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NSG 533 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is nociceptive pain?

A

Transient pain caused by damage to tissue. ( cutaneous tissue, bone, muscle, connective tissue)
- Typically response to NSAIDS or opioids

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2
Q

What is neuropathic pain

A

Spontaneous pain and hypersensitivity to pain associated with damage to the central nervous system

  • often described as shooting or burning pain
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3
Q

What is malignant pain?

A
  • pain resulting from cancer or AIDS
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4
Q

WHO 3 step ladder approach to pain management

A
  1. Mild pain (1-4/10) : nonopioid analgesics such as acetaminophen or NSAIDS
  2. Moderate pain (4-6/10) : weak opioids like codeine or tramadol in combo with nonopiod
  3. Severe pain (6-10/10) : strong opioid like morphine or oxycodone in combo with nonopiod
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5
Q

What is the mechanism of action for NSAIDS ?

A
  • inhibits the COX enzyme which reduces prostaglandin synthesis.
  • Indicated for pain and inflammation
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6
Q

What are precautions against NSAIDS?

A
  • GI bleeding. All NSAIDs are ulcerogenic and induce GI bleeding due to activity against COX
  • renal impairment
  • cardiovascular risks
  • platelet inhibition , sodium retention
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7
Q

Use NSAIDs in caution with patients …

A
  • but reduced cardiac output because of sodium retention
  • taking anti-hypertensive, warfarin, and lithium
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8
Q

Use NSAIDs in caution with patients …

A
  • but reduced cardiac output because of sodium retention
  • taking anti-hypertensive, warfarin, and lithium
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9
Q

What kind of pain are NSAIDs preferred for?

A
  • mild to moderate
  • rheumatoid arthritis
  • Menstrual cramps
  • post surgical pain

These are all mediated by prostaglandins

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10
Q

What is a ceiling effect for NSAIDs?

A
  • increasing the dose may not provide significant additional benefits
  • at ceiling doses, the cox enzyme activity sites becomes saturated with the nsaid . No free enzyme can bind to further substrates which produces a plateauing effect on the drugs efficacy
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11
Q

What is the mechanism of action of acetaminophen ( APAP)?

A
  • reduces pain and fever by inhibiting press the gland and synthesis in the central nervous system by blocking cox enzyme
  • ACETAMINOPHEN NOT FOR INFLAMMATION
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12
Q

Precautions with acetaminophen

A
  • liver toxicity ( hepatotoxicity)
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13
Q

Precautions with acetaminophen

A
  • liver toxicity ( hepatotoxicity)
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14
Q

What is the normal dosing for acetaminophen in adults?

A
  • 4g (4,000mg) in adults
  • 3 g (3,000mg) in elderly
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15
Q

What is the normal dosing for acetaminophen in adults?

A
  • 4g (4,000mg) in adults
  • 3 g (3,000mg) in elderly
  • over-the-counter medication’s like cold meds also carry acetaminophen so if patient is taking Tylenol and cold medicine, they can get too much
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16
Q

What is an example of neuropathic pain?

A

Post hepatic neuralgia (PHN) : pain associated with acute hepatic neuralgia or an acute singles outbreak

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17
Q

Peripheral versus central neuropathic pain

A
  • peripheral: HIV or chemo
  • Central: central stroke pain, trigeminal neuralgia
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18
Q

What type of non-opiate medication’s? Would you use for a patient with neuropathic pain?

A
  • peripheral: TCAS ( amitriptyline or notriptyline)
  • SSRI or SNRI ( duloxetine or venlafaxine)
  • central: clonidine or baclofen
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19
Q

What does adjuvants analgesics mean?

A
  • medications that were not primarily designed for pain, relief, but can enhance analgesic effects or treat specific pain types.

Ex: antidepressants or anti-convulsants for neuropathic pain

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20
Q

What does adjuvants analgesics mean?

A
  • medications that were not primarily designed for pain, relief, but can enhance analgesic effects or treat specific pain types.

Ex: antidepressants or anti-convulsants for neuropathic pain

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21
Q

When would Advent analgesics be appropriate?

