ANTIBIOTICS FROM HEAD TO TOE: PART 3 –
PNEUMONIA (HAP, CAP, AND EVERYTHING IN
BETWEEN)
LAUREN HYNICKA, PHARM.D.
ANTIBIOTICS FROM HEAD TO TOE: PART 3 – PNEUMONIA (HAP, CAP,
AND EVERYTHING IN BETWEEN
ACTIVITY DESCRIPTION
ACCREDITATION
Antibiotic use in the safest and most efficacious
manor possible is critically important for multiple
reasons. Appropriate antibiotic use decreases the
morbidity and mortality associated with infectious
diseases. However, in an era where antibiotic
resistance is becoming increasingly more
problematic, this must be balanced with judicious
use to preserve antibiotic effectiveness. In the series
titled, "Antibiotics from Head to Toe" we will review
appropriate antibiotic use by disease state.
PHARMACY
PharmCon, Inc. is accredited by the
Accreditation Council for Pharmacy
Education as a provider of continuing
pharmacy education.
NURSING
PharmCon, Inc. is approved by the California Board of
Registered Nursing (Provider Number CEP 13649) and
the Florida Board of Nursing (Provider Number 503515). Activities approved by the CA BRN and the FL
BN are accepted by most State Boards of Nursing.
TARGET AUDIENCE
The target audience for this activity is pharmacists
and pharmacy technicians in hospital, community,
and retail pharmacy settings.
CE hours provided by PharmCon, Inc. meet the ANCC criteria
for formally approved continuing education hours. The ACPE
is listed by the AANP as an acceptable, accredited continuing
education organization for applicants seeking renewal
through continuing education credit. For additional
information, please visit
http://www.nursecredentialing.org/RenewalRequirements.aspx
LEARNING OBJECTIVES
After completing this activity, the pharmacist will be
able to:
 Define community acquired pneumonia
(CAP), hospital acquired pneumonia (HAP),
ventilator associated pneumonia (VAP) and
healthcare associated pneumonia (HCAP)
 Identify the most common organisms seen in
CAP, HAP, VAP and HCAP
 Select appropriate empiric antibiotic therapy
for a patient with pneumonia
After completing this activity, the pharmacy
technician will be able to:
 Identify the symptoms of pneumonia
 List ways to treat pneumonia
Universal Activity No.: 0798-0000-13-210-H01-P&T
Credits: 1 contact hour (0.1 CEU)
Release Date: June 3, 2014
Expiration Date: June 3, 2016
ACTIVITY TYPE
Knowledge-Based, Home-Study Webcast
FINANCIAL SUPPORT BY
Pharmaceutical Education Consultants, Inc.
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ABOUT THE AUTHOR
Dr. Hynicka is an assistant professor of
pharmacotherapy at the University of Maryland School
of Pharmacy and serves as a clinical pharmacy specialist
on a general internal medicine team at the University of
Maryland Medical Center. She received her doctor of
pharmacy degree from the University of Pittsburgh
School of Pharmacy in Pittsburgh, PA. She then
completed residencies in Pharmacy Practice and
Internal Medicine at the Virginia Commonwealth
University Health System in Richmond,VA. In addition
to her areas of practice, her other interests include
infectious disease, immunology, hepatology,
pharmacoeconomics and pharmacogenomics.
Lauren Hynicka, PharmD
Assistant Professor, University of Maryland
School of Pharmacy
FACULTY DISCLOSURE
It is the policy of PharmCon, Inc. to require the
disclosure of the existence of any significant financial
interest or any other relationship a faculty member or
a sponsor has with the manufacturer of any
commercial product(s) and/or service(s) discussed in
an educational activity. Lauren Hynicka reports no
actual or potential conflict of interest in relation to
this activity.
Peer review of the material in this CE activity was
conducted to assess and resolve potential conflict of
interest. Reviewers unanimously found that the
activity is fair balanced and lacks commercial bias.
Please Note: PharmCon, Inc. does not view the existence of
relationships as an implication of bias or that the value of
the material is decreased. The content of the activity was
planned to be balanced and objective. Occasionally,
authors may express opinions that represent their own
viewpoint. Participants have an implied responsibility to use
the newly acquired information to enhance patient
outcomes and their own professional development. The
information presented in this activity is not meant to serve
as a guideline for patient or pharmacy management.
