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Pharm I > Lower Respiratory Tract Infections > Flashcards

Lower Respiratory Tract Infections Flashcards

1
Q

Risk factors for bronchitis

A

Cold or damp climate
Cigarette smoke
Air pollution

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2
Q

Causative organisms of bronchitis

A 
Viral pathogens mcc
-Common cold virus
-Influenza
-Adenovirus
-RSV
Bacterial pathogens
-Chlamydophilia pneumonia
-Mycoplasma pneumonia
-Bordetella pertussis
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3
Q

Acute bronchitis tx

A

Symptomatic and supportive care

  • Antipyretics
  • Antitussives
  • Bronchodilators
  • Corticosteroids
  • -Medrol dose pack
  • -Prednisone dose pack
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4
Q

When are abx indicated for acute bronchitis?

A

High-risk pts

Persistent sx

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5
Q

Choice of abx for bronchitis

A

Similar to CAP
Macrolide or doxycycline
Respiratory FQ

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6
Q

ASA adult dose

A

325-650 mg q4h

Max: 4 gm/day

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7
Q

ASA pediatric dose

A

CI in children 2nd

Reye’s syndrome

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8
Q

ASA pearls/side effects

A

Inhibit prostaglandin synthesis (AKI)
Tinnitus
Upper GI events

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9
Q

Ibuprofen adult dosing

A

200-800 mg Q4-6H

Max: 3.2 gm/day

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10
Q

Ibuprofen pediatric dosing

A

10 mg/kg PO q4-6h

Max: 50 mg/kg/day

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11
Q

Ibuprofen pearls/side effects

A 
Use in age > 6 mos
Inhibit prostaglandin synthesis (AKI)
Epigastric pain/dyspepsia
GI ulcer/bleeding
Increased CV events
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12
Q

Acetaminophen adult dose

A

650 mg PO q4-6h

Max: 4 gm/day

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13
Q

Acetaminophen pediatric dose

A

10-15 mg/kg PO q4-6h

Max: 60 mg/kg/day

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14
Q

Acetamiophen pearls/side effects

A

Preferred in children
Caution in liver disease
Skin reactioAns

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15
Q

Influenza tx

A

Antivirals should be started within 48 hrs of symptom onset

-Reduces illness duration ~1.3 days

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16
Q

Amantadine

Rimantadine clinical pearls

A

Spectrum: Influenza A

Use not currently recommended due to resistance issues

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17
Q

Olsetamivir adult dose and influenza spectrum

A

Dose: 75 mg PO BID x 5 days
Spectrum: A and B

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18
Q

Zanamavir adult dose and influenza spectrum

A

Dose: 10 mg INH BID x 5 days
Spectrum: A and B

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19
Q

Olsetamivir pearls

A

Renally eliminated
Safe in children
Increased risk of neuropsychiatric events

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20
Q

Zanamivir pearls

A

Age >7
Increased risk of neuropsychiatric events
Bronchospasm

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21
Q

Azithromycin MOA

A

Inhibits protein synthesis (50s)

Bacteriostatic

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22
Q

Azithromycin typical adult dosing: pneumonia

A

Variable: 500 mg IV or PO daily on day 1, then 250 mg IV or PO daily on day 2-5

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23
Q

Azithromycin spectrum of activity

A

Some gram neg
Gram pos
ATYPICALS

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24
Q

Azithromycin pearls/ side effects

A

QT prolongation
Increased cardiac risk
D/N/V

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25
Q

Doxycycline MOA

A

Inhibits protein synthesis (30s)

Bacteriostatic

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26
Q

Doxycycline typical adult dosing pneumonia

A

100 mg IV or PO q12h

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27
Q

Doxycycline spectrum of activity

A

Gram neg
Gram pos
ATYPICALS

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28
Q

Doxycycline pearls/side effects

A 
Esophageal irritation (take with water)
GI upset (N/V)
-Take with food
Decreased absorption with food
Photosensitivity
Tooth discoloration/hyperpigmentation
-Caution in age < 8 yrs
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29
Q

Clinical presentation of pneumonia

A 
Cough +/- sputum
Fever/chills
Pleuritic chest pain
Dyspnea
Crackles on chest exam
Consolidation on chest radiography
AMS
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30
Q

