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  1. types of pneumonia
    • community acquired (CAP)
    • Hospital acquired (HAP)
    • Ventilator associated (VAP)
    • health-care associated pneumonia (HCAP)
  2. pneumonia has the greatest cause of death in what age group
  3. what is the second most aqcuaired nosocomial infection
    HAP (accounts for 25% of all ICU infections)
  4. CAP has the highest incidence in which age group
    children and adults
  5. what are the clinical features for CAP
    • cough
    • fever 
    • sputum production
    • pleuritic chest pain
  6. are positive cultures needed for the diagnosis of pneumonia
    diagnosis does not need required supporting microbiological data
  7. what are the risk factors for CAP
    • COPD
    • smoking
    • aspiration
    • exposure to animal feces
    • HIV
    • previous travel
    • flu season
    • active flu in the patients community
  8. when should a pneumonia pt be treat in outpatient care
    if they have a PSI class I to II
  9. when should a CAP pt be admitted into the hospital
    • if they have a CURB-65 >= 2
    • PSI class III to V
  10. when should you admit a CAP pt in the ICU
    • if the have severe pneumonia 
    • CURB-65 score >=3
  11. which pathogens are seen in outpatient, inpatient ICU and non ICU
    • s. pneumoniae
    • h. influenzae
  12. how do you define severe CAP
    >=1 major or >=3 minor criteria
  13. major criteria for CAP
    • mechanical ventilation
    • septic shock on vasopressors
  14. what is CURB-65 criteria
    • Confusion
    • Uremia (BUN >=20)
    • Respiratory rate (>=30)
    • Blood pressure (<90 systolic or <60 diastolic)
    • 65 years old or greater
  15. diagnostic testing for outpatient CAP
    identification for pathogens is optional
  16. diagnostic testing for inpatient CAP
    blood and sputum cultures
  17. diagnostic testing for severe CAP
    • blood cultures
    • sputum cultures
    • urinary antigen tests
  18. what pathogens are tested in CAP in severe pts
    • legionella pneumophila
    • streptococcus pneumoniae
  19. diagnostic testing for severe CAP pts with intubation
    • blood cultures 
    • sputum cultures
    • urinary antigen tests
    • endotracheal aspirate
  20. when is fungal and tuberculosis cultures indicated
    cavitary infliltrates
  21. when does the IDSA say a pt with CAP should receive antibiotic therapy if they are admitted to the ED
    give the first dose in the ED
  22. when does the HQA say that pts with CAP should recieve antibiotic therapy
    initial anitbiotic therapy should be received within 4 hours of hospital arrival
  23. empiric therapy for an outpatient CAP pt that was previously healthy
    macrolide or doxycycline
  24. empiric therapy for an outpatient CAP pt that has a comorbidities
  25. empiric therapy for a CAP pt in the medical ward
    • FQN 
    • beta-lactam plus macrolide
  26. what are the respiratory FQN
    • levo
    • moxi
    • gemiflox
  27. empiric therapy for a CAP pt that is admitted into the ICU
    • FQN
    • beta-lactam plus azithromycin
  28. MRSA empiric therapy for CAP should be covered if a pt has which of the following
    • ICU admission
    • necrotizing or cavitary lesions
    • empyema
  29. what is the recommended therapy for MRSA CAP pts
    • vancomycin
    • linezolid
  30. what is the preferred  antibiotic for CAP pts with cultures showing s. pneumoniae
    • beta-lactams
    • FQN
  31. what is the first line agent for CAP pts with positive cultures for h.influenzae
  32. what are the second line agents used to treat CAP pts with cultures positive for h.influenzae
    • FQN
    • Macrolide 
    • doxycycline
  33. which FQN has both antipseudomonal and pneumococcal coverage
  34. which cephalosporins are less effective for antipneumococcal coverage
  35. which macrolide antibiotics are rarely used due to poor tolerance
    • azithro
    • clarithro
    • erythro
  36. risk factors for poor tolerance of b-lactams
    history of penicillin allergy
  37. what are the risk factors for poor performance with macrolide abx
    • age 
    • poor QT
  38. risk factors for toxicity and poor tolerance
    • HF
    • electrolyte imbalance
    • prolonged QT
    • CNS disorders
    • concomitant steroids
  39. risk factors for poor tolerance with AGs
    • age 
    • concomitant diuretics
    • age
  40. duration of antibiotic therapy for CAP
    • min of 5 days 
    • pt should be afebrile for at least 2 - 3 days
    • should have no more than one sign of clinical instability
  41. what is the first-line agent and how long is the duration of tx for outpatient treatment of previously healthy children and infants
    amoxicillin (90mg/kg/day) for 10 days
  42. who does the CDC recommend receive the pneumococcal vaccine
    • anyone >65
    • adults 19-64 with:
    •   chronic illness
    •   conditions that weaken the immune system
    •   cochlear implants or CSF leaks
    • adults 19-64 who smoke
  43. what are the pneumococcal vaccines for children and adults
    • children; 13-valent 
    • adults; 23-valent
  44. distinguishing between viral from bacterial pneumonia
    bacterial infections are usually in adults and have a rapid onset and rate of response to antibiotic tx. they present with high fever and tachypnea (increase in WBC, C-RP, procalc)

    viral infections are usually in children <5 and have a slow onset and slow/non response to antibiotics. pts present with rhinitis and wheezing and have a decrease in biomarkers.
