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Advanced Pharm > Chapter 51 - Upper Respiratory Infections > Flashcards

Chapter 51 - Upper Respiratory Infections Flashcards

Week 2

1
Q

URI S/s

A

Starts with nasal congestion, rhinorrhea, malaise, and scratchy throat
Peak severity days 3-6, may persist to 10-12 days, most symptom free 7-10 days after start
May have generalized muscle aches but no fever
Young children can have low-grade fever for 24-48 hours
Adults with fever or high-grade fever in children suggest influenza or secondary infection (eg. sinusitis/OM)

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2
Q

URI Pathophysiology

A

Primary cause is rhinovirus (160 serotypes; Multiple strains is reason for reinfections despite immunity)
Additional viruses
- Adenovirus
- Common cold coronaviruses
- COVID-19
- Respiratory syncytial virus
- Parainfluenza virus
- Influenza viral strain
- Human Metapneumovirus

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3
Q

URI Transmission

A

Airborne/DC via secretions

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4
Q

URI Goals of Treatment

A

Symptom relief

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5
Q

URI Drug Therapy

A

Decongestants
- Oral - Pseudoephedrine HCl, Pseudoephedrine sulfate, Phenylephrine (Pseudoephedrine can make meth. FDA restrictions)
- Topical - Phenylephrine HCl, Oxymetazoline HCL
(Vasoconstrict capillaries of nasal mucous membranes to promote drainage and decrease stuffiness)

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6
Q

URI Decongestants for children under 4?

A

Not recommended. Insufficient evidence for effectiveness

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7
Q

URI Nonpharm Therapy

A

Increased fluid intake, nonmedicated cough drops, nasal saline spray, rest

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8
Q

URI Monitoring

A

Watch for secondary bacterial infection
Cardiac patients - HTN from vasoconstriction by oral decongestant
Older - more likely to have adverse rxn

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9
Q

URI Complications

A

Most common is sinusitis (0.5-2% of adults, 6-7% in children,
Otitis Media in infants (27%)
- OM can be due to middle ear/etustachian tube anatomy
- Day care children tend to have more otopathogens - more likely to develop OM with URI
Exacerbation of asthma (30-50% of adults, 60-79% of children)

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10
Q

URI Education

A

Symptom management
Proper dosing of decongestants
Abx not necessary

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11
Q

Sinusitis

A

Diagnosed by persistent URI >10 days w/o clinical improvement likely to be bacterial sinusitis

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12
Q

Sinusitis s/s

A

High fever, facial pain, purulent nasal discharge for 3-4 days
Possible “Double-sickening”; worsening of symptoms that were previously improving

Adults
- Purulent Rhinorrhea, Facial Pain/Pressure, and Nasal obstruction
- H/A that worsens when they bend over
- Cough that’s worse at night
Children; S/s will be more subtle due to lack of development of frontal sinuses
- Increased frequency of colds require careful hx check to see if this is a new infection or prolonged s/s
Both
- Puffy eyes, cough that worsens when they lie down

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13
Q

Is imaging useful in Sinusitis

A

Questionable because sinus images will look the same in viral URI and sinus infection

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14
Q

Chronic Sinusitis

A

s/s for 8-12 weeks
Confirmed with Endoscopy or CT
Multiple episodes of acute bacterial sinusitis per year

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15
Q

Sinusitis Pathophysiology (Acute)

A

Common: Streptococcus Pneumoniae (Strep P), Haemophilus Influenzae, Moraxella Catarrhalis
Rarer: Staphylococcus

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16
Q

Sinusitis Pathophysiology (Chronic)

A

Common; Staphylococcus, Gram-Neg Enteric, Anaerobic Bacteria
Rarer; Fungal (Aspergillus)

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17
Q

Sinusitis Cause Agent finding requires

A

Sinus/Endoscopic aspiration for accurate organism. Nasal mucosa culture not useful

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18
Q

Sinusitis consideration for immunocompromised pt

A

Severe infections with possible invasive extensions to eye/mouth/brain

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19
Q

Sinusitis Goals of Treatment

A

Absence of infection, free of all s/s of sinus infection

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20
Q

Sinusitis Drug

A

First Choice ABX: Amoxicillin (PO) w or w/o clavulanate (Augmentin)
- Standard dose for bacterial sinusitis
- High-dose if patient is at risk for resistance
Alternate if allergic to Penicillins
- Adult: Doxycycline (PO) or Respiratory Fluoroquinolone (Levofloxacin/Moxifloxacin)
- Children: Gen 3 Cephalosporin (Cefdinir, Cefuroxime, Cefpodoxime)

21
Q

Sinusitis Drug if not improving in 72 hours

A

Adults: High-dose amoxicillin-clavulanate or Fluoroquinolone (Levofloxacin/Moxifloxacin)
Children: High-dose Amoxicillin-clavulanate or gen 3 cephalosporins (listed above)

22
Q

Patient failure to respond to drug therapy indicates?