Microbiologic diagnosis of pneumonia

A 
Sputum gram stain/culture
- >25 PMN and < 5 epithelial cells
Blood culture
Broncho-alveolar lavage (BAL)
- > 10 to the sixth CFU/mL
Protected specimen brush (PSB)
- > 10 to the third CFU/mL
Urine antigen tests
-Legionella and S. pneumo
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31
Q

Community Acquired Pneumonia (CAP)

A

New infection in pt residing in the community without a recent hx of antimicrobial use or exposure to health care environments

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32
Q

Hospital Acquired Pneumonia (HAP)

A

New infection occurring greater than or equal to 48 hrs after hospital admission

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33
Q

Ventilator Associated Pneumonia (VAP)

A

New infection occurring greater than or equal to 48 hours after endotracheal intubation

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34
Q

Atypical coverage of pneumonia

A

Macrolides
Doxycycline
Fluoroquinolones

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35
Q

MRSA pneumonia coverage

A

Vancomycin
Linezolid
Ceftaroline
Telayancin

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36
Q

Anti-pseudomonal agents: other antimicrobials

A 
FQs
-Ciprofloxacin
-Levofloxacin
Aminoglycosides
-Gentamicin
-Amikacin
-Tobramycin
Colistin
Polymyxin B
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37
Q

Side effects of PCNs

A

GI (N/V/D)
Rash
Hypersensitivity
Seizure

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38
Q

Amoxicillin adult dose PNA

A

1 gm PO TID

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39
Q

Amoxicillin spectrum of activity

A

Gram pos

Gram neg

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40
Q

Amox-clav adult dose PNA

A

2 gm PO BID

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41
Q

Amox-clav spectrum of activity

A

Gram pos
Gram neg
Anaerobe

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42
Q

Amox-clav pearls and side effects

A

N/V/D

Hepatotoxic- reversible

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43
Q

Ampicillin/sulbactam spectrum of activity

A

Same as amox-clav

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44
Q

Ampicillin/sulbactam pearls and side effects

A

Hepatic impairment

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45
Q

Piperacillin/tazobactam adult dosing PNA

A

3.375 g IV q8h ext. inf. (4.5 g IV q6h)

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46
Q

Piperacillin/tazobactam spectrum of activity

A

Same as amox/clav + PSA

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47
Q

Piperacillin/tazobactam pearls and side effects

A

Thrombocytopenia
Caution in CHF
Dermatologic
(+) Coombs

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48
Q

Cephalosporins side effects

A

GI (N/V/D)

Seizure

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49
Q

Drug interactions: cephalosporins

A

May increase INR

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50
Q

Cefuroxime adult dose PNA

A

750 mg IV q8h
500 mg PO q12h
2nd generation

51
Q

Cefuroxime spectrum of activity

A

< Gm pos
> Gm neg (not nosocomial)
Anaerobes

52
Q

Cefuroxime pearls and side effects

A

Only if PCN MIC less than or equal to 2

53
Q

Cefpodoxime spectrum of activity

A

< Gm pos

> Gm neg (nosocomial)

54
Q

Cefotaxime spectrum of activity

A

Same as cefpodoxime

55
Q

Cefotaxime pearls and side effects

A

Not spec. indicated PNA

56
Q

Ceftazadime spectrum of activity

A

Same as cefpodoxime and PSA

57
Q

Ceftazadime pearls and side effects

A

Neurotoxic

58
Q

Ceftriaxone adult dose PNA

A

1 gm q24h

3rd gen

59
Q

Ceftriazone spectrum of activity

A

Same as cefpodoxime

60
Q

Ceftriaxone pearls and side effects

A

Pancreatitis
Gallstones
Avoid in neonates
Avoid with Ca solutions

61
Q

Cefepime spectrum of activity

A

Gram pos

Nosocomial gm neg including PSA

62
Q

Cefepime pearls and side effects

A

Neurotoxic

(+) Coombs test

63
Q

Carbapenems side effects

A

GI (N/V/D)

Seizure

64
Q

Carbapenems drug interaction

A

Can decrease valproate concentrations

65
Q

Imipenem/cilostatin spectrum of activity

A 
Gram pos
Gm neg
Anaerobic
PSA
Enterococcus
66
Q

Imipenem/cilostatin pearls and side effects

A 
Seizures (highest risk)
Hematologic effects (pediatrics)
67
Q

Meropenem adult dose PNA

A

500 mg IV q6h or 1 gm IV q 8h

68
Q

Meropenem spectrum of activity

A

Gm pos
Gm neg
Anaerobic
PSA

69
Q

Meropenem pearls and side effects

A

Extended infusion dosing

70
Q

Doripenem

A

Not reliable in pna

71
Q

Ertapenem spectrum of activity

A

Gm pos
Gm neg
Anaerobic
NO PSA

72
Q

Ertapenem pearls and side effects

A

Once daily product

73
Q

Community acquired pneumonia most common pathogens

A 
S. pneumoniae
H. influenza
M. catarrhalis
Atypical
-M. pneumoniae
-C. pneumoniae
-L. pneumonophilia
Viral
74
Q

