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pharmacotherapy 2 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

There are five types of pneumonia:

A
  1. Community-acquired pneumonia
  2. Hospital-acquired pneumonia
  3. Ventilator-associated pneumonia
  4. Aspiration pneumonia
  5. Health care-associated pneumonia
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2
Q

Pneumonia?

A

Pneumonia is inflammation of the lung with consolidation.
Pulmonary consolidation iswhen the air in the small airways is replaced with something else such as solids e.g. cells or fluids e.g. pus, blood, or water.

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3
Q
  1. Community-acquired pneumonia
A

Pneumonia in the outpatient setting and patient have not been in any health care facilities (which include wound care and hemodialysis clinics)

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4
Q
  1. Community-acquired pneumonia
    risk factos:
A
  • Age >65 years
  • Diabetes mellitus
  • Asplenia
  • Chronic cardiovascular, pulmonary, renal and / or liver disease
  • Smoking and / or alcohol abuse
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5
Q
  1. Hospital-acquired pneumonia
  2. Ventilator-associated pneumonia
A
  • Pneumonia that occurs 48 hours or more after admission
  • Endotracheal intubation for at least 48 to 72 hours before the onset of pneumonia
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6
Q

risk factor of
hospital and ventilation

A
  • COPD, ARDS, coma
  • Administration of antacids, H2RA or PPIs
  • Supine position
  • Enteral nutrition, nasogastric tube
  • Reintubation, tracheostomy
  • Prior antibiotic exposure
  • Head trauma, Intracranial Pressure monitoring
  • Age >60 years
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7
Q
  1. Health care-associated pneumonia
A
  1. Pneumonia occurring in any patient hospitalized for at least 2 days within 90 days of the onset of the infection
  2. Residing in a nursing home or long-term care facility
  3. Received IV antibiotic therapy, wound care, or chemotherapy within the last 30 days prior to the onset of the infection
  4. Attended a hemodialysis clinic
  5. Contact with a family member with infection caused by MDR pathogen
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8
Q

Respiratory defenses:

A

Mechanical barriers (mucociliary apparatus & nasal hair)
normal bacterial flora
the immune system

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9
Q

Microorganisms enter the lower respiratory tract by three routes:

A

Inhaled as aerosolized particles
Via the bloodstream from extra-pulmonary site of infection
Via aspiration of oropharyngeal contents

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10
Q

aspiration

A

Aspiration is common even in healthy people during sleep and is a major mechanism by which pathogens enter the lower airways and alveoli.

Aspiration of pathogens from the oropharynx can result in pneumonia if lung defenses are not functioning properly

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11
Q

symtoms of pneumonia

A

Respiratory Symptoms
cough (productive or nonproductive), shortness of breath, difficulty breathing

Non Respiratory symptoms
fever, fatigue, sweats, headache, myalgias, mental status changes

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12
Q

clinical presentation

A
  • Temperature may increase or decrease from baseline, but most often it is elevated. The temperature may be sustained or intermittent.

Respiratory rate is often increased. Cyanosis, , and use of accessory muscles of respiration are suggestive of severe state

Breath sounds may be diminished. Rales or rhonchi may be heard.
Confusion, lethargy, and disorientation are relatively common in elderly patients.

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13
Q

Diagnostic Tests and lab test

A

Chest x-ray
Oxygen saturation: ˃ 90%
ABGs for severe pneumonia.

The WBC . In elderly patients, a drop in WBCs also can be a sign of infection.
BUN & SCr) is needed for proper antibiotics dosing and to minimize or prevent drug toxicity (especially in the elderly patients).
Microbiology Tests need to be done

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14
Q

Usual pathogens for CAP:

A

Streptococcus pneumoniae (70% of cases):
Haemophilus influenzae
Moraxella catarrhalis
Atypical pathogens (including Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella

paul has many cute lamps mostly atypical

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15
Q

DRSP risk factors:

DRSP (drug-resistant Streptococcus pneumoniae)

A
  • Age less than 2 years or greater than 65 years
  • Recent use of beta-lactam antibiotics
  • Alcoholism
  • Childcare attendance
  • Immunosuppressive therapy or illness
  • Underlying medical conditions

aa b c d e

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16
Q

CA-MRSA risk factors:

A
  • End-stage renal disease (ESRD)
  • Intravenous drug abuse (IVDA)
  • Recent influenza infection
  • Prior antibiotic use, especially fluoroquinolones (FQs)
17
Q

pseudomonas resistant risk factor

A

structural lung disease, such as bronchiectasis or chronic obstructive pulmonary disease (COP) with frequent steroid or antibiotic use

18
Q

outpatient cap treatment

A

without risk factors of DRSP
Macrolides (e.g., azithromycin, clarithromycin)
Doxycycline

with risk factor of drsp
FQ: levi, moxi, gemi
or B-lactam( amoxicillin/ clauvanat 2mg bid)
+ macrolid

19
Q

in patient treatment

A

without icu:
fq(levi, moxi, gemi) or B-lactam ( ceftrixone , cefloxicin)
+ macrolid( azithro, clathrio)

20
Q

treatment: Early onset Pneumonia (≤ 5 days since admission):

A

3rd generation cephalosporin (eg. ceftriaxone or cefotaxime)

Respiratory fluoroquinolone (eg. gemifloxacin, levofloxacin, or moxifloxacin)

Carbapenems (eg. Imipenem or meropenem)

Ampicillin + sulbactam (not used widely now).

21
Q

The optimal duration depends on several factors including:

A
  • The type of pneumonia (bacterial, fungal etc.)
  • Whether the patient is treated in the hospital or at home (inpatient/outpatient)
  • The patient’s other health conditions (comorbidities)
  • Whether there’s an accompanying bloodstream infection (bacteremia/sepsis)
  • The specific antibiotic chosen
22
Q

Potential negative effects of prolonged antibiotic therapy:

A
  • Colonization with resistant pathogens
  • Clostridium difficile colitis
  • Overgrowth of fungi
  • Higher risk of toxicity from the agent
  • Increase in cost
23
Q

Late-onset pneumonia
risk factors for MDR organisms:

A
  • P. aeruginosa
  • extended-spectrum β-lactamase–producing K. pneumoniae
  • Acinetobacter spp.
  • MRSA
24
Q

Late-onset Pneumonia (˃ 5 days since admission) :
treatment

A

Empirical antibiotic
β-lactams, carbapenems, or fluoroquinolones alone or in combination with one of the aminoglycosides.
If MRSA is suspected, then either vancomycin or linezolid should be added to the regimen.

25
Q

Duration of treatment of CAP

A

adult:
azithromycin and FQ: 5days
other therpies: 7-10 days

children: azithro: 5 days other therpy: 10 days

adult patients admitted to the hospital
culture +: be 2 weeks
culture-: 7 days

26
Q

Duration of treatment of HAP, HCAP, or VAP

A

from 10 - 21 days.

27
Q

Supportive care

A

Humidified oxygen if hypoxemia exist
Adequate hydration
Bronchodilators (e.g. salbutamol) when bronchospasm is present
Chest physiotherapy with postural drainage if there is evidence of retained secretions.
Optimal nutritional support
Fever control

pharmacotherapy 2 (15 decks)

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