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PHRM 865 > Respiratory Tract Infections I (Kays) > Flashcards

Respiratory Tract Infections I (Kays) Flashcards

1
Q

What are the most common bacterial pathogens seen in CAP?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Mycoplasma pneumoniae
  • Legionella pneumophila
  • Chlamydophila pneumoniae
  • Staphylococcus aureus
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2
Q

In what groups is Streptococcus pneumoniae-related CAP more prevalent/severe?

A
  • splenic dysfunction (removed or sickle cell)
  • diabetes
  • immunocompromised
  • chronic cardiopulmonary disease
  • chronic renal disease
  • HIV
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3
Q

What are the risk factors for drug-resistant S. pneumoniae (DRSP)?

A
  • extremes of age (<6 YO, >65 YO)
  • prior antibiotic therapy
  • underlying illnesses/comorbdities
  • daycare attendance or family of a child in daycare
  • recent/current hospitalization
  • immunocompromised, HIV, nursing home, prison
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4
Q

How is Mycoplasma pneumoniae CAP spread?

A

close person-to-person contact (especially enclosed populations like the military and dorms)

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5
Q

Mycoplasma pneumoniae CAP symptoms are usually _________ and ______________.

A

benign; self-limiting

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6
Q

How is Legionella pneumophila CAP spread?

A

inhalation of aerosols containing Legionella

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7
Q

What is, arguably, the most unique symptom associated with Legionella pneumophila CAP?

A

presence of high fevers (>104°F)

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8
Q

What CAP pathogen is most likely to appear in patients post-influenza?

A

Staphylococcus aureus

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9
Q

What are some symptoms associated with Staphylococcus aureus CAP?

A
  • sudden onset of shaking chills
  • pleuritic chest pain
  • productive cough
  • increased WBC with left shift
  • consolidation
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10
Q

What are some factors that may lead us to suspect a CAP patient has CA-MRSA?

A
  • concurrent/recent influenza infection with CA-MRSA (patient or close contact)
  • necrotizing pneumonia or cavitary infiltrates
  • ICU admission
  • rapid progression of symptoms
  • respiratory failure
  • empyema formation
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11
Q

What signs/symptoms are considered to be classic CAP presentation?

A
  • sudden onset of fever and chills
  • pleuritic chest pain
  • dyspnea
  • productive cough
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12
Q

Are CAP patients typically brachycardic or tachycardic?

A

tachycardic

relative bradycardia may indicate that the infection is viral or atypical

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13
Q

What are some indicators that a CAP patient is experiencing serious respiratory compromise?

A
  • tachypnea
  • cyanosis
  • use of accessory muscles for respiration
  • sternal retraction
  • nasal flaring
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14
Q

Evidence of consolidation in CAP is suggestive of ___________ infection.

A

bacterial

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15
Q

What events may be considered evidence of consolidation in CAP?

A
  • dullness to percussion
  • increased breath sounds
  • inspiratory crackles
  • increased tactile fremitus
  • whisper pectiloquy
  • egophany
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16
Q

What pathogen may be involved if a patient has rust-colored sputum?

A

S. pneumoniae

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17
Q

What pathogen may be involved if a patient has dark red, mucoid sputum?

A

K. pneumoniae

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18
Q

What pathogen may be involved if a patient has foul-smelling sputum?

A

mixed anaerobes

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19
Q

What pathogen is implicated if a patient’s Gram stain shows Gram (+), lancet-shaped diplococci?

A

S. pneumoniae

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20
Q

What pathogen is implicated if a patient’s Gram stain reveals small, Gram (-) coccobacilli?

A

H. influenzae

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21
Q

What are the components of CURB-65?

A
  • confusion
  • uremia
  • respiratory rate
  • (low) blood pressure
  • age >65
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22
Q

What CURB-65 range indicates that a patient needs outpatient treatment?

A

0-1

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23
Q

What CURB-65 score indicates that a patient may need admitted to a general ward?

A

2

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24
Q

What CURB-65 range indicates that a patient may require ICU care?

