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PHAR 152* > Pneumonia > Flashcards

Pneumonia Flashcards

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1
Q

Describe pneumonia?

A

Acute infection of the lung parenchyma
most common cause of death due to infectin

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2
Q

In what group of people is the mortality rate higher?

A

Higher in infants - elderly - debiliated patients

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3
Q

What are the risk factors for pneumonia?

A

Alcohol abuse
Immunosuppression
lung disease
institutionalization
Age > 70

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4
Q

How does pneumonia occur?

A

1- inhalation of airborne particles
2- Aspiration of oropharyngeal material (silent or goss)
3- Hematogenous spread (S.aureus)

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5
Q

What is the most common pathogenisis of pneumonia?

A

B aspiration of oropharyngaeal material

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6
Q

Explain the respiratory defence system

A
  • Hairs lining nasal passages, ciliated
    cells, mucous production, salivary
    enzymes — all prevent foreign material
    from entering lungs
  • Have macrophages in the alveoli, PMNs, antibodies
    and complement present in lung tissues
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7
Q

True or false.
Most of the defects in the respiratory system can compromise the host defence.

A

False
All of them

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8
Q

What is epiglottal and cough reflexes affected by?

A

Alcohol
Anesthetics
Pain
Impaired consciousness
Seizures
NG tube

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9
Q

what is Tracheobranchial secretions and mucociliary transport is affected by?

A

Alcohol
smoke
anesthetics
narcotics
lung disease
viruses
OXYGEN LEVELS

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10
Q

What does a defect in the host defence lead to ?

A

Lung being exposed to increased amount of micro-organisms for sufficient period to cause inflammatory changes

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11
Q

What is the most common microorganism that causes pneumonia?(bacterial version)

A

streptococcus pneumonia

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12
Q

What is the most common microorganism in people with COPD?

A

Haemophilus influenzae

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13
Q

What is the most common microorganism causing pneumonia in young people?

A

Mycoplasma pneumoniae

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14
Q

What ist the number one cause of pneumonia in a hospital microorganism ?

A

Klebsiella pneumoniae

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15
Q

What are two conditions that are commonly associated with recurrent pneumonia?

A

COPD and HF

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16
Q

What is the most common microorganism that causes pneumonia in cystic fibrosis?

A

S. aerues

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17
Q

What are the signs and symptoms of pneumonia?

A

Abrupt onset of fever, chills, dyspnea, cough
Rust colored sputum or hemoptysis
Pleuritic chest pain (stabbing pain)
Other non-specific sx

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18
Q

What is the clinical presentation of pneumonia?

A

Tachypnea
Tachycardia
Dullness to percussion (should have a hollow sound)
Diminished breath sounds over affected area
Inspiratory crackles

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19
Q

What test is needed to diagnose penumonia?

A

Chest X-ray

look for pulmonary infiltrates or consolidation

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20
Q

What are the two algorithms used to determine if a pt should be admitted to the hospital?

A

Pneumonia severity index (PSI) - Tool of choice
CURB-65 - simpler to use, but fewer parameters

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21
Q

What are the laboratory findings of pneumonia?

A

low O2 saturations
elevated WBC
sputum sample - reveal PMNs and the causative org

one third to one half of pt report URTI preceding pneumonia

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22
Q

How to diagnose using a sputum specimen?

A

The pt needs to expectorate the deep sputum
Bronchoscopy, transtracheal aspirate, biopsy (mainly for in patients)
The normal flora will always be present, so the sample is often contaminated
Gram stain and C&S

Sputum not needed in outpatients
Inpatients - we suspect MRSA or P. aeruginosa

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23
Q

What are the other samples that we can use to diagnose

A

Blood cultures
Cultured pleural fluid
Serology (takes 4 weeks tho)
WBC
Chest x-ray - we want black. Black = air
Other - Oxygenation

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24
Q

What can be used to diagnose pneumonia?

