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Pharm II: Exam 1 > Upper Respiratory Tract Infection > Flashcards

Upper Respiratory Tract Infection Flashcards

(49 cards)

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1
Q

What are possible upper respiratory tract infection (URI) that have been discussed?

A
  • Otitis Media
  • Sinusitis
  • Pharyngitis
  • Laryngitis
  • Common cold
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2
Q

What is Otitis Media?

A

Inflammation of the middle ear

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3
Q

What is considerd acute otitis media (AOM)?

A

Rapid symptomatic infection with fluid in the middle ear

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4
Q

What is considered otitis media with effusion (OME)?

A

No signs of acute illness but fluid in middle ear

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5
Q

Why is daycare considered a risk factor for AOM?

A

More likely to be exposed to resistant bacteria (also seen with recent antibiotic use)

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6
Q

What are common bacteria that may cause AOM?

A
  • Streptococcus pneumonia
  • Hemaophilis influenza
  • Moraxella catarrhalis
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7
Q

What is the pathophysiology associated with AOM?

A

Nasopharyngeal viral infections impair eustachian tube function causing the mucosa mucociliary clearance promoting bacterial infection (children less able to drain tube compared to adults) with possible effusion from allergens/toxic exposure

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8
Q

What are the requirements for a diagnosis of AOM?

A
  • Rapid onset of S/Sx
  • Middle ear effusion finding with pneumatic otoscopy
  • Inflammation indicated by either otoscopic evidence or otalgia
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9
Q

How is a severe AOM different from a non-severe AOM?

A
  • Pain (mild vs moderate/severe)
  • Fever (above vs below 39ºC, past 24h)
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10
Q

What treatment goal for patients with AOM?

A

Focus on symptom relief (i.e. pain, relief) and prevention of complications; Ususally resolves spontaneously with no treat

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11
Q

What are non-pharmacological therapies are available for treatment of AOM?

A
  • External heat/cold (pain relief)
  • Tympanostomy tubes (chronic OME)
  • Adeniodectomy (Chronic nasal obstruction)
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12
Q

What is common ABX resistance observed in patients with AOM? (think common bacteria)

A

Penicillin-resistant Sreptococcus pneumoniae (PRSP)

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13
Q

When should ABX be used for AOM? (Think age dependent)

A
  • < 6 months: Use ABX
  • 6 M/O – 2 Y/O w/ certain DX: use ABX
  • > 2 Y/O w/ certain DX and severe infection: use ABX Otherwise observe and treat if needed
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14
Q

T or F: When patients with AOM should consider penicillin allergies?

A

T

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15
Q

If patient has no allergy and no severe illness, what ABX should be considered for treatment?

A
  • Aminopenicillins
    • Amoxicillin (high dose)
  • 3rd Generation Cephalosporins
    • Cefuroxime
    • Cefpodoxime
    • Cefdinir
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16
Q

If a patient has no allergies but severe illness, what ABX should be considered for treatment?

A
  • Augmentin (Amoxicillin + Cavulanic Acid)
  • Ceftriaxone (IV/IM)
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17
Q

If patient has a Type 1 allergy to penicillin, what ABX should be considered for treatment?

A
  • Macrolides (Erythromycin)
  • Clindamycin
  • Trimethoprim/sulfamethoxazole
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18
Q

If a patient has a non-type-1 allergy, what ABX should be considered for treatment?

A

Non-severe:

  • Cefuroxime
  • Cefpodoxime
  • Cefdinir

Severe:

  • Ceftriaxone (IM/IV)
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19
Q

What analgesics are available for patients with AOM?

A

If fever:

  • Acetaminophen
  • Ibuprofen

If no fever:

  • Benzocaine (topical; Auralgan drops)
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20
Q

What is the prognosis for patients being treated for AOM?

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A

Should expect response from treatment within 72 hours with therapy

If symptoms persist/worsen reevaluate for proper diagnosis and treatment (prescence of fluid does not indicate treatment failure

21
Q

What is sinusitis? Rhinosinusitis?

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A

Inflammation of the paranasal sinuses

Involves contagious nasal mucosa (occurs in all viral respiratory infections)

22
Q

What is the difference between acute and chronic rhinosinusitis?

Study These Flashcards
A

Acute: symptoms up to 4 weeks

Chronic: more than 12 weeks

23
Q

What is the pathophysiology of acute bacterial rhinosinusitis (ABRS)?

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A

Mucosa in inflammation and local damage to mucociliary clearance (INC ‘d mucus production leads to blockage sinus ostia)

24
Q

What are the common bacterial causes of ABRS?