A

≥3

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25
What CAP empiric therapy would you recommend for a healthy outpatient with no prior antibiotic use in the last 90 days?
amoxicillin OR doxycycline *can only use macrolides in areas with pneumococcal resistance \<25% (which basically means you can't use them at all)*
26
What CAP empiric therapy would you recommend for an outpatient with comorbidities/has used antibiotics in the last 90 days?
respiratory FQ OR Augmentin/cefpodoxime/cefuroxime + macrolide OR Augmentin/cefpodoxime/cefuroxime + doxycycline
27
What empiric therapy would you recommend for an inpatient with non-severe CAP and no risk factors for MRSA or *P. aeruginosa*?
Unasyn/cefotaxime/ceftriaxone/ceftaroline + macrolide OR respiratory FQ OR Unasyn/cefotaxime/ceftriaxone/ceftaroline + doxycline *(if contraindication for other regimens)*
28
What empiric therapy would you recommend for an inpatient with severe CAP, but without risk factors for MRSA and *P. aeruginosa*?
Unasyn/cefotaxime/ceftriaxone/ceftaroline + macrolide OR Unasyn/cefotaxime/ceftriaxone/ceftaroline + respiratory FQ
29
If an inpatient has CAP (severe or non-severe) and prior respiratory isolation of MRSA, what drug(s) should you add to their regimen?
vancomycin OR linezolid
30
If an inpatient has CAP (severe or non-severe) and prior respiratory isolation of *P. aeruginosa*, what drug(s) should be added to their regimen?
Zosyn OR cefepime OR ceftazidime OR aztreonam OR carbapenem (mero- or imipenem)
31
What drug should be added for adults with CAP who also test positive for influenza?
oseltamivir
32
What is the appropriate duration of antibiotic therapy for patients with CAP who are improving?
should be continued until the patient is clinically stable, and for **no less than 5 days**
33
Along with being afebrile for 48-72 hours, CAP patients should also demonstrate no more than 1 CAP-associated sign of clinical instability in order to discontinue antibiotic treatment after 5 days. What are these CAP-associated signs?
* temperature ≤100.04 * HR ≤100 bpm * RR ≤24 breaths/min * SBP ≥90 mmHg * arterial O2 saturation ≥90% or pO2 ≥60 mmHg on room air * ability to take PO medications * normal mentation
34
What therapy options are _preferred_ for CAP with penicillin-susceptible (MIC \<2) *Streptococcus pneumoniae*?
penicillin G OR amoxicillin
35
What therapy options are _alternatives_ for CAP with penicillin-susceptible (MIC \<2) *Streptococcus pneumoniae*?
macrolides OR cephalosporins OR respiratory FQs OR doxycycline
36
What therapy options are _preferred_ for CAP with penicillin-resistant (MIC ≥2) *Streptococcus pneumoniae*?
respiratory FQs OR ceftriaxone OR cefotaxime
37
What therapy options are _alternatives_ for CAP with penicillin-resistant (MIC ≥2) *Streptococcus pneumoniae*?
vancomycin OR linezolid OR high-dose amoxicillin (3 g/day)
38
What therapy option is _preferred_ for CAP with non-β-lactamase-producing *Haemophilus influenzae*?
amoxicillin
39
What therapy options are _alternatives_ for CAP with non-β-lactamase-producing *Haemophilus influenzae*?
respiratory FQs OR doxycycline OR macrolides
40
What therapy options are _preferred_ for CAP with β-lactamase-producing *Haemophilus influenzae*?
2nd/3rd generation cephalosporins OR Augmentin
41
What therapy options are _alternatives_ for CAP with β-lactamase-producing *Haemophilus influenzae*?
respiratory FQs OR doxycycline OR macrolides
42
What therapy options are _preferred_ for CAP with *Mycoplasma* and/or *Chlamydophila pneumoniae*?
macrolides OR doxycycline
43
What therapy option is an _alternative_ for CAP with *Mycoplasma* and/or *Chlamydophila pneumoniae*?
respiratory FQs
44
What therapy options are _preferred_ for CAP with *Legionella pneumophila*?
respiratory FQs OR azithromycin
45
What therapy option is an _alternative_ for CAP with *Legionella pneumophila*?
doxycycline
46
What therapy options are _preferred_ for CAP patients with MSSA?
nafcillin OR oxacillin
47
What therapy options are _alternatives_ for CAP patients with MSSA?
cefazolin OR clindamycin
48
What therapy options are _preferred_ for CAP with MRSA?
vancomycin OR linezolid
49
What therapy option is an _alternative_ for CAP with MRSA?
Bactrim
50
What therapy options are _preferred_ for CAP with anaerobes (aspiration)?
β-lactam/β-lactamase inhibitor combo OR clindamycin
51
What therapy option is an _alternative_ for CAP with anaerobes (aspiration)?
carbapenems
52
What therapy options are _preferred_ for CAP with Enterobacteriaceae?
3rd/4th generation cephalosporins OR carbapenems
53
What therapy options are _alternatives_ for CAP with Enterobacteriaceae?
β-lactam/β-lactamase inhibitor combo OR respiratory FQs
54
What is omadacycline's mechanism of action?
binds to 30S ribosomal subunit to block protein synthesis (bacteriostatic)
55
What pathogens is omadacycline FDA-approved for?
* MSSA * *S. pneumoniae* * *H. influenzae* * *L. pneumophila* * *M. pneumoniae* * *C. pneumoniae*
56
True or false: omadacycline has coverage against *Pseudomonas*.
false
57
What administration consideration is of note for omadacycline?
must give fasting (PO bioavailability is decreased with food)
58
Does omadacycline need to be renally dose-adjusted?
no
59
What is a major drug interaction for omadacycline?
di- and trivalent cations
60
What is the recommended duration of treatment with omadacycline?
7-14 days
61
What organisms does delafloxacin have in vitro activity against?
* MRSA * *S. pneumoniae* and other streptococci * *H. influenzae* * *M. catarrhalis* * atypicals * *E. coli* * *K. pneumoniae*
62
Does delafloxacin have coverage against *Pseudomonas*?
no
63
What is lefamulin's mechanism of action?
inhibits bacterial protein synthesis by **binding to the peptidyl transferase** center of the bacterial ribosome
64
What pathogens does lefamulin cover?
* *S. pneumoniae* * MSSA * *H. influenzae* * *L. pneumophila* * *M. pneumoniae* * *C. pneumoniae*
65
Does lefamulin cover *Pseudomonas*?
no
66
What major drug interaction should we be concerned about with lefamulin?
CYP3A4
67
Does lefamulin need to be renally dose-adjusted?
no
68
What advice would you give to a breastfeeding mother taking lefamulin?
pump and discard for the duration of treatment and for 2 days after the last dose

PHRM 865 (59 decks)

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