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Pharm I > Sinusitis and Bronchitis > Flashcards

Sinusitis and Bronchitis Flashcards

1
Q

Clinical presentation of acute bacterial rhinosinusitis

A

Onset with persistent signs or sx, lasting from greater than or equal to 10 days without any evidence of clinical improvement
Onset with severe signs or sx of high fever and purulent nasal drainage or facial pain lasting for at least 3-4 consecutive days at the beginning of the illness
Onset with worsening signs or symptoms characterized by new-onset fever, headache, or increase in nasal discharge

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2
Q

S/Sx (examples) of acute bacterial rhinosinusitis

A

Purulent anterior nasal d/c
Nasal congestion
Facial congestion
HA

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3
Q

Desired outcome for rhinosinusitis

A 
Reduce s/sx
Limit abx tx
Eradicate infection
Minimize duration of illness
Prevent complications
Prevent progression
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4
Q

What is the first line tx for acute bacterial rhinosinusitis?

A

Augmentin

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5
Q

Nonpharmacologic therapy for nonbacterial rhinosinusitis

A

Nasal decongestant sprays
-Phenylephrine and oxymetazoline
Oral decongestants

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6
Q

Nonpharmacologic therapy for acute bacterial rhinosinusitis

A

Decongestants and antihistamines are not recommended
Intranasal saline irrigation
Intranasal corticosteroids

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7
Q

When is high-dose augmentin preferred in acute bacterial rhinosinusitis?

A 
Geographic regions with high rates of invasive pcn-nonsusceptible S. pneumoniae
Severe infection
Attendance at daycare
<2 yrs or <65 yrs
Recent hospitalization
Abx use within the last mo
Immunocompromised persons
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8
Q

Pcn allergy (children) tx for acute bacterial rhinosinusitis

A

Levofloxacin

Clindamycin + cefixime or cefpodoxime

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9
Q

Pcn allergy (adults) tx for acute bacterial rhinosinusitis

A

Doxycycline
Levofloxacin
Moxifloxacin

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10
Q

Adverse effects of Levofloxacin

A

Tendon rupture

Cartilage growth hindrance

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11
Q

Side effects of doxycycline in children

A

Bone growth abnormalities

Tooth discoloration

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12
Q

What are FDA guidelines regarding acute sinusitis, acute bronchitis, and URI tx?

A

No FQs

If you tried everything and it still doesn’t work, go to FQs

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13
Q

Duration of therapy for acute bacterial rhinosinusitis

A

10-14 days courses (uncomplicated rhinosinusitis, children)
5-7 days (adults)
Reevaluate and initiate alternative antibiotics if symptoms persist or worsen after 48 to 72 hours of appropriate antibiotic therapy

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14
Q

What is the hallmark symptom of acute bronchitis?

A

Cough

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15
Q

Goals of acute bronchitis therapy

A

Provide comfort

Treat dehydration and respiratory compromise

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16
Q

Approach to acute bronchitis tx

A

Symptomatic and supportive

17
Q

Pharmacologic therapy for acute bronchitis

A 
Mild analgesic-antipyretic therapy
-ASA
-Acetaminophen
--No longer preferred by pediatricians
-Ibuprofen
--Use as antipyretic has increased
No sufficient evidence for beta 2 agonist or corticosteroid
Dextromethorphan may assist with persistent cough
Routine use of abx is discouraged
18
Q

When should you use ibuprofen with caution?

A

Children < 6 mos
Elderly
Poor renal fxn

19
Q

Chronic bronchitis

A

Most often a component of COPD

Presence of a chronic cough productive of sputum lasting > 3 consecutive months/year for 2 consecutive years

20
Q

Contributing factors to chronic bronchitis

A

Cigarette smoking
Occupational exposure
Environmental pollution
Host factors

21
Q

S/sx of chronic bronchitis

A

Excessive sputum expectoration
Cough
Cyanosis

22
Q

Physical exam of chronic bronchitis

A

Chest auscultation
Hyperresonance on percussion
Nl vesicular breathing sounds ar diminished

23
Q

Chest radiograph of chronic bronchitis

A

Barrel chest

Depressed diaphragm with limited mobility

24
Q

Lab tests for chronic bronchitis

A

Erythrocytosis (increased hematocrit)

25
Q

Pulmonary function tests for chronic bronchitis

A

Decreased vital capacity

Prolonged expiratory flow

26
Q

Gold 1 criteria for COPD

A

Mild

FEV greater than or equal to 80% predicted

27
Q

Gold 2 criteria for COPD

A

Moderate

FEV1 50-80% predicted

28
Q

Gold 3 criteria for COPD

A

Severe

FEV1 30-50 predicted

29
Q

Gold 4 criteria for COPD

A

Very severe

FEV1 <30% predicted

30
Q

Common bacterial pathogens in chronic bronchitis

A 
H. influenzae
M. catarrhalis
S. pneumoniae
E. coli
Enterobacter
Klebsiella
P. aeruginosa
31
Q

Goals of tx therapy for chronic bronchitis

A

Reduce severity of chronic sx and ameliorate acute exacerbations
Achieve prolonged exacerbation-free intervals

32
Q

General approach to chronic bronchitis tx

A

Reduce exposures
Pulmonary rehabilitation
Postural drainage techniques

33
Q

Pharmacologic therapy for chronic bronchitis

A 
Vaccinations
Inhalers
-SABA
-LABA
-LAMA
-ICS
-Phosphodiesterase inhibitors
Antimicrobials
-Based on hx and response
34
Q

Anthonisen criteria (chronic bronchitis)

A

Increase in shortness of breath
Increase in sputum volume
Production of purulent sputum

35
Q

Factors in selecting abx for chronic bronchitis

A

Infection-free period
Effective against responsible pathogen
Least risk of drug interactions
Promotes compliance

36
Q

Long-term usage of abx in chronic bronchitis

A

Macrolides have been associated with a significant reduction in acute exacerbations

Pharm I (10 decks)

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