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Therapeutics > Common/Viral Infect, Immunizations > Flashcards

Common/Viral Infect, Immunizations Flashcards

1
Q

common pathogens for sinusitis

A

s. pneumoniae, h. influenzae, m. catarrhalis

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2
Q

when are antibiotics used for sinusitis

A

-persistent sx >= 10 days without evidence of improvement
-severe sx >=3-4 days at beginning of illness
-worsening sx after typical viral URTI, double sickening

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3
Q

treatment duration for sinusitis

A

5-7 days adults
10-14 days children

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4
Q

drug of choice for sinusitis

A

amoxicillin/clavulanate

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5
Q

treatment duration for pharyngitis

A

10 days

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6
Q

drug of choice for pharyngitis

A

penicillin VK or amoxicillin

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7
Q

common pathogens for otitis media

A

s. pneumoniae, h. influenzae

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8
Q

When are antibiotics ABSOLUTELY GIVEN for otitis media

A

 6mo-12yrs + moderate-severe pain or temperature 102.2.
 6mo-23mo + non-severe bilateral acute OM.

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9
Q

when are antibiotics CONSIDERED for otitis media

A

 6mo-23mo + non-severe unilateral.
 2-12yrs + acute non-severe acute OM.

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10
Q

what is drug of choice for initial treatment of otitis media

A

amoxicillin (1st time)
amoxicillin/clavulanate (with hx)

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11
Q

drugs of choice for otitis media after treatment failure

A

amoxicillin/clavulanate, ceftriaxone

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12
Q

when are antibiotics used for COPD exacerbation

A

o Patient has three cardinal symptoms- increase in dyspnea, sputum volume, sputum purulence.
o Has two cardinal symptoms if sputum purulence is one of them.
o Anyone who requires mechanical ventilation.

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13
Q

drugs of choice for COPD exacerbation

A

azithromycin, doxycycline, amoxicillin/clavulanate

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14
Q

typical pathogens causing CAP

A

s. pneumoniae, h. influenzae, anaerobes

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15
Q

atypical pathogens causing CAP

A

M. pneumoniae, C. pneumoniae

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16
Q

which type of pneumonia has abrupt onset, unilateral infiltrate, significant fever, chills, sweats, dyspnea, purulent sputum, pleuritic chest pain

A

typical pneumonia

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17
Q

which type of pneumonia has gradual onset, gradual onset, diffuse infiltrates, ground-glass appearance, mild fever, mild dyspena, dry cough, myalgias, diarrhea, abdominal pain

A

Atypical pneumonia

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18
Q

pathogens that cause HAP

A

s. pneumoniae, h. influenzae, m. pneumoniae (atypical), S. aureus

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19
Q

treatment duration for CAP

A

at least 5-7 days

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20
Q

outpatient treatments for CAP

A

healthy- amoxicillin
comorbidities- amox/clav or cephalosporin + macrolide

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21
Q

inpatient treatment for CAP

A

non-severe/severe- IV beta lactam (amp/sul, ceftriaxone) + macrolide, fluoroquinolone

add anti-MRSA or anti-pseudomonal if needed

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22
Q

treatment duration for HAP

A

7 days

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23
Q

empiric drug options for HAP

A

ceftriaxone, levofloxacin, moxifloxacin, amp/sul, ertapenem

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24
Q

drugs to cover MDR organisms in HAP

A

MRSA- vanco, linezolid
Pseudomonas- pop/tazo, cefepime, ceftazidime, imipenem, meropenem, etc.

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25
Q

clinical UTI is defined by

A

significant bacteriuria + pyuria and signs/symptoms of infection

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26
Q

common pathogen causing UTIs

A

E. coli

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27
Q

infection in the lower UT

A

cystitis

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28
Q

infection in the upper UT

A

pyelonephritis

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29
Q

should you treat asymptomatic bacteriuria? if so when

A

NO
unless pregnant, prior to invasive UT surgery, prior to renal transplant

30
Q

drugs of choice for acute uncomplicated UTI

A

Nitrofurantoin monohydrate/macrocrystals 100 mg PO BID x 5 days.
Bactrim DS 160/800 mg PO BID x 3 days.

