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Pharm > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

T or F: Pneumonia is the #1 cause of death from ID

A

true

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2
Q

types of pneumonia (3)

A

Community aquired
Hospital acquired (nosocomial)
Aspiration pneumonia

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3
Q

Two types of hospital acquired pneumonia

A

health care associated

ventilator associated

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4
Q

What type of pneumonia do we see most often?

A

community acquired

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5
Q

CURB-65 scoring system defined

A 
C - confusion
U - uremia or BUN > 20 mg/dL
R - resp rate at least 30
B - blood pressure systolic < 90 or diastolic < 60
65 - Age at least 65

Each is worth one point
0-1: tx at home
2: consider inpt
>3: potential ICU

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6
Q

Organisms for community acquired pneumonia

A 
strep pneumonia 
h inluenza
legionella spp*
mycoplasma pneumoniae*
chlamoydophila pneumonia*
Less common: 
M Cat
Klebsiella pneumoniae
Staph aureus 
Viruses

*“atypical” organisms

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7
Q

DRSP

A

drug resistant strep pneumonia

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8
Q

Risk factors for drug resistant strep pneumonia (DRSP)

6

A 
Age <2 or >65
abx within the last 3 months
alcoholism
medical comorbidities
immunosuppressive illness or therapy
exposure to child at day care
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9
Q

Guidelines from Infectious disease society of America/American thoracic society
(3)

A
  • sputum and blood cultures are recommended for all community acquired pneumonia patients, not just those with severe CAP.
  • especially for those receiving empirics for MRSA or pseudomonas
  • recommending against steroids for pneumonia unless they are in refractory septic shock
  • recommending against follow up routine chest imaging
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10
Q

IDSA/ATS therapy updates

A
  • recommending against macrolide mono therapy bc of resistance
  • beta lactam/macrolide and beta lactam/fluoroquinolone are both still acceptable for severe CAP but the evidence is stronger for beta lactam/macrolide
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11
Q

IDSA/ATA guidelines for initial treatment in outpatient CAP pts include

A

high dose amoxicillin- best

doxycycline* save for those with Qtc or allergy to amoxicillin
amoxicillin/clavulanate*
various cephalosporins
FQs
macrolides (at the bottom of the list bc of resistance)

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12
Q

high dose amoxicillin is

A

1g TID

outpatient regimen

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13
Q

most often tx for inpatient CAP

A

B lactam macrolide

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14
Q

it’s not likely to see staph aureus in CAP but if you do expect it

A

vanco

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15
Q

2 common options for empiric therapy in the non icu patient

A

macrolide plus beta lactam

FQ alone

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16
Q

macrolide plus beta lactam for empiric, non ICU CAP.

examples (3)

A

ceftriaxone
ampicillin
ertapenem

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17
Q

Fluroquinolone empiric therapy for the non ICU pt c CAP

example

A

levo or moxi

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18
Q

empiric therapy options for ICU patients with CAP
2
plus 1 if PCN allergic

A

ceftriaxone or cefotaxime
ampicillin sulbatam PLUS FQ
if PCN allergic: moxi or levo PLUS aztreonam

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19
Q

modifying factors of CAP treatment

A

structural lung disease
beta lactam allergy
community acquired MRSA

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20
Q

structural lung disease as a modifying factor for CAP tx

A

use an anti pseudomonal agent (like cefepime, pip/tazo, imipenem, or meropenem) PLUS macrolide or levo or cipro.

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21
Q

beta lactam allergy as a modifying factor for CAP

A

use FQ with or without vanco

22
Q

Community acquired MRSA as a modifying factor for CAP tx

A

Vanco plus linezolid plus FQ

23
Q

Hospital acquired pneumonia

A

developed at least 48 hours after admission, with no mechanical ventilation involved

24
Q

ventilator associated pneumonia

A

pneumonia occurring 48 hours after intubation

can take place on top of existing hospital acquired.

25
Q

how many HAPs per 1000 admissions

A

5 - 15

26
Q

how much does being on a ventilator increase risk of HAP?

A

6 - 20 x

27
Q

how many days does HAP increase a hospital stay?

