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Advanced Pharm > Chapter 47 Without Medications > Flashcards

Chapter 47 Without Medications Flashcards

Week 2

1
Q

Define Community-Acquired Pneumonia (CAP)

A

Pneumonia occurs when an organism invades the lung parenchyma in the presence of depressed host defenses.

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2
Q

CAP Etiology

A

Includes bacterial, viral, fungal, rickettsial, and parasitic organisms, as well as inhalation of toxic substances.

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3
Q

Common Pathogens of (CAP) in Adults

A

Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus (especially in influenza-associated cases), respiratory viruses (in one-third of cases).

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4
Q

Common Pathogens of (CAP) in Children and Infants

A

Variable based on age, including viruses, S. pneumoniae, H. influenzae, S. aureus

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5
Q

CAP Clinical Presentation Symptoms

A

Cough, dyspnea, sputum production, fever, abnormal breath sounds (crackles).

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6
Q

CAP Diagnostics

A

Initial chest radiograph recommended to evaluate for new or progressive infiltrate.

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7
Q

Microbiological Testing of CAP

A

Often empirical treatment due to limitations of diagnostic testing in outpatient settings.

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8
Q

Antibiotic Selection and General Recommendations (CAP)

A

Based on severity, comorbidities, and risk factors for drug-resistant pathogens.

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9
Q

Outpatient Treatments Options
Healthy Adults (No Comorbidities)

A

Amoxicillin, Doxycycline, Macrolide in areas with <25% resistance.

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10
Q

Outpatient Treatment Options
Adults (with Comorbidities)

A

Amoxicillin/clavulanate, Cephalosporin plus macrolide, Respiratory fluoroquinolone

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11
Q

Clinical Improvement

A

Expected within 48-72 hours; resolution of symptoms within 5-7 days.

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12
Q

Monitoring and Follow-Up for CAP Treatments

A

Clinical Improvement

Outcome Evaluations

Complications

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13
Q

Complications

A

Consider if no improvement within 5 days, reassess for resistant pathogens or other complications.

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14
Q

Outcome Evaluation

A

Afebrile, improved vital signs, normalized appetite and mentation.

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15
Q

Patient Education

A

Medication Adherence

Side Effects

Symptom Monitoring

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16
Q

Medication Adherence

A

Importance of completing the full course of antibiotics.

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17
Q

Side Effects

A

Potential adverse reactions and drug interactions.

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18
Q

Symptoms Monitoring

A

Instructions to seek medical care if symptoms worsen or do not improve

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19
Q

Severity Classification, Outpatients
Previously Healthy:

A

No history of cardiopulmonary disease. No risk factors for drug-resistant Streptococcus pneumoniae (DRSP).

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19
Q

ATS Guidelines (1993, 2001, 2019)

A

Initial management of adults with CAP.

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20
Q

Severity Classification, Outpatients
With Comorbidities

A

Cardiopulmonary disease, diabetes, liver/renal disease, alcoholism, malignancies, asplenia, immunosuppression.

Risk factors for DRSP or gram-negative bacteria.

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21
Q

Severity Classification, Outpatients Inpatients (Non-ICU)

A

Cardiopulmonary disease or other modifying factors. No cardiopulmonary disease or modifying factors.

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22
Q

ICU-admitted Patients

A

No risks for Pseudomonas aeruginosa.

Risks for P. aeruginosa.

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23
Q

Severity Criteria (2019 ATS/IDSA Guidelines)

A

Major, and Minor

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24
Q

Major Criteria:

A

Septic shock with need for vasopressor support. Respiratory failure requiring mechanical ventilation.

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25
Q

Minor Criteria

A

Respiratory rate ≥30 breaths/min. PaO2/FIO2 ratio ≤250. Multilobar infiltrates. Confusion/disorientation. Uremia (BUN ≥20 mg/dL). Leukopenia (WBC <4000 cells/μL). Thrombocytopenia (platelets <100,000/μL). Hypothermia (core temperature <36°C). Hypotension requiring aggressive fluid resuscitation.

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26
Q

Alternative Tool:

A

CURB-65.

Evaluates confusion, BUN, respiratory rate, blood pressure, age (≥65).

Accurately predicts mortality in CAP patients.

26
Q

Tools for Severity Assessment:

A

Preferred Tool, and Alternative Tool

27
Q

Preferred Tool:

A

Pneumonia Severity Index (PSI). Considers age, comorbidities, physical exam findings, and diagnostic test results. More sensitive to predicting mortality but requires invasive testing.

28
Q

Rational Drug Selection

A

Outpatient Treatment
Inpatient Treatment
ICU Management

29
Q

Outpatient Treatment

A

Based on modifying factors that increase risk of infection with specific pathogens. Refer to ATS/IDSA guidelines for appropriate treatment decisions.

30
Q

Inpatient Treatment:

A

Tailored based on severity criteria and causative pathogens. Adjust treatment if patient condition worsens or improves.

31
Q

ICU Management:

A

Differentiated based on risk for Pseudomonas aeruginosa. Adjust treatment based on response to initial therapy.