  45. when is recommended tx time for viral influenza CAP
    • early as possible
    • within 48 hours of symptom onset
    • starting after 48 hours may still benefit pt
    • tx should not what for lab confirmation of flu
  46. which drug should be used when treating flu
    • neuraminidase inhibitor:
    • oseltamivir
    • zanamivir
  47. how long is the tx for CAP influenza
    5 days but can consider for pts who remain severely ill
  48. how long should a pt continue treatment on chemoprophylaxis for viral CAP
    for 7 days after the last known exposure
  49. how long should a person taking antiviral chemoprophylaxis continue on antiviral medication
    until immunity after vaccination develops (usually about 2 weeks in adults and can take longer in children)
  50. when is chemoprophylaxis not recommended
    if it has been longer than 48 hours
  51. dosing for tamiflu and relenza
    • Tamiflu; tx 75 mg BID chemo 75 mg QD
    • Relenza; tx 10mg (2 inhal) BID chemo QD
  52. what are the CDC recommendations for viral pneumonia prevention
    all person >=6 months old get vaccinated
  53. what is the definition of HAP
    occurs >=48 hours after hospital admission of a non-intubated patient
  54. definition of VAP
    pneumonia that arises >= 48 - 72 hours after endotracheal intubation
  55. definition of HCAP
    • pneumonia that occurs <=48 hours of admission with the presence of;
    • 1. has received IV antibiotics, hemodialysis, chemo, or wound care
    • 2. in the last 90 days, hospitalized >1 day
    • 3. ever resided in nursing home or long-term care facility
  56. what is the clinical dx for HAP
    • new or progressive radiographic infiltrate 
    • plus at least two or three clinical features;
    • 1. fever > 38C
    • 2. leukocytosis
    • 3. leukopenia
    • 4. purulent secretions
  57. time onset of CAP and HCAP
    within 48 hours
  58. time onset of early onset HAP and VAP
    48 to 120 hours after admission
  59. when is late on set HAP and VAP
    5 or more days after admission
  60. common aerobic gram-negative bacilli pathogens for HAP
    • p. aeruginosa
    • e.coli
    • klebsiella pneumoniae
    • acinetobacter species
  61. common gram-positive cocci pathogens for HAP
    s. aureus
  62. what are the risk factors for HAP s. aureus
    • DM
    • head trauma
    • admission to the ICU
  63. initial therapy for HAP should be which route of administration
    IV and then can transition to PO as appropriate
  64. what is the coverage required for early onset (<=4th day) HAP with no risk factors and cultures postive for gram negative bacilli
    • only one agent(does not pseud activity)
    • ceftriaxone
    • respiratory FQN
    • unasyn
    • ertapenem
  65. what is the coverage required for early onset HAP with no risk factors and cultures positve for MRSA
    not required
  66. what is the coverage required for a pt with late onset HAP or risk factors with cultures positive for gram negative bacilli
    • two antipseudomonal agents used:
    • ceph, carbapen, B-lactam/b-lactamase Inhi
    • +
    • antipseudomonal FQN or AG
  67. what are the antipseudomonal FQN
    • levofloxacin
    • ciprofloxacin
  68. MRSA coverage required for pts with late onset HAP or risk factors
    linezolid or vancomycin
  69. which pathogen can produce ESBL
  70. which antimicrobial agent is enterobacter resistant to
    first through third cephalosporins
  71. what are the most effective agents used to treat acinetobacter species
    • carbapenem
    • sulbactam
    • polymyxins
  72. what should the vancomycin troughs be for pneumonia
    15 - 20 ug/mL
  73. what has been found to be a comparable option to vancomycin
  74. which agent, which is normally a viable option for MRSA, is not used
    daptomycin, not active in the lung tissue
  75. duration of therapy for uncomplicated HAP mgmt without pseudomonas
    7-8 days is recommended
  76. complications from HAP
    • empyema
    • lung abscess
    • c. difficile 
    • occult infection
    • drug fever
Card Set
pt IV
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