Cps Ii Exam 2- Cap/pyelonephritis

Front 1

flow chart for decision to hospitalize for CAP

Back 1

if pt > 50 yo--> assign pt to risk class II-IV according to points sheet

if pt less than 50 yo and has one of the following:

cancer, CHF, cerebrovascular disease, renal or liver disease then assign class II-IV

if not, assign risk class I if they have any of the following:

AMS
pulse > 125
RR> 30
systolic BP less than 90
Temp less than 35 or greater than 40

Front 2

CURB-65- what's it stand for

Back 2

C: Confusion (MMSE ≤8, new disorientation to person, place, or time)
U: Uremia (BUN >20 mg/dL
R: Respiratory Rate ≥ 30/minute
B: Diastolic BP ≤ 60 mmgHg or Systolic BP < 90 mmHg
65: Age ≥ 65

Front 3

how to interpret CURB score (3) what's it used for

Back 3

0-1: Probably suitable for home treatment; low risk of death
2: Consider hospital supervised treatment
≥3: Manage in hospital as severe pneumonia; high risk of death

to determine if you are sending home or not

Front 4

CAP needs to be treated within...

Back 4

Treat within 24-48hrs

Front 5

drug for CAP if no comorbid conditions and no use of antimicrobials within the previous 3 months (1 drug class, 1 alternative)

Back 5

macrolide (azithromycin, clarithromycin, or erythromycin)—doxycycline alternative (weak evidencE)

Front 6

7 "Comorbidities" that would change how you treat CAP

Back 6

chronic heart, lung, liver or renal disease, DM, alcoholism, malignancies, asplenia, immunosuppressing conditions or drugs, antimicrobial use within last 3mo

Front 7

2 options for treating CAP in pt with comorbidities

Back 7

A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin )- just means they are strong against respiratory pathogens- first line

A β-lactam plus a macrolide (or doxycycline instead of macrolide but weak evidence)

Front 8

preferred beta lactam


alternatives (3)

Back 8

High-dose amoxicillin [e.g., 1 g 3 times daily] or amoxicillin-clavulanate [2 g 2 times daily] is preferred; alternatives include ceftriaxone, cefpodoxime, and cefuroxime

Front 9

. In regions with a high rate (>25%) of infection with high-level(MIC _16 mg/mL) macrolide-resistant Streptococcus pneumoniae, consider use of what instead?

Back 9

doxycycline in place of macrolide

Front 10

Inpatients, non-ICU treatment for CAP (2)

Back 10

A respiratory fluoroquinolone (strong recommendation; level I evidence)
A β-lactam plus a macrolide (strong recommendation; level I evidence)

Front 11

Suggest causes of non-response in a patient with community acquired pneumonia. (4)

Back 11

Resistant microorganism, nosocomial superinfection, parapneumonic effusion/empyema or noninfectious complication of pneumonia is present

Front 12

7 s/sx of flu

Back 12

Fever over 100 F (38 C)
Aching muscles, especially in your back, arms and legs
Chills and sweats
Headache
Dry cough
Fatigue and weakness
Nasal congestion

Front 13

State the pathogens commonly associated with community acquired pneumonia in adults for outpatients (5)

Back 13

Streptococcus pneumoniae Mycoplasma pneumoniae Haemophilus influenzae Chlamydia pneumoniae Respiratory viruses

Front 14

Pathogens for inpatients (6- same as outpatient but one more)

Back 14

Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydia pneumoniae Haemophilus influenzae Legionella spp*** Respiratory viruses

Front 15

Pathogens for Intensive care unit (5)

Back 15

Strepococcus pneumoniae Legionella spp Haemophilus influenzae Gram negative bacilli Staphylococcus aureus (NOT mycoplasma, chlamydia, respiratory viruses)

Front 16

Pneumococcal vacc recommendations

Back 16

high risk for pneumonia pt should get both vaccines? (PPSV23 and PCV13)

