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603 Therapeutics > URI/ LRI > Flashcards

URI/ LRI Flashcards

(47 cards)

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1
Q

Major nonspecific symptoms of sinusitis

A

-purulent anterior nasal discharge
-purulent or discolored posterior nasal discharge
-nasal congestion or obstruction
-facial congestion or fullness
-decreased sense of small

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2
Q

Minor nonspecific symptoms of sinusitis

A

-fever
-headache
-ear pain, pressure or fullness
-halitosis, dental pain
-cough
-fatigue

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3
Q

Viral sinusitis treatment

A

decongestants, irrigation, mucolytics

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4
Q

Bacterial sinusitis treatment

A

no decongestants or antihistamines

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5
Q

Persistent symptoms antibiotic use

A

> /= 10 days without evidence of clinical improvement

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6
Q

Severe symptoms antibiotic use

A

> /= 3-4 days at the beginning of illness
- fever > 102F
-purulent nasal discharge
-facial pain

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7
Q

Worsening symptoms after a typical viral upper respiratory. infection (~5 days)- double sickening antibiotic use

A

new onset fever, headache or increased nasal drainage

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8
Q

amoxicillin/ clavulanate

A

-now recommended over amoxicillin
–> increasing prevalence of beta-lactamase producing H. influenzae and M. catarrhalis
-combination of an aminopenicillin + beta-lactamase inhibitor
-cover: S. pneumoniae (30-40%), H. influenzar (30-40%), M. catarrhais (25% in kids, less in adults)
-common side effects include diarrhea and rash
–>taking with food can reduce GI upset

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9
Q

Fluoroquinolones

A

-provided good coverage including penicillin resistant strains
-does not have better outcomes vs beta-lactams
-concern for cost, side effects and development

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10
Q

adult duration of antibiotics

A

5-7 days
-same outcomes as longer courses w less adverse effects

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11
Q

kids duration of antibiotics

A

10-14 days
shorter course not well studied

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12
Q

Chronic sinusitis

A

-symptoms persist > 12 weeks
-often not infectious
-s. pneumoniae and H. influenzae are still the most-commonly isolate organisms, but staphylaococcus, corynebacterium, fungi and other organisms are isolated with greater frequency
-cultures are recommended

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13
Q

Pharyngitis common viral pathogens

A

-adenovirus
-rhinovirus*
-coronovirus
-parainfluenza virus
-RSV
-Herpes simplex
-EBV

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14
Q

Pharyngitis common bacterial pathogens

A

-Group A strep
-Group C strep
-Group G strep
-Fusobacterium

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15
Q

Clinical features by suspected etiologic agent
Group A strep

A

-sudden onset of sore throat
-age 5-15
-fever
-headache
-tonsilliopharyngeal inflammation
-palatal petechiae
-anterior cervical adentitis (tender nodes)
-winter and early spring presentation
-history of exposure to strep pharynitis
-scarlatiniform rash

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16
Q

Why treat Group A Strep?

A
  • judiciously treat: up to 60% of patients receive antibiotics for “sore throat”
    -improve clinical symptoms
    -prevent transmission to 24h (infectious during acute illness and for another week thereafter)
    -avoid post-pharyngitis complications
    –acute rheumatic fever
    –peritonsillar abscess
    –cervical lymphadenitis
    –mastoiditis
    –glomerulonephritis
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17
Q

Treatment of Group A strep

A

Drug of choice: Penicillin VK or Amoxicillin
-narrow spectrum of activity, well tolerated, inexpensive
Duration: 10 days

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18
Q

Treatment of Group A strep Penicillin-allergic patients

A

Mild allergy (rash)
-first generation cephalosporin
-Cephalexin x 10 days
Severe allergy (anaphylaxis)
-Clindamycin x 10 days
-Azithromycin x 5 days

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19
Q

Treatment of Group A strep for patients with unlikely adherence

Study These Flashcards
A

Benzathine penicillin IM x 1

20
Q

Otitis media epidemiology

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A

-16 million clinic and ER visits annually in US
-$2.3 billion direct annual costs
-highest incidence of AOM occurs between 6 months and 24 months of age
-infrequent in adults
-OM: acute, w/effusion, chronic, recurrent

21
Q

OM microbiology

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A

Predominantly bacterial
Common: S. Pneumoniae
-40% non-susceptible to penicillin
Common: H. influenzae
-40% produce beta-lactamases
Uncommon: M. catarrhalis
-90% produce beta-lactamases

22
Q

OM signs and symptoms

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A

-fluid in the middle ear
-inflammation of the mucosa of the middle ear (identified by erythema of the tympanic membrane)
-ear pain
-ear drainage
-hearing loss
-nonspecific: fever, lethargy, or irritability

23
Q

American Academy of Pediatrics

Study These Flashcards
A

Middle ear effusion PLUS
-mod to severe bulging of tympanic membrane or new onset otorrhea (not due to acute otitis externa) OR
-mid bulging of tympanic membrane AND onset of ear pain within last 48 hr or intense erythema of tympanic membrane

Vaccination
-Pneumococcal conjugate vaccine (PCV7)
-Influenza

Antibiotics only for acute OM

24
Q

OM Management

Study These Flashcards
A

Pain assessment
-developmentally appropriate
-psychological cues
-behavioral cues
-physiological cues

Options: PRN and typically needed for up to a week
-PO Acetaminophen or ibuprofen
-OTIC ibuprofen (brief, 5-12 years)

