Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics IV > Upper Respiratory Infection - Block 2 > Flashcards

Upper Respiratory Infection - Block 2 Flashcards

1
Q

Most URTIs derive from?

A

Viral etiologies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common infection for pediatric patients receiving antibiotics in the US?

A

Acute otitis media: 6-24 months olds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the subtypes of otitis media?

A
  1. Aucte otitis media
  2. Otitis media with effusion
  3. Chronic otitis media
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the common pathogens of AOM? MOA?

A
  1. Strep pneumoniae: alteration of PBP
  2. H. flu: production of b-lactamases
  3. Moraxella catarrhalis: production of b-lactamases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the appearances of a non-infected vs otitis media?

A

Non-infected: thin, clear tympanic membrane
Otitis media: bulging, erythematous tympanic membrane from fluid build up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why are children more susceptible to ear infections?

A

Shorter, more horizontal ETs -> increased bacteria entry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the s/s of AOM?

A

Otalgia: moderate to severs if pain is ≥48H
Fever: Severe if ≥39C or 102.2F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the diagnostic criteria for AOM?

A

Middle ear effusion and 1 of the following:
1. Moderate-severe bulging of tympanic membrane or new onset otorrhea
2. Mild bulging of tympanic membrane AND onset of ear pain within last 48H OR intense erythema of tympanic membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the screening tool for middle ear effusion?

A

pneumatoscopy and/or tympanometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the difference between AOM and otitis media with effusion?

A

Otitis media with effusion: has the fluid without s/s of acute ear infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pharm tx for OM with effusion?

A

ABX is not necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

First line treatment for AOM?

A

Amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Consider change to current treatment plan, if complications develop or symptoms worsen within ___ days?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is initial observation?

A

Only initiate ABX if sx worsen/decline within 48-72H of sx onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who qualifies for initial ABX?

A
  1. Children ≥ 6 months with AOM who present with severe symptoms (i.e., toxic-appearing, persistent ear pain ≥ 48 hours , or temperature ≥ 39°C or 102.2°F)
  2. Children ≥ 6 months with AOM and otorrhea
  3. Children aged 6 – 23 months with bilateral AOM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Who qualifies for initial observation?

A
  1. Children ≥ 6 months with non-severe unilateral AOM without otorrhea
  2. Children ≥ 2 years with bilateral AOM without otorrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pharm tx of initial diagnosis of AOM?

A
  1. Amoxicillion
  2. Augmentin
  3. Azithromycin or Clindamycin
  4. Cefdinir, Cefuroxime, Cefpodoxime
  5. Ceftriaxone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pharm tx for AOM tx failure at 48-72H?

A

Augmentin or Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How long do you need to reconsider tx plan?

A

symptoms worsen or decline with 48 - 72 hours of onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is excluded from amoxicillin tx?

A
  1. Recieved amoxicillin in the past 30 days
  2. Have concurrent purulent conjunctivitis
  3. Have a hx of recurrent infections unresponsive to amoxicillin

These patients get Augmentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why is amoxicillin considered the first line?

A

Efficacious for S. pneumoniae
* More spontaneous resolution with H flu and Morexella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the advantages of using Augmentin in AOM?

A

Patients with concurrent purulent conjuntivitis and AOM are likely infected by non-typeable H. flu -> requiring b-lactamase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

AOM tx for non severe penicillin allergies?

A

Second gen: Ceftin (cefuroxime)
Third gen:
* Omnicef (cefdinir)
* Vantin (Cefpodoxime)
* Rocephin (Ceftriaxone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Apart from amoxicillin what are the advantages of using ceftriaxone over other cephalosporins for AOM?

A

Ceftriaxone is the only ceph option that achieve a drug concnetration above MIC for >40% of the dosing interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Types of IgE mediated rx?

A

anaphylaxis, angioedema, wheezing, laryngeal edema, hypotension, hives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Types of serious delayed rx?

A

SJS, TEN, cytopenia

28
Q

Tx for AOM with severe penicillin allergy? SOA?

A
  1. Azithromycin (has activity for all 3)
  2. Clindamycin (NO activity against H flu or M. cat)
29
Q

When would you consider adjunct therapy for AOM?

A
  1. ABX doesn’t reduce pain in initial 24H of tx
  2. Pain continues for 3-7 days while on ABX
30
Q

What are the recommended adjuct meds for AOM? Dosing?

A

Tylenol:
* WBD: 10-15 mg/kg Q4-6H, don’t exceed 5 dose/24H
* Max DD: 75 mg/kg/d Don’t exceed 4g/d

Motrin:
* WBD: 4-10 mg/kg Q6-8H
* Max: 600 mg/dose
* Max DD: 2.4 g/d

31
Q

Duration of AOM therapy?

A

Penicillin and cephalosporin (except Rocephin):
* <2YO, with perforation or recurrent AOM: 10 days
* ≥ 2YO, no perforation or hx of recurrent AOM: 5-7 days

Azithromycin: 5 days
Ceftriaxone: 1-3 days

32
Q

When do you follow up with AOM tx?

A

Within 48-72H

If sx worsen:
* Initial observation occurred: initiate ABX
* Initiated ABX: change therapy due to Hflu and Mcat risk

33
Q

Common pathogens of ABRS?

A
  1. S. pneumoniae
  2. H. influenzae
  3. M. catarrhalis
34
Q

ABRS commonly affect what?

A

Maxillary and ethmoid sinuses

35
Q

What are the presentations of ABRS?

