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Pharmacology for APRN > Bacterial, Fungal, Viral Infections > Flashcards

Bacterial, Fungal, Viral Infections Flashcards

1
Q

Animal Bites: causative organism & treatment

A

All bites that break the skin require antibiotics

Organism: Most common = staph aureus or pasteurella multocida

Oral Amoxicillin Clavulanate

IV Ampicillin-Sulbavtam

PCN Allergy: Oral or IV Doxycycline

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2
Q

Impetigo and Ecthyma: Causative organisms & Presentation

A

Cause: Staph Aureus, GAS, or both

Bullous Impetigo: blisters or bullae, S. Aureus. Age <2

Impetigo: scattered macules –> vesicles + pustules –> honey colored crust

Ecthyma: Chronic, dermis involvement, vesicles –> ulcerations –> erythematous halo

Risk: poststreptococcal glomerulonephritis

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3
Q

Cellulitis and Erysipelas: Causative organisms & Presentation

A

Cellulitis Cause: GAS, S. Aureus

From Animal Bites or Scratches: Pasteurella Multocida

Erysipelas Cause: S. Pyogenes

Presentation Cellulitis: Skin and SQ layers, may spread systemically

Presentation Erysipelas: LE’s, scalp, face. Sharply demarcated erythema, orange-peel. spreads rapidly

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4
Q

Orbital Cellulitis First Line

A

Ceftin, Ceftaxamine plus MRSA coverage

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5
Q

First Line Tx Cellulitis: Animal Bites

A

Amoxicillin / Clavulanate for aerobic and anaerobic coverage

Grab a swab!

Pasteurella multocida is bacterium

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6
Q

First Line Cellulitis: Paranychia

A

Cefalexin, Augmentin

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7
Q

First Line Tx: Cellulitis & Erysipelas

A

Amoxicillin / Clavulanate: GAS, Staph, MSSA (no MRSA)
Cephalexin: GAS, MSSA (No MRSA)
Doxycycline: MRSA + MSSA (poor GAS)
PCN Allergy: Clindamycin: MRSA + MSSA (C.Diff Risk)
TMP/SMX: MRSA (Poor GAS)

IV: Vancomycin, Daptomycin, Linezolid

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8
Q

Folliculitis: Causative organism & Presentation

A

Most Common: S. Aureus, MRSA

Hot tub use: Pseudomonas aeruginosa

Presentation: Superficial infection of the hair follicle, erythematous pruritic papules –> pustules

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9
Q

Furunculosis and Carbunculosis: Causative organism & Presentation

A

Most common: S. Aureus

Presentation: Pus-filled nodule that encircles a hair follicle

Carbuncle: several furuncles together

Risk: Secondary infection like osteomyelitis and endocarditis

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10
Q

First Line Tx: Purulent Skin Infection

A

I&D

If systemic: Augmentin, Cefalexin

Second-Line: Bactrim, MRSA coverage

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11
Q

Diabetic Foot Infection: Causative organism & Presentation

A

Presentation: Must show purulence or 2 signs of inflammation

Erythema, warmth, tenderness, pain, induration

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12
Q

First-Line Tx Oral: Diabetic Foot Infection

A

MSSA: Clindamycin, TMP/SMX, Cephalexin (superficial ulcer +no MRSA)

MRSA: Clindamycin, TMP/SMX, minocycline, linezolid, vancomycin

Aerobic Streptococci: First-3rd line cephalosporins, clindamycin

Enterobacteriaceae: cephalosporins, TMP/SMX

Pseudomonas aeruginosa: Ciprofloxacin, levofloxacin

Bacteroides: metronidazole, clindamycin
Aerobic+Anaerobic: Cipro+Clinda

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13
Q

Necrotizing Fasciitis: Causative organism & Presentation

A

Organism: Pasturella multocida, Erysipeiothrix, MSSA, MRSA, GAS

Type 1: Polymicrobial
Type 2: Monomicrobial
Type 3: gas gangrene from Clostridium perfringens

