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

Upper Respiratory Tract Infection Flashcards

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?

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?

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?

A

Acute: symptoms up to 4 weeks

Chronic: more than 12 weeks

23
Q

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

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?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae

(accounts for more than one half of known cases)

25
Q

Whjat is a more common bacteria that causes ABRS in children?

A
  • M. catarrhalis (20% of cases)
26
Q

What is the typical duration of ABRS?

A

7-10 days after viral infection

27
Q

How is ABRS diagnosed?

A

Acute S/Sx not resolved after 10 days or worsen (7-10 days after viral infection)

28
Q

What are S/Sx of ABRS observed in Adults?

A
  • Nasal congestion
  • Purulant nasal/post-nasal discharge
  • Facial pain/pressure
  • Diminished sense of smell
  • Fever
  • Cough
  • Maxillary tooth pain
  • Fatigue
  • Ear fullness/pain
29
Q

What are S/Sx of ABRS observed in Children?

A
  • 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
Q

What are treatment goals for patients with ABRS?

A

Relieve symptoms (first 7-10 days), eliminate bacteria with approriate ABX

31
Q

T or F: ABX therapies are 1st LINE treatment for ABRS?

A

F; reserve ABX TX for patients with worsening conditions after 10 days

32
Q

If patient diagnosed with ABRS has no penicillin allergies, what ABX treatment should be considered?

A
  • Amoxicillin (1st LINE)
  • Augmentin
33
Q

If patient diagnosed with ABRS has severe allergies, what ABX treatment should be considered? Adult? Children?

A

Adult:

  • Bactrim (1st LINE)
  • Respiratory FQ (if resistance)
  • Doxycycline
  • Macrolide

Children:

  • Macrolides
34
Q

T or F: Patients under 8 can be treated with Doxycycline for ABRS.

A

F; DO NOT GIVE to patients this young and should avoid under 18 Y/O

35
Q

DON’T GIVE BACTRIM!!

A

Kids might be resistant (not an answer on the test)

36
Q

What is Pharyngitis? What is the most common cause?

A

Acute painful inflammation of the throat; S. pyogenes (20-30% children, 15% adults)

37
Q

T or F: May choose to treat pharyngitis for S. pyogenes before the rapid strep test confirms DX.

38
Q

What is the specific treatment for pharyngitis caused by S. pyogenses?

A
  • Penicillin or Amoxicillin (1st LINE TXs)
  • Cephalosporin (more effective in recurance, option in non-type 1 PCN allergies)
  • Macrolides
  • Clindamycin
39
Q

T or F: Patients can return to school/work if improving after 24h therapy.

A

T; symptoms should resolve in 3-5 days.

40
Q

What are S/Sx of Streptococcal pharyngitis?

A
  • 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
Q

What diagnostic test are available for streptococcal pharyngitis?

A
  • Rapid antigen detection test (RADT)
  • Throat swab and culture (GOLD STANDARD)
42
Q

What is the etiology of the common cold?

A
  • 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
Q

What induces cough in patients with a common cold?

A

Tracheobronchial inflammation and irritation

44
Q

What are treatment goals for patients with the common cold?

A

Minimize symptoms and prevent spread (No role for ABX)

45
Q

What are non-pharmacological therapies for treatment of the common cold?

A
  • Cool mist humidification
  • Intranasal saline with/without buld suctioning
  • INC fluids throat lozenges
  • Saline gargles
  • Rest
46
Q

What pharmacological therapies are available for treatment of common cold? Name them.

A
  • Cough and cold preparations (OTC)
  • Analgesics (Acetaminophen, Ibuprofen)
  • Decongestants
    • Intranasal: Oxymetasoline, Phylephrine
    • Systemic: Phenyephrine, Pseudoephedrine
  • Cough Supressants (Dextromethorophen)
  • Expectorants (Guaifenesin)
  • Anticholinergics (Intranasal Ipratropium)
47
Q

T or F: Dextromethorphan, a relative of morphine, lacks opiate properties except in overdose and will control cough

A

T; depresses medullary cough center

48
Q

What ADRs are associated with Guaifenesin? Why?

A

N/V; irritates gastric mucosa and stimulates respriatory secretions –> INC fluid volumes, DEC viscosity

49
Q

What vitamins and herbs are beneficial for adults?

A
  • Vitamin C
  • Echnacea purpurea

Pharm II: Exam 1 (7 decks)

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