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PHA 415 - Remediation > Exam 6 - LRTI > Flashcards

Exam 6 - LRTI Flashcards

1
Q

What 3 things/areas does the lower respiratory tract involve?

A

1) Bronchi
2) Bronchioles and alveoli
3) Lungs

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2
Q

How do you get bacterial pneumonia?

A

1) Inhalation of contaminated air droplets

2) Aspiration

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3
Q

Name the 4 complications of bacterial pneumonia.

A

1) Pleuritis
2) Abscess
3) Bronchiectasis
4) Sepsis

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4
Q

Name frequent co-morbid conditions associated with bacterial pneumonia (7).

A

1) Asthma
2) COPD
3) DM
4) HF
5) Alzheimer’s
6) Influenza
7) COVID-19

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5
Q

Name the 3 classifications of bacterial pneumonia.

A

1) Hospital Acquired Pneumonia (HAP) - s/s after a minimum of 48 hours in the hospital
2) Ventilator Associated Pneumonia (VAP) - after 48-72 hours of intubation
3) Community Acquired Pneumonia (CAP) - none of the above, resides in the community

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6
Q

What it is primary bacteria in CAP?

A

Strep. pneumo

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7
Q

What are the 3 bacteria species/classes that present in CAP?

A

1) Strep pnemo
2) H. flu
3) Mycoplasma pneumoniae

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8
Q

Name the 5 total bacteria that can be seen in CAP.

A

1) Strep pneumo
2) H. flu
3) Mycoplasma pneumo
4) Legionella pneumophilia - uncommon
5) Klebsiella pneumo - alcoholism

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9
Q

Name the 7 types of bacteria that can be seen in HAP/VAP.

A

1) Strep pneumo
2) Legionella - atypical bacteria
3) Klebsiella
4) Pseudomonas aeruginosa
5) E. coli
6) Staph aureus
7) MRSA

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10
Q

Name the “Typical” s/s of bacterial pneumonia (5).

A

1) Cough with sputum production
2) Fever
3) Chills
4) Pleuritic chest pain - pain in side with deep inspiration
5) SOB

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11
Q

Name the “Atypical” s/s of bacterial pneumonia (3).

A

1) HA
2) Low-grade fever or afebrile
3) Dry, persistent cough

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12
Q

Name the physical findings of bacterial pneumonia (6).

A

1) Distant or coarse breath sounds
2) Rhales
3) Inspiratory crackles
4) Dullness to percussion
5) Tachypnea
6) Tachycardia

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13
Q

What is the GOLD STANDARD in diagnosis bacterial pneumonia?

A

Radiographic evidence

  • Chest x-ray
  • CT scan
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14
Q

When is a sputum culture obtained?

A

Severe infections

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15
Q

What is meant by “left shift” in WBC count?

A

Increase in bands

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16
Q

What does an elevated/positive PCT indicate?

A

Bacterial infection

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17
Q

Name three scenarios that can elevate PCT.

A

1) Thyroid cancer
2) COVID-19
3) Kidney failure

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18
Q

What is the name of the lab value that is a biomarker of bacterial infection?

A

PCT - procalcitonin

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19
Q

What value is indicative of a bacterial infection with PCT values?

A

> 0.25 ng/mL

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20
Q

What do you use PCT levels for in a patient with an infection?

A

Deciding to escalate or de-escalate antibiotics

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21
Q

T/F: PCT can be used to decide whether to start antibiotics or not.

A

FALSE - PCT should NOT be used to decide whether to start antibiotics or not

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22
Q

Streptococcus pneumoniae is gram _____.

A

Streptococcus pneumoniae is gram POSITIVE.

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23
Q

Name the 4 general approaches to management of bacterial pneumonia.

A

1) Oxygenate
- If O2 below 92%, then need supplemental oxygen

2) Hydrate
- Water is the best mucolytic

3) Analgestics/antipyretics
- IBU or APAP - caution with suppressing fever and using that as an indication for changing/stopping antibiotics
- Morphine, Percocet for pain so that patients can breath

4) Antibiotics

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24
Q

Why can you not use Daptomycin for MRSA pneumonia?

