Community-Acquired Pneumonia Flashcards by Christopher Swims-Vernor

How do mucous and pH make the nose and throat inhospitable for some organsims

Germs are caught and cannot move while the pH is to low for some germs

How well did you know this?

Not at all

Perfectly

T/F: Cilia constantly move mucus up and out

True

How well did you know this?

Not at all

Perfectly

T/F: Cough and Gag reflex helps to aid in destroying organisms by either spitting out or sending them to the stomach

True

How well did you know this?

Not at all

Perfectly

How do microorganisms gain access to the body

Aerosolized particles, hematogenous, Aspiration

How well did you know this?

Not at all

Perfectly

What diseases can impair lung defenses

Guillian Barre, Multiple Sclerosis, Seizures, Cystic Fibrosis, Myocardial Infaction, Stroke, HIV

How well did you know this?

Not at all

Perfectly

What factors can impair lung defenses

using narcotics, alcohol, smoking, colonization

How well did you know this?

Not at all

Perfectly

What lung sounds can be heard in a patient

Rales and rhonchi, dullness to percussion

How well did you know this?

Not at all

Perfectly

What is a key way to know if pneumonia is present

Infiltrates on chest x-rays

How well did you know this?

Not at all

Perfectly

What is the definition of community acquired-pneumonia

an acute infection of the pulmonary parenchyma in a patient that has not been recently hospitalized, exposed to antibiotics , or residing in a nursing home

How well did you know this?

Not at all

Perfectly

Along with the definition of community acquired-pneumonia what else is need to diagnose community-acquired pneumonia

Clinical symptoms or presence of an infiltrate or ausculatory findings

How well did you know this?

Not at all

Perfectly

T/F: Diagnosing the cause of pneumonia is done 70% of the time

False: 40-60% of cases of CAP fail to identify a causative organism

How well did you know this?

Not at all

Perfectly

What are the typical organisms that cause pneumonia

Streptococcus pneumonia, moraxella catarrhalis, hemophilus influenzae

How well did you know this?

Not at all

Perfectly

What are the atypical organisms that cause pneumonia

Chlamydophilia, mycoplasma

How well did you know this?

Not at all

Perfectly

What are the opportunistic organisms that pneumonia (Immunocompromisde/elderly)

legionella, influenza

How well did you know this?

Not at all

Perfectly

What risk factors for acquiring pneumonia

Age, immunocompromised (HIV/ Hematologic malignancy), COPD. smoking, alcoholism, chronic cardiovascular disease, diabetes

How well did you know this?

Not at all

Perfectly

What constitutes a good sputum culture

Greater than 25 WBCs and less than 10 epithelial cells

How well did you know this?

Not at all

Perfectly

T/F: A negative chest X-ray proves there is no pneumonia

False: Negative chest X-rays could be because the patient is dehydrated

How well did you know this?

Not at all

Perfectly

What is the CURB-65, what does each letter stand for

Clinical predication tool for the severity of the pneumonia/ C= confusion, U=uremia, R= respiratory rate, B= blood pressure

How well did you know this?

Not at all

Perfectly

What are the ranges for each section of the CURB-65

Uremia- BUN greater than 20mg/dl, Respiratory rate- greater than or equal to 30, Blood Pressure less than 90/60 mmHg, Age greater than 65

What score on the CURB-65 leads to outpatient, inpatient, ICU

0-1, 2, greater than 3

What are the the two antibiotics that can be given for a patient with no risk factors and has not be on any antibiotics

Macrolides OR doxycycline

What is the drugs names dose, frequency for macrolides used to treat a patient with pneumonia with no risk factors and not recent antibiotic therapy

Azithromycin extended release suspension 2 grams once or 500 mg tablet for 1 day then 250 mg tablet for 4 days, clarithromycin 250-500 mg every 12 hours or extended release 1 gram for 1 day

What is dose and frequency for doxycycline used to treat a patient with pneumonia with no risk factors and no recent antibiotic therapy

100 mg every 12 hours for 7 to 14 days

T/F: Clarithromycin must be renally adjusted and is a strong inhibitor of 3A4 therefore it is not used as often as azithromycin

