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Therapeutics 3 > Lower Respiratory Tract Infections > Flashcards

Lower Respiratory Tract Infections Flashcards

1
Q

Bronchitis

What is the causitive pathogens of bronchitis?

A
  • VIRUSES! > 90% of cases
  • bacteria (atypical organisms)= mycoplasma pneumoniae, chlamydia pneumoniae, bordatella pertussis (whopping cough)
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2
Q

Bronchitis

When is acute bronchitis treated?

A

if the infection is caused by bordatella pertussis (whopping cough)

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3
Q

Bronchitis

What antibiotics are used to treat Bordatella pertussis?

A
  • macrolide
  • sulfamethoxazole/trimethoprim
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4
Q

Pneumonia

What is the diagnosis criteria of pneumonia?

A

new lung inflitrate + clinical evidence for an infectious origin (fever, purulent sputum, leukocytosis, decreased oxygenation)

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5
Q

Pneumonia

What is the cause of pneumonia?

A
  • aspiration (suble aspiration common in all indivuals, but risk factors may predispose pt)
  • inhalation
  • hematogenous
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6
Q

Pneumonia

What are the risk factors for pneumonia?

A
  • viral infections predispose pt to secondary bacterial pneumonia (commonly seen in elderly)
  • hospitalization
  • mechanical ventilation
  • smoking
  • alcoholism
  • elderly
  • immunosuppresion
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7
Q

Pneumonia

How is hospital acquired pneumonia (HAP) classified?

A

pneumonia that occurs > 48 hours after admission to the hospital and was not incubated at the time of admission

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8
Q

Pneumonia

How is ventilator acquired pneumonia (VAP) classified?

A

pneumonia that occurs > 48 hours after endotracheal intubation

~9-27% incidence rate of intubated patient, risk increases with time

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9
Q

Pneumonia

What is the cause of aspiration pneumonia?

A

large inoculum of less virulent pathogens (anaerobes- normal flora)

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10
Q

Pneumonia

What are the risk factors for aspiration pneumonia?

A
  • drugs
  • altered mental status
  • impaired host defenses (cough/gag reflex)
  • neuromuscular disease
  • dysphagia (history of stroke)
  • mechanical ventilation, bronchoscopy, nasogastric feeding
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11
Q

Pneumonia

What is the clinical presentation of pneumonia?

A
  • cough
  • dyspnea
  • sputum production
  • pleuritic chest pain
  • signs of systemic infection (fever, chills, hypoxemia, tachycardia, tachypnea)

peds: grunting, retractions, nasal flaring

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12
Q

Pneumonia

What labs and diagnostic tests can be used to diagnosis pneumonia?

A
  • chest Xray
  • sputum culture
  • blood culture
  • pulse oximetry
  • WBCs
  • urine antigen testing
  • rapid influenza molecular assay (especially during the season in the elderly)
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13
Q

Pneumonia

What are the common pathogens that are respondsible for community acquired pneumonia (CAP)?

A
  • streptococcus pneumoniae
  • haemophilus influenzae
  • staphylococcus aureus
  • mycoplasma pneumoniae
  • legionella species (serious illness)
  • chlamydia pneumoniae
  • moraxella catarrhalis
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14
Q

Pneumonia

What are the common pathogens that are respondsible for hospital acquired pneumonia (HAP)?

A
  • escherichia coli
  • staphylococcus aureus
  • klebsiella pneumoniae
  • acinetobacter spp.
  • pseudomonas aeruginosa
  • enterobacter spp.
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15
Q

Pneumonia

What is the most common bacterial pathogen that causes pneumonia in ages birth- 3 weeks?

A

group B strep

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16
Q

Pneumonia

What is the most common bacterial pathogen that causes pneumonia in ages 3 weeks- 3 months?

A
  • streptococcus pneumoniae
  • bordatella pertussis

viruses= RSV

17
Q

Pneumonia

What is the most common bacterial pathogen that causes pneumonia in ages 3 months-5 years?

