diseases and drugs

  1. dx: Legionell pneumonia
    risk factors COPD, ETOH, smokers, males and immunosuppresed. client does not require hospitalization
    what antbx's?
    • Erythromycin
    • Doxycycline
    • Azithromycin
    • Clarithromycin
    • Fluoroquinolone
  2. -Strep pneumonia most common pathogen.
    often PCN resistant.
    -test with pneumococcal urinary antigen assay (legionellas can be tested with this assay also)
    what antibx for treatment?
  3. -Staph Aureus most serious pneumonia
    -commonly follows URI infection-esp flu
    -common nosocomial
    -at risk groups IV drug users, chronic care places, young people & cystic fibrosis.
    what antibx for treatment
  4. -Haemophilus Influenza is a common cause of bronchitis in adults with chronic lung disease.
    (smokers, COPD) especially following URI
    - >20% are beta lactamase producers
    what antbx for treatment?
  5. -Klebsiella pneumonia causes tissue necrosis
    -currant jelly hemoptysis
    -high incidence of abscess formation
    -common in debilitated or ETOH persons
    what antbx for treatment?
  6. Mycoplasma pneumonia
    headache, ear pain, sore throat, non-productive cough.
    what antbx for treatment?
    macrolide or tetracycline
  7. Chlamydia pneumonia is often confused with viral URI and laryngitis, dry cough and pharyngitis. often self limiting but when it is not what antbx for treatment?
    tetracycline or macrolide
  8. Moraxelola Catarrhalis Pneumonia
    common in winter, low grade fever, productive cough
    underlying pulmonary disease usually present also in ETOH, DM and CA
    often self limiting, but if not what antibx for treatment?
    • this pneumonia is a beta lactamase producer resitiant to PCN and amoxicillan.
    • cefuroxamine?
  9. match the clissic sign to the pneumonia
    SX:headache, diarrhea, myalgias, bullous myringitis, blood tinged sputum.
    DX: pneumococcus & TB, mycoplasma, Legionaires, mycoplasma, virus.
    • headach-mycoplasma
    • diarrhea-legionnaires
    • myalgias-virus
    • bullous myringitis-mycoplasma
    • blood tinged sputum-pneumococcus & TB
  10. Empirical treat CAP with what antbx's?
    what symtomatic measures?
    • macrolides
    • doxycycline
    • 3rd or 4th gen quinolone for those with comorbid or who failed intial tx.
    • hydration, humdification, expectorant (guaifenesin) no cough suppression, tylenol.
  11. whooping cough antibx treatment?
    macrolide (azithromycin)
  12. Ear wax not removed by irrigation or curret you can send them home with what medication and direction?
    Debrox/urine 3-4gtt 3-4 times daily
  13. what ear gtts for OE?
    bacterial & fungal
    • Polymxin BSulfate, NEomycin or Cortisporin Otic 4 gtts QID x7 days
    • TobraDex 4gtts QID x7days
    • Cipro HC Otic or Floxin Otic 3gtts BID x7days
    • FUNGAL
    • Otic Domeboro 5gtts QID x7days
    • *severe cases require systemic antbx like cipro 500 mg BID 7-10 days or Augmentin 875mg po BID for 7-10 days
  14. Treatment for OM?
    • 1st line: Amoxicillin 500mg TID x10days or TMZ-SMZ one DS tab BID x 10 days
    • 2nd line: Augmentin 875mg PO BID x10days
    • Azithromycin 500mg day 1 then 250mg day 2-5
    • ALL: tylenol, auralgan Otic (topical pain relief) avoid antihistamines. return in 2-3 days if not better/2-3 weeks for re-check)
  15. OM with effusion, treatment?
    • watchful waiting, most (90%)resolve without antbx.
    • if antibx use betalactamase stable such as amoxicillin Clavulante (augmentin) 500mg BID or clarithromycin (Biaxin) 500mg BID x7-14 days
  16. Anticholinergic bronchodilator what is it and what is it used for?
    • Atrovent (Ipratropium bromide) q 4-6 hours RTC new Spireva (tiotropium) 1x daily
    • not a good rescue inhaler for COPD
    • inhibits airway constriction
    • decreases lung overinflation which improves dyspnea
    • decreases mucus secretion
  17. Beta Agonist bronchodilators relax smooth muscles, enhance mucocilliary clearance and produce vasodilation both pulmonary and vascular reducing afterload. What are these drugs?
    Albuterol (proventil, pirbuterol (maxair), metaproterenol (alupent) and terbutaline they can be used
  18. patients experiencing COPD exacerbations with clinical signs of airway infections (increased color/volume of sputum &/or fever) may benefit from antibx tx. the most common pathogens are strep pneumonia, influenza & maraxalla catrarrhalis. (see it is improtant to get the flu shot). what antibx should you order?
    respiratory floroqinolones like moxifloxacin
  19. How do you manage COPD exacerbations?
    • increase dose of beta 2 agonist
    • increase atrovent dosage
    • consider antbx macrolide, amoxicillin, docxycycline,
    • add oral corticosteroid
    • O2 consider admisssion
  20. Steroids are not really useful in preventing COPD progression however they are beneficial in manageing exacerbations. They are often given too little, too late and for too long. how should they be given?
    30-40mg/day for 7-10 days.
  21. treatment for gonorrhea?
    • cefriazone 250mg IM x1 or
    • cefiximine (suprax) 400mg PO x1 plus
    • Azithromycin 1g PO x1 or doxycycline 100mg PO BID x7 days
    • REMEBER no doxy in prenant people
  22. what types of HPV cause condylomatas (gential warts)?
    types 6 & 11
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diseases and drugs
disease and pharmocological recommendations