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Infectious Disease > Disease States and Treatments Test 3 > Flashcards

Disease States and Treatments Test 3 Flashcards

1
Q

What are the most common risk factors for infective endocarditis?

A

Prosthetic valve and previous endocarditis

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2
Q

What are the most common causes of endocarditis and the adherence mechanisms of each?

A 
Staph= glycocalyx
Strep= dextran
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3
Q

What are the most common risk factors for a Staph endocarditis?

A

1st year of prosthetic valve, IV drug users

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4
Q

What are the most common risk factors for endocarditis caused by Enterococci?

A

genitourinary or obstetric procedures

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5
Q

What are the most common risk factors for gram negative endocarditis?

A

IV drugs users, prosthetic valves, cirrhosis

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6
Q

Peripheral stigmata

A

Seen in endocarditis
Osler nodes, splinter hemorrhages, petechiae, Janeway lesions, Roth spots, clubbing
“FROM JANE”

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7
Q

Clinical criteria for diagnosing endocarditis?

A
  • 2 “major” criteria= (+)ECG + persistent bacteremia w/IE pathogens
  • 1”major” and 3 “minor” criteria= persistent bacteremia OR (+) echo + fever, eye hemorrhages, + Osler nodes
  • 5 “minor” criteria
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8
Q

Treatment for highly susceptible and relatively resistant Strep endocarditis

A

Highly susceptible:
Native valve: PCN G (12-18M)
Prosthetic: PCN G (24M)+ Mandatory 2 week gentamicin
Relatively resistant: PCN G + 2 week gentamicin

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9
Q

Tx for highly resistant Strep and susc. enterococci endocarditis

A

ampicillin + 4-8 weeks of gentamicin

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10
Q

Tx for endocarditis

A

LOOK AT TABLE IN NOTES

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11
Q

First line therapy for acute otitis media

A

HIGH-DOSE amoxicillin (90 mg/kg/day) x 5-10 days

**If that doesn’t work w/in 48-72 hours –> HIGH DOSE amox/clav (Augmentin)

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12
Q

First line therapy for acute sinusitis

A

Standard dose amox-clav

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13
Q

Drugs of choice in acute pharyngitis (Strep throat)

A

penicillin OR amoxicillin x 10 days

PCN allergy: azithromycin x 5 days

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14
Q

First line for acute bronchitis

A

USUALLY SELF LIMITING

If sx >1 week –> azithro/clarithromycin, doxy, or FQ

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15
Q

Place of care based on PSI score

A

0-70= outpatient
71-90= outpatient or brief inpatient stay
91 - >130= inpatient

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16
Q

CURB-65 criteria

A

Confusion, Urea 30, SBP, Age >65
0-1= outpatient
3-5= inpatient (4-5 can be ICU)

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17
Q

First line outpatient therapy for CAP

A

Previously healthy: macrolide
Recent abx thx or cormorbid conditions: Resp FQ
Suspected aspiration: amox/clav
Flu w/ the CAP: oral BL or resp FQ

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18
Q

First line inpatient therapy for CAP

A

Medical ward: Resp FQ

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19
Q

First line inpatient ICU therapy for CAP

A

Need to cover MRSA!
BL+ Azithro OR Resp FQ
Need to cover pseudomonas? Antipseudomonal BL + Resp FQ
Allergy to penicillins? Aztreonam

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20
Q

Gold standard for diagnosis of HCAP

A

lung biopsy (however generally reserved for pediatric or immunosuppressed pts)

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21
Q

Risk factors for MDR pathogens

A

Abx w/in 90 days, current hospitalization >5 days, high abx resistance in community, immunosuppression, RISK FACTORS FOR HCAP

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22
Q

Risk factors for HCAP

A

Hospital stay >2 days w/in the last 90 days, nursing home, home infusion tx, chronic dialysis, home wound care, family w/MDR pathogen

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23
Q

“early onset” pneumo

A

<5 days after admission; need to cover Strep pneumo, H. flu, MSSA, and PEcK

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24
Q

“late onset” pneumo

A

> 5 days after admission; need to cover all early onset pathogens PLUS MRSA, pseudomonas

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25
Q

First line tx for early onset HCAP with no risk factors for MDR pathogens

A

ampicillin/sulbactam, ceftriaxone, FQ, ertapenem

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26
Q

First line tx for late onset HCAP with risk factors for MDR pathogens

A

MRSA COVERAGE + ANTIPSEUDOMONAL BL + ANTIPSEUDOMONAL AG OR FQ
MRSA coverage is always vanc or linezolid

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27
Q

What is the most common portal of entry for osteomyelitis?

A

Contiguous (47%) or vascular insufficiency (34%)

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28
Q

Lab and Radiologic tests for osteomyelitis

A

inc WBC, inc ESR/CRP
Need blood culture, blood culture, and joint aspiration to get diagnosis (superficial cultures are NOT reliable)
MRI and bone scan can detect changes very early

29
Q

First line treatment in hematogenous osteomyelitis

A

Children/ Sickle Cell pts: nafcillin + cefotaxime OR ceftriaxone
Adults: nafcillin
IV users: vancomycin + anti-pseudomonal

30
Q

First line treatment in contiguous osteomyelitis/ vascular insufficiency

A

pip/tazo, cefepime + metronidazole (+ Vanc for MRSA) x AT LEAST 4-6 weeks

31
Q

Non-pharm therapy for osteomyelitis

A

surgical debridement, hyperbaric oxygen therapy

32
Q

What is the most common kind of infectious arthritis?

