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Pharm I ( Melicia) > Lower Respiratory Infections > Flashcards

Lower Respiratory Infections Flashcards

1
Q

Most common infections involving lower respiratory tract?

A

bronchitis, bronchiolitis, pna

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2
Q

What is bronchitis?

A

inflammation of the walls of the bronchi and bronchioles which causes narrowing

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3
Q

What is bronchiesctasis?

A

widening of the bronchi and bronchioles but excessive mucus production narrows the bronchial tree

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4
Q

Acute bronchitis usually affects who? chronic bronchitis? bronchiolitis?

A

ind. of all ages

adults

infancy

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5
Q

Signs/sxs of bronchiolitis?

A

Prodrome with irritability, restlessness, and mild fever

Cough and coryza, V/D, noisy breathing, and increased RR

Labored breathing with retractions, nasal flaring, and grunting

tachycardia, wheezing/inspiratory rales

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6
Q

Main cause of Acute bronchitis?

A

mostly viral, so no abx

therapy is symptomatic: Ibuprofen/Acetaminophen, fluids for rehydration

antitussives rarely indicated

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7
Q

What bacteria can cause bacterial acute bronchitis?

A

mycoplasma pneumoniae

Chlamydophilia pneumoniae, B. pertussis

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8
Q

When should you suspect bacterial etiology of acute bronchitis?

A

fever for more than 4-6 d

predisposed pts (immunocompromised)

if suspected by hx of if confirmed by culture serology/PCR

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9
Q

How can you tx bacterial acute bronchitis?

A

azithromycin or respiratory fluoroquinolone

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10
Q

Acute bronchiolotitis

A

RSV is the most common cause

usually self limiting in healthy infants

if severe: +/- O2 therapy, IV fluids, subset (aerosolized bronchodilators, Ribavirin)

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11
Q

What pts can benefit from Ribavirin?

A

pts with bronchopulmonary dysplasia, congenital heart disease, prematurity or immunodeficiency

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12
Q

other tx approach for acute bronchitis in pts with underlying pulmonary or cardiovascular disease?

A

Prophylaxis against RSV

  • give monthly during RSV season
  • RSV immune globulin or Palivizumab ( a monoclonal ab for RSV)
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13
Q

ADEs of Palivizumab?

A

fever, rash, ab formation, anaphylaxis (rare), thrombocytopenia

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14
Q

Hallmark of chronic bronchitis?

A

chronic cough, excessive sputum production, expectoration w/ persistent presence of microorganisms in the pts sputum

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15
Q

signs/sxs of chronic bronchitis?

A

excessive sputum expectoration, cyanosis

PE: in/exp rales, rhonchi and mild wheezing. Hyperresonance on percussion.

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16
Q

Tx for chronic bronchitis?

A

attempts to mobilize and enhance sputum expectoration: chest physiotherapy, humidification of inspired air

O2

aerosolized bronchodilators (albuterol)

abx

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17
Q

Most common organisms that cause chronic bronchitis?

A

H. Influenzae, M. Catarrhalis, S. pneumoniae, E. coli

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18
Q

What abx should you use for the tx of chronic bronchitis?

A

which ever abx has the lowest resistance and highest sensitivity

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19
Q

signs/sxs of pna?

A

abrupt onset of fevers, chills, dyspnea, productive cough

rust colored sputum or hemoptysis

pleuritis CP

20
Q

Pna PE?

A

tachypnea and tachycardia. Dullness to percussion, increased tactile fremitus, CW retractions, diminished breath sounds over affected areas, inspiratory crackles during lung expansion

21
Q

Pna CXR? lab tests?

A

dense lobar or segmental infiltrate

leukocytosis w/ predominance of polymorphonuclear cells

low O2 sat

22
Q

Most common cause of CAP in adults?

A

S. pneumoniae

other causes: m. pneumoniae, legionella species, C. pneumonia, H. influenzae

23
Q

Tx for CAP?

A

humidified oxygen for hypoxemia

bronchodilators when bronchospasm present

fluids

chest physiotherapy

abx (based on presumed causative pathogens)

24
Q

Recommended empiric abx for healthy pts with CAP, no abx in last 3 months?

A

Macrolide or Doxycycline

25
Q

Recommended empiric abx for CAP pt with comorbid conditions?

