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PHRM 865 > E3 LRTI > Flashcards

E3 LRTI Flashcards

1
Q

definition of CAP

A

pneumonia that developed outside of the hospital or within the first 48 hours of hospital admission

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2
Q

3 things listed under pathogenesis for CAP, and then which one is most common

A

Aspiration **
Aerosolization
Bloodborne

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3
Q

which microorganism class is the most common pathogenic organism for CAP?
A. Fungus
B. Bacteria
C. Virus
D. Protozoa

A

C

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4
Q

most common bacterial pathogen

A

streptococcus pneumoniae

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5
Q

risk factors for drug resistance : strep pneumo

A
  • age <6 or >65
  • prior antibiotic therapy
  • comorbid conditions
  • recent hospitalization
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6
Q

“more common” atypical bacteria for CAP

A

mycoplasma pneumoniae

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7
Q

common way mycoplasma pneumo is spread

A

person to person contact

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8
Q

how is legionella pneumo spread

A

aerosolization

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9
Q

what is an important thing to consider in an infection caused by staph aereus

A

get MRSA nasal PCR test to predict value for MRSA in CAP*

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10
Q

5 conditions that serve as risk factors for many pathogens

A
  • alcoholism
  • COPD/smoker
  • post influenza pneumo
  • structural lung disease
  • recent antibiotic exposure
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11
Q

clinical presentation of CAP (5)

A
  • sudden onset of fever
  • chills
  • pleuritic chest pain
  • dyspnea
  • productive cough
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12
Q

clinical presentation of CAP:
gradual onset with lower severity for ________ and _______ pneumoniae

A

mycoplasma
chlamydia

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13
Q

clinical presentation of CAP, elderly patients:
classic symptoms may be _________ such as what 2 things

A

absent
afebrile, mild leukocytosis

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14
Q

4 vitals for clinical presentation of CAP

A
  • febrile
  • tachycardia
  • hypotensive
  • tachypnea
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15
Q

what is rec for all pts with suspicion for CAP

A

chest x ray

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16
Q

what does sputum look like:
viral:
bacterial:

A

viral -> clear
bacterial -> gross

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17
Q

when doing a microscopic exam of sputum we only evaluate samples with >__ PMNs and < 10 epithelial cells

A

25, 10

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18
Q

i dont remember what he said on slide 21 so i will go back and find that later i promise

A

thanks cole

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19
Q

what are the 2 major criteria for severe CAP? how many of these do you need to qualify it as severe

A
  • septic shock requiring vasopressors
  • respiratory failure requiring mechanical ventilation
    (only need one of these to occur for severe)
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20
Q

9 minor criteria for severe cap and how many do you need to consider it severe (i dont think we will need to know all of this but might as well throw it in here) i will star ones that came up in his cases tho frfr

A
  • resp rate >30BPM *
  • PaO2/FlO2 <250
  • multilobar infiltrates
  • confusion/disorientation *
  • uremia (BUN >20) *
  • Leukopenia (WBC <4000)
  • Thrombocytopenia (Pit <100,000)
  • Hypothermia (temp <36)
  • hypotension requiring fluids *
    NEED 3 OF THESE
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21
Q

Other tools for CAP:
procalcitonin
when is it clinically useful?

A

guiding DURATION of treatment

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22
Q

T or F:
procalcitonin is a useful tool to determine antibiotic needs for CAP

A

false *

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23
Q

what are the two clinical prediction tools for CAP and which one is common

A
  • pneumonia severity index (PSI)
  • CURB-65 *
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24
Q

what does CURB-65 do?

