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70 Cards in this Set
- Front
- Back
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How do you treat outpatient community acquired pneumonia if they have not had any ABX in last 90 days?
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Respiratory floroquinolone (levofloxacin, moxiflaxacin)
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How do you treat inpatient Community Acquired Pneumonia?
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- Combo of macrolide (azithromycin) plus a B-lactam (ceftriaxone)
OR - Respiratory fluoroquinolone (levofloxacin) for cephalosporin allergy |
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How do you treat ICU community acquired pneumonia?
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- Macrolide (Azithromycin) or respiratory fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin)
PLUS - Antipneumococcal/antipseudomonal B-lactam (piperacillin-tazobactam, zosyn) |
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How do you treat anaerobic/aspiration pneumonia?
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Clindamycin or amoxicillin-clavulanate
or PCN plus metronidazole PCN alone is not adequate tx Abx therapy should be continued until CXR improves (may take a month or more) |
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Abx for Hospital Acquired Pneumonia for Low risk PT?
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Low risk PT for drug-resistant use ONE of the following:
o Ceftriaxone o Flouroquinolone (Anything ending in –floxacin) o Ampicillin-sulbactam o Piperacillin-tazobactam o Ertapenem |
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Abx for Hospital Acquired Pneumonia High risk PT?
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High risk of drug resistant use ONE from EACH class
Antipseudomonal • Cefipime, Imipenem, Piperacillin-tazobactam • PCN allergy: aztreonam Second antipseudomonal • Levoflaxacin, ciprofloxacin • Gentamicin, tobramycin, amikacin Coverage for MRSA • Vancomycin • Linezolid |
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Step One therapy for asthma
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SABA PRN
(Albuterol, Xopenex, Maxair, Alupent) |
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Step Two therapy for asthma
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Low dose ICS
(QVAR, Pulmicort, Aerobid, Flovent, Asmanex, Azmacort) |
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Alternative tx for Step Two therapy for asthma?
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Cromolyn, Nedocromil, LTRA, Thophylline
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Step Three therapy for asthma?
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Low dose ICS + LABA or Medium dose ICS
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Step Four therapy for asthma?
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Medium dose ICS + LABA and consult
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Step Five therapy for asthma?
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High dose ICS + LABA and consult
Consider an immune modulator (Xolair) |
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Step Six therapy for asthma?
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High dose ICS + LABA, oral steroid and consult
Consider an immune modulator (Xolair) |
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Alternate therapy for Step Three and Four in asthma?
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LTRA, Theophylline
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What drugs are considered LABA?
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Severent, Foradil/Perforomist, Brovana
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What drugs are considered LTRA?
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Singulair, Zyflo, Accolate
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What drugs are considered Cromolyn/Nedocromil?
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Intal and Tilade
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What drugs are considered anticholingerics in asthma?
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Atrovent
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What is indicative of well controlled asthma?
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Symptoms < 2day/wk
Nighttime awakenings < 2x/m Interference w/ activity: None FEV1 > 80% Exacerbations requiring PO steroids: 0-1x/yr |
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What are the recommended actions for well controlled asthma?
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Maintain current step or consider step down if controlled for 3m; f/u in 1-4m
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What is indicative of not well controlled asthma?
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Symptoms >2days/wk
Nighttime awakenings 1-3x/wk Interference w/ activity: Some FEV1 60-80% Exacerbations requiring PO steroids: >2x/yr |
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What are the recommended actions for not well controlled asthma?
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Step up one step
f/u in 2-6wks |
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What is indicative of very poorly controlled asthma?
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Symptoms all day
Nighttime awakenings > 4x/wk Interference w/ activity: Extremely FEV1 < 60% Exacerbations requiring PO steroids > 2x/yr |
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What are the recommended actions for very poorly controlled asthma?
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Consider PO steroids
Step up 1-2 steps f/u in 2wks |
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what is the single most important intervention in COPD?
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smoking cessation
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What drug is first line treatment for COPD?
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SAMA-Ipratropium bromide (MDI or nebulized)
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What drugs have been shown to improve functional status in COPD?
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Combo of ICS and LABA
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When is Theophylline indicated in tx of COPD?
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4th line for patients who do not achieve adequate sx control w/anticholinergics, beta-agonists and ICS therapy.
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when are antibiotics indicated in COPD?
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1) to treat acute exacerbations
2) treat acute bronchitis 3) prophylactically, to prevent acute exacerbations in high risk pts |
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What non-pharmological therapies are often indicated in the treatment of COPD?
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-oxygen therapy
-pulmonary rehab |
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What tx should be considered in hospitalized pts with COPD?
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-supplemental oxygen
-inhaled Ipratropium bromide plus B-agonists - broad spectrum abx -theophylline if therapy has been initiated before hospitalization |
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What should be done with a large pneumothorax?
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Large bore needle followed by chest tube
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What should be done with a small pneumothorax?
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no tx, repeat observation via CXR, may be self-limiting or progress to tension pneumothorax
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What should be done with a new pneumothorax?
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Pt should be hospitalized on bed rest w/ serial CXR every 12-24 hours if stable for days then can follow as outpatient
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What do patients need to avoid after experiencing a pneumothorax?
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Smoking
Exposure to high altitudes Scuba diving |
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Treatment for Asbestosis?
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No specific treatment
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Supportive treatment for hospitalized pts with RSV?
