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PHRM 865 > Exam 3 - RTIs > Flashcards

Exam 3 - RTIs Flashcards

1
Q

Main physiologic mechanisms that prevent lung infections?

A

Upper Airways: Nasopharynx, Oropharynx
Conducting Airways: Trachea, Bronchi
Lower Respiratory Tract: Terminal airways/alveoli

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2
Q

Host defense mechanisms seen in the nasopharynx?

A 
nasal hair
turbinates
anatomy of upper airways
mucociliary apparatus
IgA secretion
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3
Q

Host defense mechanisms seen in the oropharynx?

A

saliva
sloughing of epithelial cells
complement production

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4
Q

Host defense mechanisms seen in the trachea/bronchi?

A 
cough
epiglottis reflexes
sharp/angled branching airways
mucuociliary apparatus
Immunoglobulin production (IgG, IgM, IgA)
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5
Q

Host defense mechanisms seen in the terminal airways/alveoli

A 
alveolar lining fluid (surfactant/fibronectin, complement, immunoglobulin)
cytokines (TNF, IL-1, IL-8)
Alveolar macrophages
PMNs
Cell mediated immunity
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6
Q

Host defenses:

_______ inhibits adherence of bacteria to cell surfaces –> prevents colonization

A

fibronectin

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7
Q

Host defenses:
Microbes possess surface adhesions, pilis, exotoxins, and proteolytic enzymes that degrade _____ –> promote colonization

A

IgA

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8
Q

Host defenses:

Adherence of microorganisms to _______________ = critical first step in colonization and subsequent infections

A

epithelial surfaces of upper airways

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9
Q

Host defenses:

_______ secretions contain non-specific inhibitors of infection

A

respiratory

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10
Q

Host defenses:
________ eliminate organisms by phagocytosis and produce cytokines that recruit neutrophils to the lungs –> local area becomes ______ and _____ = impairs phagocytic activity

A

alveolar macrophages

acidic/hypoxic

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11
Q

Factors that will interfere with host defenses:

what 7 things are known to do this…?

A 
Altered level of consciousness
Smoking
viruses
Alcohol
Endotracheal tubes/NG tubes, Ventilators
Immunosuppression
Elderly
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12
Q

why does altered level of consciousness lead to decrease host defenses?

A

altered level of consciousness –> compromise epiglottic closure –> aspiration

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13
Q

why does alcohol alter/lead to a decrease in host defenses?

A
  • impair cough/epiglottic reflexes –> aspiration
  • increases oropharyngeal colonization w/ gram NEGATIVE organisms
  • decreased mobilization of neutrophils
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14
Q

what are examples of immunosuppression that can lead to decrease in host defenses

A

malnutrition
immunosuppresive therapy…
HIV

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15
Q

what does CAP stand for?

A

community acquired pneumonia

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16
Q

what does VAP stand for?

A

ventilator associated pneumonia

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17
Q

what does HAP stand for?

A

hospital acquired pneumonia

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18
Q

what does HCAP stand for?

A

healthcare associated pneumonia

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19
Q

what is the most common cause for BACTERIAL pneumonia

A

Aspiration

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20
Q

what is aspiration?

A

common thing to happen in people during sleep

means you’re breathing foreign objects into your airways. Usually, it’s food, saliva, or stomach contents when you swallow, vomit, or experience heartburn

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21
Q

what is aerosolization

A

droplet nuclei (breathing in viruses)

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22
Q

most common way that VIRUSES are caught for pneumonia?

A

aerosolization

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23
Q

most common bugs seen in CAP

A 
STREPTOCOCCOUS PNEUMONIAE!!
H. Influenzae
Mycoplasma Pneumoniae
Legionella pneumophila
Chlamydophila pneumoniae
Staphylococcus aureus
Viral!!!!!
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24
Q

what is the MOST common cause of CAP

A

VIRUSES!!

