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Pneumonia/influenza pharm Flashcards

(58 cards)

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1
Q

What are the types of pneumonia?

A

CAP

Nosocomial - includes:
1. HAP (>=48 hours after admission); includes…
2. VAP (>= 48 hours after endotracheal intubation)

Atypical

Aspiration

Chemical pneumonitis

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2
Q

What organisms cause atypical pneumonia?

A

Atypical bacterial pathogens:
- Legionella
- Mycoplasma
- Chlamydia
- Coxiella Burnetii

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3
Q

What is chemical pneumonitis?

A

Inflammation of the lungs or breathing difficulty due to inhalation of chemicals

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4
Q

What is the first step in CAP management?

A

Outpatient or inpatient care?

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5
Q

When is microbiologic testing NOT necessary?

A

ambulatory care setting with mild disease;
empiric therapy is usually successful

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6
Q

What are some co-morbidities to look out for with pneumonia?

A

DM
Heart
Lung
Liver
Kidney
AUD

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7
Q

What are the most common bacterial causes of CAP in normal, healthy patients?

A

Strep pneumoniae
Haemophilus influenzae
Atypicals

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8
Q

What are the most common causes of CAP in patients with comorbidities, recent AB use, smokers, and elderly patients?

A

Beta lactamase producing H. flu
Moraxella catarrhalis
MSSA

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9
Q

What are the most common bacterial causes of pneumonia in patients with structural lung disease? (Advanced COPD)

A

E. Coli
Klebsiella

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10
Q

What general type of antibiotic should be used to target S. Pneumoniae?

A

Beta Lactam

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11
Q

What general type of antibiotic should be used to target atypical pathogens?

A

Macrolides or doxycycline

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12
Q

REVIEW - what groups are what bacteria?

A

Gram +:
MRSA
Staph
Strep
Enterococcus

Gram -:
E. coli
H. flu
M. cat
Pseudomonas
Atypicals (mycoplasma, chlamydia, rickettsia, legionella, mycobacteria)
ESBL

Anaerobes:
Strep (+)
Clostridia (+)
Bacteroides (-)

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13
Q

Beta - Lactams - important points?

A

All the -cillins
Cephalosporins get more gram negative coverage as generations go up
-3rd gen: cefotaxime & ceftriaxone
-4th gen: cefepime

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14
Q

What are the macrolides?

A

erythromycin
clarithromycin
azithromycin

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15
Q

Vancomycin is a ___?

A

glycopeptide

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16
Q

Which ABx inhibit cell wall synthesis?

A

Beta-lactamases + vancomycin

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17
Q

Which ABx inhibit bacterial protein synthesis?

A

Aminoglycosides
Macrolides*
Tetracycline
Linezolid
Clindamycin

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18
Q

Which ABx inhibit nucleic acid synthesis?

A

Fluoroquinolones
Rifampin

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19
Q

Which ABx inhibit folic acid synthesis?

A

Sulfonamides
Trimethoprim

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20
Q

Which ABx inhibit free radical formation?

A

Metronidazole

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21
Q

What side effects will result from most the majority of ABx?

A

N/V/D
Rash
Thrush

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22
Q

Cephalosporins cause ___?

A

C Diff

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23
Q

Macrolides cause ____?

A

Hepatitis
QT interval prolongation

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24
Q

Quinolones cause ___?

