Acute Respiratory Flashcards
(25 cards)
-Antihistamines also known as_______
(First generation) examples:
_______ effects
Cause ________
Active for___-____ hrs
(second generation)
selective for _______ receptors
Dont cross _____
Active for ______
Used for______
-h1 antagonist
(diphenhydramine/benadryl)
-anticholinergic
-sedation
4-6
(claritin/loratidine)
peripheral
bbb
12
sneezing, rhinorrhea, watery eyes, itching
Steroid nasal spray Used specifically for\_\_\_\_\_\_ does not treat \_\_\_\_\_\_ Drugs delivered \_\_\_\_\_ Potential symptoms (3)
Treat _____ not ______
Example
- allergic rhinitis not common cold
- locally
- nasal irritation, dryness, epistaxis
sight of action not systemic
fluticasone/flonas
Viral Upper Respiratory Infections aka ______
Refers to what type of infection?
Most common virus?
Lasts how long?
What are symptoms predictive of viral origin?
Symptoms
common cold
nonbacterial, so viral
rhinovirus
7-9 days
significant runny nose cough on days 1-4
nasal congestion, rhinorrhea, malaise, scratchy sore throat, nasal d/c starts thin thickens to green/yellow, muscle aches, adults NO fever, children LOW-GRADE
COUGH AND COLD Decongesgants
_____ _____ receptor _____ aka __________
cause _________ to reduce mucase membrane swelling
Examples: (2) which one is safer and why?
Come in two forms
What is rebound?
Alpha adrenergic receptor antagonists (sympathomomimetics)
vasoconstriction
Phenylephrine, pseuophedrine (bc of cardiac effects)
More congestion than what you started with, do not use longer than 3-5 days
Alpha adrenergic receptor antagonists AKA
-
-
Sympathomimetics
Pseudoephedrine
Phenylephrine
Phenylephrine (neosyneprhine)
Oxymetazoline (afrin)
Oral decongestants (aara cont)
Action:
ADRs:
Vasoconstriction of capillary vessels, decrease congestion
- tachycardia
- hypertension
- anxiety/restlessness/irritability
URI TX
Encourage:
Decongestants used in which population?
Antibiotics?
Systemic decongestants in children?
fluids, antipyretics
older children and adults, no young children/infants
No difference in clinical outcomes
No evidence, may be hazardous
Cough and cold cont
-
-
May be given together
- dextromethorphan
- codeine
- benzonatate (analgesic)
-guafenesin
Cough Suppressants (antitussive)
Dextromethorphan- how does it work? analog of? caution with which class of medication and why?
Codeine-how does it work?What does it have little efficacy with and why?
Potential for abuse?
cough center suppressant
morphine molecule
antidepressants- serotonergic syndrome
centrally acting cough suppressant
URI- bc cough is due to irritation
Large quantities hallucinations- no euphoria
Expectorant
Guiagenesin (Robitussin)
Action:
-stimulates? - decreases?
No evidence for efficacy in?
Patients need to be?
stimulates respiratory tract secretions
decreases viscosity of secretions
chronic cough, cough d/t URI
hydrated
Decongestants
caution with?
children <4 or eldlery or CV disease
Acute bacterial rhinosinusitis
common pathogens
s. pneumoniae
h. flu
moraxella catarrhalis
staphylococcus (rare)
Sinusitis TX
Duration of abx
Adult uncomplicated
Children
-
What is not recommended?
5-7
10-14
intranasal saline intranasal corticosteroids (esp hx allergic rhinitis)
Topical and oral decongestants
Sinusitis tx continued clarify this in book
First line tx? Children? Adults?
Who do you use high dose for?
For PCN allergic patients?
Drugs not recommended for empiric therapy?
Amoxicillin/clavulanate (augmentin)
- severe infx >39 degrees
- daycare
- <2
- recent hospitalization or abx use in last month
Doxycycline (adults) or respiratory fluoroquinolone
resp fluroquinolone, macrolides, bactrim (trimethoprim/sulfamethoxazole)
Non responsive
If symptoms worsen in __ to ___ days
or no improvement in ___to ___ days
consider that it may be?
if fail tx 1 and 2 then…
2-3
3-5
resistant pathogen, noninfectious, structures
seek consult, imaging, culture
Influenza
Antivirals? tx what types?
Pharmacodynamics/kinetics
ADRs
Oseltamivir (tamiflu)
Zanamivir (relenza)
dynamics- tx A or B
kinetics-
tamiflu- well absorbed after oral
relenza- inhaled 4-17% absorbed
minimal ADRs
Pneumonia
How does it develop?
Bacterial pneumonia results when?
Common pathogens?
Organism invades lung parenchyma and host defenses are depressed
Lungs PRIMARY defenses are altered (viral, immunological)
S. pneumoniae
Patients with underlying lung disease
Nontypeable Haemophilus influenza and Moraxella catarrhalis
Staph aureus: co-pathogen with influenza
Mycoplasma pneumoniae
Viral pneumonia (usually bacterial)
Outcomes for pneumonia treatment
Return to baseline \_\_\_\_ Fever resolve in\_\_\_ to \_\_\_ days Leukocytosis resolves by Chest-xray may take \_\_\_\_ to return to normal Clinical improvement in \_\_ to \_\_\_days
respiratory status 2-4 day 4 4 weeks 2-3 days
Community Acquired Pneumonia (CAP)
Review different recommendations
What is curb65?
Confusion Uremia Respiratory low Blood pressure 65+
Adult treatment CAP NO RISK FACTORS
First line? Examples?
If allergy?
Treat for a minimum of ___ days or afebrile for __ to ___days
Macrolides
* azithromycin or clarythromyin, erythromycin * lowest SE and interactions
Doxycycline
5, afebrile 2-3 days
Adult treatment CAP with COMORBIDITIES or HX drug resistant S.pneumo (drsp)
Tx: Oral?
Parenteral?
Oral:
respiratory fluoroquinolone
beta lactam and a macrolide
if allergic to macrolide give doxycycline
IV Ceftriaxone (Rocephin) or fluoroquinolones IM Ceftriaxone (Rocephin)
fluoroquinolone drugs
beta lactam+ macrolide
*moxifloxacin, *levofloxacin, gemifloxacin
amoxicillin + amoxicillin/clavulanate OR cefpodoxime/cefuroxime
OR
Parenteral ceftriaxone then oral cefpodoxime
Tx CAP pregnant women
Main pathogens?
Which class?
Category B example
Category C example
If co-morbid condition or recent abx use treat with what?
S. pneumoniae, H. influenzae, M. pneumoniae
Macrolides
*arythromycin, erythromycin
clarythromycin (category c)
Beta lactam + macrolide
Pediatric pneumonia CAP
Most common pathogen
Infants 4-16 weeks consider_____
age 5- adolescense consider____
S. pneumoaie
chlamydia
mycoplasma