25
OM antibiotics
YES - 6mo-12years PLUS mod-severe pain OR temp 102.2 - 6mo-23mo PLUS non-severe bilateral acute OM Consider (threshold is worsening) - 6mo-23mo PLUS non-severe unilateral - 2-12years PLUS acute non-severe acute OM Risk/Benefit -diarrhea for modest efficacy
26
What is Pneumonia?
-New lung infiltrate+ clinical evidence that infiltrate is of infectious origin (fever, purulent sputum, leukocytosis, dec. O2) -Often: RR>30, HR>100, temp>100
27
Pneumonia signs&symptoms
-cough -sputum production -dyspnea -fever and chills -hemoptysis -pleuritic chest pain -tachypnea -tachycardia -diminished breath sounds -egophony -increased WBC Differentiate from other respiratory presentations: -URTI, COPD, asthma, CHF, anxiety, trauma
28
Gram stain
-gram pos diplcocci (lancet/football shaped): Streptococcus pneumoniae -cluster of gram positive cocci are suggestive of Staphylococcus aureus -tiny gram negative coccobacilli are suggestive of Haemophilus influenzae -gram negative diplococci (kidney bean) are suggestive of Moraxella catarrhalis -Plump gram negative rods are suggestive of Klebsiella pneumoniae -thin gram negative rods are suggestive of Pseudomonas aeruginosa
29
Sputum Culture
-generally expectorated sputum -reserve for severe cases (hospitalized) -try to obtain before antibiotics --prior antibiotic use decreases yield of gram stain & culture -many times present with normal flora -contamination from the oropharynx with a large conc of multiple bacteria -- <10 squamous epithelial cells -- >25 polymorphonuclear leukocytes
30
Other Diagnostics for pneumonia
-BAL (bronchoalveolar lavage) -Blood cultures (admitted and severe) -procalcitonin (only in severe/sepsis) -oxygen saturation -urinary antigen testing --pneumococcal --legionella -viral panel
31
CURB-65
Confusion (disorientation to person, place or time) =1 Uremia (BUN>20mg/dL) Respiratory Rate >/= 30 breaths/min =1 Systemic Blood Pressure <90 or DBP<60 Age >65 =1 Scores 0-1: outpatient 2: inpatient-general med (floor) >3: ICU
32
Outpatients with CAP
S. pneumoniae* Haemophilus influnezae Mycoplasma pneumoniae (atypical) Chlamydophila pneumoniae (atypical) Respiratory viruses (influenza, RSV & parainfluenza virus)
33
Inpatients (not ICU) with CAP
S. pneumoniae* H. influenzae M. pneumoniae (atypical) Chlamydophila pneumoniae (atypical) Legionella (atypical) Respiratory viruses
34
ICU patients with CAP
S. pneumoniae S.aureus Legionella Gram negative bacilli H. influenzae
35
Streptococcus pneumoniae Risk factors
most common cause of pneumonia must know resistance rates in your community Rusty colored sputum
36
Haemophilus influenzae, Moraxella catarrhalis risk factors
More common in patients with: COPD, EtOH abuse, cystic fibrosis, HIV, impaired humoral immunity
37
Anaerobes risk factors
loss of consciousness after EtOH/ frug overdose. Post seizure, gingival disease, esophageal motility disorder
38
Community acquired MRSA risk factors
after influenza cavitary lesions severe CAP/ICU admission Empyema
39
Typical pneumonia
abrupt onset unilateral well-defined infiltrate significant fever, chills, sweats, dyspnea purulent sputum production primarily pulmonary symptoms -pleuritic chest pain
40
Atypical pneumonia
gradual onset diffuse infiltrates, ground-glass appearance mild fever, mild dyspnea dry cough extrapulmonary symptoms common -myalgias -diarrhea -abdominal pain
41
Outpatient treatment of CAP (previously healthy + no risk factors for drug resistance)
PO Amoxicillin PO doxycycline (alternate) PO macrolide (*azithro, clarithro)- for allergies
42
Outpatient treatments of CAP (comorbidities (age <2 or > 65, beta-lactam within prior 3 mo, EtOH abuse, immunosuppression, exposure to daycare, cancer, chronic respiratory disease)
PO Amoxicillin/ clavulanate or cephalosporin (*cefpodox, cefdinir, cefurox) PLUS macrolide (*azithro, clarithro) PO Respiratory Quinolone (*levo, *moxi)
43
Inpatient treatment of CAP (hospitalization that includes respiratory complications +/- systemic inflammation +/- comorbidities
Non-severe: -IV beta-lactam (ie ampicillin/ sulbactam, ceftriaxone) PLUS macrolide OR respiratory FQ Severe -IV beta-lactam PLUS Macrolide OR -IV beta-lactam PLUS respiratory FQ Anti-MRSA IF prior respiratory cultures Anti-pseudomonal IF prior respiratory cultures
44
Duration of antibiotics for CAP
minimum 5 days (generally 7 days) should be afebrile for 48-72 hours
45
Pretreatment tests
-blood cultures and expectorated sputum samples for gram stain and culture should be sent for all patients with anti-MRSA or anti-pseudomonal antibiotic orders -patients with severe CAP should have urinary antigen test for Legionella and Strep pneumonaie
46
Antibiotic Assessments
check for allergies check for QTc prolongation (quinolones and azithromycin can both prolong the QTc)
47
Viral Pneumonia (non-covid)
more common in kids than adults may cause significant morbidity in elderly can result in co-infection with bacterial pathogens Viral: -respiratory syncytial virus (RSV --similar to influenza, more rhinorrhea, wheezing, dyspnea and less incidence of febrile episodes -influenza A&B -adenovirus -parainfluenza

603 Therapeutics (5 decks)

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