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Pharmacology Exam 1 > Respiratory Infections > Flashcards

Respiratory Infections Flashcards

1
Q

Acute bronchitis - clinical presentation

A

Usually preceded by URI
*Productive cough
Rhonchi and moist rales
Cxr normal (pneumo has consolidation)

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2
Q

Bronchitis - organisms

A

Usually Viral - flu, RSV, rhinovirus, coronavirus

Bacterial - mycoplasma pneumo, chlamydia pneumo, pertussis

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3
Q

Chronic bronchitis - clinical presentation

A

“smoker’s cough”

incessant coughing (worse in am) and purulent sputum

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4
Q

Acute bronchitis - treatment

A

Treat symptoms: Rest, fluids, decrease viscosity of secretions, APAP/NSAIDS, Cough - dextromethorphan

If bacterial or viral x 4-6 days, consider abx (macrolides and FQ)

If high suspicion flu - Tamiflu or relenza if flu

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4
Q

Pneumonia - atypical pathogens

A

Chlamydia pneumo, mycoplasma pneumo (12-20%) “walking pneumo”, legionella pneumo (GI symptoms)

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5
Q

Chronic bronchitis - treatment

A

Non pharmacological - smoking cessation, postural drainage, humidification of air to liquefy secretions

Bacterial - amp, doxy, TMP/SMX, fluoro and macrolides (esp. Azithromycin)

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6
Q

Pneumonia - typical pathogens

A 
*Strep pneumo (70%)
Staph aureus (more common post viral)
H. Influenza
Moraxella catarrhalis
Klebsiella pneumo (currant jelly sputum)
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7
Q

Pneumonia - when to consider anaerobes

A

Consider if pt has impaired consciousness or periodontal disease

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8
Q

Pneumonia - common pathogens (COPD/smoking)

A

Strep pneumo
H. Influenza
Moraxella
Legionella

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9
Q

Pneumonia - common pathogens (aspiration)

A

Anaerobes

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10
Q

Pneumonia - common pathogens (poor dental hygiene)

A

Anaerobes

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11
Q

Pneumonia - common pathogens (nosocomial)

A

Staph aureus

Gr - (klebsiella & pseudomonas)

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12
Q

Pneumonia - clinical presentation

A 
Abrupt onset
Fever, chills, dyspnea, productive cough
Sputum - rust colored or hemoptysis
*CXR - dense lobar or segmental infiltrates 
CBC - leukocytosis
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13
Q

Pneumonia - approach to treatment

A
  1. Determine most likely organism
  2. Admit or outpatient (PORT prediction scale or CURB-65/CRB-65)
  3. Comorbidities? HIV, neutropenia
  4. Consider organisms that might be missed
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14
Q

Preventative measures for CAP

A

Immunizations - flu and pneumonia

RSV antibody for high risk infants

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15
Q

Chronic bronchitis - organisms

A 
*viral
H.influenza
Strep pneumo
Moraxella
Klebsiella pneumo
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16
Q

What factors increase risk for aspiration?

A

Altered LOC

Neuromuscular disease

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17
Q

Risk stratification for pneumonia

A

PORT prediction rule
CURB 65
CRB65

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18
Q

Why are patients on PPIs or H2RAs at higher risk for pneumonia?

A

Lower gastric acid means some bugs in the gut are not killed. If aspirates, can get in lungs.

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19
Q

What are the co-morbidities to consider in pneumonia treatment?

A 
Chronic heart/lung/renal disease
DM
Alcoholism
Asplenia
Malignancies
Immunosuppressed
DRSP infection
20
Q

How long to treat pneumonia?

A

Minimum 5 days (afebrile x 48-72 hrs)
Clinically stable - vitals, sats, mental status

Do not discharge within 24 hours if any sign of clinical instability. Must be able to tolerate PO meds.

21
Q

Pneumonia (healthy, no abx past 3 months) - DOC

A

Macrolides (clarithro or azithro) or

Doxycycline (ONLY if walking pneumonia)

22
Q

Pneumonia - w/ co-morbidity or hospitalized (non-ICU)

A 
DOC - Resp FQ (moxi, gemi, high dose levo) or 
Resp BL (piperacillin or ticarcillan) + macrolide (to add coverage for atypicals)
23
Q

What level should you monitor when giving vancomycin?

A

Troughs (want 15-20)

Why? Time dependent killer

24
Q

What are the preferred macrolides for pneumonia?

A

Azithromycin and clarithromycin

25
Q

What are the Beta Lactams used in pneumonia (“resp BL”)?

A

Piperacillin and ticarcillan

26
Q

What are the resp FQ?

A

Moxi, gemi, high dose Levo

27
Q

Pneumonia - who gets treated with only a macrolide?

A

healthy patients with no abx in last 3 months

28
Q

Pneumonia - who gets treated with a respiratory FQ or a beta lactam + macrolide?

A

pt with co-morbitities or hospitalized (non-ICU)

29
Q

Pneumonia with pseudomonas

A

Antipneumococcal, antipseudomonal BL (Piperacillin, Ticarcillin) + FQ (Cipro, Levo)

30
Q

Pneumonia with CA-MRSA

A

usual treatment + Vancomycin or Linezolid

31
Q

What are the antipseudo BL’s?

A

Piperacillin and Ticarcillin

32
Q

How long to treat pedi CAP?

A

if no parapneumonic effusion or empyema - up to 10 days

if parapneumonic effusion/empyema - 2-4 weeks

33
Q

Pediatric CAP <5 yrs old (bacterial) - DOC

A

High dose AMX (90 mg/kg/d)

34
Q

Pediatric CAP > 5 yrs old (bacterial) - DOC

A

High dose AMX +/- Azithro if ? atypicals

35
Q

Treatment for Pediatric Influenza Pneumona (any age, setting)

A

Oseltamivir or zanamivir (over 5 yrs.)

36
Q

Acute Bronchitis - DOC (flu)

37
Q

Acute Bronchitis - DOC (bacterial)

A

Macrolide (Azithro or Clarithro) or

FQ (Cipro or Levo)

38
Q

“walking” pneumonia - DOC

A

Macrolide (Azithro or Clarithro) or doxycycline

39
Q

Chronic bronchitis - diagnosis

A

Productive cough for 3+ months/yr for 2 consecutive years

40
Q

If a patient has poor dental hygiene, what organism should you consider?

41
Q

Which abx are used to treat infections from atypical organisms?

A

Macrolides (#1) or FQs

because they penetrate the cell

42
Q

bronchitis vs pneumonia - CXR

A

clear vs infiltrates

43
Q

Chronic bronchitis vs acute bronchitis - ages

A

adult vs any age

44
Q

Pedi Cap (viral) - DOC

A

Tamiflu or Relenza (>5)

45
Q

Pedi Cap (+atypicals) - DOC

A

Add Macrolide (Azithro)

46
Q

Pedi Cap (narrowed therapy +GABHS) - DOC

A

AMX (because easier dosing than PCN VK)

47
Q

Pedi Cap (narrowed therapy +MRSA) - DOC

A

Vanc (alt. Linezolid)

48
Q

Azithromycin - general treatment length

Pharmacology Exam 1 (19 decks)

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