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Therapeutics IV > Lower Respiratory Infection - Block 2 > Flashcards

Lower Respiratory Infection - Block 2 Flashcards

1
Q

What is the most commont cause of severe sepsis?

A

Pneumonia

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2
Q

What are the routes respiratory pathogens can reach the LRT?

A
  1. Direct inhalation
  2. Aspiration
  3. Spread from another infection through the bloodstream
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3
Q

What are come things that complicate an infection?

A
  1. Immunocompromised patient
  2. Reduced lung antibacterial capacity from viruses
  3. Intake of alcohol and narcotics
  4. Reduced clearance of aspirated bacteria
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4
Q

What is CAP?

A

Pneumonia developing outsde of the hospital setting or <48H after hospital admission

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5
Q

What is HAP?

A

Pneumonia developing ≥48H after hospital admission

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6
Q

What is VAP?

A

Pneumonia developing ≥48H after endotracheal intubation

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7
Q

Most common pathogens of CAP?

A

Strep pneumoniae
G-: H flu, Moraxella
Atypical: Chlamidia pneumo, Mycoplasma, Legionella

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8
Q

Most common pathogens of HAP?

A

PA, Acinetobacter
Kleb, E coli
S. aureus

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9
Q

Most common pathogens of VAP?

A

S aureus
PA, Acinetobacter
Kleb, E coli

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10
Q

S/s of pneumonia?

A
  1. Fever, chills, malaise
  2. Productive cough
  3. Dyspnea
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11
Q

Physic exam of Pneumonia?

A

Inspiratory crackles

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12
Q

Lab test for pneumonia?

A
  1. Leukocytosis
  2. Low oxygen saturation
  3. Chest radiograph: pulmonary infiltrates
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13
Q

How do we diagnose pneumonia?

A

Clinical presentations and radiologic findings
* Blood and suptum cultures: confirm diagnosis and idenitfy etiology

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14
Q

How do you diagnose of CAP?

A
  1. Empiric therpay
  2. Outpatient CAP management -> sputum cultures not recommended
  3. Obtain blood & sputum cultures for patients with severe CAP
  4. Urinary antigen tests for S. pneumoniae adn Legionella -> recommended for severe CAP
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15
Q

Types of CAP severity assessment tools?

A
  1. Pneumonia severity index
  2. CURB-65
  3. Major and minor criteria for severe CAP
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16
Q

What is CURB-65?

A

Used in the outpatient setting or whe data necessary for PSI scoe is not reasily available:
* 0 – 1 = outpatient treatment (*)
* 1 – 2 = admission to general ward
* 3 – 5 = ICU admission

If the patient’s CURB-65 score ONLY equals one (1) because of age ≥ 65 years old & NO other major comorbidities are present, hospital admission is NOT necessarily indicated.

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17
Q

What are the RF of CAP?

A
  1. ≥65YO
  2. DM
  3. Asplenia
  4. Chronic CV, pulmonary, renal, liver dx
  5. Smoking/alcohol abuse
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18
Q

Outpatient CAP management and tx?

A

No Comorbidities: Amoxicillin, doxycycline, macrolide (azithromycin, clarithromycin)

≥1 comorbid: Respiratory FQ (levo and moxi)
* Combo: b-lactam + macrolide or doxycyclinee

beta-lactams: high-dose amoxicillin or amoxicillin/clavulanate (preferred), cefpodoxime, cefuroxime, ceftriaxone (IM)

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19
Q

Inpatient CAP management

A
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20
Q

MRSA RF?

A
  1. Known colonization
  2. G+ cocci in clusters
  3. Receipt of IV ABX: past 90 days
  4. ESRD, MSM, crowds, incarceration, IVDU, contact sport
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21
Q

RF of Pseudomonas?

A
  1. Known colonization
  2. G- bacilli
  3. Receipt of IV ABX for the past 90 day
  4. Structural lung dx: CF, COPD, bronchiectasis
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22
Q

ABX for CAP?