How to select empiric antimicrobial therapy for pna

A 
Cover the most likely pathogens
-Assess pt risk factors
Assess severity of illness
Consider local resistance patterns
Penetration to site of action
Pt specific factors
75
Q

Severity of illness assessment

A

Home vs hospital
ICU vs non-ICU
Pneumonia severity index (PSI)
CURB- 65

76
Q

CURB-65

A 
One point each
Confusion
Urea (BUN) > 20 mg/dL
Respiratory rate > 30
BP (SBP < 90 or DBP < 60)
Age greater than or equal to 65
77
Q

CURB-65 score 0-1

A

Outpatient

Oral abx

78
Q

CURB-65 score 2

A

Oupatient or inpatient

Oral or IV abx

79
Q

CURB-65 score 3

A

Inpatient

IV abx

80
Q

CURB-65 score 4-5

A

Inpatient +/- ICU

IV abx

81
Q

CAP- outpatient tx

A 
Otherwise healthy: Macrolide 
-Azithromycin, clarithromycin
 Doxycycline
Outpatient comorbidities: respiratory fqs, 
-Moxifloxacin, levofloxacin
B-lactam + macrolide
82
Q

RF for P. aeruginosa

A 
Structural lung disease
-Bronchiectasis
Corticosteroid therapy
- > 10 mg prednisone/day
Broad spectrum abx for > 7 days in past 30 days
Malnutrition
83
Q

RF for Drug-resistant S. pneumonia (DRSP)

A 
Antibiotic in past 3 mos
Alcoholism
Immune-suppression
-Disease or medications
Multiple comorbidities
-CHF, CKD, COPD, liver disease, diabetes
Splenectomy
High rate of macrolide-resistant S. pneumo in community
84
Q

Side effects of FQs

A 
QT prolongation
CNS effects
Hypoglycemia
Peripheral neuropathy
Photosensitivity
Tendon rupture
85
Q

Tx of CAP- inpatient (non-ICU)

A

Respiratory FQ
-Moxifloxacin, levofloxacin
Beta-lactam + macrolide (or doxycycline)

86
Q

Tx of CAP- inpatient (ICU)

No MDR pathogens

A

Beta-lactam + azithromycin
Beta-lactam + resp. FQ
PCN allergy: resp. FQ + aztreonam

87
Q

CAP- inpatient (ICU)

Risk for pseudomonas

A

Atipseudomonal beta-lactam + cipro/levofloxacin

Antipseudomonal beta-lactam + AMG + azithromycin

88
Q

CAP- inpatient (ICU)

Risk for MRSA

A 
Add coverage
Vancomycin
Linezolid
Ceftaroline
Telayancin
89
Q

Aspiration pneumonia- oral contents pathogens

A

Anaerobes

Strep spp.

90
Q

Aspiration pneumonia- oral contents tx

A

Pen G
Ampicillin/sulbactam
Clindamycin

91
Q

Aspiration pneumonia- gastric contents pathogens

A

Enteric GN bacilli

S. aureus

92
Q

Aspiration pneumonia- gastric contents tx

A

Ampicillin/sulbactam
Amoxicillin/clavulanate
Piperacillin/tazobactam
Ticarcicillin/clavulanate

93
Q

Criteria for clinical stability- IV to PO switch

A

Temperature less than or equal to 37.8 degrees Celsius
HR less than or equal to 100 bpm
RR less than or equal to 24 breaths/min
SBP greater than or equal to 90 mm Hg
SpO2 greater than or equal to 90% or pO2 greater than or equal to 60 mm Hg on room air
Ability to maintain oral intake
Nl mental status

94
Q

Do not use in age <5

A 
Ciprofloxacin
Moxifloxacin
Levofloxacin
Tetracycline
Doxycycline
95
Q

CAP in pediatric pts

A

Most often viral

-Supportive therapy (antipyretics, hydration)

