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NRS 271A: optho, pulm, GU, Renal, Heme/onc > Pneumonia and Immunizations > Flashcards

Pneumonia and Immunizations Flashcards

1
Q

Types of PNA

A
  1. Community acquired
    1. outside healthcare facilities
  2. Aspiration
    1. aspiration of oral or GI content
  3. Hospital Acquired
    1. PNA occurs 48+ hours after admission
  4. Ventilator Associated
    1. 48-72 hours after intubation
  5. Health Care Associated
    1. hospitalized at least 2 days within 90 days
    2. SNF and LTC
    3. IV abx, wound care, chemo, HD within last 30 days
    4. Resemble HAP; more resistant bacteria
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2
Q

Common Pathogens associated with each type of PNA

A
  1. CAP
    1. Hflu, Moraxella, Strep pna
      1. Atypical: mycoplasma, chlamydia, legionella
  2. Aspiration:
    1. anaerobes
      1. strep viridans, Gram - bacilli
  3. Hospital/ VAP/ HCAP
    1. MSSA, klebsiella, E.coli, Strep pneumo
    2. MRSA, ESBL+, Klebseilla, pseudomonas, acinetobacter
    3. atypical: mycoplasma, chlamydia (rare)
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3
Q

CURB-65

A

1 point per positive: (1 = treat outpatient; 2+ = hospitalize)

  • age 65+
  • confusion
  • uremia (BUN19+mg/dL)
  • RR >30/min
  • BP <90/60
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4
Q

SOAR Score

A

1 point per positive: (<2 = non severe; 2+ = severe)

  • SBP <90
  • Oxygen (Pa02; Fi02 <250)
  • age 65+
  • RR 30+/min
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5
Q

Assessing Severity of PNA: Step 1

A

is yes to ANY of these then proceed to step 2; if all no = RISK CLASS I

  • Presence of:
    • >50 yo
    • AMS
    • P: 125+/min
    • RR >30/min
    • SBP<90mmHg
    • Temp <35C or 40+C
  • Hx of:
    • neoplastic disease
    • congestive heart failure
    • cerebrovascular disease
    • renal disease
    • liver disease
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6
Q

Assessing Severity of PNA: Step 2 (demographics)

A

Male

Female

SNF resident

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7
Q

Assessing Severity of PNA: Step 2 (Comorbidities)

A
  • Cancer
  • liver disease
  • CHF
  • Cerebrovascular
  • Renal Disease
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8
Q

Assessing Severity of PNA: Step 2 (PE findings)

A
  • AMS
  • P125+/min
  • RR >30/min
  • SBP <90mmHg
  • Temp <35C or 40+
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9
Q

Assessing Severity of PNA: Step 2 (Lab/Radiology)

A
  • Arterial pH <7.35
  • BUN 30+
  • Na+ <130
  • Glucose 250+
  • Hct <30%
  • PaO2 <60mmHg
  • Pleural Effusion
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10
Q

Assessing Severity of PNA: Step 2 Scores

A
  • <70 = Risk Class II
  • 71-90 = Risk Class III
  • 91-130 = Risk Class IV
  • >130 = Risk Class V
  • all are outpatient until IV (Moderate Risk) and V (High Risk) = hospital admission
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11
Q

Treatment of CAP with CURB-65 = 1 with no co-morbidities

A
  • Amox 1gm TID
  • Macrolides
  • Doxy 100mg BID
  • Prior Abx
    • azith/clarith + HD amox/HD aug or fluoroquinolones
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12
Q

Treatment of CAP with CURB-65 = 1 with co-morbidities

A
  • gemi, levo, moxi
  • azith/clarith or doxy + HD amox/HDaug
  • axith/clarith or doxy + cefdinir, cefpodoxime, cefprozil, cefuroxime
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13
Q

Tx of PNA with CURB-65 score 2+ (non-ICU)

A

tx 5 days or 48-72s without fever

  • azith + ceftriaxone
  • azith + ertapenem
  • levo, moxi
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14
Q

ICU PNA txs (pseudomonas risk, no risk, and MRSA)