32
Q

Patient With Nursing Home–Acquired Pneumonia
Epidemiology and Risk Factors:

A

Pneumonia is common among nursing home residents, with a significant morbidity rate.

About 1 in 20 elderly patients in nursing homes develop pneumonia annually.

Increased risk factors include close living conditions, exposure to other ill residents, frequent antibiotic use, and immunosuppressive therapies.

33
Q

Patient With Nursing Home–Acquired Pneumonia Pathogens:

A

Similar to the general population: S. pneumoniae, H. influenzae, K. pneumoniae.

More frequent: P. aeruginosa, MRSA, anaerobic organisms (Peptostreptococcus, Bacteroides, Provotella) in cases with aspiration risk.

34
Q

Patient With Nursing Home–Acquired Pneumonia Treatment

A

Follow 2019 inpatient pneumonia guidelines:

Non-severe pneumonia: beta-lactam plus macrolide or respiratory fluoroquinolone.

Severe pneumonia: beta-lactam plus macrolide or beta-lactam plus respiratory fluoroquinolone.

Consider additional coverage for Pseudomonas or MRSA based on history.

35
Q

Pregnant Patient With Pneumonia
Epidemiology and Risk Factors:

A

Pregnant women are more predisposed due to physiological changes.

Pneumonia prevalence: 0.5 to 1.5 cases per 1,000 pregnancies.

Risk factors: anemia, advanced maternal age, prior lung disease, smoking, corticosteroid use, and tocolytic agents.

36
Q

Pregnant Patient With Pneumonia
Pathogens

A

Pregnant women are more predisposed due to physiological changes.

Pneumonia prevalence: 0.5 to 1.5 cases per 1,000 pregnancies.

Risk factors: anemia, advanced maternal age, prior lung disease, smoking, corticosteroid use, and tocolytic agents.

37
Q

Pregnant Patient With Pneumonia
Complications

A

Maternal mortality during pandemics: 20-50% for influenza, 0.9% for COVID-19.

Complications: maternal and fetal death, preterm labor, low birth weight.

38
Q

Pregnant Patient With Pneumonia
Treatment

A

Antibiotics: macrolides (erythromycin, azithromycin, clarithromycin) are safe; avoid doxycycline and fluoroquinolones.

Consider beta-lactam plus macrolide in women with comorbid conditions or recent antibiotic use.

39
Q

Pregnant Patient With Pneumonia
Prevention:

A

Vaccination: ACOG recommends varicella, MMR before pregnancy; influenza and COVID-19 vaccination during pregnancy.

Pneumococcal vaccination for high-risk individuals.

40
Q

Pregnant Patient With Pneumonia
Lifestyle Modifications

A

Hydration: encourage adequate fluid intake to liquefy secretions.

Rest: important for recovery; advise against working until improvement.

Smoking cessation: tobacco smoke irritates the lungs, worsens cough.

41
Q

Pregnant Patient With Pneumonia
Monitoring and Outcome Evaluation

A

Monitor clinical status closely: vital signs, fever curve, hydration status, activity tolerance.

Clinical improvement indicators: afebrile in 48-72 hours, symptom resolution in 5-7 days, stable vital signs, improved appetite and mentation.

Consider failure to improve within 5 days as a marker for worse outcomes.

42
Q

Pregnant Patient With Pneumonia
Patient Education

A

Understand the type of pneumonia and expected course of improvement.

Educate on prescribed antibiotics: adverse reactions, interactions, treatment duration.

Discuss lifestyle modifications: hydration, smoking cessation, rest.

Symptoms of worsening: when to seek urgent care.

Expect clinical improvement in 48-72 hours.

43
Q

Age: Neonates
Common Pathogens

A

Coliform bacteria, Cytomegalovirus, Enterovirus,Group B streptococci, Herpesvirus, Mycoplasma hominis, Ureaplasma urealyticum

44
Q

Age: Infants (4 to 16 weeks)
Common Pathogens:

A

Cytomegalovirus, Influenza virus, Parainfluenza virus, Respiratory syncytial virus (RSV), Chlamydia trachomatis, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Ureaplasma urealyticum

45
Q

Age: Children up to 5 years
Common Pathogens:

A

Adenovirus, Group A streptococci, Influenza virus, RSV, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae

46
Q

Age: Children (5 years through adolescence)
Common Pathogens:

A

Influenza virus, Varicella, Chlamydia pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycoplasma pneumoniae, Streptococcus pneumoniae

47
Q

Adults Group 1: No cardiopulmonary disease and no modifying factors
Common Pathogens:

A

Respiratory viruses, Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Streptococcus pneumoniae
Other (1%): Endemic fungi, Legionella spp., Mycobacterium tuberculosis, Staphylococcus aureus

48
Q

Adults Group 2: With cardiopulmonary disease and/or modifying factors
Common Pathogens:

A

Aerobic gram-negative bacilli, Respiratory viruses, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae (including DRSP)

Other (1%): Endemic fungi, Legionella, Moraxella catarrhalis, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Mixed infection

49
Q

Pediatric Patients with Pneumonia
Pathophysiology:

A

S. pneumoniae: Most common cause of bacterial pneumonia in children.

Vaccination: Pneumococcal conjugate vaccines (PCV13, PCV15, PCV20) and pneumococcal polysaccharide vaccine (PPSV23) are used.