Study These Flashcards
A

QT prolongation
tendonitis
convulsions

25
Vancomycin causes ___?
Red man syndrome
26
Tetracyclines cause ___?
hepatotoxicity stained teeth photosensitivity dysphagia
27
What are the top 3 options for treating CAP if no comorbidities? (outpatient)
Amoxicillin Doxycycline Clarithromycin
28
What should be given for a patient with CAP + comorbidities? (out-patient)
Option 1 - respiratory quinolone monotherapy Option 2 - Beta-lactam PLUS macrolide of doxycycline
29
How should non-severe CAP be treated inpatient?
*IV not oral! Option 1: monotherapy with a respiratory quinolone Option 2: Beta-lactam + macrolide *if isolate P aeruginosa, make sure you use beta-lactam that is anti-pseudomonal
30
How should severe CAP be treated inpatient?
*IV not oral! Option 1: Beta-lactam + macrolide Option 2: Beta-lactam + respiratory fluoroquinolone (levo or moxi)
31
How long should a patient with CAP be treated (w/ specific cases)?
min - 5 days, continue until patient is clinical stable Legionella - azithromycin x 3 days MRSA or P. aeruginosa - 7 days
32
When is a routine follow-up CXR NOT recommended?
symptoms resolution in 7 days
33
When is influenza season and peaks?
October to May Peak December and February
34
What populations are at a high risk for developing influenza complications
1. Person ages < 5 years old 2. Persons with chronic medical conditions 3. Immunosuppressed/ immunocompromised 4. Women who are pregnant or <= 2 weeks post-partum 5. Children and adolescents aged <= 18 years old who are taking meds with salicylates 6. American indian/alaskan native persons 7. Residents of nursing homes or chronic care facilities 8. Persons with extreme obesity (>=40 BMI)
35
What are the two influenza tests and which should be used in hospitalized patients for greater S&S?
rapid influenza diagnostic tests Rapid molecular assays ***
36
What are the benefits of antiviral influenza treatment?
1. Early treatment shortens duration of symptoms/hospitalization 2. Reduces risk of influenza-related complications *should be initiated early as possible (w/i 48 hours best)
37
In what patients is antiviral treatment indicated in?
Hospitalized patients Severe complicated/progressive illness Increased risk of influenza complications
38
Which antiviral is recommended for patients with severe complicated or progressive illness who may or may not be hospitalized?
oral oseltamivir
39
What are the options for influenza antiviral treatment?
1. Neuraminidase inhibitors: - Oseltamivir - Zanamivir - Peramivir 2. Baloxavir Marboxil - prodrug - endonuclease inhibitor - LONG HALF LIFE - single dose
40
What are the antiviral options for acute uncomplicated outpatients
1. oral oseltamivir 2. inhaled zanamivir 3. IV peramivir 4. oral baloxavir
41
What is the preferred antiviral for pregnant patients
oral oseltamivir
42
Severe/complicated in patient NOT hospitalized preferred antiviral?
oral oseltamivir
43
What is Oseltamivirs dosage for treatment
Adults and children >=13 years: 75mg PO BID x 5 days Age 2 weeks-12 years: weight-based dose BID x 5 days
44
What is Oseltamivirs dosage for chemoprophylaxis?
Adults and children >=13 years: 75 mg po daily Age >= 1 years: weight-based dose daily
45
What is Oseltamivirs side effects and considerations for use?
GI upset, insomnia, behavioral changes
46
What antivirals are NOT recommended for prophylaxis?
peramivir and baloxavir
47
What is the route and duration for each antiviral (treatment)?
1. oseltamivir - oral (5 days) 2. zanamivir - inhaled (5 days) 3. peramivir - IV (single dose) 4. Baloxavir - oral (single dose)
48
What is the duration for antiviral prophylaxis?
7 days after last known exposure For outbreaks in an institution - min 2 weeks continuing 1 week past last identified case baloxavir is approved for post-exposure prophylaxis if 12+
49
What is the relationship between the antivirals and the ILAIV?
vaccine efficacy decreased: O and Z - wait 48 hours P - wait 5 days B - wait 17 days If not followed, should revaccinate with alternative vaccine
50
What class and meds are not recommended for influenza treatment?
Adamantanes - amantadine - rimantadine
51
What are the pneumococcal vaccines?
PCV13 PCV15 PCV20 PCV21 PPSV23
52
What are the guidelines for the influenza vaccine?
1. Annual for all patients >= 6 months (inactivated influenza vaccine) 2. only 18+ - recombinant vaccine 3. adjuvant and high dose inactivated - only 65+ 4. approved in pregnancy 5. Still acceptable to give if egg allergy
53
Who should NOT get the flu shot?
1. <6 months 2. severe life threatening allergies to ingredients (not egg) 3. severe previous allergic reaction to a dose of influenza vaccine
54
What brands of flu vaccine can be given according to age group?
Fluzone - 6-35 months Fluarix - 18+ FluLaval - 18+ Fluvirin - 4+ Afluria - 18+ FluMist - 2-49 years (only NS)
55
Childhood guidelines for Pneumococcal conjugate vaccine?
All children < 5 years: -2 mos -4 mos -6 mos -12-15 mos
56
What pneumococcal vaccine is appropriate for adults 50 years of age and older?
PCV15 PCV20 or PCV21 *no pneumococcal vaccine previously If PCV15 is chosen, PPSV23 must be given one year later Minimum 8 weeks can be considered if: -Immunocompromising condition -cochlear implant -cerebrospinal fluid leak
57
What are the pneumococcal vaccine guidelines in adults 65+
-Shared clinical decision making -Option to get PCV20 or PCV21 or to not get additional OR PCV 20 or PCV21 can be administered if they have received both: -PCV13 at any age -PPSV23 at 65+
58
What are the guidelines for immunocompromised patients with specific conditions aged 19-49
PCV20 or 21 * wait 1 year if PPSV23 or PCV13 alone in the past *wait 5 years if PCV13 + PPSV23 in the past

Pulmonary Unit (12 decks)

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