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Therapeutics P3 Spring > Exam 3 lecture 2 > Flashcards

Exam 3 lecture 2 Flashcards

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1
Q

What is acute bronchitis? Most common pathogen that causes it?

A

Inflammation of the bronchi, caused by respiratory viruses

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2
Q

Clinical presentation of acute bronchitis, compare to pneumonia

A

Normal chest imaging (pneumonia has consolidation on chest x ray)
Fever
HEadache
Malaise
Coryza (runny nose, sneezing, post nasal drip) (They could have pirulence/sputum but not bacterial like pneumonia)
Sore throat
Cough

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3
Q

Treatment of acute bronchitis

A

ANTIBIOTIC THERAPY NOT NECESSARY PLEASE

symptomatic management
Corticosteroids not necessary

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4
Q

What is harm associated with the use of antibiotics and acute bronchitis (NNH)

A

5 patients.

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5
Q

Why would chronic bronchitis pts be more susceptible to bacteria infection

A

We slow everything down due to chronic inflammation and makes it hard for the body to eliminate bacteria

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6
Q

What is the established diagnosis for chronic bronchitis

A

Chronic cough with productive sputum on most days for > 3 consecutive months for 2 years

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7
Q

WHat are the hall mark signs of acute chronic bronchitis exacerbation

A

Increased sputum purulence
Increased sputum volume
Increased cough or SOB

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8
Q

WHat are the most common organisms seen with acute exacerbation of chronic bronchitis? Most common organisms seen with frequent antibiotic use?

A

Most common- strep. pneumoniae
H. Influenzae
<praxella catarrharis

Patients with frequent antibiotic use
- enterobacterales
-pseudomonas aeruginosa

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9
Q

What is 1st line for acute exacerbation of chronic bronchitis

A

Amox/clav (preferred)
Cefuroxime
Cefpodoxime

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10
Q

What are alternative tx for acute exacerbation of chronic bronchitis

A

Doxycycline
TMP/SMX
Azithro

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11
Q

What treatment is used for acute exacerbation of chronic bronchitis with risk for pseudomonas aeruginosa

A

Levo

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12
Q

tx duration for acute exacerbation of chronic bronchitis

A

5-7 days

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13
Q

What are common pathogens for acute pharyngitis?

A

Respiratory viruses
- rhino virus, corona virus, adenovirus

bacteria
- strep pyogenes (group A) Important

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14
Q

Clinical presentation of acute pharyngitis

A

Sudden onset of sore throat with dysphagia and fever

Pharyngeal hyperemia and tonsillar swelling

ENlarged tender lymph nodes

Red swollen uvula

Petechiae on soft plate

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15
Q

WHat is an important thing to note about testing for acute pharyngitis

A

Rapid antigen tests are used instead culture.

Back up testing with culture or PCR based needed if RADT negative

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16
Q

treatment of acute pharyngitis? duration? WHen should alternatives be used?

A

Targeted tx for strep pyogenes so B lactams are drugs of choice

Penicillin VK and amoxicillin
10 day duration

alterantive only used with anaphylactic rxn

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17
Q

What would we use for acute pharyngitis in case of non anaphylactic allergy to penicillin? Anaphylactic rxn to penicillin?

A

Non anaphylatic- cephalosporins (Cephalexin, cefadroxil, cefuroxime, cefpodoxime

Anaphylactic- Azithro, clinda

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18
Q

Describe symptoms and duration of acute rhinosinusitis? Viral

A
  1. Acute rhinosiusitis

Purulent nasal drainage

Nasal obstruction, facial pain/pressure

May last >4 wks

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19
Q

How long does viral sinusitis resolve in?

A

10 days

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20
Q

What are 3 things to know about acute bacterial rhinosinusitis (ABRS)

A

Persistent symptoms- >10 days with no improvement
severe symptoms- Fever, purulent nasal discharge, facial pain for 3-4 consecutive days
Worsening symptoms- new onset of symptoms after initial impROvement in sx

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21
Q

What is the difference between recurrent acute rhinosinusitis and chronic rhinosinusitis

A

Recurrent aucte rhinosinusitis- 4 or more episodes of ABRS per uear

Chronic rhinosinuusitis- >2 signs/symptoms for 12 wks or longer

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22
Q

common pathogens for acute bacteria rhinosinusitis? Additonal pathogens with frequent antibiotic use?

A

Strep pneumoniae
H. Influenza
M. Catarrhalis

with frequent antibiotic use
- staph aureus (MRSA, MSSA)
P. aeruginosa

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23
Q

What are the two approaches to ABRS treatment

A
  1. initiate antibacterial therapy AS SOON as bacterial infection esablished
  2. Watchful waiting up to 7 days to observe if improvement occurs without antibiotic therapy
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24
Q

