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Y4 PPT > B44 - meningitis, encephalitis > Flashcards

B44 - meningitis, encephalitis Flashcards

1
Q

Meningitis most common causative organisms age>3m

A 
Neisseria meningitidis (meningococcus) - a gram-negative, aerobic diplococcus
Streptococcus pneumoniae (pneumococcus) -a gram-positive, anaerobic bacteria with a lancet shaped diplococcus structure.
Haemophilus influenzae type b
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2
Q

Immediate Mx suspected meningitis

A

ABCDE

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3
Q

Treatment given in community for suspected meningitis

A

Benzylpenicillin sodium IV/IM in IV unavailable

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4
Q

Benzylpenicillin sodium doses based on age

A

<11m - 300mg
1-9y - 600mg
>10y (&adults) - 1.2g

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5
Q

Benzylpenicillin drug class

A

Beta lactam antibiotics (penicillins)

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6
Q

Beta-lactam pen ab MOA

A

bind to penicillin-binding proteins and inhibit synthesis of the peptidoglycan layer of the cell wall

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7
Q

Benzylpenicillin particularly effective against..

A

aerobic gram-positive bacteria, with some activity against gram-negative cocci and anaerobic organisms and no activity against gram-negative bacilli.

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8
Q

Benzylpenicillin indications (7)

A

Meningitis
Endocarditis
Intrapartum prophylaxis against group B streptococcal infection
Tonsillitis/otitis media/pneumonia/cellulitis

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9
Q

Benzylpenicillin CI

A

Hypersensitivity to penicillins

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10
Q

Benzylpenicillin SE (6)

A 
Hypersensitivity
GI disturbance
CNS toxicity
Interstitial nephritis
Blood disorders
Antibiotic associated colitis
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11
Q

Benzylpenicillin interactions (2)

A

Warfarin

Methotrexate (risk of toxicity)

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12
Q

What drug (& class/dose) is offered immediately following LP in suspected meningitis (adult)

A

3rd generation cephalosporin: Ceftriaxone or Cefotaxme IV

8g daily in 4 daily doses, increased if necessary to 12g daily in 3-4 divided doses

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13
Q

Alternative initial drugs offered immediately following LP in suspected meningitis

A

Penacillin (if cephalosporin anaphylaxis)

Chloramphenicol: Used ONLY in life-threatening conditions, because of its toxicity. Biggest unwanted effect is bone marrow toxicity (aplastic anaemia, reversible anaemia).
Can cause “grey baby” syndrome

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14
Q

Why are Third generation cephalosporinsare usually the empirical antibiotic of choice for bacterial meningitis

A

Known bactericidal activity for both pneumococci and meningococci
Increased ability to cross the blood-brain barrier

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15
Q

How are beta-lactam cephalosporins classified

A

Classified by generations, with succeeding generations having enhanced activity against gram-negative bacilli at the expense of gram-positive activity and increased ability to cross the blood-brain barrier.

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16
Q

cefotaxime indications (3)

A

Meningitis
Haemophilus epiglottitis
Sexually transmitted infections

17
Q

cefotaxime CI (2)

A

Hypersensitivity to cephalosporins

Immediate hypersensitivity to penicillin

18
Q

Cefotaxime SE (6)

A 
Hypersensitivity
GI disturbance
Skin reactions (including Stevens-Johnson syndrome)
Cholestatic jaundice
Blood disorders
Antibiotic associated colitis
19
Q

Cefotaxime interactions

A

Ibuprofen
Aminoglycosides
Methotrexate (nephrotoxicity)

20
Q

What can be given to help prevent/treat cerebral oedema and act as an adjunct treatment of bacterial meningitis?

A

Dexamethasone

21
Q

dexamethasone indications (4)

A

Cerebral oedema and adjunct treatment of bacterial meningitis
Rheumatic disease
Suppression of inflammatory and allergic disorders
Symptom control in a palliative care setting

(Potential uses within a palliative care setting include pain due to nerve compression, nausea and vomiting, dyspnoea due to bronchospasm/obstruction, anorexia and dysphagia.)

