Lower Respiratory Tract Flashcards
(106 cards)
1
Q
Possible pathogens of community acquired pneumonia
A
s. pneumoniae
h. influence
m. pneumoniae
c. pneumoniae
legionella
2
Q
What put someone at risk for drug resistant s. pneumoniae
A
recent antimicrobial use in last 3 months >65 day care exposure alcohol use medical comorbidities
3
Q
s. pneumoniae desriptions
A
gram pos diplococci
most common cause or fatal CAP
4
Q
Antimicrobial for drug resistant s. pneumoniae
A
High dose Amox 3-4 g/day
Resp fluroquinolones: moxi, levo, gemifloxacin
telithromycin
5
Q
Risk with fluroquinolones
A
tendon rupture
6
Q
Antimicrobial for non resistant s. pneumo
A
macrolide: azithro, clarithro, erythro
Amox 1.5-2.5 g/d
cephalosporins
tetracyclines: doxy
7
Q
Risk with macrolide use
A
QT prolongation and increased risk of CV death
8
Q
H. influenzae description
A
gram neg bacillus
common with tobacco related lung disease
9
Q
What is h. influenzae resistant to?
A
beta-lactamase
10
Q
Antimicrobial for h. influenzae
A
those stable in the presence of beta-lactamase cephalosporins amoxicillin-clavulanate macrolids: "mycins" respiratory fluoroquinolones testracyclines: doxy
11
Q
M.pneumoniae and c.pneumoniae description
A
not revealed by gram stain
cough transmitted
from close proximity
12
Q
Antimicrobials not effective with m. and c. pneumoniae
A
beta lactams (cephalosporins and pcn
13
Q
Antimicrobials effective with m. and c. pneumoniae
A
macrolides “mycins”
fluoroquinolones : not clarithromycin
tetracyclines
14
Q
Legionella sp description
A
not revealed by gram stain
contracted by inhaling mist or aspirating liquid from a water source
NOT person to person
15
Q
candidate for out pt thearpy for CAP
A
previously healthy
no antimicrobials in last 3 months
younger
16
Q
what is the likely pathogen in the healthy with CAP
A
s. pneumoniae with low DRSP
atypicals: m. and c. pneumoniea
influenza A&B
RSV
adenovirus
parainfluenza
17
Q
outpt tx for the healthy with CAP
A
macrolide: azithro, clarithro, erythro
doxy
18
Q
Comorbidities that could be present with CAP
A
COPD DM renal failure heart failure asplenia alcoholism immunosuppressing meds
19
Q
likely pathogens in those with comorbidities and CAP
A
s. pneumoniae with high DRSP risk
h. influenzae
m. and c. pneumoniae
legionella
respiratory viruses
20
Q
outpt tx for those with comorbidities and CAP
A
fluoroquinolones: moxi, gemi, levo macrolide plus beta lactam azithro/clarithro + HD amox claculanate certriaxone cefpodoxime cefuroxime
21
Q
Recommended dose of levoflaxacin
A
750mg x 5 days
22
Q
High dose Amox facts
A
does not cover DRSP or atypicals so you must add another with
23
Q
Cephalosporin facts
A
does not cover DRSP or atypicals so you must add another with
24
Q
Doxy facts
A
covers atypicals but DRSP by itself
25
Normal range for WBC
6,000-10,000
26
Components of a WBC
```
neutrophil
lymphocyte
monocyte
Eosinophil
basophil
```
27
point of action with neutrophil
bacteria
28
point of action with lymphocyte
virus
29
point of action with monocyte
debris
30
point of action for eosinophil
allergens
parasites
wheezes
31
point of action for basophils
anaphylaxis
32
Right shift =
viral
33
Left shift =
bacterial
34
WBC response to viral infection
normal TWBC
Normal bands and segs
elevated lymphs
35
WBC response to bacterial infection
```
