Lecture 18

Question 1

what is pertussis, how does it sprad

Answer 1

whooping cough
bacteria remain on surface of airways
spread by cough and nasal droplets

Question 2

how does bacteria work in pertrusis

Answer 2

bacteria produces toxins, which paralyze respiratory cell cillia. doesnt allow body to clear out mucous

Question 3

pertussis common pathogen

Answer 3

bordetella perussis
aerobic gram - coccobacillus
humans are the only host

Question 4

which age group is most susceptible

Answer 4

infants

Question 5

first stage of pertussis

Answer 5

catarrhal stage, lasts 1-2 weeks.
runny nose, sneezing, low grade fever, mild cough

Question 6

second stage of pertussis

Answer 6

paroxysmal stage (lasts 1-6 weeks)
bursts of cough, thick music, high pitched whoop
can vomit and get exhausted

appear normal between attacks

Question 7

last stage

Answer 7

Convalescent stage, gradual recovery

Question 8

what happens if you have ab in the cat stage

Answer 8

may prevent or minimize severity

Question 9

what happens if you have ab in the paroxysmal stage

Answer 9

decreases transmission to others but does not affect duration of pertussis or severity of disease

Question 10

Which class of ab do we give

Answer 10

macrolides, if allergy, then tmp smx

Question 11

dose of macrolides - clarithromycin

Answer 11

7.5mg/kg PO BID x 7 days

Question 12

dose of macrolides - azithromycin

Answer 12

10mg/kg PO daily x 5 days

Question 13

dose of macrolides - erythromycin

Answer 13

10mg/kg PO QID x 7 days

Question 14

if macrolide allergy, dose of TMP/SMX

Answer 14

4mg/kg PO BID x 10 days

Question 15

does diphenhydramine work

Answer 15

no

Question 16

does salbutamol work

Answer 16

no change in coughing

Question 17

how effective it pertussis immunization

Answer 17

85%, but need boosters

Question 18

who do we give antibiotics to as prevention

Answer 18

• infants under 2 months of age
• infants under 12 mo age if unvaccinated
• pregnant woman in 3rd trimester
• direct contacts prior to them developing signs/symptoms

Question 19

what is defined as direct contact

Answer 19

• face to face exposure for less than 5 minutes
• shared confined space in close proximity for greater than an hour
• respiratory, oral, or nasal secretion –> kissing, coughing, sneezed upon

Question 20

pertussis prevention dose azithromycin

Answer 20

Infant < 6 mo: 10mg/kg PO daily for 5 days

Child: 10mg/kg PO x 1 then 5mg/kg PO daily x 4 days

Adults: 500mg PO x 1 then 250mg PO daily x 4 days

Question 21

pertussis prevention dose clarithromycin

Answer 21

child: 7.5mg/kg PO BID x 7 days
adults: 500mg PO BID x 7 days

Question 22

which med to use in pregnant woman

Answer 22

azithro or erythro

Question 23

allergy to macrolides, tmp/smx dosing prevention

Answer 23

child: 4mg/kg PO BID x 10 days

adult: 1DS tab PO BID x 10 days

Question 24

Croup risk factors

Answer 24

• late fall- early winter disease
• age: 3 mo - 3 years of age
• boys > girls

Question 25

Croup common pathogens

Answer 25

VIRUSES
parainfluenzae
influenza A/B
RSV
HMPV
coronavirus

Question 26

croup signs/symptoms

Answer 26

cough, sounds like seal
rhinorrhea
symptoms are worse at night
inspiratory stridor
chest wall retractions
xray: steeple sign

Question 27

non pharm for kids, croup

Answer 27

keep child calm
cold air

Question 28

Croup Pharmacotherapy

Answer 28

Corticosteroids

Question 29

croup dexamethasone dosing

Answer 29

0.6mg/kg PO 1 dose, max 16mg/dose
relieves symptoms within 2-3 hours

Question 30

croup budesonide inhaled dosing

Answer 30

2mg inh via neb x 1 dose

Question 31

croup inhaled epinephrine dosing

Answer 31

5mg epinephrine inh via neb, 10 minute onset, lasts 1-2 hours

Question 32

what is bronchiolitis

Answer 32

LRTI
obstruction of small airways
- acute inflammation
- edema
- necrosis of epithelial cells
- increased mucous

Question 33

bronchiolitis risk factors

Answer 33

age <1
ex prem
Congenital cardiac disease
chronic pulm disease
immunodeficiency
winter/spring
viral URTI

Question 34

Bronchiolitis

Answer 34

VIRUSES
- RSV
-Inf A/b
-HMPV
etc

Question 35

bronchiolitis

Answer 35

fever, cough, rhinorrhea
decreased feeding
increased resp rate, wheeze/crackles
grunting sound, nasal flaring, in-drawing, belly breathing

Question 36

bronchiolitis pharmacotherpy

Answer 36

oxygen if O2 less than 92%
hydration

Question 37

concern with children with pharmacotherapy

Answer 37

hyponatremia - low sodium, can develop seizures

Question 38

how to prevent hyponatremia

Answer 38

add sodium to feeds
if IV fluid, add 0.9% NaCl in there

Question 39

which therapies are not recommended for bronchiolitis

Answer 39

salbutamol
corticosteroids
antibiotics
antivirals

Question 40

Palivizumab prevention treatment dosing and effectiveness

Answer 40

IM injection monthly, 3-4 doses, decreased hospitalizations

Question 41

Nirsevimab prevention treatment dosing and effectiveness

Answer 41

IM injection, one dose per season, lasts 5 month, decreases severe RSV

Question 42

acute bronchitis symptom

Answer 42

cough, occurs in winter, prolonged can last more than 3 weeks, no fever, normal vitals

Question 43

common pathogens of acute bronchitis

Answer 43

Mycoplasma pneumonia
chlamydia pneumonia
bordetella pertussis

Question 44

Treatment

Answer 44

• acetaminophen and ibuprofen

Question 45

does dextromethorphan, codeine, OTC cough and cold prep work with acute bronchitis

Answer 45

no benefit, no evidence of efficacy

Question 46

beta 2 agonists for acute bronchitis

Answer 46

may be evidence for those who have airflow obstruction

Question 47

what is post natal age

Answer 47

time from birth till now

Question 48

corrected gestational age

Answer 48

gestational age at birth + post natal age