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PHA 416 - Therapeutics IV > Exam 1 - Treatment of CNS Infections > Flashcards

Exam 1 - Treatment of CNS Infections Flashcards

1
Q

What type of infections are the following:

  • meningitis
  • meningoencephalitis
  • encephalitis
  • brain and meningeal abcesses
  • shunt infections
A

CNS Infections

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2
Q

In bacterial meningitis, where does the organism attach?

A

Organism attaches to epithelial cells of the NASOPHARYNGEAL or OROPHARYNGEAL mucosa

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3
Q

T/F: Organisms that transmit bacterial meningitis are encapsulated.

A

TRUE - capsule is a polyprotein that surrounds organism and evades host defenses

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4
Q

Why don’t macrophages try to phagocytize organisms that cause bacterial meningitis?

A

Because of the capsule that surrounds the organism

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5
Q

When bacteria evade host defenses, what do they cause?

A

Bacteremia

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6
Q

The Leptomeninges are made up of what two structures?

A

1) Pia mater

2) Arachnoids

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7
Q

What tissue/structure lies directly over the brain tissue?

A

PIA MATER

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8
Q

What is the name of the middle layer between the dura mater and pia mater?

A

ARACHNOIDS

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9
Q

Where is the subarachnoid space (SAS) located?

A

Between the pia mater and arachanoids

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10
Q

What serves as a conduit for CSF?

A

SAS

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11
Q

Meningitis is an infection of the ______.

A

Meningitis is an infection of the SAS.

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12
Q

What values are obtained in a lumbar puncture?

A
  • Glucose
  • Protein
  • WBC
  • Lactic acid
  • pH
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13
Q

T/F: Bacteria which lack polysaccharide capsule are incapable of producing meningitis.

A

TRUE - unless its an open head injury

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14
Q

Name the s/s that a patient with meningitis might present with.

A
  • Fever, stiff neck, or back
  • Nuchal rigidity
  • (+) Brudzinski sign
  • (+) Kernig sign

All lead to seizures and/or hydroencephalus

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15
Q

What are the diagnostic procedures for meningitis?

A
  • Cultures
  • Physical exam
  • CT scan (looking for hydroencephalus) and MRI imaging

Need meds before doing diagnostic tests

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16
Q

Name the factors that affect antibiotic transfer into the CNS.

A
  • Small molecular weight (Vancomycin has a large molecular weight)
  • Antibiotics which are un-ionized (ionization stops it)
  • Highly lipid soluble (Aminoglycosides don’t cross the BBB because they are hydrophilic)
  • Low protein binding (unbound part interacts with organism)
  • Relationship between MBC and concentration in the CSF (should be ~8:1)
17
Q

Which causative organism is most common in children and young adults in the winter or spring?

A

Neisseria meningitidis (Meningococcus)

18
Q

What is the source of Neisseria meningitidis (Meningococcus)?

A

An asymptomatic carrier

19
Q

Name the five serotypes responsible for Neisseria meningitidis.

A

A, B, C, Y, and W-135

20
Q

Why do 50% of patients die within the first 24 hours of Neisseria meningitidis infection?

A

Because of its fulminant course - occurs suddenly and escalates quickly

21
Q

What is the primary clue that the underlying pathogen is N. meningitis?

A

Presence of petechiae

-50% of patients will present with either purpuric lesions, petechiae, or both

22
Q

Which organism can have patients that present with a subclinical picture of DIC (Disseminated Intravascular Coagulopathy) with elevated PT and PTT and thrombocytopenia, and elevated fibrinogen and fibrin factors?

A

Neiserria meningitis

23
Q

Name the treatment for Neisseria meningitis.

A

Immediate intervention with Cefotaxime (Kids) 2 g IV Q4H OR Ceftriaxone (Adults) 2 g IV Q12H

24
Q

T/F: Close contacts of patients with N. meningitidis are at an increased risk of contracting the disease.

A

TRUE - secondary cases usually develop within 30 days of contact with the index case

25
Q

Who are at the greatest risk of contracting N. meningitidis as a close contact?

A

Young children are at the greatest risk

26
Q

What is the prophylaxis treatment for N. meningitidis for adults?

A

600 mg Rifampin Q12H x 4 doses

27
Q

What is the prophylaxis treatment for N. meningitidis for children 1 month - 12 years of age?

A

10 mg/kg Rifampin Q12H x 4 doses

28
Q

What is the prophylaxis treatment for N. meningitidis for children < 1 month old?

A

5 mg/kg Rifampin Q12H x 4 doses

29
Q

What can be used when Rifampin is contraindicated?

A

Ceftriaxone IM (pregnancy in adults)

30
Q

Which organism occurs in the very young (1-4 months) and the very old?

A

Streptococcus pneumoniae (Pneumococcus)

31
Q

What is the most common cause of meningitis in adults and accounts for 12% of meningitis in children 2 months - 10 years of age?

A

STREPTOCOCCUS PNEUMONIAE (PNEUMOCOCCUS)

32
Q

T/F: 50% of cases of are secondary to primary infections involving the ear or paranasal sinuses.

A

TRUE

33
Q

Name the risk factors for contracting Streptococcus pneumoniae.

A
  • Pneumonia
  • CSF leak secondary to head trauma
  • Splenectomy
  • Alcoholism
  • Sickle cell disease
  • Bone marrow transplantation
34
Q

Name treatment for Streptococcus pneumoniae.

A

Cefotaxime (Kids) 2 g IV Q4H OR Ceftriaxone (Adults) 2 g IV Q12H

  • If relative resistant, use Ceftriaxone
  • If highly resistant, use Vancomycin
35
Q

What was the most common cause of meningitis in children 6 months - 3 years, but reduced incidence with creation of vaccination?

A

Haemophilus influenzae

36
Q

Which organism is often a complication of a primary infection involving the middle ear, paranasal sinuses or lungs?

A

Haemophilus influenzae

37
Q

Which organism can cause coma and seizures early in the course of the disease?

A

Haemophilus influenzae

38
Q

T/F: H. influenzae show no ampicillin resistance.

A

FALSE - Up to 35% of H. influenzae are ampicillin resistant

39
Q

What are the drugs of choice in treating the organism Haemophilus influenzae because of incidence of beta-lactamases?

A

3rd generation cephalosporins (Cefotaxime; Ceftriaxone)

PHA 416 - Therapeutics IV (10 decks)

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