Nurs 605 Module 2 Flashcards
What is acute bronchitis?
- inflammation of the bronchi
- cough <3 weeks
What are the common pathogens of acute bronchitis?
> 90% is viral
<5% - c. pneumoniae, mycoplasma pneumoniae, bordatella pertussis
What are the clinical manifestations of acute bronchitis?
cough <3 weeks no tachycardia no dyspnea no fever localized or normal chest sounds
What are the nonpharmaceutical recommendations for acute bronchitis?
self limiting
watchful waiting
hydration, natural health products ie) honey
return to clinic if worsens or no improvement after 2-3 weeks
What are the pharmaceutical recommendations for acute bronchitis?
analgesics
cough suppressants
bronchodilators ie) ventolin
opiods cough syrup
What is acute otitis media (AOM)?
middle ear infection
common in children due to shorter eustachian tubes
What are the risk factors for AOM?
age children in smaller households children in daycare second hand smoke exposure immunocompromised indigenous children orofacial abnormalities
Do we need to treat for AOM and why?
mostly self limiting
often don’t need to treat
watchful waiting for 24-48 hours, no improvement or worsening, consider abx
What are the clinical manifestations of AOM?
onset of acute ear pain otalgia (pulling or touching of the ear) fever irritabillity middle ear inflammation
Describe middle ear inflammation
TM bulging
dull, no light refraction
may be filled with fluid (potentially grey colour)
When would you advise watchful waiting for a child with AOM?
reliable follow up
>6 months of age
non severe symptoms for 72 hours (no temperature)
What are the common pathogens of AOM?
S. pneumoniae (31-49%; most common)
H. Influenzae
M. Catarhalis
What is the systemic standard treatment for AOM?
Amoxicillin 40mg/kg TID x 5 days OR
Amoxicillin 90mg/kd BID/TID x 5 days
What is acne vulgaris?
most common skin disorder
often appears at puberty but can present at any stage in life
Describe the topical treatment options for acne
topical benzoyl peroxide or topical retinoids or topical antibiotics or a combination of the above
Describe the adverse reactions to topical benzoyl peroxide
relatively safe
first line
larger doses or concentrations can bleach clothing
What is the recommended topical benzoyl peroxide concentration and at what concentration are topical benzoyl peroxides prescribed?
recommended for acne 2.5%-10% concentration
>5% concentration is via prescription only
What is the most commonly used topical antibiotic?
Clindamycin topical ointment
Write a rx for topical benzoyl peroxide
Benzoyl peroxide 5% cream apply to affected areas BID as needed
What is the recommended systemic treatment for acne?
tetracyclines
reserve macrolides for more severe cases or if tetracyclines don’t work
Name the gram + staphylococci species
staph aureus**
staph epidermis**
staph saprophyticus
Name the gram + streptococcus species
strep progenies/group A** group B strep group C strep strep viridian's strep pneumonia** enterococcus
Name the gram + bacilli species
listeria monocytogenes
bacillus anthrax
clostridium
Name the gram - cocci species
neisseria gonorrhoea
n. meningitis
moraxella catarrhalis **
Name the gram - bacilli species
h. influenza**
legionella pneumophila
bactericides fragilis
Name some enterobacteraciae
e. coli
klebsiella pneumoniae
proteus vulgaris
Name psuedomonads
pseudomonas aeurginosa
What is osteomyelitis?
infection of the bone
usually because of infection of soft tissue gets into the bone
What are the causes of osteomyelitis?
soft tissue injury
IVDU
traumatic injury such as bite wounds or fractures
What are the clinical manifestations of osteomyelitis?
history of risk i.e.) soft tissue injury etc.
ongoing and worsening MSK pain
fever
What are the different types of antimicrobials
antivirals antibiotics antifungals antiprotozoals anthelminics-parasites
What is the difference between gram + and gram - bacteria?
gram +: thicker petidoglycan outer layer, stains blue; vulnerable to penicillins
gram -“ thinner polysaccaride outer layer; resistant to penicillin (blocks the entry of abx)
Bacteriostatic vs. bacteriocidal
bacteriostatic-inhibits growth of bacteria
bacteriocidal-destroys and kills the organisms
certain pathogens and infections require bactericidal effects such as meningitis
Describe the difference between time dependent killing and concentration dependent killing
abx classes fall under time dependent or concentration dependent killing
certain abx require more frequent dosing in order to have bacterialcidal effects (time dependent)
other abx require less frequent dosing but higher concentrations in order to achieve bacteriocidal effects
What are the 4 targeted mechanisms of action of antibiotics?
