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Clinical Pharmacology > Bronchitis, pneumonia, pharyngitis, tonsillitis, otitis media, sinusitis > Flashcards

Bronchitis, pneumonia, pharyngitis, tonsillitis, otitis media, sinusitis Flashcards

1
Q

Penicillin V - Dose and route (Otitis media)

A

Adults: 1g x 4 for 5-7 days orally
Children: 15mg/kg x 4 for 5-7 days

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2
Q

Penicillin V - MoA

A

Inhibits bacterial cell wall synthesis

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3
Q

Penicillin V - Adverse effects

A

Hypersensitivity
Urticaria (hives)
Interstitial nephritis

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4
Q

Penicillin V - Contraindications

A

Hypersensitivity

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5
Q

Penicillin V - Interactions

A

Probenecid: inhibits renal secretion – increased serum concentration

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6
Q

Penicillin V - Dose and route (Sinusitis)

A

1g x 4 for 7-10 days orally

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7
Q

Penicillin V - Dose and rouse (Pharyngitis)

A

500mg x 2 for 10 days orally

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8
Q

Penicillin V - Dose and route (Acute tonsillitis)

A

650mg x 4 for 10 days orally

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9
Q

Clindamycin - Dose and route

A

150 mg x 4 orally

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10
Q

Clindamycin - MoA

A

Protein synthesis inhibitor

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11
Q

Clindamycin - Adverse effects

A

Nausea
Vomiting
Diarrhea that can lead to pseudomembranous colitis

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12
Q

Clindamycin - Contraindications

A

Porphyria
Premature or newborn (can lead to gasping syndrome)
Liver and kidney dysfunction

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13
Q

CURB-65 score

A 
Confusion
Urea >7mmol/L (19mg/dL)
Respiration rate >30/min
Blood pressure <90/60mm Hg
Age >65 years
Score:
0: Treat home
2: Hospitalized
> or equal 3: management in ICU
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14
Q

Pneumococcal pneumonia first line treatment

A

Penicillin V: 1,3g x 4 for 7-10 days orally

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15
Q

Staphylococcal pneumonia first line treatment

A

Dicloxacillin: 0,5 - 2g x 4 orally or IV

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16
Q

Haemophilus influenzae pneumonia first line treatment

A

Ampicillin: 500 mg X 4 IV

Amoxicillin - 250-500 mg PO

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17
Q

Mycoplasma-, Chlamydia- Legionella- and B. Pertussis -first line treatment

A

Erythromycin: 500 x 4 orally

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18
Q

Pneumonia - Diagnosis based on physical exam

A
  • Tachypnea (RR>30/min), Use of accessory muscles
  • Fever, Cough, pleuritic chest pain, Dyspnea
  • Oxygen saturation < 90% in adults, <95% in children
  • SBP:<90 DBP<60
  • Increased/decreased tactile fremitus
  • Percussion: Dull –> consolidation, Flat –> pleural fluid
  • Auscultation: Crackles, bronchial breath sounds, pleural friction rub
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19
Q

Pneumonia - Diagnosis

A

Imaging:
- CXR: identify the inflammation, Lobar/multilobar infiltrates, cavitation, pleural effusion. Differentiate CAP from other conditions. Pneumatoceles or abscess –> S. aureus. Upper-lobe cavitating lesion –> tuberculosis
- CT: pts suspected postobstructive pneumonia caused by a tumor/foreign body or suspected cavitary diseases
Etiologic:
- Gram’s staining of sputum sample: Sputum sample must have > 25 neutrophils, < 10 squamous epithelial cells per low-power field.
- Blood cultures: Leukocytosis > 10*10^9/L
- Urinary antigen test: S. pneumonia and L. pneumophila.
- PCR of nasopharyngeal swabs
- Serology: Rise in titer of IgM antibody
- Biomarkers: CRP>50-100 mg/L, Procalcitonin; distinguish bacterial from viral infection.

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20
Q

Pneumonia - Empirical treatment

A

Penicillin V- 1,3 g x 4 PO
Hospitalized pts: Penicillin G 3g X4 IV (CURB 2-3)
Penicillin- Allergy: Erythromycin - 500 mg X 4 IV

CURB65:
0-2: Penicillin V or Penicillin G
3-4: Penicillin G + Gentamycin

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21
Q

Dicloxacillin - MoA

A

Inhibits bacterial cell wall synthesis, beta lactam antibiotic.