elevated TWBC (leukocytosis)
elevated neutrophils
elevated bands (>4%)
normal lymphs (25-45%)
```
36
substrate defined
a med or substance that is metabolized by the isoenzyme utilizing this enzyme in order to be modified so it can reach drug site
37
example of a substrate
CPY450 substrates: sildenafil, atorvastatin
| simvastatin, venlafaxine, alprazolam
38
inhibitor defined
blocks the activity of the isoenzyme limiting the substrate section
increasing level of substrate
39
example of inhibitor
CPY450 inhibitors: erythro, claithro, telithromycin
40
If a substrate and inhibitor are given together
can increase the substrate
41
inducer defined
accelerates the activity of the isoenzyme so that substrate is pushed out the exit pathway
reducing substrate levels
42
example of inducer
St. Johns wort
oral contraception
cyclosporine
can cause tx failure of substrate
43
likely causative organism in CAP
s. pneumoniae and respiratory viruses
44
If someone is pregnant and has atypical pneumonia tx with
azithro or erythro
45
If low risk and has atypical pneumonae and PCN allergic
try doxy x 7 days
46
If someone is a smoker and has multiple comorbidities and atypical pneumonae tx with
5 day levofloxacin
47
physical exam findings with pneumonia
consolidation and pleural inflammation/pleurisy
48
detecting consolidation on physical exam
dullness to percussion: dense tissue sounds dull
| increased tactile fremitus: increased with increased density
49
detecting pleural inflammation on physical exam
pt report of sharp, local pain worse with a deep breath or cough
sounds like stepping into fresh snow when there is a friction rub
50
When to do a rpt chest x-ray following pneumonia
6-8 weeks
51
What is the most common pathogen of bronchitis
respiratory infections
52
other causes of bronchitis
m. pneumoniae
c. pneumoniae
b. pertussis
53
Tx of bronchitis from virus
anticholinergic bronchodilator: ipratropium bromide
inhaled beta agonist: albuterol
corticosteroid
54
Tx of bronchits from other organisms
macrolide or tetracycline
55
Asthma defined
chronic disorder characterized by variable and recurring symptoms, airway obstruction, bronchial hyperresponsiveness and inflammation
56
make the dx of asthma when
recurrent cough, wheeze, SOB
symptoms worse at night or with exercise or irritants
increase in FEV1 >12% after giving beta agonist
57
what test is needed to officially make dx of asthma
spirometry
| peak flow used for monitoring, not dx
58
3 goals of asthma therapy
reduce impairment
reduce risk
optimize health and function
59
Assessment of asthma
classify the severity
identify precipitating factors
identify pts at risk for exacerbations or death
assess knowledge and skills
60
visit frequency in a person with asthma
3-6 months if well controlled
2-6 weeks if not well controlled
2 weeks if very poorly controlled
61
inhaled corticosteroids
```
mometasone
fluticasone
budesonide
beclomethasone
ciclesonide
```
62
inhaled corticosteroids and long acting beta agonists
budesonide + formoterol
fluticasone + salmeterol
mometasone + formoterol
63
Tx with ICS/LABA cautions
should not be used in those who do not respond to inhaled corticosteroids alone
64
Leukotriene modifiers with asthma
montelukast (Singulair)
| help with allergic rhinitis
65
Is an inhaled corticosteroid systemically absorbed?