Presentation: similar to cellulitis + severe pain, erythema, edema

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14
Q

First-Line: Impetigo & Ecthyma

A

Bullous & Non-Bullous: Mupirocin 2% if limited BSA
Retapamulin 1%

Oral ABX: Amoxicillin-Clavulanate or Dicloxacillin (PCN) or Cephalexin (1st Gen Cephalosporin) for Staph & Strep

GAS: PCN

MRSA or PCN allergy: Doxycycline, Clindamycin, or SMX-TMP

Streptococcal Glomerulonephritis: IV PCN

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15
Q

First Line Impetigo & Ecthyma if Steptococcus Pyogenes

A

First generation cephalosporin: Cephalexin (Keflex) or topical Mupirocin 2%

Topical Mupirocin 2%
Retapamulin 1%
Pen VK, PenG
Amoxicillin
Cephalexin
Cefadroxil

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16
Q

Second Line Impetigo & Ecthyma if Steptococcus Pyogenes

A

Amox/Clavulanate
Macrolides

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17
Q

First-Line Impetigo and Ecthyma if Staphylococcus Aureus:

A

Topical mupirocin 2%
Retapamulin 1%
Cephalexin (MSSA)
Cefadroxil (MSSA)
Dicloxacillin (MSSA)

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18
Q

Second-Line Impetigo and Ecthyma if Staphylococcus Aureus:

A

Amox/ Clavulanate (MSSA)
TMP/SMX (MRSA)
Doxycycline (MRSA)
Clindamycin (MRSA)

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19
Q

First Line: Necrotizing Fasciitis

A

Surgical Debridement

IV: Piperacillin-Tazobactam, Clindamycin, Vancomycin

Culture

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20
Q

Special Considerations Pregnancy & Breastfeeding: Category B Preferred

A

Amoxicillin-Clavulanate
Cephalexin & Cephalosporins
Clindamycin
Daptomycin
Dicloxacillin

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21
Q

Tinea Versicolor / Pityriasis Versicolor: Organism & Presentation

A

Organism: overgrowth of Malassezia

Presentation: Well-demarcated, scaling patches of pink, tan, brown

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22
Q

First Line Tx: Tinea Versicolor / Pityriasis Versicolor

A

First-Line: Selenium Sulfide 2.5% x 7 days, Ketoconazole BID x 2 weeks (cream or shampoo)

Second-Line: Systemic Itraconazole 200 mg x 5 days(Sporanox), oral ketoconazole, oral fluconazole 300 mg once weekly x 2 weeks

Dx: Positive potassium hydroxide test

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23
Q

Candidiasis: Organism & Presentation

A

Organism: Candida albicans

Presentation: intertriginous areas, diaper, oral, nails, groin. Pustular satellite lesions

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24
Q

First Line Tx: Candidiasis

A

Topical: Clotrimazole, miconazole, nystatin BID until infection clears

Advantage of being applied only where needed, avoiding antibiotic resistance

25
Q

Second Line Tx: Candidiasis

A

Fluconazole 150 mg once weekly x 4 weeks
itraconazole, Ketoconazole

If topical non-effective or infection severe / recurrent
More severe infections or causes that do not respond to tropicals
Typically used for oral, genital, or systemic

26
Q

Tinea Types & Definition

A

Dermatophytes that infect nonviable keratinized cutaneous tissues

Tinea Capitis: Head
Tinea Corporis (Ringworm): Body
Tinea Cruris (Jock itch): groin
Tinea Pedis (athletes foot): Feet
Tinea Manuum: hand
Tinea Unguium (onychomycosis): Nails

27
Q

First Line Tinea Capitis

A

Oral Therapy only

Griseofulvin 500 mg adults 10 mg/kg/d peds x 6 weeks

28
Q

First Line Tinea Unguium

A

Oral therapy only

Terbinafine or Azole Antifungal
250 mg daily x 6 weeks fingernails
250 mg daily x 12 weeks toenails