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A
  • Streptococcus pneumoniae
  • Haemophilus influenzae

(accounts for more than one half of known cases)

25
Whjat is a **more common bacteria** that causes **ABRS** in **children**?
* **M. catarrhalis** (20% of cases)
26
What is the **typical duration** of **ABRS**?
**7-10 days after viral infection**
27
How is **ABRS** diagnosed?
**Acute S/Sx not resolved after 10 days or worsen** (7-10 days after viral infection)
28
What are **S/Sx** of **ABRS** observed in **Adults**?
* Nasal congestion * Purulant nasal/post-nasal discharge * Facial pain/pressure * Diminished sense of smell * Fever * Cough * Maxillary tooth pain * Fatigue * Ear fullness/pain
29
What are **S/Sx** of **ABRS** observed in **Children**?
* Purulant nasal/post-nasal discharge * Nasal congestion * Mouth breathing * Persistant cough (worse at night) * Fever * Pharyngitis * Ear discomfort * Halitosis * Morning periorbital edema * Fatigue * Facial/Tooth Pain
30
What are **treatment goals** for patients with **ABRS**?
**Relieve symptoms** (first 7-10 days), **eliminate bacteria with approriate ABX**
31
**T or F**: ABX therapies are 1st LINE treatment for ABRS?
**F**; reserve ABX TX for patients with worsening conditions after 10 days
32
If patient diagnosed with **ABRS** has **no penicillin allergies**, what **ABX treatment** should be considered?
* **Amoxicillin** (1st LINE) * **Augmentin**
33
If patient diagnosed with **ABRS has severe allergies**, what **ABX treatment** should be considered? **Adult**? **Children**?
**Adult**: * Bactrim (1st LINE) * Respiratory FQ (if resistance) * Doxycycline * Macrolide **Children**: * Macrolides
34
**T or F**: Patients under 8 can be treated with Doxycycline for ABRS.
**F**; DO NOT GIVE to patients this young and should avoid under 18 Y/O
35
**DON'T GIVE BACTRIM**!!
**Kids might be resistant** (not an answer on the test)
36
What is **Pharyngitis**? What is the **most common cause**?
**Acute painful inflammation** of the **throat**; **S. pyogenes** (20-30% children, 15% adults)
37
**T or F**: May choose to treat pharyngitis for S. pyogenes before the rapid strep test confirms DX.
T
38
What is the specific **treatment** for **pharyngitis** caused by **S. pyogenses**?
* **Penicillin** or **Amoxicillin** (1st LINE TXs) * **Cephalosporin** (more effective in recurance, option in non-type 1 PCN allergies) * **Macrolides** * **Clindamycin**
39
**T or F**: Patients can return to school/work if improving after 24h therapy.
**T**; symptoms should resolve in 3-5 days.
40
What are **S/Sx** of **Streptococcal pharyngitis**?
* Sudden onset sore throat with severe painful swelling * Fever * HA * Abdominal pain * N/V * Eyrthema with possible patchy exudates (pharyngeal, tonsillar) * Swollen red uvala * Halitosis * Soft palate petachiae * Sarlitinoform rash
41
What **diagnostic test** are available for **streptococcal pharyngitis**?
* **Rapid antigen detection test** (RADT) * **Throat swab and culture** (GOLD STANDARD)
42
What is the **etiology** of the **common cold**?
* Rates INC in **fall and winter months** * **Last 10-14 days** * Can be **complicated by bacterial infections** * **Children** most likely to transfer cold to adults
43
What induces cough in patients with a **common cold**?
**Tracheobronchial inflammation** and **irritation**
44
What are **treatment goals** for patients with the **common cold**?
**Minimize symptoms and prevent spread** (No role for ABX)
45
What are **non-pharmacological therapies** for treatment of the **common cold**?
* Cool mist humidification * Intranasal saline with/without buld suctioning * INC fluids throat lozenges * Saline gargles * Rest
46
What **pharmacological therapies** are available for treatment of common cold? Name them.
* **Cough and cold preparations** (OTC) * **Analgesics** (Acetaminophen, Ibuprofen) * **Decongestants** * **Intranasal**: Oxymetasoline, Phylephrine * **Systemic**: Phenyephrine, Pseudoephedrine * **Cough** **Supressants** (Dextromethorophen) * **Expectorants** (Guaifenesin) * **Anticholinergics** (Intranasal Ipratropium)
47
**T or F**: Dextromethorphan, a relative of morphine, lacks opiate properties except in overdose and will control cough
**T**; depresses medullary cough center
48
What **ADRs** are associated with **Guaifenesin**? Why?
**N/V**; irritates gastric mucosa and stimulates respriatory secretions --\> INC fluid volumes, DEC viscosity
49
What **vitamins and herbs** are beneficial for adults?
* Vitamin C * Echnacea purpurea

Pharm II: Exam 1 (7 decks)

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