A
  • neuropathic pain
  • chronic pain like fibromyalgia and diabetic neuropathy
  • inflammatory pain, like rheumatoid arthritis and inflammatory bowel disease
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22
Q

Examples of adjuvants medication for a different diseases

A
  • diabetic peripheral neuropathy (DPN) : gabapentin ( anti-convulsant). SNRI like duloxetine
  • Post hepatic neuralgia (PHN): gabapentin and lidocaine patch
  • Fibromyalgia : duloxetine, amitriptyline. Avoid amitriptyline in older adults
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23
Q

What is the mechanism of action for opioids?

A
  • binds to opioid receptors (mu receptors)in central nervous system, which alters pain, perception and response .
  • binds to mu receptors and central nervous system, which leads to decrease transmission of pain signals. Has an effect on reward pathways because it leads to a feeling of euphoria which reinforces behaviors associated with opioid use
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24
Q

What are the adverse effects of opioids?

A
  • respiratory depression
  • constipation, sedation, drowsiness, physical dependence
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25
Q

What prophylactic measures should you take with opioids?

A
  • Laxatives for constipation
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26
Q

What is the medication to reverse respiratory depression with opioids?

A
  • Naloxone
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27
Q

What if a patient has an anaphylactic allergy to an opioid? What are the other medication options?

A
  • non-opioid analgesic like acetaminophen or NSAID
  • adjuvants and OG like anti-convulsants, TCAs, or lidocaine
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28
Q

What is equianalgesic dose?

A
  • doses of different drugs that provide approximate equal analgesic effects
  • comparing doses of different opioids based on their potency
  • Doses of different medication’s that are expected to produce comparable pain or relief when used in patients who have developed tolerance to one drug and need to switch to another
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29
Q

What is incomplete cross tolerance?

A

-When patient who has developed tolerance to one opioid may not exhibit, the same level of tolerance to another opioid because different opioids may act on different receptors

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30
Q

What is opioid rotation?

A
  • switching from one opioid to another to achieve better pain control or manage adverse effects. Reasons could be in adequate pain, relief or intolerable side effects or patient preference
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31
Q

What are examples of NSAIDs?

A

NSAIDS THINK NSAIK

Naproxen
Salicylate acid (aspirin)
Acetylsalicylic acid ( aspirin
Ibuprofen and Indomethacin
Ketorlac (Tordol)

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32
Q

What disorders are contraindicated for NSAIDs?

A
  • Peptic ulcer disease or any other bleeding disorder
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33
Q

What disorders are contraindicated for NSAIDs?

A
  • Peptic ulcer disease or any other bleeding disorder
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34
Q

All NSAID except what’s increase cardiovascular risk

A

Aspirin

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35
Q

What is an example of a NSAID cox 2 inhibitor?

A

Celebrex ( celecoxib)
- good for osteoarthritis or rheumatoid arthritis
- side effects is increased risk for a thrombosis which can lead to a stroke

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36
Q

When is Celebrex contraindicated

A
  • if a patient is allergic to aspirin, NSAID, or sulfonamides
  • Celebrex can cause increased cardiovascular risk
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37
Q

What is aspirin good for?

A
  • aspirin is an NSAID so it’s good for pain, inflammation, and fever
    Is also good for preventing myocardial infarction and patients who are at risk
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38
Q

What are side effects of aspirin?

A

Tinnitus (ringing in ears)
GI upset and rash ( like all other NSAIDS)

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39
Q

When is aspirin contraindicated

A
  • peptic ulcer disease
  • Children with fever (Reyes syndrome)
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40
Q

Should you ever take two NSAIDs together?

A

NO!!

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41
Q

Are NSAID safe for asthma?

A

-No!!
- patients with asthma or nasal polyps should use acetaminophen instead

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42
Q

How long do migraines last?

A

4-72 hrs

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43
Q

What are some symptoms of migraines?

A
  • photosensitivity, sound sensitivity, nausea and vomiting, throbbing pain
  • Unilateral pain
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44
Q

What is the difference between migraines and cluster headaches?

A
  • cluster headaches= no throbbing
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45
Q

What are cluster headaches?

A
  • Unilateral non-throbbing pain typically around the eye or a temporal
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46
Q

What is the medication of choice for cluster headaches?

A
  • Verapamil
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47
Q

How long do cluster headaches last?

A
  • 30 min- 2 hrs
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48
Q

What are some food triggers for headache?

