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IOS 10 Exam 3
Community aquired pneumoniae
| Question | Answer |
|---|---|
| Describe the epidemiology of community aquired pneumonia | 3 million cases per year, 10 million office visits, 500,000 hopsitalizations. Mortality in 30-40% of severly ill patients |
| Pathophysiology of community aquired pneumonia | Pathogens gain entry to lower airways in 3 ways: Aspiration of oropharyngeal secretions, inhalation, hematogenous spread via bacteremia |
| Causative pathogens of community aquired pneumonia | Strep pneumoniae, H. influenza, M. catarrhalis, sometimes atypical |
| Atypical clinical presentation of community aquired pneumoniae | Insideous onset, malaise, fatigue, diarrhea, muscle aches, low grade fever, non-productive cough |
| Typical clinical presentations of community aquired pneumoniae | Sudden onset, VERY ILL, High temperature, Left shift, chills,purulent productive cough, cyanotic, tachypnea, tachycardia |
| Risk factors for community aquired pneumoniae | Advanced age, Alcoholism, cigarette smoking, COPD, congestive heart failure, chronic liver disease, chronic renal disease, neoplastic disease, neurological disorders, immuosuppression, neutropenia |
| Pathogens who cause the greatest mortality | P. aeuruginosa, S. aureus, klebsiella pneumoniae, strep pneumonia |
| Risks for community aquired aspirations | Alcholism,CVA, drug intoxication, endotracheal tubes, esophageal dysfunction, generalized surgery,head injury,nasogastric tubes, neuorological disorder, periodontaial disease, seizure, severe illiness, tracheotomy |
| Community aquired pneumonia specimen content (PMN& epithelial cells) | PMN should be >25 thus indicative of infection, there should be <10 epithelial cells which indicates no contimination |
| Community aquired pneumonia gram stains | Should show 1 pathogen but many cases no pathogen is identified |
| Risk factors for drug resistant S. pneumoniae in treating pneumoniae | Alcoholism, Age> 65, child in daycare, Immunosupression, multiple comorbidities, Recent stay in hospital or LTC, Recent antibiotic exposure |
| Goals of therapy:community aquired pneumoniae | Complete eradication, complete cure, Decision to treat as inpatient or outpatient is SINGLE MOST IMPORTANT treatment decision (infection risk, compliance, complications) |
| Community aquired non-pharm | adequate hydration and nutrition, bed rest, chest physiolotherapy, humidifer, mechanical ventilation, supplemental oxygen |
| Pharmacological therapy includes | Antipyretics, antitussives, bronchodialators, antibiotics |
| Empiric antibiotics are based on | Severity of illiness, Risk for resistant pathogens, risk of complications and increased mortality |
| Community acquired pneumonia- previously healthy no past antibiotic therapy | Either a Macrolide (Gram+ or atypical) or Doxycyline (Gram +, Atypical) |
| Antibiotic treatment of community aquired pneumoniae recent antibiotic therapy | Fluoroquinolone (Gram+, Gram-, atypical) or Advanced macrolide(Gram+, Anaerobic) + B-lactam (Gram -, Anaerobes) or Advanced macrolide and Augmentin |
| Antibiotic treatment of community aquired pneumoniae Comorbidities-no recent antibiotic therapy | Either advanced macrolide or Fluoroquinolone |
| Antibiotic treatment of community aquired pneumoniae comorbidities & recent antibiotic use | Fluoroquinolone or Advanced macrolide + B-lactam(augmentin or cefpodosime, cefprozil, cefuroximine) |
| Antibiotic treatment of community aquired pneumoniae Medical ward patient | Macrolide and B-lactmam (amoxicillin, augmentin, ceftriaxone, cefpodoxime) or Fluoroquinolone |
| Antibiotic treatment of community aquired pneumoniae Nursing Home | B-Lactam (ceftriaxone, cefpodoxime) and macrolide or Advanced macrolide and B-lactam and augmentin, or Fluoroquinolone |
| Antibiotic treatment of community aquired pneumoniae critically ill | IV Cephalosporin (ceftriaxone, cefpodoxime) and macrolide (or fluoroquinolone) or Augmentin or Zosyn or TImentin + macrolide or fluoroquinolone |
