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PHRM 865 > Exam 3 RTI > Flashcards

Exam 3 RTI Flashcards

1
Q

What are the three broad locations of host defense mechanisms

A
  1. Upper airways
  2. Conducting airways
  3. Lower respiratory tract
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2
Q

What is part of the upper airways (2)

A
  1. Nasopharynx

2. Oropharynx

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3
Q

Nasopharynx defense mechanism (5)

A
  1. Nasal hair
  2. Turbinates
  3. Anatomy of upper airways
  4. Mucociliary apparatus
  5. IgA secretion
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4
Q

Oropharynx defense mechanism (3)

A
  1. Saliva
  2. Sloughing of epithelial cells
  3. Complement production
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5
Q

What makes up the conducting airway (2)

A
  1. Trachea

2. Bronchi

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6
Q

Conducting airway host defense mechanism (5)

A
  1. Cough
  2. Epiglottic Reflexes
  3. Sharp, angled, branching airways
  4. Mucociliary apparatus
  5. IgG/M/A production
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7
Q

What makes up the lower respiratory tract (2)

A
  1. terminal airways

2. alveoli

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8
Q

Lower respiratory tract defense mechanisms (5)

A
  1. Alveolar lining fluid
  2. Cytokines
  3. Alveolar macrophages
  4. PMNs
  5. Cell-mediated immunity
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9
Q

What makes up alveolar lining fluid (4)

A
  1. surfactant
  2. fibronectin
  3. Complement
  4. immunoglobulin
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10
Q

What cytokines do we see in lower respiratory tract (3)

A
  1. TNF
  2. IL-1
  3. IL-8
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11
Q

Fibronectin mechanism

A

inhibits adherence of bacteria to cell surfaces –> prevents colonization

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12
Q

What happens when IgA gets degraded

A

colonization is promoted

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13
Q

Alveolar macrophages mechanism

A

eliminate organisms by phagocytosis and produce cytokines that recruit neutrophils into the lungs –> local area becomes acidic and hypoxic –> impairs phagocytic activity

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14
Q

Different types of pathogenesis for pneumonia (3)

A
  1. Aspiration
  2. Aerosolization
  3. Bloodborne
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15
Q

Most common pathogenesis for bacterial pneumonia

A

Aspiration that causes bacteria to colonize the oropharynx

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16
Q

Specific pathogens in CAP (7)

A
  1. Strep pneumoniae
  2. H. influenzae
  3. Mycoplama pneumoniae
  4. Legionella
  5. Chlamydophila
  6. Staph aureus
  7. Viral
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17
Q

Outpatient CAP pathogens (5)

A
  1. S. pneumoniae
  2. M. pneumoniae
  3. H. influenzae
  4. C. pneumoniae
  5. Respiratory viruses
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18
Q

Inpatient (non-ICU) CAP pathogens (7)

A
  1. S. pneumoniae
  2. M. pneumoniae
  3. C. pneumoniae
    4 H. influenzae
  4. Legionella species
  5. Aspiration
  6. Respiratory viruses
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19
Q

Inpatient ICU CAP pathogens (6)

A
  1. S. pneumoniae
  2. Legionella
  3. S. aureus
  4. GNB
  5. H. influenzae
  6. Influenza
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20
Q

most common species for bacteremic pneumonia cases

A

strep pneumoniae

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21
Q

Risk factors for DRSP

A
  1. extremes of age
  2. prior antibiotic therapy
  3. underlying illness/co-morbid
  4. Day care
  5. Recent or current hospitalization
  6. immunocompromised, HIV, nursing home, prison
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22
Q

symptoms of mycoplasma pneumoniae

A

gradual onset of fever, headache, and malaise; development of persistent, hacking, nonproductive cough after 3-5 days
sore throat, ear pain, and rhinorrhea usually present
non-pulmonary symptoms very common (N/V, diarrhea, myalgia, arthralgia)

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23
Q

mycoplasma timing

A

slow growth of 2-3 weeks

symptoms last up to 4 weeks

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24
Q

mycoplasma radiographic findings

A

patchy, interstitial infiltrates (not consolidation)

