Day 4- Pneumonia Flashcards
What are your risk factors for pneumonia?
What is the time cutoff for HAP/VAP?
What are your CAP pathogens?
Age >65, <2. Chronic disease(cardiac, pulmonary, diabetes, renal), smoking(current/past), URTI in last month, environmental factors(dust,chemicals, air pollution, toxic fumes).
> 48 hours after hospital admission/intubation.
S.pnuemoniae, H.influenzae, Atypicals( M.pnuemoniae, C.pnuemoniae, Legionella spp.)
What are common extra COPD/smoking pathogen and what about aspiration?
What are common extra lung abscesses pathogen and influenza in community?
What are extra pathogens for structural lung disease and injection drug use?
Pseudomonas. Oral anaerobes.
CA-MRSA, Influenza, S.pneumoniae, S.aureus.
Pseudomonas, S.aureus.
What are signs and symptoms of pneumonia?
How do you diagnose CAP?
What does CURB 65 stand for?
Dyspnea(SOB, increased RR), Pleuritic chest pain, fever, cough, Most infections: leukocytosis
Diagnosed with CXR and clinical presentation.
Confusion, Uremia( BUN >20), Respiratory Rate >30, Blood pressure ( SBP <90, DBP <60), 65 or older.
What are your CURB 65 risks and treatment setting?
What are the 4 comorbidities to consider in CAP that put you at risk for resistant strep pneumonia?
What are your outpatient DRSP risk factors?
0-1 low and outpatient, 2 is moderate and inpatient non-icu, Severe is 3 and inpatient ICU(non icu sometimes), 4-5 is highest inpatient ICU.
Chronic heart failure. lung, liver or renal disease. diabetes mellitus, alcoholism.
Age <2 or >65, b-lactam therapy in last 3 months, alcoholism, exposure to a child in a day care center.
What is 1st line outpatient empiric therapy for CAP?
What is 2nd line outpatient empiric therapy for CAP?
What is treatment for patients with comorbidities or risk factors for DRSP?
Z pak 500 mg PO day 1 and 250 mg day 2-5. or zpak azithromycin 500 mg po daily for 3 days.
Doxycycline 100 mg po q12h.
Levofloxacin 750 mg po daily OR Azithromycin regimen from previous slide and Augmentin 2 g PO BID, Amoxicillin 1 g PO TID or Cefdinir 300 mg PO BID.
What is inpatient therapy for CAP?
What is inpatient ICU therapy for CAP?
How do you cover for pseudomonas in inpatient?
Levofloxacin 750 mg PO/IV daily OR Azithromycin 500 mg IV/PO daily for 3 days AND Ceftriaxone 1 G IV daily or Ampicillin 1-2 G IV q6hr.
Ceftriaxone 1 G IV daily or Ampicillin-sulbactam(use if concerned about aspiration) 1.5-3 G IV q6h. + Levofloxacin 750 mg IV daily OR Azithromycin 500 mg IV daily x 3 days.
B-lactam + Fq or Beta lactam + aminoglycoside and azithromycin.
Which patients would benefit from steroid therapy in CAP?
Does Cipro cover S.pnuemoniae?
Does moxifloxacin cover pseudomonas or need renal dosing?
Sepsis or resp failure with Fi02> 50% + 1 or more of the following: metabolic acidosis, Lactate >4, C-reactive protein >150.
NO.
NO.
Does Azithromycin or Clarithromycin cover S.pneumoniae?
Does erythromycin cover H.influenzae?
Do erythromycin have a high rate of GI intolerance?
NO.
NO.
YES.
What is minimum length of treatment for CAP?
5 days.