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-O2 for SaO2 <90-92%
-SaO2 monitoring -IV fluids -possible NG feeding -B2 agonist |
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RSV prevention for high risk patients <2yrs old
(premature, bronchopulomonary dysplasia, cyanotic heart disease) |
Palivizumab (Synagis)
-start in nov, dec, and give 5 IM monthly doses |
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Out-patient treatment of RSV/Bronchiolitis?
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-Mostly supportive
-hydration, suctioning of secretions, humidified O2 - SABA |
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Tx for Coal Worker's pneumoconiosis
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no treatment specified
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What is the treatment for idiopathic interstitial pneumonia?
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No study has shown any tx to improve survival or quality of life
Prednisone trial can be tried |
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What is the treatment for histoplasmosis?
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Itraconazole for mild to moderate disease
IV amphotericin B in severe illness |
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Treatment for Cystic Fibrosis?
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-Tx requires a multidisciplinary approach
-referral to an accredited CF care center -bronchodilators -chest physiotherapy -saline nebulizer -anti-inflammatory therapy (inhaled steroids, ibuprofen) -Abx -lung transplant |
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what is the prognosis for a patient with CF?
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CF is a fatal disease
Average life expectancy is 37years |
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What are non-surgical ways to treat obstructive sleep apnea?
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- weight loss
- avoidance of alcohol and hypnotic meds - Nasal continuous positive airway pressure (CPAP) - supplemental oxygen |
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What are surgical ways to treat obstructive sleep apnea?
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- Uvulopalatopharynoplasty (UPPP) for narrowed oropharynx
- Nasal septoplasty for deviated septum - Tracheostomy to relieve upper airway obstruction |
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What is the treatment for pulmonary HTN?
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If responds to vasodilators: 1st line CCB
If doesn't respond other meds used Supplemental oxygen Diuretics Women should not get pregnant Pulmonary transplant |
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What do most patients with pulmonary HTN die from?
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Right ventricular failure
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What tx is needed for an acute outpatient exacerbation of a patient with bronchiectasis?
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Oral abx for 10-14 days
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What tx is needed for persistent pseudomonas in a patient with bronchiectasis?
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Inhaled aminoglycosides
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What tx is needed for frequent exacerbations in a patient with bronchiectasis?
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chronic abx administered for cycles of 2wks on then 2 wks off
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What is tx is needed for a pt with bronchiectasis?
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Abx therapy
Chest physiotherapy Mucolytic agents and airway hydration Bronchodilators Anti-inflammatory meds Immunizations Surgery when localized dz w/ severe symptoms |
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How can you prevent the progression to bronchiectasis?
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prevent tobacco smoke exposure
ensure completion of vaccinations aggressively tx respiratory infections identify & tx underlying causes of recurrent pneumonias and other respiratory infections |
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Tx for Hypersensitive pneumonitis?
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Identify offending agent
Avoid further exposure Severe or protracted - Oral corticosteroids may be given |
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What is the mainstay for a Pulmonary Embolism?
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Systemic Anticoagulation
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What drugs should be given for Pulmonary Embolism?
Other options? |
Lovenox or Heparin, which are used until PT has therapeutic INR on Warfarin
- Admit to Hosptial - IVC filter |
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How is hyaline membrane disease treated in a preterm baby?
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- Supplemental oxygen with nasal CPAP
- Intubation for surfactant administration and ventilation |
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How would you treat the granulomatous inflammation associated with Sarcoidosis?
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PO corticosteroids
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What can be given the mother to help prevent hyaline membrane disease in a pre-term baby?
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Antenatal Corticosteroids
given more than 24 hours prior to birth |
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What are the treatment options for Exudative pleural effusion?
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-early intervention is important to avoid progression
-Tx the disease causing the perfusion - Thoracentesis performed quickly -possible bx -consider CT for massive effusion or r/o Cancer - sputum gram stain and culture/ blood culture -possibly antibiotics -when complicated: closed chest drainage - Last resort, open surgical drainage |
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When is thoracentesis not necessary in transudative pleural effusion?
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for bilateral effusions w/CHF
-in this case, thoracentesis only for symptomatic for massive effusions that cause dyspnea |
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What can be used to treat influenza?
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Oseltamivir (Tamiflu)
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When should pharmacologic treatment be considered for influenza?
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Greatest effect when administered within 48 hours of symptom onset
In persons at higher risk for complications |
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What are the benefits of pharmacologic treatment for influenza?
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shortens duration of fever and illness symptoms
reduces the risk of complications can shorten duration of hospitalization |
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What makes a person at high risk for influenza complications?
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- children < 2yrs old
- adults 65 and older - persons with chronic conditions/illnesses - persons with immunosuppresion - women who are pregnant or have delivered in the last 2 wks - persons under 19 receiving long term ASA therapy - American Indians and Alaska natives - persons who are morbidly obese - residents of nursing homes or chronic care facilities |
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Should you wait for a lab diagnosis of influenza before starting anti-viral therapy if clinical presentation is correct?
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No
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How can influenza be prevented?
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Vaccination
Prophylactic treatment for high risk persons that have been exposed or care facilities that have been exposed |
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How long do you treat CAP?
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At least 5 days or until PT has been afebrile for 48-72 hours
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What is the best prevention for CAP for high risk groups or anyone age 65 and older?
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Pneumococcal vaccine and Seasonal Influenza Vaccine
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How do you treat Legionnaires Disease?
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Flouorquinolone (any Floxacin)
OR Macrolide (Azithromycin or Clarithromycin) NO Erythromycin |
