-
Intermittent asthma
Symptoms <2x/week
-
Mild persistent asthma
Symptoms>2x/week, nocturnal symptoms >2/month
-
Preferred ICS for pregnancy
Budesonide
-
Oral therapy for acute asthma exacerbations
Prednisolone (1/mg/kg/day up to 50 mg) x 5-7 days
-
Treat mild or moderate asthma exacerbation
SABA 4-10 puffs q20 min x 3
-
Treat life threatening asthma attack
- SABA
- ipratropium bromide
- O2
- Oral corticosteroid
-
Severe asthma exacerbation parameters
- O2 sat on air <90
- pulse > 120 bpm
- PEF <50%
- RR >30
-
Treat bronchiectasis (3)
- Amoxicillin w/wo clavulanate
- Bactrim
- Ciprofloxacin
- 10-14 days
-
How long to treat bronchiectasis
10-14 days
-
Treatment plan bronchiectasis
- Bronchodilator
- chest physiotherapy
- amoxicillin, Augmentin, bactrim, ciprofloxacin for 10-14 days
-
Treat epiglottitis
- 1g cefuroxime IV q8
- dexamethasone 8 mg x 1, then 4 mg q6 IV
-
Treat pertussis
Erythromycin 500 mg QID P.O. x 7 days
-
contacts of pertussis pt should be given what, within what timeframe
contacts exposed within three weeks of the cough onset in the index case should take erythromycin 500 QID x 7 days
-
Treat simple CAP
- Clarithromycin 500mg BID
- or
- Doxycycline 100 mg BID
-
S/S pneumonia
- Productive cough
- purulent sputum
- dyspnea or RR>20
- tachycardia
- crackles
- fever/sweats/chills
- myalgias, headaches
- Consolidation on chest PE (20% of pts)
-
DDx PNA vs bronchitis
CRP elevated in PNA but not in bronchitis
-
When to obtain sputum culture for pneumonia
- HAP or VAP
- ICU admission
- abx therapy failure
- ETOH abuse
- comorbid lung disease
- PE
- urine antigen test + for Legionella or pneumococcus
-
CURB criteria
- Confusion +1
- Urea>7 +1
- RR>30 +1
- BP: S<90, D<60
- Age>65
-
Gold standard test for pertussis
Sputum Culture. False - common
-
Gram negative organisms
- Chlamydia
- e. Coli
- gonorrhea
- h. influenzae
- klebsiella
- legionella
- meningococcus
- pertussis
- pseudomonas
- rickettsiae
- salmonella
- shigella
- vibrio
-
Gram positive organisms
- Bacillus anthracis
- botulism
- clostridium
- corynebacteria
- diphtheria
- Enterocci
- listeria
- staph
- strep
- Tetanus
-
What can treat pseudomonas
Fever, polyarthralgia, bilateral hilar lymphadenopath
-
what can treat atypicals
- macrolides
- tigecycline
- tetracyclins
- moxifloxacin
-
treat anaerobes
- Augmentin
- Zosyn
- cefoxitin
- cefotetan
- carbapenems
- clindamycin
-
what bacterial lung infection is more common in smokers than non smokers
Haemophilus influenza
-
1st generation cephalosporin (2) and infections they combat
- cephalexin
- cefazolin
- Gram +
- staph
- strep
-
2nd generation cephalosporins (2) and types of infections It combats
- cefotetan
- cefoxitin
- anaerobes
- gram +/-
-
3rd generation cephalosporins (3) and infections they combat
- ceftazidione: psuedomonas
- nosocomial infections
- Gram -
- ceftriaxone
- cefixime
-
What drug classes offer Gram +/- and pseudomonas coverage
- carbapenems
- 4th generation cephalosporins
- piperacillin-tazobactam (Zosyn)
-
CAP drugs
Azithromycin 500 mg PO one dose, then 250 mg PO daily for 4 days or
Clarithromycin 500 mg PO bid or
Doxycycline 100 mg PO bid
-
Treat CAP with comorbidities
- Levofloxacin 750 mg PO q24h
- or
- Moxifloxacin 400 mg PO q24h
-
Treat CAP pt who has taken abx w/in past 3 mos
- Azithromycin plus amoxicillin 1 g PO q8h
- or
- levofloxacin 750 mg PO daily
- or
- moxifloxacin 400 mg PO daily
-
what two cephalosporins cover anaerobes?
-
what drug treats Protozoa and obligate anaerobes
metronidazole
-
drug interaction of metronidazole
ETOH
-
sulfonamides amplify what other drugs?
- warfarin
- phenytoin
- oral hypoglycemic
-
adverse effects of sulfonamides
- hemolytic anemia
- stevens Johnson
- renal damage
-
Adverse effects of ciprofloxacin
- candida infection
- tendon rupture
- seizures
-
treat mycoplasma PNA with
doxycycline 100 mg BID
-
RIPE stands for what, and what are the most common side effects of treatment?