PCV13: Recommended universally for children <2 years, and in certain medical conditions for older children and adults.

PPSV23: Recommended for adults over 65 years and individuals with high-risk conditions.

49
Q

Pediatric Patients with Pneumonia
Epidemiology:

A

CAP: Leading cause of morbidity and mortality in children under 5 years.

Etiology: Viral in 73%, bacterial in 15% of cases (EPIC study, Jain et al., 2015).

Hospitalization: Indications include moderate to severe respiratory distress, failure to respond to oral antibiotics, lobar consolidation in more than one lobe, immunosuppression, empyema, abscess, or underlying cardiopulmonary disease.

50
Q

Pediatric Patients with Pneumonia
Antimicrobial Stewardship:

A

Indications for Antibiotics: Based on identified pathogen and clinical severity.

Reasons to Avoid Antibiotics: Viral etiology, minimal clinical benefit, potential harm from side effects.

50
Q

Pediatric Patients with Pneumonia
Treatment Guidelines:

A

Outpatient Treatment: Based on organism and clinical stability.

Hospitalization: Required for severe cases or failure of outpatient therapy.

51
Q

Pediatric Patients with Pneumonia
Patient Education:

A

Compliance: Importance of completing antibiotic course.

Side Effects: Common side effects and when to seek medical attention.

Immunizations: Importance of pneumococcal and influenza vaccines.

52
Q

Bacterial Pneumonia in Children

A

Causes: Often secondary to viral infections; S. pneumoniae most common in <5 years.

Diagnosis: Chest radiograph shows lobar consolidation; blood cultures if no improvement.
Treatment:

Amoxicillin for outpatient treatment.

IV therapy: Ampicillin, cefotaxime, or ceftriaxone for penicillin-resistant strains.

Vancomycin for life-threatening infections.

Special Cases: S. aureus pneumonia treated with vancomycin plus beta-lactam.

53
Q

Chlamydial Pneumonia in Infants

A

Presentation: Afebrile infants aged 2 to 19 weeks with staccato cough, tachypnea, cervical adenopathy, and rales.

Diagnosis: PCR assays are preferred for rapid and accurate detection.
Treatment: Macrolides are standard.

Outpatient Management: Feeding and hydration ability determine outpatient suitability.

54
Q

Mycoplasma Pneumonia in Children and Adolescents

A

Presentation: Mild symptoms, dry cough, malaise, headache; may include wheezing and rash.

Diagnosis: PCR test for M. pneumoniae; chest radiograph shows broncho vascular markings.

Treatment: Macrolides are preferred.

55
Q

Duration of Therapy

A

The Short-Course Antimicrobial Therapy for Pediatric Respiratory Infections (SAFER) study found that 5 days of high-dose amoxicillin is as effective as 10 days for treating pediatric CAP in healthy children.

Authors recommend future guidelines to consider 5 days of high-dose amoxicillin due to its effectiveness and alignment with antimicrobial stewardship.

56
Q

Lung Ultrasound

A

Efforts to limit children’s radiation exposure continue.
A meta-analysis found lung ultrasonography (LU) has higher sensitivity but lower specificity compared to chest radiography for diagnosing pediatric CAP.
LU shows promise for future use

57
Q

Biomarkers

A

Differentiating viral from bacterial pneumonia is crucial for treatment.
A meta-analysis reviewed 31 studies on 23 biomarkers.

C-reactive protein and procalcitonin are more sensitive than white blood cell count and erythrocyte sedimentation rate, but not yet independent diagnostic biomarkers.

Continued research is promising for improving CAP diagnosis and management.

58
Q

Patient Education:

A

Assessment of Respiratory Status:
Plan for Worsening Condition:
Medication Administration:
Assessment of Hydration:

59
Q

Assessment of Respiratory Status:

A

Educate caregivers on how to assess the child’s respiratory status and signs of respiratory deterioration.

Provide clear instructions, such as “If breathing more than __ breaths per minute, call the practitioner.”

60
Q

Plan for Worsening Condition:

A

Provide a clear plan for where caregivers should take the child if their condition worsens during the evening or night.

Explain how to access high-quality pediatric after-hours care, considering insurance rules.

Discuss the use of the emergency 911 system for respiratory distress, with clear guidelines on what constitutes respiratory distress.

61
Q

Medication Administration:

A

Instruct caregivers on how to administer medication appropriately.

Ensure caregivers have a medicine syringe for accurate oral medication administration.

Remind them about any special instructions regarding the administration of the antibiotic (e.g., with or without food).

62
Q

Assessment of Hydration:

A

Educate caregivers on how to assess hydration and expected parameters for urine output.

Provide clear instructions, such as “The infant should have a wet diaper every 6 to 8 hours at a minimum.”

Advanced Pharm (50 decks)

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