Common Outpatient conditions Flashcards
1
Q
treatment for acute bronchitis
A
- cough suppressants such as codeine or dextromethophan
- short acting beta-agnoists (controls symptoms - bronchospasm, wheeze, dyspnea and cough)
- PO NSAIDS- Improves the associated contitutional sxs
- antibiotics not recommended (acute bronchitis caused by pertussis infection is only indication)
- decongestants (toopical & oral) - effective for nasal congestion
2
Q
prevention of acute bronchitis?
A
- influenza vaccine
- zinc
- pneumococcal vaccine indicated for chronic bronchitis
3
Q
- cough for up to 3 weeks
- most commonly 2nd to common cold
- but first step is to determine etiology
A
Acute cough
4
Q
- cough for more than 8 weeks
- differential large, but also not emergency
- most common etiologies: upper airway cough syndrome, asthma, and gastroesophogeal reflux disease
A
chronic cough
5
Q
Top 4 chronic cough causes?
A
Upper airway cough syndrome
asthma
GERD
ACE inhibitors
6
Q
- # 1 cause of chronic cough in nonsmoking immunocompotent pt w/ normal CXR
- dx: based on H&P
- PE: draining posterior pharynx, nasal discharge, throat clearing, oropharyngeal cobblestoning
- TX: PO or topical decongestant, 1st gen antihistamine, +/- SABA inhaler
A
upper airway cough syndrome
7
Q
- acid reflux stimulates the afferent limb of cough refelx or esophageal-brochial cough reflex
- though sxs could be silent
- therapy: oral PPI recommended
- if poor respose to therapy- 24hr esophageal monitoring
A
GERD
8
Q
- cause cough in 5-20% of patients on these medications
- women more often than men
- not dose related
- cough starts 1-6 weeks after initiation
- tx: D/C medication, start ARB
A
ACE inhibitor
9
Q
- constantly occuring/ localized outbreaks
- these are small changes in the virus that happen continually over time. Antigenic drift produces new virus strains that may not be reconized by the body’s immune system
- ex. pts was infected with a particular flu viral, develops antibodies and gets infected with a new virus and antibody doesn’t recognize new virus
- one of the main reason why you can get the flu multiple times
A
antigenic drift
10
Q
- occasionaly occurs/ more widespread
- abrupt, major change in a virus, resulting in new hemagluttinin and/or new hemagglutinin and neuraminidase proteisn in viruses that infect hums
- Results in a new virus subtype or a virus with a hemag. or hemagglutinin and neuramindase combo that has emerged from an animal pop. that is different from the subtype in humans
- people have little or no protectin against the new virus
A
anteginc shift
11
Q
High risk population for influenza
A
- residents of nursing homes and chronic care facilites
- adults >65 years of age
- pregnant women and women up to two weeks postpartum. the risk of complicated influenza increased by trimester
- individuals with chronic medical conditions
- native americans and alaska natives
- morbidly obese individuals
12
Q
how do people infected with the influenza present?
A
- abrupt onset of fever, HA, myalgia and malaise
- accompanied by: URI, non-productive cough, ST, PND and rhinorrhea
- febrile, oropharyngeal hyperemia, cervical adenopathy(more prominent in younger patients), chest exam unremarkable
- sxs last, on average 2-5 days, possible a week or more
- complications: #1 pneumonia (strep pneumo is most common but staph is #2
13
Q
Influenza antiviral treatment
A
Neuraminidase inhibitors
- < 1% resistanace found
- reduces sxs by 1 day
Adamantines
- due to high level of resistance- not used to treat influenza 2013
These medication should not be used to treat other respiratory viruses
14
Q
- MOA: interfere with the release of these new influenza virsues from infected cells. Which prevents new round of infection from starting
- Medications: oseltamivir (tamiflu), Zanamivir
- ADRS: GI (N/V) and rash, rare neuropsych effects (delirium, hallucinations, confusion)
A
Neuraminidase inhibitors
15
Q
- MOA: prevents viral replication by blocking the viral M2 protein ion channel, preventing fusion of the virus and host-cell membranes (prevents the uncoating of the viruse proceeding its entry into cells)
- class is active only for influenza A, but high rate of viral resistance to this class
A
Influenza antiviral treatment
