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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
Second Line Tx: Candidiasis
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
Tinea Types & Definition
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
First Line Tinea Capitis
Oral Therapy only Griseofulvin 500 mg adults 10 mg/kg/d peds x 6 weeks
28
First Line Tinea Unguium
Oral therapy only Terbinafine or Azole Antifungal 250 mg daily x 6 weeks fingernails 250 mg daily x 12 weeks toenails
29
Topical Allylamine Antifungals (Terbinafine, Lamisil): Drug Facts
MOA: disrupts production of ergosterol. Effective against Dermatophyte Use: Tinea Corporis, tinea cruris, Tinea pedis Dose: Apply BID to effect SE: Burning, irritation
30
First Line Tinea: All other tineas
Topical Azoles, Miconazole, Lamisol, Tinactin
31
Griseofulvin Drug Facts
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
Systemic Allylamine Antifungal (Terbinafine, Lamisil): Drug Facts
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
Systemic Azole Antifungals (Itraconazole, Cresemba): Drug Facts
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
Selenium Sulfide (Selsun Blue) Drug Facts:
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
Nystatin (Mycostatin) Drug Facts
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
HSV Diagnostics
HSV-1: PCR is most sensitive and spcific VZV: PCR
37
First-Line Tx: HSV-1
Topical: mild, immunocompetent Acyclovir 5% or Penciclovir 1%
38
Second-Line Tx: HSV-1
Systemic therapy with Acyclovir, Famciclovir, or Valacyclovir When topical ineffective or outbreak is severe
39
Topical Acyclovir 5% and Penciclovir 1% Drug Facts
MOA: inhibit viral DNA synthesis Apply: 5 times daily x 4 days SE: skin irritation, pruritus
40
Oral Acyclovir, Famciclovir, and Valacyclovir Drug Facts
MOA: inhibit viral DNA synthesis Acyclovir: low bioavailability Dosing: 5-10 days CXN: renal disease SE: HA, Depression, Increased LFTs
41
First-Line Tx: VZV
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
First-Line Verrucae
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
Psoriasis: Drug Causes
Systemic corticosteroids Lithium Carbonate Antimalarials Beta Blockers Systemic Interferon Alcohol
44
Psoriasis Diagnostics:
Clinical Presentation: well-demarcated erythematous papules or plaques surrounded by silvery or whitish scales
45
Psoriasis Types
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
First-Line Tx: Psoriasis
Moisturizers & topical steroids x 2 weeks High-potency or very-high potency steroid BID with occlusive dressing
47
Second-Line Tx: Psoriasis
1 week rest from TCS then 2wks of therapy with same agent x 2 more times Add a Vitamin D analog BID
48
Third-Line Therapy: Psoriasis
UV B light treatments, Antimetabolites, Etanercept, or Psoralens plus UVA light therapy
49
Psoriasis Topical Agents: Corticosteroid Drug Facts
MOA: promote vasoconstriction Apply: BID x 2 weeks, decrease to alternating days
50
Psoriasis Topical Agents: Coal Tar Drug Facts
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
Psoriasis Topical Agents: Anthralin Drug Facts
MOA: inhibit DNA synthesis, decrease epidermal proliferation Apply: 30min -1H, remove Contraindicated: acute psoriasis, inflammation CXN: staining
52
Psoriasis Topical Agents: Vitamin D Analogs Drug Facts
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
Psoriasis Topical Agents: Retinoid Drug Facts
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
Psoriasis Systemic Agents: Retinoid Drug Facts
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
Psoriasis Systemic Agents: Methotrexate Drug Facts
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
Psoriasis Systemic Agents: Cyclosporine Drug facts
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
Psoriasis systemic agents: Phosphodiesterase 4 Inhibitors Drug Facts
Apremilast (Otezla) MOA: Oral small molecule specific to cyclic adenosine monophosphate Dose: 30 mg BID SE: Diarrhea, weight loss
58
Psoriasis Systemic Agents: Biologics Drug Facts
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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