Exam II resp studying

Question 1

What are 3 ways to treat uncomplicated outpatient CAP?

Answer 1

-Amoxicillin 1g TID
-Azithromycin (avoid in areas with macrolide resistance)
-Doxycycline 100mg BID

Question 2

How do you Tx outpatient CAP with risks including MRSA or pseudomonas?

Answer 2

1) Augmentin+ azithromycin
2) Levofloxacin

Question 3

For inpatient CAP, you DO NOT empirically treat for MRSA and pseudomonas if what?

Answer 3

Hospitalized AND IV antibiotics in last 90 days

Question 4

How to Tx inpatient CAP?

Answer 4

CLL
1) Ceftriaxone IV (Cefepime IV if previous pseudomonas infection)
2) Levofloxacin IV
3) Linezolid or vancomycin IV

Question 5

How to Tx VAP (with and without risks)

Answer 5

1) No MDR/MRSA/pseudomonas risk
-Piperacillin/tazobactam
-Cefepime
-Levofloxacin
2) MDR or MRSA or pseudomonas risk factors = Cefepime+amikacin+vancomycin or linezolid

Question 6

What can Tx HAP if hospitalization/IV antibiotics in last 90 days, prior MRSA? (hint: 2 options)

Answer 6

CVL or LVL:

cefepime+vancomycin or linezolid
levofloxacin+vancomycin or linezolid

Question 7

How to Tx HAP if no hospitalization/IV antibiotics in last 90 days? (hint: 2 meds)

Answer 7

-Piperacillin/tazobactam
-Cefepime(better acinetobacter spp. coverage)

Question 8

Oral mucosa anesthesia (if capsules are chewed/dissolved in mouth) occurs with what med?

Answer 8

Benzonatate (antitussive)

Question 9

DO NOT GIVE what antitussive to pts less than 2 years old?

Answer 9

Bromfed DM
(combo of brompheniramine (antihistamine), pseudoephedrine (sympathomimetic nasal decongestant), dextromethorphan (non opioid antitussive))

Question 10

How do you dose the 2 types of hydrocodone antittussives?

Answer 10

1) Hydrocodone 10mg/Chlorpheniramine 8mg/5mL ER : 5mL every 12 hours (MAX 10mL per day)
2) Hydrocodone 5mg/Homatropine 1.5mg/5mL hydromet : 5mL every 4-6 hours (MAX 30mL per 24hr)

Question 11

What is a common cause of severe sepsis?

Answer 11

Pneumonia

Question 12

Staphylococcal pneumonia will show what?

Answer 12

Necrotizing lesions

Question 13

List the etiologies of CAP, HAP, and VAP

Answer 13

1) CAP: S. pneumoniae, H. influ., M. and C. and K. pneumoniae, legionella, s. Aureus, e. Coli, Group B strep
2) HAP: P. aeruginosa, acinetobacter spp., K pneumoniae, and E. coli and S. aureus
3) VAP: S. aureus

Question 14

List the CURB-65 and the scoring

Answer 14

-Confusion
-Uremia(BUN>20mg/dL or 7.1mmol/L)
-Respiratory rate > or equal to 30 bbm
-Blood pressure: systolic <90, diastolic < or equal to 60)
-Age: 65 or older
2> outpatient
=2 inpatient
>2 inpatient ICU

Also 3+ minor criteria or 1 major = inpatient treatment!
Minor:
-thrombocytopenia
-hypothermia
-wbc <4000
-CURB65

Question 15

1) How would you dose Oseltamivir for treatment for a pt with a ClCr of 40ml?
2) What abt if they needed it for prophylaxis?

Answer 15

1) 30mg BID for 5 days
2) 30mg Q day for 10 days
(this works for 30-60)

Question 16

What is the difference between Oseltamivir Tx and prophylaxis?

Answer 16

Tx is 75mg BID x5days, prophylaxis is x10 days

Question 17

How do you dose Oseltamivir if the pt has a ClCr of 15?

Answer 17

1) Tx: 30mg Q day for 5 days
2) Prophylaxis: 30mg QOD for 10 days
(this works for 10-30)

Question 18

What are the criteria for flu prophylaxis?

Answer 18

• Cannot be vaccinated
• Exposed within 2 weeks of vaccination
• Severe immunodeficiency
• Long term care facility residency

Question 19

Who should get a high dose flu vax?

Answer 19

Over 65 or organ transplant, or immunocompromised