PHRM 865 Exam 3 Study Guide
Mechanisms of resistance of infection by the lungs - ANSWER alveolar lining fluid
(surfactant, fibronectin, complement, and Ig)
cytokines
alveolar macrophages
PMN's
cell mediated immunity
How do microbes destroy immunoglobulins and cause lung infections? - ANSWER they
have surface adhesions, pili, exotoxins, and enzymes that destroy immunoglobulins in
alveolar lining fluid
Factors known to impair host defense mechanisms - ANSWER altered level of
consciousness
smoking
impaired macrophage function
alcohol
immunosuppression
mech. ventilation
nasogastric tubes
diabetes
asplenia (dysfunction or removal)
elderly
Impaired macrophage function increases risk for - ANSWER S. aureus infections
asplenia increases risk for - ANSWER strep pneumoniae infections
CAP: Definition - ANSWER pneumonia *outside* the hospital or *<48* hrs after hospital
admission
CAP: Patho - ANSWER aspiration (bacterial)
aerosolization/direct inhalation (viral)
,CAP: Organisms - ANSWER *strep pneumo*
h. inf
mycoplasma pneumo
legionella pneu
chlamydia pneu
s. aureus (*rare*)
rhinovirus
influenza
resp. synctial virus
CAP: Clinical Presentation - ANSWER rapid/sudden onset of fever, chills, productive
cough, chest pain, SOB
CAP: Exams - ANSWER pulse increase 10 BPM for every 1 C increase
*consollidation*
sputum exam
cultures
CAP: Labs - ANSWER Chest x-ray
SCr, electrolytes
WBC
O2
PCR swab
HAP: definition - ANSWER *48 hours or more* after hospital admission
VAP: definition - ANSWER > 48-72 hours after endotracheal intubation
HAP/VAP: Patho - ANSWER micro/aspiration
direct inoculation
mech. ventilation
HAP/VAP: Organisms - ANSWER P. aeruginosa
Acinetobacter baumannii
,S. Aureus
HAP/VAP: Exams - ANSWER culture of resp secretions
blood cultures
HAP/VAP: Labs - ANSWER *new* lung infiltration on X-ray (changes in radiology)
HAP/VAP: Risks - ANSWER increased age
severity of underlying disease
hospital duration
endo intubation
mech ventilation
naso tubes
AMS
surgery
prev abx tx
HAP/VAP: Risk factors for Multi-Drug Resistance (MDR) - ANSWER prior IV abx use
within 90 days
CAP: Empiric Tx- Healthy Outpatient (no comorbid.) - ANSWER *amoxicillin*
doxy
, amox or doxy + macrolide
CAP: Empiric Tx- Outpatient w/ comorbidities - ANSWER levofloxacin
moxifloxacin
augmentin, cefpodoxime, cefuroxime with macrolide or doxy
CAP: Empiric Tx- Inpatient (Non-ICU) Monotherapy - ANSWER levofloxacin
moxifloxacin
CAP: Empiric Tx- Inpatient (Non-ICU) Combo - ANSWER *ceftriaxone*, unasyn,
cefotaxime, ceftaroline, with macrolide or doxy
CAP: Empiric Tx- Inpatient (ICU) - ANSWER *ceftriaxone*, unasyn, cefotaxime,
ceftaroline with macrolide (preferred) or FQ's
CAP: Empiric Tx- Concern for MRSA - ANSWER vanc or linezolid
CAP: Empiric Tx- Concern for Pseduemonas - ANSWER Zosyn
cefepime
ceftazidime
aztreonam
Mechanisms of resistance of infection by the lungs - ANSWER alveolar lining fluid
(surfactant, fibronectin, complement, and Ig)
cytokines
alveolar macrophages
PMN's
cell mediated immunity
How do microbes destroy immunoglobulins and cause lung infections? - ANSWER they
have surface adhesions, pili, exotoxins, and enzymes that destroy immunoglobulins in
alveolar lining fluid
Factors known to impair host defense mechanisms - ANSWER altered level of
consciousness
smoking
impaired macrophage function
alcohol
immunosuppression
mech. ventilation
nasogastric tubes
diabetes
asplenia (dysfunction or removal)
elderly
Impaired macrophage function increases risk for - ANSWER S. aureus infections
asplenia increases risk for - ANSWER strep pneumoniae infections
CAP: Definition - ANSWER pneumonia *outside* the hospital or *<48* hrs after hospital
admission
CAP: Patho - ANSWER aspiration (bacterial)
aerosolization/direct inhalation (viral)
,CAP: Organisms - ANSWER *strep pneumo*
h. inf
mycoplasma pneumo
legionella pneu
chlamydia pneu
s. aureus (*rare*)
rhinovirus
influenza
resp. synctial virus
CAP: Clinical Presentation - ANSWER rapid/sudden onset of fever, chills, productive
cough, chest pain, SOB
CAP: Exams - ANSWER pulse increase 10 BPM for every 1 C increase
*consollidation*
sputum exam
cultures
CAP: Labs - ANSWER Chest x-ray
SCr, electrolytes
WBC
O2
PCR swab
HAP: definition - ANSWER *48 hours or more* after hospital admission
VAP: definition - ANSWER > 48-72 hours after endotracheal intubation
HAP/VAP: Patho - ANSWER micro/aspiration
direct inoculation
mech. ventilation
HAP/VAP: Organisms - ANSWER P. aeruginosa
Acinetobacter baumannii
,S. Aureus
HAP/VAP: Exams - ANSWER culture of resp secretions
blood cultures
HAP/VAP: Labs - ANSWER *new* lung infiltration on X-ray (changes in radiology)
HAP/VAP: Risks - ANSWER increased age
severity of underlying disease
hospital duration
endo intubation
mech ventilation
naso tubes
AMS
surgery
prev abx tx
HAP/VAP: Risk factors for Multi-Drug Resistance (MDR) - ANSWER prior IV abx use
within 90 days
CAP: Empiric Tx- Healthy Outpatient (no comorbid.) - ANSWER *amoxicillin*
doxy
, amox or doxy + macrolide
CAP: Empiric Tx- Outpatient w/ comorbidities - ANSWER levofloxacin
moxifloxacin
augmentin, cefpodoxime, cefuroxime with macrolide or doxy
CAP: Empiric Tx- Inpatient (Non-ICU) Monotherapy - ANSWER levofloxacin
moxifloxacin
CAP: Empiric Tx- Inpatient (Non-ICU) Combo - ANSWER *ceftriaxone*, unasyn,
cefotaxime, ceftaroline, with macrolide or doxy
CAP: Empiric Tx- Inpatient (ICU) - ANSWER *ceftriaxone*, unasyn, cefotaxime,
ceftaroline with macrolide (preferred) or FQ's
CAP: Empiric Tx- Concern for MRSA - ANSWER vanc or linezolid
CAP: Empiric Tx- Concern for Pseduemonas - ANSWER Zosyn
cefepime
ceftazidime
aztreonam
