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Therapeutics 5 Kappa Epsilon > 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
Q

what is the most common bug that causes bacteremic pneumonia cases

A

streptococcus pneumoniae

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26
Q

what are risk factors for drug resistant s. pneumoniae (DRSP)

A

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
Q

Typical or atypical pathogen?

Mycoplasma pneumoniae

A

atypical

NO CELL WALL = NO GRAM STAIN

28
Q

Typical or atypical pathogen?

Legionella pneumophila

A

atypical

29
Q

Typical or atypical pathogen?

Chlamydophila pneumoniae

A

atypical

30
Q

Typical or atypical pathogen?

staphylcoccus aures

A

typical

31
Q

Typical or atypical pathogen?

streptococcus pneumoniae

A

typical

32
Q

A patient may have pneumonia about 2 - 14 days after ________
seen commonly in what bugs?

A

after influenza

seen in staph. aures

33
Q

what bug is known to be seen post influenza?

A

staph aureus

34
Q

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
A

high suspicion of MRSA

also if pt has hx of skin infection with CA-MRSA….

35
Q

_________ should be performed on all outpatients and inpatients with suspected CAP

A

chest radiography

36
Q

Sputum Exam:
Rust colored = what bug?
Dark red, mucoid sputum = what bug?
Foul-Smelling Sputum = what bug?

A

rust: s. pneumoniae
dark red: k. pneumoniae
foul: mixed anaerobic infection

37
Q

what score is used to evaluate severity of illness and predict mortality (in RTI lecture)

A

CURB 65

38
Q

what is CURB65

A 
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
Q

CURB65:
if score of ____: treat as outpatient
if score of ____: admit to general ward
if score of ____: may require ICU care

A

0 - 1
2
>/= 3

40
Q

EMPIRIC CAP Outpatient Treatment:

what patient factors matter when picking this treatment?

A

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
Q

EMPIRIC CAP Outpatient Treatment:

If pt is healthy and has no prior antibiotic use within previous 3 months — treat with that?

A

Macrolide (erythromycin, clarithromycin, azithromycin)
or
Doxycycline
*remember drug interactions for drugs above)

42
Q

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)

A

Respiratory FQ (Moxifloxacin or Levofloxacin)
OR
Beta-Lactam + Macrolide

43
Q

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?

A

Respiratory FQ
OR
Beta Lactam + Macrolide

44
Q

EMPIRIC CAP Inpatient Treatment:

If patient is in general medical ward (non-ICU) — how to treat?

A

Respiratory FQ
OR
Beta lactam + macrolide

(Use IV!!)

45
Q

EMPIRIC CAP Inpatient Treatment:

If patient is in ICU — how to treat?

A

DUAL THERAPY
Beta lactam + Macrolide
OR
Beta lactam + Respiratory FQ

46
Q

what are the preferred beta lactams for empiric CAP inpatient treatment

A

Ceftriaxone
cefotaxime
ampicillin

47
Q

CAP Directed Therapy:
If Strep. Pneumo:
Based on its resistance mechanism:
get results that let you know if it is ______ or _____

A 
PCN susceptible (MIC <2)
or
PCN resistant (MIC > 2)
48
Q

CAP Directed Therapy:

If Strep. Pneumo and PCN susceptible – treat with what?

A

PCN G or amoxicillin

*if deathly allergic ot PCN — macrolide, cephalosporin, Respiratory FQs or doxy….

49
Q

CAP Directed Therapy:

If Strep. Pneumo and PCN resistant – treat with what?

A

respiratory FQ or ceftriaxone or cefotaxime

50
Q

Specific Conditions and Specific Pathogens for CAP:

If on hotel/cruise ship in previous 2 weeks – worried about what bug?

A

Legionella pneumophila

51
Q

Specific Conditions and Specific Pathogens for CAP:

If IV drug user – worried about what bug?

A

S. Aureus (skin flora)

52
Q

Specific Conditions and Specific Pathogens for CAP:

If lung abscess – worried about what bug?

A

CA-MRSA

53
Q

what are examples of some antipneumococcal and antipseudomonal beta lactams (aka drugs good when pseudomnas suspected in pneumonia)

A

pip/tazo
cefepime
Carabapenems (except ertapenem bc no pseudomonas coverage!)

54
Q

how long to treat CAP (minimum amount of days?)

A

5 days

55
Q

what are signs of CAP associated clinical stability

A 
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
Q

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

A

at least 24 - 48 hours

no more than 1 CAP instability sign

57
Q

Pathogen Directed Therapy for CAP: What drug for

If H. influenzae - NON beta lactamase producing?

A

Amoxicilin

58
Q

Pathogen Directed Therapy for CAP: What drug for

If H. influenzae - beta lactamase producing?

A

2nd/3rd gen ceph
or
Amox clav

59
Q

Pathogen Directed Therapy for CAP: What drug for

Mycoplasma or Chlamydophila?

A

macrolide or doxycycline

60
Q

Pathogen Directed Therapy for CAP: What drug for

Legionella

A

FQs

Azithromycin

61
Q

Pathogen Directed Therapy for CAP: What drug for
Staph Aureus:
MSSA?
MRSA?

A

MSSA: nafcillin or oxacillin

MRSA: Vanc or linezolid

62
Q

Pathogen Directed Therapy for CAP: What drug for

Anaerobes?

A

beta lactam + beta lactamase inhibitor
or
clindamycin

63
Q

Pathogen Directed Therapy for CAP: What drug for

Enterbacteriaceae (if KPC/AmpC producing..)

A

3rd/4th ceph
or
Carbapenem

Therapeutics 5 Kappa Epsilon (27 decks)

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