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25
what is the most common bug that causes bacteremic pneumonia cases
streptococcus pneumoniae
26
what are risk factors for drug resistant s. pneumoniae (DRSP)
extremes of age (< 6; > 65) PRIOR ABX THERAPY underlying illnesses, co morbid conditions day care attendance (infested kids recent/current hospitalization immunocompromised/HIV/nursing home/prison
27
Typical or atypical pathogen? | Mycoplasma pneumoniae
atypical | NO CELL WALL = NO GRAM STAIN
28
Typical or atypical pathogen? | Legionella pneumophila
atypical
29
Typical or atypical pathogen? | Chlamydophila pneumoniae
atypical
30
Typical or atypical pathogen? | staphylcoccus aures
typical
31
Typical or atypical pathogen? | streptococcus pneumoniae
typical
32
A patient may have pneumonia about 2 - 14 days after ________ seen commonly in what bugs?
after influenza seen in staph. aures
33
what bug is known to be seen post influenza?
staph aureus
34
the following indicate a high index suspicion of what bug? - necrotizing pneumonia or cavity infiltrates - concurrent or recent influenza infection - ICU admission/respiratory failure - rapid progression of sxs - formation of empyema
high suspicion of MRSA | also if pt has hx of skin infection with CA-MRSA....
35
_________ should be performed on all outpatients and inpatients with suspected CAP
chest radiography
36
Sputum Exam: Rust colored = what bug? Dark red, mucoid sputum = what bug? Foul-Smelling Sputum = what bug?
rust: s. pneumoniae dark red: k. pneumoniae foul: mixed anaerobic infection
37
what score is used to evaluate severity of illness and predict mortality (in RTI lecture)
CURB 65
38
what is CURB65
``` score used to evaluate severity of illness and predict mortality C: "C"onfusion U: "U"remia R: "R"espiratory rate B: low "B"lood pressure > "65" y.o ```
39
CURB65: if score of ____: treat as outpatient if score of ____: admit to general ward if score of ____: may require ICU care
0 - 1 2 >/= 3
40
EMPIRIC CAP Outpatient Treatment: | what patient factors matter when picking this treatment?
if pt is healthy or not (comorbid conditions?) any prior abx use in past 3 months? drug allergies of course if region has a high resistant rate
41
EMPIRIC CAP Outpatient Treatment: | If pt is healthy and has no prior antibiotic use within previous 3 months --- treat with that?
Macrolide (erythromycin, clarithromycin, azithromycin) or Doxycycline *remember drug interactions for drugs above)
42
EMPIRIC CAP Outpatient Treatment: If pt has comorbidities OR has used antimicrobials in past 3 months --- treat with what? (*comorbidities could be chronic heart/liver/lung/renal disease, diabetes, alcoholism, malinancy or asplenia*)
Respiratory FQ (Moxifloxacin or Levofloxacin) OR Beta-Lactam + Macrolide
43
EMPIRIC CAP Outpatient Treatment: if in region with a high rate (>25%) of infections caused by high level (MIC > 16) MACROLIDE resistant S. Pneumoniae --- treat with what?
Respiratory FQ OR Beta Lactam + Macrolide
44
EMPIRIC CAP Inpatient Treatment: | If patient is in general medical ward (non-ICU) --- how to treat?
Respiratory FQ OR Beta lactam + macrolide (Use IV!!)
45
EMPIRIC CAP Inpatient Treatment: | If patient is in ICU --- how to treat?
DUAL THERAPY Beta lactam + Macrolide OR Beta lactam + Respiratory FQ
46
what are the preferred beta lactams for empiric CAP inpatient treatment
Ceftriaxone cefotaxime ampicillin
47
CAP Directed Therapy: If Strep. Pneumo: Based on its resistance mechanism: get results that let you know if it is ______ or _____
``` PCN susceptible (MIC <2) or PCN resistant (MIC > 2) ```
48
CAP Directed Therapy: | If Strep. Pneumo and PCN susceptible -- treat with what?
PCN G or amoxicillin *if deathly allergic ot PCN --- macrolide, cephalosporin, Respiratory FQs or doxy....
49
CAP Directed Therapy: | If Strep. Pneumo and PCN resistant -- treat with what?
respiratory FQ or ceftriaxone or cefotaxime
50
Specific Conditions and Specific Pathogens for CAP: | If on hotel/cruise ship in previous 2 weeks -- worried about what bug?
Legionella pneumophila
51
Specific Conditions and Specific Pathogens for CAP: | If IV drug user -- worried about what bug?
S. Aureus (skin flora)
52
Specific Conditions and Specific Pathogens for CAP: | If lung abscess -- worried about what bug?
CA-MRSA
53
what are examples of some antipneumococcal and antipseudomonal beta lactams (aka drugs good when pseudomnas suspected in pneumonia)
pip/tazo cefepime Carabapenems (except ertapenem bc no pseudomonas coverage!)
54
how long to treat CAP (minimum amount of days?)
5 days
55
what are signs of CAP associated clinical stability
``` temperature < 37.8 C (100.04..) HR < 100 BPM RR < 24 breaths PM Systolic BP > 90 Arterial O2 > 90 Ability to take oral meds normal status ```
56
Duration of CAP treatment should be at least 5 days.. also patients need to be afebrile for at least _______ and not more than _____ CAP-associated signs of clinical instability
at least 24 - 48 hours no more than 1 CAP instability sign
57
Pathogen Directed Therapy for CAP: What drug for | If H. influenzae - NON beta lactamase producing?
Amoxicilin
58
Pathogen Directed Therapy for CAP: What drug for | If H. influenzae - beta lactamase producing?
2nd/3rd gen ceph or Amox clav
59
Pathogen Directed Therapy for CAP: What drug for | Mycoplasma or Chlamydophila?
macrolide or doxycycline
60
Pathogen Directed Therapy for CAP: What drug for | Legionella
FQs | Azithromycin
61
Pathogen Directed Therapy for CAP: What drug for Staph Aureus: MSSA? MRSA?
MSSA: nafcillin or oxacillin MRSA: Vanc or linezolid
62
Pathogen Directed Therapy for CAP: What drug for | Anaerobes?
beta lactam + beta lactamase inhibitor or clindamycin
63
Pathogen Directed Therapy for CAP: What drug for | Enterbacteriaceae (if KPC/AmpC producing..)
3rd/4th ceph or Carbapenem

PHRM 865 (59 decks)

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