no, most goes to the lungs
66
reliever meds in asthma
SABA with onset 1 min and lasting 4 hours
| systemic corticosteroids with onset in 6 hours
67
what would suggest a need for better control in asthma
use of SABA >2 days/week for anything other than exercise
68
anticholinergics in ashtma tx
used for the prevention NOT tx of bronchospasm
| "bromide"
69
theophylline in asthma tx
increases cyclic AMP
| narrow therapeutic index
70
intermittent asthma classification
< 2 days/week
not waking up more than 2 times/hs/month
using SABA 80% predicted
FEV/FVC normal
71
mild persistent asthma classification
```
> 2days/week but not daily
waking up at hs 3-4x/month
needing SABA >2x/week but not daily
minor activity limitation
FEV >80%
FEV/FVC normal
```
72
mod persistent asthma classification
```
daily symptoms
waking up at hs > 1x week
daily use of SABA
some activity limitation
FEV >60 but <80
FEV/FVC reduced by 5%
```
73
severe persistent asthma classification
```
multiple times in a day
HS waking every night
need for SABA multiple times daily
extreme activity limitation
FEV 5%
```
74
level of asthma severity is determined by
impairment and risk
| impairment by asking previous 2-4 weeks and spirometry
75
what approach is used in managing asthma
stepwise approach
| steps 1-6
76
approach to intermittent asthma
step 1 : SABA prn
77
approach to mild persistent asthma
step 2: low dose ICS
| could do cromolyn, LRTA
78
approach to mod persistent asthma
step 3: low dose ICS plus a LABA or a medium dose ICS
79
approach to sev persistent asthma
step 4: med dose ICS plus LABA
| refer to specialist for anything step 4 and above
80
step 5 in asthma approach
high dose ICS plus LABA
81
step 6 in asthma approach
high dose ICS plus LABA plus corticosteroids
82
those eligible for step down in asthma tx plan
asthma well controlled for 3 months
83
you would anticipate this finding on an acute asthmatic or COPD flare
hyperresonance
| trouble getting air out
84
other findings with air trapping
decreased tactile fremitus
wheeze (expir first then inspir)
low diaphragms
increased AP diameter
85
COPD described
preventable and tx disease
its pulmonary components is characterized by airflow limitation that is not fully reversible
the airflow limitation is progressive
86
consider a dx of COPD if
progressive dyspnea
chronic cough
sputum production
hx of exposure to risk factors suchs as smoke, pollution
87
How is degree of limitation assessed in COPD
spirometry
FEV/FVC < 70% post bronchodilator confirms limitation
classification is then based on FEV1 alone
88
Mild airway limitation in COPD
FEV1>80%
89
mod airway limitation in COPD
FEV1< 80%
90
severe airway limitation in COPD
FEV1<50%
91
very severe airway limitation in COPD
FEV1<30%
92
Med management for low risk COPD with less symptoms
anticholinergic: ipratropium PRN
SABA prn
LABA
93
med management for low risk COPD with more symptoms
LA anticholinergic: tiotropium
LABA: salmeterol
or a combo of the 2
94
med management for high risk COPD with less symptoms
ICS: fluticasone, budesodine
plus
LABA or LA anticholinergic
95
med management for high risk COPD with more symptoms
ICS plus LABA or anticholinergic
96
goal of long term ashtma therapy in COPD
ensure adequate oxygen delivery by increasing PaO2 at rest to 60mm Hg and producing sat of 90% or >
97
COPD exacerbation defined
an event in the natural course of the disease characterized by a change in the pts baseline dyspnea, cough and or sputum
98
Tx of COPD exacerbation
bronchodilators suchs as SABA or LABA
If FEV < 50% add systemic steroid
add inhaled coritocosteroid
stop smoking
99
Antimicrobial therapy in COPD if
increased dyspnea
increased sputum volume
increased sputum purulence
100
For mild to mod COPD exacerbation what abx
Amox
Doxy
Cephalosporin
Bactrim
101
For severe COPD exacerbation what abx
```
Amox-claulanate
Cephalosporin
Azithro
Clarithro
Fluroquinolone
may need x-ray if fever of low SaO2
```
102
What is consistend with the dx of all stages of COPD
FEV1/FVC ration < 0.70
103
Classic presentation of pneumothorax
```
sudden onset
pleuritic chest pain
difficulty breathing
diminished breath sounds
decreased tactile fremitus and hyperresonance
```
104
inhaled anthrax clinical presentation
low grade fever, non productive cough
| on x-ray see widened mediastinum due to hemorrhage into bone
105
cutaneous anthrax clinical presentation
pustular skin lesion that eventually forms ulcer and eschar
106
injection site care following vaccinia "smallpox" vaccine
keep covered