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22
Q

Dicloxacillin - Adverse effects

A

Hypersensitivity
Urticaria (hives)
Interstitial nephritis

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23
Q

Dicloxacillin - Interaction

A

Probenecid: inhibits renal secretion – increased serum concentration

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24
Q

Dicloxacillin - Contraindication

A

Hypersensitivity

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25
Q

Amoxicillin - MoA

A

Inhibits bacterial cell wall synthesis, beta lactam antibiotic.

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26
Q

Amoxicillin - Adverse effects

A

Superinfection
Hypersensitivity
Interstitial nephritis

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27
Q

Amoxicillin - Interactions

A

Probenecid: inhibits renal secretion – increased serum concentration

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28
Q

Amoxicillin - Contraindication

A

Decreases effect of contraceptives

Hypersensitivity

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29
Q

Erythromycin - MoA

A

Protein synthesis inhibitor. Macrolide antibiotic

30
Q

Erythromycin - Adverse effects

A

Stomatitis
Heart burn
Uncoordinated peristalsis

31
Q

Erythromycin - Interactions

A

Inhibits Cyt P-450 and increases levels of statins

32
Q

Erythromycin - Contraindications

A

Hypersensitivity

33
Q

Pneumonia - Prevention

A

Vaccination: influenza and pneumococcal polysaccharide vaccine
Stop smoking

34
Q

Bronchitis - Diagnosis

A

Physical exam:
- Auscultation: wheezing & whistling
- Symptoms: cough, mucus production, dyspnea, chest congestion, sore ribs, runny nose, low fever
- Oxygen saturation: severity of the disease
- CXR: rule out pneumonia
- CRP, CBC
- Lung function tests (spirometry): rule out emphysema and asthma
- Culture of sputum: rule out diseases caused by bacteria f.ex. whooping cough (B. pertussis)
Ask pt about recent colds or viruses, time period of cough, and SOB.

35
Q

Bronchitis - Treatment

A 
Empirical:
Rest, stop smoking, drink plenty of water
Acetaminophen if fever/pain
Codeine: 25 mg max 3 X daily for adults
Ephedrine: 1mg/ml for children
If bacterial: Penicillin V
If caused by Influenza virus you may give:
Zanamivir
If caused Whooping Cough (B. pertussis):
Erythromycin: 500mg x 4 orally
36
Q

Zanamivir - Dose and MoA

A

Neuraminidase inhibitor

2 inhalations, each containing 5 mg, twice daily for 5 days

37
Q

Zanamivir - Adverse effects

A

Respiratory and GI- irritations

38
Q

Zanamivir - Interactions

A

Do not the flu vaccine within 48 h –> decreases its effectiveness

39
Q

Zanamivir - Contraindication

A

Asthma and Emphysema

40
Q

Grading of symptoms in sinusitis

A

Visual analogue scale
0-30: Mild
30-70: Moderate
70-100: Severe

41
Q

Sinusitis - Diagnosis

A

Acute:
Based on clinical features and illness duration.
Moderare symptoms for > 10 days or Severe symptoms of any duration, incl unilateral/focal facial swelling or tooth pain.
Acute fungal sinusitis: take cultures and biopsy from involved areas
Acute hospital-acquired sinusitis: Confirm with CT; not otherwise used

Nasal Endoscopy and Skin-test for allergy can also be used to confirm diagnosis or rule out other disease.

Chronic:
Bases on clinical symptoms and history
CT: extent of disease, underlying anatomic defect or obstruction (polyp)
Endoscopy-derived tissue samples for histology and culture: guide treatment, visualization for abnormal anatomy

42
Q

Acute Sinusitis - Treatment

A

Symptoms < 5 days –> VAS<30 –> Symptomatic treatment: Pain killer, Oxymetazoline, Nasal saline lavage, sinus drainage
Symptoms >5 days –> VAS 30-70 –> Symptomatic treatment + Budesonide
Symptoms >5 days –> VAS >70 –> Penicillin V and Budesonide

Antibiotics should be given to pts with severe symptoms and for pts without improvement after 10-14 days.

Fungal sinusitis: Amphotericin B

Intracranial complications (assess, orbital involvement): surgical interventions and IV antibiotics

Chronic: Sinus surgery, surgical removal of impacted mucus.
Exacerbation of chronic sinusitis: Doxycycline 200 mg PO first day, 100 mgx1 next 7-10 days.

