CLASP Flashcards
Holiday heart syndrome?
SVT with spontaneous resolution (caused by binge-drinking)
Tx methanol poisoning?
Ethanol/dialysis
Antabuse?
Inhibits aldehyde dehydrogenase making drinking unpleasant (rehab)
Why does heart beat faster when intoxicated?
Alcohol is negative inotrope (faster HR to maintain CO)
Veisalgia cephalgia?
Headache :)
Septic shock?
Septic shock = sepsis + BOTH of the following:
- Persistent hypotension (requiring vasopressors to maintain MAP greater than 65)
- Lactate greater or equal to 2
qSOFA criteria?
RR > 22 aBP <100 altered GCS * 0 = <1% mortality * 1 = 2-3% * >2 = >10%
when should you think sepsis?
NEWS score >5 + evidence of infection
SEPSIS 6?
BUFALO
- Blood cultures
- Urine output
- Fluids IV - crystalloid, 250-500 mls over 15 mins, aim for 30ml/kg over first 3 hours
- Antibiotics IV
- Lactate - high lactate is sign of hypoperfusion + high mortality if >4
- Oxygen - 94-98%
What if no response to fluids?
if no response refer to HDU for CVC and vasopressors (noradrenaline)
how to tell if septic patient is deteriorating?
- New confusion
- High RR
- Low BP
- Low BM
Gram positive organisms?
Cocci
- staphylococci (aureus + epidermidis)
- streptococci
- enterococci (E. faecalis)
Bacilli
- listeria
- clostridia (c.diff)
- corynebacterium (diptheroids)
B lactams? (6)
- penicillin
- flucloxacillin
- amoxicillin
- cephalosporins
- piperacillin/tazobactam
- carbepenems
features of streptococci? (2)
- facultative anerobes
* catalase positive
Classification of strep via agar?
B haemolytic
Alpha haemolytic - green
Gamma haemolytic
Classification of strep via antigens?
Lancefield group
- GAS
- Group B
- Group C
Types of streptococci? (5)
- strep pyogenes - GAS (pharyngitis, skin)
- strep agalactaiae - group B (pregnancy and neonates)
- streptococcus pneumoniae
- viridans streptococcal group (own group)
- streptococcus gallollyticus - typical endocarditis pathogen
Tx enterococcus faecium?
resistant to penicillin, fluclox, cephalosporin, aminoglycosides
gram positive?
gram negative?
\+ = purple - = pink
streptococcus pneumoniae causes? (3)
- otitis
- pneumonia
- meningitis
tx streptococcus pneumoniae?
If not penicillin resistant, penicillin
bind to penicillin binding proteins needed to synthesise peptidoglycan
E. faecialis found?
Ax?
Gastrointestinal tract
- UTI
- endocarditis
- bacteraemia
Tx E. faecalis?
Amoxicillin IV
* step down to oral amox or co-trimoxazole
What is used to treat enterococcus (E. faecialis etc) if amoxicillin resistant?
Vancomycin
Tx VRE (vancomycin resistant enterococcus)? (4)
- linezolid
- daptomycin
- tigecycline
- quinupristine/dalfopristin
what is mean inhibitory concentration (MIC)?
concentration of drug required to kill 99.9% of organisms in first 24 hrs
Tx staphylococcus aureus? (2)
Flucloxacillin IV in sepsis
* vancomycin IV in allergy or MRSA
Tx coagulae negative staph (i.e. not staph aureus)?
E.g?
many are flucloxacillin resistant
* oral doxycycline, cotrimoxazole, clindamycin
e.g. staph epidermidis
pharmacokinetics?
Pharmacodynamics?
pharmacokinetics = how body processes drug Pharmacodynamics = relationship between infection outcome and drug outcome
gram negative cell envelope?
contains additional outer membrane composed of phospholipids and lipopolysaccharides
Pathogenesis of gram-negative bacteria?
stems from lipopolysaccharide (LPS)
antibiotics active against gram negatives?
- B-lactams!
- aminoglycosides!
- macrolides
- tetracyclines
- chloramphenicol
- co-trimoxazole!
- polymixins!
Haemophillus influenzae?
Growth?
gram-negative coccobacillus
* chocolate agar media
Tx haemophillus influenzae?
- Amoxicillin
* Doxycycline
Atypical pneumonia?
Not strep pneumonia
* mycoplasma pneumoniae, coxiella burnetti, chlamydophila psittaci, legionella pneumophila
Tx for atypical pneumonia? (3)
- doxycycline - not legionella
- clarithromycin
- quinolones (levofloxacin) - legionella
Ax legionella?
Risk factors? (8)
- showers
- air conditioning
- taps
Risk factors
- smokers
- males
- COPD
- immunosuppressed
- malignancy
- diabetes
- dialysis
- hot tubs
pathogenesis legionella?
invades and grows within alveolar macrophages
which serogroup of legionella causes most disease?
Serogroup 1
Coliforms?
Examples?
gram negative rods
* E.coli and similar organisms e.g. klebsiella, proteus, enterobacter, serratia
Agar for coliorms + E.coli?
Macconkey agar = turns pink
Extended spectrum B lactamases (ESBLs)?
reistant to penicillins, cephalosporins, and aztreonam
Tx ESBLs? (3)
- clavulanate
- sulbactam
- tazobactam