A
  1. Onset with persistent signs or sx, lasting for ≥10 days
  2. Onset with severe sx for 3-4 consecutive days
  3. Onset with worsening sx lasting 5-6 dyas (double sickening)
36
Q

Improvement of viral rhinosinusitis should be seen in ___ days?

A

7-10

37
Q

What is first line for ABRS?

A

Child: Augmenten 45 mg/kg/day (OR) 90 mg/kg/day, PO divided in 2 doses

Adults: Augmenten 500/125mg PO TID (OR) 875/125mg PO BID (OR) 2,000/125mg PO BID

38
Q

RF for pneumococcal resistance?

A
  1. Living in geographic regions with rates of penicillin-non-susceptible S. pneumoniae
  2. Age ≤2YO or ≥65YO
  3. Attendance at daycare
  4. Recent hospitalization within the past 5 days
  5. ABX within the past month
  6. Immunocompromised px
  7. Multiple comorbidities
  8. Severe infection
39
Q

Identify medications for symptomatic management of ABRs?

A
  1. OTC analgesics for pain and fever
  2. OTC products for nasal drainage and inflammation
  3. Don’t use products that excessively dry nasal mucosa or clear secretions (sudafed, afrine, antihistamines)
40
Q

What is the initial empiric tx for ABRS in children first line?

A

Augmentin

41
Q

What do you give for ABRS if child presents with b-lactam allergy?

A

Non-type 1 allergy: Clindamycin + cefixime or cefpodoxime

Type 1 allergy: Levofloxacin

42
Q

Dose of Augmenin for ABRS?

A

45 mg/kg/day (OR) 90 mg/kg/day, PO divided in 2 doses

43
Q

If a child has failed ABRS tx or show resistnce, what do you use?

A

Augmentin: 90 mg/kg/day, PO divided in 2 doses
Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime)
Levofloxacin

44
Q

If a child has severe ABRS requiring hospitalization, what do you use?

A

Augmntin
Ceftriaxone
Cefotaxime
Levofloxacin

45
Q

What do you give for ABRS if an adult presents with b-lactam allergy?

A

Non type 1 allergy: Doxycycline
* Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime)

Type 1 allergy: Doxycycline, Levofloxacin, Moxifloxacin

46
Q

If an adult has failed ABRS tx or show resistnce, what do you use?

A

Augmentin
Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime)
Levofloxacin
Moxifloxacin
Doxycycline

47
Q

If an adult has severe ABRS requiring hospitalization, what do you use?

A
  1. Ampicillin-sulbactam
  2. Ceftriaxone
  3. Cefotaxime
  4. Levofloxacin
  5. Moxifloxacin
48
Q

Duration of therapy for ABRS? Evaluation?

A

Adults: 5-7 days
Children: 10-14 days

Reassess in 48-72 hrs

49
Q

What is most common sx of acute pharyngitis?

A

Sore throat primarily derived from viral etiology

50
Q

What is the pathogen causing acute pharyngitis?

A

S. pyogenes (Group A b-hemolytic Strep. pyogenes)

51
Q

Who are more susceptible to acute pharyngitis?

A
  1. Children 5-15 YO
  2. Parents of school aged children
  3. Individuals who work with children
52
Q

How long is the incubation period of GAS?

A

2-5 days

53
Q

Untreated GAS patients are infectious for how long? Treated patients?

A

Untreated: During acute illness and 7 days after
Treated: 24H after starting ABX

54
Q

most common bacterial cause of acute pharyngitis

A

GAS

55
Q

Presentation of viral pharyngitis?

A
  1. Conjunctivitis
  2. Cough
  3. Coryza: inflammation of mucous membrane in the nose
56
Q

What are the presentations of bacterial pharyngitis?

A
  1. SOre throat
  2. Painful swallowing
  3. Fever
  4. HA
  5. N/V
  6. Erythema/inflammation
  7. Red swollen uvula, petchiae on soft palate
57
Q

Lab tests for GAS?

A
  1. Throat swab and culture (gold standard)
  2. Rapid antigen detection test (more practical)
58
Q

Describe the Centor criteria?

A

≥ 3 Centor criteria -> test for GAS
< 3 Centor criteria -> GAS unlikely; no testing necessary
* DOESN’T replace GAS testing

Can’t cough, exudate, nodes, temp >38C, Young or old
* <15YO: +1 point
* >44YO: -1 point

59
Q

If RADT produces positive (+) result for the patient:

A

Pateint has GAS pharyngitis

60
Q

If RADT produces negative (-) result in children or adolescents:

A

Recommend a throat swab to confirm

61
Q

If RADT produces negative (-) result in adult patient:

A

NOT necessary to confirm results with throat culture -> patient is not likely to have GAS

62
Q

What is the preferred ABX for GAS?

A
  1. penicillin VK
  2. Penicillin G benzathine
  3. Amoxicillin
63
Q

What is the preferred ABX for GAS with non-type 1 allergy?

A
  1. Cephalexin
  2. Cefadroxil
  3. Cefuroxime
  4. Cefpodoxime
  5. Cefdinir
  6. Cefixime
64
Q

What is the preferred ABX for GAS with type 1 allergy?

A
  1. Clindamycin
  2. Azithromycin
65
Q

What is the duration of therapy for GAS?

A

Penicillin V, cephalosporin, clindamycin, clarithromycin: 10 days
Azithromycin: 5 days
Penicillin G benzathine: 1 day

66
Q

Evaluation and follow up with GAS tx?

A

Without ABX: resolution 3-4 days
With ABX: resolution is earlier

Follow-up testing generally is NOT necessary, unless patients remains symptomatic 2-7 days after finishing initial antibiotic therapy.

Therapeutics IV (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions