Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Therapeutics P3 Spring > Exam 3 lecture 1 > Flashcards

Exam 3 lecture 1 Flashcards

(70 cards)

Start Studying
1
Q

Where do LRTI usually take place? Where does pneumonia usualy take place?

A

Trachea, bronchi, bronchules, alveoli

Alveoli most important because most pneumonia occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the host defence mechanism for URT? LRT?

A

URT
1. Nasopharynx
-nasal hair
-IgA secretion
-Mucocilliary apparatus
-fibronectin

  1. Oropharynx
    - saliva
    -slough epithelial cells
    -complement prodyction

LRT
3. Trachea/bronchi
- cough
-epiglottic reflex
- Anatomy of conducting airways
-Mucocilliary apparatus
-Immunoglobulin

  1. Alveolar lining fluid
    cytokines
    macrophages + PMN
    cell mediated immunity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define community acquired pneumonia

A

Pneumonia developed outside of the hospital or within the 1st 48hrs of hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the importance of CAP (community acquired pneumonia) (how common is it?, mortality?)

A

Most common cause of infection related hospitalization and mortality in the US

30 day mortality after hospitalization due to CAP is 2.8% for those <60 yo while about 26.8% for those 60 and above with comorbid conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are ways CAP infection happen?

A
  1. Aspiration- most common pathway. Common for all individuals during sleep. Organism cleared if host defense is functioning properly.
  2. Aerosolization- Direct inhalation of pathogen. Primarily ciruses, bacteria and fungi. Droplet Nuclei, particles containing pathogen
  3. Bloodborne- Translocate to pulmonary site. Extremely unlikely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common organism that causes pneumonia

A

Virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are common bacterial pathogens

A

Strep pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae (atypical)
Legionella Pneumophila (atypical)
Chylamydia oneumonia (atypica)
Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where do we see the presence of strep pneumoniae?

A

Increased prevalence in patients that have immunocompromised states (chemo, transplant drugs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Wha t are risk factors for drug resistance with strep pneumoniae

A

Age<6 or >65, prior antibiotic therapy, co morbid conditions, day care, recent hospitalization, close quarters (nirsing home, dorm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe penicillin and macxrolide use with strep pneumoniae

A

penicillin- 3% resistance
Macrolide- 45-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe how mycoplasma pneumoniae is identified? spread?

A

Atypical bacteria- so will not show up on gram stain

Spread by person to person contact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does mycoplasma pneumonia present at first? Symptoms? Imaging?

A

2-3 weel incubation period, followed by slow onset of symptoms

Persistent, non productive cough, fever, headache, sore throat, rhinorrhea, N/V, arthralgia

Imaging usually more pronounced with patchy, interstitial infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of bacteria is legionella pneumonophilia? How is it spread? Risk factors?

A

Atypical pathogen

spread by aerosolization

Increased risk: older males, chronic bronchitis, smokers, and immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is legionella pneumophilia characterized (sx/ss)

A

Multi system incolvement (fever, bradycardia, mental status change and increased LFTs + SCr)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Prevalence of staph aureus pneumonia? Risk factors for mRSA?

A

Low prevalence

RF
- 2-14 days post influenza
- previous MRSA infection/isolation
-Previous hospitalization
- Previous IV antibiotics use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is important to do when dealing with staphylococcus aureus

A

Important to get MRSA nasal PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the most common pathogens with structural lung disease (cystic fibrosis, bronchiectasis)? Recent antibiotic exposure?

A

S. Aureus, P. aeruginosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the classic presentation for CAP? For elderly patients?

A

Classic- sudden onset of fever, chills, pleuric chest pain, dyspnea, productive cough

  • gradual onset with lower severity for mycoplasma pneumonniae and chylamidia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Elderly patients clinical presentation for CAP?

A

Classic symptoms may be absent (afebrile and mild leukocytosis)
- more likely to have decrease in functional status, weakness, and mental status changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how to diagnose CAP?

A

-Chest radiography (recommended for all pts with suspicion for CAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some key words to look for in chest radiography that shows CAP? What type of infiltrates are seen in lung?

