Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX > Chapter 23: Infectious Diseases II > Flashcards

Chapter 23: Infectious Diseases II Flashcards

1
Q

Perioperative Abx Selection

A
  • Cefazolin (is preferred to prevent MSSA and streptococci infections)
  • Clindamycin is alt if beta-lactam allergy
  • Vanco if MRSA colonization risk is present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Perioperative Abx Selection: cardiac or vascular surgeries

A
  • Cefazolin or cefuroxime

- Vanco or clinda if beta-lactam allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Perioperative Abx Selection: hip fracture repairs / total joint replacments

A
  • Cefazolin

- Vanco or clinda if beta-lactam allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Perioperative Abx Selection: Colon (colorectal) or other surgeries involving the abdominal space

A

Cefotetan, cefoxitin, amp/sulbactam, ertapenem
or
Metronidazole + (cefazolin or ceftriaxone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Perioperative Abx Selection: Colon (colorectal) or other surgeries involving the abdominal space
Beta-lactam allergy

A

Clinda + (aminoglycosides, quinolones, or aztreonam)
or
Metronidazole + (aminoglycoside or quinolones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Meningitis empiric tx: neonate (<1month)

A 
Ampicillin (for listeria coverage)
\+
Cefotaxime (NO ceftriaxone)
or 
Gentamicin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Meningitis empiric tx: age 1 month to 50 years

A

Ceftriaxone or cefotaxime
+
Vanco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Meningitis empiric tx: >50 years or immunocompromised

A 
Ampicillin (for listeria coverage) 
\+
ceftriaxone or cefotaxime
\+
vanco
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute Otitis Media (AOM) Abx therapy first-line

A

Amox 80-90mg/kg/day in 2 divided doses
or
Amox/clav 90mg/kg/day (6.4mg/kg/day clav) in 2 divided doses
or
Ceftriaxone 50mg/kg IM or IV for 1 or 3 days (if vomiting and unable to tolerate po)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Acute Otitis Media (AOM) Abx alternative therapy (beta-lactam allergy)

A

Cefdinir 14mg/kg/day in 1 or 2 doses
Cefuroxime 30mg/kg/day in 2 divided doses
Cefpodoxime 10mg/kg/day in 2 divided doses
Ceftriaxone 50mg/kg IM/IV qd for 1 or 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common Cold etiology, symptoms, criteria for anti-infective, and tx options

A

Etiology: respiratory viruses (rhinovirus, seasonal coronavirus)
Symptoms: sneezing, runny nose, cough
Anti-infective: none
Tx: OTC cold medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Influenza etiology, symptoms, criteria for anti-infective, and tx options

A

Etiology: influenza virus
Symptoms: sudden onset fever, chills, fatigue, body aches
Criteria for anti-infective: <48 hours since symptom onset
Tx: oseltamivir x 5 days, baloxavir marboxil x 1 dose, zanamivir inh x 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pharyngitis etiology, symptoms, criteria for anti-infective, and tx options

A

Etiology: respiratory viruses, S. pyogenes
Symptoms: “strep throat,” sore throat, swollen lymph nodes, white patches on tonsils
Criteria for anti-infective: + rapid antigen diagnostic test
Tx: penicillin or amox or 1st or 2nd gen cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sinusitis etiology, symptoms, criteria for anti-infective, and tx options

A

S. pneumoniae, H. influenzae, and M. catarrhalis; Staphylococci, anaerobes, gram-neg rods
Symptoms: nasal congestion, purulent nasal discharge, facial/ear/dental pain, headache
Criteria for tx: >=10 days w/symptoms; >=3 days of severe symptoms
Tx: amox/clav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bronchitis

A

Causes can include bordetella pertussis (whooping cough), S. pneumoniae, Mycoplasma pneumoniae, H. influenzae
Abx only indicated if whooping cough then treat with azith, clarith, or SMX/TMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Acute Bacterial Exacerbation of Chronic Bronchitis

A 
ABECB
Supportive measures (O2, short-acting bronchodilators, IV or PO steroids)
Then abx for 5-7 days if one of the following are met: increased dyspnea, increased sputum volume, increased sputum purulence; mechanically ventilated
Preferred abx: amox/clav, azith, doxy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CAP symptoms and diagnostics

A
  • Fever
  • Cough with purulent sputum
  • Rales (crackling noises in lungs)
  • Tachypnea (increased resp rate)

Chest x-ray is gold standard for diagnostics and will have inflitrates, opacities, or consolidation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CAP pathogens

A

S. pneumoniae, H. influenzae, M. pneumoniae and possibly C. pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Outpatient CAP Tx: Category 1

A 
(no comorbidities)
Amox high dose (1gm tid)
or 
Doxy
or
Macrolide (azith or clarith) if local pneumococcal resistance is <25%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Outpatient CAP Tx: Category 2

