Pneumonia

Question 1

What is pneumonia

Answer 1

An infection of the respiratory tree in the gas exchange regions of the lungs.

Question 2

What are the symptoms of pneumonia

Answer 2

• Cough
• Breathlessness
• Pain
• Sputum production.

Question 3

What are the signs of pneumonia

Answer 3

• Temperature
• Inspiratory crackles/crepitations.
• Pleural rub if the pleural surface of the lung is affected.

Question 4

What are the 5 categories of pneumonia

Answer 4

• Community acquired pneumonia
• Hospital acquired pneumonia
• Aspiration pneumonia
• Pneumonia in the immunocompromised
• Necrotising pneumonia

Question 5

What is the most common type of pneumonia

Answer 5

Community acquired pneumonia

Question 6

What organisms cause community acquired pneumonia

Answer 6

• Streptococcus pneumoniae
• Haemophilus influenzae
• Mycoplasma pneumoniae

Question 7

In which type of patients is hospital acquired pneumonia more common

Answer 7

Patients on immunosuppressive drugs

Question 8

When is pneumonia considered to be hospital acquired

Answer 8

When the onset is more than 48 hours following hospital admission

Question 9

What organisms cause hospital acquired pneumonia

Answer 9

• Gram negative rods
• Enterobacteriae
• Staph aureus

Question 10

What is aspiration pneumonia

Answer 10

This occurs in patients with aspiration of the upper airway. It comes about when people breathe commensal organisms from the upper airways into the lungs and this tends to be anaerobic organisms around the mouth however these can mix with aerobic organisms from the environment.

Question 11

What tends to cause pneumonia in immunocompromised patients

Answer 11

Unusual bacterial, viral and fungal organisms such as aspergilla and candida. Also pneumocystis jiroveci.

Question 12

What two drugs are used to treat community acquired pneumonia

Answer 12

• Amoxicillin (penicillin derived)

- Clarithromycin (macrolide)

Question 13

What is used to treat hospital acquired pneumonia which is more mild

Answer 13

Hospital acquired pneumonia needs to be treated with more broad spectrum antibiotics. Mild pneumonia tends to be treated with co-amoxiclav (a penicillin derivative with a penicillinase inhibitor)

Question 14

What is used to treat severe hospital acquired pneumonia

Answer 14

Piperacillin or tazobactam

Question 15

What two drugs are used to treat aspiration pneumonia

Answer 15

Cefuroxime and metronidazole (drugs which also cover anaerobes)

Question 16

What is used to treat pneumonia in immunocompromised patients caused by pneumocystis jiroveci

Answer 16

High dose co-trimoxazole.

Question 17

What is amoxycillin

Answer 17

A common antibiotic. it is an example of a penicillin drug.

Question 18

What are similar drugs to amoxycillin

Answer 18

Phenoxymethylpenicillin, benzylpenicillin, flucloxacillin

Question 19

What are the main actions of amoxycillin

Answer 19

Bactericidal against gram positive cocci and bacilli

Question 20

What are the indications of the use of amoxycillin

Answer 20

Chest infections and UTIs.

Question 21

What are the adverse effects of amoxycillin

Answer 21

• Rash
• Diarrhoea
• Hypersensitivity

Question 22

What is clarithromycin

Answer 22

A macrolide antibiotic

Question 23

What is a similar drug to clarithromycin

Answer 23

Erythromycin

Question 24

What are the main actions of clarithromycin

Answer 24

It interferes with bacterial protein synthesis

Question 25

What are the indications of clarithromycin

Answer 25

• Acute bacterial exacerbations of COPD
• other pneumonias - atypical
• Allergy to penicillin

Question 26

What is an example of an adverse effect of clarithromycin

Answer 26

it can cause phlebitis when given by IV and there are multiple drug reactions such as with warfarin and simvastatin.

Question 27

What is important to remember about macrolides and other drugs

Answer 27

Macrolides can inhibit the metabolism of other drugs by shutting down the action of the cytochrome P450 system.