ARDS/Geriatric PHM/Sepsis/Pneumonia Flashcards Preview

Block 3b1 PHM > ARDS/Geriatric PHM/Sepsis/Pneumonia > Flashcards

Flashcards in ARDS/Geriatric PHM/Sepsis/Pneumonia Deck (71):
1

Beer's List: Ex's of 1st gen antihistamines (4)

Diphenhydramine, Doxylamine, Hydroxyzine, Meclizine

2

Beer's List: Risks of 1st gen antihistamines

Confusion, dry mouth, constipation, cognitive impairment, delirium

3

Alt to 1st gen antihistamines & (3) ex's

2nd gen antihistamines (eg: loratadine, fexofenadine, cetirizine)

4

Beer's List: Ex's of Antithrombotics (2)

Dipyridamole, Ticlopidine

5

Beer's List: AE's of Dipyridamole & Ticlopidine

Antithrombotic AE's (2 drug ex's) Orthostasis, bleeding Bleeding

6

Beer's List: Alt of Antithrombotics

Acetylsalicylic Acid (ASA): Aspirin

7

Beer's List: Categories & Ex's of Antihypertensives (2)

Alpha-blocker: Terazosin Central Alpha Agonist: Clonidine

8

Beer's List: When should antihypertensives be avoided?

Not 1st line, esp in HTN

9

Beer's List: AE's of antihypertensives

Orthostatic hypotension, CNS effects, bradycardia

10

Beer's List: Antihypertensive Alts (4)

Thiazides, ACE-I, Beta Blockers, CCB

11

Beer's List: Why should tricyclic antidepressants (TCA'S) be avoided?

Highly anticholinergic

12

Beer's List: Alts to Tricyclic Antidepresssants (TCA's) (2)

SSRI, SNRI

13

Beer's List: Why should 1st and 2nd gen antipsychotics be avoided?

Behavioral problems of dementia

14

Beer's List: What are the alts of 1st and 2nd gen antipsychotic meds?

Non-PHM Tx

15

Beer's List: Ex's of Analgesics (3)

Meperidine, NSAID's, Skeletal muscle relaxants

16

Beer's List: AE's of Analgesics

Neurotoxicity, Risk of GI bleed, Anticholinergic effects, Peptic Ulcer Disease

17

Beer's List: Alts of Analgesics (2)

Low dose opioids, tramadol

18

What are ex's of lipid soluble medications?

Antipsychotics (ie: Benzodiazepine); Valium

19

What are ex's of water soluble medications? (2)

Digoxin, Aminoglycosides

20

What is a highly protein bound drug used vs. seizures?

Phenytoin

21

Inotrope in Sepsis Tx

Dobutamine

22

What are ex's of cytokine modulators for Sepsis Tx? (4)

High-dose steroids, mab's, Toll-receptor antagonists, Statins

23

What are ex's of coagulation regulators for Sepsis Tx? (2)

Heparin Activated Protein C (Xigris)

24

What biological mechanism may decrease mortality in Sepsis?

Vit C

25

What is Legionella pneumophilia?

Aerobic, flagellated, non-spore forming gram (-) rod

26

How do gram (-) organisms stain? & Give ex

Pink (i.e.: Legionella)

27

What are 3 singular clinical manifestations of Legionellosis?

GI sx, Hyponatremia, Pontiac fever (non-pneumonic disease w/ flu-like sx)

28

What are 2 key Dx methods for Legionellosis?

Urine antigen test: detect serotype 1

 

Culture: charcoal yeast agar (Fe/cysteine)

29

How do you treat Legionellosis?

W/ Pontiac Fever-self lim; no ab Tx req

 

Ab Tx: 7-10 days Quinolone Macrolides (ie: Azithromycin/Clindomycin) Tetracycline Rifampin

30

What is a RF for ARDS related to influenza?

Obesity

31

How does a CXR and CT present for MRSA pneumonia?

CXR: diffuse, bilateral opacities

 

CT: multi-lobar cavitary infiltrates

32

What cause of pneumonia may be preceded by an influenza like illness?

CA-MRSA

33

Who might be affected by CA-MRSA?

Young, otherwise healthy

34

What are complications of CA-MRSA?

Empyema, Lung abscess, Sepsis

35

What are RF's for MRSA pneumonia?

Recent ab use; influenza-like illness

36

What are RF's for Legionellosis?

Immunosuppression;

 

Age >50

37

How can CA-MRSA be acquired?

Inhalation/aspiration into lower airway-> Hematogenous Seeding

38

When is CA-MRSA pneumonia associated w/ increased mortality?