A

estimates mortality for CAP

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25
CAP Empiric therapy, outpatient, NO comorbidities (3)
- amox 1 gm PO Q8h - doxy 100 mg PO BID - macrolide resistance <25%: azithromycin
26
CAP Empiric therapy, outpatient, WITH comorbidities: monotherapy -> ___ combo therapy -> __
mono: levo, moxi (respiratory FQs) combo: B-lactam + macrolide OR doxy
27
what are the comorbidities we focus on for treatment options? (a lot)
- heart disease - lung disease - renal disease - T2DM - alcoholism - cancer - asplenia/immunosuppression (wont be asked about probably)
28
3 recommended b-lactams for the combos used with outpatient CAP
- amox/clav - cefpodoxime - cefuroxime
29
CAP empiric therapy, non-severe, inpatient, NO comorbidities mono: combo:
mono: levo, moxi combo: B-lactam + macrolide
30
rec beta lactams for use in inpatient setting for combo therapy
amp/sulbactam (unasyn) ceftriaxone
31
CAP empiric therapy, inpatient, severe combo 1: combo 2:
combo 1: levo/moxi + b-lactam combo 2: b-lactam + macrolide
32
CAP empiric therapy, inpatient: MRSA risk factors present, what 2 drugs
- vanc - linezolid
33
CAP empiric therapy, inpatient: pseudomonas risk factors present, what 3 drugs
- Piper/Tazo (Zosyn) - cefepime - meropenem
34
3 risk factors for MRSA
- 2-14 days post influenza - previous MRSA infection - previous hospitalization and use of IV antibiotics in last 90 days
35
2 risk factors for Pseudomonas
- previous pseudomonas infection - previous hospitalization and use of IV antibiotics within last 90 days
36
T or F: corticosteroids are a staple in treatment of non-severe CAP
false
37
if corticosteroids arent recommended in CAP, when is the ONLY time they'd be considered
surviving sepsis guidelines when patient has CAP and septic shock *
38
recommended duration of CAP therapy
minimum of 5 total days
39
CAP clinical stability: - Temp < __ - HR < ____ - RR < ___ - SBP > __
- 38 - 100 - 24 - 90
40
aspiration pneumonia: No _______ coverage recommended unless lung abscess or empyema present
anaerobic
41
HAP= pneumo occuring > __ hours after hospitalization
48
42
VAP= pneumo occuring > __ hours after endotracheal intubation
48
43
some of the risk factors for HAP/VAP
- old - comorbid diseases - duration of hospitalization - endotracheal tube - nasogastric tube - altered mental status * - surgery - previous antibiotic therapy
44
what is the gold standard for diagnosing HAP/VAP
none idiot
45
typical presentation of HAP/VAP
new lung infiltrate + clinical signs and sxs ( new onset fevre, purulent sputum, leukocytosis, decline in oxygenation)
46
Common pathogens for HAP/VAP: 3 aerobic GN bacilli
pseudomonas enteric GN bacilli (e. coli, kleb, citrobacter) acinetobacter
47
Common pathogens for HAP/VAP: other one
staph aureus (MRSA greater concern in this population)
48
T or F: invasive respiratory cultures have diagnostic threshold
true whatever that means
49
Respiratory culture diagnostic threshold: - may hold ________ based on threshold - protected specimen brush < __ CFU/mL - BAL: < __ CFU/mL
- antibiotic - 10^3 - 10^4
50
what does MDR mean
multi drug resistant
51
1 risk factor for MDR HAP
prior IV antibiotic use within 90 days
52
1 risk factor for MRSA HAP/VAP
prior IV antibiotic use within 90 days
53
2 risk factors for MDR pseudomonas aeruginosa
- prior IV antibiotic use within 90 days - carbapenems, broad-spectrum b- lactams, FQs
54
5 risk factors for MDR VAP
- prior antibiotic use within 90 days - septic shock at time of diagnosis - acute respiratory distress syndrome prior to diagnosis - acute renal replacement therapy prior to VAP onset - > 5 days of hospitalization prior to diagnosis
55
Empiric therapy - antibiotic choice: MRSA coverage , 3 risk factors
- typical risk factors for MRSA - ICUs where > 10-20% MRSA isolates - treatment where prevalence is unknown
56
Empiric therapy - antibiotic choice: MRSA coverage first line choices
- vanc - linezolid
57
Empiric therapy - antibiotic choice: Pseudomonas coverage 2 risk factors
- ICUs where >10% of isolates resistant - treatment where resistance rates are unknown
58
Empiric therapy - antibiotic choice: Pseudomonas coverage 5 drug choices
- Piper/tazo - cefepime - imipenem - meropenem - levofloxacin
59
Empiric therapy - HAP (NOT at high risk for mortality) : goal
provide coverage for MSSA + pseudomonas
60
Empiric therapy - HAP (NOT at high risk for mortality): 5 drug choices
- Piper/tazo - cefepime - imipenem - meropenem - levofloxacin
61
Empiric therapy - HAP (NOT at high risk for mortality, BUT MRSA risk): drugs
same as last time with the 5 but also consider vanc or linezolid
62
Empiric therapy - HAP ( HIGH risk for mortality and MRSA risk) (on ventilator support or septic shock): goal
provide coverage for MRSA + MDR pseudomonas
63
Empiric therapy - HAP ( HIGH risk for mortality and MRSA risk) (on ventilator support or septic shock): drugs
PICK 2 DIFF CLASSES: ** - piper/tazo - cefepime - imipenem - meropenem - levofloxacin - tobra/amikacin + vanc or linezolid
64
Empiric therapy - VAP: goal
provide coverage for MRSA + pseudomonas
65
Empiric therapy - VAP: when do you choose 2 anti-pseudomonals
risk factors for resistance
66
Empiric therapy - VAP: drugs
same as all the other shit with the vanc and linezolid too
67
Non-beta lactam considerations: when should daptomycin be used for LRTIs
never dumbass
68
Non-beta lactam considerations: Polymyxins (3)
- avoid empiric use if possible - reserve for pts with high prevalence of MDR pathogens - Significant nephrotoxicity
69
Non-beta lactam considerations: AMGs (3)
- recommend AGAINST use as monotherapy - avoid empiric use unless necessary - poor lung penetration, nephrotoxicity, ototoxicity, reports of lower clinical response rates
70
Non-beta lactam considerations: tigecycline (2)
- great for polymicrobial infections BUT.. - associated with increased mortality (rip)
71
Pathogen-Specific therapy: MSSA (2)
cefazolin, nafcillin
72
Pathogen-Specific therapy: Enterobacterales (1 class)
3rd gen cephs
73
Pathogen-Specific therapy: ESBL-producer (2)
carbapenem ceftazidime/avibactam
74
Pathogen-Specific therapy: KPC-Producer (3)
- meropenem/vaborbactam - imipenem/relebactam - ceftazidime/avibactam
75
Pathogen-Specific therapy: NDM/VIM-producer (2)
- ceftazidime/avibactam + aztreonam - cefederocol
76
Pathogen-Specific therapy: Acinetobacter spp (3)
- carbapenem - amp/sulb - cefiderocol
77
duration of therapy for HAP/VAP
7 day if clinically stable
78
does piperacillin/tazobactam cover ESBL producers
no, usually go to a carbapenem

PHRM 865 (40 decks)

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