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URI's
Pharm I
| Question | Answer |
|---|---|
| MC bacterial pathogen for pharyngitis | GABHS 40% viral cases |
| Features of viral pharyngitis etiology | sore throat w/ conjunctivitis, coryza, cough, diarrhea |
| Infectious complications of GABHS pharyngitis | Peritonsillar and retropharyngeal abscess |
| Non infectious complications of GABHS | Rheumatic fever, glomerulonephritis |
| Drug of choice and dosing for Strep pharyngitis | Penicillin V PO Kids: 250mg bid/tid 10days Adults 250mg tid or qid, 500mg bid, 10 days |
| Alternative for penicillin in strep pharyngitis | amoxicillin for taste |
| If adhearence is an issue for strep abx, what is an alternative to PO penicillin | IM benzathine penicillin G 1.2 x10^6U or 6.0 x10^5 for <27kg for adults, 1 dose |
| Oral options for PCN allergy for strep pharyngitis | Erythromycin or 1st-gen ceph 10 days |
| Abx options for recurrent pharyngitis | Clindamycin or Augmentin |
| Sxs resolve when for Strep pharyngitis | 24-48hrs MUST take full course to dec. risk of RF |
| Acute sinusitis ≥3 a year | recurrent sinusitis |
| Factors that contribute to acute sinusitis | obstruction of sinus ostia, impaired ciliary fxn, viscous secreations, impaired host immunity |
| Factors that contribute to chronic sinusitis | mucosal hyperplasia, eosinophilic tissue infiltrate, polyps |
| MC cause of acute sinusitis | Viral, IF bacterial H.flu, S. pneumo, M. cat |
| Tx of acute sinusitis | Supportive, Decongestants, Acetaminophen and NSAIDS |
| Dosing for Acetaminophen and NSAIDS | A: 10-15mg/kg po q4-6 hrs, Adults: up to 1000mg tid/qid, Ibuprofen: 5-10mg/kg q 6-8hrs Adult: 250mg po q6-8hrs |
| Other tx’s for acute sinusitis | NS, 2nd gen. antihistamines (only w/ allergic), Nasal corticosteroids, expectorants (water!) |
| When are abx prescribed for acute sinusitis | mod-sev sxs >10days, sxs worsen after initial improvement, pt’s w/ severe sxs |
| Initial therapy for bacterial sinusitis | No recent abx: Amoxicillin, Augmentin 1st gen. cephs, PCN allergy: clarithromycin, azithromycin Recent abx: Augmentin and Respiratory FQ’s PCN allergy: same |
| Respiratory FQ’s | Gemifloxacin, levofloxacin, moxifloxacin (5days)-azithromycin too |
| Clinical failure of Abx tx for sinusitis post 3 days | Same as initial w/o amoxicillin, Recent abx: Resp. FQ’s 10 days for most tx |
| Etiology of Epiglottits | trauma/thermal injury but Kids: strep pneumo, pyogenes, S. aureus (H.flu rare but serious ) adults Groupd A strep |
| High fever, sore throat, dyspnea, rapidly progressive respiratory obstruction | Serious sxs of epiglottis |
| 4 D’s | Drooling, Dysphagia, Dysphonia (horsness) Distress (resp)-seen in epiglottis |
| Onset of epiglottis | 2-4hrs in kids, days in adults |
| Tx for epiglottis | Establish airway! Abx: 3rd gen ceph: Cefotaxime/Ceftriaxone, Alt: ampicillin-sulbactam or Bactram |
| Household tx for those w/o Hib vaccine for epiglottitis | rifampin |
| Clinical presentation of viral URI | Sneezing, coryza, nasal obstruction, ST, cough/hoarseness, malaise, fever/chills, HA |
| Tx of Viral URI | supportive, Analgesics, Decongestants >6yo, maybe antihistamines , Anticholinergics, |
| When would antitussives be recommended | non-productive Codeine, Dextromethorphan (usually >3wks no <6yo) |
| Reasons against abx for viral | Diarrhea, skin rxn, may cause ER visit, resistance |
| Rating classifications for drugs | ABCDE: strength of recommendation A good for use, E against use, I,II,III: quality of evidence I: many studies III: some expert advise |
Created by:
becker15
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