A

Comorbidities present (chronic heart, liver, lung, or renal disease; diabetes, alcoholism, malignancy or asplenia)

  • Beta-lactam + macrolide or doxy
    e. g amox/clav or cephalosporin + macrolide or doxy
  • Respiratory quinolone monotherapy (levoflox, gemiflox, mociflox)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Inpatient CAP Tx: Non-severe (non-icu)

A

-Beta-lactam + macrolide or doxy
(preferred beta-lactams: ceftriaxone, cefotaxime, ceftaroline, or amp/sulb)
-Respiratory quinolone monotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Inpatient CAP Tx: Severe (ICU typically required)

A
  • Beta-lactam + macrolide

- Beta-lactam + respiratory quinolone (do not use quinolone monotherapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Inpatient CAP Tx: if risk factors for Pseudomonas and/or MRSA add on

A

MRSA: add coverage with vanco or linezolid
Pseudomonas: add coverage with pip/tazo, cefepime, ceftazidime, imipenem/cilastatin, meropenem or aztreonam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

HAP and VAP onset

A

> 48 hours after hospital admission

>48 hours after start of mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Common Pathogens in HAP and VAP

A
  • MRSA

- MDR gram-negative rods: P. aeruginosa, Acinetobacter spp. Enterobacter spp. E. coli, and Klebsiella spp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

HAP/VAP Empiric Regimen: Identifying Risk for MRSA and MDR

A
  • Positive MRSA nasal swan
  • High prevalence (>10%) of pathogen resistance to any single agent noted in hospital unit
  • IV abx within the last 90 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

HAP/VAP Empiric Regimen: all patients need

A

Coverage for Pseudomonas and MSSA

E.g cefepime and pip/tazo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

HAP/VAP Empiric Regimen: MRSA

A
  • Vanco
  • Linezolid

For example:
cefepime + vanco
Meropenem + linezolid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

HAP/VAP Empiric Regimen: Pseudomonas if risk for MDR pathogens

A

If patient has risk for MDR pathogens then typically has risk for MRSA. Requires 3 drug regimen)
E.G pip/tazo + cipro + vanco
cefepime + linezolid + gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

HAP/VAP Empiric Regimen: Abx for pseudomonas

A
  • pip/tazo
  • cefepime, ceftazidime, or ceftolazone/tazobactam
  • levofloxacin or ciprofloxacin
  • imipenem/cilastatin or meropenem
  • aztreonam
  • tobramycin, gentamicin, amikacin (these are always used with another antipseudomonal drug)
  • colistimethate or polymixin b
31
Q

HAP/VAP Empiric Regimen: Abx for MRSA

A

Vanco

Linezolid

32
Q

Latent TB: Preferred Regimens

A
  • Isoniazid (INH) and rifapentine qweek x12weeks (do not use on pregnant women) (for >2 children and adults)
  • Rifampin 600 qd x4 months (children of all ages and HIV pts)
  • INH and rifampin qd x3months (adults, children of all ages and HIV)
33
Q

Latent TB: alternate regimens

A

INH 300mg qd for 6 months or 9 months (HIV positive and negative patients of all ages)

34
Q

Active TB Tx

A 
RIPE (Intensive therapy for 2 months) 
R- rifampin
I- INH
P- pyrazinamide
E- ethambutol

Continuation with two drugs (usually rifampin and INH) for remaining 4 months

35
Q

Rifampin SE, notes

A

SE: increased LFTs, hemolytic anemia, flu-like syndrome, orange-red discoloration of body secretions (sputum, urine, sweat, tears, teeth) can stain contact lenses, clothing
Note: rifampin has many drug interactions, in some cases rifabutin can replace it

36
Q

Isoniazid warnings, SE

A

Warnings: peripheral neuropathy (supplement with pyridoxine [b6] 25-50mg po qd to decrease risk)
SE: increased LFTs, DILE, hemolytic anemia

37
Q

Pyrazinamide CI, SE

A

CI: acute gout
SE: increased LFTs, hyperuricemia/gout

38
Q

Ethambutol SE

A

SE: increased LFTs, optic neuritis (dose-related), confusion, hallucinations

39
Q

Rifampin Drug Interactions

A
  • Protease inhibitors (substitute rifabutin)
  • Warfarin (very large decrease in INR)
  • Oral contraceptive (decrease efficacy)
  • Do not use with apixaban, rivaroxaban, edoxaban, or dabigatran
40
Q

Infective Endocarditis Diagnosis

A

Modified Duke Criteria which includes an echocardiogram to visualize vegetation and positive blood cultures

41
Q

Infective Endocarditis Most Common Pathogens

A

Streptococci, staphylococci, and enterococci

42
Q

Infective Endocarditis Tx

A
  • Generally Vanco and ceftriaxone. Sometime Gentamicin is added for synergy
  • Usually tx is is 4-6 weeks of IV abx
43
Q