A
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23
Q

TX of inpatient CAP NKDA or Non-type 1 with no RF for MRSA or PA?

A

Combo is preferred: anti-pneumococal b-lactam + macrolide or doxycycline
OR
Respiratory FQ (levo or moxi)

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24
Q

TX for inpatient CAP NKDA or Non-type 1 with MRSA only?

A

Anit MRSA (vanc or linezolid)
PLUS
Combo is preferred: anti-pneumococal b-lactam + macrolide or doxycycline
OR
Respiratory FQ (levo or moxi)

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25
Q

Tx for inpatient CAP NKDA or Non-type 1 with RF of PA?

A

Anti-pseudomonal, anti-pneumococcal b-lactam
PLUS
Anti-pseudomonal FQ

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26
Q

Tx for inpatient CAP NKDA or Non-type 1 with RF for MRSA and PA

A

Anti-MRSA agent (i.e., vancomycin, linezolid)
PLUS
Anti-pseudomonal, anti-pneumococcal β-lactam
PLUS
Anti-pseudomonal fluoroquinolone

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27
Q

TX of inpatient CAP Type 1 allergies with no RF for MRSA or PA?

A

Respiratory fluoroquinolone (i.e., levofloxacin, moxifloxacin)

28
Q

TX of inpatient CAP Type 1 allergies with RF for MRSA?

A

Anti-MRSA agent (i.e., vancomycin, linezolid)
PLUS
Respiratory fluoroquinolone (i.e., levofloxacin, moxifloxacin)

29
Q

TX of inpatient CAP Type 1 allergies with RF for PA?

A

Levofloxacin
PLUS
Aztreonam
PLUS
Aminoglycoside

30
Q

TX of inpatient CAP Type 1 allergies with RF for PA and MRSA?

A

Anti MRSA (vancomycin, linezolid)
PLUS
Levofloxacin
PLUS
Aztreonam
PLUS
Aminoglycoside

31
Q

TX of ICU CAP NKDA or Non-type 1 allergies with no RF for MRSA and PA?

A

Combo therapy (preferred): anti-pneumococcal β-lactam + macrolide
(OR)
Combo therapy (alternative): anti-pneumococcal β-lactam + respiratory fluoroquinolone

32
Q

TX of ICU CAP NKDA or Non-type 1 allergies with RF for MRSA?

A

Anti-MRSA agent (i.e., vancomycin, linezolid)
(PLUS)
Combo therapy (preferred): anti-pneumococcal β-lactam + macrolide
(OR)
Combo therapy (alternative): anti-pneumococcal β-lactam + respiratory fluoroquinolone

33
Q

TX of ICU CAP NKDA or Non-type 1 allergies with RF for PA?

A

Anti-pseudomonal, anti-pneumococcal β-lactam
(PLUS)
Anti-pseudomonal fluoroquinolone

34
Q

TX of ICU CAP NKDA or Non-type 1 allergies with RF for PA and MRSA?

A

Anti-MRSA agent (i.e., vancomycin, linezolid)
(PLUS)
Anti-pseudomonal, anti-pneumococcal β-lactam
(PLUS)
Anti-pseudomonal fluoroquinolone

35
Q

TX of ICU CAP Type 1 allergies with no RF for PA and MRSA?

A

Respiratory fluoroquinolone + aztreonam

36
Q

TX of ICU CAP Type 1 allergies with RF for PA and MRSA?

A

Anti-MRSA agent (i.e., vancomycin, linezolid)
PLUS
Levofloxacin
PLUS
Aztreonam + aminoglycoside

37
Q

TX of ICU CAP Type 1 allergies with RF for PA?

A

Levofloxacin
(PLUS)
Aztreonam
(PLUS)
Aminoglycoside

38
Q

TX of ICU CAP Type 1 allergies with RF for MRSA?