Conclusions drawn by participants should be derived from
objective analysis of scientific data presented from this
monograph and other unrelated sources.
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ACTIVITY TEST
1. Please use the following case to answer the next 3 questions.
PL is a 53 yo Caucasian male who presents to his PCP’s office (Dr. Smith) with a chief complaint
of shortness of breath (SOB) and cough x 3 days. PL has no significant PMH, has never required
hospitalization and does not take any medications. A chest x-ray is obtained and shows an
infiltrate in the right lower lobe. You are working at CVS when you get a call from Dr. Smith
about PL’s case.
Dr. Smith provides you with the information above and believes PL is a candidate for outpatient
treatment of his community acquired pneumonia (CAP). What additional information will you
ask Dr. Smith for to help determine how PL should be triaged?
A. Mental status exam, Uremia, respiratory rate, blood pressure
B. Mental status exam, BUN, respiratory rate, blood pressure
C. Mental status exam, serum creatinine, respiratory rate, blood pressure
D. Mental status exam, serum ammonia, respiratory rate, blood pressure
2. After you obtain the additional information from Dr. Smith you determine PL is an
appropriate candidate to receive outpatient treatment. Dr. Smith agrees and you begin to
discuss the organisms most likely to have caused PL’s infection. Dr. Smith recalls that
streptococcus pneumoniae is a common organism in this patient population. Which other
organisms are among the most common causes of CAP in this patient population?
A. Atypical organisms, haemophilus influenzae and respiratory viruses
B. Atypical organisms, haemophilus influenzae and staphylococcus aureus
C. Atypical organisms, staphylococcus aureus and gram negative bacilli
D. Atypical organisms, haemophilus influenzae and gram negative bacilli
3. Based on your knowledge of the likely infecting pathogens, the IDSA guideline
recommendations for specific patient populations and the treatment location, please select
the antibiotic regimen that would be most appropriate to recommend to Dr. Smith for the
treat PL’s CAP. (HINT: Assume low rates of macrolide resistant s. pneumo).
A. Azithromycin
B. Ceftriaxone + Azithromycin
C. Levofloxacin + Azithromycin
D. Levoflaxacin
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4. RD is a 49 yo AAF with a PMH significant for end stage renal disease secondary to
uncontrolled hypertension who received hemodialysis 3 days a week. She presents to the ED
with a history of shortness of breath and subjective fever for the last 24 hours. You are
suspicious for pneumonia. Which of the following types of pneumonia does RD likely have?
A. CAP
B. HCAP
C. HAP
D. VAP
5. What organism(s) are most likely to cause RD’s pneumonia?
A. Respiratory virus
B. Fungi
C. Anaerobes
D. Aerobic gram-negative bacilli
6. Which of the following are considered minor criteria when determining severity of illness for
a patient with CAP?
A. Multilobar infiltrates
B. Leukopenia
C. Thrombocytopenia
D. All of the above
7. Additional testing is recommended for patients with HAP/VAP. Which additional testing
should be done for ALL patients with HAP?
A. Blood cultures
B. Legionella urine antigen testing
C. Lower respiratory secretion culture
D. All of the above
8. Immunizations have been shown to decrease risk of pneumonia. Which immunizations are
most beneficial in reducing a patient’s risk for pneumonia?
A. Herpes zoster vaccine
B. Pneumococcal vaccine
C. Influenza vaccine
D. A and C
E. B and C
9. Which of the following fluoroquinolones is NOT considered a respiratory fluoroquinolone
and therefore should NOT be used as empiric therapy for CAP?
A. Ciprofloxacin
B. Levofloxacin
C. Moxifloxacin
D. Avelox
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10. Risk for MRSA pneumonia is increasing. Daptomycin should NOT be used in the treatment
of a patient suspected of having MRSA pneumonia because of which of the following
reasons?
A. Daptomycin only covers MSSA
B. Daptomycin is inactivated by lung surfactants
C. Daptomycin is unable to penetrate into the lungs
D. Daptomycin can be used to treat MRS pneumonia
Please submit your final responses on freeCE.com. Thank you.
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