29
Q

Topical Allylamine Antifungals (Terbinafine, Lamisil): Drug Facts

A

MOA: disrupts production of ergosterol. Effective against Dermatophyte

Use: Tinea Corporis, tinea cruris, Tinea pedis

Dose: Apply BID to effect

SE: Burning, irritation

30
Q

First Line Tinea: All other tineas

A

Topical Azoles, Miconazole, Lamisol, Tinactin

31
Q

Griseofulvin Drug Facts

A

MOA: Depostis keratin precursor cells increasing keratin resistance to fungus

SE: N/V/D, HA, Photosensitivity

Interaction: increase levels of wararin, decrease levels of barbiturates and cyclosporines, decrease efficacy of oral contraceptives, disulfiram effect with alcohol

32
Q

Systemic Allylamine Antifungal (Terbinafine, Lamisil): Drug Facts

A

MOA: inhibit squaline epoxidase, causing deficiency of ergosterol

Fingernail: 250 mg/d x 6 weeks
Toenail: 250 mg/d x 12 weeks

SE: diarrhea, dyspepsia, rash, HA, INCREASED LFTs

33
Q

Systemic Azole Antifungals (Itraconazole, Cresemba): Drug Facts

A

MOA: inhibit CYP-450 enzymes and inhibits synthesis of ergosterol

Use: tinea capitis and tinea unguium

SE’s: GI, Elevated LFT’s, Visual disturbances

34
Q

Selenium Sulfide (Selsun Blue) Drug Facts:

A

MOA: control yeast on the scalp

Use: Seborrheic dermatitis, dandruff, tinea versicolor

Apply: once daily for 10 min, rinse off. Prophylactic use

SE’s: Irritation, hair loss

35
Q

Nystatin (Mycostatin) Drug Facts

A

MOA: bind to sterols of cell membrane of the fungus, changes membrane permeability

Use: moist areas, oral thrush, diaper rash, groin, candida species

CXN: not in immunocompromised patients

36
Q

HSV Diagnostics

A

HSV-1: PCR is most sensitive and spcific

VZV: PCR

37
Q

First-Line Tx: HSV-1

A

Topical: mild, immunocompetent
Acyclovir 5% or Penciclovir 1%

38
Q

Second-Line Tx: HSV-1

A

Systemic therapy with Acyclovir, Famciclovir, or Valacyclovir

When topical ineffective or outbreak is severe

39
Q

Topical Acyclovir 5% and Penciclovir 1% Drug Facts

A

MOA: inhibit viral DNA synthesis

Apply: 5 times daily x 4 days

SE: skin irritation, pruritus

40
Q

Oral Acyclovir, Famciclovir, and Valacyclovir Drug Facts

A

MOA: inhibit viral DNA synthesis

Acyclovir: low bioavailability

Dosing: 5-10 days

CXN: renal disease

SE: HA, Depression, Increased LFTs

41
Q

First-Line Tx: VZV

A

Immunocompromised, Pregnant, Rash <72 hrs, Age >50:
Systemic Acyclovir or Valacyclovir x 5 days

Immunocompetent: Treat symptomatically
Capsaicin: reduces substance P, helps postherpetic neuralgia

42
Q

First-Line Verrucae

A

Common Verruca Vulgaris (HPV-2): Topical Salicylic Acid 17% at bedtime for 8-12 weeks until wart healed

Plantar Wart (HPV-1): 40% salicylic acid at bedtime for 24-48 hours at a time x 12 weeks

43
Q

Psoriasis: Drug Causes

A

Systemic corticosteroids
Lithium Carbonate
Antimalarials
Beta Blockers
Systemic Interferon
Alcohol

44
Q

Psoriasis Diagnostics:

A

Clinical Presentation: well-demarcated erythematous papules or plaques surrounded by silvery or whitish scales

45
Q

Psoriasis Types

A

Guttate: small, scattered, teardrop papules & plaques. Triggered by infection

Erythrodermic: generalized erythema & scale shedding. Burned appearance. Medical emergency

