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Pharm Exam 4, URI, LRI, URI, PNE, abx, STD, Seizure, HA, Osteo > URI > Flashcards

URI Flashcards

1
Q

Acute Otitis Media is defined as

A

rapid developing, symptomatic middle ear infection with effusion or presence of fluid

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2
Q

Common bacterial causative agent for AOM

A

S. Pneumonae, H. influenzae, M catarrhalis

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3
Q

First line therapy for AOM

A

Amoxicillin x 10d

2m-5y 80-90mg/kg/d divided q12hr

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4
Q

Otitis Media with effision is defined as

A

presence of middle ear fluid without symptoms of acute illness

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5
Q

Common viral causative agents

A

RSV, influenza, parainfluenza, enterovirus, rhinovirus, adenovirus

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6
Q

Risk factors for OM

A 
Native American or Inuit
GERD
socioeconomic status
male
recent viral infection
age of <1yo
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7
Q

AOM clinical presentation young children

A

ear tugging, irritable, poor sleeping, poor eating habits

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8
Q

AOM clinical presentation for older children

A

ear pain, ear fullness, hearing impairment

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9
Q

Signs of AOM

A

some pt have fever, middle ear effusion, otorrhea, bulging TM, limited or absent mobility of TM, redness of TM, cloudy TM

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10
Q

AOM dx

A 
-moderate to severe bulging of TM
or
-new onset of otorrhea not due to OE
or
-mild bulging of the TM AND recent onset of ear pain or redness of TM (<48hr)
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11
Q

AOM antibiotic therapy- who gets treated?

A

ALL children <6m with suspected AOM
Pt with severe SS no matter the age
102.2 >fever, persistent ear pain or inability to follow up
children <2y with bilateral AOM
For all others, close observation and follow up in 2-3 days- abx if SS have not improved at that time

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12
Q

First line therapy if previous AOM <30d

A

Augmentin 80-90mg/kg/d divided q12hr x10d

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13
Q

First line therapy if allergic to PNC

A

Cephalosporin - cefuroxime, cefdinir, cefpodoxime PO

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14
Q

Type 1 PCN allergy is…

A

hives, anaphylaxis

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15
Q

non-type 1 pnc allergy is…

A

rash

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16
Q

Preferred oral cephalosporin?

A

Cefdinir

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17
Q

Observational treatment with AOM is indicated when…

A

pt is 6m-2y with mild SS or uncertain dx
pt >2yo with uncertain dx

If SS get worse or don’t go away in 48-72, concider abx therapy

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18
Q

What supplements can not be taken with cephalosporins

A

Iron, antacids. Separate by 2 hours

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19
Q

Adjunctive therapy with AOM…

A

Do not use ibuprofen in children under 6mos
Do not alternate Tylenol and ibuprofen
Decongestants, steroids, and antihistamines have no role in AOM treatment, can prolong effusion or duration

20
Q

What vaccines can help prevent OM?

A

Flu vaccine for 2yo >

21
Q

Explain the anatomy of the ear in an adult vs child

A

.

22
Q

Sinusitis, define…

A

an inflammation or infection of the paranasal sinus mucosa. 


23
Q

Chronic sinusitis

A

Chronic rhinosinusitis typically persists as a cough, rhinorrhea, or nasal obstruction for greater than 90 days.

24
Q

Acute Bacterial Sinusitis (ABRS)

A

Acute bacterial rhinosinusitis is an infection of the sinuses that can occur independently or be superimposed on chronic sinusitis.

25
Q

Acute sinusitis

A

Acute rhinosinusitis is characterized by symptoms that resolve completely in under four weeks.