A

respiratory fluoroquinolone

or macrolide + beta lactam

26
Q

Recommended empiric abx for pts living in regions with high rates of macrolide resistant to S. pneumoniae?

A

respiratory fluoroquinolone

or macrolide + beta lactam

27
Q

Inpt therapy for CAP, for pt not in ICU?

A

respiratory fluoroquinolone

or macrolide + beta lactam ( for fluoroquinolone allergy)

28
Q

CAP tx for pts admitted to ICU?

A

Azithromycin or respiratory fluoroquinolone + anti-pneumococcal beta lactam

PCN all: fluoroquinolone + Aztreonam

29
Q

Tx of CAP for pts at risk for pseudomonas infection ?

A

antipneumococcal, antipseudomonal beta lactam

+ aminoglycoside (gentamicin, tobramicin)

+Azithromycin or respiratory fluoroquinolone

30
Q

Tx for CAP in pts at risk for MRSA

A

antipneumococcal, antipseudomonal beta lactam

+ aminoglycoside (gentamicin, tobramicin)

+Azithromycin or respiratory fluoroquinolone

+ Vancomycin or Linezolid
???

31
Q

Risk factors for multi drug resistant pathogens (MDR)?

A

abx therapy within the last 3 mos, septic shock, ARDS, 5+ days in hospital prior to HAP/VAP, acute renal replacement, tx in a unit where local susceptibility rates are not known

32
Q

Risk factors for MRSA in pts with HAP and VAP?

A

abx therapy in the last 3 mos, renal replacement therapy, use of gastric acid suppressive agents,+ culture or MRSA in the past 3 mos, hospitalized in unit where prevalence of MRSA is not known

33
Q

Risk factors for pseudomonas aeruginosa and other gram - bacilli?

A

abx therapy in the last 90 days

structural lung disease

recent hospitalizations

+ culture within the past yr

34
Q

Recommended initial empiric abx for HAP and VAP?

A

one of the following:

Piperacillin-tazobactam (Zosin)

Cefepime

Levofloxacin

Imipenem

Meropenem

35
Q

Recommended initial empiric tx for HAP/VAP in pts with risk factors for MRSA?

A

Pick one: Piperacillin-tazobactam (Zosin), Cefepime, Ceftazidime, Levofloxin, Aztreonam, etc.

+ one:

Vancomycin or Linezolid

36
Q

Recommended initial empiric abx tx for HAP with risk factors for pseudomonas?

A

Pick one: Piperacillin-tazobactam (Zosin), Cefepime, Ceftazidime, Levofloxin, Aztreonam, etc.

+ one:

Levofloxacin, Gentamicin, Tobramycin, Aztreonam

37
Q

Recommended initial empiric abx for HAP/VAP with risk factors for MRSA, MDR, pseudomonas and other gram - bacilli?

A

Pick one: Piperacillin-tazobactam (Zosin), Cefepime, Ceftazidime, Levofloxin, Aztreonam, etc.

+ one:

Levofloxacin, Gentamicin, Tobramycin, Ciprofloxacin

+one:

Vancomycin or Linezolid

38
Q

which organisms cause pna in peds?

A

RSV, parainfluenza, adenovirus

M. pneumoniae in older children

39
Q

Name a first generation cephalosporin. Use?

A

Cephalexin

skin, soft tissue, UTIs

40
Q

Name a second generation cephalosporin. Use?

A

Cefotetan

Cefoxitin

Cefuroxime

more active v. S pneumoniae and H influenzae, B fragilis

41
Q

Name a third generation cephalosporin. Use?

A

Ceftriazone

Cefixime

Cefotaxine

Ceftazidime

many uses including pna, meningitis and gonorrhea. Broad activity, beta lactamase stable

42
Q

Name a 4th generation cephalosporin. Use?

A

cefipime

pseudomonas coverage

43
Q

Name a 5th generation cephalosporin. Use?

A

ceftaroline

skin, CAP

44
Q

PK of cephalosporins

A

oral use for older drugs, mostly IV for newer drugs

renal elimination, short half lives

third gen. drugs enter CNS

45
Q

ADEs of cephalosporins

A

hypersensitivity rxn

first gen. partial cross reactivity with penicillins

GI upset

46
Q

Name a carbapenem. Use?

A

Imipenem-cilastatin (a beta lactam)

broad spectrum, some PRSP strains, gram negative rods, pseudomonas sp

Pharm I ( Melicia) (18 decks)

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