A

Because Daptomycin cannot be used in the lungs

-Broken down by enzymes in the lungs

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25
Q

In which type of bacterial pneumonia is CURB-65 used?

A

CAP ONLY!

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26
Q

What is CURB-65 used for?

A

To assess the severity of CAP

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27
Q

What assessment tool is used to assess severity of CAP?

A

CURB-65

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28
Q

Name the 6 risk factors for drug resistance in bacterial pneumonia.

A

1) Age >65
2) Beta lactam therapy within 3 months
3) Alcoholism
4) Immunosuppressive therapy/disease
5) Multiple medical co-morbidities
6) Exposure to a child in day care

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29
Q

List the 3 drugs used in OUTPATIENT treatment of CAP in ADULTS WITHOUT co-morbid conditions (“ADA”).

A

One single agent below:

1) Azithromycin 500 mg po once, then 250 mg qd
- QT interval prolongation

2) Doxycycline 100 mg po bid
- CI during PG

3) Amoxicillin 1 g po tid

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30
Q

List 2 combinations of meds for OUTPATIENT treatment of CAP in ADULTS WITH co-morbid conditions.

A

1) Amox/Clav (Augmentin)
- 500/125 po TID
- 875 or 2000 mg/125 po BID

2) Second or third gen CPN
- Cefdinir
- Cefpodoxime

One of the above WITH either Azithromycin, Clarithromycin, or Doxycycline

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31
Q

What does Augmentin cover?

A

Strep

H. flu

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32
Q

T/F: FQNs cover mycoplasma.

A

TRUE

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33
Q

Why are Azithromycin, Clarithromycin, or Doxycycline added in outpatient treatment of CAP in patients with co-morbidities?

A

Cover Mycoplasma

34
Q

T/F: Ceftibuten is a 3rd generation CPN with good staph coverage.

A

FALSE - poor staph coverage

35
Q

List the 3 drugs and additional drug used in INPATIENT treatment in ADULTS WITHOUT risk for Pseudomonas and MRSA with non-severe infection.

A

1) Ampicillin/Sulbactam (Unasyn)

2) Ceftriaxone
- 3rd gen

3) Ceftaroline
- 5th gen

Any of the above AND Azithromycin, Clarithromycin, or Doxycycline

36
Q

List the combination of meds used in a severe infection for INPATIENT treatment of CAP in ADULTS WITHOUT Pseudomonas and MRSA.

A

Levofloxacin OR Moxifloxacin PLUS a beta-lactam (Amp/Sulbactam, Ceftriaxone, Ceftaroline)

37
Q

Name the INPATIENT treatment for CAP in ADULTS with risk for Pseudomonas and MRSA.

A

MRSA
-Vancomycin, Linezolid, or Ceftaroline

Pseudomonas
-Pip/tazo, Cefepime (4th gen), Ceftazidime (3rd gen) or Aztreonam (resistance)

38
Q

Name the drugs that are available for pts with HAP or VAP.

A

Cefepime OR Meropenem OR Pip/Tazo

PLUS

Cipro OR Levo OR Aminoglycoside

One from each group above PLUS Vancomycin

39
Q

What do you save Meropenem for?

A

ESBL

Severe PCN allergy

40
Q

T/F: Cefepime is less nephrotoxic than Zosyn.

41
Q

Cefepime is which class of CPN?

42
Q

T/F: Zosyn has broad coverage.

43
Q

What should you add to Cefepime if you think there are anaerobes involved?

A

Metronidazole, Clindamycin

44
Q

Which has better gram negative coverage, Cipro or Levo?

45
Q

What are useful parameters to monitor improvement of bacterial pneumonia (6)?

A

1) Decreased temp
2) Decreased WBC
3) Decreased cough and chest pain
4) Rising O2 saturation
5) Decreased RR
6) Decreasing PCT

46
Q

Which antibiotics have concentrations with PO approximate IV (going from IV to PO)? (7)

A

1) Doxycycline
2) Ofloxacin, Cipro, Levo
3) Metronidazole
4) Clindamycin
5) TMP/SMX

47
Q

What are the requirements to switch from IV to PO therapy (6)?

