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Therapeutics ID Nelson
Exam 2 URI
37
Chemistry
Graduate
01/23/2010

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Cards

Term
Common Cold: Treatments
Definition
  1. Analgesics (APAP, ASA, IBU, Naproxen)
  2. Antihistamines
  3. Decongestants

Topical (oxymetazoline, xylometazoline)

-short term use only to prevent rebound congestion

Systemic (pseudoephedrine)

-can raise blood pressure

 

4. Other Treatments

-Cromolyn Sodium (duration of cold shortened, symptoms decreased final 3 days)

-interferon nasal spray

-zinc gluconate lozenges

-high dose Vit C

 

Term
Etiology for Rhinosinusitis
Definition
  1. Viral
  2. Strep. pneumoniae
  3. H. influenzae
  4. Moraxella catarrhalis
Term
Classification and Duration of Rhinosinusitis
Definition

Acute: < 4 weeks

Subacute: 4 - 12 weeks

Chronic: > 12 weeks

Term
Signs and Symptoms of Rhinosinusitis
Definition

Common:

 

sinus tenderness, cough, sinus pressure, nasal obstruction, headache, postnasal drainage, discolored nasal discharge, sore throat

 

Possible:

 

halitosis, malaise, fever/chills, maxillary toothache, periorbital swelling

Term
Risk Factors for Rhinosinusitis
Definition
  • Allergies
  • GERD
  • Structural abnormalities
  • Immunodeficiency
Term
Differential Diagnosis for Rhinosinusitis
Definition

Perennial Rhinitis (seasonal allergies)

Viral sinusitis (7-10 days)

Acute bacterial sinusitis (Sx > 10 days)

Term
High Dose Amoxicillin for Bacterial Rhinosinusitis
Definition
90 mg/kg/day, 2 divided doses
Term
Low Dose Amoxicillin for Bacterial Rhinosinusitis
Definition
45 mg/kg/day, 2 divided doses
Term
Symptomatic Treatment for Rhinosinusitis
Definition

1. Topical and Systemic Decongestants

-relieves nasal congestion

-may not promote sinus drainage

2. Antihistamines

-useful in patients with allergic rhinitis

3. Intranasal Corticosteroids

-provides relief of facial pain and tenderness, turbinate swelling

-not for first sinus infection, but for repeated episodes

Term
Etiologies for Pharyngitis
Definition

1. Bacterial (more severe, see PCP)

-Strep. pyogenes (Group A Beta Hemolytic)

-Group C and G Strep.

-Arcanobacterium hemolyticum

-Mycoplasma pneumoniae

-Chlamydia pneumoniae

 

2. Viral (monitor at home)

-Rhinovirus

-Coronavirus

-Adenovirus

-Parainfluenza virus

-HSV

-Influenza

-Coxsackievirus

-Epstein Barr Virus

-CMV

 

Term
Signs and Symptoms of Pharyngitis
Definition
  1. Acute onset sore throat
  2. Fever
  3. Tonsilar Exudate
  4. Swollen, tender anterior cervical lymph nodes
  5. Group A Streptococci

-erythematous throat with patches of purulent exudate (white to gray) on tonsils and posterior pharynx

-erythema of uvula and tongue

-fever > 38 degrees C

Term
Diagnosis of Pharyngitis
Definition

1. Throat Culture

-swab posterior pharynx and plate

-lengthy (requires 18-24 hrs incubation)

- >90% sensitive and highly specific

 

2. Rapid Antigen Test

-throat swab testing requiring 5 minutes

- 60-90% sensitive and very specific

Term
Pharyngitis Treatment: DOC, alternatives to allergies, and alt. drugs
Definition

DOC: PCN

 

PCN allergy type 1: Erythromycin

PCN allergy (non-type 1): 1st gen Cephalosporins

 

Alternatives:

 

Ampicillin/Amoxicillin

1st gen. cephalosporins

Macrolides

Term
Pharyngitis Complications
Definition

1. Suppurative

-peritonsilar abscess

-retropharyngeal abscess

-cervical lymphadenitis

-otitis media

-sinusitis

-mastoiditis

 

2. Toxin-Mediated

-scarlet fever

-streptococcal toxic shock-like syndrome

 

3. Non-Suppurative

-rheumatic fever

-acute glomerulonephritis

Term
Definition of Acute Laryngotracheobronchitis
Definition

AKA Viral Croup

 

Viral illness that causes inflammation and edema of the tracheal wall, narrowing of the lumen, and restriction of airflow

Term
Etiologies of Acute Laryngotracheobronchitis
Definition
  1. Parainfluenza virus
  2. Adenovirus
  3. RSV
  4. Influenza A virus
Term
Signs and Symptoms of Acute Laryngotracheobronchitis
Definition
  1. Rhinorrhea
  2. Mild pharyngitis
  3. Cough (sounds like a seal)
  4. Low grade fever
  5. Inspiratory stridor (sounds like dog whining)
  6. Hoarseness
Term
Duration of Acute Laryngotracheobronchitis
Definition