A

Physical exam
Signs and symptoms
Chest x-ray

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25
What else must patients be able to do aside from the severity score saying that patients can be treated as an outpatient?
Take oral fluids and antibiotics Comply with outpatient care carry out activities of daily living
26
What are the goals of therapy for penumonia?
Eradicate the microorg Resolve signs and sx Reduce risk of complications and hospitalization Reduce risk of adverse events Minimize the development of antimicrobial resistance
27
What are the general tx measures for pneumonia?
Bed rest hydration nutrition (labored breathing takes alot of energy and burns calories) analgesics/antipyretics O2 for hypoxemia cough suppression (cough keeping pt up at night) drainage of empyema/abscess
28
True of false; if admitted to hospital, mortality rates increase if tx is delayed for more than 8 hours?
True
29
What are the main pathogens of pneumonia?
Streptococcus pneumoniae Haemophilus influenzae Mycoplasma pneumoniae
30
What are ABs that cover the three main pathogens of pneumonia?
Azithromycin (worried about R) Levofloxacin (worried about R)
31
What is said about fluoroquinolones as an empiric AB?
We should reserve them, use as a2nd line option when DOC doesn't work Attractive - Potent and broad spectrum with good kinetics for po Problem - resistance (esp with gram -ves)
32
What is the tx of mild to moderate CAP in adults with no comorbidities and no risk factors for MRSA or P. aeruginosa?
Amoxicillin 1000 TID Doxycycline 100mg BID Clarithromycin 500 BID or 1000mg OD Azithromycin 500mg day 1, then 250mg for 4 days OR 500mg daily for 3d *macrolides only if local pneumococcal resistance is less than 25%
33
What are the risk factors for MRSA or P.aeruginosa?
Prior respiratory isolation or MRSA or P. aeruginosa or recent hospitalization AND receipt of parenteral AB in last 90d
34
What are the comorbidities for pneumonia tx?
chronic heart, lung , liver, or renal disease diabetes mellitus, alcoholism, malignancies, asplenia AB within the last 3mo - consider switching types if significant exposure to a particular ab class
35
What are the AB for adults with comorbidities, but no risk factors for MRSA or P. aeru ?
Amoxicillin/clavulanate 500mg/125 mg TID or 875mg/125 mg BID Cefuroxime axetil 500mg BID Cefprozil 500mg BID any one beta-lactam above PLUS clarithromycin, azithromycin, or doxy OR monotherapy with: Levofloxacin 750 mg OD for 5d Moxifloxacin 400 mg OD
36
What to do for CAP in regions with high rates (25%+) macrolide resistance
Consider alternative agent including those with no comorbidities Duration of 7-14 days. there is good evidence for short therapy duration too Minimum of 5 days, be afebrile for 48-72 hr and otherwise clinically stable (azithro 3d)
37
What is clinically stable?
Good resp rate Good HR
38
What are the general guidelines when the pathogen is identified?
Adjust therapy based on the sensitivity results Choose the agent that is most effective or has the most evidence Has the fewest adverse effects Convenience and lowest cost should be considered
39
What is the duration of therapy for outpatients tx with CAP
5d providing clinical stability is reached (most pt reach it in 48-72hrs) Ability to east and normal mentation
40
What is the duration of tx for Staph aureus of Ps. aeruginosa?
7d
41
What is the main characteristic of Streptococcus pneumoniae infxn?
once shaking chill followed by by high temperature - the chill is v. intense pleuritic chest pain and headache are also common
42
Who are the patients at risk with S. pneumoniae?
Those with splenic dysfxn or asplenia, DM, renal disease, cardio-pulmonary disease
43
What is the tx for strep penumoniae?
Pen G 5-10M units/d IV or IM Oral penicillin V or amoxicillin Alternative: If allergic - cefazolin erythromycin or FQ
44
What is the tx for Pen R strep pneumoniae?
Low lvl R - Penicillin IV (HD) or amoxicillin (HD) or cefuroxime High level R - Pen G 2MU IV q6h or cefotaxime or ceftriaxone or resp. FQ When the pt is afebrile for 2-3d can switch to oral therapy
45
What is the main cause of penicillin resistance?
Reduced affinity for PBP or change in the amount of PBP present (higher dose to flood the receptors)
46
Where is staph aureus more common in? what can the org do?
Debilitated patients (lung disease) and cystic fibrosis patients Can release enzymes and endotoxins which lead to empyema and abscess
47
What are the AB active against Staph aureus?
Cloxacillin - Yes, but not for MRSA Clindamycin - MRSA and MSSA TMP/SMX - MSSA or MRSA Vancomycin - always works
48
What is the treatment for MSSA and MRSA staph aureus?
