Pneumonia

Question 1

What are the symptoms of pneumonia

Answer 1

fever,
productive cough (w/purulent sputum), &
pleuritic chest pain,
rales over infected lobe

Question 2

What medications are used for the treatment of out patient treatment of CAP in a previously healthy patient?

Answer 2

Mecrolides: Zithromax, Biaxin, E.E.S
or
Doxycyline

Question 3

What medications are used for the treatment of out patient treatment of CAP in a patient at risk for drug resistance?

Answer 3

Respiratory FQ: moxifloxacin, gemifloxacin, levofloxacin 750mg
or
Beta lactam + a macrolide

Question 4

What Beta-lactams are preferred for use in out patient CAP

Answer 4

high dose amoxicillin or Augmentin

Question 5

What are the preferred alternative agents to Beta-lactam based therapy for CAP ?

Answer 5

Rocephin
cefpodoxime
Ceftin(cefuroxime)
ampicillin

Question 6

What agent can be used as an alternative to macrolides in CAP treatment ?

Answer 6

doxycycline

Question 7

What are the risk factors for developing drug resistance?

Answer 7

antibiotic use in the past 3 months

comorbidites

Question 8

what comorbidites put a patient at risk for drug resistance?

Answer 8

HF cancer
DM alcoholism
Liver/ kidney dysfunction
aplenia immunosuppresion

Question 9

What are the preferred Beta-lactam agents in an inpatient non-ICU setting for the treatment of CAP

Answer 9

ceftriaxone-Rocephin
cefotaxime
ampicillin

Question 10

What are the agents used in an inpatient non-ICU setting for the treatment of CAP

Answer 10

Beta-lactam + macrolide
or
Respirtory fluroquinolones: Factive, Avelox,levaquin

Question 11

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?

Answer 11

Respiratory FQ

Question 12

If CA-MRSA is suspected, what agents should be added to therapy?

Answer 12

Vancomycin
or
linazolid

Question 13

What is the recommended therapy for an ICU patient with non-psuedomonal CAP

Answer 13

Macrolide + B-lactam or respiratory FQ

Question 14

A PCN allergic patient is admitted to the hospital for Cap, what is the recommended therapy?

Answer 14

Respiratory FQ + Aztreonam

Question 15

What is the 2 agent course of therapy for an ICU patient with psudamonal CAP

Answer 15

antineumococal antipseudomonal Beta lactam
+
Ciprofloxacin or Levofloxacin

Question 16

What are the antipnumococal antipseudomonal Beta lactams?

Answer 16

Zosyn- piperacillin/taxobactam
Primaxin- Imipenem/cilastin
Doribax-Doripenem
Maxipime-cefepime

Question 17

What agent is the alternative to the antipnumococal antipseudomonal Beta lactams?

Answer 17

azithromycin + AMG

or Aztreonam + Cipro/Levo

Question 18

What is the 3 agent course of therapy for an ICU patient with psudamonal CAP

Answer 18

antineumococal antipseudomonal Beta lactam

+ Azith or Respiratory FQ

Question 19

Cipro & Levo are what type of quinolone

Answer 19

antipsuedomonal FQ

Question 20

What is the minimum duration of therapy for CAP

Answer 20

5 days based on symptoms

Question 21

What are the non-pharmacological ways to prevent HAP

Answer 21

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.

Question 22

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?

Answer 22

early onset HAP (b/c

Question 23

When does a patient receive a diagnosis of late onset HAP

Answer 23

> 5 days hospitalization

or MDR pneumonia during hospitalization

Question 24

What is the recommended drug options for early onset HAP

Answer 24

Invanz-ertapenam
Respirtory FQ- Levoquin/Avelox
Rocephin-ceftriaxone
Unasyn-ampicillin/sulbactam

Question 25

What 3 classes of medications must be given for late onset HAP

Answer 25

antipsudamonal beta lactim + 2nd antipsudamonal agent + Anti-MRSA agent

Question 26

What anti antipsuedamonal Beta lactam agents are used for HAP

Answer 26

Cephlasporin: Maxapime-cefepime or Fortaz-ceftazadime
carbopenems: Merem-meropenem or Primaxin-pmepenem/cilastin
Zosyn- piperacillin/tazobactam

Question 27

What are the options for the second non-betalactam antipsuedamonal agent used in HAP

Answer 27

AMG: tobramycin, gentamicin, amikacin

antipsudamonal FQ: Cipro/Levo

Question 28

What anti-MRSA agents are used for HAP

Answer 28

Vancomycin

Linazolid

Question 29

If a patient has a PCN allergy what tx options are available for HAP

Answer 29

Aztreonam + FQ
or
AMG + Vancomycin/ linazolid

Question 30

what is the duration of therapy for a non-psuedamonal or acinetobactore patient or a patient without connected blood?

Answer 30

7 days

Question 31

What is the duration of therapy for a psuedamonal or acinetobactore patient or a patient with connected blood?

Answer 31

14 days

Question 32

What is the therapeutic level for vancomycin when treating HAP?

Answer 32

trough 15-20mcg/mL

Question 33

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?

Answer 33

Hepatotoxicity

Question 34

A patient is currently taking a loop diuretic for HF, are there any concerns to monitor for if vancomycin is used for pneumonia?

Answer 34

ototoxicity & hepatotoxicity

Question 35

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

Answer 35

Motrin- this is an NSAID which increases the concentration of vancomycin as well as has the ability to cause hepatotoxicity itself.