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72 Cards in this Set
- Front
- Back
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True or false: lower respiratory tract infections are usually the cause of a virus.
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False - viral infections are usually confined to the upper respiratory tract whereas lower respiratory tract infections are characterized by bacterial infections
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What are the 4 different types of pneumonia?
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CAP - community acquired
HAP - hospital acquired HCAP - healthcare associated VAP - ventilator associated |
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What are disease conditions that increase the risk for contraction of CAP?
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Immunosuppressed (age,therapy,HIV)
Uncontrolled Diabetes ESRD on hemodialysis Chronic liver/lung/kidney disease Impaired cough/gag reflex CHF |
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True or false: if a patient is believed to have pneumonia a CXR should be performed to verify
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True - a CXR should be done to verify the diagnosis and can also be used to monitor therapy - usually at discharge
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True or false: the drug of choice for CAP needs to be an agent that is sensitive for enterobacteriacaea
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False - the drug of choice for CAP needs to be an agent that is sensitive for strep pneumoniae
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True or false: P. aerguinosa is a common cause for CAP
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False - P. aerguinosa is not common for CAP
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What is strept pneumoniae's key virulence factor?
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It is enclosed in a polysacchraide capsule that protects it from phagocytosis
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What CAP causing bacteria are transmitted via respiratory droplets?
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Strep pneumoniae
Chlamydophila pneumoniae Mycoplasma pneumoniae |
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What patients are at greatest risk for strep pneumoniae infections?
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Patients over 65 or under 2
Alcoholics Patients with day care contact |
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How can strept pneumoniae be detected in patients with a suspected infection?
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Urinary Antigens
Blood cultures Sputum cultures |
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What are the 3 atypical organisms that can cause CAP?
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Chlamydophila spp.
Mycoplasma spp. Legionella spp. |
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True or false: patients with CAP should receive vaccinations
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True - patients who enter hospital for CAP should receive vaccines before discharge
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How is the legionella spp transmitted since it is not spread from person to person?
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Legionella spp is usually contracted in a reservoir environment that is hot tubs, hot water tanks, large plumbing systems, or whirlpool spas.
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When do anaerobes play a role in CAP?
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Only plays in a role with patients who have alcohol/drug abuse or a seizure disorder - anaerobic coverage is warranted in the setting of aspiration secondary to loss of consciousness.
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What are the typical anaerobic suspects for aspiration related CAP?
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Mouth anaerobes - peptostreptococcus/fusobacterium
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What is the key sign of a possible pneumonia infection?
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Chest x-ray visible infiltrate
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True or false: sputum cultures for pneumonia are not accurate for diagnosis
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True - sputum cultures are often inconclusive, with a low yield, and may grow normal respiratory flora.
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True or false: strept pneumoniae is the only type of CAP infection detectable with urine antigen testing
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False - legionella pneumoniae can also be detected with urine antigen testing but it is also important to perform blood cultures as well.
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Define the admission criteria for patients suffering from CAP
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Confusion
Uremia: BUN greater than 20 Respiratory Rate: 30 or more BPM BP (low): DBP 60 or lower, SBP 90 or lower 65 years or older |
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True or false: Requirement of vasopressors, intubation, or mechanical ventilation are all criteria for direct ICU admission in CAP patients
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True - patients who meet any of those 3 major criteria require immediate ICU admission
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True or false: antibiotics should be administered within 24 hours of patient presentation for CAP
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False - according to JCAHO mandate antibiotics should be initiated within 4 hours of presentation and if a patient is admitted the first dose should be given in the ER
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What are the recommended vaccinations for patients who present with CAP?
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Pneumococcal vaccine
Influenza vaccine |
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What is the recommended outpatient CAP treatment for a previously health patient with no antibiotic treatment for 3 months prior to infection?
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1st line therapy: macrolides with azithromycin 500mg PO daily preferred
2nd line therapy: tetracyclines with doxycycline 100mg PO BID preferred |
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What is the recommended outpatient CAP treatment for a patient suffering from a co-morbid condition?