A

Hematogenous (seeding from systemic infection)

33
Q

Clinical features of gonococcal and nongonococcal infectious arthritis

A

SEE CHART IN LECTURE

34
Q

Treatment for infectious arthritis

A

Children/adults: nafcillin + cefotaxime OR ceftriaxone

Prosthetic joint, surgery, or IV users: vanc + antipseudomonal

35
Q

Duration of treatment for infectious arthritis

A

Nongonococcal: 2-3 weeks
Gonococcal: 7-10 days

36
Q

Types of Diarrhea

A

Acute: 14 days
Chronic: >4 weeks

37
Q

Which types of E. coli are in watery diarrhea?

A

Enterotoxigenic and enteropathogenic

38
Q

First line treatment for diarrhea

A

FLUID REPLACEMENT/ oral rehydration therapy

39
Q

Examples of anti-motility agents

A

diphenoxylate, loperamide

DO NOT USE IN INFLAMMATORY DIARRHEA

40
Q

Example of absorbent

A

Kaolin-pectin/aluminum hydroxide

41
Q

When do you recommend antibiotics in diarrhea?

A

usually not indicated!

only for use in Shigella, Campylobacter, and Yersinia

42
Q

Diagnosis of C. diff

A

stool culture and at least one toxin test (ELISA)

43
Q

Treatment for initial infection of C.diff

A

Mild-Mod= metronidazole PO
Severe= vancomycin PO
Severe, complicated= vanc PO + metronidazole IV

44
Q

Treatment for relapse of C. diff

A

1st relapse= same agent that you used on initial infection according to severity
>2nd relapse= vancomycin (taper)

45
Q

Bismuth subsalicylate

A

use in traveler’s diarrhea
inhibit enterotoxin activity and prevent diarrhea
do not use for >3 weeks or in prego

46
Q

Antimicrobials for traveler’s diarrhea

A

usually not needed

DOC is FQ (Cipro or Norfloxacin)

47
Q

Main causative organism in Primary CAPD

A

S. aureus

48
Q

Causative org in primary SBP

A

E. coli

49
Q

Main causative org in secondary peritoneal disease

A

polymicrobial: E. coli, Bacteroides, and Candida can be seen

50
Q

Source Control

A

Antibiotics alone are not enough to treat secondary intra-abdominal infections!! Need to drain infected foci, abscesses, and fluid collections and do surgical repair of damage (seldom used in primary infections)

51
Q

Treatment of primary CAPD

A

Gram (+) coverage (cefazolin or vanc) + Gram (-) coverage (aminoglycoside, FQ)

52
Q

Treatment of primary SBP

A

cefotaxime, ceftriaxone, FQ

53
Q

Treatment of secondary intra-abdominal infections

A

CA, mild-mod risk: ticarcillin/clavulanate, cefoxitin, ertapenem, metronidazole + ceph
CA, high risk: pip/tazo, antipseudomonal carbapenems

54
Q

Aminoglycosides PD

A

CONCENTRATION DEPENDENT

Peak conc 8-10X the MIC of the pathogen

55
Q

beta-Lactams PD

A

TIME DEPENDENT

40-50% of the time >MIC

56
Q

MIC Creep

A

MIC’s are rising for some org which makes it harder to meet target in some agents

57
Q

Vancomycin PD

A 
TIME DEPENDENT (troughs are assoc w/ efficacy)
AUC/MIC >400
58
Q

FQ PD

A

CONCENTRATION DEPENDENT
Gram (-)= AUC/MIC >125
Gram (+)= AUC/MIC >33.7

59
Q

Loading Dose for Vancomycin

A

for pts with SEVERE illness
25-30 mg/kg IV x 1
Max 2000 mg (2 grams)

60
Q

Maintenance Dose for Vancomycin

A

15-20 mg/kg/dose using ABW (max 2 gr)

Q8-12H based on renal function

61
Q

SIRS Criteria (did I already put these on here? I can’t even remember anymore #pharmacyschoolprobs)

A 
HR >90
RR >20
Temp >38 (>100.4)
WBC >12,000
NEED > OR = 2 OF THE 4 CRITERIA
62
Q

Sepsis

A

SIRS + infection

63
Q

Severe sepsis

A

Sepsis + organ dysfunction or hypotension

64
Q

Septic shock

A

Severe sepsis + hypotension that won’t come down even after fluid therapy and requires vasopressor

65
Q

Common pathogens in sepsis

A

S. aureus, P. aeruginosa, Enterobacteriace

Gram (-) and fungi (yeast) have high mortality

66
Q

What are the three things sepsis causes?

A

Coagulation, vasodilation, and capillary leak

67
Q

Diagnosis of sepsis

A

do not delay abx administration due to cultures

minimum 2 blood cultures + 1 or more percutaneous blood cultures + one blood culture from each vascular access device

68
Q

How do you treat hypotension in sepsis?

A

FLUID RESUSCITATION FIRST! If that doesn’t work, then vasopressors (norepinephrine). If that doesn’t work, then steroids

Infectious Disease (6 decks)

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