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Block 3b1 PHM > ARDS/Geriatric PHM/Sepsis/Pneumonia > Flashcards

ARDS/Geriatric PHM/Sepsis/Pneumonia Flashcards

1
Q

Beer’s List: Ex’s of 1st gen antihistamines (4)

A

Diphenhydramine, Doxylamine, Hydroxyzine, Meclizine

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2
Q

Beer’s List: Risks of 1st gen antihistamines

A

Confusion, dry mouth, constipation, cognitive impairment, delirium

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3
Q

Alt to 1st gen antihistamines & (3) ex’s

A

2nd gen antihistamines (eg: loratadine, fexofenadine, cetirizine)

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4
Q

Beer’s List: Ex’s of Antithrombotics (2)

A

Dipyridamole, Ticlopidine

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5
Q

Beer’s List: AE’s of Dipyridamole & Ticlopidine

A

Antithrombotic AE’s (2 drug ex’s) Orthostasis, bleeding Bleeding

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6
Q

Beer’s List: Alt of Antithrombotics

A

Acetylsalicylic Acid (ASA): Aspirin

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7
Q

Beer’s List: Categories & Ex’s of Antihypertensives (2)

A

Alpha-blocker: Terazosin Central Alpha Agonist: Clonidine

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8
Q

Beer’s List: When should antihypertensives be avoided?

A

Not 1st line, esp in HTN

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9
Q

Beer’s List: AE’s of antihypertensives

A

Orthostatic hypotension, CNS effects, bradycardia

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10
Q

Beer’s List: Antihypertensive Alts (4)

A

Thiazides, ACE-I, Beta Blockers, CCB

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11
Q

Beer’s List: Why should tricyclic antidepressants (TCA’S) be avoided?

A

Highly anticholinergic

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12
Q

Beer’s List: Alts to Tricyclic Antidepresssants (TCA’s) (2)

A

SSRI, SNRI

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13
Q

Beer’s List: Why should 1st and 2nd gen antipsychotics be avoided?

A

Behavioral problems of dementia

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14
Q

Beer’s List: What are the alts of 1st and 2nd gen antipsychotic meds?

A

Non-PHM Tx

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15
Q

Beer’s List: Ex’s of Analgesics (3)

A

Meperidine, NSAID’s, Skeletal muscle relaxants

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16
Q

Beer’s List: AE’s of Analgesics

A

Neurotoxicity, Risk of GI bleed, Anticholinergic effects, Peptic Ulcer Disease

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17
Q

Beer’s List: Alts of Analgesics (2)

A

Low dose opioids, tramadol

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18
Q

What are ex’s of lipid soluble medications?

A

Antipsychotics (ie: Benzodiazepine); Valium

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19
Q

What are ex’s of water soluble medications? (2)

A

Digoxin, Aminoglycosides

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20
Q

What is a highly protein bound drug used vs. seizures?

A

Phenytoin

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21
Q

Inotrope in Sepsis Tx

A

Dobutamine

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22
Q

What are ex’s of cytokine modulators for Sepsis Tx? (4)

A

High-dose steroids, mab’s, Toll-receptor antagonists, Statins

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23
Q

What are ex’s of coagulation regulators for Sepsis Tx? (2)

A

Heparin Activated Protein C (Xigris)

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24
Q

What biological mechanism may decrease mortality in Sepsis?