A

Misdiagnosis or resistance
- CT/MRI to confirm dx

23
Q

Sinusitis Monitoring

A

Should resolve in 7 days of treatment
Untreated, can lead to orbital cellulitis or brain involvement
Can exacerbate asthma

24
Q

Sinusitis Education

A

Same as URI
Don’t go diving
If flying/driving over high altitude, use topical decongestants

25
Q

Pharyngitis

A

Infection of pharynx or tonsils; Cause of Sore throat 20-30% in children, 5-15% in adults

26
Q

Pharyngitis Causative Agent (Viral)

A

Adenovirus
Influenza
Parainfluenza
Rhinovirus
Coxsackievirus
RSV
Epstein-Barr

27
Q

Pharyngitis Causative Agent (Bacterial)

A

Group A Streptococcal (GAS) most common, commonly seen in children 5-15
- Confirmed by Rapid Antigen Testing/culture

28
Q

Pharygitis S/s

A

Presents sore throat, fever, Pharynx erthematous w or w/o exudate
- Children: H/A, N/V, abd pain
- Possible petechiae on soft palate, uvula red/swollen, strawberry tongue, confluent sandpaper rash (scarlatine rash aka scarlet fever)

29
Q

Pharyngitis Treatment Goals

A

Eradicate bacteria
Prevent development of Acute Rheumatic Fever (ARF)
- Can be prevented if antimicrobial started within 9 days of onset of s/s

30
Q

Pharygitis Drugs (Bacterial)

A

Beta-Lactams for GAS; Minimal resistance
- First Line: Penicillin V or Amoxicillin (PO)
- Penicillin G Benzathine (IM) can be given for children by weight

Nonanyphylactic allergy to penicillin
- Gen 1 Cephalosporin (Cephalexin)

Type 1 Penicillin allergy
- Clinamycin or Azithromycin

Pharyngeal carriers of GAS
- Clinamycin, Amoxicillin-Clavunalic Acid, or Penicillin w/Rifampin added on the last days of treatment

31
Q

Pharyngitis Monitoring

A

ADR
S/s resolution

32
Q

Pharyngitis Outcomes

A

Rapid antigen test to confirm GAS
S/s should improve within first 24 hours
Complete treatment to prevent ARF

33
Q

Pharyngitis Education

A

Antipyretics for fever/discomfort
Take full therapy
Warm fluids and cool, soft foods tolerated better

34
Q

Ottis Media

A

Most common reason for children getting abx
Most common in children <10 years
Vaccine PCV7, PCY13, and Haemophilus influenzae (HiB) decreased cases of AOM

35
Q

Ottis Media s/s

A

Often fever, Possible hearing loss, tinnitus, dizziness, unsteady gain, balance problems
Children
- Tug and poke at ear, irritable, poor sleep, Vomiting/Diarrhea

36
Q

Ottis Media Dx

A

1) Moderate-Severe bulging of Temporal Membrane or new onset of orrrhea
2) Mild bulging of TM and recent onset of ear pain or intense erythema of TM
***No diagnosis of AOM in children who do not have middle ear effusion

37
Q

Ottis Media Pathophysiology

A

Eustachian tube dysfunction, blocking secretion flow from middle ear to pharynx; negative pressure develops in middle ear causing reflux of bacteria into middle ear space
Leads to MEE infected with nasopharyngeal bacteria

Children more susceptible due to shorter/more horizontal/more flaccid eustachian tubes

Risk factors
- URI
- Down
- Cleft palate
- HIV
- Eskimo/Native American
- Higher rate of infection in bottle vs breast fed and living with tobacco smokers
- Daycare doubles odds of AOM
- Immunocompromised/NG tubes

38
Q

Ottis Media Causative Agent (Bacterial)

A

S Pneuimoniae
H Influenzae (Most common since PCV7 and PCV13)
- Approximate 90% nontypable
M Catarrhalis

39
Q

Ottis Media Causative Agent (Viral)

A

RSV, Rhino, Corona, Adeno, Parainfluenza found alone (4%) or as a copathogen (66%)

40
Q

Ottis Media Treatment Goals

A

Clear infection from ME with abx. If effective, infection clears
Treatment is empirical and may require change of abx

41
Q

Ottis Media Drug

A

First Line: Amoxicillin

Repeated AOM/Abx in last 30 days: Beta-lactamase stable amoxicillin/clavulanate or Betalactamase-stable cephalosporin (for penicillin allergy)

Can choose to treat by waiting/observing with “safety net” prescription to use if needed

42
Q

Ottis Media and Abx resistance

A

Frequent use of abx gave rise to resistance, causing reevaluation of use

Almost 100% of M Catarrhalis produce beta-lactamase (resistant to amoxicillin/other penicillins)

97% of pneumococci susceptible to penicillin; Amoxicillin remains first line

S Pneumoniae resistant to common macrolides
More frequent in
-Children attending daycare
-Recurrent AOM
-Younger than 2 years
-Recently treated with Beta-lactamase abx

43
Q

Ottis Media Monitoring

A

Effectiveness of treatment based on 2-3 montoring or Abx prescription
If s/s resolve, should be reexamined
- Children <2: 8-12 weeks after starting sbx
- Children >2: Next scheduled wellness exam

44
Q

Ottis media Education

A

Must be firm with treatment choice (observation or treatment)

Reexamine if still having significant pain after 48 hours

Ensure they finish treatment

45
Q

Ottis Externa

A

Also known as “Swimmer’s Ear”

OM in external auditory canal

46
Q

Ottis Externa S/s

A

Severe ear pain, starting with itching/irritation that is unilateral and localized
Pinna/Tragus manipulation causes pain
TM is normal but External canal is swollen

47
Q

Ottis Externa Pathophysiology

A

Trauma/prolonged exposure to moisture
P Aeruginosa most common, then S Aureus

48
Q

Ottis Externa Drug

A

Topical Therapy
- Combo med: Corticosteroids and Abx
- Solo Abx
- Acetic acid/alcohol drops

49
Q
A

Advanced Pharm (50 decks)

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