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Exam 2- Practical Therapeutics > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A

An acute infection of the pulmonary parenchyma

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2
Q

How soon do you want to begin antibiotics for pneumonia and what other care should be supplied?

A

Want to have PROMPT antibiotic initiation with appropriate spectrum of activity is an essential step in pneumonia management.

  • supportive care with bronchodilators, symptomatic management and fluids
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3
Q

CAP definition

A

Microbiological therapy is usually successful, and knowledge of which pathogen does not usually change therapy

  • empiric Abx therapy is usually successful and knowledge of which pathogen does not usually change therapy
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4
Q

Important bacteria to cover empirically for CAP

A
  1. S. pneumoniae and H. influenzae (typical)
  2. M catarrhalis, MSSA ( higher suspicioni in smokers, elderly, recent Abx use, those with comorbidities)
  3. Enterobacteriaceae such as K. pneumonie, E.coli (higher suspicioisn in structural lung diseases like COPD)
    1. Atypical bacteria- mycoplasma pneumoniae, legionella pneumophila, and chlamydia pneumoniae
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5
Q

Mainstay of therapy for CAP

A

beta- lactams are the mainstay of therapy

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6
Q

Which populations would likely have M. catarrhalis and MSSA

A

Higher suspicion in:

  1. smokers
  2. elderly
  3. recent Abx use
  4. those with comorbidities
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7
Q

Which populations would likely have enterobacteriaceae such as k.pneumoniae, e.coli

A

Higher suspicion in structural lung diseases such as COPD

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8
Q

CAP treatment for healthy individuals, under 65, with no recent antibiotic use

A
  1. Amoxicillin (GP, GN, Anaerobes, Atypical) - covers most strains of s. pneumoniae and h. influenzae
  2. +/- AZITHROMYCIN (PREFERRED) or doxycycline - targets the atypicals
  3. PCN allergy but tolerate cephalosporins - 3rd generation cephalosporin (cefdinir)
  4. Last- line : Levofloxacin (covers atypicals and normal pathogens)
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9
Q

CAP Treatment with comorbidities, 65+, recent antibiotics, smokers- expand coverage a bit

A
  1. amoxicillin/ clauvulanic acid (augmentin) + azithromycin or doxycycline
  2. alternative- 3rd generation - cefdinir + azithromycin OR doxycyline
    1. last line: Levofloxacin
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10
Q

Duration of therapy for CAP treatment

A

typically 5 days - afebrile > 48 hours and clinically stable (exception: high dose Azithromycin)

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11
Q

Pathogenic organisms in CAP typically a/w severe illness

A

Pseudomonas, Klebsiella, MRSA

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12
Q

Amoxicillin use

A
  1. first line treatment usually with azithromycin for healthy individuals and CAP treatment
  2. treating those with CAP and comorbidities. Usually combined with clavulanic acid (augmentin) then combined with azithromycin AND doxycyline
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13
Q

ADR of amoxicilliin

A
  1. allergic reaction- PCN allergies
    1. Cdiff and AAD (antibiotic associated diarrhea)
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14
Q

Augmentin is which drugs?

A

Amoxicillin and clavulanic acid

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15
Q

ADR of augmentin

A

More AAD than amoxicillin alone

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16
Q

Adjustment for augmentin

A

Renal adjusment is needed

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17
Q

Azithromycin indications

A

CAP and GP, GN, Atypicals

NO MRSA and Pseudomonas

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18
Q

Contraindications of azithromycin

A

Hx of cholestatic jaundice/ hepatic dysfunction a/w prior azithromycin use

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19
Q

Z pack

A

Aztithromycin

2 tabs 500mg day 1, then 250 mg qd x 4 days

20
Q

ADR of azithromycin

A
  1. QT prolongation- increased risk of fatal heart rhythms
21
Q

Doxycycline Contraindications

A

relative - children <8 years of age d/t discoloration of teeth - can use if no other alternative therapies

22
Q

ADR of doxycyline

A
  1. GI disturbances
  2. AAD
  3. Photosensitivity
23
Q

Levofloxacin Indications

A

Covers pseudomonas (no MRSA)

24
Q

Levofloxacin US Box Warnings

A
  1. Tendinitis
    1. Exacerbation of myasthenia gravis

Levofloxacin is a fluoroquinolone that covers MSSA, GP, GN, Pseudomonas and atypicals

25
Q

Adjustments of Levofloxacin

A
  1. Requires a renal adjustment
    1. Absorption is decreased by cations - Ca, Zn, Al, Mg, Fe- give 2 hours before and 6 hours after
26
Q

What is HAP

A

A pneumoniae that occurs 48 hours or more AFTER admission and does NOT appear to be incubating at the time of admission

27
Q

VAP

A

a type of HAP that develops more than 48 hour after ET intubations

28
Q

Treatment for HAP and VAP

A
  1. Cefepime + Vanco, +/- Levofloxacin
  2. Zosyn + Vanco, +/- Levofloxacin
  3. If they have a PCN/ Cephalosporing allergy- Meropenem + Vanco, +/- Levofloxacin
  4. Can consider adding azithromycin or doxycycline if high suspicion of atypical but do NOT want to use levofloxacin
29
Q

Cefepime inidications

A
  1. pneumonia (pseudomonal coverage)
30
Q

Routes of cefepime

A

IV (only use this in the hospital)

31
Q

ADR of Cefepime

A
  1. c.diff associated diarrhea
  2. antibiotic associated diarrhea
  3. neurotoxicity- encephalopathy, aphasia, myoclonus, seizures- rare!
32
Q

Vancomycin indications

A

MRSA coverage

33
Q

Routes of Vanco

A
  1. IV- all systemic infections
    1. Oral- C. Diff infections
34
Q

ADR of Vanco

A
  1. Nephrotoxic- Renal Failure
  2. Red Man Syndrome- Rapid infusion can cause histamine release- flushing, rash, pruritis, tachycardia, hypotension
  3. thrombocytopenia- decreased platelets
35
Q

Metabolism / excretion of Vanco

A

Dosed by nomogram- kidney function and weight based

36
Q

Zosyn is which drugs

A

Piperaciillin and tazobactam

37
Q

Indications of Zosyn

A

Pneumonia (pseudomonal coverage)

38
Q

Route of zosyn

A

IV

39
Q

ADR of Zosyn

A

AKI- particularly in combo with Vanco and other nephrotoxic drugs

40
Q

HCAP comes from which places

A
  1. dialysis
  2. residing in nursing home
  3. previous hospitalization
  4. immunocompromised state
41
Q

What is aspiration pneumonia

A

Type of pneumonia that results from the entry of gastric OP fluids which may contain bacteria

  • leads to a pneumonia that may be aerobic, anaerobic or a mixture
42
Q

Aspiration Pneumonia Outpatient Treatment

A

Augmentin (GP, GN and Anaerobes)

43
Q

Aspiration Pneumonia- Inpatient therapy for those who are not severely ill

A

Unasyn (Ampicillin - sulbactam)

(GP, GN, Anaerobes, Atypicals)

44
Q

Aspiration Pneumonia- Inpatient therapy for those who are severely ill

A

Zosyn (piperacillin and tazobactam)

  • might use if someone is choking and can’t speak or has an unclear history. Could even add vanco to cover HAP, VAP or HCAP
45
Q

3 treatments for aspiration pneumonia bring:

A

anaerobic coverage in addition to covering the normal suspected pathogens

46
Q

What to do with a mixed etiology pneumonia

A

May have to cover a broader spectrum empirically and narrow

  • unsure if it is aspiration or HCAP - lean toward Zosyn

Exam 2- Practical Therapeutics (10 decks)

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