| Antibiotic treatment of community aquired pneumoniae with suspected aspiration | Fluoroquinolone + clindamycin, or Moxifloxacin, IV augmentin or Zosyn, or Timentin+ macrolide or fluoroquinolone |
| Community aquired pneumonia monitoring parameters for assessing efficacy | Temperature, left shift, productive cough, respiratory rate, pleural pain |
| Community aquired pneumonia monitoring parameters monitoring parameters for assessing safety of therapy | Serum levels of drugs, Scr, Superinfection, C. diff |
| Three categories of bronchitis are | Acute, chronic, and acute exacerbation of chronic bronchitis (AECB) |
| Acute bronchitis cause | Typically caused by virus |
| Acute exerbation of chronic bronchitis caused by | 50% virus, H. influenza, H. influenza, S. pneumonia, Gram - |
| Goals of chronic bronchitis therapy | relieve symptoms, increase interval between exacerbations, decrease PCP visits & hospitalizations, decrease use of antibiotics, lower cost of treatment |
| Non-pharm recommendations for chronic bronchitis | Rest, reduce or quit smoking, maintain hydration, humidifer or vaporizer, chest physiotherapy |
| Pharmacological recommendations for chronic bronchitis | Bronchodialators, antibiotics |
| Acute excerbation of chronic bronchitis treatment duration | 7-10 days |
| Monitoring parameters for clinical efficacy of chronic bronchitis | FEV1, Normalization of mucus |
| Monitoring parameters for assessing safety of therapy of chronic bronchitis | VS, intake,output, sputum production, respiratory state,breath sounds, daily weight, Edema |
| Define Hospital aquired pneumonia | Pneumonia that occurs 48 hours of more after admission which was not incubating at the time of admission. |
| Define ventilator associated pneumonia | Pneumonia that arised more than 48-72 hours after endotracheal intubation |
| Define healthcare associated pneumoniae | Hospitalization for >2 days within preceeding 90 days, Resided in nursing home, extended care facility |
| Risk factors for hospital aquired pneumoniae | Alcoholism, advanced age, cigarette smoking, Coma, enteral feedings, hypotension, metabolic acidosis, malnutrition, major organ dysfunction, nasogastric intubation, severe illiness |
| Risk factors for multidrug-resistant (MDR) pathogens in HA/VAP | antimicrobial therapy in past 90d, Current hospitalization, chronic dialysis, family members with MDR pathogen, home wound care, home infusion therapy, immunosuppressive disease, hopsitalization >2 d, Reside in nursing home, LTC |
| Goals of HAP therapy | Resolution of clinical s/s, reduction in mortality, reduction in infection-related complications such as sepsis or seeding, avoid intolerable SE, and drug toxcities, eradication of pathogen, minimization of resistance, prevention of recurrence |
| Nonpharmalogical recommendations for hospital aquired pneumoniae | maintain respiratory function, adequate hydration, nutrition, suction of secretions, chest physiotherapy, antipyretics, beonchodialator, rapid empiric antibiotic therapy, approriate culture (instutional-specific), broad initial then narrow |
| Duration of Hospital aquired pneumonia | 14 to 21 days |
| Clinical improvement of hospital aquired pneumonia is | 48-72 hours |
| Treatment of hopsital aquired pneumoniae- no risk for MDR pathogens Early onset of penumoniae | Ceftriaxone, Fluoroquinolone, Ampicillin/sulbactam |
| Treament of hospital aquired pneumoniae- Risk for MDR bacteria | antipseudomonial B-lactam (cefepime, ceftazidine, Zosyn)+ aminoglycoside +- vancomycin (if MRSA)Carbapenem + aminoglycoside +-vancomycin (MRSA) PCN ALL- Cipro + aminoglycoside +- vancomycin or Azetroname + aminoglycoside or cipro or levo +- vancomycin |
| Monitoring hospital aquired pneumonia for efficacy, should include | Temperature, leukocytosis, change is sputum, respiratory funtion, change in chest radiograph |
| Monitoring hospital aquired patients for safety, should include | CXr, Cultures, electrolytes, Po2 |
Created by:
liza001
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