31
Q

treatment duration for acute moderate pyelonephritis

A

7-14 days

32
Q

drug of choice for acute moderate pyelonephritis

A

Bactrim DS 160/800 mg PO BID x 14 days

33
Q

treatment duration for acute severe pyelonephritis

A

10-14 days

34
Q

drug of choice for for acute severe pyelonephritis

A

extended spectrum cephalosporin or penicillin +/- aminoglycoside

35
Q

drugs for UTI/asymptomatic bacteriuria in pregnancy

A

amox/clav x 7 days, cephalexin x3-7 days

alt: nitrofurantoin, amoxicillin, Bactrim

36
Q

drugs for pyelonephritis in pregnancy

A

IV beta-lactams (ceftriaxone, cefazolin) and switch to oral when possible x 14 days.

37
Q

antibiotics that are contraindicated in pregnancy

A

quinolones, tetracyclines

38
Q

what do you do for recurrent UTI

A

relapse within 1-2 weeks –> extend treatment up to 6 weeks
reinfection–> treatment duration per guidelines

39
Q

drug of choice for prostatitis

A

Bactrim DS 160/800 mg PO BID

40
Q

bacterial causes of infectious diarrhea

A

shigella, salmonella, e. coli, s. aureus, c. diff

41
Q

which antibiotics are used for travelers diarrhea if necessary

A

Bactrim, fluoroquinolones, azithromycin

42
Q

which OTC items can be used for travelers diarrhea

A

loperamide max 2 days
pepto bismol

43
Q

super toxin producing e. coli strain

A

O157:H7

44
Q

antibiotics used for enterotoxic e.coli if necessary

A

cipro 750 mg QD x 3 days
rifaximin
azithromycin 1g x 1 or 500 mg QD x 3 days

45
Q

what is contraindicated in enterotoxic e. coli

A

antimotility agents

46
Q

signs of mild water loss

A

<5% body weight loss
alert, restless, increased thirst, moist/slightly dry mucus membranes, normal/slightly decreased UOP.

47
Q

signs of moderate water loss

A

6-9% body weight loss
lethargic, restless, low volume (low BP, high HR), dry mucus membranes, delayed capillary refill, dark urine.

48
Q

signs of severe water loss

A

> 10% body weight loss
drowsy, limp, LOC, bradycardia, cyanosis, skin “tenting”, no urine production.

49
Q

when to use oral rehydration

A

mild or moderate water loss due to infectious diarrhea

50
Q

when to use IV rehydration

A

severe water loss due to infectious diarrhea

51
Q

non-severe c. diff

A

leukocytosis (WBC <15k cells/mL) AND SCr <1.5 mg/dL

52
Q

drugs for initial treatment of NON-SEVERE c. diff

A

Vancomycin 125 mg PO QID x 10d
Fidaxomicin 200 mg PO BID x10d
(Metronidazole 500 mg PO TID x 10d)

52
Q

severe c. diff

A

leukocytosis (WBC >15k cells/mL) OR SCr > 1.5 mg/dL

53
Q

fulminant c. diff

A

hypotension or shock, ileus, megacolon

53
Q

what do you avoid and/or discontinue when treating c. diff infection

A

avoid anti-peristaltic agents
discontinue concurrent antibiotics if possible

54
Q

drugs for initial treatment of SEVERE c. diff

A

Vancomycin 125 mg PO QID x 10d
Fidaxomicin 200 mg PO BID x10d

55
Q

drugs for initial treatment of FULMINANT c. diff

A

Vancomycin 500 mg PO or NG QID
(PLUS Metronidazole 500 mg IV Q8H- if ileus is present)

56
Q

what drug do you use for the FIRST episode of recurrence of C. diff

A

same regimen as initial

57
Q

which drugs do you use for second or more recurrences of c. diff

A

vanco tapered, vanco pulsed, fidaxomicin 200 mg BID x 10d, vanco 125 mg QID x 10d then rifaximin 400 mg TID x 20d

58
Q

most common candida species

A

candida albicans

59
Q

risk factors for candida infection

A

chemotherapy
exposure to immunosuppressives
neutropenia

60
Q

drug of choice for candida

A

fluconazole

61
Q

most common aspergillus species

A

A. fumigates

62
Q

drugs of choice for aspergillus infection

A

amphotericin B, voriconazole

63
Q

which antifungal classes have cell membrane activity

A

azoles
polyenes (amphotericin B)

64
Q

side effects of voriconazole

A

visual disturbances, hallucinations, nightmares

65
Q

which antifungals act against the cell wall of fungi

A

echinocandins (-fungin)

66
Q

which antifungal has intracellular activity against fungi

A

pyrimidine analogues (flucytosine)

67
Q

azoles have major interactions with

A

CYP3A4 substrates

68
Q

major AE of amphotericin B

A

nephrotoxicity

Therapeutics (20 decks)

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