43
Q

Oxymetazoline - Dose

A

0,5 mg/mL 1 spray in each nostril 2-3 X daily

44
Q

Oxymetazoline - MoA

A

Alpha 1 adrenoceptor agonist

45
Q

Oxymetazoline - Adverse effects

A

Increases BP

Cardiovascular and CNS deprression

46
Q

Oxymetazoline - Interaction

A

MAO- inhibitors; increases hypertensive effects

47
Q

Oxymetazoline - Contraindication

A

Children < 6 years and elderly

Heart disease’

48
Q

Budesonide - Dose

A

32 mcg / dose –> 2 spray in each nostril; morning and evening

49
Q

Budesonide - MoA

A

Long- acting glucocorticoid

50
Q

Budesonide - Adverse effects

A

Dry nose
nose bleed
itching

51
Q

Budesonide - Interactions

A

Itraconazola and cyclosporine increases the conc of budesonide

52
Q

Budesonide - Contraindication

A

Hypertension, PUD, heart disease, allergy

53
Q

Amphotericin B - Dose

A

1 mg/kg IV infusion

54
Q

Amphotericin B - MoA

A

Binds to ergosterol in cell membrane and increases cell membrane permeability and leakage of cell contents

55
Q

Amphotericin B - Adverse effects

A

Renal toxicity –> hypokalemia, hypomagnesemia
Azotemia
Liver failure

56
Q

Amphotericin B - Interactions

A

Cyclosprine, thiazides and corticosteroids increases hypokalemia

57
Q

Amphotericin B - Contraindication

A

Renal failure/ renal disease

58
Q

Otitis media - Diagnosis

A

Clinical manifestations
Pneumoatic otoscopy: fluid in middle ear and immobile TM
TM: erythematous, bulging or retracted
CT/MRI

59
Q

Acute Otitis media - Treatment

A

spontaneous resolution in 80% pts –> wait 2-3 days be roe initiating antibiotics

Symptomatic treatment: Decongestants and pain killers
Penicillin V: if high fever, secretions for several days, suspicion of or proved complications
Position the head elevated
Tympanocentesis

60
Q

Chronic otitis media - Treatment

A

Surgery: prevent complications, remove/decrease secretions, improve hearing
Removal of pus, detritus and cholesteatoma
Inactive disease: Topical antibiotic drops - Ciprofloxacin
Tympanocentesis

61
Q

Ciprofloxacin - dose

A

3mg/mL. Apply the content of one single-dose container in the infected ear.

62
Q

Pharyngitis - Diagnosis

A

If symptoms is consistent with viral URI –> no strep testing
If not:
Throat swab culture
Rapid antigen-detection tests for gr a strep infection
Samples for specific cultures for other bacterial/viral causes should be obtained if suspected
HIV considered –> test for HIV RNA

63
Q

Pharyngitis - Treatment

A

Most cases: no treatment, symptomatic; acetaminophen, throat lozenge
S. pyogenes confirmed: Penicillin V, if allergy –> Clindamycin 300 mg TID
Influenza: Zanamivir
HSV: Acyclovir - 200 mg X5 po

64
Q

Tonsillitis - Diagnosis

A

Physical exam: high fever, red tonsils with pus, swollen and painful submandibular lymph nodes
Rapid antigen detecting test: for hemolytic strep
Throat culture: identify pathogen
CBC, CRP

65
Q

Tonsillitis - Treatment

A 
Mild- Moderate: rest, paracetamol, drink plenty of water, throat lozenges/spray
Severe: Penicillin V
Chronic Tonsillitis: 
Clindamycin
Tonsillectomy
66
Q

Pneumonia - Differential diagnosis

A

Acute bronchitis, acute exacerbation of chronic bronchitis, HF, PE, hypersensitivity pneumonitis, Whooping cough

67
Q

Gentamicin - Dose

A

5 mg/kg IV x1

68
Q

Erythromycin - Dose in Acute otitis media

A

500 mg X3 PO

69
Q

Gentamicin - MoA

A

Protein synthesis inhibitor

70
Q

Gentamicin - Adverse effects

A

Nephrotoxicity
Ototoxicity (vestibular and cochlear)

Drug-induced renal failure (acute tubular necrosis, when they accumulate in proximal tubule cells)

71
Q

Gentamicin - Contraindications

A

Decreased kidney function

Pregnancy

72
Q

Gentamicin - Interactions

A

Neuromuscular blocking agents: potentiated effect of these drugs.
Similar drugs: additive nephrotoxicity
Loop diuretics: increased ototoxicity

Clinical Pharmacology (14 decks)

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