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Flashcards in Sinusitis and Bronchitis Deck (36)
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1

Clinical presentation of acute bacterial rhinosinusitis

Onset with persistent signs or sx, lasting from greater than or equal to 10 days without any evidence of clinical improvement
Onset with severe signs or sx of high fever and purulent nasal drainage or facial pain lasting for at least 3-4 consecutive days at the beginning of the illness
Onset with worsening signs or symptoms characterized by new-onset fever, headache, or increase in nasal discharge

2

S/Sx (examples) of acute bacterial rhinosinusitis

Purulent anterior nasal d/c
Nasal congestion
Facial congestion
HA

3

Desired outcome for rhinosinusitis

Reduce s/sx
Limit abx tx
Eradicate infection
Minimize duration of illness
Prevent complications
Prevent progression

4

What is the first line tx for acute bacterial rhinosinusitis?

Augmentin

5

Nonpharmacologic therapy for nonbacterial rhinosinusitis

Nasal decongestant sprays
-Phenylephrine and oxymetazoline
Oral decongestants

6

Nonpharmacologic therapy for acute bacterial rhinosinusitis

Decongestants and antihistamines are not recommended
Intranasal saline irrigation
Intranasal corticosteroids

7

When is high-dose augmentin preferred in acute bacterial rhinosinusitis?

Geographic regions with high rates of invasive pcn-nonsusceptible S. pneumoniae
Severe infection
Attendance at daycare
<2 yrs or <65 yrs
Recent hospitalization
Abx use within the last mo
Immunocompromised persons

8

Pcn allergy (children) tx for acute bacterial rhinosinusitis

Levofloxacin
Clindamycin + cefixime or cefpodoxime

9

Pcn allergy (adults) tx for acute bacterial rhinosinusitis

Doxycycline
Levofloxacin
Moxifloxacin

10

Adverse effects of Levofloxacin

Tendon rupture
Cartilage growth hindrance

11

Side effects of doxycycline in children

Bone growth abnormalities
Tooth discoloration

12

What are FDA guidelines regarding acute sinusitis, acute bronchitis, and URI tx?

No FQs
If you tried everything and it still doesn't work, go to FQs

13

Duration of therapy for acute bacterial rhinosinusitis

10-14 days courses (uncomplicated rhinosinusitis, children)
5-7 days (adults)
Reevaluate and initiate alternative antibiotics if symptoms persist or worsen after 48 to 72 hours of appropriate antibiotic therapy

14

What is the hallmark symptom of acute bronchitis?

Cough

15

Goals of acute bronchitis therapy

Provide comfort
Treat dehydration and respiratory compromise

16

Approach to acute bronchitis tx

Symptomatic and supportive

17

Pharmacologic therapy for acute bronchitis

Mild analgesic-antipyretic therapy
-ASA
-Acetaminophen
--No longer preferred by pediatricians
-Ibuprofen
--Use as antipyretic has increased
No sufficient evidence for beta 2 agonist or corticosteroid
Dextromethorphan may assist with persistent cough
Routine use of abx is discouraged

18

When should you use ibuprofen with caution?

Children < 6 mos
Elderly
Poor renal fxn

19

Chronic bronchitis

Most often a component of COPD
Presence of a chronic cough productive of sputum lasting > 3 consecutive months/year for 2 consecutive years

20

Contributing factors to chronic bronchitis

Cigarette smoking
Occupational exposure
Environmental pollution
Host factors

21

S/sx of chronic bronchitis

Excessive sputum expectoration
Cough
Cyanosis

22

Physical exam of chronic bronchitis

Chest auscultation
Hyperresonance on percussion
Nl vesicular breathing sounds ar diminished

23

Chest radiograph of chronic bronchitis

Barrel chest
Depressed diaphragm with limited mobility

24

Lab tests for chronic bronchitis

Erythrocytosis (increased hematocrit)

25

Pulmonary function tests for chronic bronchitis

Decreased vital capacity
Prolonged expiratory flow

26

Gold 1 criteria for COPD

Mild
FEV greater than or equal to 80% predicted

27

Gold 2 criteria for COPD

Moderate
FEV1 50-80% predicted

28

Gold 3 criteria for COPD

Severe
FEV1 30-50 predicted

29

Gold 4 criteria for COPD

Very severe
FEV1 <30% predicted

30

Common bacterial pathogens in chronic bronchitis

H. influenzae
M. catarrhalis
S. pneumoniae
E. coli
Enterobacter
Klebsiella
P. aeruginosa