A
  • tyramine( aged cheese, wine, organ meats)
  • Citrus foods, bananas, avocado, raisins , chocolate
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49
Q

What medication are triggers for headache?

A
  • Indomethacin, nifedipine, nitrates
  • estrogen or oral contraceptives
  • Menstrual cycles
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50
Q

What are headache, red flags? ( need urgent medical evaluation)

A
  • New onset and/or severe headache( thunderclap headache - could be subarachnoid hemorrhoids)
  • systemic signs like fever, weight loss and accelerated hypertension
  • Facial neurologic symptoms like weakness and numbness
  • patients with cancer or HIV
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51
Q

Treatment of acute migraine

A

NSAIDS like aspirin
Acetaminophen
Combination products containing caffeine with or without an opioid

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52
Q

When should triptans be used for migraine treatments?

A
  • when analgesic are ineffective and for severe headaches
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53
Q

When should triptans be avoided for migraines?

A
  • migraines associated with neurologic focalty
  • history of previous stroke
  • Uncontrolled hypertension
  • unstable angina
  • pregnancy
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54
Q

What other migraine medication should triptans not be used with together?

A

Ergotamine

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55
Q

What are typical symptoms of osteoarthritis?

A
  • joints pain
  • Stiffness
  • decreased range of motion
  • Symptoms worsen with activity and improve with rest
  • Commonly affected weight-bearing joints, like knees, hips, and spine
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56
Q

What is osteoarthritis?

A

Degenerative joint disease that primarily affects the cartilage and underlying bone in joints. Most common type of arthritis and typically develops over time

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57
Q

Nonpharmacological treatment of osteoarthritis

A
  • exercise, weight loss
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58
Q

Nonpharmacological treatment of osteoarthritis

A
  • exercise, weight loss
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59
Q

What are pharmacological treatments for osteoarthritis?

A
  • acetaminophen as first line/ initial therapy . For a mild to moderate osteoarthritis.
  • NSAID for inflammation and pain. For moderate to severe pain or therapeutic failure of acetaminophen.
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60
Q

What are the difference between cox 1 and cox 2 inhibitors

A
  • cox 1 inhibitors ( traditional NSAIDS ) have higher GI risk
  • cox 2 inhibitors have less Gi toxicity but may increase cardiovascular risks ( celebrex is cox 2)
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61
Q

Who would benefit from a COXib?

A

COXib=cox 2= celebrex
- patience at a high risk of G.I. complications

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62
Q

When are opioids/tramadol used for osteoarthritis

A

Reserved for patients who are unresponsive to other therapies or when other therapies are contraindicated

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63
Q

Symptoms of a cluster headache

A
  • nasal congestion
  • Eyelid edema
  • sweating
  • Agitation and pacing
  • Restlessness
  • Sensation of fullness in the ear
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64
Q

Other red flags for headaches?

A
  • cough - excretion- or valsalva triggered headache
  • Pregnancy or postpartum state
  • cancer or HIV
  • Seizures
  • New onset sudden and or severe pain
  • Systemic signs like fever and weight loss and accelerated hypertension
  • focal neurologic symptoms
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65
Q

What is the goal for treatment for osteoarthritis?

A
  • Reduce pain and inflammation
  • Treatment is not curative
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66
Q

NSAID versus acetaminophen for osteoarthritis

A
  • osteoarthritis can occur with and without inflammation
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67
Q

What is osteoporosis?

A

Decreased bone density and increased risk of fractures

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68
Q

What are some risk factors for osteoporosis?

A

-Old age
Women
Family history
Low body weights or BMI
Smoking, excessive alcoholic consumption
Low calcium or vitamin D intake
Lack of physical activities
Medications: steroids, anticonvulsants, proton pump inhibitors, ssri

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69
Q

What are the recommended calcium and vitamin D amounts?

A
  • calcium : 1000 mg a day. For women over 50 and men over 70: 1200 mg
  • Vitamin D:
    600-800
    800-1000 IU daily for adults over 70
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70
Q

How do you interpret T scores?

A

Normal : -1.0 or higher

Osteopenia ( low bone mass): between -1.0-2.5

Osteoporosis : -2.5 or lower

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71
Q

What calcium supplement would be the best to give a patient with a history of reflux

A
  • calcium carbonate
  • calcium citrate ( would be the preferred choice. It is better tolerated, and people with sensitive stomachs.)
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72
Q

What is the use of bio phosphates for osteoporosis?

