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Pharm II > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

what is CAP?

A

Not recently hospitalized and lacking healthcare associated risk factors

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2
Q

what is HAP?

A

Pneumonia that occurs >48 hours after hospital admission

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3
Q

what is VAP?

A

Pneumonia that arises > 48-72 hours after endotracheal intubation

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4
Q

what is HCAP? 4

A

Any patient who was hospitalized for >2 days in the last 90 days
Resided in nursing home or long-term care facility
Received recent IV antibiotic, chemotherapy or wound care within past 30 days
Patient on hemodialysis

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5
Q

what is the most common etiology of bacterial pneumonia?

A

Streptococcus pneumoniae

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6
Q

what is the 2nd most common cause of bacterial pneumonia?

A

Mycoplasma pneumoniae

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7
Q

what causes colonization increases in patients with COPD and cystic fibrosis

A

Haemophilus influenzae

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8
Q

what is a more common cause in young children and elderly

A

Moraxella catarrhalis

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9
Q

what is the most common cause of CAp in children?

A

Viral-RSV, influenza A, parainfluenza

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10
Q

what is DRSP? to how many drugs?

A

Drug resistant S. pneumoniae (DRSP)
Strains resistant to at least 3 drugs
Becoming more and more common

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11
Q

what are risk factors of DSRP?

A 
Age < 2 years or > 65 years
Antibiotic therapy within previous 3 months
Alcoholism
Medical comorbidities
Immunospupression
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12
Q

what are risk factors of CA-MRSA? 10

A 
Cavitary Pneumonia
Lung necrosis
Rapidly increasing pleural effusion
Gross hemoptysis
Neutropenia
Concurrent infection
Erythematous skin rash 
Previously healthy
Summer season
Prior conjugate pneumococcal vaccination
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13
Q

what are risk factors for aspiration pneumonia?

A

Dysphagia, change in oropharyngeal colonization, GERD, decreased host defenses, oral contents, gastric contents

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14
Q

what causes dysphagia?

A

Stroke, seizures, alcoholics, and aging

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15
Q

what causes Change in oropharyngeal colonization

A

Oral/dental disease, poor hydiene, tube feedings, medications

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16
Q

what may GER cause

A

May allow gram (-) bacilli to colonize gastric contents

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17
Q

what can decreased host defenses cause?

A

Impaired mucus production or cilia function, decreased immunoglobulin in secretions, altered cough reflex

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18
Q

what anaerobes may be found in oral contents?

A

Bacteroides spp., Fusobacterium spp,. Prevotella spp. and anaerobic gram cocci

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19
Q

what microbes may be in gastric contents?

A

Gram (-) bacilli and S. auerus

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20
Q

what is the 2nd most common nosocomial infection in the US

A

HAP

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21
Q

what are risk factors for HAP

A

Intubation and mechanical ventilation
Aspiration
Risk of aspiration increased in ICU patients
Oropharyngeal colonization
Affected by antibiotics, and poor infection control measures
Hyperglycemia
Directly and indirectly promote infections
Inhibit phagocytosis, provides nutrients for the bacteria

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22
Q

what is the etiology of pneumonia? 5

A 
-Aerobic Gram-negative bacteria
Ps. aeruginosa
E. coli
K. pneumonia
Acinetobacter sp.
-Gram-positive bacteria
S. aureus (MRSA)
Anaerobes: very rare
23
Q

what is the symptoms of pneumonia?

A

Cough, SOB, difficulty breathing

Fever, fatigue, headaches, myalgia, mental status change; confusion, lethargy, and disorientation

24
Q

what are the signs of pneumonia?

A

Fever, sustained or intermittent, cyanosis and use of accessory muscles, breath sounds may be diminished, rhales or rhonci may be heard

25
Q

what does the chest xray of pneumonia show?

A

Multilobar infiltrates
Rapid progression infiltrates
Pleural effusion
Necrotizing pneumonia

26
Q

How do you Dx pneumonia? 3

A

Chest Xray should reveal infiltrates
O2 saturation should be over 90%
CBC, elevated or drop in WBC, differential should show a predominance of neutrophils

27
Q

what are 2 additional things that need to be done in hospitalized patients with pneumonia before you diagnose?

A

Sputum gram stain may or may not show a predominance of on organism

Blood cultures MUST be obtained in all patients hospitalized with pneumonia

28
Q

what is CURB65?

A

how to know where to place them…
Confusion, Uremia, Respiratory Rate, Blood Pressure over 65.

2 points; consider hospital admission
>3 points; consider ICU admission

29
Q

what criteria must be met to dx HAP/VAP?

A 
Chest X-ray should reveal a new infiltrate plus two of the following:
Temp > 38 C (100.4 F)
Leukocytosis or leukopenia
Purulent secretions
Cultures identifying pathogen
30
Q

73 year old woman presents to your clinic complaining of difficultly breathing and shortness of breath. PE reveals decreased breath sounds on left side compared to the right, and rales in the left lower lobe. Temp 37.4C, RR 20, BP 110/76. Chest X ray: lower left lobe infiltrates. O2 saturation 92%.
what does she have?
what pathogen
what else should you know?