True

What are drug interactions for doxycycline

Antacids, magnesium, iron, calcium

What are the antibiotics would be given if a patient has pneumonia as well as co-morbid diseases as well but no risk factors

Respiratory fluoroquinolone OR macrolide or doxycline plus a beta-lactam

What is the drug, dosing, and frequency for respiratory fluroquinolones used to treat pneumonia in a patient with co-morbid conditions

Levofloxacin 750 mg daily for 5 days or 500 mg daily for 7 days, moxifloxacin 400 mg daily, gemifloxacin 320 mg daily

T/F: All of the respiratory fluroquinolones need renal adjustment except moxifloxacin

True

What is drug, dosing, and frequency for beta lactams used with macrolide OR doxycycline to treat pneumonia in a patient with co-morbid conditions

Amoxicillin-clavulanate 500 mg every 8 hours or 875 mg every 12 hours, Amoxicillin 1 gram every 8 hours, cefuroxime 500 mg every 12 hours, cefpodoxime 200mg every 12 hours

T/F: Beta-Lactams do not need to adjusted for renal disfunction

False: Beta-lactams do need to be renally adjusted

What are the antibiotics name, dose, frequency that would be given if a patient has aspiration pneumonia

Clindamycin 300 mg every 6 hours or 450 mg every 8 hours, Amoxicillin-clavulanate 500 mg every 8 hours or 875 mg every 12 hours

What is the usual length of therapy for pneumonia, what is the pneumonia is caused by legionella, what antibiotics are the exceptions

7-14 days, 10 days, azithromycin and levofloxacin 750 mg

What are the antibiotics that would be given to a patient that is inpatient

Respiratory fluoroquinolone OR macrolide or doxycline plus a beta-lactam

What are the beta-lactams name, dose, frequency and route given if a patient is inpatient with pneumonia

Ceftriaxone 1 gram IVPB every day, Cefuroxime 0.75-1.5 grams IVPB every 8 hours, ampicillin/sulbactam 3 grams IVPB every 6 hours or ertapenem 1 gram IVPB daily

T/F: For the beta-lactams that are given inpatient they all need to be renally adjusted except ceftriaxone

True

What is the macrolide and doxycline dose, route and frequency that will be given along with the beta-lactam for inpatient

Azithromycin 500 mg IVPB daily, Doxycycline 100 mg IVPB every 12 hours

What are the fluoroquinolones name, route, dose and frequency given for inpatient pneumononia

levofloxacin 500-750 mg IVPB daily, moxifloxacin 400 mg IVPB daily

T/F: Macrolide, doxycycline and fluroquinolone can give the same oral doses as alternates in inpatient

False: Macrolides and fluroquinolones can be given as alternative oral doses in inpatient

What are the antibiotics that would be given if the patient is in the ICU from pneumonia

Beta-lactam PLUS macrolide or respiratory fluroquinolone

What are the beta lactams that name, dose, frequency and route given if a patient is ICU with pneumonia

Ceftriaxone 1 gram IVPB every 12 hours, Cefuroxime 0.75-1.5 grams IVPB every 8 hours, ampicillin/sulbactam 3 grams IVPB every 6 hours or ertapenem 1 gram IVPB daily

What are the macrolide and respiratory fluroquinolones name, dose, frequency, and route given if a patient is in ICU with pneumonia

Azithromycin 500 mg IVPB daily, levofloxacin 500-750 mg IVPB daily, moxifloxacin 400 mg IVPB daily

What is given if a patient has pneumonia in the ICU but also has a penicillin alergy

Respiratory fluroquinolone AND aztreonam 1-2 grams IVPB every 8 hours

T/F: Psedumonal infection caused pneumonia get treated as hospital acquired pneumonia patiens

True

What are special populations when treating pneumonia

Cystic fibrosis, bronchiectasis, HIV

How long should therapy be if the patient is inpatient or ICU

7-14 days total

When should a patient be switched from IV to Oral

Afebrile 24-48 hours and the GI tract is intact

What are the best ways to prevent pneumonia

Vaccination, hand hygiene