Front 17

Identify individuals that are candidates for antiviral treatment of influenza

Back 17

Suspected or confirmed influenza who are at higher risk of complications

Front 18

Characteristics that indicate pt is at higher risk of complications from flu (and should get antiviral treatment) (7)

Back 18

• Children <2yo
• Adults >65
• Pregnant and up to 2wk postpartum (including following pregnancy loss)
• Chronic pulmonary, CV (except HTN), renal, hepatic, hematological, or metabolic disorders
• Disorders that can compromise respiratory fxn or the handling of respiratory secretions or that can increase the risk for aspiration (eg cognitive dysfunction, neuromuscular disorders)
• Immunosuppression, including those immunosuppressed in HIV med.
• <19yo receiving long-term ASA therapy

Front 19

What is the dose and duration of treatment of influenza with oseltamivir

Back 19

Oseltamivir 75mg BID x5

Front 20

Dose duration of zanamivir and route

Back 20

Zanamivir 10mg: 2 5mg inhalations BID x5

Front 21

Signs of acute pyelonephritis (3)

Back 21

Urinalysis and urine culture will indicate bacteriuria, pyuria, and haematuria

Front 22

Symptoms of acute pyelo onset

Back 22

develop rapidly over a few hrs or a day

Front 23

Sx of acute pyelo (5)

Back 23

High fever of 39C or greater, flank pain usually unilateral that may worsen on micturition, Rigors, N/V/D, cystitis (frequency, dysuria etc) are possible

Front 24

Properties of a complicated UTI (setting they arise from, 7 other shits)

Back 24

Complicated: arise in setting of catheterization, instrumentation, urologic anatomic or structural abnormalities, stones, immunosuppression, renal disease, diabetes, or pregnancy

Front 25

Properties of uncomplicated UTI (how’s it spread)

Back 25

infection usually spreads from bladder to ureters and kidneys

Front 26

State the pathogens commonly associated with acute pyelonephritis (complicated and uncomplicated)

Back 26

Complicated and uncomplicated: mainly Gram – enterobacteriaceae

Front 27

Antimicrobial therapy for outpatient and duration

Back 27

Outpatient: FQ x5-7 days

Front 28

FQ dosing for: cipro, cipro ER< levo, moxi, oflox

Back 28

Cipro 500mg BID, Cipro ER 1000mg QD, Levofloxacin 750mg QD, Moxifloxacin 400mg QD, or Ofloxacin 400mg BID)

Front 29

Hospital therapy for pyelonephritis (uncomplicated):

Back 29

IV FQ until afebrile for 1-2 days, then complete with oral drugs x14 days.

Front 30

Oral drugs (abx) used for hospital therapy of pyelonephritis after fever is over? (1 combo, or 2 other options)

Back 30

(Ampicillin + Gentamicin or 3rd gen cephalosporin such as ceftriaxone or Piperacillin/Tazobactam)

Front 31

2

Complicated pyelonephritis treatment(5 options) and duration

Back 31

Ampicillin + Gentamicin or Ticarcillin/Clavulanic acid or Piperacillin/Tazobactam or Imipenim or Meripenim: 2-3 Weeks

Front 32

Target serum conc for gentamicin and Tobramycin: (trough, peak for serous infections, and peak for synergy/UTI)

Back 32

less than 2mcg/ml trough, 6-10mcg/ml peak for serious infections and 3-6mcg/ml peak for synergy/UTI

Front 33

Amikacin target conc for trough, peak for serous infections, and peak for synergy/UTI

Back 33

less than 10mcg/ml (trough), 20-30, and 15-20, respectively.

Front 34

Calculate a loading dose, maintenance dose and dosing interval using traditional and once daily aminoglycoside dosing guidelines (Formulas will be supplied)

Back 34

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Front 35

Recognize patients that are NOT candidates for once daily aminoglycoside dosing. (7)

Back 35

CrCl below 60, pediatrics, ascites, dialysis, enterococcal endocarditis, pregnancy, burns >20%