A

CAP - strep pneumo - where did she come from

31
Q

48 yo male admitted s/p MVA, intubated at scene. SICU day #9, the nurse notes thick green sputum upon tracheal aspiration.

V.S.:T 101.5oF O2Sat 90% on 3L O2
P.E.:difficult to assess lung
WBC:16,000 / mm3
X-Ray: LLL infiltrates
what is the pathogen?
A

MRSA

32
Q

Empirical treatment for CAP - health outpt?

A

Macrolide or Doxycycline

33
Q

Empirical treatment for CAP - outpt at risk for DRSP

A

Respiratory Fluoroquinolone
Or
Beta-lactam + Macrolide

34
Q

Empirical treatment for CAP - inpt nonICU - 1st is for IDSA 2nd is JCCMS

A

Respiratory Fluoroquinolone
Or
Beta-lactam + Macrolide

Antipneumococcal quinolone OR
Beta-lactam + doxycycline or Tigecycline montherapy or Macrolide monotherapy

35
Q

Empirical treatment for CAP - inpt ICU - 1st is for IDSA 2nd is JCCMS

A

Beta-lactam + azithromycin
Or
Beta-lactam + respiratory fluoroquinolone

Macrolide and Beta-lactam * or antipneumococcal/antipsuedomonal Beta-Lactam OR
Antipneumococcal quinolone OR
Antipseudomonal quinolone + Beta-lactam or antipneumococcal/antipseudomonal beta lactam OR
Antipneumococcal/antipseudomonal beta-lactam + aminoglycoside + either antipneumococcal quinolone or macrolide

36
Q

Respiratory Fluoroquinolone

A

: Levofloxacin, moxifloxacin, gemifloxacin

37
Q

Beta-lactam (Inpatient)

A

Ceftriaxone, cefotaxime, ampicillin/sulbactam

38
Q

CA-MRSA treatment options

A

Vancomycin or Linezolid

39
Q

Antipneumococcal/antipseudomonal beta-lactam

A

Cefepime, Imipnem, meropenem,

piperacillin/tazobactam

40
Q

Antipneumococcal quinolone

A

cipro or levo

41
Q

you are able to ID organism how long after admission?

A

24-72hrs

42
Q

what is the duration of therapy?

A

Duration of therapy 5-7 days

Minimum 5 days until patients are afebrile for 48-72 hours

43
Q

when should therapy be longer?

A

Longer for S. auerus or Pseudomonas

44
Q

when clinical able…

A

switch to PO

45
Q

when can you d/c pts?

A

Vital signs and Oxygen status are stable and no unresolved comorbidities

46
Q

how do you treat Aspiration of oral contents pneumonia?

A

PCN G, ampicillin/sulbactam, and clindamycin all cover typical pathogens

47
Q

how do you treat aspiration of oral and gastric contents pneumonia?

A

Ampicillin/sulbactam, amoxicillin/clavulante piperacillin/tazobactam

48
Q

what are the key concerns for HAP

A

MRSA, Pseudomonas aeruginosa, Acinetobacter spp., and Stenotrophomonas maltophilia

49
Q

if onset within 5 days of admission what pathogens caused HAP

A

S. pneumoniae, H. influenzae, MSSA, and enteric gram (-) bacilli

50
Q

how do you treat early onset HAP?

A

3rd generation cephalosporin +macrolide
or
Respiratory fluoroquinolone

51
Q

what are risk factors for multidrug resistant? lots…

A

Antimicrobial therapy in preceding 90 days
Current hospitalization of 5 days or more
High frequency of antibiotic resistance in the community or in the specific hospital unit
Presence of risk factors for HCAP:
Hospitalization for >2 days in the preceding 90 days
Residence in a nursing home or extended care facility
Home infusion therapy (including antibiotics)
Chronic dialysis within 30 days
Home wound care
Family member with multidrug-resistant pathogen
Immunosuppressive disease and/or therapy

52
Q

how do you treat MDR?

A

Antipsuedomonal cephalosporin (Cefepime, ceftrazidime)
OR
Antipseudomonal carbapenem (imipenem or meropenem)
Or
Beta-lactam/Beta-lactamase inh (Piperacillin/ tazobactam)
Antispeudomonal fluoroquinolone (cpirofloxacin or levofloxacin)
Or
Aminoglycoside (amikacin, gentamicin or tobramycin)
Vancomycin
Or
Linezolid

53
Q

how do you treat VAP?

A 
Cefotaxime 2 g IV q 8H
		or
	Ceftriaxone 2 g IV q 24H
		or
	Ampicillin/Sulbactam 3 g IV q 8H
		or
	Antipneumococcal fluoroquinolone
		Plus
	Vancomycin or linezolid (if high rates of MRSA)
54
Q

what are pathogens of VAP

A

S.aureus, S. pneumoniae, H. influenzae, gram-negative Enterobacteriaceae

Pharm II (8 decks)

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