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PHAR 152* > Pharyngitis > Flashcards

Pharyngitis Flashcards

1
Q

What is pharyngitis?

A

Inflammation in the back of the throat

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2
Q

What are the causes of sore throat and is sore throat common?

A

Allergies
Medications
Irritating substances (hot, cold, smoke)
Trauma
Tumors
Infxn

1-2% of all doctor visits

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3
Q

What is the most common cause of pharyngitis?

A

Rhinovirus

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4
Q

Is pharyngitis mainly caused by a virus or a bacteria? Explain

A

Mainly caused by a virus (80-90% of adults ; >70% of children)

There is no need for antimicrobial tx
Tx sx if bothersome
Self-limiting (resolves by itself)
usually rhinovirus, coronavirus, or influenza

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5
Q

Provide examples of viruses and what conditions that they may cause

A

Rhinovirus, coronavirus, - common cold
Adenovirus - pharyngoconjunctival fever (red eyes, throat fever)
herpes simplex type 1 and 2 - pharyngitis, gingivostomatitis
Parainfluenza - cold sx, croup
Coxsakie A - herpangina, HFM disease
Epstein-Barr virus - infectious mononucleosis
Influenza A and B - influenza
Cytomegalovirus - CMV mononucleosis
HIV - primary HIV infxn

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6
Q

Explain the bacteria causes of Pharyngitis in adults and children

A

In adults: 5-15% causes are caused by Group A b-hemolytic streptococci (GAS)
In children 15-30% of sore throats are from GAS

Bacterial causes are still self-limiting

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7
Q

True or False: Group C and group G streptococci can also cause sore throat, which requires treatment

A

Yes, they can cause sore throat
They don’t require treatment

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8
Q

Why are antibiotics overused in pharyngitis?

A

Pt expect them
Pt will see other MD’s if they don’t get them
Pt will not be satisfied w/o a Rx
Faster to write a Rx than to explain why one is not needed

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9
Q

True or False: antibiotics are not overused in pharyngitis cases

A

False

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10
Q

What time of the year does strep throat occur the most?

A

During the colder months - late winter and early spring (the same as respiratory disease season)

Viral orgs and strep throat peak in the fall to the spring

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11
Q

How is strep throat spread?

A

Spread among close contacts

Common in families -> kids are the major reservoir (ping-pong spread)

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12
Q

What is the only group of bacteria that we should give ABs to for strep throat?

A

Group A strep (GAS)

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13
Q

What are the signs and symptoms of Group A strep pharyngitis?

A

Signs and sx may vary widely

Painful swallowing
Exudate
Enlarged anterior cervical lymph nodes
Fever
Increased WBCs
Nausea and vomiting (NOT diarrhea unless its viral)
Scarlatiniform rash

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14
Q

Explain a scarlatiniform rash

A

A blushy, fine rash with a sandpaper feel

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15
Q

Explain the criteria (7) for the modified centor scoring for GAS

A

Age 3-14: +1
Age 15-44: 0
Age 45+: -1
Exudate or tonsil swelling: +1
Swollen anterior cervical nodes: +1
Temp 38+ (oral): +1
No cough: +1

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16
Q

Based on the Centor scoring system, what scores warrant a RADT? How about empiric AB tx?

A

2+ for RADT (can also use a throat swab +culture)
4+ for AB tx (but still only around 50% sure its strep)

17
Q

What scores warrant symptomatic tx?

A

1,0,-1 No RADT, but culture or AB needed

18
Q

What are the gold standards for GAS strep diagnosis? What are the differences between them?

A
  1. Culturing, 90+ sensitivity
    May take 1-2 days to get results
  2. Rapid antigen detection test (RADT)
    Takes minutes
    Positive means strep throat
    Only 70-90% sensitivity
19
Q

How long does strep throat last untreated?

A

4-5 days

20
Q

What are the 4 main reasons to treat strep throat?

A

To get rid of sore throat
To reduce transmission to others
To reduce complications
To prevent rheumatic heart disease

21
Q

What does AB therapy accomplish in pt with GAS strep throat?

A

Treats the bothersome sx

If AB started w/in 2-3 days, then sx can improve sx by 1-2 days

22
Q

Explain AB tx for GAS strep throat from a transmission perspective

A

Just 24hrs of AB therapy greatly reduces the recovery of GAS from pharyngeal cultures
Prevents the ping pong effect

23
Q

What are the complications of GAS strep throat?

A

Peritonsillar abscess, lymph adenitis, otitis media, sinusitis, etc

All have low incidence, but still

24
Q

What is rheumatic heart disease? How soon must GAS be treated to prevent it?

A

Heart valve damage due to the bacteria causing inflammation and destruction of the heart valves
9 days

25
Q

What is post-strep glomerulonephritis? What is significant about it?

A

Severe kidney dialysis, can cause a child to be on dialysis

this condition is not prevented by anitbiotics

26
Q

What is the incidence of acute rheumatic fever in Canadian and First Nation children? Why is it higher in FN?

A

CAD: 0.3/100,000
FN: 21.3/100,000

Due to limited access to health care and poor living conditions

27
Q

What is the DOC for GAS? Why?

A

penicillin V

narrow spectrum of activity
Effective, safe, cheap -> and prevents RHD
MIC is very low, so a low concentration is v. effective

28
Q

What is the dosing of Pen V for adults and children with GAS?

A

Adults = 300mg TID or 600mg BID
Pediatrics: 40mg/kg/day BID or TID

Duration is 10d (full course needed for RHD prevention)

Preferably on empty stomach

29
Q

What is the rate of penicillin resistance with GAS?

A

0%

30
Q

Explain the GAS treatment for beta-lactam agents such as amoxicillin

A

Appropriate in kids, but tastes v. bad, so suspensions are available

Adults: 500mg BID
Pediatrics: 40-50mg/kg/day given OD or BID (max 1g/d)

Duration of 10 days

May be taken with meals

31
Q

What do we give to patients with GAS who have a penicillin allergy?

A

Macrolides (erythromycin) are the DOC

Erythromycin base: 250-500mg BID to QID
Ethylsuccinate: 40mg/kg/day BID to QID
Estolate: 40mg/kg/day BID to QID

Duration of 10 days

Clarithromycin: 15mg/kg/day BID (max 500mg/d)

Azithromycin: 12 mg/kg daily x5 days (max 500mg/d)

32
Q

What is the rate of erythromycin resistance with GAS?

A

15%+

33
Q

What are the ABs that are used 2nd line or if treatment fails?

A

Cephalosporins (1st and 2nd gen)
Clindamycin
Intramuscular penicillin

34
Q

Does TMP/SMX eradicate GAS from the throat?

A

No

35
Q

What is the symptomatic treatment for GAS strep throat?

A

Oral analgesics (for pain management)
Topical analgesics (very short acting)
Lozenges (soothing)
Gargling with salt water (avoid use in ppl with salt restriction)
Fluids
Rest

36
Q

How long does it take after AB are given to prevent transmission of GAS strep?

A

24 hours

37
Q

What to do as a pharmacist if the patient does have strep throat? (general)

A

AB are warranted
Pt needs to be educated
Proper drug, does, duration need to be used

PHAR 152* (16 decks)

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