1st line tx of ABRS and duration

A
  • amox clav 5-7 days
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25
2nd line tx of ABRS
Doxy levo moxi
26
What are not recommended for ABRS
oral 2nd and 3rd gen caphalosporins, macrolides and TMP-SMX not recommended due to concerns of S. pneumoniae resistance
27
For ABRS, what do we do if we have a concern for MRSA?
Add agent with MRSA coverage (Doxy, TMP/SMX, Linezolid, clindamycin) Maintain coverage for common organisms unless culture suggests monomicrobial infections with MRSA
28
For ABRS, what do we do if we have concern for P. aeruginosa
Levofloxacin ,aintain coverage for common organsims unless it is shown monobacterial infection
29
Spportive care acute bacterial rhinosinusitis
Avoid antihitamines- thickens mucus, more difficult to clear Maintain hydration- thin secretions CAution with decongestants NSAIDs and/or acetaminophen Warm facial packs Intranasal saline irrigation
30
What antibiotics put the patient at risk for P. aeruginosa
Antibiotics that do not cover P. aeruginosa like amoxicillin, doxycycline, Azithro
31
What are the different levofloxacin doses?
750 mg PO QD if trying to cover P. aeruginosa 500 mg PO QD for regular
32
What are the different types of genitourinary infections
Pyelonephritis Cystitis Urethritis Prostatitis Epididymitis
33
What are risk factors for genitourinary infections forthe different genders
Female- pregnancy Sexual intercourse Diaphragm/ spermicide use Male- lack of circumcision Prostatic enlargement COndom catheter drainage Both- urinary tract obstruction Urinary instrument and catheterization Neurogenic bladder Renal transplantation
34
What are charcateristics of complicated UTIs
ANatomical abnormality of urinary tract Recent urologic procedure or instrumentation Immunocompromised pateints Recurrent infections despite appropriate tx Male sex UTI in pregnancy
35
What are examples of anatomical abnormality of urinary tract
Obstruction (often due to calculi) Hydronephrosis Renal tract calculi Colovesical fistula
36
What are patients with recent urologic procedure or instrumentation
Catheter stenting tubes
37
What is an uncomplicated UTI
Premenopausal women with normal anatomy Patients not meeting criteria for complicated UTI
38
What is THE MOST common pathogen for genitourinary infections
E COLI
39
UTI signs and symptoms
- new onset dysuria (pain with urination), increased urinary urgency and increased frequency - suprapubic heaviness sensationpain -Urine may be turbid or foul smelling -Hematuria
40
What are s/s of pyelonephritis
systemic igns of infection- fever, chills, rigors, nausea, vomiting, diarrhea F;ank pain (costovertebral angle (CVA) tenderness)
41
What are some clinical presentations of complicated UTI
Classic UTI sx present but not always - fever -malaise -altered mental status incontinence
42
What are some clinical presentations of catheter associated UTI
Classic UTI sx often not present Pain over kidney Fever Lethargy and malaise
43
What do we need for diagnosis of UTI and pyelonephritis
1 of cystitis symptoms or pyelonephritis symptoms with Microbiologic criteria
44
For diagnosis of UTI and pyelonephritis, what are cystitis symptoms? What are pyelonephritis symptoms?
cystitic symptoms- dysuria, increased urinary frequency, increased urinary urgency, suprapubic heaviness/pain Pyelonephritis- Fever, chills, rigors, CVA, tenderness, malaise
45
What are some microbiologic criteria for UTI/pyelonephritis diagnosis
>10^5 of > or = 1 bacterial species from a clean void >10^3 of > or = 1 bacterial species from a catheter (placed in last 48 hrs)
46
What tools do we use to help us with microbiologic criteria
Urinalysis Urine culture
47
What are 4 key components of urinalysis
Bacteria present WBC present Leukocyte esterase present Nitrite may or may not be present (enterobacterales convert nitrates to nitrites)
48
Why are urine cultures helpful?
Assist with identification of organism and confrim suscpetibility to antibiotic resistance. Turn around time 2-3 days
49
In a urinalysis, what would the presence of squamous epithelial cells suggest?
It would suggest that the sample we got is not clean
50
What is the treatment of asymptomatic bacteriuria
Does not require treatment outside of a few specific cases. Most commonly in pregnancy only.
51
What is the most misdiagnosed infection? What does this entail
ASB diagnosed as UTI is one of the most common misdiagnosed infections Over diagnosis leads to overtreatmet leads to antimicrobial resistance
52
Commonly used agents for UTI agents (EXAM)
Nitrofurantoin (uncomplicated only) Sulfamethoxazole/trimethoprim Sluoroquinolones - cipro, levo Fosomycin (uncomplicated only) Beta lactams
53
What are the 5 B lactams that are commonly used oral agents for UTI tx
Cephalexin Cefadroxil Cefpodoxime Amoxicillin/clauvlanate Amoxicillin (only after susceptibility confirmed)
54
What is the recommended duration of tx for complicated and uncomplicated UTI
Uncomplicated- 3-7 days Complicated- 7-14 days
55
When should we not use an agent empirically
If 20% resistance is seen
56
What are considerations for prostatitis treatment
Must consider antibiotic penetration into the prostate - no active transport of antibiotics into the prostate tissue - Need an option with high level of free drug, low protein binding
57
What are recommended tx options for prostatitis
Fluoroquinolones SMX-TMP Some beta lactams (Cephalexin, amox/clav)
58
Treatment duration for prostatitis
2-4 wk
59
What is the definition of recurrent UTI
3 or more infections in 1 year 2 or more infections in 6 months
60
What are potential causes for recurrent UTI? When may we consider prophylactic antibiotic?
Sexual intercourse and diaphragm/spermicide use Post menopausal women Urologic abnormality May consider prophylactic antibiotic if no correctable cause identified
61
Would increased water intake hep with UTI
YES
62
What would we look at to determine amoxicillin susceptibility?
Ampicillin
63
What antibiotic would we look at to determine cefpodozime susceptibility
Cefazolin (clinical pearl)
64

Therapeutics P3 Spring (33 decks)

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