A

streptococcus pneumoniae

VIRUSES

18
Q

Pneumonia

What is the most common bacterial pathogen that causes pneumonia in ages 5 years- 15 years?

A

atypical organisms
- mycoplasma pneumoniae
- chlamydophila pneumoniae
- streptococcus pneumoniae

19
Q

Pneumonia

What is the criteria for community acquired pneumonia (CAP) to be considered severe?

A

major criteria
- septic shock with the need for vasopressors
- respiratory failure requiring mechanical ventilation

lots of minor criteria, but focus on major criteria

20
Q

Pneumonia

What is the CURB-65?

A

5 criteria to assess whether the pt may be treated inpatient or outpatient, score of 2+ = hospitalization or agressive home care due to increased risk of mortality
- Confusion
- BUN > 20mg/dL
- Respiratory rate 30+ bpm
- Blood pressure <90/<60mmHg
- Age 65+

21
Q

Pneumonia

What is the standard regimen for community acquired pneumonia (CAP) treatment outpatient?

A
  • amoxicillin 1 g PO TID
  • doxycycline 100 mg PO BID
  • levofloxacin 750 mg PO daily

no comorbities or risk factors for MRSA or pseudomonas aeruginosa

22
Q

Pneumonia

What is the standard regimen for community acquired pneumonia (CAP) treatment for patient’s with comorbidites outpatient?

A
  • amoxicillin OR cephalosporin (2nd or 3rd gen) AND macrolide OR doxycycline
  • respiratory fluroquinolone (levofloxacin)

heart/lung/liver/renal disease, DM, alcoholism, malignancy, asplenia

23
Q

Pneumonia

What is the treatment for non-severe community acquired pneumonia (CAP) inpatient?

A

beta-lactam + advanced macrolide (clarithromycin or azithromycin) OR respiratory fluroquinolone (levofloxicin or moxifloxacin)

24
Q

Pneumonia

What is the treatment for severe community acquired pneumonia (CAP) inpatient?

A

beta-lactam + advanced macrolide (clarithromycin or azithromycin) OR beta-lactam + respiratory fluroquinolone (levofloxacin or moxifloxacin)

25
Q

Pneumonia

What is the first line treatment for pneumonia for appropiately immunized preschool aged children?

A

amoxicillin or amoxicillin/clavulanate

26
Q

Pneumonia

What is the first line treatment for pneumonia for school aged children (> 5 years old)?

A

amoxicillin + azithromycin

27
Q

Pneumonia

What is the treatment duration of treatment for community acquired pneumonia (CAP)?

A

5+ days, 7 days for MRSA or P. aeruginosa

28
Q

Pneumonia

What are the risk factors for high mortality in hospital acquired pneumonia?

A
  • ventilator support due to pneumonia
  • septic shock
29
Q

Pneumonia

What are the risk factors for milti-drug resistance pneumonia?

A

previous IV antibiotic use in past 90 days

30
Q

Pneumonia

When should MRSA be empirically covered for hospital acquired pneumonia (HAP)?

A
  • multi-drug resistant risk factors
  • > 20% MRSA isolates
  • high risk for mortality
31
Q

Pneumonia

How is it decided whether a patient requires 1 or 2 antipseudomonal agents for hospital acquired pneumonia (HAP)?

A
  • 1 antipseudomonal agent= no MDR risk factors, low risk for mortality
  • 2 antipseudomonal agents (2 different classes)= MDR risk factors, high risk of mortality, gram stain with numerous gram negative bacilli, patients with structural lung disease
32
Q

Pneumonia

What antibitoics may be used for MRSA coverage in hospital acquired pneumonia (HAP)?

A

VANCOMYCIN or linezolid

33
Q

Pneumonia

What antibacterials can be used for Pseudomonal coverage?

A
  • piperacillin/tazobactam
  • cephalosporin
  • carbapenems
  • monobactams (penicillin allergy)
  • fluroquinolones
  • aminoglycosides (never used alone)
  • polymyxins
34
Q

Pneumonia

What is the duration of therapy for hospital acquired pneumonia (HAP)?

A

7 days

Therapeutics 3 (14 decks)

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