A

Vit C

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25
What is Legionella pneumophilia?
Aerobic, flagellated, non-spore forming gram (-) rod
26
How do gram (-) organisms stain? & Give ex
Pink (i.e.: Legionella)
27
What are 3 singular clinical manifestations of Legionellosis?
GI sx, Hyponatremia, Pontiac fever (non-pneumonic disease w/ flu-like sx)
28
What are 2 key Dx methods for Legionellosis?
Urine antigen test: detect serotype 1 Culture: charcoal yeast agar (Fe/cysteine)
29
How do you treat Legionellosis?
W/ Pontiac Fever-self lim; no ab Tx req Ab Tx: 7-10 days Quinolone Macrolides (ie: Azithromycin/Clindomycin) Tetracycline Rifampin
30
What is a RF for ARDS related to influenza?
Obesity
31
How does a CXR and CT present for MRSA pneumonia?
CXR: diffuse, bilateral opacities CT: multi-lobar cavitary infiltrates
32
What cause of pneumonia may be preceded by an influenza like illness?
CA-MRSA
33
Who might be affected by CA-MRSA?
Young, otherwise healthy
34
What are complications of CA-MRSA?
Empyema, Lung abscess, Sepsis
35
What are RF's for MRSA pneumonia?
Recent ab use; influenza-like illness
36
What are RF's for Legionellosis?
Immunosuppression; Age \>50
37
How can CA-MRSA be acquired?
Inhalation/aspiration into lower airway-\> Hematogenous Seeding
38
When is CA-MRSA pneumonia associated w/ increased mortality?
Severity of dis at presentation ↓ Vancomycin susceptibility
39
What genotype strain is associated w/ CA-MRSA pneumonia & what are its components? What can it cause?
USA300 strain -SCCmecIV -Panton-Valentine Leukocidin (PVL gene): toxin prod -Assoc w/ CA-MRSA but also ID in 20% of HAP Necrotizing, severe infection
40
How can CA-MRSA pneumonia be Dx clinically?
Influenza-like prodrome Hemoptysis
41
What is cultured to dx CA-MRSA pneumonia?
Blood, sputum, pleural fluid
42
What are the ab's & techniques used to Tx MRSA-pneumonia?
Ab's: Vancomycin Linezolid Clindamycin Empyema drainage
43
When is Daptomycin used?
Tx vs. MRSA but not pneumonia
44
What pneumonia causing agent is this?
Legionella Pneumophilia
45
What pneumonia causing agent is this?
Staphylococcus aureus
46
What condition is this a CXR of?
Legionella Pneumonia: bilateral lobar infiltrates
47
What condition is this a CXR of?
MRSA pneumonia: diffuse bilateral pattern
48
What condition is this a CT scan of?
MRSA pneumonia: cavitary pneumonia
49
What is this a CXR of?
HAP: lobar infiltrate, bulging fissure sign indicative of Klebsiella
50
What is this a stain of?
Klebsiella pneumoniae: moderate Gram (-) stain
51
Under what circumstances might HAP/VAP be suspected?
2 or more days after admission/post endotracheal intubation (50% of HAP cases)
52
What is the pathogenesis of HAP?
Bacterial colonization of aerodigestive tract Aspiration of contaminated secretions into lower airways
53
What are pathogens of HAP pneumonia?
Gram (-): Klebsiella pneumoniae Pseudomonas aeruginosa E Coli Serratia marcescens Stenotrophomonas maltophilia Actinetobacter species Gram (+): Staphylococcus aureus- MSSA vs. MRSA
54
How does HAP present clinically?
Fever, SOB, hypoxia, ↑ sputum production
55
How are respiratory cultures attained if HAP is suspected?
Non-invasive: tracheal aspiration Invasive: bronchoscopy
56
What are RF's for ab resistance?
Recent hospitalization Long term care facility residence Ab exposure within past 90 days Chemo Open wounds
57
What are the Tx's for HAP?
Anti-pseudomonal PCN's Fluoroquinlones Aminoglycosides Polymixins Vancomycin Linezolid
58
What are ex's of anti-pseudomonal PCN's in HAP tx?
Piperacillin-tazobactam (Zosyn) Cefepime Azactam Meropenem Ceftolazone-tazobactam (Zerbaxa)
59
What are ex's of fluoroquinolones in HAP tx?
Ciprofloxacin, Levofloxacin
60
What are ex's of Aminoglycosides in HAP tx?
Amikacin, Tobramycin, Gentamicin
61
What is this a CXR of?
**N**ocardia pneumonia: bilateral **n**odular pattern
62
What is unique about Nocardia's staining pattern?
Not mycobacterial like TB but can still stain w/ acid fast
63
Where is Nocardia species found?
Soil, water, decaying plants, sometimes food
64
Why is Nocardia an "opportunistic pathogen"?
More common in immunosuppressed (ie: transplant, HIV)
65
How is Nocardia acquired?
Inhalation from environment
66
How does Nocardia present clinically?
Pneumonia: nodular/cavitary; sub-acute-\>chronic px Lung abscess Disseminated infection (ie: **brain, skin**, bone, kidney, eye, heart); predilection for **CNS**
67
What is this a stain of?
Nocardia species: Gram (+) bacilli w/ branching filamentous forms, non-spore forming, mildly acid fast
68
What is a unique RF for Nocardiosis?
Alcoholism: can affect immune system over time
69
What are 3 methods of Dx for Nocardia?
1) Culture: Sputum-bronchoscopy Lung Tissue Skin Biopsy 2) Stain: modified Ziehl-Neelsen 3) Brain imaging/Lumbar puncture (to rule out CNS infection) \*even if asymptomatic, imp in immunocompromised\*
70
How is Nocardia Tx?
Ab's: Sulfonamides (ie: Bactram) Carbapenems (ie: Imipenem) Ceftriaxone Amikacin Linezolid Tigecycline
71
What are organisms that cause 'atypical' CAP?
Chlamydia pneumoniae Mycoplasma pneumoniae Legionella Chlamydia psittaci

Block 3b1 PHM (5 decks)

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