A

Anti-MRSA agent (i.e., vancomycin, linezolid)
(PLUS)
Respiratory fluoroquinolone
(PLUS)
Aztreonam

39
Q

Classifications of HAP?

A
40
Q

RF for HAP?

A
  1. MDR/Mortality: Ventilatory support, septic shock, Receipt of IV antibiotics during hospitalization in past 90 days)
  2. MRSA
  3. PA
41
Q

Tx for HAP with MDR?

A

1 anti-MRSA agent + 2 anti-pseudomonal agents (from different classes)

42
Q

Tx for HAP with MRSA?

A

1 anti-MRSA agent + 1 anti-pseudomonal agent

43
Q

Tx for HAP with MRSA and PA?

A

1 anti-MRSA agent + 2 anti-pseudomonal agents (from different classes)

44
Q

Tx for HAP with no MDR, MRSA, PA

A

1 anti-pseudomonal agent

45
Q

Tx for HAP wih PA?

A

2 anti-pseudomonal agent (from different classes)

46
Q

Classifications of VAP?

A
47
Q

RF for VAP?

A
48
Q

Tx for VAP with MDR?

A

1 anti-MRSA agent + 2 anti-pseudomonal agents (from different classes)

49
Q

Tx for VAP with MRSA?

A

1 anti-MRSA agent + 1 anti-pseudomonal agent

50
Q

Tx for VAP with MRSA and PA?

A

1 anti-MRSA agent + 2 anti-pseudomonal agents (from different classes)

51
Q

Tx for VAP with no MDR, MRSA, PA

A

1 anti-pseudomonal agent

52
Q

Tx for VAP with PA?

A

2 anti-pseudomonal agent (from different classes)

53
Q

Tx for Penicillin susceptible S. pneumoniae?

A

Preferred: ampicillin, amoxicillin, pen G
Alt: Ceftriaxone, cefotaxime, macrolides, levofloxacin, moxifloxacin, doxycycline, clindamycin, vancomycin

54
Q

Tx for penicillin resistant S. pneumoniae?

A

preferred: Cetriaxone, cefotaxime, levofloxacin, moxifloxacin
Alt: High dose amoxcillin, linezolid, clindamycin, vancomyci

55
Q

Tx for non-b-lactamase producing H flu?

A

Preferred: ampicillin, amoxicillin
Alt: FQ, doxycycline, azithromycin, clarithromycn

56
Q

Tx for b-lactmase producing h flu?

A

Preferred: Ceftriaxone, cefotaxime, ampicillin-sulbactam, augmentin
Alt: FQ, doxycyclin, azithromycin, clarithromycin

57
Q

Tx for mycoplasma

A

Preferred: Macrolid, doxycycline
Alt: FQ

58
Q

Tx for Chlamydia pneumo?

A

Preferred: Macrolide, doxycycline
Alt: FQ

59
Q

Tx for legionella?

A

Preferred: FQ, azithromycin
Alt: Doxycycline

60
Q

Tx for MSSA?

A

Preferred: Cefazolin, anti-staph, penicillin
Alt: Clindamycin, vancomycin

61
Q

Tx for MRSA

A

Preferred: Vanc, linezolid
Alt: Telavancin, ceftaroline, Synercid, Clindamycin, Bactrm

62
Q

Tx for Pseudomonas?

A

Preferred: Anti-pseudomonal β-lactam or fluoroquinolone
* AG for septic shock or high risk

Alt: Colistin, polymixin B

63
Q

Tx for Acinetobacter

A

Preferred: Carbapnem or ampicillin-sulbactam
Alt: Colistin, polymixin B

64
Q

Tx for ESBL?

A

Preferred: Carbapenem
Alt: Zosyn or cefepime

65
Q

Tx for carbapenem resistance?

A

Ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam

66
Q

When shoudl resolution of pneumonia occur?

A

Within first 2 days -> 5-7 days

Therapeutics IV (39 decks)

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