A

Dense lobar consolidation or infiltrates= suspicion for bacterial origin

Patchy, diffuse, interstitial infiltrates= atypical or viral pathogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some microbiology testing methods for CAP

A

Tracheal aspiration
Bronchoscopy
Bronchoalveolar lavage (BAL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are markers we look at when looking for CAP

A

-WBC with differential
-Scr, BUN, electrolytes, LFTs
- Pulse oximetry, O2 sat
- Urinary antigen tests Tests for either
- S. pneumoniae
- Legionella pneumophilia
- Nasopharyngeal PCR swabs
-MRSA
- Viral swabs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When are cultures used?

A

Respiratory cultures or blood cultures are used for severe patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is severe CAP? What are the criterias
Major criteria (we only need one) - Septic shock requiring vasopressors - Respiratory failure requiring mechanical ventilation Minor (we need atleast 3) -Resp rate > 30bpm -multilobar infiltrates - COnfusion/disorientation -uremia (BUN 34) - Leukopenia -Thrombocytopenia -Hypothermia -Hypotension
26
What is a biomarker for CAP? WHen should and should it not be used?
Procalcitonin elevated in presence of bacterial infection. SHOULD NOT be used to determine need for antibiotic for CAP
27
What are supportive measures for treatment of CAP
Humidified oxygen Brinchodilators Fluids Chest physiotherapy
28
Empiric therapy for outpatient CAP WITHOUT comorbidities or risk factors for antibiotic resistance1
1. Amoxicillin 1 gm PO Q8H 2. Doxycycline 100 mg PO BID 3. Macrolide resistance <25%, Azithromycin 500 mg PO on day 1, followed by 250 mg PO on day 2-5 (rare)
29
What are comorbidities that we look out for with patients with CAP
Chronic heart, lung or renal disease; diabetes mellitus; alcoholism; malignancy; asplenia or immunosuppression
30
Monotheraoy for Outpatient CAP? dose?
Respiratory fluoroquinolones (levafloxacin 750 mg PO daily, moxifloxacin 400 mg PO qd)
31
Combo therapy for outpatient CAP
preferred due to resistance and AE Beta lactam + Macrolide (doxyxyxline if contraindicated)
32
What are beta lactams used in outpatient CAP? Dose?
AMoxicillin/clauvulanate 875/125 mg PO Q12H Cefpodoxime 200 mg PO Q12H - Cefuroxime 500 mg PO Q12H
33
What can we use to treat non severe inpatient CAP without MRSA/pseudomonas aeruginosa risk factors
Monotherapy- Respiratory fluoroquinolones (levo and moxi) Combination therapy- Beta lactam + Macrolide
34
What are the B lactams recommended for non severe in patient CAP? What can be used if FQ or macrolide contraindicated?
Ampicillin/sulbactam CEftriaxone Doxy can be used if FQ or macrolide contraindicated
35
for severe in patient caps with no MRSA/pseudomonas risk factors what is tx
COmbination therapy- beta lactam + Macrolide (1st choice) Combination therapy- Respiratory fluoroquinalone + Beta lactam
36
What B lactams are recommended
Ampicillin/sulbactam Ceftriaxone
37
What can be a choice for severe in patient CAP with no MRSA/pseudomonas aeruginosa risk factors
Doxycycline
38
What are MRSA risk factors
-2-14 days post influenza -Previous MRSA respiratory infection - previous hospitalization and use of IV antibiotics within last 90 days
39
What can we utilize for MRSA coverage for in patient severe CAP
Vancomycin Linezolid
40
What are Pseudomonas aeruginosa risk factors?
-Previous pseudomonas aeruginosa risk factors - Previous hospitalization and use of IV antibiotics within last 90 days
41
What are antibiotics used for pseudomonas coverage
- piperacillin/tazobactam -Cefepime -Meropenem
42
When are corticosteroids not recommended
Only recommended with septic shock. Not used for severe or non severe CAP
43
Duration of therapy for pneunmonia
5 total days. Ensure clinical stability prior to dx antibiotics (temp, HR, RR, SBP, O2 sat, baseline mental status)
44
do we have to worry about anaerobic coverage for aspiration pneumonia?
Recommend against anaerobic coverage unless lung abscess or empyema present.
45
When should we stay away from fluoroquinolones
QT prolongation
46
Define HAP?
pneumonia occuring >48 hrs after hospital admission
47
Define VAP
