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EBM Dr. Freshie > EBM Session 5 > Flashcards

EBM Session 5 Flashcards

1
Q

what is Septra/Bactrim?

A

TMP/SMX

trimethoprim and sulfamethoxazole

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2
Q

What is the moa of trimethoprim?

A

Inhibits dihydrofolate reductase to impair DNA.

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3
Q

What is the moa of sulfamethoxazole?

A

Structurally similar to PABA and so blocks DHF synthesis inhibiting DNA synthesis.

Often paired with Trimethoprim to create septra/bactrim.

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4
Q

What is the spectrum of activity for bactrim/septra?

A

TMP/SMX is best used for community aquired MSSA and has no coverage against anaerobes.

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5
Q

What is the dosage for bactrim?

A

2 tablets 80mg TMP/400mg SMX q 12 h

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6
Q

When is bactrim use contraindicated?

A

Increased drug levels of:
Coumadin and sulfonureas.
Also cleared renally/hepatically.

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7
Q

what is cubicin and what is its moa?

A

Cubicin is Daptomycin

It works by depolarizing cell membranes.

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8
Q

What is the indication for cubicin use?

A

Daptomycin use indicated in hospital aquired MRSA and MSSA.

Also hits enterococcus.

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9
Q

What is the dosage for cubicin?

A

IV injection over 2 mins or infusion over 30

4mg/kg q 24h for 7-14 days.

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10
Q

What is the moa of tygacil/tigecycline?

A

Inhibits protein translation by binding to the 30s subunit.

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11
Q

What is the indication for tygacil use?

A

MRSA and MSSA used for extreme cases in which there is a mixed infection or sepsis!!!!

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12
Q

What is the dosage for tygacil?

A

100 mg; 50 mg q 12h over 30-60 minutes.

Has extreme side effect of death.

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13
Q

What are the golden rules of surgical prophylaxis?

A

The drug should reach maximum levels at the time of the incision.

the abx should be directed against the most commonly found organism.

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14
Q

Which wound types demand prophylaxis?

A

Bites!

research has found that punctures and lacerations do not require prophylaxis unless signs of infection begin.

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15
Q

Which prophylaxis should be used if MRSA/MRSE is expected?

A

Vancomycin

1g 1 hour before surgery followed by 1g 12 hours following the first dose post op./

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16
Q

When would clindamycin prophylaxis be utilized?

A

Penicillin allergies or in the case of implantation.

600-900 mg IV is used.

17
Q

What is the general consensus with surgical prophylaxis?

A

Some believe it must always be performed.

Other studies have shown that it does not decrease risk of infection at all.

18
Q

How will synovial fluid analysis change with an infection?

A

Increased cell count normal 0-3000 with infection can get as high as 100,000

19
Q

What is the most common infectious agent in acute hematogenous osteomyelitis?

A

Staph aureus!

GBS in neonates 0-3 months

H. influenzae in children under 2 years

Pseudomonas in drug user

Salmonella in sickle cell patients!

20
Q

What ESR in children notates acute hematogenous osteomyelitis?

A

ESR >20 mm/h

or WBC >12,000

Realise that radiographs will lag behind by a week.

21
Q

What are the best imaging modalities for acute hematogenous myelitis?

A

Bone scan for early cases.
MRI is the best non-invasive study when used without contrast. Will be looking for decreased T1 signal.

bone biopsy and bone culture is the gold standard here.

22
Q

What is the treatment for hematogenous osteomyelitis in adults?

A

Vancomycin 15-20mg/kg/dose q8 to 12h

If IV drug user want to cover pseudomonas

23
Q

What is the treatment of choice in adults that have osteomyelitis but also have sickle cell anemia?

A

This requires cipro to cover S. aureus and salmonella.

Ciprofloxacin 750 mg PO or 400 mg IV q 12 hours.

24
Q

What antibiotic coverage should be used in children over 3 months old vs under 3 months with acute hematogenous osteomyelitis?

A

IV nafcillin/oxacillin clindamycin or vancomycin if over 3 months old.

Target group B strep if under 3 months and use cephtriaxone IV combined with vancomycin or nafcillin/oxacillin.

EBM Dr. Freshie (6 decks)

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