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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
Q

What antibiotic is the best but held on reserve?

A

fluoroquinolones

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26
Q

Why is fluoroquinolones best for pneumonia? What is the problem with them?

A

attraction
potent and broad spectrum of activity
good kinetics po = iv and once daily dosing

problem
resistance

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27
Q

First Line Adult for CAP no complications

A

amoxicillin
doxycycline
clarithromycin
azithromycin

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28
Q

Dose for CAP for adults for amoxicillin

A

1000 mg TID

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29
Q

Dose for CAP for adults for doxycycline

A

100 mg BID

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30
Q

Dose for CAP for adults for clarithromycin

A

500 mg BID
1000 mg daily (ex. release)

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31
Q

Dose for CAP for adults for azithromycin

A

500 mg first day
250 mg x 4 days
or
500 mg daily for 3 days

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32
Q

What are the resistance rates in Saskatoon Strep pneumoniae - macrolides

A

outpt 19%
inpt 21%

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33
Q

What are the resistance rates in Regina Strep pneumoniae - macrolides

A

26%

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34
Q

Risk factors for MRSA or p. aeruginosa

A

Prior respiratory isolation of MRSA or P. aeruginosa or recent hospitalization AND receipt of parenteral antibiotics in last 90 days

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35
Q

List some comorbidities that affect treatment for pneumonia

A

chronic heart, lung, liver or renal disease
diabetes mellitus
alcoholism
malignancies
asplenia
antibiotic within last 3 months

36
Q

Treatment opinions for adults with comorbidities

A

amoxicillin/clavulanate
cefuroxime
cefprozil
any beta lactam PLUS
clarithromycin, azthromycin, or doxycylcine
or mono therapy
levofloxacin
moxifloxacin

37
Q

dose for CAP with comorbidities for adults for amox/clav

A

500 mg/125 mg TID
or
875 mg/125 mg BID

38
Q

dose for CAP with comorbidities for adults for cefuroxime

A

500 mg BID

39
Q

dose for CAP with comorbidities for adults for cefprozil

A

500 mg BID

40
Q

dose for CAP with comorbidities for adults for levofloxacin

A

750 mg daily for 5 days

41
Q

dose for CAP with comorbidities for adults for moxifloxacin

A

400 mg daily

42
Q

What is the duration of CAP for antibiotics?

A

7-14 days
min 5 days

43
Q

What do you do when the pathogen is identified?

A

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
Q

Duration of therapy for outpt. tx for CAP

A

5 days provided clinical stability

45
Q

How long until most pts with outpt tx of CAP reach clinical stability?

A

in 48-72 hrs

46
Q

Duration of tx for staph aureus or ps. aeruginosa

A

7 days
longer if complicated

47
Q

Who is at risk for streptococcus pneumoniae?

A

splenic dysfunction or asplenia
DM
Renal disease
cardio pulmonary disease

48
Q

What is the first line treatment for streptococcus pneumoniae? Dose?

A

Penicillin G
5 to 10 M units/d IV or IM
Oral Penicillin V or AMoxicillin

49
Q

What is the alt. treatment for streptococcus pneumoniae? Dose?

A

cefazolin
erythromycin
FQ

50
Q

What is the cause of pen res for strep pneumoniae?

A

due to reduced affinity for PBP or change in amount of PBP present

51
Q

Treatment for pen resistance strep pne. for low level resistance

A

low level resistance - penicillin IV or amoxicillin or cefuroxime

52
Q

Treatment for pen resistance strep pne. for high level resistance

A

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
Q

What are some details about streptococcus pne?

A

is a gram positive
one shaking chill followed by a high temperature
pleuritic chest pain and headache are common

54
Q

What are some details about staphylococcus aureus?

A

gram positive cocci in clusters
increased incidence following influenza epidemics
can release enzymes and endotoxing which lead to empyema and abscess

55
Q

What is empyema?