A

1) Able to ingest PO meds
2) HR <100, systolic BP >90
3) O2 sat >90%
4) RR <25 per minute
5) Temperature <100.9 F
6) Return to cognitive baseline

48
Q

What is the duration of treatment for CAP?

49
Q

What is the duration of treatment for VAP or HAP?

50
Q

What 3 vaccines are prevention for bacterial pneumonia?

A

1) Annual influenza
2) PCV20
3) COVID-19

51
Q

List management for moderate-severe COVID-19 pneumonia (5).

A

1) Oxygen supplementation
2) Conservative fluid management
3) Dexamethasone for pts needing oxygen
4) Remdesivir for pts needing oxygen or at risk of severe disease
5) DVT/PE prophylaxis with Enoxaparin

52
Q

What is outpatient treatment for CAP in infants/pre-school peds patients?

A

Amoxicillin

53
Q

What is inpatient treatment for infant/pre-school peds pts with CAP?

A

Ceftriaxone OR Cefotaxime

-both 3rd gen

54
Q

What is outpatient treatment for school age children with CAP?

55
Q

What is inpatient treatment for school age children with CAP?

A

Beta-lactam + Macrolide

56
Q

What is the treatment duration for peds patients with CAP?

57
Q

What is the preferred parenteral for MSSA?

A

Cefazolin (1st gen)

58
Q

What is oral step down for MSSA?

A

Cefazolin to Cephalexin (1st gen) OR Clindamycin

59
Q

What is the preferred parenteral for MRSA?

A

Vancomycin

60
Q

What is the step down oral therapy for MRSA?

A

Vancomycin to Clindamycin OR Linezolid

61
Q

What is the preferred parenteral for Group A Strep?

62
Q

What is oral step down therapy for Group A Strep?

A

Pen G to Amoxicillin OR Clindamycin

63
Q

What is the preferred parenteral for H. flu?

A

Ampicillin or Ceftriaxone

64
Q

What is step down oral therapy for H. flu?

A

Ampicillin or Ceftriaxone to Amoxicillin OR 2nd/3rd gen CPN

65
Q

What is preferred parenteral for Mycoplasma pneumoniae?

A

Azithromycin

66
Q

What is oral step down therapy for Mycoplasma?

A

Azithromycin to Azithromycin OR Clarithromycin OR Levo

67
Q

What is the term for acute exacerbation of chronic bronchitis?

A

Acute bronchitis

68
Q

How long is the duration of cough in acute bronchitis?

A

<2-3 weeks

69
Q

T/F: Acute bronchitis is usually self-limiting.

70
Q

What are treatment options for acute bronchitis?

A

Supportive therapy

  • APAP/IBU
  • Cough suppressant at night
71
Q

When is acute bronchitis referred for antibiotic therapy (5)?

A 
Febrile
HR >100
Elevated PCT
Symptoms persist beyond 2 weeks
Age >65
72
Q

How long is the presence of cough in chronic bronchitis?

A

Cough with sputum production for a minimum of 3 months for 2 consecutive years

73
Q

Name the 3 bacterial pathogens present in complicated acute bronchitis and AECB (Acute Exacerbation of Chronic Bronchitis)?

A

1) H. flu
2) S. pneumoniae
3) M. catarrhalis

74
Q

Name the 4 types of antibiotics that can be used to treat complicated acute bronchitis and AECB.

A

1) Macrolides
2) Doxycycline
3) Amox/Clav
4) 2nd/3rd gen CPN

75
Q

T/F: Bronchiolitis is not self-limiting.

A

FALSE - bronchiolitis is usually self-limiting

76
Q

During what months/season does bronchiolitis occur?

A

November - April

77
Q

What are the 3 pathogens for bronchiolitis?

A

1) RSV
2) Parainfluenza
3) Rhinovirus

78
Q

What nebulized treatment is superior to beta 2 agonists in treatment of bronchiolitis?

A

Nebulized Epinephrine

79
Q

What is Ribavarin indicated in?

A

Bronchiolitis treatment

80
Q

Who receives RSV prophylaxis?

A

BABIES - Neonates

81
Q

What is Palivizumab (Synagis) indicated for?

A

RSV prophylaxis

PHA 415 - Remediation (11 decks)

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