A
  • pseudomonas risk?
    • cefepime or ceftazidine, or zosyn, or imipenim, or meropenem, + cipro or levo or aminoglycoside
  • no pseudo risk?
    • cefotaxime or ceftriaxone + azith
    • levo/moxi
  • MRSA?
    • add vancomycin or linezolid to above
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15
Q

HAP/VAP/HCAP empiric tx without risk factors for MDR

A
  • ceftriaxone/cefotaxime
  • gemi/levo/moxi
  • unasyn
  • ertapenem
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16
Q

HAP/VAP/HCAP empiric tx with risk factors for MDR

A
  • cefepime/ceftazidime
  • cipro/levo
  • zosyn/timentin
  • imipenem/meropenem
  • aminoglycosides
17
Q

HAP/VAP/HCAP empiric tx with risk for MRSA

A

vancomycin, linezolid

18
Q

duration of tx for adult outpatient CAP

A

5 days if levo or azith

7-10 days for other agents

19
Q

duration of tx for pediatric uncomplicated CAP

A

10 days, except azith = 5 days

20
Q

duration of tx for HAP

A

blood cx (-) = 7-10 days

blood cx (+) = 14 days

HCAP/VAP = 10-21 days (no pseudomonas? 7 days)

21
Q

PCV-13

A

for =5 and 65+

6 yo+ with high risk (immunocompromised)

22
Q

PPSV-23

A

65+

2-64 yo with high risk (should not receive second dose at/after age 65 if within 5 years of last PPSV-23 vaccine or within 1 year of last PCV-13 vaccine)

  • inffective in children <2yo
23
Q

Pts 19yo+, high risk, and the PCV-13 and PPSV-23 dosing

A

PCV-13 then at least 8 weeks apart PPSV-23

then at least 5 years later PPSV-23

then at least 5 years later AND 65+ PPSV-23

24
Q

Antiviral Medications for Influenza

A
  • Adamantanes
    • amantadine (Symmetrel)
    • Rimantadine (Flumadine)
  • Neuraminidase Inhibitors
    • Zanamivir (Relenza)
    • Oseltamivir (Tamiflu)
    • Peramivir (Rapivab)
  • Cap-dependent Endonuclease inhibitor
    • Baloxavir marboxil (Xofluza)
25
Q

tx of Diptheria

A

diptheria antitoxin (DAT)

Macrolides IV (erythromycin) or Penicillin G IV

26
Q

Pertussis

A

aka whooping cough

tx: macrolides or septra (trimethoprim/sulbactam)

27
Q

Who should NOT get the flu live vaccine?

A
  • age 2-4 years with diagnosis of asthma or had wheezing/asthma in the past 12 months
  • immunocompromised
  • close contacts of severely immunocompromised
  • pregnant women
  • pts who have received influenza antiviral within the previous 48 hours
28
Q

Influenza Vaccines

A
  • Live intranasal:
    • approved for 2-49 yo; non-pregnant
  • Injectable:
    • egg based:
      • IIV3 (inactive influenza vaccine trivalent)
      • IIV4 (quadrivalent)
    • Cell-cx based:
      • IIV4
    • Recombinant Hemagglutinin (HA)
      • RIV4
29
Q

Non-Egg Based Flu Vaccines

A

IIV4: Flucelvax (Cell cx based)

RIV4: Flublok (Recombinant Hemagglutinin (HA)

30
Q

Zanamivir (Relenza)

A

inhaled

inhibits influenza neuraminidase

SEs: Bronchospasm, SJS, TEN, Seizures

prophylaxis: 10 mg inhaled qday x 10 days

31
Q

Oseltamivir (Tamiflu)

A

Oral

inhibits influenza neuraminidase

SEs: abdominal pain, conjunctivitis, ear disorder

epistaxis, insomnia/delirium, NVD

DDI: clopidogrel = decrease levels of tamiflu

32
Q

Peramivir (Rapivab)

A

Administered IV

inhibits influenza neuraminidase

SEs: Delirium, anaphylaxis/SJS. neutropenia, diarrhea/hyperglycemia

33
Q

Baloxavir Marboxil (Xofluza)

A

inhibits DNA synthesis

prodrug

not recommended in pregnant/breastfeeding, complicated outpt, or hopsitalized

SEs: diarrhea, bronchitis

NRS 271A: optho, pulm, GU, Renal, Heme/onc (10 decks)

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