Cloxacillin 8-12 g/d IV (up to 2g q4h) Alternate: cefazolin, clindamycin or vancomycin MRSA -> vancomycin, linezolid, tigecycline
49
How long does it take to see a response in staph aureus after AB tx?
May take up to 3 weeks to see a response Cont. tx for 14-21d
50
What type of pt does haemophilus influenzae mainly target?
COPD pt Kids more common COPD Elderly
51
What are the AB tx for H. influenzae (non B-lactamase and B-lactamase)?
Non: Ampicillin 6 -8 g/d IV q6h or amoxicillin 3g/d po B-lactamase: amox/clav or 2nd gen ceph or 3rd gen ceph or FQ or azithro or clarithro or doxy
52
What is the empirical tx for aerobic gram -ve rods?
3rd gen ceph carbapenem piperacillin/tazobactam
53
Who does Ps. aeruginosa primarily target? What are the signs and sx? What may occur?
Pt with underlying lung damage or in CF Fever chills, cough, green sputum with characteristic smell Can prod necrotizing process in alveolar tissue
54
What is the tx for Ps. aeru?
piperacillin/tazobactam + cipro or AMG (tobramycin) ceftazidime + cipro or AMG Ciprofloxacin + AMG Cefepime + cipro or AMG Meropenem + cipro or AMG Only FQ that has activity is CIPRO
55
What is the tx for mycoplasma pneumoniae? And how does it present?
More viral sx Congestion sore throat, chest pain, cough triad of sx - maculopapular rash, arthritis, pneumonia Erythromycin 2540mg QID or doxy Alternate: FQ
56
Explain Legionella peneumophilia?
Aerobic gram -ve Rare in SK Loves H20 - Contaminates hot water plumbing, air conditioners, sprinklers, fountains Seen in smoker, males (50-600, alcohol use Spreads by inhaled water droplets incubation period of up to 10d Fever, chills, malaise, myalgia, headache, cough, GI probs Diagnosed by antibody titers or anitbody detection
57
What is the tx for legionella pneumophilia?
Azithromycin Alt: respiratory FQ Rifampin may be added
58
What is the tx of Chlamydophila pneumonaie? What do you see in these infxns?
Low grade fever, nonprod cough, normal WBC Doxycycline or macrolide Alt: FQ
59
What is aspiration pneumonia?
Pt aspirating gastric contents -> may cause pneumonitis (lung inflammation) Aspirated secretions creates a shift of fluid into the involved lung area, every pt will experience change in breathing, can get rapid hypoxia and shock following the massive fluid shifts
60
What else can patients experience with aspiration pneumonia?
Atelectasis, hemorrhage, and pulmonary edema Some may also develop secondary bacterial pneumonia from decreased defenses
61
How can you determine a secondary infxn? (tests)
New onset of fever Change on x-ray increased WBC Prescence of bacteria
62
When do CAP patients improve after starting ABs? Discuss x-ray resolution as well
Within 2 days Mainly feature a decrease in temp and WBC Chest x-ray takes longer - 3weeks in young healthy adults, up to 12 weeks in elderly or those with complicated infxn - follow up x-ray not routinely recommended
63
What are some indicators that are useful for monitoring drug efficacy in pneumonia?
Subjective response within 3 days Objective response: Decreased cough, dypnea, respiratory rate, fever, sputum production Improved oxygenation (indicator for alveolar function) Normalization of WBCs (decreased immune response)
64
What are some reasons why drug therapy for pneumonia can fail?
Non-adherence Complication Spread of infection Superinfection (concurrent or subsequent infections) Misdiagnosis of non-infectious causes
65
What are some indicators for drug toxicity?
Insert answer
66
What are some other monitoring considerations?
Duration of therapy Route of administration Should patient be hospitalized Adherence Other drug therapy required Non-drug therapy
67
Who benefits the most from influenza vaccines in reducing pneumonia?
Those at risk of influenza complications (old age, smokers, etc) Household contacts of high risk people Anyone
68
What pneumococcal vaccines are available in Saskatchewan?
23 valent polysaccharide vaccine: 65+ and patients with risk factors (COPD, HF, alcoholism, diabetes, etc) 13 valent polysaccharide-protein conjugate vaccine: Only certain risk groups are covered in Saskatchewan
69
What is the advantage of a polysaccharide-protein conjugate vaccine vs. a polysaccharide vaccine?
Polysaccharide vaccines do not evoke a strong immune response in young children, hence this drug is generally given to older adults
70
What is strain replacement?
Vaccines that cover x number of strains, reduce the prevalence of those strains, but other strains can take over and increase their share in the types of causative pathogens
71
Does the COVID-19 vaccine pose a concern for subsequent pneumonia?
Yes, there is a possibility for secondary infection

PHAR 152* (16 decks)

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