Resp 1 Flashcards
pharyngitis
usually caused by group a strep (strep pyogenes)
GAS may cause poststrep glomerulonephritis or acute rheumatic fever (now rare in US)
GAS pharyngitis presentation
throat pain, usually severe and worse on 1 side
avoid what as first line in GAS pharyngitis tx
Azithromycin
strep rapidly develops resistance to macrolides
consider if PCN allergic
Fusobacterium necrophorum pharyngitis
newly recognized cause of pharyngitis endemic in adolescents and young adults may cause 10% of cases in this age group may develop lemierre syndrome (life-threatening, mortality rate 5%) consider txing if lack of cough
F necrophorum pharyngitis tx
clindamycin or PCN + metronidazole
cough
do not suppress indiscriminately
don’t suppress productive cough
typically suppress if tiring or sleep-limiting
nonproductive cough tx
antitussives or cough suppressants
productive cough tx
expectorants or mucolytics
dextromethorphan
d-isomer of codeine analog of loverphanol inhibits central (medullary) cough center
Guaifenesin
helps loosen phlegm and bronchial sec’s
inc efficacy of mucociliary mech
pertusis
chronic cough caused by bordatella pertussis
china: “cough of 100 days”
atypical presentations are v common
(completely or partially immunized pt’s, adolescents or adults)
complications confined to infants < 6 mo’s
pertussis cough
paroxysmal
post-tussive emesis occurs frequently
pertussis incidence
rising
waning immunity (maybe as short as 3-6 yrs)
morse with newer acellular vaccines
many severe complications with whole cell vaccines
consider in all kids with cough > 14 days
topical decongestants
sympathomimetics (a agonists) produce vasoconst prolonged use (>3-5 days) may produce rebound congestion limit dose and freq
other long acting topical decongestant
xylometazoline HCl
systemic decongestants
much lower incidence of rebound congestion
results typically last longer than topical
due to restrictions on pseudophedrine - sales restriction by law
systemic decongestant SE
potent selective a1-agonists (vasoconstrictors)
activate B-rec at higher []s
antihistmaines
relieve immediate-type hypersensitivity rxns
red/prevent physiologic effects of histamine release
no effect on pre-released histmaine
first gen prod sedation
second gen are peripherally selective (much less sedating)
sedation with antihistmaines
caution against driving or tasks requiring alertness
supervise kids in hazardous activities
influenza
prevention is key
promote and practice annual immunization
Community Acquired Pneumonia
generally not multi-drug resistant
common org’s: strep pneumonia and H flu
used pneumonia severity index for risk
gram + cocci in clusters
staph aureus
consider adding vanco
gram negative bacilli
any risk of MDR gram - org?
consider adding an anti-pseudonomal (cefepime, imipenem)
few epi cells
good specimen, many epi’s prob a mouth specimen
