Pneumonia Flashcards
What are the symptoms of pneumonia
fever,
productive cough (w/purulent sputum), &
pleuritic chest pain,
rales over infected lobe
What medications are used for the treatment of out patient treatment of CAP in a previously healthy patient?
Mecrolides: Zithromax, Biaxin, E.E.S
or
Doxycyline
What medications are used for the treatment of out patient treatment of CAP in a patient at risk for drug resistance?
Respiratory FQ: moxifloxacin, gemifloxacin, levofloxacin 750mg
or
Beta lactam + a macrolide
What Beta-lactams are preferred for use in out patient CAP
high dose amoxicillin or Augmentin
What are the preferred alternative agents to Beta-lactam based therapy for CAP ?
Rocephin
cefpodoxime
Ceftin(cefuroxime)
ampicillin
What agent can be used as an alternative to macrolides in CAP treatment ?
doxycycline
What are the risk factors for developing drug resistance?
antibiotic use in the past 3 months
comorbidites
what comorbidites put a patient at risk for drug resistance?
HF cancer
DM alcoholism
Liver/ kidney dysfunction
aplenia immunosuppresion
What are the preferred Beta-lactam agents in an inpatient non-ICU setting for the treatment of CAP
ceftriaxone-Rocephin
cefotaxime
ampicillin
What are the agents used in an inpatient non-ICU setting for the treatment of CAP
Beta-lactam + macrolide
or
Respirtory fluroquinolones: Factive, Avelox,levaquin
The antibiotic biogram of a hospital indicates high levels of macrolide resistant S.areus. What agent must be added to the CAP therapy regardless of comorbidities?
Respiratory FQ
If CA-MRSA is suspected, what agents should be added to therapy?
Vancomycin
or
linazolid
What is the recommended therapy for an ICU patient with non-psuedomonal CAP
Macrolide + B-lactam or respiratory FQ
A PCN allergic patient is admitted to the hospital for Cap, what is the recommended therapy?
Respiratory FQ + Aztreonam
What is the 2 agent course of therapy for an ICU patient with psudamonal CAP
antineumococal antipseudomonal Beta lactam
+
Ciprofloxacin or Levofloxacin
What are the antipnumococal antipseudomonal Beta lactams?
Zosyn- piperacillin/taxobactam
Primaxin- Imipenem/cilastin
Doribax-Doripenem
Maxipime-cefepime
What agent is the alternative to the antipnumococal antipseudomonal Beta lactams?
azithromycin + AMG
or Aztreonam + Cipro/Levo
What is the 3 agent course of therapy for an ICU patient with psudamonal CAP
antineumococal antipseudomonal Beta lactam
+ Azith or Respiratory FQ
Cipro & Levo are what type of quinolone
antipsuedomonal FQ
What is the minimum duration of therapy for CAP
5 days based on symptoms
What are the non-pharmacological ways to prevent HAP
Universal precaution- gloves, gowns, face mask
wash hands
elevate head of bed 30 degrees or more
wean off ventilators quickly
Remove NG tubes
D/C stress ulcer prophylaxis if not needed.
A patient is admitted to the hospital for a heart attack 2 days ago. Today the patient is found to have a fever, increased purulent sputum production, elevation in WBC, chest pain & rales upon examination. what is a possible diagnosis for this patient?
early onset HAP (b/c
When does a patient receive a diagnosis of late onset HAP
> 5 days hospitalization
or MDR pneumonia during hospitalization
What is the recommended drug options for early onset HAP
Invanz-ertapenam
Respirtory FQ- Levoquin/Avelox
Rocephin-ceftriaxone
Unasyn-ampicillin/sulbactam
What 3 classes of medications must be given for late onset HAP
antipsudamonal beta lactim + 2nd antipsudamonal agent + Anti-MRSA agent
What anti antipsuedamonal Beta lactam agents are used for HAP
Cephlasporin: Maxapime-cefepime or Fortaz-ceftazadime
carbopenems: Merem-meropenem or Primaxin-pmepenem/cilastin
Zosyn- piperacillin/tazobactam
What are the options for the second non-betalactam antipsuedamonal agent used in HAP
AMG: tobramycin, gentamicin, amikacin
antipsudamonal FQ: Cipro/Levo
What anti-MRSA agents are used for HAP
Vancomycin
Linazolid
If a patient has a PCN allergy what tx options are available for HAP
Aztreonam + FQ
or
AMG + Vancomycin/ linazolid
what is the duration of therapy for a non-psuedamonal or acinetobactore patient or a patient without connected blood?
7 days
What is the duration of therapy for a psuedamonal or acinetobactore patient or a patient with connected blood?
14 days
What is the therapeutic level for vancomycin when treating HAP?
trough 15-20mcg/mL
A patient’s current medication list consists of: cisplatin, gentamicin, NSAID, amphoteracin B, colistimethate and they just got radio contrast dye for an MRI. What is the concern if Vancomycin is used for their pneumonia?
Hepatotoxicity
A patient is currently taking a loop diuretic for HF, are there any concerns to monitor for if vancomycin is used for pneumonia?
ototoxicity & hepatotoxicity
A patient has been using vancomycin for pneumonia for 5 days. 10 days later the patient’s SCr changes form 0.6 to 1.5. Which of the following could have caused this change and why?
a. Rocephin
b. Motrin
c. Protonix
d. Tobradex
Motrin- this is an NSAID which increases the concentration of vancomycin as well as has the ability to cause hepatotoxicity itself.
