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PDAT6 ID > 23 - CNS > Flashcards

23 - CNS Flashcards

1
Q

ADRs of
IV VANCOMYCIN

A
  • *REDMAN’S SYNDROME**
  • *Pruritis & Erythema** –> upper body

Caused by:
RAPID INFUSION
VVV
USE SLOW INFUSION

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2
Q

Differences in 3rd generation cephs
against S. pneumoniae

All 3rd generation cephs are not interchangable​

A

X = GOOD - z = inadequate

CefTRIAXone = q12-24 hours
why its used more often

CefoTAXime = q6-8 hours

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3
Q

Differences in 3rd-4th Generation Cephs

w/ respect to P. aeruginosa

A

CEFTAZIDIME** + **CEFEPIME
have anti-Pseudomonal activity

  • NOT cefTRIAXone*
  • inadequate activity*
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4
Q

Why is VANCOMYCIN needed for Empiric Therapy?
Acute Bacterial Meningitis

A

3rd Gen Cephalosporin = CefTRIAXone + CefoTAXime
Covers the major pathogens:
H. Influenzae + N. Meningitidis + S.Pneumoniae

but it does NOT cover:
Penicillin NON-susceptible S. PNEUNONIAE
VVV
Vancomycin covers it

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5
Q

Gram Stain of CSF shows:
DIPLOCOCCI

What Organism / Treatment Changes?

A

STREP. PNEUMONIAE
DIPLO-cocci

  • *Need** Penicillin & Ceftriaxone MIC
  • S. pneumiae can have PENICILLIN / CEF RESISTANCE*
  • *Pen MIC <** 0.06 = Pen G or Ceftriaxone
  • can remove Vancomycin*

Pen MIC > 0.12 = KEEP SAME
Vanc + Ceftriaxone

Cef MIC > 1 = KEEP SAME

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6
Q

Acute vs Chronic
Meningitis

A

Acute
Sxs last: Hours - Days
Rapidly FATAL
Caused by BACTERIA + VIRUS

  • *Chronic**
  • *> 4 weeks**
  • *M. Tuberculosis** + FUNGAL
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7
Q

Confirming Diagnosis:
CSF Findings
for
Bacterial Meningiitis

A

WBC > 500

Major Cell Type = PMNs

High Protein

LOW GLUCOSE

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8
Q

Acute Bacterial Meningitis:

What do we do AFTER empiric therapy?

A

CONFIRM DIAGNOSIS
by testing cultures & susceptibility

BLOOD
hematogenous infection

  • *CSF**
  • *Gram Stain + Glucose + Protein + WBC**

Gram Stain for
preliminary Pathogen ID

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9
Q

PREVENTION
for S. Pneumoniae

A
  • *UNconjugated 23-Valent Vaccine**
  • *ADULTS**
  • some serotypes are NON-susceptible to penicillin*

CONJUGATED 13-Valent Vaccine
Kids + Adult

ChemoProphylaxis
for those in close contacts w/ meningitis pts

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10
Q
  • *Duration of Therapy**
  • Meningitis
A

10-21 Days

Dependent on:
PATHOGEN
LONGER for Gram NEG = E.Coli / Kleb
&
Complications SECONDARY to Infxn
abscesses

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11
Q

Meningitis

Common Pathogens + Empiric Treatment

A
  • *VANCOMYCIN_ + _3rd Gen CEPHALOSPORIN_ + _STEROIDS**
  • *CefTRIAXone** or CefoTAXime

S. Pneumoniae + N. Meningitidis

Also for Age 1-23mo:
H. Influenzae

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12
Q

Acute Bacterial Meningitis:

PETECHIAL RASH

What Organism / Change in Treatment?

A

N. MENINGITIDIS
RASH

CEFTRIAXONE
ONLY

Stop Vancomycin –> not active for N. meningitidis

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13
Q

How can steroids improve the clinical outcome of patients with acute bacterial meningitis?

A

Give steroid BEFORE or within 1st dose of ABx

ABx –> bactria EXPLODE
vvv
Inflammation in CNS** –> **PRESSURE
VVV
Neurologic damage
(Unfavorable outcomes)
H.Influenzae in children –> Hearing issues

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14
Q

Acute Bacterial Meningitis + POST-NEUROSURGERY

What is ORGANISM is Vancomycin targeting?

Empiric Treatment is:
Vancomycin
PLUS
CEFEPIME** / **CEFTAZIDIME** / **MEROPENEM

A

GRAM-POSITIVE COCCI = MRSA
VANCOMYCIN

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15
Q

CEFTRIAXONE
S. Pneumoniae

ADRs

A

BILIARY ELIMINATION

High Dose CefTRIAXone –> precipitation in biliary tract

Sx:

  • *Cholecystitis** = inflammation of galbladder
  • *Ab pain / nausea / vomiting**
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16
Q

Alternate ABx for S. Pneumoniae

Instead of:
Vancomycin / Ceftriaxone (biliary disease)

A

CARBAPENEMS

  • *MEROPENEM** > Imipenem
  • due to SEIZURES*

Imipenem = renally eliminated
↓Dose –> ↓Seizure Risk

17
Q

Empiric ABx treatment for:

Acute Bacterial Meningitis + POST-NEUROSURGERY

A

Vancomycin
PLUS
CEFEPIME** / **CEFTAZIDIME** / **MEROPENEM
ceftazidime is not recommended for P.Pneumoniae

18
Q

Acute Bacterial Meningitis + POST-NEUROSURGERY

What is ORGANISM is the BETA-LACTAM targetting?

Empiric Treatment is:
Vancomycin
PLUS
CEFEPIME** / **CEFTAZIDIME** / **MEROPENEM

A

Hospital-aquired meningitis:
GRAM-NEGATIVE BACILLI
beta-lactams

  • *P.AERUGINOSA**
  • *Ceftazadime / Cefepime / Meropenem**

Also:
Aminoglycosides & Polymixin B (intra-thecal)
&
AZTREONAM for PCN ALLERGY

19
Q

AMINOGLYCOSIDES

ADR’s

Used for what type of Meningitis Bacteria?

A
  • *POST-NEUROSURGERY** –> HOSPITAL ACQUIRED
  • *Gram-NEGATIVE Bacilli** (P.Aerugiosa)
  • *AminoGlycosides:
  • POOR PENETRATION*–>directly into CSF**

Toxicity:
Ototoxicity** + **Nephrotoxicity
minimize toxicity with:
Weight Dosing / Renal Fucntion / Follow Serum levels

20
Q

Gram Stain of CSF shows:
COCCO-BACILLI

What Organism / Treatment Changes?

A

H. INFLUENZAE
Coccus + Bacilli

CEFTRIAXONE** or **CEFOTAXIME
ONLY

  • vancomycin does not target H. influenzae* –>
  • STOP VANCOMYCIN*
21
Q

PREVENTION / PROPHYLAXIS

N. Meningitidis Meningitis
RASH

A

Chemoprophylaxis
close contacts

  • *VACCINATION:**
  • *Serogroups A.C.Y.W-135** = MENomune / MENactra / MENveo

Serogroup B = TruMENba / BEXero

PDAT6 ID (31 decks)

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