Pneumonia (CAP And HAP) Flashcards

1
Q

Classification of pneumonia and definitions

A

CAP- pneumonia developing in patients with no contact to medical facility
HAP-pneumonia developing >48hours of hospital admission
Ventilation associated (VAP)-pneumonia developing >48 hours after intubation and mechanical ventilation

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2
Q

Risk factors for CAP

A

Age >65years
DM
Asplenia
Smoking/alcohol use
Renal, cardiovascular, liver , pulmonary disease

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3
Q

Risk factors for HAP

A

Aspirations
COPD, coma
Antacids, PPI, H2 antagonist
Supine position
>60years
Head trauma
MDR risk ie (MRSA, MDR pseudomonas) if IV use within 90 days

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4
Q

Causative pathogens

A

S. Pneumonia, h. Influenza, legionella species, M. Pneumonia, C. Pneumonia

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5
Q

Pathophysiology

A

Microorganisms gain access to lower respiratory tract by:
Inhalation of aerosols
Lungs via bloodstream from extra pulmonary site
Aspiration (anearobes)
Impaired mucociliary clearance, alveolar macrophage impaired

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6
Q

Pathogens likely for paediatric group

A

Due to virus, adenovirus, parainfluenza,
Bacterial S.pneumonia, S. Aeureus, A streptococcus

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7
Q

Clinical presentation Pneumonia

A

Pleuritic chest pain
Onset of fever,chills, productive cough, dyspnea
Hemoptysis or rust color sputum
Tachycardia
Crackles on lung expansion
Diminished breath sounds

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8
Q

Give diagnostic measures pneumonia

A

Lab tests-cbc for leukocytosis
ABG- low oxygen saturation
Chest radiograph-denser lobar
Cultures and sensitivity
Renal -increased Creatinine, BUN
Blood cultures of concern of sepsis

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9
Q

Non Pharmacological management

A

Humidified oxygen for hypoxemia
Bronchodilators is salbutamol when bronchospasm is present
Adequate hydration
IV fluids
Optimal nutrient support
Fever control ie tepid sponging and use of analgesics

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10
Q

Give empiric therapy for previously healthy no risk factors ie comorbidities

A

Macrolide monotherapy- azithromycin 500mg q24hours 7-10 days
Or tetracycline doxycycline 100mg q12h

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11
Q

Explain rationale for combination therapy for patients with comorbidities

A

Add beta lactam(to prevent superinfection by multiple pathogens in patients with comorbidities ) combination aids to cover resistant strains ie typical and atypical ie mycoplasma , legionella , chlamydia

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12
Q

Give treatment for patients with comorbidities

A

Augmentin - 500mg q8h 7-10 days
Cefuroxime 500mg q8h IV/IM
Ceftazidime 1-2g q8-12h IV

Plus
Azithromycin 500mg day 1 , 250 mg day 2-4 (covers legionella)

Or monotherapy
Levofloxacin 500mg q24h 5-10days (covers legionella)

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13
Q

Discuss CURB 65 score

A

RR >30 breaths /minute
BP systolic <90 mmHg diastolic <60 mmHg
Age >65 years
Uremia sign of AKI
0= low risk manage outpatient
1-2= consider hospitalization
3-4=high risk hospitalization

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14
Q

Treatment for elderly with macrolide resistant S.pneumonia

A

Piperacillin/tazobactam 3.375g q6h
Ceftazidime 1-2g q8h

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15
Q

Treatment of pneumonia
causative organism=MRSA

A

Vancomycin 15-20mg/kg q8-12h
Linezolid children 12 years and older 600mg oral/IV q12h for 10-14 days
Ceftaroline 600mg q12h IV

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16
Q

Antibiotics for klebsiella pneumonia

A

Pipracillin-tazobactam- 3.375g q6h
FQs-levofloxacin 500mg OD 7-14 days
Or IV 250-500mg q24h
Carbapenem -imipem-cilastin 500mg -1g q6-8hour IV 2-14 days
Cephalosporins-ceftriaxone 1-2g q24h for 7-14 days

17
Q

What antibiotics do you use for pseudomonas

A

Pipiracillin-Tazo , levofloxacin, cefepime, ceftazidime, impineme with cilastin, aztreonem

18
Q

Compare regimen for inpatient vs outpatient

A

Outpatient no risk factors -macrolide/doxycycline
Inpatient suspect legionella-macrolide, FQs
Inpatient pseudomonas -levofloxacin,carbapenem,cefepine,Ceftazidime,imipenem with cilastin,pip-tazo,aztreonem
MRSA-linezolid, vancomycin
Klebsiella-FQ,ceph,carbapenems,pip-tazo

19
Q

Compare classes within (amoxicillin with amoxicillin/clavulanic acid

A

Resistance-amoxicillin prone
Utilization- amox/clav good for severe /complicated infections and where resistance likely
Spectrum -amox-broad while amox/clav broad but also cover b-lactamase producing
S/E- git effects increased in amox/clav
Composition -amox just penicillin type , amox-clav is combined with clavulonic acid

20
Q

Compare macrolide and tetracycline

A

Start with examples
MOA- tetracycline-30s ribosome subunit with macrolide 50s subunit
Utilization-tetracycline used as alternative but used where resistance is concern
Spectrum -both broad cover gram positive and negative but macrolide particularly effective against atypical ie Legionella
S/E -macrolide - QT prolongation,hepatotoxicity,c.difficile diarrhea,ototoxoxity
Tetracycline-git effects ie N/V , throat irritation (take lot of water), photosensitivity, children teeth discoloration and impact bone growth

21
Q

Compare within macrolide

A

Clarithromycin and Azithromycin have broader spectrum than erythromycin which is an older generation, and these other 2 are better tolerated and have a better safety profile. Erythromycin admin 2-4t ones ,clarithro x2 , azitho-x1

22
Q

Monitoring parameters

A

Amox-clav: allergic reaction, c.diff infection,git
Erythromycin-QT prolonging caution In pt with heart issues
Blood tests assses CBC due to thrombocytopenia of penicillins and hematologic toxicity of cephalosporins
ABG tests asses for oxygen
Chest X ray-signs of consolidation
Symptoms resolution