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25
Legionella symptoms
* gradual onset * presence of high fevers * relative bradycardia * Rapid progression on CXR and multilobar involvement * Mental status changes * Need for ICU care * Increased LFTs and SCr
26
What bacteria is more likely in patients post influenza
staph aureus
27
stap aureus symptoms
sudden onset of shaking chills, pleuritic chest pain, productive cough, increased WBC with left shift, consolidation
28
General symptoms of CAP
``` sudden onset of fever chills pleuritic chest pain dyspnea productive cough tachycardia ```
29
when is chest radiography needed in CAP
should be performed on all outpatients and inpatients with suspected CAP
30
chest radiography findings in CAP
dense lobar consolidation or segmental infiltrates suggestive of bacteria etiology
31
What should be seen on a gram stain
>25 PMNs | <10 epithelial cells/LPFs
32
rust-colored sputum
s. pneumoniae
33
dark red, mucoid sputum
k. pneumoniae
34
foul smelling sputum
mixed anaerobic infection
35
In adults with CAP, should Gram stain and culture of lower respiratory secretions be obtained at time of diagnosis
Recommend NOT obtaining sputum gram stain and culture of respiratory secretions in adults with CAP managed in outpatient setting
36
When to do CAP gram stain
- classified as severe CAP, esp if intubated - being treated for MRSA or p. aeruginosa - Previously infected with above - Were hospitalized and received parenteral antibiotics in the past 90 days
37
Initiation of CAP treatment and testing
Recommend initiation of empiric antibiotic therapy in adults with clinically suspected and radiographically confirmed CAP regardless of initial serum procalcitonin concentration
38
General treatment of CAP
1. humidified oxygen if hypoxemic 2. Bronchodilators 3. Fluids 4. Chest physiotherapy 5. Appropriate antimicrobial therapy
39
Treatment of CAP for healthy outpatient adults without comorbidities or risk factors for antibiotic-resistant pathogens
1. Amoxicillin | 2. Doxycycline
40
Can you give macrolides for Treatment of CAP for healthy outpatient adults without comorbidities or risk factors for antibiotic-resistant pathogens
Yes where resistant is < 25% Z-pack Clarithromycin
41
Treatment of CAP for outpatient adults with co morbidities general
FQ monotherapy beta lactam + macrolide beta lactam + doxycycline
42
FQ Treatment of CAP for outpatient adults with co morbidities
levofloxacin moxifloxacin gemifloxacin
43
beta lactam Treatment of CAP for outpatient adults with co morbidities
Augmentin Cefpodoxime Cefuroxime
44
macrolide Treatment of CAP for outpatient adults with co morbidities
Z pack | Clarithromycin
45
doxycycline Treatment of CAP for outpatient adults with co morbidities
doxycycline 100 mg q 12h (? loading dose of 200 mg)
46
treatment of CAP in inpatient setting for empiric treatment of non-sever CAP in adults without risk factors for MRSA and P. aeruginosa general
beta lactam + macrolide respiratory FQ beta lactam + doxy if CI to FQs and macrolides
47
beta lactam treatment of CAP in inpatient setting for empiric treatment of non-sever CAP in adults without risk factors for MRSA and P. aeruginosa
Ampicillin/sulbactam Cefotaxime Ceftriaxone ceftaroline all IV
48
macrolide treatment of CAP in inpatient setting for empiric treatment of non-sever CAP in adults without risk factors for MRSA and P. aeruginosa
Azithromycin | Clarithromycin
49
respiratory FQ treatment of CAP in inpatient setting for empiric treatment of non-sever CAP in adults without risk factors for MRSA and P. aeruginosa
Levo | Moxi
50
doxycycline treatment of CAP in inpatient setting for empiric treatment of non-sever CAP in adults without risk factors for MRSA and P. aeruginosa
100 mg IV/PO q 12
51
treatment of CAP in inpatient setting for empiric treatment of severe CAP in adults without risk factors for MRSA and P. aeruginosa general
beta lactam + macrolide | beta lactam + FQ
52
beta lactam treatment of CAP in inpatient setting for empiric treatment of severe CAP in adults without risk factors for MRSA and P. aeruginosa
Ampicillin/sulbactam Cefotaxime Ceftriaxone ceftaroline all IV
53
macrolide treatment of CAP in inpatient setting for empiric treatment of severe CAP in adults without risk factors for MRSA and P. aeruginosa
Azithromycin | Clarithromycin
54
respiratory FQ treatment of CAP in inpatient setting for empiric treatment of severe CAP in adults without risk factors for MRSA and P. aeruginosa
Levo | Moxi
55
In inpatient setting, should patients with suspected aspiration pneumoniae receive additional anerobic coverage beyond standard empiric treatment for CAP
No
56
