Exam 3 - RTIs Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 3 - RTIs > Flashcards

Flashcards in Exam 3 - RTIs Deck (63):
1

Main physiologic mechanisms that prevent lung infections?

Upper Airways: Nasopharynx, Oropharynx
Conducting Airways: Trachea, Bronchi
Lower Respiratory Tract: Terminal airways/alveoli

2

Host defense mechanisms seen in the nasopharynx?

nasal hair
turbinates
anatomy of upper airways
mucociliary apparatus
IgA secretion

3

Host defense mechanisms seen in the oropharynx?

saliva
sloughing of epithelial cells
complement production

4

Host defense mechanisms seen in the trachea/bronchi?

cough
epiglottis reflexes
sharp/angled branching airways
mucuociliary apparatus
Immunoglobulin production (IgG, IgM, IgA)

5

Host defense mechanisms seen in the terminal airways/alveoli

alveolar lining fluid (surfactant/fibronectin, complement, immunoglobulin)
cytokines (TNF, IL-1, IL-8)
Alveolar macrophages
PMNs
Cell mediated immunity

6

Host defenses:
_______ inhibits adherence of bacteria to cell surfaces --> prevents colonization

fibronectin

7

Host defenses:
Microbes possess surface adhesions, pilis, exotoxins, and proteolytic enzymes that degrade _____ --> promote colonization

IgA

8

Host defenses:
Adherence of microorganisms to _______________ = critical first step in colonization and subsequent infections

epithelial surfaces of upper airways

9

Host defenses:
_______ secretions contain non-specific inhibitors of infection

respiratory

10

Host defenses:
________ eliminate organisms by phagocytosis and produce cytokines that recruit neutrophils to the lungs --> local area becomes ______ and _____ = impairs phagocytic activity

alveolar macrophages
acidic/hypoxic

11

Factors that will interfere with host defenses:
what 7 things are known to do this...?

Altered level of consciousness
Smoking
viruses
Alcohol
Endotracheal tubes/NG tubes, Ventilators
Immunosuppression
Elderly

12

why does altered level of consciousness lead to decrease host defenses?

altered level of consciousness --> compromise epiglottic closure --> aspiration

13

why does alcohol alter/lead to a decrease in host defenses?

-impair cough/epiglottic reflexes --> aspiration
-increases oropharyngeal colonization w/ gram NEGATIVE organisms
-decreased mobilization of neutrophils

14

what are examples of immunosuppression that can lead to decrease in host defenses

malnutrition
immunosuppresive therapy...
HIV

15

what does CAP stand for?

community acquired pneumonia

16

what does VAP stand for?

ventilator associated pneumonia

17

what does HAP stand for?

hospital acquired pneumonia

18

what does HCAP stand for?

healthcare associated pneumonia

19

what is the most common cause for BACTERIAL pneumonia

Aspiration

20

what is aspiration?

common thing to happen in people during sleep

means you're breathing foreign objects into your airways. Usually, it's food, saliva, or stomach contents when you swallow, vomit, or experience heartburn

21

what is aerosolization

droplet nuclei (breathing in viruses)

22

most common way that VIRUSES are caught for pneumonia?

aerosolization

23

most common bugs seen in CAP

STREPTOCOCCOUS PNEUMONIAE!!
H. Influenzae
Mycoplasma Pneumoniae
Legionella pneumophila
Chlamydophila pneumoniae
Staphylococcus aureus
Viral!!!!!

24

what is the MOST common cause of CAP

VIRUSES!!

25

what is the most common bug that causes bacteremic pneumonia cases

streptococcus pneumoniae

26

what are risk factors for drug resistant s. pneumoniae (DRSP)

extremes of age (< 6; > 65)
PRIOR ABX THERAPY
underlying illnesses, co morbid conditions
day care attendance (infested kids
recent/current hospitalization
immunocompromised/HIV/nursing home/prison

27

Typical or atypical pathogen?
Mycoplasma pneumoniae

atypical
(NO CELL WALL = NO GRAM STAIN)

28

Typical or atypical pathogen?
Legionella pneumophila

atypical

29

Typical or atypical pathogen?
Chlamydophila pneumoniae

atypical

30

Typical or atypical pathogen?
staphylcoccus aures

typical

31

Typical or atypical pathogen?
streptococcus pneumoniae

typical

32

A patient may have pneumonia about 2 - 14 days after ________
seen commonly in what bugs?

after influenza

seen in staph. aures

33

what bug is known to be seen post influenza?

staph aureus

34

the following indicate a high index suspicion of what bug?
- necrotizing pneumonia or cavity infiltrates
- concurrent or recent influenza infection
- ICU admission/respiratory failure
- rapid progression of sxs
- formation of empyema

high suspicion of MRSA
(also if pt has hx of skin infection with CA-MRSA....)