Pustular: Generalized, localized, palmar-plantar types. 2-3 mm sterile pustules

46
Q

First-Line Tx: Psoriasis

A

Moisturizers & topical steroids x 2 weeks

High-potency or very-high potency steroid BID with occlusive dressing

47
Q

Second-Line Tx: Psoriasis

A

1 week rest from TCS then 2wks of therapy with same agent x 2 more times

Add a Vitamin D analog BID

48
Q

Third-Line Therapy: Psoriasis

A

UV B light treatments, Antimetabolites, Etanercept, or
Psoralens plus UVA light therapy

49
Q

Psoriasis Topical Agents: Corticosteroid Drug Facts

A

MOA: promote vasoconstriction

Apply: BID x 2 weeks, decrease to alternating days

50
Q

Psoriasis Topical Agents: Coal Tar Drug Facts

A

MOA: depresses DNA synthesis, antiinflammatory and antipruritic properties

Apply: dissolve in hot bath x 10-20 min soak for 30-45 days, 3-7 days per week

CXN: odor, stains clothes and tubs, photosensitivity

51
Q

Psoriasis Topical Agents: Anthralin Drug Facts

A

MOA: inhibit DNA synthesis, decrease epidermal proliferation

Apply: 30min -1H, remove

Contraindicated: acute psoriasis, inflammation

CXN: staining

52
Q

Psoriasis Topical Agents: Vitamin D Analogs Drug Facts

A

Calcipotriene & Calcipotriol: Mild to moderate psoriasis

MOA: reduction of cell proliferation by binding to receptors in epidermal keratinocytes

Apply: BID x 6-8 weeks

Contraindicated: Hypercalcemia, Vit D toxicity

SE: dry skin, hypercalcemia, rash

53
Q

Psoriasis Topical Agents: Retinoid Drug Facts

A

Tazarotene: mild to moderate Psoriasis

MOA: normalizes epidermal differentiation, diminishes inflammation

Apply: once daily at bedtime. 1 week to improvement, clear in 8 weeks

Contraindication: Pregnancy

SE: Pruritis, erythema, burning

54
Q

Psoriasis Systemic Agents: Retinoid Drug Facts

A

Acitretin: Long-term therapy

MOA: normalizes epidermal differentiation, decreases inflammation

P/T Therapy: CBC, CMP, Lipid profile

Dosing: 10 mg daily up to 50 mg daily until lesions clear

Contraindicated: pregnancy

SE: elevated lipids, abnormal LFT’s, alopecia, skin peeling, pruritus, dry skin

55
Q

Psoriasis Systemic Agents: Methotrexate Drug Facts

A

MTX: generalized psoriasis

MOA: inhibits folic acid reductase

Dosing: 7.5 mg / week administered in 3 doses over 24 hour period

Contraindicated: pregnancy and lactation

SE: HA, Blurred vision, fatigue, malaise, GI distress

56
Q

Psoriasis Systemic Agents: Cyclosporine Drug facts

A

MOA: suppresses cell-mediated immune reactions and humoral immunity, inhibits IL-2

Dose: 2-5 mg/kg/d

Contraindication: pregnancy and lactation

CXN: Nephrotoxic

57
Q

Psoriasis systemic agents: Phosphodiesterase 4 Inhibitors Drug Facts

A

Apremilast (Otezla)

MOA: Oral small molecule specific to cyclic adenosine monophosphate

Dose: 30 mg BID

SE: Diarrhea, weight loss

58
Q

Psoriasis Systemic Agents: Biologics Drug Facts

A

Etanercept (Enbrel), Infliximab, Adalimumab

MOA: binds and inhibits TNF decreasing inflammation

Screening: TB screening p/t initiation

Dose: 50 mg SQ BID x 3 mon

Contraindication: live vaccine, active infection

SE: infection, erythema, rash, URI, ABD pain

CXN: neurotoxicity, liver toxicity

Pharmacology for APRN (11 decks)

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