PNEUMONIA BY NITHIN KUMAR PHARM.D(PB) II ND YEAR MRIPS

INTRODUCTIONPneumonia is an inflammation and infection

of the lungs.Inflammation is the immune system normal

response to injury or contaminants.Germs, bacteria and viruses are

contaminants and can cause inflammation.There are more than 50 kinds of pneumonia.Pneumonia can affect one or both lungs.

when it affects both lungs ,it sometimes called double pneumonia.

Pneumonia has been a common disease throughout human history.

Every year,more than 60,ooo americans die of pneumonia.

It can effect any body. but it is more dangrous to

older adults,babies and patient with chronic illness.

TYPES OF PNEUMONIA

Community acquired pneumonia refers to pneumonia you get,or aquire from your community such as school,work or gym.

Hospital aquired pneumonia or nosocomial pneumonia is a serious pneumonia aquired at a hospital or a health care facility it usually effects patients who are

Mechanical ventilators.I cu unit.Or having weak immune system.

Bacterial Pneumonia:Bacterial Pneumonia occurs when pneumonia-causing bacteria masses and multiplies in the lungs. The alveoli become inflamed and pus is produced, which spreads around the lungs. The bacteria that caused Bacterial Pneumonia are:

streptococcus pneumonia, hemophilus influenza, legionella pneumophilia and staphylococcus aureus.

Viral Pneumonia:Viral Pneumonia is believed to be the cause of half of all pneumonias. The viruses invade the lungs and then multiply- causing inflammation

Aspiration pneumonia happens when any thing other than air gets in to the lungs

Walking pneumonia refers to a pneumonia that is mild enough you may not even known you have it.you may able to walk around this type of pneumonia.

PATHOPHYSIOLOGYPneumonia develops when foreign matter such as viruses, bacteria,

parasites, or fungus enters the lungs and causes inflammation. There are also chemicals that can enter the lungs and cause pneumonia. Additionally, an injury to the lungs may cause pneumonia, but it is much less common. Once this foreign matter enters the body, it provokes a response of the immune system. After that, the person's oxygen levels begin to deplete and he or she begins to breathe faster.

The mucus production also begins to increase. As the mucus production increases, the fluid begins to fill the alveoli, which are the small pocket-like sacs in the lungs where gas exchange takes place. As the development of pneumonia progresses, the patient's white blood cell count begins to rise. Once the white blood cell count rises, the debris they leave behind also fill the alveoli. All of these things filling the alveoli is what causes pneumonia to become life-threatening very quickly if left untreated

SIGN AND SYMPTOMSFever ChillsCoughUnusually fast breathingWheezing difficulty in breathing

GUIDE TO EMPIRIC ANTIBIOTIC THERAPY FOR ACUTE UN COMPLICATED PNEUMONIAPATIENT AGE ANTI-INFECTIVE

DURATION AGENTNeonate ampicillin+aminoglycoside 10-14

days consider adding methicillin 1-3 mon ampicillin consider adding nafcillin or 10-

14 days using cefuroxime alone consider adding erythromycin

3-5mon CST 7-10 DAYS

>5yrs Erythromycin 7 days consider adding Ampicillin or cefuroxime Aspiration Community, Ampicillin or penicillin 7-10 days Hospital aquired CST 10-14

days Pneumonia ,

DIAGNOSISClinical history and examChest x raySputum AnalysisVisual bronchoscopyBronichial lavage

PREVENTIONCough or sneeze in to a tissue.Use separate drinking glasses and eating

utensils.Wash your hands often with warm soapy

water.Use alcohol based gel for hand washing when

soap and water are not available.

VACCINES

Vaccines help prevent pneumococcal pneumonia but cannot prevent all cases of infection. However, vaccination can lead to milder and less long cases of pneumonia as well as fewer serious complications. The following vaccines are recommended to help protect you against pneumonia.

Haemophilus influenzae type b (Hib) - The Hib vaccine is a type of bacteria that can cause pneumonia and meningitis and is given to children from 2 month - 5 years old to help prevent these infections..

Influenza vaccine - This vaccine is administered once a year in order to prevent the flu, which can precede cases of pneumonia. Influenza vaccines are usually given in October or November, before peak flu season.

Pneumococcal pneumonia vaccine - This vaccine helps prevent pneumococcal pneumonia and is often good for at least 5 years. This vaccine is often recommended for people aged 65+, people diagnosed with chronic diseases, serious long-term health problems, or weak immune systems, certain Native American populations, and children who are 2 years or younger, between the ages of 2 and 5 diagnosed with a chronic disease or who attend group daycare programs.

CASE

STUDY

NAME: XYZ AGE: 58

IP NO:1216597 WT: 65kgs

WARD:MMW-1 DOA:25/10/12

SUBJECTIVEC/o Fever Cough for 4 days Breathlessness SOCIAL HISTORY: SMOKER,ALCOHOLIC SINCE

15DAYS.

PAST MEDICAL HISTROY: HTN SINCE 9 YRS on medication of amlodipine

and enalapril

OBJECTIVE:The patient lab investigation shows following

abnormalities:FBS:144MG/DL PBS:237MG/DL WBC: 17,700 GLYCOSYLATED HAEMOGLOBIN (HBA1C): 5.7%USA: GRADE 1: RENAL PARENCHYMAL DISEASE

ASSESSMENT

PNEUMONIA WITH DIABETES MELLITUS

THERAPEUTIC PLAN:DAY 1:

BP:100/70 mm/hgPR:74b/minTEMP:101 cP/A:soft

RX:INJ piperacillin sodium Iv 4.5gm TID INJ pantoprazole iv 40mg ODINJ Levofloxacin IV 500MG ODTAB Paracetamol IV P/O 650MG SOSSYRUP Terbutaline sulphate+bromohexine

hydrochloride 10ML TIDNEB salbutamol +ipratropium bromide budenosideIV FLUIDSDNS AND MVI

Day 2:BP: 130/70 mmhgPR:80b/minCVS:S1,S2P/A:SOFT RX:CST + NEB Salbutamol and budenosideGRBS 8TH HRLY

Day 3:BP:130/80 mmhg RX: CSTPR:80b/MIN INJ Human

actrapidRR:20/MIN cap multivitamin 1

tab BDTEMP:99 FCVS:S1,S2P/A: SOFT

Day 4:BP: 120/80 RX: CSTPR:98b/min Crimaffin(liquid

paraffin,milkCVS: S1,S2) of magnesia )15ml

H/S

Day 5:BP:110/70 RX: CSTPR:78b/MIN Day 6: BP:110/70 RX: CSTPR: 81b/MINCVS: S1,S2

THERAPEUTIC GOALSThe two main goals of treatment for

pneumonia are to:

1. Cure the infection.2. prevent FURTHER complications.

INTERVENTIONSLUNG FUNCTIONAL TEST SHOULD BE

PERFORMED.ADVERSE DRUG REACTION :

AMLODIPINE: HYPERGLYCEMIA . ENALAPRIL : RENAL DISEASE.

PATIENT COUNSELLINGLIFE STYLE MODIFICATIONS:

Eat healthy.Sleep well.Avoid smoking.Exercise.Reduce stress.Avoid drinking alcohol excessively

REFERENCESWWW. X PLAIN.COM TEXT BOOK OF PHARMACOTHERAPHY

HAND BOOK BY JOSEPH T. DIPIRO www.ehealthforum.com.

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