Severity of dis at presentation

 

 

↓ Vancomycin susceptibility

39

What genotype strain is associated w/ CA-MRSA pneumonia & what are its components? What can it cause?

USA300 strain -SCCmecIV -Panton-Valentine Leukocidin (PVL gene): toxin prod -Assoc w/ CA-MRSA but also ID in 20% of HAP Necrotizing, severe infection

40

How can CA-MRSA pneumonia be Dx clinically?

Influenza-like prodrome

 

Hemoptysis

41

What is cultured to dx CA-MRSA pneumonia?

Blood, sputum, pleural fluid

42

What are the ab's & techniques used to Tx MRSA-pneumonia?

Ab's: Vancomycin

Linezolid

Clindamycin

Empyema drainage

43

When is Daptomycin used?

Tx vs. MRSA but not pneumonia

44

What pneumonia causing agent is this?

 

Q image thumb

Legionella Pneumophilia 

45

What pneumonia causing agent is this?

Q image thumb

Staphylococcus aureus 

46

What condition is this a CXR of?

Q image thumb

Legionella Pneumonia: bilateral lobar infiltrates

47

What condition is this a CXR of?

Q image thumb

MRSA pneumonia: diffuse bilateral pattern 

48

What condition is this a CT scan of?

Q image thumb

MRSA pneumonia: cavitary pneumonia 

49

What is this a CXR of?

Q image thumb

HAP: lobar infiltrate, bulging fissure sign indicative of Klebsiella

50

What is this a stain of?

Q image thumb

Klebsiella pneumoniae: moderate Gram (-) stain

51

Under what circumstances might HAP/VAP be suspected?

2 or more days after admission/post endotracheal intubation (50% of HAP cases)

52

What is the pathogenesis of HAP?

Bacterial colonization of aerodigestive tract

Aspiration of contaminated secretions into lower airways

53

What are pathogens of HAP pneumonia?

Gram (-):
Klebsiella pneumoniae
Pseudomonas aeruginosa
E Coli

Serratia marcescens

Stenotrophomonas maltophilia 

Actinetobacter species

Gram (+):
Staphylococcus aureus- MSSA vs. MRSA

54

How does HAP present clinically?

Fever, SOB, hypoxia, ↑ sputum production

55

How are respiratory cultures attained if HAP is suspected?

Non-invasive: tracheal aspiration

Invasive: bronchoscopy

56

What are RF's for ab resistance?

Recent hospitalization

Long term care facility residence

Ab exposure within past 90 days

Chemo

Open wounds

57

What are the Tx's for HAP?

Anti-pseudomonal PCN's
Fluoroquinlones

Aminoglycosides

Polymixins

Vancomycin

Linezolid

58

What are ex's of anti-pseudomonal PCN's in HAP tx?

Piperacillin-tazobactam (Zosyn)
Cefepime

Azactam

Meropenem

Ceftolazone-tazobactam (Zerbaxa)

59

What are ex's of fluoroquinolones in HAP tx?

Ciprofloxacin, Levofloxacin

60

What are ex's of Aminoglycosides in HAP tx?

Amikacin, Tobramycin, Gentamicin 

61

What is this a CXR of?

Q image thumb

Nocardia pneumonia: bilateral nodular pattern 

62

What is unique about Nocardia's staining pattern?

Not mycobacterial like TB but can still stain w/ acid fast

63

Where is Nocardia species found?

Soil, water, decaying plants, sometimes food

64

Why is Nocardia an "opportunistic pathogen"?

More common in immunosuppressed (ie: transplant, HIV) 

65

How is Nocardia acquired?

Inhalation from environment

66

How does Nocardia present clinically?

Pneumonia: nodular/cavitary; sub-acute->chronic px

Lung abscess

Disseminated infection (ie: brain, skin, bone, kidney, eye, heart); predilection for CNS

67

What is this a stain of?

Q image thumb

Nocardia species: Gram (+) bacilli w/ branching filamentous forms, non-spore forming, mildly acid fast

68

What is a unique RF for Nocardiosis?

Alcoholism: can affect immune system over time

69

What are 3 methods of Dx for Nocardia?

1) Culture: Sputum-bronchoscopy
Lung Tissue

Skin Biopsy

2) Stain: modified Ziehl-Neelsen

3) Brain imaging/Lumbar puncture (to rule out CNS infection) *even if asymptomatic, imp in immunocompromised*

70

How is Nocardia Tx?

Ab's: Sulfonamides (ie: Bactram)

Carbapenems (ie: Imipenem)

Ceftriaxone

Amikacin

Linezolid

Tigecycline

71

What are organisms that cause 'atypical' CAP?

Chlamydia pneumoniae

Mycoplasma pneumoniae

Legionella

Chlamydia psittaci