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Respiratory FQ (Levo 750 PO daily)
or Beta lactam + macrolide (amoxicillin 1g PO TID or Augmentin 2g PO BID + azithro 500mg PO daily) |
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What is the recommended inpatient treatment for a patient that is not in the ICU?
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Respiratory FQ
or Beta lactam + macrolide |
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What is the recommended inpatient CAP treatment for a patient that is admitted to the ICU?
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Beta lactam + macrolide or FQ
FQ cannot be used as monotherapy |
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What are the recommended IV macrolide treatments for CAP?
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Azithromycin IV
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What are the recommended IV Beta lactam treatments for CAP?
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Cefotaxime
Ampicillin-Sulbactam Ceftriaxone |
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What are the recommended IV respiratory FQ treatments for CAP?
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Moxifloxacin
Levofloxacin Gemifloxacin |
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Why are the select drug classes used for inpatient treatment of CAP?
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These drug classes have good lung penetration
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What is the recommended drug therapy for CA-MRSA (doses)
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Vancomycin: 10-15mg/kg/dose IV Q12
Linezolid: 600mg IV Q12 |
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What are appropriate beta lactam drug selections for pseudomonas aeruginosa in CAP?
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Pipercillin-tazobactam IV
Cefepime IV Imipenem IV Meropenem IV |
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What are appropriate macrolide drug selections for pseudomonas aeruginosa in CAP?
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Azithromycin 500mg IV daily
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What are appropriate FQ drug selections for pseudomonas aeruginosa in CAP?
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Levofloxacin IV
Ciprofloxacin IV |
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What are appropriate aminoglycoside drug selections for pseudomonas aeruginosa in CAP (doses)?
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Gentamicin/Tobramycin ODA: 5mg/kg IV
Amikacin ODA: 15mg/kg IV |
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What is abbreviation ODA and what is it's significance in drug dosing?
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ODA means once daily administered and means that the drug must be renally dosed for renally impaired patients or patients with altered volume of distribution - use traditional dosing.
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What patients are usually considered to have an altered Vd?
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Obese
Elderly/Pediatric Pregnant Burn patients Cystic fibrosis |
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True or false: Imipenem is associated with seizures especially in patients with renal dysfunctions.
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True - imipenem use should be monitored because the drug is associated seizures especially in patients with renal dysfunction
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True or false: if the lab results show that s. pneumoniae is the cause of CAP - Pen G/amoxicillin would be acceptable drug therapy
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True - as long as the s. pnuemoniae is not PCN resistant then these would be appropriate drug therapies - PCN resistant would require a susceptibility test.
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What would be appropriate drug therapy if a culture result for a CAP patient came back growing H. Influenzae?
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Ampicillin/amoxicillin if beta lactamase (-)
Ampicillin-sulbactam/amoxicillin-clavulanate if beta lactamase (+) |
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What are appropriate drug selections for treatment of CAP caused by legionella spp bacteria?
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Respiratory FQ or azithromycin
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True or false: macrolides or doxycycline are appropriate drug selections for treatment of any CAP causing bacteria
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False - macrolides and doxycycline are only preferred agents for treatment of CAP caused by mycoplasma pneumoniae or chlamydophila pneumoniae
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What does DRSP stand for and what can be used against it?
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Drug resistant strep pneumoniae is susceptible to ceftriaxone. If a PCN allergy is present then a respiratory FQ is recommended.
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What are risk factors for contracting DRSP?
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Treatment with beta lactam in last 90 days
Alcoholism Multiple co-morbidities Immunosuppression Exposure to child day care 65 and older |
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True or false: it is important for patients with DRSP risk factors to receive macrolide treatment as monotherapy
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False - patients with DRSP risk factors should not receive macrolide monotherapy
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How long should patients with CAP receive treatment?
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CAP patients should receive treatment for 5-7 days and should be switched to PO medications when hemodynamically stable and able to tolerate PO.
