ITE-1 and ITE-2 stacks - 2

Question 1

With what meds may I treat patients admitted to ICU with pneumonia?

Answer 1

Respiratory fluoroquinolone + anti-pneumo beta-lactam OR aztreonam
OR
Antipseudomonal + quinolone + vanc

Question 2

With what meds may I treat patients admitted with pneumonia?

Answer 2

Respiratory quinolone
OR
Beta-lactam + newer macrolide

Question 3

Which meds offer anti-pseudomonal coverage?

Answer 3

• Zosyn

- meropenem

Question 4

One way to preventdrug resistance is torefrain from giving an antibiotic agent that…

Answer 4

the patient has received within the past 3 months

Question 5

How often are blood cultures postive in CAP eval? What infectious agent is isolated in 2/3 of all positive cases?

Answer 5

• 5%-14% positive blood cultures

- Strep pneumo in 2/3 of positive cases

Question 6

Which meds are macrolides?

Answer 6

-mycins:
Azithro-
Clarithro-
Erythro-

Question 7

Which meds are considered respiratory quinolones?

Answer 7

-floxacins
Gemi-
Levo-
Moxi-

Question 8

Which meds are considered Beta-lactams?

Answer 8

Amoxicillin
Augmentin
Cefotaxime
Ceftriaxone
Ampicillin/Sulbactam (Unasyn)

Question 9

Which meds are anti-pneumococcal/anti-pseudomonal beta lactams?

Answer 9

Zosyn
Meropenem
Cefipime
Imipenem

Question 10

With which meds may I treat my ICU patient with pseudomonal pneumonia?

Answer 10

Anti-pneumococcal/Anti-pseudomonal Beta lactam (IV)
+
Fluoroquinolone (IV)
OR
Aminoglycoside + Antipneumococcal Fluoroquinolone

Question 11

What is BIRP criteria used for?

Answer 11

to identify patients @ increased risk of drug-resistant HCAP
B: broad-spectrum abx in past 3 months
I: ICU admission
R: Resident of NH or poor functional status
P: Priior hospitalization w/in past 3 months

Question 12

With what meds may I treat my NH patient with pneumonia?

Answer 12

In consideration of increased risk of drug-resistant bacteria…

1. Anti-pseudomonal +
2. Antipseudomonal fluoroquinolone OR Aminoglycoside
3. CONSIDER: Anti-MRSA (Vanc, Linezolid)

Question 13

Which drugs are Aminoglycosides

Answer 13

Gentamycin

Tobramycin

Question 14

How long should I treat my patient with CAP?

Answer 14

• minimum of 5 days
• until afebrile 48-72 hours
• until no more than 1 CAP-associated sign of clinical instability

Question 15

What are the more common pathogens that cause HCAP?

Answer 15

• MRSA
• S. pneumonia
• P. aeruginosa
• MSSA
• H. influenza

Question 16

In what patient populations might I consider including coverage for MRSA when treating for pneumonia?

Answer 16

• one or more BIRP + factors
• if severe CAP (admission to ICU)
• after an episode of the flu

Question 17

To which patients should I offer PPSV-23?

Answer 17

• > 65 yo - single dose
• children at risk > 2yo (8 wks after PCV 13)
• 2-64 yo if chronic disease or resident of any institution

Question 18

PPSV-23 and PCV 13: What is the relevant timing for administration?

Answer 18

If PCV 13 given –> wait 8 weeks –> give PPSV-23

If PPSV-23 given –> wait 1 year –> PCV-13

Question 19

What are the generalized rules for reading TB skin tests?

Answer 19

Rules are based on risk of exposure to TB:

• if NO RISK: 15 mm (prior BCG ok)
• IF MINIMAL RISK: 10mm (chronic dz, immigrant, housing facility)
• If INCREASED RISK: 5 mm (exposure, immunocompromised, etc)

Question 20

What is the booster phenomenon as it relates to Tuberculin skin testing (TBT)?

Answer 20

TST initially negative —> wait 1-3 weeks –> repeat test is +
- This phenomenon indicates history of TB in the past - NOT an active infection

Question 21

All pneumonia treatment begins with usage of which antibiotic? What risk factors RE: microbial involvement direct decisions for other treatments to add?

Answer 21

Start with quinolones:
Then broaden coverage based on risk factors for:
- pseudomonas
- pneumococcus
- MRSA
- antibiotic resistance