- inhibits cell wall synthesis
- inhibits protein synthesis
- inhibits nucleic acid synthesis
- inhibits cell membrane function
How do beta lactam antibiotics inhibit cell wall synthesis?
beta lactam ring
inhibits cell wall synthesis by hydrolyzing the cell wall of bacteria
How do antibiotics act on the cell wall on pathogens?
antibiotics effectly kill bacteria by inhibiting the synthesis of the cell wall by binding itself to the proteins that make up the cell wall-bacteriocidal
Describe beta lactam resistance
bacteria synthesizes beta lactamase which is an enzyme that destroys the beta lactam ring in the abx thus making it useless
What are common beta lactam abx?
penicillins: penicillin, ampicillin, amoxicillin
cephalosporins: cefazolin, cefixime, ceftriaxone
carbapenems: meropenum
How do abx inhibit protein synthesis?
abx work to inhibit protein synthesis by binding to ribosomal subunits in bacteria to prevent complex protein cascades=bacteriostatic and prevents growth of bacteria
What types of abx inhibit protein synthesis of bacteria?
aminoglycosides
tetracyclines
macrolides
What are some considerations of prescribing aminoglycosides?
can be nephrotoxic, ototoxic and can cause visceral toxicity
must dose according to patients GFR
distributes well into lean body tissue
What are some common aminoglycosides?
gentamycin
tobramycin
Tetracyclines are used for what conditions?
CAP
acne, STIs, lyme disease
What are some considerations when precscribing tetracyclines?
can cause gastritis when taken incorrectly
no dairy products
can increase photosensitivity
no pregnant women and children under 8 years of age
Describe considerations when using macrolides
macrolides should be reserved for atypical bacteria and gram pos. bacteria or beta lactam allergies increasing resistance to macrolides do not prescribe for CAP poor activity against enterococci
What are common tetracyclines?
doxycylne
minocycline
What are common macrolides
azithromycin
erythromycin
What is an adverse side effect of clindamycin that should be reported immediately?
can cause pseudomonas colitis which is severe diarrhea-should be reported
How do abx inhibit nucleic acid synthesis?
disrupts bacterial RNA/DNA and precursor synthesis causing cell death
What classes of antibiotics are considered those that inhibit nucleic acid synthesis?
nitromiazoles-flagyl
fluoroquinolones
sulphanomides
Describe the use of metroniazole and what considerations should you have for the patient?
metroniazole or flagyl is a nucleic acid synthesis inhibitor
used against anerobic bacterias such as H. pylori, amoebas
those taking flagyl should not have alcohol as it can cause excessive vomiting
What is a common fluoroquinolone?
ciprofloxacin
Describe the use of ciprofloxacin, what class of abx it is in and any special considerations with this abx.
used for gram negative bacteria such as e.coli, H. infleunza and pseudomona aeuringinosa
is an older generation flouroquinolone
What are the respiratory fluroquinaoles and what considerations must be taken with them?
moxafloxacin and levofloxacin
reserved for 3rd line treatment only
improved gram + coverage and gram - coverage
won’t cover pseudomonas
What are the sulphonamides and what are considersations when using using this abx/
sulpha drugs
usually used in conjunction wth other medications such as trimethoprim (TMP/SMX) to increase coverage
gram +/- coverage, some protozoa coverage
increasing resistance
medication interactions: wafarin, phenytoin, methotrexate
What are some considerations of choosing an antimicrobial?
treatment actually needed? start small and narrow cultures and sensitivities cost toxicity adverse events and cost? allergies?
What is the treatment for dog, cat, and human bites?
Amoxicillin/Clavulin 875mg PO BID x 7-10 days
A patient has just suffered a cat bite and has a beta lactam allergy; what would be the choice of treatment?
Doxycycline 100mg PO BID x 7-10 days
A patient presents with phargyngitis, no cough, tonsillar exudate and a fever of 39.0. What would your differential diagnosis and treatment?
group A hemolytic strep throat
cultures and sensitivities
treat with penicillin 600mg BID PO x 10 days
children: pencillin 20mg/kig BID PO x 10 days
When would you advise treatment for acute sinusitis and what would be your drug of choice?
watchful waiting, generally spontaneously resolved in 7-10 days
viral 98% but may turn bacterial complications
amoxicillin 500mg-1000mg TID PO x 5-7 days is drug of choice
In a child that has AOM, what doses of acetaminophen or ibuprofen can you provide?
acetaminophen 10-15mg/kg/dose q 4 hours (max 75mg/kg/day)
ibuprofen 10mg/kg/dose q 6-8 hours (max 40mg/kg/day)
If the child has a perforated tympanic membrane from AOM; what would be the drug of choice?
Amoxicillin 45mg/kg/day TID PO x 10 days AND amoxi-clav (7:1) 45mg/kg/day TID x 10 days
A child presents with AOM and purulent conjunctivitis; what antibiotic treatment would you provide?