35

_________ should be performed on all outpatients and inpatients with suspected CAP

chest radiography

36

Sputum Exam:
Rust colored = what bug?
Dark red, mucoid sputum = what bug?
Foul-Smelling Sputum = what bug?

rust: s. pneumoniae
dark red: k. pneumoniae
foul: mixed anaerobic infection

37

what score is used to evaluate severity of illness and predict mortality (in RTI lecture)

CURB 65

38

what is CURB65

score used to evaluate severity of illness and predict mortality
C: "C"onfusion
U: "U"remia
R: "R"espiratory rate
B: low "B"lood pressure
> "65" y.o

39

CURB65:
if score of ____: treat as outpatient
if score of ____: admit to general ward
if score of ____: may require ICU care

0 - 1
2
>/= 3

40

EMPIRIC CAP Outpatient Treatment:
what patient factors matter when picking this treatment?

if pt is healthy or not (comorbid conditions?)
any prior abx use in past 3 months?
drug allergies of course
if region has a high resistant rate

41

EMPIRIC CAP Outpatient Treatment:
If pt is healthy and has no prior antibiotic use within previous 3 months --- treat with that?

Macrolide (erythromycin, clarithromycin, azithromycin)
or
Doxycycline
*remember drug interactions for drugs above)

42

EMPIRIC CAP Outpatient Treatment:
If pt has comorbidities OR has used antimicrobials in past 3 months --- treat with what?
(*comorbidities could be chronic heart/liver/lung/renal disease, diabetes, alcoholism, malinancy or asplenia*)

Respiratory FQ (Moxifloxacin or Levofloxacin)
OR
Beta-Lactam + Macrolide

43

EMPIRIC CAP Outpatient Treatment:
if in region with a high rate (>25%) of infections caused by high level (MIC > 16) MACROLIDE resistant S. Pneumoniae --- treat with what?

Respiratory FQ
OR
Beta Lactam + Macrolide

44

EMPIRIC CAP Inpatient Treatment:
If patient is in general medical ward (non-ICU) --- how to treat?

Respiratory FQ
OR
Beta lactam + macrolide

(Use IV!!)

45

EMPIRIC CAP Inpatient Treatment:
If patient is in ICU --- how to treat?

DUAL THERAPY
Beta lactam + Macrolide
OR
Beta lactam + Respiratory FQ

46

what are the preferred beta lactams for empiric CAP inpatient treatment

Ceftriaxone
cefotaxime
ampicillin

47

CAP Directed Therapy:
If Strep. Pneumo:
Based on its resistance mechanism:
get results that let you know if it is ______ or _____

PCN susceptible (MIC <2)
or
PCN resistant (MIC > 2)

48

CAP Directed Therapy:
If Strep. Pneumo and PCN susceptible -- treat with what?

PCN G or amoxicillin

*if deathly allergic ot PCN --- macrolide, cephalosporin, Respiratory FQs or doxy....

49

CAP Directed Therapy:
If Strep. Pneumo and PCN resistant -- treat with what?

respiratory FQ or ceftriaxone or cefotaxime

50

Specific Conditions and Specific Pathogens for CAP:
If on hotel/cruise ship in previous 2 weeks -- worried about what bug?

Legionella pneumophila

51

Specific Conditions and Specific Pathogens for CAP:
If IV drug user -- worried about what bug?

S. Aureus (skin flora)

52

Specific Conditions and Specific Pathogens for CAP:
If lung abscess -- worried about what bug?

CA-MRSA

53

what are examples of some antipneumococcal and antipseudomonal beta lactams (aka drugs good when pseudomnas suspected in pneumonia)

pip/tazo
cefepime
Carabapenems (except ertapenem bc no pseudomonas coverage!)

54

how long to treat CAP (minimum amount of days?)

5 days

55

what are signs of CAP associated clinical stability

temperature < 37.8 C (100.04..)
HR < 100 BPM
RR < 24 breaths PM
Systolic BP > 90
Arterial O2 > 90
Ability to take oral meds
normal status

56

Duration of CAP treatment should be at least 5 days..
also patients need to be afebrile for at least _______ and not more than _____ CAP-associated signs of clinical instability

at least 24 - 48 hours

no more than 1 CAP instability sign

57

Pathogen Directed Therapy for CAP: What drug for
If H. influenzae - NON beta lactamase producing?

Amoxicilin

58

Pathogen Directed Therapy for CAP: What drug for
If H. influenzae - beta lactamase producing?

2nd/3rd gen ceph
or
Amox clav

59

Pathogen Directed Therapy for CAP: What drug for
Mycoplasma or Chlamydophila?

macrolide or doxycycline

60

Pathogen Directed Therapy for CAP: What drug for
Legionella

FQs
Azithromycin

61

Pathogen Directed Therapy for CAP: What drug for
Staph Aureus:
MSSA?
MRSA?

MSSA: nafcillin or oxacillin

MRSA: Vanc or linezolid

62

Pathogen Directed Therapy for CAP: What drug for
Anaerobes?

beta lactam + beta lactamase inhibitor
or
clindamycin

63

Pathogen Directed Therapy for CAP: What drug for
Enterbacteriaceae (if KPC/AmpC producing..)

3rd/4th ceph
or
Carbapenem