatin do you give for MDR?

A

0.5 - 1 g q 6-12 hours

62
Q

How are long-term care facilities more like hospitals?

A

Chronically ill pts
Long lengths of stay
May have instrumentation in place
Increased likelihood of MDR colonization/infection

63
Q

Do you treat health care associated pneumonia more like CAP or HAP?

A

HAP

64
Q

What is aspiration pneumonitis?

A

Acute lung injury after inhalation of regurgitated gastric contents

65
Q

Is aspiration pneumonitis usually witnessed or not?

A

Witnessed

66
Q

What happens with aspiration pneumonitis?

A

Chemical reaction due to stomach acidity

67
Q

When does aspiration pneumonia develop?

A

After inhalation of colonized oropharyngeal organisms

68
Q

How do you dx aspiration pneumonia?

A

CXR to see infiltrate in at risk pts

69
Q

Is aspiration pneumonia witnessed or nah?

A

Not witnessed

70
Q

What is aspiration pneumonia?

A

An infection in the lungs due to colonized bacteria

71
Q

What are some RF for aspiration pneumonia?

A

Older
Antacids
PPIs
poor dentition

72
Q

What are some protective factors against aspiration pneumonia?

A

Few organisms
Cough reflex
Active ciliary transport

73
Q

Aspiration tx

A

See slide 57

Pharm (32 decks)

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