(ventilator associated) Pneumonia occuring >48 hrs after endotracheal intubation
48
How does HAP take place? Is it usually gram positive or negative?
micro aspirations of oropharyngeal secretions that are colonized with bacteria. Usually colonized with aerobic gram positive bacteria and converts to gram negative after 3-5 days of hospitalization
49
What are risk factors for HAP/VAP
Advanced age severity of comorbid disease Duration of hospitalization ENdotracheal intubation Nasogastric tube Altered mental status Surgery Previous antimicrobial therapy
50
How to diagnose HAP/VAP
timing (48 hrs from admission) Typical presentation (New lung infiltrate + Clinical signs and symptoms)
51
common pathogens for HAP
- aerobic gram negative bacilli= 70% - pseudomonas aeruginosa= 10-20% - Enteric gram negative bacilli = 20-40% - Acinetobacter baumanii= 5-10% - S. aureus= 20-30% - MRSA greater concern in this population
52
What are common microbiology testing used in HAP
-respiratory cultures (utilized for intubated pts) -blood culture
53
What happens if we get invasive respiratory culture for HAP such as a BAL
we want to look at how much we are collecting. We only have infection if BAL>10,000
54
risk factors for MDR for HAP? VAP?
- Multi-drug resistant (MDR) HAP -prior IV antibiotic use within 90 days - MDR VAP - prior IV antibioic use within 90 days - septic shock at time of diagnosis - Acute respiratory distress syndrome prior to diagnosis - Acute renal replacement therapy prior to VAP onset - >or= 5 days of hospitalization prior to diagnosis
55
What should empiric therapy for HAP
should be based on local antibiogram
56
When choosing empiric therapy for HAP, what are the risk factors for MRSA? WHat drugs to use
-ICUs where >10-20% MRSA isolates -IV antibiotic within last 90 days Vancomycin Linezolid
57
For empiric therapy in HAP, what are risk factors for resistance when treating pseudomonas aeruginosa
ICUs where >10% of ioslates resistant - treatment where resistance rates are unknown
58
For pseudomonas aeruginosa, what would we use to treat it for HAP?
-Piperacillin- tazobactam -Cefepime -Imipenem -Meropenem -Levofloxacin
59
What is the goal when treating patients with HAP with no risk of mortality? What are the requirements to be classed not high risk?
Goal- provide coverage for MSSA + Pseudomonas aeruginosa Requirement- not on ventilatory support or septic shock
60
For not high risk mortality pts with HAP what would we use to treat
Piperacillin- tazobacta, - cefepime Imipenem meropenem levofloxacin
61
What is the goal for treating HAP not at risk for mortality but MRSA risk? What are antibiotics used for this?
Goal- Provide coverage for MRSA + Pseudomonas aeruginosa Piperacillin- tazobactam Cefepime imipenem meropenem levofloxacin (Pseudomonas) + Vanc or linezolid (FOR MRSA)
62
What is the goal of treating high risk (On ventilator or septic shock) mortality and MRSA risk? What is antibiotic therapy?
Goal- provide coverage for MRSA+ MDR p. aeruginosa Pick 2 different of these drugs for P. aeruginosa - piperacillin-tazobactam - Cefepime - Imipenem - Meropenem - Levofloxacin - Tobramycin/Amikacin (SHOULD BE 1 betam lactam and 1 non beta lactam) + Vancomycin Linezolid
63
When treating VAP, when do we choose 2 anti peudomonals? What are the antibiotics used for VAP?
- When we have risk factors for resistance ( Antibiotic IV, resiatance rate >10%) Piperacillin-tazobactam Cefepime Imipenem Meropenem Levofloxacin Tobramycin/amikacin + Vancomycin Linezolid
64
What does daptomycn cover? What should we never do?
MRSA SHould never be used for LRTI
65
What are aminoglycosides considerations
Recommend against use as monotherapy Avoid empiric use unless necessary Poor lung penetration, nephrotoxicity, ototoxicity,
66
What are considerations for polymixin
avoid empiric use reserved for pts with HIGH MDR pathogens. SIgnificant nephrotoxicity
67
Tigecycline considerations
Associated with increased mortality, great for polymicrobial infections
68
recommended duration for HAP/VAP
7 day duration
69
When we get ESBL, what do we use
meropenem due to resistance to B lactamase
70

Therapeutics P3 Spring (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions