Therapeutics Id Maynard Test Questions – Flashcards

1. Nasal Hair/Mucus Producing Cells: initial mechanical barrier
2. Current Flora: prevents colonization
3. Epiglottis: physical barrier when swallowing
4. Trachea/Bronchioles: ciliated columnar epithelial cells interspersed with mucus-secreting cells
5. Alveoli: alveolar lining contains surfactant, fibronectin, IgG, Iron-binding proteins, immune and phagocytic cells

1. Increased aspiration risk (alcohol, seizures, stroke, MS/neurologic disorders)
2. Reduced mucociliary transport of debris (smoking, cold, elderly, cystic fibrosis)
3. Decreased macrophage activity (alcoholism, elderly, immunosuppression)

1. MRSA (prisoners, homeless, children in daycare)
2. Legionella (DM, cancer, HIV, smoking)
3. Resistant Strep. pneumoniae (beta lactam in past 3 months, elderly, immunosuppression, alcoholism)

1. New Cough that is productive

Watery, scant (atypicals)

Rust colored (Strep. pneumoniae)

Red jelly (Klebsiella)

Foul smelling, putrid (anaerobes)

2. Increased sputum production/change in consistency

3. Fever or hypothermia

4. Chills

5. Fatigue, myalgias, abdominal pain, anorexia, headache

6. Dyspnea

7. Rigors

8. Sweats

9. Pleuritic chest pain

1. Dullness to percussion of the chest
2. Crackles or rales
3. Bronchial breath sounds
4. Tactile fremitus
5. Egophony
6. Tachypnea

1. Elevated WBCs
2. Elevated Bands with Left Shift (more immature WBCs)

• < 10 epithelial cells
• > 25 WBCs (neutrophils)

1. Sputum
2. Blood
3. Urine Antigen (rapid and simple)

• No good sputum sample/can't get one
• Some bacteria don't gram stain/slow growers
• Time to get results
• Usually can't get a culture before you start antibiotics
• Contamination with normal flora

1. Mycoplasma pneumoniae
2. Streptococcus pneumoniae
3. Haemophilus influenzae
4. Chlamydia pneumoniae
5. Legionella pneumoniae

1st Line: Macrolides (azithromycin, clarithromycin, erythromycin)

2nd Line: Doxycycline

3rd Line: Ketolide

;

;

1st Line: Resp. Fluoroquinolones (moxifloxacin, gemifloxacin, levofloxacin)

OR

Beta Lactam + Macrolide

2nd Line: Doxycycline

3rd Line: Ketolide

Amoxicillin 1 g TID

OR

Augmentin 2 g BID

Resp. Fluoroquinolone

OR

Beta Lactam (ceftriaxone, cefotaxime, ampicillin) + Macrolide

• Piperacillin-Tazobactam
• Cefepime
• Imipenem
• Meropenem

• Aztreonam
• Aminoglycoside
• Antipneumococcal Fluoroquinolone (Ciprofloxacin, Levofloxacin)

Vancomycin

OR

Linezolid

Preferred: PCN G, Amoxicillin

Alt: Macrolide, cephalosporins, clindamycin, vancomycin, linezolid, high dose amoxicillin

Agents chosen on basis of susceptibility

If MIC < 4, high dose amoxicillin

Preferred: Amoxicillin

Alt: Fluoroquinolone, doxycycline, azithromycin, clarithromycin

Preferred: 2nd/3rd Gen. Cephalosporins, amoxicillin-clavulanate

Alt: Fluoroquinolone, doxycycline, azithromycin, clarithromycin

Preferred: Macrolide, tetracycline

Alt: Fluoroquinolone

Preferred: Azithromycin, Fluoroquinolones

Alt: Doxycycline

Preferred: TCN

Alt: Macrolide

Preferred: Tetracycline

Alt: Macrolide

Preferred: Doxycycline

Alt: Gentamicin, Fluoroquinolone

Preferred: Streptomycin, gentamicin

Alt: Doxycycline, Fluoroquinolone

Preferred: 3rd gen. Cephalosporins, Carbepenems

Alt: Beta Lactam/Beta Lactamase Inhibitors, Fluoroquinolones

Preferred: Itraconazole

Alt: Amphotericin B

Preferred: Isoniazid + Rifampin + Ethambutoll + Pyrazinamide

Alt: Guideline-directed

• Typically 10-14 days, minimun of 5 (10-14 days for immunosuppressed or Legionella infection)
• Should be afebrile for 48-72 hrs
• Should have no more than one CAP-associated sign of clinical instability before discontinuing therapy
• Longer duration needed if initial therapy was not active against identified pathogen or if course infection was complicated (meningitis, endocarditis)

• Small changes in hemagluttinin and/or neuraminidase molecules
• Responsible for seasonal epidemics

• Virus acquires a new hemagluttinin and/or neuraminidase via genetic reassortment rather than point mutations
• H1N1 (swine flu)

• Strep. pneumoniae
• Oral anaerobes
• Klebsiella pneumoniae
• Acinetobacter spp.
• Mycobacterium tuberculosis

• H. influenzae
• P. aeruginosa
• Legionella spp.
• S. pneumoniae
• Moraxella catarrhalis
• Chlamydophila pneumoniae

• G- Enteric Pathogens
• Oral anaerobes

• S. aureus
• Anaerobes
• Mycobacterium tuberculosis
• S. pneumoniae