- Rifampin - hepatitis, orange body fluids
- isoniazid-hepatitis
- pyrazinamide
- ethambutol - optic neuritis
- Give B6 to reduce risk of peripheral neuropathy
-
chlamydia PNA PE findings and treatment
- Sore throat, dysphonia, sinusitis
- Treat with azithromycin 500 mg BID
-
mycoplasma PNA PE findings and treatment
- Low fever, cough, bullous myringitis, pharyngitis, wheezing
- Quinolones: LEvofloxacin 750 mg QD x 7 days
-
atypical PNA DDx
- Mycoplasma: pharyngitis, wheezing, low grade fever, cough, possible bullous tympanic membrane - quinolone
- Chlamydia: sore throat, hoarseness, sinusitis - azithromycin
- Legionella: nonspecific, diarrhea - azithromycin
-
klebsiella presentation
"currant jelly" sputum
-
most common types of PNA in CF patients
Pseudomonas & Gram negative, aminoglycosides (if suspected drug resistant, or if hospitalized, add a beta lactam)
-
PJP presentation and treatment
- fever, tachypnea, dyspnea, dry cough
- diffuse perihilar infiltrates but no effusions
- TMP-SMX
-
COPD patients are more likely to get PNA from what pathogen, with gram stain and treatment
- Haemophilus pneumoniae, Gram negative
- macrolide (azithromycin) or fluoroquinolone (ciprofloxacin) if pt is at high risk
-
-
Ingredients of flovent
Fluticasone
-
ingredients of spiriva
Tiotropium
-
Ingredients of pulmicort
Budesonide
-
-
ingredient of singulaIr
Montelukast 10 mg every evening
-
-
ICS
- fluticasone Flovent
- budesonide Pulmicort
-
-
-
SABA SAMA
- albuterol, ipratropium
- combivent, duoneb
-
Pulmonary embolism s/s
Dyspnea, tachycardia, pleuritic chest pain, swollen calf/thigh, weakness, syncope, dizziness
-
Expected diagnostic findings for PE
- ECG - sinus tachycardia, ST-T changes, S1Q3T3
- D-dimer >500
- CXR - atelectasis, infiltrates
-
treat pulmonary embolism
start heparin immediately and continue as a five day bridge while warfarin levels come up
-
s/s idiopathic pulmonary fibrosis
DOE, inspiratory crackles, digital clubbing, nonproductive cough
-
Light’s criteria
- Fluid is exudate if:
- Effusion LDH/serum LDH >0.6
- Or Effusion protein/serum protein >0.5
- or effusion LDH Level more than 2/3 the normal limit of serum LDH
-
Virchow’s triad
- Endothelial injury
- venous stasis
- blood hyper coagulability
-
Lofgren syndrome
Fever, polyarthralgia, bilateral hilar lymphadenopathy
-
Treatment of sarcoidosis
NSAIDS, corticosteroids, methotrexate, hydroxychloroquine.
-
onset Of pertussis
- Insidious:
- low fever
- mild hacking cough
- runny nose, coryza
- sneezing
-
Treat pertussis
Azithromycin
-
do not give cough suppressants
Under four years old
-
ARDS s/s
- Dyspnea
- tachypnea
- tachycardia
- diaphoresis
- cough
- bilateral rales
-
Berlin criteria for ARDS
- Respiratory symptoms within one week of insult,
- bilateral opacities on CXR not explained otherwise,
- Pulmonary edema of non cardiac origin
-
ARDS severity based on
PaO2 / FiO2
- mild: 200-299
- moderate: 100-199
- severe: <100
-
treat ARDS
- O2, intubation
- prone positioning
-
S/S bronchiectasis
Cough, daily sputum production, dyspnea, rhinosinusitis, crackles, wheezing
-
treat bronchiectasis exacerbation
- Sputum-guided antibiotic
- bronchodilators
- inhaled steroids
- systemic steroids
-
Side effects beta agonist inhaler
Constipation, fatigue, weakness are signs of hypokalemia. Mania, sleep disturbance, agitation, nausea, vision changes, mydriasis
-
Side effects of muscarinic antagonists
constipation, dry mouth, sore throat, nausea
-
Ipratropium
SAMA, Atrovent
-
-
-
Tiotropium, olodaterol
LAMA, LABA, Stiolto
-
albuterol/ipratropium
SABA/SAMA, duoneb, combivent
-
fluticasone / salmeterol
ICS/LABA Advair
-
Treat acute exacerbation of COPD
Duoneb, prednisone taper, Z-pak. SpO2 target 88-92%
-
S/S cor pulmonale
- Split S2, prominent P2,
- murmur
-
5 causes of pulmonary hypertension
- 1) pulmonary artery disease
- 2) left heart failure
- 3) lung disease
- 4) emboli
- 5) miscellaneous
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