how long will a cough last for acute bronchitis?
up to three weeks is completely normal
how do you treat acute bronchitis?
95% cases are viral--
... [Show More] tessalon pearls to help with cough. * prednisone is never the answer **
explain the following views of chest xrays: AP, PA, PA and lateral
which one do you want for pneumonia patient?
AP- shows the heart predominantly because its from front to back
PA- shows the lungs predominantly because its back to front
lateral shows fluid line
what is the gold standard for diagnosing community acquired pneumonia
chest xray- PA/lateral, repeat post treatment in 6 weeks (repeat not really done anymore)
treatment guidelines for CAP- healthy adult no comorbidities
MAD LUNG
amoxicillin 1 gram TID (best choice)
doxycycline 100 mg twice daily
macrolide (mycin) in areas with low macrolide resistance so not the best choice
treatment guidelines for CAP- adult with comorbidities
monotherapy: respiratory quinolone (levofloxacin 750 mg daily)
combination therapy: augmentin or cephalosporin PLUS macrolide or doxy
what are common respiratory fluroquinolones?
Think FLOXACIN-- moxifloxacin, gemifloxacin, levofloxacin
what are common macrolides for CAP
think "MYCIN" -- azithromycin, clarithromycin
what are common tetracyclines for CAP
doxycycline
what are common beta lactams for CAP
amoxicillin, augmentin (amox with clav), cefpodoxime, cefuroxime
how would you treat a pregnant 29 year old with pneumonia?
Amoxicillin 1 g TID-- cant give levaquine (flouroquinolones no in pregnancy due to fetal ligament destruction, doxycycline no in pregnancy stains tooth bones in fetus)
how long do you give antibiotics to patient with pneumonia?
5-10 days, you always want to continue antibiotics for 3 more days after clinically stable (no fever)
When do you get a chest xray for pneumonia?
it is the gold standard for diagnosis, you do not need to do resolution chest xray unless things are lingering or you suspect something else.
When do you give pneumococcal vaccine?
adults > 65 years old you give PPSV23 or you can give both PCV 13 and PPSV23 but must be 1 year apart
adults > 65 with immunocompromising condition give both pcv 13 and ppsv23
adults 19-64 at increased risk of pneumococcal disease (asthma, copd, smokers, cv dz) - give PPSV23 only
adults 19-64 with asplenia, cochlear implants, csf leak-- give pCV13 NOW then PPSV23 in 8 weeks , then PPSV23 in 5 years.
What is the diagnostic criterion for COPD
FEV1/FVC ratio of < 0.70
What are characteristics of COPD
midlife onset, symptoms slowly progressive, exposure to lung irritant, DOE is progressive, chronic cough and chronic sputum production
what are characteristics of asthma
onset early in life, symptoms vary widely from day to day, symptoms worse at nighttime/early AM, allergic rhinitis, eczema, family history, obesity
what are characteristics of heart failure (when evaluating diff dx of COPD)
chest xray with dilated heart, pulmonary edema
what are characteristics of tuberculosis when ruling out for COPD patient
onset all ages, chest xray with lung infiltrate, microbiologic confirmation
what are the characteristics of bronchiectasis
LOTS OF PURULENT SPUTUM, chest xray shows bronchial wall thickening and bronchial dilation
What intervention has the greatest influence on slowing progression of a COPD patient?
smoking cessation!!
what are first line smoking cessation drugs? (3)
varenicline (chantix), nicotine patch, buproprion extended release (zyban)
what is second line smoking cessation drug?
sertraline (zoloft)
what smoking cessation drug would you give to someone with a history of a suicide attempt?
nicotine patch-- NOT CHANTIX OR ZYBAN
What are the short acting beta agonists
albuterol, levalbuterol [Show Less]