Treatment of CAP in inpatient, non-severe or severe CAP, prior respiratory isolation of MRSA
Add MRSA coverage: vanc linezolid
57
treatment of CAP in inpatient, non-severe or severe CAP, prior respiratory isolation of p. aeruginosa
``` Pip/tazo cefepime ceftazidime aztreonam meropenem imipenem ```
58
In inpatient setting, should adults with CAP be treated with corticosteroids
No
59
In adults with CAP who test positive for influenza, should the treatment regiment include antiviral therapy?
Yes
60
In outpatient and inpatient adults with CAP who are improving, what is the appropriate duration of antibiotic therapy?
antibiotic therapy should be continued until the patient achieves clinical stability and for no less than a total of 5 days
61
in adults with CAP who are improving, should follow-up chest imaging be obtained?
NO
62
CAP strep pneumoniae MIC < 2 (pen sus) preferred therapy
pen g | amoxicillin
63
CAP strep pneumoniae MIC < 2 (pen sus) alternative therapy
macrolide cephalosporin respiratory FQ doxycyline
64
CAP strep pneumoniae MIC > 2 (pen resistant) preferred therapy
respiratory FQ ceftriaxone cefotaxime
65
CAP strep pneumoniae MIC > 2 (pen resistant) alternative therapy
vanc linezolid high-dose amoxicillin 3g/day
66
CAP non beta lactamase producing h. influenzae preferred therapy
amoxicillin
67
CAP non beta lactamase producing h. influenzae alternative therapy
fq doxycycline azithromycin clarithromycin
68
CAP beta lactamase producing h. influenzae preferred therapy
2/3 gen ceph | augmentin
69
CAP beta lactamase producing h. influenzae alternative therapy
FQ doxycyline azithromycin clarithromycin
70
CAP mycoplasma/chlamydophila preferred therapy
macrolide | doxycycline
71
CAP mycoplasma/chlamydophila alternative therapy
FQ
72
CAP legionella preferred therapy
FQ | azithromycin
73
CAP legionella alternative therapy
doxycyline
74
CAP meth-sus s. aureus preferred therapy
nafcillin | oxacillin
75
CAP meth-sus s. aureus alternative therapy
cefazolin | clindamycin
76
CAP meth-res s. aureus preferred therapy
vanc | linezolid
77
CAP meth-res s. aureus alternative therapy
bactrim
78
CAP anaerobes preferred therapy
beta lactam/ase inhibitor | clindamycin
79
CAP anaerobes alternative therapy
carbapenem
80
CAP enterobacteriaceae preferred therapy
3/4 gen ceph | carbapenem
81
CAP enterobacteriaceae alternative therapy
beta lactam/ase inhibitor | FQ
82
HAP
pneumonia occuring > 48 hours after hospital admission
83
VAP
pneumonia occurring > 48-72 hours after endotracheal intubation
84
Outcomes in patients treated with guideline-adherent therapy
increased mortality noticed
85
Pathogenesis of HAP, VAP
- Microaspiration of oropharyngeal secretions colonized with pathogenic bacteria (gram negatives) - Aspiration of esophageal/gastric contents - hematogenous spread from distant site of infection - direct inoculation into airways of intubated patient by ICU personnel - mechanical ventilator- endotracheal tube bypasses host defenses and impairs lower respiratory tract defenses
86
Diagnosis of HAP/VAP
* no gold standard - time in relation to hospitalization and intubation - new lung infiltrate plus clinical evidence that the infiltrate is of an infectious origin
87
common pathogen of HAP/VAP
aerobic gram-negative bacilli
88
factors associated with increased risk of MDR VAP
- prior antibiotic use in past 90 days - >5 days of hospitalization prior to occurrence of VAP - septic shock at time of VAP - ARDS before VAP - Acute renal replacement therapy prior to VAP
89
risk factors for MDR HAP
prior iv antibiotic use in last 90 days
90
risk factors for MRSA HAP/VAP
- prior iv antibiotic in past 90 days | - late onset hap/vap
91
risk factors for MDR p. aeruginosa HAP/VAP
prior antibiotic use within 90 days (carbapenems, broad-spectrum cephalosporins, FQ)
92
empiric treatment of clinically suspected VAP
provide coverage for: - s. aureus - p. aeruginosa - other GNB Include agent active against MRSA (vanc or linezolid)
93
when to use 2 antipseudomonal antibiotics from different classes
- risk factors for resistance - In ICU where > 10% of Gram negative isolates are resistant to monotherapy agent - In ICU where local resistant rates unknown
94
when to prescribe empiric monotherapy for p. aeruginosa
- w/o risk factors for resistance | - In ICU where <10% of gram negative isolated are resistant to monotherapy agent
95
VAP gram + antibiotics with MRSA acitivyt
vanc or linezolid
96
VAP beta lactam antibiotics with antipseudomonal activity
``` Pip-tazo or cefepime ceftazidime or imipenem meropenem or aztreonam ```
97
VAP non beta lactam antibiotics with antipseudomonal activity
``` cipro 400mg q 8 levo 750 mg q 24 or amikacin 15-20mg/kg q 24 gentamicin 5-7 mg/kg q 24 tobramycin 5-7 mg/kg q 24 or colistin polymyxin B 1.5mg/kg q 12 ```
