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Flashcards in Allergy, Flu, Pneumonia Deck (73):
1

What do you use antihistamines for?

Immediate type hypersensitivity reactions

2

What two kinds of activity to antihistamines have?

Anticholinergic
Antimuscarinic

3

What kind of drugs are antihistamines?

Reversible competitive H1 receptor antagonists

4

What is the affect of antihistamines?

Reduce or prevent physiologic effects of histamine release

5

Do antihistamines affect the pre-released histamine?

No

6

What is an issue with first-generation antihistamines?

They produce sedation

7

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

They are peripherally selective drugs
They are much less sedating

8

What is a ethanolamine antihistamine?

Diphenhydramine (benadryl)

9

What is a phenothiazine antihistamine?

Promethazine

10

What are some classes of first generation antihistamines?

Ethanolamines
Phenothiazines
Piperazines

11

What is a piperazine antihistamine?

Hydroxyzine

12

What are some classes of second generation antihistamines?

Phthalazinone
Piperazine
Piperidines

13

What is a phthalazinone antihistamine?

Azelastine

14

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

Cetirizine
Active metabolite of hydroxyzine

15

What are piperidine antihistamines?

Loratadine
Desloratadine
Fexofenadine

16

What is desloratadine a metabolite of?

Active metabolite of loratadine

17

When is desloratadine contraindicated?

In pts hypersensitive to loratadine

18

When is cetirizine contraindicated?

In pts who are hypersensitive to hydroxyzine

19

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

Less

20

What activities should pts on antihistamines take caution with?

Driving
Tasks requiring alertness

21

What precautions should be taken with children taking antihistamines?

Supervise children in hazardous activities

22

What substances should you avoid with antihistamines?

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

23

AEs of promethazine

Possible fatal respiratory depression
Lower seizure threshold
Prolong QT interval

24

Can promethazine induced respiratory depression be reveresed with naloxone?

No

25

When is promethazine contraindicated?

Children < 2 years

26

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

Tissue necrosis

27

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

Prevention
Promote annual immunization

28

What is the MOA of amantadine?

Chemoprophylaxis of signs and sx of influenza A

29

What does amantadine treat?

Uncomplicated RTI with influenza a

30

What is the MOA of oseltamivir?

Chemoprophylaxis of signs and sx of influenza A/B

31

What does oseltamivir treat?

Uncomplicated RTI with influenza a/b

32

What might decrease the effectiveness of oseltamivir?

Emergence of resistance

33

When do you give oseltamivir as prophylaxis?

Following contact w/ an infected individual

34

When do you give oseltamivir as tx?

W/in 2 days of onset of flu sx

35

What do you give zanamivir for prophylactically?

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

36

What do you treat with zanamivir?

Flu a/b in pts > 7 years old

37

What is rimantadine used for in adults?

Prophylaxis and tx of influenza A in adults

38

What is rimantadine used for in kids?

Prophylaxis of flu a in kids

39

When do you start rimantadine?

ASAP after sx appear
Preferably w/in 48 hours

40

How long do you give rimantadine?

7 days

41

What populations do you reduce rimantadine dosing for?

Elderly
Nursing home pts

42

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

Generally not

43

What are some common CAP organisms?

Streptoccous pneumonia
Haemophilus influenzae

44

What is the pneumonia severity index?

PSI -> see slide 46

45

What is the CAP tx algorithm?

see slide 47

46

What are the CAP empiric antibiotics?

See slide 48

47

What organism is gram positive and has cocci in clusters?

S. aureus

48

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

Vancomycin

49

What organism causes CAP and is gram negative?

Pseudomonas

50

What should you add if the CAP organism is pseudomonas?

Anti-pseudomonal (ex: Tazo, cefepime)

51

What do many WBCs on gram stain indicate?

Pneumonia more likely

52

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

Many organisms

53

Is pneumonia more likely with mixed morphology or single?

Single morphology

54

Severe CAP empiric tx?

See slide 50

55

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

When it is new after 3-5 days as inpatient

56

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

More likely

57

What drug should you consider to add for HAP?

Vancomycin

58

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

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

59

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

4.45 g q 6-8 hours
*renally adjust

60

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

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

61

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

0.5 - 1 g q 6-12 hours

62

How are long-term care facilities more like hospitals?

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

63

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

HAP

64

What is aspiration pneumonitis?

Acute lung injury after inhalation of regurgitated gastric contents

65

Is aspiration pneumonitis usually witnessed or not?

Witnessed

66

What happens with aspiration pneumonitis?

Chemical reaction due to stomach acidity

67

When does aspiration pneumonia develop?

After inhalation of colonized oropharyngeal organisms

68

How do you dx aspiration pneumonia?

CXR to see infiltrate in at risk pts

69

Is aspiration pneumonia witnessed or nah?

Not witnessed

70

What is aspiration pneumonia?

An infection in the lungs due to colonized bacteria

71

What are some RF for aspiration pneumonia?

Older
Antacids
PPIs
poor dentition

72

What are some protective factors against aspiration pneumonia?

Few organisms
Cough reflex
Active ciliary transport

73

Aspiration tx

See slide 57