Lower Resp Infections Flashcards Preview

Fall2014 - Pharm ID/Pulm > Lower Resp Infections > Flashcards

Flashcards in Lower Resp Infections Deck (31):
1

What is the most common cause of acute bronchitis?

mostly viral (influenza, rhinovirus, coronavirus, RSV)

2

Treatment of Acute Bronchitis

-antibiotic therapy NOT indicated
-unless bacterial pathogen is identified with sputum culture
-symptomatic: rest, fluids, analgesics prn (aspirin, aceto, ibup); anti-tussives

3

What role do OTC cold medications play in tx of acute bronchitis?

none!
-those w/ decongestants will thicken sputum and make it harder to clear the infection

4

What are the most common pathogens in acute bacterial exacerbation of chronic bronchitis?

-up to 50% may be culture negative
-viral 20-50% of cases
-C and M pneumoniae

5

Tx of Acute Exacerbation of Chronic Bronchitis

-stop smoking! (COPD)
-postural drainage to clear secretions
-if severe, consider CXR, inhaled anticholinergic bronchodilator (will dry secretions), 2 week oral prednisone burst

6

What role do abx play in Tx of Acute Exacerbation of Chronic Bronchitis?

-mild to moderate dz: no or maybe
severe: role debated, but some value has been shown; broad spectrum like augmentin, azithro, clarithro, FQs

7

Clinical Presentation of Strep pneumoniae

-rust colored sputum
-rapid fever onset
-high WBC
-CXR: lobar consolidation

8

Clinical Presentation of Mycoplasma pneumoniae

-slow course
-non-productive cough
-WBC normal or slightly elevated

9

Clinical Presentation of Legionella pneumoniae

-pleuritic chest pain
-can see hemoptysis
-increased LFTs
-hyponatremia

10

How is CAP treatment determined?

-out vs inpatient
-and non-ICU vs ICU
-presence of co-morbidities like COPD, DM, HF

11

CAP Tx in Previously Healthy Outpatient with No Abx

-macrolide or doxycycline

12

CAP Tx in Outpatient w/ Presence of Co-morbidities, Immunosuppressing Conditions, or Use of Antimicrobials w/in 3 Months

-respiratory FQ
-or macrolide plus beta-lactam

13

CAP Tx in Outpatient in a region with >25% high level Macrolide Resistant Strep pneumoniae

-respiratory FQ
-or macrolide plus beta-lactam

(same as for tx of pts w/ co-morbidities)

14

CAP Tx of Inpatient Non-ICU

-respiratory FQ
-or macrolide plus beta-lactam

15

CAP Tx of Inpatient ICU with no Pseudomonas

-beta lactam and azithromycin
-or respiratory FQ

16

CAP Tx of Inpatient ICU with Pseudomonas

-beta lactam + cipro
-BL + azithro + AG
-BL + AG + antipneumococcal FQ

17

CAP Tx of Inpatient ICU with CA-MRSA

-add vancomycin or linezolid to cover MRSA

18

When do you switch from IV to oral CAP therapy?

-pt is hemodynamically stable
-pt improving clinically (cough, dyspnea)
-pt able to ingest meds
-normal functioning GI tract

19

Duration of CAP Therapy

-minimum 5 days
-afebrile 48-72 hours
-no more than 1 CAP associated sign of instability (fever, tachcayrdic, tachpneic, low SBP, low O2 sat) before discontinuation of therapy

20

HAP Mortality Rates

-30-50%

21

What pathogens cause HAP?

-P. aeruginosa
-E. coli
-Klebsiella pneumoniae
-Acinetobacter species
-Staph aureus, esp MRSA

22

Indication for Tamiflu/Oseltamivir

-tx of influenza A and B in adults and kids older than 2 weeks
-sxs no more than 2 days
-prophylaxis against influenza A or B in pts over 1 y.o

23

Tamiflu/Oseltamivir Efficacy

-reduced sxs duration by about 1 day
-begin tx w/in 24 hours
-w/in 12 hours of fever onset, decrease total illness by 3 days

24

Tamiflu/Oseltamivir AEs

-with tx: N/V, insomnia, vertigo
-with Px: HA, fatigue, cough, diarrhea

25

Tamiflu/Oseltamivir Dosage for Tx and Px

-tx: 75 mg PO BID x 5 days
-px: 75 mg po qday 7+ days

26

Indication for Zanamivir/Relenza

-tx of flu A and B in adults and kids over 7 y.o
-sxs no more than 2 days
-px against A or B in pts over 5 y.o
-DO NOT USE IN PTS w/ underlying airway disease

27

Zanamivir/Relenza Efficacy

-relieved sxs 1.5 days earlier than placebo

28

Zanamivir/Relenza AEs

-HA, N/V/D, dizziness, respiratory sxs
-may cause bronchospasm
-decreased lung fx or death in pts w/ underlying airway dz

29

Zanamivir/Relenza Dosage

2 inhalations BID x5 days

30

Amantadine and Rimantadine Indication

-both approved for tx of flu A
-neither has activity against B
-not currently recommended

31

Amantadine and Rimantadine AEs

-common: nervous, anxiety, difficulty concentrating, lightheaded, nausea, anorexia
-serious: behavioral changes, delirium, hallucinations, agitation, seizures