22
Q

dexamethasone contraindications (3)

A 
Systemic infection (except bacterial meningitis as benefits outweigh risk)
Live vaccines (if high dose)
Many associated cautions
23
Q

Dexamethasone SE

A

Cushings syndrome

Infections
Myopathy
Osteonecrosis/porosis
Neuropsychiatric symptoms
HPA insufficiency
Weight gain, oedema, impaired glucose metabolism, insulin resistance, beta cell dysfunction
Gastric ulcer (w concomitant NSAIDS)
Hirsutism, skin thinning
Cataract, glaucoma
^ Cardiovascular risk
24
Q

Consequences of abruptly stopping dexamethasone

A

acute adrenal insufficiency, hypotension and death

due to HPA surpression

25
Q

Drugs which interact with dexamethasone to cause hypokalaemia (9)

A 
Citalopram & venlafaxine
Amiodarone
Antipsychotics
Lithium
Clarithromycin & erythromycin
Sildenafil
Ondansetron
Furosemide
Methadone
26
Q

Drugs which interact with dexamethasone to produce GI effects (2)

A

NSAIDs (bleeding)

Nicorandil (perforation)

27
Q

Drug toxicity interactions with dexamethasone (4)

A

Digoxin
(digoxin toxicity)
Warfarin 
(increased anticoagulant effect)
Clarithromycin (increased exposure to steroid)
Ketoconazole (increased steroid exposure)

28
Q

Suspected meningitis (w/o signs of shock, severe sepsis or brain shift) immediate Ix/Mx (5 steps)

A 
Blood cultures
Lumbar puncture
Dexamethasone 10mg IV
Ceftriaxone or Cefotaxime 2mg immediately following LP, or if LP can't be done within 1 hour immediately after blood cultures taken (penicillin 2nd line)
Careful fluid resus (avoid overload)

CT scan usually NOT indicated

29
Q

Suspected meningitis with signs suggestive of shift of brain compartments secondary to increased ICP immediate Ix/Mx (7 steps)

A

Get critical care input
Secure airway, high flow O2
Take bloods including cultures
Dexamethasone 10mg IV
Give ceftriaxone of cefotaxime 2mg IV immediately after blood cultures taken
DELAY LP
Arrange neurological imaging once patient stabilised

30
Q

Susepected meningitis with signs severe sepsis or a rapidly evolving rash (with or without signs or symptoms of meningitis) 7 steps Ix/Mx

A 
Get critical care input
Secure airway and give high flow O2
Fluid resus
Blood cultures
Ceftriaxone or cefotaxime 2mg immediately after blood cultures taken
DELAY LP
Follow surviving sepsis guidelines
31
Q

Differences in presentation between viral meningitis and encephalitis

A

Viral Meningitis -
Symptoms of headache, neck stiffness,photophobia.GCS normal unless unresponsive.
Caused by enteroviruses and herpes viruses.

Encephalitis -
Flu-like symptoms, headache, psychiatric symptoms. (triad headache, fever, altered GCS/confusion)
Caused by herpes simplex.

32
Q

Viral encephalitis 1st line Mx

A

Aciclovir

33
Q

Aciclovir MOA

A

Guanosine analogue which inhibits synthesis of viral DNA. Requires phosphorylation by viral enzymes that are not present in uninfected host cells, preventing cytotoxic effects on human cells. Aciclovir targets viral DNA polymerase terminating viral DNA synthesis and thus replication.
Most active against HSV

34
Q

Aciclovir indications

A

Herpes simplex and varicella zoster infections

35
Q

Aciclovir cautions

A

Elderly patients (risk of neurological reactions)

36
Q

Aciclovir SE (6)

A

GI disturbance (nausea, vomiting, diarrhoea, abdominal pain),
Skin reactions and photosensitivity
Blood disorders (anaemia, leucopenia, thrombocytopenia),
Renal impairment
CNS effects (agitation, coma, confusion, ataxia, dizziness, encephalopathy, psychosis)
Hepatic disorders

37
Q

Aciclovir administration route for encephalitis

A

IV only
Not available as oral treatment for encephalitis
Available as oral tablet for chickenpox/shingles/labial or genital herpes

38
Q

Aciclovir length of treatment encephalitis

A

Min 14 days
Min 21 days if immunocompromised
Repeat LP to confirm CSF is negative before stopping

Y4 PPT (10 decks)

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