A
  • they work by inhibiting bone resorption, which helps to maintain or increase bone mineral density, and reduce the risk of fractures
73
Q

What are examples of biophosphonates?

A
  • Alendronate ( Fosamax)
    risedronate ( Actonel)
    ibadronate ( Bonvia)

Biophosphonates : end in dronate

74
Q

What are counseling points you should give to your patients when giving biphosphonates?

A
  • oral: take on an empty stomach in the morning. Sit upright for at least 30 minutes after taking to minimize risk of esophageal reflux.
75
Q

What are adverse effects of biophosphonates?

A
  • ## GI upset ( especially with oral) , musculoskeletal pain, headache
76
Q

Alendronate

A
  • used for post menopausal osteoporosis and pagets disease ( a bone disease. Rare form of breast cancer)
  • mode of action: prevents bone resorption by inhibiting activity of osteoclasts ( usually osteoclasts break down bone take calcium from bone and put it in bloodstream. Alendronate helps keep calcium in the bone)
77
Q

Side effect of Alendronate

A
  • key: esophagitis ( inflammation of esophagus). Think Alan drones on and on about his esophagitis
  • GI upset, muscle pain, visual disturbances
78
Q

Teaching points for alendronate

A
  • take on empty stomach in the morning with full glass of water
  • sit up for 30 min! Don’t lay down, can result in esophagitis
  • encourage calcium and vitamin D intake ( vitamin D needed for calcium absorption)
  • weight bearing exercises
79
Q

Selective Estrogen Receptor Modulator ( SERM) medication

A

Raloxifene
( look at name of med, fix backwards so think fix O = fix osteoporosis)
- used for post menopausal osteoporosis and can help reduce risk of breast cancer
- mode of action: binds to estrogen receptors which decrease bone resorption
- side effects : * increased risk for embolic events ( DVT, stroke, PE) * black box warning on this med for this reason
-hot flashes and leg cramps also common

Education: increase calcium and vitamin D intake and encourage weight bearing exercise

80
Q

Selective Estrogen Receptor Modulator ( SERM) medication

A

Raloxifene
( look at name of med, fix backwards so think fix O = fix osteoporosis)
- used for post menopausal osteoporosis and can help reduce risk of breast cancer
- mode of action: binds to estrogen receptors which decrease bone resorption
- side effects : * increased risk for embolic events ( DVT, stroke, PE) * black box warning on this med for this reason
-hot flashes and leg cramps also common

Education: increase calcium and vitamin D intake and encourage weight bearing exercise

81
Q

Hypocalcemic agent ( calcitonin)

A
  • Calcitonin= think tone down calcium
    -helps bring down calcium levels in the blood
  • used for post menopausal osteoporosis and for hypercalcemia
  • inhibits the activity of osteoclasts
  • side effects: GI upset. Nasal irritation and dryness if taking it intranasally
  • teaching: calcium and vitamin D intake, weight bearing exercises.
82
Q

Denosumab

A

For postmenopausal osteoporosis and hypercalcemia

83
Q

Teriparatide

A
  • medication for postmenopausal osteoporosis. Synthetic form of natural human parathyroid hormone
84
Q

What is asymptomatic hyperuricemia?

A

Where serum urate concentration is elevated but there are no signs of crystal deposition like gout

May lead to gout overtime especially if there are other risk factors like obesity or alcohol consumption

85
Q

What are secondary causes of hyperuricemia?

A

Purine rich foods ( organ meats, pork, beef, anchovies, alcohol, shellfish, soft drinks)
Alcohol consumption
Certain meds like diuretics

86
Q

When should urate lowering therapy be instituted?

A
  • in patients with recent gout attacks, tophi, or radiographic evidence of joint damage
  • goal is to reduce uric acid levels below 6.0
87
Q

What is the approach to therapy for acute gout attack?

A

1st line: NSAIDS ( ex Indomethacin), colchine, or oral corticosteroids

If GI ulcers - avoid NSAIDS
If diabetic- use caution with corticosteroids
If renal function- adjust colchine and NSAID dose

88
Q

When to avoid colchicine?