Amoxicillin clavulin (7:1) 45mg/kg BID x 5 days
A child that has AOM was started on abx but has not seen any improvement, what would be your next steps?
add amoxi-clav (7:1) 45mg/kg/kg BID x 10 days and amoxiicillin 45mg/kg/day BID x 10 days
if already given at high dose, give amoxi-clav only
What would you give a child with AOM that has a beta lactam allergy?
decide whether it’s a real allergy because options are limited
can try cefixime and clindamycin (must be together)
TMP-SMX
doxycycline if >8 years
may need to consult
What is acute sinusitis?
inflammation and infection of the sinuses
Do you need to treat for acute sinusitis?
not usually as most are viral in nature
can proceed to bacterial infection
What would you suggest to someone that is having acute sinusitis?
watchful waiting
rinses, analgesics
return to clinic if worsens in 7 days
What would be the systemic treatment for acute sinusitis?
amoxicillin 500mg TID PO x 5-7 days
What are the common pathogens of acute sinusitis?
s. pnuemonia
h. influenzae
m. catarrhalis
What would you provide to someone that has a beta lactam allergy who presents with worsening acute sinusitis
doxycycline 100mg BID x 7 days
What are the systemic treatments for acute exacerbation of bronchitis?
amoxicillin 1000mg TID x 5-7 days or doxycycline 200mg stat, then 100mg BID x5-7 days TMP/SMX 1 DS tab BID
First line systemic treatment for acute exacernbation of acute bronchitis has failed, what is the next abx option?
amoxi/clav 875mg BID x 5-10 days or levofloxacin 750mg daily x 5 days
What is community aquired pneumonia?
CAP is an acute lung infection
can be treated in or out of hospital
generally better survival rates when treated as outpatient
older adults are at increased risk of mortality
What are the common pathogens that cause CAP?
s. pnuemoniae
h. influenzae
atypicals: mycoplasma pneumonia, chlamydia pneumonia
What are risk factors that can cause CAP?
COPD, hospitalization, smoking, alcoholism, lung cancern
What is first line treatment for CAP?
doxycycline 200mg stat, then 100mg BID PO x 5-7 days or +/-amoxicillin 1000mg TID x 5-7 days
What would your drug of choice be for an individual who has COPD but presents with CAP?
amoxicilin 1000mg TID x 5-7 days or amoxi/clav 875mg BID x 5-7 days PLUS doxycycline 200mg stat, then 100mg BID x 5-7 days
A patient presents with unresolved CAP despite treatment of doxycyline; what would be the treatment of choice?
try what the patient hasn’t tried before
amoxicillin 1000mg TID x 5-7 days or amoxi/clav 875mg BID x 5-7 days PLUS TMP/SMX 1 DS tab BID x 7 days
Patient presents with CAP, has tried amoxicillin/doxy combo with no effect, what is the treatment for this failure?
can try respiratory abx
levofloxacin 750mg PO daily x 7 days
What is cystitis and its clinical manifestations?
"bladder infection" increased urinary frequency increased urinary urgency dysuria suprapubic pain
You find leukocytes in urine but the patient is asymptomatic; what do you call this condition and would you treat it?
asymptomatic bactereuremia
no do not treat unless symptomatic
What is pyleonephritis and its clinical manifestations?
kidney infection; infection of the upper urinary tract flank pain nausea/vomiting malaise fever
What is the first line treatment for women with cystitis?
nitrofurantoin 100mg BID x 5 days
fosfomycin 3g x 1 dose
What are alternative treatments for women with cystitis (aside from macrobid and fosfomycin)?
TMP/SMX 1 tab x 7 days
cefixime 400mg OD x 7 days
ciprofloxacin 250mg BID
increasing resistance in cipro and TMP/SMX
A woman presents with a recurrent UTI, it has been < 1 month since her last UTI; what are their treatment options?
same organism? same drug different organism? treat as if pyelonephritis cefixime 400mg OD cipro 500mg BID TMP/SMX 1 DS BID amox/cav 875 mg x 10 days
Why would you not use nitrofurantoin in someone who has pyelonephritis?
macrobid does not penetrate well into the renal tissues therefore not effective
A pregnant female presents with cystitis; what would be your drug of choice?
macrobid 100mg BID x 7 days (avoid near term)
fosfomycin 3g x 1 dose
cefixime 400mg OD x 7 days
A male presents with cystitis; what would be your first choice of treatment?
cefixime 400mg OD x 7 days
ciprofloxacin 500mg BID x 7 days
amoxi/clav 875mg BID x 7 days
TMP/SMX 1 DS tab x 7 days
