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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
Q

What is Legionella pneumophilia?

A

Aerobic, flagellated, non-spore forming gram (-) rod

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26
Q

How do gram (-) organisms stain? & Give ex

A

Pink (i.e.: Legionella)

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27
Q

What are 3 singular clinical manifestations of Legionellosis?

A

GI sx, Hyponatremia, Pontiac fever (non-pneumonic disease w/ flu-like sx)

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28
Q

What are 2 key Dx methods for Legionellosis?

A

Urine antigen test: detect serotype 1

Culture: charcoal yeast agar (Fe/cysteine)

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29
Q

How do you treat Legionellosis?

A

W/ Pontiac Fever-self lim; no ab Tx req

Ab Tx: 7-10 days Quinolone Macrolides (ie: Azithromycin/Clindomycin) Tetracycline Rifampin

30
Q

What is a RF for ARDS related to influenza?

A

Obesity

31
Q

How does a CXR and CT present for MRSA pneumonia?

A

CXR: diffuse, bilateral opacities

CT: multi-lobar cavitary infiltrates

32
Q

What cause of pneumonia may be preceded by an influenza like illness?

A

CA-MRSA

33
Q

Who might be affected by CA-MRSA?

A

Young, otherwise healthy

34
Q

What are complications of CA-MRSA?

A

Empyema, Lung abscess, Sepsis

35
Q

What are RF’s for MRSA pneumonia?

A

Recent ab use; influenza-like illness

36
Q

What are RF’s for Legionellosis?

A

Immunosuppression;

Age >50

37
Q

How can CA-MRSA be acquired?

A

Inhalation/aspiration into lower airway-> Hematogenous Seeding

38
Q

When is CA-MRSA pneumonia associated w/ increased mortality?

A

Severity of dis at presentation

↓ Vancomycin susceptibility

39
Q

What genotype strain is associated w/ CA-MRSA pneumonia & what are its components? What can it cause?

A

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
Q

How can CA-MRSA pneumonia be Dx clinically?

A

Influenza-like prodrome

Hemoptysis

41
Q

What is cultured to dx CA-MRSA pneumonia?

A

Blood, sputum, pleural fluid

42
Q

What are the ab’s & techniques used to Tx MRSA-pneumonia?

A

Ab’s: Vancomycin

Linezolid

Clindamycin

Empyema drainage

43
Q

When is Daptomycin used?

A

Tx vs. MRSA but not pneumonia

44
Q

What pneumonia causing agent is this?

A

Legionella Pneumophilia

45
Q

What pneumonia causing agent is this?

A

Staphylococcus aureus

46
Q

What condition is this a CXR of?

A

Legionella Pneumonia: bilateral lobar infiltrates

47
Q

What condition is this a CXR of?

A

MRSA pneumonia: diffuse bilateral pattern

48
Q

What condition is this a CT scan of?

A

MRSA pneumonia: cavitary pneumonia

49
Q

What is this a CXR of?

A

HAP: lobar infiltrate, bulging fissure sign indicative of Klebsiella

50
Q

What is this a stain of?

A

Klebsiella pneumoniae: moderate Gram (-) stain

51
Q

Under what circumstances might HAP/VAP be suspected?

A

2 or more days after admission/post endotracheal intubation (50% of HAP cases)

52
Q

What is the pathogenesis of HAP?

A

Bacterial colonization of aerodigestive tract

Aspiration of contaminated secretions into lower airways

53
Q

What are pathogens of HAP pneumonia?

A

Gram (-):
Klebsiella pneumoniae
Pseudomonas aeruginosa
E Coli

Serratia marcescens

Stenotrophomonas maltophilia

Actinetobacter species

Gram (+):
Staphylococcus aureus- MSSA vs. MRSA

54
Q

How does HAP present clinically?

A

Fever, SOB, hypoxia, ↑ sputum production

55
Q

How are respiratory cultures attained if HAP is suspected?

A

Non-invasive: tracheal aspiration

Invasive: bronchoscopy

56
Q

What are RF’s for ab resistance?

A

Recent hospitalization

Long term care facility residence

Ab exposure within past 90 days

Chemo

Open wounds

57
Q

What are the Tx’s for HAP?

A

Anti-pseudomonal PCN’s
Fluoroquinlones

Aminoglycosides

Polymixins

Vancomycin

Linezolid

58
Q

What are ex’s of anti-pseudomonal PCN’s in HAP tx?

A

Piperacillin-tazobactam (Zosyn)
Cefepime

Azactam

Meropenem

Ceftolazone-tazobactam (Zerbaxa)

59
Q

What are ex’s of fluoroquinolones in HAP tx?

A

Ciprofloxacin, Levofloxacin

60
Q

What are ex’s of Aminoglycosides in HAP tx?

A

Amikacin, Tobramycin, Gentamicin

61
Q

What is this a CXR of?

A

Nocardia pneumonia: bilateral nodular pattern

62
Q

What is unique about Nocardia’s staining pattern?

A

Not mycobacterial like TB but can still stain w/ acid fast

63
Q

Where is Nocardia species found?

A

Soil, water, decaying plants, sometimes food

64
Q

Why is Nocardia an “opportunistic pathogen”?

A

More common in immunosuppressed (ie: transplant, HIV)

65
Q

How is Nocardia acquired?

A

Inhalation from environment

66
Q

How does Nocardia present clinically?

A

Pneumonia: nodular/cavitary; sub-acute->chronic px

Lung abscess

Disseminated infection (ie: brain, skin, bone, kidney, eye, heart); predilection for CNS

67
Q

What is this a stain of?

A

Nocardia species: Gram (+) bacilli w/ branching filamentous forms, non-spore forming, mildly acid fast

68
Q

What is a unique RF for Nocardiosis?

A

Alcoholism: can affect immune system over time

69
Q

What are 3 methods of Dx for Nocardia?

A

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
Q

How is Nocardia Tx?

A

Ab’s: Sulfonamides (ie: Bactram)

Carbapenems (ie: Imipenem)

Ceftriaxone

Amikacin

Linezolid

Tigecycline

71
Q

What are organisms that cause ‘atypical’ CAP?

A

Chlamydia pneumoniae

Mycoplasma pneumoniae

Legionella

Chlamydia psittaci

Block 3b1 PHM (5 decks)

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