Allergy, Flu, Pneumonia

Question 1

What do you use antihistamines for?

Answer 1

Immediate type hypersensitivity reactions

Question 2

What two kinds of activity to antihistamines have?

Answer 2

Anticholinergic

Antimuscarinic

Question 3

What kind of drugs are antihistamines?

Answer 3

Reversible competitive H1 receptor antagonists

Question 4

What is the affect of antihistamines?

Answer 4

Reduce or prevent physiologic effects of histamine release

Question 5

Do antihistamines affect the pre-released histamine?

Answer 5

No

Question 6

What is an issue with first-generation antihistamines?

Answer 6

They produce sedation

Question 7

What is an advantage of second generation antihistamines and what is the result?

Answer 7

They are peripherally selective drugs

They are much less sedating

Question 8

What is a ethanolamine antihistamine?

Answer 8

Diphenhydramine (benadryl)

Question 9

What is a phenothiazine antihistamine?

Answer 9

Promethazine

Question 10

What are some classes of first generation antihistamines?

Answer 10

Ethanolamines
Phenothiazines
Piperazines

Question 11

What is a piperazine antihistamine?

Answer 11

Hydroxyzine

Question 12

What are some classes of second generation antihistamines?

Answer 12

Phthalazinone
Piperazine
Piperidines

Question 13

What is a phthalazinone antihistamine?

Answer 13

Azelastine

Question 14

What is a piperazine antihistamine? What is it a metabolite of?

Answer 14

Cetirizine

Active metabolite of hydroxyzine

Question 15

What are piperidine antihistamines?

Answer 15

Loratadine
Desloratadine
Fexofenadine

Question 16

What is desloratadine a metabolite of?

Answer 16

Active metabolite of loratadine

Question 17

When is desloratadine contraindicated?

Answer 17

In pts hypersensitive to loratadine

Question 18

When is cetirizine contraindicated?

Answer 18

In pts who are hypersensitive to hydroxyzine

Question 19

Do 2nd degree antihistamines have more or less sedative properties?

Answer 19

Less

Question 20

What activities should pts on antihistamines take caution with?

Answer 20

Driving

Tasks requiring alertness

Question 21

What precautions should be taken with children taking antihistamines?

Answer 21

Supervise children in hazardous activities

Question 22

What substances should you avoid with antihistamines?

Answer 22

Co-administration of other CNS depressants (drugs or alcohol)

Question 23

AEs of promethazine

Answer 23

Possible fatal respiratory depression
Lower seizure threshold
Prolong QT interval

Question 24

Can promethazine induced respiratory depression be reveresed with naloxone?

Answer 24

No

Question 25

When is promethazine contraindicated?

Answer 25

Children < 2 years

Question 26

What is a concern with IV/SQ administration of promethazine?

Answer 26

Tissue necrosis

Question 27

What is key with influenza? What can we do to deal with this?

Answer 27

Prevention | Promote annual immunization

Question 28

What is the MOA of amantadine?

Answer 28

Chemoprophylaxis of signs and sx of influenza A

Question 29

What does amantadine treat?

Answer 29

Uncomplicated RTI with influenza a

Question 30

What is the MOA of oseltamivir?

Answer 30

Chemoprophylaxis of signs and sx of influenza A/B

Question 31

What does oseltamivir treat?

Answer 31

Uncomplicated RTI with influenza a/b

Question 32

What might decrease the effectiveness of oseltamivir?

Answer 32

Emergence of resistance

Question 33

When do you give oseltamivir as prophylaxis?

Answer 33

Following contact w/ an infected individual

Question 34

When do you give oseltamivir as tx?

Answer 34

W/in 2 days of onset of flu sx

Question 35

What do you give zanamivir for prophylactically?

Answer 35

The flu for pts >5 years for flu a/b

Question 36

What do you treat with zanamivir?

Answer 36

Flu a/b in pts > 7 years old

Question 37

What is rimantadine used for in adults?