26
Q

Bacterial vs Viral Sinusitis…

A

Viral resolves in 7-10d
Bacterial SS more sever than viral. SS without resolution that last 8-10d> after a cold. Fever, malaise. Facial pain, pressure. Symptoms can get better then more severe

27
Q

Risk for ABRS

A 
smoke inhalation 
septal defects
dental surgery
winter season
recent viral infection
cystic fibrosis
swimming 
allergies
nasal drug use
mechanical ventilation in a hospital setting
28
Q

Pathogens of ABRS

A

Streptococcus pneumoniae and H influenza are the tow main pathogens - about 70%
M. Catarrhalis contribute to approximate 20% of the cases seen in children.


29
Q

ABRS presentation, adults

A

.

30
Q

ABRS non Rx therapy

A

Saline nasal spray, nasal irrigation (isotonic or hypertonic), humidifiers

31
Q

Oral decongestants, who should avoid use?

A

avoid in children <4yo, pt with uncontrolled HTN, IHD

32
Q

Intra nasal decongestants

A

used in ages 6 and older limit to 3 days to avoid rebound congestion

33
Q

Treatment algorithm for ABRS

A

amoxicillin
if recent amor use in past 30 days then Augmentin
if PCN allergy > cephalosporins
cefuroxime, cefdnir, cefpodoxime

34
Q

non type 1 PCN allergy in ABRS, treatment is…

A

uncomplicated :1st cephalosporin 2nd cephalosporins

3rd clines or FQ

35
Q

type 1 PCN allergy and treatment failure

A

uncomplicated macrolide, bactrum, doxy, FQ
clindamycin or FQ
cephalosporin has a cross reactivity with PCN allergies

36
Q

For patients with a type I penicillin allergy and uncomplicated ABRS, treatment is

A

clarithromycin, azithromycin, Bactrim, doxycycline, or a respiratory fluoroquinolone can be used

37
Q

For patients with treatment failure or recent antibiotic use

A

a respiratory fluoroquinolone is recommended and for resistance, clindamycin.

38
Q

what cephalosporins are indicated for PCN allergy

A

cefpodoxime cefuroxime cefdnir

39
Q

When to use antihistamines in sinusitis

A

avoid- they thicken mucus and impartial clearance

however consider their use in pt with chronic sinusitis and predisposed allergies

40
Q

Intranasal steroids

A

alleries or chronic sinusitis - may be beneficial mono or with abx for ABRS

41
Q

what is pharyngitis

A

acute throat infection, viral or bacterial usually self limiting- untreated bacterial can cause streptococcal illness
usually in winter time and early spring

42
Q

what causes pharyngitis

A

normal viral pathogens for respiratory infx and Epstein bar

bacterial is caused by group A BH strep, Strep PY - direct contact with infected secretions

43
Q

how do you dx pharyngitis

A

will present with swollen lymph nodes, painful to swallow, petechiae on soft palate HA, and pain, nc in Childs especially
red throat with possible exudate, scarlet rash

rapid antigen test-80-90 percent accurate, results in minutes
Gold standard is throat culture- 24-48hr results
ALL neg rapids in children, adolescents, and adults with heavy contact with peds

44
Q

complications of pharyngitis

A

abx therapy only prevents accesses, lymphadenitis, and rheumatic fever

It does not impact
acute gloulernephritis
reactive arthritis
PANDAS- OCD, tics post strep infx

45
Q

how to treat pharyngitis x 10 days

A 
infectious period goes from 10d-24h
Pen V 100mg 500 mg/d max, split TID or QID
peds
250 bid-tid,
 500 bid for > 12yo
AMOX
same as Pen V but TID
peds
4-50 mg/kg/d - BID-TID
PCN allergy- macrolide or cephalexin (1st gen )
46
Q

CENTOR criteria for STREP

A 
each gets 1 pt 
fever >101
no cough
swollen nodes
swelling, exudate
age 3-14
subtract a point for age >45
SCORE: perent chance of
0: 1-2.5
1: 5-10
2: 11-17
3:28-35
>4: 51-53
47
Q

Recurrent Pharyngitis

A

clinda
augmenting
pen B
Pen B with rifampin

Pharm Exam 4, URI, LRI, URI, PNE, abx, STD, Seizure, HA, Osteo (23 decks)

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