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PHAR 152 (Therapeutics 1 - Dr. Y. Shevchuk)) > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What are the risk factors for contracting pneumonia?

A

Alcohol abuse
immunosuppressed
lung disease
over the age of 70
institutionalized

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2
Q

What are the ways a pneumonia infection can occur and order them in increasing occurrence?

A

Hematogenous spread
Inhalation of airborne particles
Aspiration of oropharyngeal material (Most common)

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3
Q

What respiratory defenses do we have?

A

hair, cilia, mucous, salivary enzymes, macrophages, antibodies and epithelial linings

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4
Q

In what ways can our defense systems be compromised?

A

alcohol, smoke, disease, viruses, and oxygen levels. These change the number of microorganisms and increase the chance for them to cause problems.

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5
Q

What are the most common causes of CA pneumonia?

A

S. pneumoniae=30-60%
H. infuenzae= 2-20%
S. aureus= 1-5%
M. pneumoniae= 5-10%
VIRAL TOO- 2-15%

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6
Q

What are the organisms that cause atypical pneumonia and why?

A

M. Pneumonia- infects more than one lobe, doesn’t grow on agar
Chlamydiae and legionella- infect more than one lobe and don’t grow on agar

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7
Q

What are the common organisms that cause HA pneumonia?

A

K. pneumoniae, E. coli, Enterobacter= 60%
P.aeruginosa= 8-15%
S. aureus= 13%
Anaerobes= 20%

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8
Q

What are the signs and symptoms of pneumonia?

A

Fever >39 degrees
chills
dyspnea
cough
rust color sputum
pleuritic chest pain
tachycardia
tachypnea

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9
Q

What clinical tests can we do?

A

Chest x-ray-required for diagnosis
WBC count
Sputum culture- often contaminated(NO in CAP)
blood culture- not unless severe or if suspect aeruginosa or MRSA
Serology- look at antibody titre for a specific pathogen

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10
Q

What are the two algorithms for determining severity of pneumonia?

A

Pneumonia Severity Index
CURB-65

HOWEVER, regardless of score the patient needs to be able to take food orally, do daily activities, and comply with instruction

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11
Q

What are common goals of therapy for Pneumonia?

A

Eradicate the organism by day______
Resolve signs and symptoms
reduce risk of complications
minimize resistance

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12
Q

General non-pharmacological treatment for pneumonia?

A

rest
fluids, food
analgesic/antipyretics
oxygen
drainage

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13
Q

True or false: A patient should wait for their culture before starting antibiotics

A

FALSE

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14
Q

What antibiotics cover the top 3 pathogens (Strep, Haemophilus, Mycoplasma)

A

Amox- but resistance for H. influenxae
Azith- resistance for S. pneumonia
Levofloxacin will 100% cover all three.

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15
Q

What is the first-line treatment for Pneumonia?

A

Amoxicillin 1000mg TID
Doxycycline 100mg BID
Clarithromycin 500mg BID
Azithromycin 500mg first day then 250mg for 4 days
USE MACROLIDES IF RESISTANCE IS UNDER 25%
in saskatoon= about 26%

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16
Q

When should we worry about the potential for MRSA or P. aeruginosa?

A

Prior isolation of these species or recent hospitalization in the last 90 days.
also the local level of these organisms

17
Q

What treatment do we give if a pneumonia patient has comorbidities?

A

Amox/Clav 500mg/125mg TID. OR
Cefuroxime 500mg BID. OR
Cefprozil 500 mg BID

AND
Clarithro, azithro, doxy

OR
Monotherapy of Levofloxacin or Moxifloxacin

18
Q

What is the duration of treatment for CAP?

A

Minimum of 5 days and be afebrile for 48-72 hrs
azithromycin is 3 days

For MRSA or P. aeruginosa is 7 days

19
Q

What is the specific treatment for S. Pneumonia?

A

Penicillin G
Penicillin V- high dose can overcome resistance
Amoxicillin- high dose can overcome resistance
Alt= Cefazolin, erythromycin or FQ

20
Q

What is the specific treatment for S. Aureus?

A

MSSA= Cloxacillin 8-12 g/d ALT= cefazolin, clindamycin, vancomycin
MRSA= Vancomycin, linezolid
TREATMENT TAKES 14-21 DAYS

21
Q

What is the specific treatment for H. influenza?

A

Non-B lactamase= Ampicillin 6-8 g/d, amoxicillin 3g/d

B lactamase= amox/clav, 2nd generation, 3rd generation, FQ, Doxy, azithro, clarithro

22
Q

What is the specific treatment of aerobic Gram-negative rods?

A

3rd generation cephalosporin
carbapenem
piperacillin/tazobactam

23
Q

What is the specific treatment of aerobic Gram-negative rods?

A

3rd generation cephalosporin
carbapenem
piperacillin/tazobactam

24
Q

What is the specific treatment of P. aeruginosa?

A

piperacillin/tazobactam and cipro/AMG
Ceftazidime and cipro/AMG
Ciprofloxacin and AMG
Cefepime and cipro/AMG
meropenem and cipro/AMG

25
Q

What is the specific treatment for M. pneumonia?

A

Macrolid 250 mg QID
Doxycycline
ALT= FQ

26
Q

What is the specific treatment of legionella?

A

Azithromycin
ALT= FQ

27
Q

What is the specific treatment of Chlamydophila pneumonia?

A

Doxycycline or macrolide
ALT=FQ

28
Q

What are the specific symptoms present in chlamydophila pneumonia?

A

Low grade fever, nonproductive cough

29
Q

Who is specifically at risk for Legionella infection?

A

Smokers, males aged 50-60, alcoholics

30
Q

What is the triad of symptoms common with M. pneumonia?

A

Maculopapular rash, arthritis, pneumonia

31
Q

What is interesting about the sputum created with a P. aeruginosa infection?

A

the sputum is very smelly

32
Q

Explain the process of Aspiration Pneumonia.

A

Aspirate gastric contents
body neutralizes the contents by fluid
the patient experiences a change in breathing and this cause lead to massive fluid shifts
this can then lead to secondary bacterial infection

33
Q

When can the patient expect improvement?

A

Within 2 days

34
Q

What should be considered when creating a monitoring plan?

A

duration of therapy
non drug measure
adherence
side effects
resolution of symptoms

35
Q

What vaccines are important to lower the risk of pneumonia?

A

Yearly influenza vaccine
pneumococcal vaccine (23 valent (free for at-risk and over 65 years old) and 13 valent)
COVID vaccine

PHAR 152 (Therapeutics 1 - Dr. Y. Shevchuk)) (9 decks)

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