Infective Endocarditis Gentamycin dosing

A

Target peak levels of 3-4mcg/ml and trough levels of <1mcg/ml

44
Q

Patients at high-risk for Infective Endocarditis after Dental Work

A
  • artificial (prosthetic) heart valve or heart valve repaired with artificial material
  • Hx of endocarditis
  • Heart transplant with abnormal heart valve function
  • Certain congenital heart defects including heart/heart valve disease
45
Q

Infective Endocarditis Dental Work Prophylaxis

A

PO: amoxicillin 2 grams 30-60 minutes before dental procedure

*If unable allergic to PCN: clindamycin 600mg or azith or clarith 500mg

46
Q

TX for SBP

A

Ceftriaxone for 5-7 days

SMX/TMP or cipro can be used for primary or secondary prophylaxis

47
Q

Secondary peritonitis causes

A

Usually caused by a traumatic events and the most likely pathogens are streptococci, enteric gram-neg and anaerobes (b. frag)

48
Q

Management of secondary peritonitis and cholangitis: mild to moderate infections

A

Coverage for PEK, anaerobes, streptococci and enterococci
Examples: Cefoxitin, ertapenem, moxifloxacin, (cefazolin, cefuroxime, or ceftriaxone) + metronidazole, (cipro or levoflox) + metronidazole

49
Q

Management of secondary peritonitis and cholangitis:: high-severity infections (ICU)

A

Coverage for PEK, CAPES, pseudomonas, anaerobes, streptococci+-enterococci
Examples: Carbapenems (except ertapenem), pip/tazo,, (cefepime or ceftazidime) + metronidazole, (cipro or levo) + metronidazole, Cefazolin + (aztreonam or aminoglycoside) + metronidzolw

50
Q

Superficial SSTI

A
  • Impetigo
  • Furuncles
  • Carbuncles
51
Q

Nonpurulent that penetrate the subq tissue

A

Cellulitis

52
Q

Purulent

A

Abscess

53
Q

Mild, Moderate, Severe SSTI

A

Mild- no systemic signs
Moderate- systemic signs (fever >100/4, HR > 90bpm, WBC >12,000 or <4,000
Severe- failed oral abx + incision and drainage, systemic signs, signs of deeper infection, or immunocompromised

54
Q

Impetigo tx

A

Topical mupirocin

If systemic needed use cephalexin 250mg po qid

55
Q

Folliculitis/furuncles/carbuncles Tx

A

If systemic signs: cephalexin

If non-responsive change to drug with CA-MRSA coverage: SMP/TXM, doxycycline

56
Q

Cellulitis (non-purulent)

A

Cephalexin

57
Q

Abscess

A

Mild: I and D
Moderate: SMX/TMP, Doxycycline

58
Q

Severe purulent ssti

A

IV abx with MRSA

  • vanco (trough goal 10-15)
  • daptomycin
  • linezolid
59
Q

Necrotizing Fascitis

A

Empiric therapy is broad

Vanco + beta lactam (pip/tazo, imipenem/cilastatin or meropenem)

60
Q

Diabetic Foot Infections Monotherapy

A

When no MRSA coverage needed

-Amp/sulbactam, pip/tazo, carbapenems, tigecycline, or moxifloxacin

61
Q

Diabetic Foot Infection Combo Therapy

A

When MRSA and Pseudomonas
Vanco +
ceftazidime, cefipime, pip/tazo, aztreonam, or a carbapenem (except ertapenem)

62
Q

Acute Uncomplicated Cystitis Tx:

A

Nitrofurantoin (macrobid) 1 po bid f5d

SMX/TMP ds 1 po bid f3d

63
Q

Acute Uncomplicated Cystitis in pregnancy

A

Cephalexin

Amoxicillin

64
Q

Acute Pyelonephritis

A
  • If local quinolone resistance is <10%: ciprofloxacin, levofloxacin
  • If local quinolone resistance is >10%: ceftriaxone, ertapenem, aminoglycoside
65
Q

Complicated UTI

A

Carbapenem if ESBL are present

66
Q

Traveler’s Diarrhea Tx

A

In fever, bloody stool, pregnant or pediatric: Azithromycin 500mg qd f1-3 days
If no bloody stool choose quinolone or rifaximin

67
Q

Syphilis Tx

A 
Pen G (Bicillin l-a) (desensitize for pregnancy or hiv positive) 
Alternative: doxycycline
68
Q

Gonorrhea Tx

A

Cefrtriaxone 500mg im once; if chlamydia is not excluded and doxycyline

69
Q

Chlamydia

A

Doxy (100mg po bid for 7 day) or azith (1 gram po once)

70
Q

Bacterial Vaginosis

A

Metronidazole po or pv

71
Q

Trichomonias

A

metronidazole 2gm po once

72
Q

Genital warts

A

imiquimod

73
Q

Rocky Mountain Spotted Fever

A

Doxycyline (also preferred in children)

NAPLEX (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions