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Pharmacology - Respiratory Tract Infections

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morauch630's version from 2017-11-01 23:21

Acute Otitis Media (AOM)

Question Answer
UPPER RESPIRATORY TRACT INFECTIONSOtitis Media, Pharyngitis, Sinusitis, Epiglottitis, Laryngitis
LOWER RESPIRATORY TRACT INFECTIONSBronchitis, pneumonia
types of AOM
S/S of AOMRapid onset of signs and symptoms of infection of the middle ear. Pain. Congestion. Fever. Reddened tympanic membrane
Common Organisms in AOMStreptoccocus pneumoniae (Most common pathogen), Haemophilus influenzae, Moraxella catarrhalis, Increasing resistance to amoxicillin, Increasing beta-lactamase producing bacteria
Treatment goals of AOMControl of pain, Eradication of infection, Prevention of complications, Avoidance of unnecessary antibiotics, Minimization of adverse effects of treatment
Non-bacterial therapyAnalgesics, Antipyretics, Local heat, Myringotomy, Tympanostomy tubes
Pts recommended for observationNon-severe illness, Otherwise healthy child, Uncertain diagnosis, ≥2 years of age, Certainty of follow - up
AOM preventionBreast feeding for the first six months of life, Avoid supine bottle feeding, Reduce or eliminate pacifier use in the second six months of life, Eliminate exposure to passive smoke, Influenza vaccine, Pneumococcal vaccine
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Acute Otitis Media Pharmacologic Treatment

Question Answer
First time acute Otitis Media Antibacterial txamoxicillin 80-90 mg/kg/day
Recurrent otitis or severe illness antibacterial txAmoxicillin/Clavulante (augmentin), Cefuroxime acetil (Ceftin)
If you suspect a beta-lactamase producing strains‏Amoxicillin/clavulante (Augmentin), Trimethoprim/sulfamethoxazele (Bactrim),‏ Cefuroxime axetil (Ceftin),‏ Azithromycin (Zithromax)‏
Duration of pharmacologic tx for patients with severe disease or 2 years old or less10 days
Duration of pharmacologic tx for older children and less severe disease5 days
Adverse effects of txGI – diarrhea Rash
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Pharyngitis

Question Answer
Define pharyngitisInflammation of the pharynx and surrounding lymphoid tissue that may be viral or bacterial in origin
What age is the pharyngitis usually viral4 years old and less
What is the most common bacterial organismstreptococcus progenies
What is the peak incidence of strep pharyngitis4 -14 years of age
Pharmacologic tx for bacterialPCN, erythromycin, cephalosporin like cefuroxime for 7 -10 days
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Sinusitis

Question Answer
Define acute sinusitislast up to four weeks
Define chronic sinusitispersists for 8 weeks or more OR more than 3-4 episodes/year OR repeated failure to respond to medical therapy
Organisms involvedStrep pneumoniae, H. influenzae, M. Catarralis
Sinusitis presentationmucopurulent nasal drainage, nasal congestion, facial pain, Maxiallary toothache, fever, cough, halitosis
Sinusitis txAmoxicillin, Trimethprim/Sulfamethoazole (bactrim), Fluoroquinolones (ciprofloxin, levofloxin)
Duration of sinusitis tx10 - 14 days.
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Epiglottitis

Question Answer
most common organismHaemophilis influenzae type b
Presentationdrooling, fever, respiratory distress, inspiratory stridor
Epiglottis txABCs. Establish & maintain airway, humidified O2, ABX, steroids to decrease laryngeal edema
ABX for EpiglottitisTreated with cephalosporins. Cefuroxime (Ceftin, Zinacef), Cefotaxime (claforan), Ceftriaxone (Rocephin)
Treatment for those in householdrifamipin prophylaxis 20mg/kg (max 600mg for four days)
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laryngitis

Question Answer
Presentationbarking cough, stridor, NO DROOLING
Laryngitis treatmenthumidified O2, Racemic Epinephrine, (usually SQ, decrease edema), Steroids (in mod-severe to decrease edema), ABX
Organimsviral parainfluenza. Bacterial - Staph. aureus. M. Catarrhalis, Pneumococcus
ABX for laryngitisCephuroxime (Ceftin, Zinacef), Cefotaxime (Claforan)
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Lower Respiratory Tract Infections

Question Answer
Give example of Humoral immunityAntibodies
Give example of Cellular immunityT cells
Give example of anatomic defense mechanismcilia
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