A

7 - 9

28
Q

Routes of entry for HAP

5

A

micro aspiration of oropharyngeal secretions
aspiration of gastric/esophageal contents
inhalation of infectious aerosol
hematogenous spread
direct inoculation from staff

29
Q

organisms of HAP

A 
enterobacteria like e coli and klebsiella
staph aureus
psuedomonas aeruginosa
acinetobacter
anaerobes due to aspiration
30
Q

what do you need to watch for with HAP?

A

multi drug resistant organisms

31
Q

risk factors for multi drug resistant pathogens (MDRO)

6

A
  • abx in last 90 days
  • current hospitalization > 5 days
  • inc freq of community resistance
  • immunosuppression
  • ICU
  • days on mech ventilation
32
Q

risk factors for having increased frequency of community resistance (5)

A 
hospitalized for longer than 2 days in the last 90 days
home care
dialysis
nursing home
family member with MDRO
33
Q

if you use a drug that covers MRSA, chances are

A

it’ll also cover MSSA.

Does not work the other way around.

34
Q

HAP Empiric Treatment if pt is not at high risk of mortality and no inc likelihood of MRSA

A 
need single agent for psuedomonas
*piper/tazo OR
cefepime OR
levo OR
imipenem OR
meropenem
35
Q

HAP empiric treatment if not at high risk of mortality but at risk for MRSA

A

add vanco or linezolid

36
Q

HAP empiric treatment if at high risk of mortality or received abx in the past 90 days
and concern for MRSA

A

Two of the following (but not 2 beta lactams)
- pip/tazo, cefepime, ceftazidime, levo, cipro, imipenem, meropenem, amikacin, gentamicin, tobramycin, aztreonam PLUS vanco or linezolid

37
Q

HAP empiric treatment if at high risk of mortality or received abx in the past 90 days
without concern for MRSA

A

2 of the following:
pip/tazo, cefepime, levo, imipenem, meropenem for MSSA empiric coverage
save naf/ox/diclox for proven MSSA

38
Q

VAP empiric treatment
want MRSA covered
want psuedomonas covered

A

One of each:
MRSA: Vanco, linezolid
Pseudomonas - Beta Lactam: pip/tazo OR cefepime or ceftazidime OR imipenem or meropenem OR aztreonam
pseudomonas - non beta lactam: cipro or levo* OR amikacin or gentamycin or tobramycin

39
Q

VAP empiric treatment

cover pseudomonas

A

beta

40
Q

de escalation of antibiotics as culture info comes available:
if cultures do not grow S aureus

A

stop vanco / linezolid

41
Q

de escalation of antibiotics as culture info comes available:
if cultures grow MSSA

A

use an anti staph penicillin

42
Q

de escalation of antibiotics as culture info comes available:
if cultures grow one/more of the enterobacteriaceae

A

try to use a more narrow apectrum agent based on susceptibility

43
Q

de escalation of antibiotics as culture info comes available:
when susceptibility of GNR is available:

A

narrow and discontinue second agent like amino glycoside or FQ

44
Q

Duration of therapy for HAP and VAP

A

7 days

45
Q

Aspiration pneumonia occurs

A

typically as a result of altered consciousness or anatomic abnormalities

46
Q

Asp Pneumonia, comm acquired is primarily ____ also may see ____, _____, ______

A

primarily anaerobic in nature

may also see S aureus, strep, or gram neg bacilli.

47
Q

Therapy for asp pneumonia is directed at

A

mouth flora

48
Q

Asp pneumonia, community acquired

regimens

A

clindamycin plus moxi or levo or cipro *
ampicillin/sulbactam IV or amox/clavulanate PO
imipenem

49
Q

if CAP with question of aspiration

A

moxi or amp/sulb or amox/clav

50
Q

treatment duration for aspiration pneumonia, community acquired

A

7-10 days

51
Q

Asp pneumonia, hospital acquired

treatment is geared towards

A

covering nosocomial pathogens and anaerobes

52
Q

Regimens for asp pneumonia, hospital acquired

A

add metronidazole to PCN or ceph

add clinda to FQ or aztreonam

or use drugs that already have anaerobic coverage:

  • b lactam/b lactase inhibitors (pip/tazo)
  • carbapenems (imipenem, meropenem)
  • some FQs like moxi

Pharm (31 decks)

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