Improvement after 1-2 days

Resolution by 3-7 days

Term
Diagnosis of Acute Laryngotracheobronchitis
Definition

X-Ray

CT scan

Laryngoscopy

Term
Symptomatic Treatment of Acute Laryngotracheobronchitis
Definition
  • Analgesics (APAP, IBU)
  • Adequate hydration
  • Cool mist therapy
Term
Treatment for Severe Airway Narrowing as a result of Acute Laryngotracheobronchitis
Definition
  • Nebulized epinephrine
  • Corticosteroids

Dexamethasone 0.6 mg/kg PO/IM x 1 dose (max: 10 mg)

Nebulized Budesonide

Term
Etiologies of Acute Epiglottitis
Definition
  • H. influenzae type B
  • B-Hemolytic Strep.
  • S. pneumoniae
  • S. aureus
  • Aerobic G- Bacteria
Term
Signs and Symptoms of Acute Epiglottitis
Definition
  • Fever
  • Irritability
  • Sore throat
  • Rapidly progressive stridor with resp. distress
Term
Treatment of Acute Epiglottitis
Definition

Endotracheal intubation/Emergency tracheostomy

 

IV antibiotics: cefotaxime, ceftriaxone, or ampicillin/sulbactam

 

Postexposure prophylaxis -- Rifampin for household if:

  •  child < 4 yo
  • child < 12 months and has not received Hib vaccine series
  • immunosuppressed child
Term
Risk Factors for Bronchiolitis
Definition
  • Season
  • Age (premature infant)
  • Underlying lung disease
  • Congenital heart disease
  • Immunocompromised
  • Tobacco smoke exposure
Term
Etiology for Bronchiolitis
Definition
  • RSV
  • Metapneumovirus
  • Parainfluenza viruses (Type 1, 2, 3)
  • Secondary bacterial infection

 

Term
Signs and Symptoms of Bronchiolitis
Definition
  • Irritability/Restlessness
  • Mild fever
  • Cough
  • Rhinitis
  • Vomiting/Diarrhea
  • Abnormal Breathing

-inspiration crackles

-labored with retractions

-tachypnea

-nasal flaring

-grunting

Term
Diagnosis and Duration of Bronchiolitis
Definition

Diagnosis

  • Clinical examination
  • Chest X-Ray (to rule out pneumonia)
  • Pulse oximetry (severity of resp. distress)
  • Nasopharyngeal aspirate

Duration

  • Normal/Healthy Child: symptoms improve in 3-4 days but airways may remain sensitive for weeks
Term
Outpatient Management of Bronchiolitis
Definition
  • nasal saline with bulb suctioning
  • antipyretics
  • rehydration if needed
  • infection control
  • avoid tobacco smoke exposure
  • education of disease progression
Term
Inpatient Management of Bronchiolitis
Definition

Standard Measures:

  • Supplemental O2
  • nasal saline with deep suctioning
  • antipyretics
  • rehydration
  • infection control

Questionable Measures:

  • Bronchodilators (only effective in patients with asthma)
  • Corticosteroids (no proven efficacy)
  • Ribavirin (RSV) - not routinely recommended, questionable efficacy, potential toxic effects for exposed HCP (pregnant nurses), expensive, black box warnings
Term
Bronchiolitis Prevention
Definition

Palivizumab

  • Humanized Mouse Monoclonal Antibody
  • Exhibits neutralizing and fusion-inhibitory activity against RSV
  • Only recommended for select infants
Term
Patients that Qualify for Palivizumab Therapy
Definition

Patients < 2 yo with:

  • chronic lung disease requiring medical therapy within 6 months of RSV season
  • hemodynamically significant congenital heart disease

Premature Infants:

  • < 1 yo born at < 28 weeks gestation
  • < 6 months of age born at 29-32 weeks of gestation
  • Consider if < 6 months of age born at 32-35 weeks of gestation with risk factors
Term
Otitis Media Pathophysiology
Definition
  • Allergy or URI causes congestion and swelling of nasal mucosa, nasopharynx, and eustachian tube
  • Obstruction of eustachian tube isthmus results in accumulation of middle ear secretions
  • Secondary bacterial or viral infection of effusion causes suppuration and features of Acute Otitis Media
Term
Risk Factors for Otitis Media
Definition
  • Age
  • Daycare Attendance
  • Environmental Factors
  • More than 1 sibling living at home
  • Pacifier use
  • Previous antibiotic use
  • Previous otitis media
  • Season (winter and fall)
  • Gender (Male > Female)
  • Ethnicity
  • Underlying pathology
Term
Clinical Presentation of Otitis Media
Definition
  • Otalgia (denoted by pulling of ear)
  • Irritability
  • Fever
  • Otorrhea
  • Hearing loss
  • URI present
  • Symptoms of URI
  • Nonspecific symptoms
Term
Diagnosis of Acute Otitis Media
Definition

All 3 Criteria Must Be Met:

  1. History of acute onset signs and symptoms
  2. Presence of middle ear effusion
  3. Signs and symptoms of middle ear inflammation
Term
Acute Otitis Media Etiology
Definition

Bacterial

Strep. pneumoniae

H. influenzae

Moraxella catarrhalis

Group A Strep

Staph. aureus

Anaerobic organisms

G- Enteric bacilli

 

Viral

RSV

Rhinovirus

Adenovirus

Influenza virus

Parainfluenza virus

Enterovirus

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