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True or false: only HAP and VAP are considered nosocomial infections
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False - HAP, HCAP, and VAP are all considered nosocomial infections
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Define the characteristic of Hospital acquired pneumonia
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Hospital acquired pneumonia that is acquired in the hospital 48 hours after admission
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Define the characteristics of Health Care associated pneumonia
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The patient was hospitalized within the 90 days prior to current admission, had antibiotic use within the last 90 days, or receives dialysis/nursing home resident
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Define VAP
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Occurs 48-72 hours after endotracheal intubation
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True or false: nosocomial infections are similar to CAP and therefore require strep pneumoniae coverage in antimicrobial selection
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False - nosocomial infections require pseudomonal coverage in antimicrobial selection
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True or false: Stress bleeding prophylaxis can increase the risk of nosocomial infection
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True - decreasing acidic conditions in the body to prevent stress bleeds can increase the risk of nosocomial infection
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True or false: negative respiratory cultures rules out the possibility that the patient has pneumonia
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False - viruses and legionella do not culture well and so therefore are difficult to diagnosis
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True or false: clinical improvement should occur within 48-72 hours after administration of antibiotic
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True - clinical improvement should be identified within 48-72 hours if the correct antibiotic was used
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What are the 4 risk factors for acquiring MDR pneumonia
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-antimicrobial therapy in preceding 90 days
-current hospitalization of 5 or more days -HCAP -Immunosuppressed |
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Define the purpose of distinguishing early onset pneumonia from late onset pneumonia.
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By determining whether pneumonia is early onset or late onset the proper therapy can be initiated. Using early onset therapy when appropriate saves therapy for MRSA/pseudomonas.
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Define the appropriate therapies for treating early onset pneumonia
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Levofloxacin or moxifloxacin
Ampicillin-sulbactam Ceftriaxone Ertapenem |
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True or false: ceftriaxone and ertapenem are convenient because they have pseudomonal coverage
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False - ceftriaxone and ertapenem are convenient because they are dosed once a day - also ertapenem has no pseudomonal coverage
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Define the appropriate therapy selection for treating late onset pneumonia - drug class regimen
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Requires selection of 3 drug regimen - 2 which are sensitive for pseudomonas and 1 for MRSA
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Define the appropriate therapy selection for treating late onset pneumonia - drug therapy.
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Cefepime/imipenem/meropenem/pipercillin-tazobactam
+ gent/tobra/amikacin/levo/ciprofloxacin + vanco/linezolid |
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What are the typical ODA doses for treatment of nosocomial pneumonia infections?
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Gentamicin/tobramycin: 7mg/kg IV
Amikacin: 20mg/kg IV |
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How is vancomycin dosed for treatment of nosocomial pneumonia?
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15mg/kg IV Q12
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How is pipercillin-tazobactam dosed for treatment of nosocomial pneumonia?
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4.5g IV Q6H
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True or false: the therapeutic dose for CAP treatment and nosocomial pneumonia treatment for levofloxacin are the same
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True - for both CAP treatment and nosocomial treatment the levofloxacin dose is 750mg IV daily
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Initial therapy for inpatient treatment of pneumonia is always given by IV - what 4 factors are criteria requirements for switching a patient to oral medication?
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-Hemodynamically stable
-Exhibiting good clinical response -Functioning GI tract -Bioavailability can be matched |
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True or false: therapy for patients should be narrowed as clinical improvement is assessed in the patient
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False - therapy should only be narrowed using final culture and sensitivities.
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True or false: for most cases where patients received appropriate coverage and dose, duration of therapy is usually limited to a short course sometimes as short as 7 days
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True - shorter course therapy is recommended for most etiologies except Pseudomonas/acinetobacter spp.
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What is the typically treatment duration for pseudomonas/acinetobacter infections?
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Typical treatment time is 14 days
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True or false: for legionella infections treatment lasts anywhere from 7 to 14 days with macrolides being preferred over FQ
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False - while typical treatment does last for 7 to 14 days, FQ are the preferred treatment over macrolides
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What is the typical treatment time for strep pneumoniae?
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Typical treatment time is 10-14 days
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What are the 4D's of antimicrobial therapy?
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Drug
Dose Duration De-escalation |
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Define the (5) possible causes of patient deterioration or non-resolution for pneumonia
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Inadequate/inappropriate antibiotic
Non-infectious cause Resistant organism Extra-pulmonary site of infection Complication of pneumonia |
