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Pharm Exam 4, URI, LRI, URI, PNE, abx, STD, Seizure, HA, Osteo > URI > Flashcards

URI Flashcards

(47 cards)

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1
Q

Acute Otitis Media is defined as

A

rapid developing, symptomatic middle ear infection with effusion or presence of fluid

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2
Q

Common bacterial causative agent for AOM

A

S. Pneumonae, H. influenzae, M catarrhalis

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3
Q

First line therapy for AOM

A

Amoxicillin x 10d

2m-5y 80-90mg/kg/d divided q12hr

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4
Q

Otitis Media with effision is defined as

A

presence of middle ear fluid without symptoms of acute illness

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5
Q

Common viral causative agents

A

RSV, influenza, parainfluenza, enterovirus, rhinovirus, adenovirus

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6
Q

Risk factors for OM

A 
Native American or Inuit
GERD
socioeconomic status
male
recent viral infection
age of <1yo
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7
Q

AOM clinical presentation young children

A

ear tugging, irritable, poor sleeping, poor eating habits

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8
Q

AOM clinical presentation for older children

A

ear pain, ear fullness, hearing impairment

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9
Q

Signs of AOM

A

some pt have fever, middle ear effusion, otorrhea, bulging TM, limited or absent mobility of TM, redness of TM, cloudy TM

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10
Q

AOM dx

A 
-moderate to severe bulging of TM
or
-new onset of otorrhea not due to OE
or
-mild bulging of the TM AND recent onset of ear pain or redness of TM (<48hr)
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11
Q

AOM antibiotic therapy- who gets treated?

A

ALL children <6m with suspected AOM
Pt with severe SS no matter the age
102.2 >fever, persistent ear pain or inability to follow up
children <2y with bilateral AOM
For all others, close observation and follow up in 2-3 days- abx if SS have not improved at that time

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12
Q

First line therapy if previous AOM <30d

A

Augmentin 80-90mg/kg/d divided q12hr x10d

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13
Q

First line therapy if allergic to PNC

A

Cephalosporin - cefuroxime, cefdinir, cefpodoxime PO

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14
Q

Type 1 PCN allergy is…

A

hives, anaphylaxis

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15
Q

non-type 1 pnc allergy is…

A

rash

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16
Q

Preferred oral cephalosporin?

A

Cefdinir

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17
Q

Observational treatment with AOM is indicated when…

A

pt is 6m-2y with mild SS or uncertain dx
pt >2yo with uncertain dx

If SS get worse or don’t go away in 48-72, concider abx therapy

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18
Q

What supplements can not be taken with cephalosporins

A

Iron, antacids. Separate by 2 hours

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19
Q

Adjunctive therapy with AOM…

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A

Do not use ibuprofen in children under 6mos
Do not alternate Tylenol and ibuprofen
Decongestants, steroids, and antihistamines have no role in AOM treatment, can prolong effusion or duration

20
Q

What vaccines can help prevent OM?

Study These Flashcards
A

Flu vaccine for 2yo >

21
Q

Explain the anatomy of the ear in an adult vs child

22
Q

Sinusitis, define…

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A

an inflammation or infection of the paranasal sinus mucosa. 


23
Q

Chronic sinusitis

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A

Chronic rhinosinusitis typically persists as a cough, rhinorrhea, or nasal obstruction for greater than 90 days.

24
Q

Acute Bacterial Sinusitis (ABRS)

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A

Acute bacterial rhinosinusitis is an infection of the sinuses that can occur independently or be superimposed on chronic sinusitis.

25
Acute sinusitis
Acute rhinosinusitis is characterized by symptoms that resolve completely in under four weeks.
26
Bacterial vs Viral Sinusitis...
Viral resolves in 7-10d Bacterial SS more sever than viral. SS without resolution that last 8-10d> after a cold. Fever, malaise. Facial pain, pressure. Symptoms can get better then more severe
27
Risk for ABRS
``` smoke inhalation septal defects dental surgery winter season recent viral infection cystic fibrosis swimming allergies nasal drug use mechanical ventilation in a hospital setting ```
28
Pathogens of ABRS
Streptococcus pneumoniae and H influenza are the tow main pathogens - about 70% M. Catarrhalis contribute to approximate 20% of the cases seen in children.

29
ABRS presentation, adults
.
30
ABRS non Rx therapy
Saline nasal spray, nasal irrigation (isotonic or hypertonic), humidifiers
31
Oral decongestants, who should avoid use?
avoid in children <4yo, pt with uncontrolled HTN, IHD
32
Intra nasal decongestants
used in ages 6 and older limit to 3 days to avoid rebound congestion
33
Treatment algorithm for ABRS
amoxicillin if recent amor use in past 30 days then Augmentin if PCN allergy > cephalosporins cefuroxime, cefdnir, cefpodoxime
34
non type 1 PCN allergy in ABRS, treatment is...
uncomplicated :1st cephalosporin 2nd cephalosporins | 3rd clines or FQ
35
type 1 PCN allergy and treatment failure
uncomplicated macrolide, bactrum, doxy, FQ clindamycin or FQ cephalosporin has a cross reactivity with PCN allergies
36
For patients with a type I penicillin allergy and uncomplicated ABRS, treatment is
clarithromycin, azithromycin, Bactrim, doxycycline, or a respiratory fluoroquinolone can be used
37
For patients with treatment failure or recent antibiotic use
a respiratory fluoroquinolone is recommended and for resistance, clindamycin.
38
what cephalosporins are indicated for PCN allergy
cefpodoxime cefuroxime cefdnir
39
When to use antihistamines in sinusitis
avoid- they thicken mucus and impartial clearance | however consider their use in pt with chronic sinusitis and predisposed allergies
40
Intranasal steroids
alleries or chronic sinusitis - may be beneficial mono or with abx for ABRS
41
what is pharyngitis
acute throat infection, viral or bacterial usually self limiting- untreated bacterial can cause streptococcal illness usually in winter time and early spring
42
what causes pharyngitis
normal viral pathogens for respiratory infx and Epstein bar | bacterial is caused by group A BH strep, Strep PY - direct contact with infected secretions
43
how do you dx pharyngitis
will present with swollen lymph nodes, painful to swallow, petechiae on soft palate HA, and pain, nc in Childs especially red throat with possible exudate, scarlet rash rapid antigen test-80-90 percent accurate, results in minutes Gold standard is throat culture- 24-48hr results ALL neg rapids in children, adolescents, and adults with heavy contact with peds
44
complications of pharyngitis
abx therapy only prevents accesses, lymphadenitis, and rheumatic fever It does not impact acute gloulernephritis reactive arthritis PANDAS- OCD, tics post strep infx
45
how to treat pharyngitis x 10 days
``` infectious period goes from 10d-24h Pen V 100mg 500 mg/d max, split TID or QID peds 250 bid-tid, 500 bid for > 12yo AMOX same as Pen V but TID peds 4-50 mg/kg/d - BID-TID PCN allergy- macrolide or cephalexin (1st gen ) ```
46
CENTOR criteria for STREP
``` each gets 1 pt fever >101 no cough swollen nodes swelling, exudate age 3-14 subtract a point for age >45 ``` ``` SCORE: perent chance of 0: 1-2.5 1: 5-10 2: 11-17 3:28-35 >4: 51-53 ```
47
Recurrent Pharyngitis
clinda augmenting pen B Pen B with rifampin

Pharm Exam 4, URI, LRI, URI, PNE, abx, STD, Seizure, HA, Osteo (23 decks)

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