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ID PHARM 152 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Define Pneumonia

A

is an acute infection of the lung parenchyma

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2
Q

What groups of people have higher mortality rates?

A

infants
elderly
debilitated people

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3
Q

List the risk factors for Pneumonia

A

alcohol abuse
immunosuppression
lung disease
institutionalization
age > 70

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4
Q

Causes of Pneumonia

A

inhalation of airborne particles
aspiration of oropharyngeal material
hematogenous spread

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5
Q

What are some of the etiology for CA?

A

sterptococcus pneumoniae
haemophilus influenzae
staphylcoccus aureus
mycoplasma pneumoniae
cliamydia pneumoniae
viral

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6
Q

What is the top two causes of CA for pneumonia?

A

streptococcus pneumoniae
haemophilus influenzae

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7
Q

What are the major causes of hospital acquired pneumonia?

A

klebsiella pneumoniae
e coli
enterobacter species
proteus species

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8
Q

What are pt risk factors for pneumonia?

A

certain modifying factors influence the causative organism
COPD
HF

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9
Q

Clinical Presentation Signs and Symptoms

A

fever
chills
dyspnea
cough (productive or not)
rust colored sputum
pleuritic chest pain (stabbing)

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10
Q

Clinical Presentation Physical Exam

A

tachypnea
tachycardia
dullness to percussion
diminished breath sounds over affected area
inspiratory crackles

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11
Q

Clinical Presentation in chest x ray for pn

A

pulmnoary infiltrates or consolidation

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12
Q

Clinical presentation laboratory findings of Pn

A

low oxygen saturation
elevated WBC
sputum sample - causative organisms

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13
Q

Diagnosis requirements for pneumonia

A

physical exam
signs and symptoms
Often chest x ray ( to officially diagnosis)

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14
Q

Explain sputum specimen

A
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15
Q

Explain blood culture for diagnosis for pneumonia

A

can be positive in pt with CAP but not routinely recommended unless severe CAP or treated for MRSA or p. aeruginosa

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16
Q

Explain the serology for diagnosis for pneumonia

A

> 4 fold rise in antibody titre

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17
Q

List the test that might be done for pneumonia

A

Sputum species
blood cultures
pleural fluid can be cultured
serology
WBC
chest x ray

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18
Q

List the tests used for severity score

A

pneumonia severity index
CURB 65

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19
Q

What are other factors need other than the severity score to be treated as outpatient?

A

take oral fluids and antibiotics
comply with outpatient care
carry out activities of daily living

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20
Q

Goals of Therapy for Pneumonia

A

Eradicate the micro-organism

Resolve signs and symptoms

Reduce risk of complications and hospitalization

Reduce risk of adverse events

Minimize the development of antimicrobial resistance

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21
Q

Treatment non pharm for pneumonia

A

Bed rest
Hydration
Nutrition
Analgesics/antipyretics
Oxygen for hypoxemia
Cough suppression
Drainage of empyema/abscess

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22
Q

When is antibiotics used?

A

most of the time as soon as the diagnosis is suspected or confirmed

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23
Q

At what rate does mortality rate increase if the treatment is delay in pneumonia?

A

if it is delayed for more than 8 hours

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24
Q

Pathogens for pneumonia

A

Streptococcus pneumonia
Haemophilus influenzae
Mycoplasma pneumonia

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25
What antibiotic is the best but held on reserve?
fluoroquinolones
26
Why is fluoroquinolones best for pneumonia? What is the problem with them?
attraction potent and broad spectrum of activity good kinetics po = iv and once daily dosing problem resistance
27
First Line Adult for CAP no complications
amoxicillin doxycycline clarithromycin azithromycin
28
Dose for CAP for adults for amoxicillin
1000 mg TID
29
Dose for CAP for adults for doxycycline
100 mg BID
30
Dose for CAP for adults for clarithromycin
500 mg BID 1000 mg daily (ex. release)
31
Dose for CAP for adults for azithromycin
500 mg first day 250 mg x 4 days or 500 mg daily for 3 days
32
What are the resistance rates in Saskatoon Strep pneumoniae - macrolides
outpt 19% inpt 21%
33
What are the resistance rates in Regina Strep pneumoniae - macrolides
26%
34
Risk factors for MRSA or p. aeruginosa
Prior respiratory isolation of MRSA or P. aeruginosa or recent hospitalization AND receipt of parenteral antibiotics in last 90 days
35
List some comorbidities that affect treatment for pneumonia
chronic heart, lung, liver or renal disease diabetes mellitus alcoholism malignancies asplenia antibiotic within last 3 months
36
Treatment opinions for adults with comorbidities
amoxicillin/clavulanate cefuroxime cefprozil any beta lactam PLUS clarithromycin, azthromycin, or doxycylcine or mono therapy levofloxacin moxifloxacin
37
dose for CAP with comorbidities for adults for amox/clav
500 mg/125 mg TID or 875 mg/125 mg BID
38
dose for CAP with comorbidities for adults for cefuroxime
500 mg BID
39
dose for CAP with comorbidities for adults for cefprozil
500 mg BID
40
dose for CAP with comorbidities for adults for levofloxacin
750 mg daily for 5 days
41
dose for CAP with comorbidities for adults for moxifloxacin
400 mg daily
42
What is the duration of CAP for antibiotics?
7-14 days min 5 days
43
What do you do when the pathogen is identified?
Always adjust therapy based on the sensitivity results Choose agent that is most effective or has the most evidence Has fewest adverse effects Convenience/ lowest cost
44
Duration of therapy for outpt. tx for CAP
5 days provided clinical stability
45
How long until most pts with outpt tx of CAP reach clinical stability?
in 48-72 hrs
46
Duration of tx for staph aureus or ps. aeruginosa
7 days longer if complicated
47
Who is at risk for streptococcus pneumoniae?
splenic dysfunction or asplenia DM Renal disease cardio pulmonary disease
48
What is the first line treatment for streptococcus pneumoniae? Dose?
Penicillin G 5 to 10 M units/d IV or IM Oral Penicillin V or AMoxicillin
49
What is the alt. treatment for streptococcus pneumoniae? Dose?
cefazolin erythromycin FQ
50
What is the cause of pen res for strep pneumoniae?
due to reduced affinity for PBP or change in amount of PBP present
51
Treatment for pen resistance strep pne. for low level resistance
low level resistance - penicillin IV or amoxicillin or cefuroxime
52
Treatment for pen resistance strep pne. for high level resistance
penicillin G 2MU IV q6H or cefotaxime ceftriazone resp FQ if the pt is afebrile for 2-3 days can switch to oral therapy
53
What are some details about streptococcus pne?
is a gram positive one shaking chill followed by a high temperature pleuritic chest pain and headache are common
54
What are some details about staphylococcus aureus?
gram positive cocci in clusters increased incidence following influenza epidemics can release enzymes and endotoxing which lead to empyema and abscess
55
What is empyema?
collection of pus within a naturally existing anatomical cavity
56
Treatment with MSSA first line with dose
cloxacillin 8 to 12 g/d IV
57
Treatment with MSSA alt
cefazolin clindamycin vancomycin
58
Treatment of MRSA first line
vancomycin linezolid
59
What is the length of dose for staphylococcus aureus?
may take up to 3 weeks to see a response continue treatment for 14 to 21 days
60
What are some details about h. influenza?
tiny gram negative coccobacillus COPD pt often colonized
61
What is the first line tx. for h. influenzae?
Non b-lactamase producing – Ampicillin 6 to 8 g/day IV (given q6h) or amoxicillin 3g/d po
62
What is the second line tx. for h. influenzae?
Beta-lactamase producing – amox/clavulanate or 2nd generation cephalosporin (cefuroxime) or 3rd gen ceph (cefotaxime or ceftriaxone) or FQ or azithro or clarithro or doxycycline
63
What are some risk factors for treating aerobic gram negative rods?
serious underlying disease/ICU, pulmonary disease, use of resp equipment, use of broad spectrum antibiotics
64
What is the tx. aerobic gram negative rods?
3rd gen cephalosporin carbapenem piperacillin/tazobactam
65
What are some details about pseudomonas aeruginosa?
Usually seen in pt with underlying lung damage can produce necrotizing process in alveolar tissue
66
What are some symptoms of pseudo aeruginosa?
fever chills cough green sputum with characteristic smell
67
What are the treatment opinions for pseudo aeruginosa?
piperacillin/tazobactam + cipro or AMG Ceftazidime + cipro or AMG Ciprofloxacin + AMG Cefepime + cipro or AMG Meropenem + cipro or AMG
68
What are some symptoms of mycoplasma pneumoniae?
congestion sore throat chest pain cough
69
What are the triad symptoms of mycoplasma pneumoniae?
maculopapular rash arthritis pneumonia
70
What is the first line tx. of mycoplasma pneumoniae? Dose?
Erythromycin 250mg QID (or any macrolide) or doxycycline
71
What is the alt tx. of mycoplasma pneumoniae?
FQ
72
What are some details about legionella pneumophilia?
aerobic gram negative rod rare in sask found in contaminated hot water plumbing, air conditioners, sprinkler/fountains
73
Common sym. legionella penymophilia?
fever chills malaise myalgia headache cough GI problems
74
How is legionella pneumophilia diagnosed?
antibody titers or antibody detection
75
Tx first line for legionella pneumophilia
Azithromycin
76
Tx alt for legionella pneumophilia
respiratory FQ
77
What are some details about chalmydophila pneumoniae?
obligate intracellular gram negative
78
What are some symp. from chlaymdophila pneumoniae?
low grade fever non productive cough normal WBC
79
Tx for chlamydophila pneumoniae
Doxycycline macrolide FQ (alt)
80
Explain aspiration pneumonia
pts aspirate gastric contents secretions are neutralized rapidly creates a shift of fluid into the involved lung area every pt will experience change in breathing
81
What is a risk with aspiration pneumonia?
some pt develop secondary bacterial pneumonia due to decreased defenses
82
When do most pt begin to improve?
within 2 days of starting effective antibiotics
83
What are some objective response to monitoring plans for pneumonia?
Decreased cough, dyspnea and RR Decreased fever Decreased sputum production Improved oxygenation Normalization of WBC
84
What is some ways to prevent it?
influenza vaccine pneumococcal vaccine COVID vaccine
85
Who should get influenza vaccine
Those at risk of influenza complications Household contacts of high risk people anyone
86
What are the two types of pneumococcal vaccination?
23 valent poly vaccine 13 valent protein vaccine

ID PHARM 152 (11 decks)

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