A

collection of pus within a naturally existing anatomical cavity

56
Q

Treatment with MSSA first line with dose

A

cloxacillin 8 to 12 g/d IV

57
Q

Treatment with MSSA alt

A

cefazolin
clindamycin
vancomycin

58
Q

Treatment of MRSA first line

A

vancomycin
linezolid

59
Q

What is the length of dose for staphylococcus aureus?

A

may take up to 3 weeks to see a response
continue treatment for 14 to 21 days

60
Q

What are some details about h. influenza?

A

tiny gram negative coccobacillus
COPD pt often colonized

61
Q

What is the first line tx. for h. influenzae?

A

Non b-lactamase producing – Ampicillin 6 to 8 g/day IV (given q6h) or amoxicillin 3g/d po

62
Q

What is the second line tx. for h. influenzae?

A

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
Q

What are some risk factors for treating aerobic gram negative rods?

A

serious underlying disease/ICU, pulmonary disease, use of resp equipment, use of broad spectrum antibiotics

64
Q

What is the tx. aerobic gram negative rods?

A

3rd gen cephalosporin
carbapenem
piperacillin/tazobactam

65
Q

What are some details about pseudomonas aeruginosa?

A

Usually seen in pt with underlying lung damage
can produce necrotizing process in alveolar tissue

66
Q

What are some symptoms of pseudo aeruginosa?

A

fever
chills
cough
green sputum with characteristic smell

67
Q

What are the treatment opinions for pseudo aeruginosa?

A

piperacillin/tazobactam + cipro or AMG
Ceftazidime + cipro or AMG
Ciprofloxacin + AMG
Cefepime + cipro or AMG
Meropenem + cipro or AMG

68
Q

What are some symptoms of mycoplasma pneumoniae?

A

congestion
sore throat
chest pain
cough

69
Q

What are the triad symptoms of mycoplasma pneumoniae?

A

maculopapular rash
arthritis
pneumonia

70
Q

What is the first line tx. of mycoplasma pneumoniae? Dose?

A

Erythromycin 250mg QID (or any macrolide) or doxycycline

71
Q

What is the alt tx. of mycoplasma pneumoniae?

A

FQ

72
Q

What are some details about legionella pneumophilia?

A

aerobic gram negative rod
rare in sask
found in contaminated hot water plumbing, air conditioners, sprinkler/fountains

73
Q

Common sym. legionella penymophilia?

A

fever
chills
malaise
myalgia
headache
cough
GI problems

74
Q

How is legionella pneumophilia diagnosed?

A

antibody titers or antibody detection

75
Q

Tx first line for legionella pneumophilia

A

Azithromycin

76
Q

Tx alt for legionella pneumophilia

A

respiratory FQ

77
Q

What are some details about chalmydophila pneumoniae?

A

obligate intracellular gram negative

78
Q

What are some symp. from chlaymdophila pneumoniae?

A

low grade fever
non productive cough
normal WBC

79
Q

Tx for chlamydophila pneumoniae

A

Doxycycline
macrolide
FQ (alt)

80
Q

Explain aspiration pneumonia

A

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
Q

What is a risk with aspiration pneumonia?

A

some pt develop secondary bacterial pneumonia due to decreased defenses

82
Q

When do most pt begin to improve?

A

within 2 days of starting effective antibiotics

83
Q

What are some objective response to monitoring plans for pneumonia?

A

Decreased cough, dyspnea and RR
Decreased fever
Decreased sputum production
Improved oxygenation
Normalization of WBC

84
Q

What is some ways to prevent it?

A

influenza vaccine
pneumococcal vaccine
COVID vaccine

85
Q

Who should get influenza vaccine

A

Those at risk of influenza complications
Household contacts of high risk people
anyone

86
Q

What are the two types of pneumococcal vaccination?

A

23 valent poly vaccine
13 valent protein vaccine

ID PHARM 152 (11 decks)

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