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Fall2014 - Pharm ID/Pulm > Lower Resp Infections > Flashcards

Lower Resp Infections Flashcards

1
Q

What is the most common cause of acute bronchitis?

A

mostly viral (influenza, rhinovirus, coronavirus, RSV)

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2
Q

Treatment of Acute Bronchitis

A
  • antibiotic therapy NOT indicated
  • unless bacterial pathogen is identified with sputum culture
  • symptomatic: rest, fluids, analgesics prn (aspirin, aceto, ibup); anti-tussives
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3
Q

What role do OTC cold medications play in tx of acute bronchitis?

A

none!

-those w/ decongestants will thicken sputum and make it harder to clear the infection

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4
Q

What are the most common pathogens in acute bacterial exacerbation of chronic bronchitis?

A
  • up to 50% may be culture negative
  • viral 20-50% of cases
  • C and M pneumoniae
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5
Q

Tx of Acute Exacerbation of Chronic Bronchitis

A
  • stop smoking! (COPD)
  • postural drainage to clear secretions
  • if severe, consider CXR, inhaled anticholinergic bronchodilator (will dry secretions), 2 week oral prednisone burst
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6
Q

What role do abx play in Tx of Acute Exacerbation of Chronic Bronchitis?

A
  • mild to moderate dz: no or maybe

severe: role debated, but some value has been shown; broad spectrum like augmentin, azithro, clarithro, FQs

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7
Q

Clinical Presentation of Strep pneumoniae

A
  • rust colored sputum
  • rapid fever onset
  • high WBC
  • CXR: lobar consolidation
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8
Q

Clinical Presentation of Mycoplasma pneumoniae

A
  • slow course
  • non-productive cough
  • WBC normal or slightly elevated
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9
Q

Clinical Presentation of Legionella pneumoniae

A
  • pleuritic chest pain
  • can see hemoptysis
  • increased LFTs
  • hyponatremia
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10
Q

How is CAP treatment determined?

A
  • out vs inpatient
  • and non-ICU vs ICU
  • presence of co-morbidities like COPD, DM, HF
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11
Q

CAP Tx in Previously Healthy Outpatient with No Abx

A

-macrolide or doxycycline

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12
Q

CAP Tx in Outpatient w/ Presence of Co-morbidities, Immunosuppressing Conditions, or Use of Antimicrobials w/in 3 Months

A
  • respiratory FQ

- or macrolide plus beta-lactam

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13
Q

CAP Tx in Outpatient in a region with >25% high level Macrolide Resistant Strep pneumoniae

A
  • respiratory FQ
  • or macrolide plus beta-lactam

(same as for tx of pts w/ co-morbidities)

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14
Q

CAP Tx of Inpatient Non-ICU

A
  • respiratory FQ

- or macrolide plus beta-lactam

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15
Q

CAP Tx of Inpatient ICU with no Pseudomonas

A
  • beta lactam and azithromycin

- or respiratory FQ

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16
Q

CAP Tx of Inpatient ICU with Pseudomonas

A
  • beta lactam + cipro
  • BL + azithro + AG
  • BL + AG + antipneumococcal FQ
17
Q

CAP Tx of Inpatient ICU with CA-MRSA

A

-add vancomycin or linezolid to cover MRSA

18
Q

When do you switch from IV to oral CAP therapy?

A
  • pt is hemodynamically stable
  • pt improving clinically (cough, dyspnea)
  • pt able to ingest meds
  • normal functioning GI tract
19
Q

Duration of CAP Therapy

A
  • minimum 5 days
  • afebrile 48-72 hours
  • no more than 1 CAP associated sign of instability (fever, tachcayrdic, tachpneic, low SBP, low O2 sat) before discontinuation of therapy
20
Q

HAP Mortality Rates

A

-30-50%

21
Q

What pathogens cause HAP?

A
  • P. aeruginosa
  • E. coli
  • Klebsiella pneumoniae
  • Acinetobacter species
  • Staph aureus, esp MRSA
22
Q

Indication for Tamiflu/Oseltamivir

A
  • tx of influenza A and B in adults and kids older than 2 weeks
  • sxs no more than 2 days
  • prophylaxis against influenza A or B in pts over 1 y.o
23
Q

Tamiflu/Oseltamivir Efficacy

A
  • reduced sxs duration by about 1 day
  • begin tx w/in 24 hours
  • w/in 12 hours of fever onset, decrease total illness by 3 days
24
Q

Tamiflu/Oseltamivir AEs

A
  • with tx: N/V, insomnia, vertigo

- with Px: HA, fatigue, cough, diarrhea

25
Q

Tamiflu/Oseltamivir Dosage for Tx and Px

A
  • tx: 75 mg PO BID x 5 days

- px: 75 mg po qday 7+ days

26
Q

Indication for Zanamivir/Relenza

A
  • tx of flu A and B in adults and kids over 7 y.o
  • sxs no more than 2 days
  • px against A or B in pts over 5 y.o
  • DO NOT USE IN PTS w/ underlying airway disease
27
Q

Zanamivir/Relenza Efficacy

A

-relieved sxs 1.5 days earlier than placebo

28
Q

Zanamivir/Relenza AEs

A
  • HA, N/V/D, dizziness, respiratory sxs
  • may cause bronchospasm
  • decreased lung fx or death in pts w/ underlying airway dz
29
Q

Zanamivir/Relenza Dosage

A

2 inhalations BID x5 days

30
Q

Amantadine and Rimantadine Indication

A
  • both approved for tx of flu A
  • neither has activity against B
  • not currently recommended
31
Q

Amantadine and Rimantadine AEs

A
  • common: nervous, anxiety, difficulty concentrating, lightheaded, nausea, anorexia
  • serious: behavioral changes, delirium, hallucinations, agitation, seizures

Fall2014 - Pharm ID/Pulm (10 decks)

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