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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
Amoxicillin - MoA
Inhibits bacterial cell wall synthesis, beta lactam antibiotic.
26
Amoxicillin - Adverse effects
Superinfection Hypersensitivity Interstitial nephritis
27
Amoxicillin - Interactions
Probenecid: inhibits renal secretion – increased serum concentration
28
Amoxicillin - Contraindication
Decreases effect of contraceptives | Hypersensitivity
29
Erythromycin - MoA
Protein synthesis inhibitor. Macrolide antibiotic
30
Erythromycin - Adverse effects
Stomatitis Heart burn Uncoordinated peristalsis
31
Erythromycin - Interactions
Inhibits Cyt P-450 and increases levels of statins
32
Erythromycin - Contraindications
Hypersensitivity
33
Pneumonia - Prevention
Vaccination: influenza and pneumococcal polysaccharide vaccine Stop smoking
34
Bronchitis - Diagnosis
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
Bronchitis - Treatment
``` 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
Zanamivir - Dose and MoA
Neuraminidase inhibitor | 2 inhalations, each containing 5 mg, twice daily for 5 days
37
Zanamivir - Adverse effects
Respiratory and GI- irritations
38
Zanamivir - Interactions
Do not the flu vaccine within 48 h --> decreases its effectiveness
39
Zanamivir - Contraindication
Asthma and Emphysema
40
Grading of symptoms in sinusitis
Visual analogue scale 0-30: Mild 30-70: Moderate 70-100: Severe
41
Sinusitis - Diagnosis
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
Acute Sinusitis - Treatment
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
Oxymetazoline - Dose
0,5 mg/mL 1 spray in each nostril 2-3 X daily
44
Oxymetazoline - MoA
Alpha 1 adrenoceptor agonist
45
Oxymetazoline - Adverse effects
Increases BP | Cardiovascular and CNS deprression
46
Oxymetazoline - Interaction
MAO- inhibitors; increases hypertensive effects
47
Oxymetazoline - Contraindication
Children < 6 years and elderly | Heart disease'
48
Budesonide - Dose
32 mcg / dose --> 2 spray in each nostril; morning and evening
49
Budesonide - MoA
Long- acting glucocorticoid
50
Budesonide - Adverse effects
Dry nose nose bleed itching
51
Budesonide - Interactions
Itraconazola and cyclosporine increases the conc of budesonide
52
Budesonide - Contraindication
Hypertension, PUD, heart disease, allergy
53
Amphotericin B - Dose
1 mg/kg IV infusion
54
Amphotericin B - MoA
Binds to ergosterol in cell membrane and increases cell membrane permeability and leakage of cell contents
55
Amphotericin B - Adverse effects
Renal toxicity --> hypokalemia, hypomagnesemia Azotemia Liver failure
56
Amphotericin B - Interactions
Cyclosprine, thiazides and corticosteroids increases hypokalemia
57
Amphotericin B - Contraindication
Renal failure/ renal disease
58
Otitis media - Diagnosis
Clinical manifestations Pneumoatic otoscopy: fluid in middle ear and immobile TM TM: erythematous, bulging or retracted CT/MRI
59
Acute Otitis media - Treatment
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
Chronic otitis media - Treatment
Surgery: prevent complications, remove/decrease secretions, improve hearing Removal of pus, detritus and cholesteatoma Inactive disease: Topical antibiotic drops - Ciprofloxacin Tympanocentesis
61
Ciprofloxacin - dose
3mg/mL. Apply the content of one single-dose container in the infected ear.
62
Pharyngitis - Diagnosis
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
Pharyngitis - Treatment
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
Tonsillitis - Diagnosis
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
Tonsillitis - Treatment
``` Mild- Moderate: rest, paracetamol, drink plenty of water, throat lozenges/spray Severe: Penicillin V Chronic Tonsillitis: Clindamycin Tonsillectomy ```
66
Pneumonia - Differential diagnosis
Acute bronchitis, acute exacerbation of chronic bronchitis, HF, PE, hypersensitivity pneumonitis, Whooping cough
67
Gentamicin - Dose
5 mg/kg IV x1
68
Erythromycin - Dose in Acute otitis media
500 mg X3 PO
69
Gentamicin - MoA
Protein synthesis inhibitor
70
Gentamicin - Adverse effects
Nephrotoxicity Ototoxicity (vestibular and cochlear) Drug-induced renal failure (acute tubular necrosis, when they accumulate in proximal tubule cells)
71
Gentamicin - Contraindications
Decreased kidney function | Pregnancy
72
Gentamicin - Interactions
Neuromuscular blocking agents: potentiated effect of these drugs. Similar drugs: additive nephrotoxicity Loop diuretics: increased ototoxicity

Clinical Pharmacology (14 decks)

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