Answer 37

Prophylaxis and tx of influenza A in adults

Question 38

What is rimantadine used for in kids?

Answer 38

Prophylaxis of flu a in kids

Question 39

When do you start rimantadine?

Answer 39

ASAP after sx appear | Preferably w/in 48 hours

Question 40

How long do you give rimantadine?

Answer 40

7 days

Question 41

What populations do you reduce rimantadine dosing for?

Answer 41

Elderly | Nursing home pts

Question 42

Are community acquired pneumonia (CAP) organisms multi-drug resistant?

Answer 42

Generally not

Question 43

What are some common CAP organisms?

Answer 43

Streptoccous pneumonia | Haemophilus influenzae

Question 44

What is the pneumonia severity index?

Answer 44

PSI -> see slide 46

Question 45

What is the CAP tx algorithm?

Answer 45

see slide 47

Question 46

What are the CAP empiric antibiotics?

Answer 46

See slide 48

Question 47

What organism is gram positive and has cocci in clusters?

Answer 47

S. aureus

Question 48

What should you add for CAP tx if the stain comes back as S aureus?

Answer 48

Vancomycin

Question 49

What organism causes CAP and is gram negative?

Answer 49

Pseudomonas

Question 50

What should you add if the CAP organism is pseudomonas?

Answer 50

Anti-pseudomonal (ex: Tazo, cefepime)

Question 51

What do many WBCs on gram stain indicate?

Answer 51

Pneumonia more likely

Question 52

Is pneumonia more likely with more or less organisms on gram stain?

Answer 52

Many organisms

Question 53

Is pneumonia more likely with mixed morphology or single?

Answer 53

Single morphology

Question 54

Severe CAP empiric tx?

Answer 54

See slide 50

Question 55

When do you classify pneumonia as hospital acquired (HAP)?

Answer 55

When it is new after 3-5 days as inpatient

Question 56

Is HAP more or less likely to be multi-drug resistant?

Answer 56

More likely

Question 57

What drug should you consider to add for HAP?

Answer 57

Vancomycin

Question 58

What can you add for broader mutli-drug resistance coverage?

Answer 58

High dose Pip/Tazo (zosyn) Cefepime Imipenem/cilastatin

Question 59

What dose of Pip/Tazo do you give for MDR? What's something you have to take into consideration?

Answer 59

4. 45 g q 6-8 hours | * renally adjust

Question 60

What dose of cefepime do you give for MDR? Whats an exception?

Answer 60

1 g q 12 hours | 2 g q 8 hours for febrile neutropenia

Question 61

What dose of imipenem/cilastatin do you give for MDR?

Answer 61

0.5 - 1 g q 6-12 hours

Question 62

How are long-term care facilities more like hospitals?

Answer 62

Chronically ill pts Long lengths of stay May have instrumentation in place Increased likelihood of MDR colonization/infection

Question 63

Do you treat health care associated pneumonia more like CAP or HAP?

Answer 63

HAP

Question 64

What is aspiration pneumonitis?

Answer 64

Acute lung injury after inhalation of regurgitated gastric contents

Question 65

Is aspiration pneumonitis usually witnessed or not?

Answer 65

Witnessed

Question 66

What happens with aspiration pneumonitis?

Answer 66

Chemical reaction due to stomach acidity

Question 67

When does aspiration pneumonia develop?

Answer 67

After inhalation of colonized oropharyngeal organisms

Question 68

How do you dx aspiration pneumonia?

Answer 68

CXR to see infiltrate in at risk pts

Question 69

Is aspiration pneumonia witnessed or nah?

Answer 69

Not witnessed

Question 70

What is aspiration pneumonia?

Answer 70

An infection in the lungs due to colonized bacteria

Question 71

What are some RF for aspiration pneumonia?

Answer 71

Older Antacids PPIs poor dentition

Question 72

What are some protective factors against aspiration pneumonia?

Answer 72

Few organisms Cough reflex Active ciliary transport

Question 73

Aspiration tx

Answer 73

See slide 57