96
Q

Outpatient CAP tx in peds

A

Amoxicillin +/- macrolide

97
Q

Inpatient CAP tx in peds

A

Beta-lactam +/- azithromycin
Fully immunized: Pen G IV or ampicillin IV
Not immunized: Cefotaxime or ceftriaxone

98
Q

Common gram-neg pathogens for HAP and VAP

A 
P. aeruginosa
E. coli (ESBL)
Proteus spp.
K. pneumonia (ESBL)
Acinetobacter spp.
99
Q

Common gram-pos pathogens for HAP and VAP

A

S. aureus

MRSA

100
Q

VAP risk factors for MDR organisms

A

Prior IV abx in past 90 days
Septic shock at time of VAP
ARDS preceding VAP
Greater than or equal to 5 days of hospitalization preceding VAP
Acute renal replacement therapy prior to VAP

101
Q

RR for MDR organisms- HAP

A

Prior IV abx in past 90 days

102
Q

Empiric therapy: VAP

A

Anti-PSA broad spectrum beta-lactam + double coverage IF MDR risk factors present + MRSA coverage IF MRSA risk factors present

103
Q

VAP anti-PSA broad spectrum beta-lactam

A 
Cefepime 
Ceftazidime
Imipenem
Meropenem
Piperacillin/tazobactam
PCN allergy: aztreonam
104
Q

VAP MDR risk-factors coverage drugs

A 
Ciprofloxacin
Levofloxacin
(Aminoglycosides)
(Colistin)
(Polymyxin)
105
Q

VAP MRSA coverage drugs

A

Vancomycin
Linezolid
(Telavancin)
(Ceftaroline)

106
Q

HAP group 1

A

Not at high mortality risk
AND
No MRSA risk factors

107
Q

HAP group 2

A

Not at high mortality risk
AND
MRSA risk factors present

108
Q

HAP group 3

A

High risk of mortality
OR
IV abx in last 90 days

109
Q

Increased risk of mortality for HAP

A

Ventilatory support needed for pneumonia

Septic shock

110
Q

MRSA risk factors for HAP

A

IV antibiotic tx in last 90 days
> 20% isolates MRSA and not MSSA in unit
MRSA prevalence in unit unknown

111
Q

Empiric HAP therapy- group 1

A 
Piperacillin/taxobactam
Cefepime
Levofloxacin
(Imipenem)
(Meropenem)
112
Q

Empiric HAP therapy- group 2

A 
One of the following:
Piperacillin/tazobactam
Cefepime
Levofloxacin
Ciprofloxacin
Imipenem
Meropenem
Aztreonam
One of the following:
Vancomycin
Linezolid
113
Q

Empiric HAP therapy- group 3

A 
One of the following:
Piperacillin/tazobactam
Cefepime
Ceftazadime
Imipenem
Meropenem
Aztreonam
One of the following:
Levofloxacin
Ciprofloxacin
Aminoglycoside
One of the following:
Vancomycin
Linezolid
114
Q

VAP/HAP Piperacillin/tazobactam dose

A

4.5 g IV q6h

115
Q

VAP/HAP Cefepime dose

A

2 g IV q8h

116
Q

VAP/HAP Meropenem dose

A

1 g IV q8h

117
Q

VAP/HAP Ciprofloxacin dose

A

400 mg IV 18h

118
Q

VAP/HAP Levofloxacin dose

A

750 mg IV q24h

119
Q

Duration of CAP tx

A

Minimum 5 days therapy
-Afebrile 48-72 hours
-No more than 1 CAP-associated sign of clinical instability
Longer duration may be indicated if
-Initial antibiotic not active against identified pathogen
-Clinical status resolving slowly

120
Q

MOA of FQs

A

DNA gyrase and topoisomerase IV inhibitor

Bactericidal

121
Q

MOA of aminoglycosides

A

Tobramycin, gentamycin, amikacin
Gm-neg coverage only (including PSA)
Inhibit protein synthesis (30s)
Bactericidal

122
Q

Adverse effects of aminoglycosides

A

Vestibular/ototoxicity (often irreversible)
Nephrotoxicity (esp. in combination with Vancomycin)
Neurotoxicity

123
Q

Duration of tx- VAP/HAP

A 
Short duration better
-7 days for HAP and VAP
MRSA
-7 days (blood cultures negative)
-14-21 days (blood cultures positive)
Pseudomonas aeruginosa
-7 days

Pharm I (10 decks)

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