98
HAP empiric therapy: not at high risk of mortality and no risk factors increasing likelihood of MRSA
- pip-tazo 4.5 g q 6 - cefepime 2 g q 8 - imipenem 500 mg q 6 - meropenem 1g q 8 - levo 750mg q 12
99
HAP empiric therapy: not at high risk of mortality but with factors increasing likelihood of MRSA
all ors - pip-tazo - cefepime - ceftazidime - imipenem - meropenem - levo - cipro - aztreonam PLUS vanc linezolid
100
HAP empiric therapy: high risk of mortality or receipt of IV antibiotics during the prior 90 days
Two of the following: - pip-tazo - cefepime - ceftazidime - imipenem - meropenem - levo - cipro - aztreonam PLUS vanc linezolid
101
Should we use aminoglycosides with HAP
not recommended as monotherapy b/c of poor lung penetration, nephrotoxicity,, ototoxicity, associated with lower clinical response rates
102
Should we use polymixins with HAP
avoid empiric use if alternatives available- reserve for patients with high prevalence of MDR pathogens
103
Should we use tigecycline with HAP
avoid due to poor outcomes, increased mortality
104
Treatment of MSSA in HAP and VAP
cefazolin nafcillin oxacillin
105
Treatment of MRSA in HAP and VAP
vanc | linezolid
106
Do you want to use daptomycin to treat pneumonia
No! inactivated by surfactant
107
Treatment of enterobacterales in HAP and VAP
numerous options
108
Treatment of EBSL producer in HAP and VAP
carbapenem | ceftazidime/avibactam
109
Treatment of MBL producer in HAP and VAP
aztreonam + ceftazidime/avibactam empirically | aztreonam monotherapy if suscpetible
110
Treatment of KPC producer in HAP and VAP
ceftazidime/avibactam meropenem/vaborbactam imipenem/cilastatin/relebactam
111
Treatment of acinetobacter species in HAP and VAP
carbapenem or ampicillin/sulbactam if sus | cefiderocol if resistant
112
treat of HAP and VAP if MDR to all other options
polymyxin plus inhaled colitisn if MDR to all other options
113
duration of treatment for HAP and VAP
7 day course
114
etiology of acute bronchitis
respiratory virus
115
acute bronchitis clinical presentation
``` cough (2-3 weeks) coryza sore throat malaise headache fever normal chest x ray ```
116
acute bronchitis treatment
treat symptoms
117
what to avoid in acute bronchitis treatment
corticosteroids
118
do you use antibacterial therapy in acute bronchitis
NO
119
pathogenesis of acute exacerbation of chronic bronchitis
bronchial wall becomes thickened due to irritants, number of mucus secreting goblet cells is markedly increased; hypertrophy of mucus glands --> further impairment of normal lung defenses; mucus plugging of smaller airways
120
3 cardinal symptoms of ABECB
1. increased cough or SOB 2. increased sputum volume 3. increased sputum purulence
121
bacteria involved in ABECB
- h. influenzae - s. pneumoniae - m. catarrhalis - p. aeruginosa
122
treatment duration of ABECB
5-7 days
123
Uncomplicated ABECB criteria
``` Age < 65 FEV1 >50% < 4 exacerbations/yr no comorbid conditions no risk factors ```
124
uncomplicated ABECB initial treatment options
``` 2 gen macrolide 2/3 gen ceph doxycyline amoxicillin bactrim ```
125
complicated ABECB criteria
age >65 FEV < 50% > 4 exacerbations > 2 risk factors
126
complicated ABECB initial treatment options
respiratory FQ | augmentin
127
ABECB complicated with risk for infection with p. aeruginosa criteria
severe symptoms constant purulent sputum FEV < 35% > 2 risk factors
128
ABECB complicated with risk for infection with p. aeruginosa initial treatment options
FQ w/ antipseudomonal acitivity | pip/tazo
129
pharyngitis microbes involved
viruses | group A, beta hemolytic strep
130
pharyngitis symptoms
non-suppurative complications: acute rheumatic fever, acute glomerulonephritis, peritonsillar or retropharyngeal abscess, mastoiditis, otitis media, rhinosinusitits
131
Group A strep pharyngitis treatment
``` Pen V or Amox or 2 gen cephs ```
132
Group A strep pharyngitis treatment in penicllin allergic patients
1st gen ceph x10 if no anaphyl Azithromycin x5 Clarithromycin x10 clindamycin x 10
133
ARBS initial empiric therapy children first line no resis
Augmentin
134
ARBS initial empiric therapy children second line risk for resis
Augmentin
135
ARBS type 1 hypersensitivity second line children
levo
136
ARBS second line children non-type 1 hypersensitivity
clinda + cefexime or cepodoxime
137
ARBS severe infections requiring hospitalization
Amp-sul ceftriaxone cefotaxime levo
138
first line empiric therapy ARBS adults
Augmentin | Augmentin
139
second line empiric therapy ARBS adults
Augmentin
140
second line empiric therapy ARBS adults beta lactam allergy
doxy levo moxi

PHRM 865 (59 decks)

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