Community-Acquired Pneumonia Flashcards
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
T/F: Cilia constantly move mucus up and out
True
T/F: Cough and Gag reflex helps to aid in destroying organisms by either spitting out or sending them to the stomach
True
How do microorganisms gain access to the body
Aerosolized particles, hematogenous, Aspiration
What diseases can impair lung defenses
Guillian Barre, Multiple Sclerosis, Seizures, Cystic Fibrosis, Myocardial Infaction, Stroke, HIV
What factors can impair lung defenses
using narcotics, alcohol, smoking, colonization
What lung sounds can be heard in a patient
Rales and rhonchi, dullness to percussion
What is a key way to know if pneumonia is present
Infiltrates on chest x-rays
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
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
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
What are the typical organisms that cause pneumonia
Streptococcus pneumonia, moraxella catarrhalis, hemophilus influenzae
What are the atypical organisms that cause pneumonia
Chlamydophilia, mycoplasma
What are the opportunistic organisms that pneumonia (Immunocompromisde/elderly)
legionella, influenza
What risk factors for acquiring pneumonia
Age, immunocompromised (HIV/ Hematologic malignancy), COPD. smoking, alcoholism, chronic cardiovascular disease, diabetes
What constitutes a good sputum culture
Greater than 25 WBCs and less than 10 epithelial cells
T/F: A negative chest X-ray proves there is no pneumonia
False: Negative chest X-rays could be because the patient is dehydrated
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
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