A

Avoid in patients with hepatic impairment

89
Q

When to avoid corticosteroids for gout

A

Uncontrollable diabetes or significant psychiatric conditions

90
Q

When to avoid NSAIDS/ COXibs for gout

A

GI ulcers
renal impairment
cardiovascular disease

91
Q

How does dosaging of colchicine differ when it used for acute attack vs prophylaxis?

A

Acute: initial dose of 1.2mg followed by 0.6mg one hour later ( max 1.8mg in an hour)

Prophylaxis: lower doses ( 0.6mg daily or every other day) to prevent recurrent attacks

92
Q

When is prophylaxis for gout indicated?

A

When a patient has recurrent gout attacks( known as Gouty arthritis) which can lead to joint damage and chronic pain if it is not managed properly

Goal for prophylactic treatment is to reduce the frequency and severity of gout attacks by lowering uric acid levels over long-term

93
Q

When is prophylaxis for gout indicated?

A

When a patient has recurrent gout attacks( known as Gouty arthritis) which can lead to joint damage and chronic pain if it is not managed properly

Goal for prophylactic treatment is to reduce the frequency and severity of gout attacks by lowering uric acid levels over long-term

94
Q

Xanthine Oxidase Inhibitors

A

Prophylactic treatment for gout
Ex : allopurinol, febuxostat
-Mechanisms of action: inhibits xanthine oxidase enzyme which reduces production of urine acid levels

  • First like agents for lowering uric acid levels and preventing gout attacks
  • Typically started after the acute flare has resolved to prevent subsequent attacks
95
Q

Uricosurics

A

Prophylactic medication for gout
Ex: probenecid, lesinurad

Mechanism of action: increases renal excretion of uric acid by inhibiting its reabsorption in the kidney tubes

Indication: when xanthine oxidase inhibitors are contraindicated or not tolerated. Or with patients with under excretion of uric acid

Started after acute symptoms have resolved

96
Q

Colchicine

A

Mechanism: inhibits inflammatory response to urate crystals in joints

Indication: used for both acute treatment of gout attacks, and for prophylaxis against future attacks during initiation of other therapies

Can be started simultaneously with other prophylactic agents during the acute attack phase to prevent flares triggered by initiating urate lowering lowering therapies

97
Q

Colchine

A
  • can help reduce the pain and inflammation in acute gout attack by interfering with the white blood cells initiation of the inflammatory response in the body
98
Q

Side effects of colchicine

A
  • GI upset
  • thrombocytopenia ( low platelet level)
99
Q

Patient teaching for colchicine

A
  • increase fluid intake
    -NO GRAPEFRUIT JUICE WHILE TAKING COLCHICINE

Colchine = looks like cool chicken = pecks gouty toe

100
Q

Uricosuric ( probenecid)

A

For chronic gout

  • inhibits renal reabsorption of uric acid. Helps improve excretion of uric acid

Side effects : GI upset, renal calculi ( kidney stones)

Encourage fluid intake to prevent kidney stones

Monitor uric acid levels and renal function

101
Q

Xanthine oxidase inhibitor

A

Allopurinol
Think allopurinol= purify= get rid of all uric acid

Chronic gout
Mechanism: inhibit uric acid production

Side effects: GI upset, rash, hepatic toxicity, nephrotoxicity

Fluid intake, monitor liver and renal functions

Takes 2-6 weeks to see improvement in symptoms

102
Q

How long does it take to see improvement of symptoms from allopurinol?

A

2-6 weeks

103
Q

If a patient had GERD and taking a PPI and needed calcium supplements, which one would be recommended?

A

Calcium citrate because it’s not dependent on PH or acid for absorption

104
Q

Side effects of calcium supplements

A

Increased risk of constipation , diarrhea, or abdominal pain
Higher risk of kidney stones

105
Q

Side effects of calcium supplements

A

Increased risk of constipation , diarrhea, or abdominal pain
Higher risk of kidney stones

106
Q

When should urate lowering therapies be initiated for gout?

A

2 or more gout attacks a year
Radiographic evidence
At least one subcutaneous tophus

(At least one of these)

107
Q

What is the first line for a gout prophylactics?

A
  • xanthine oxidase inhibitor ( allopurinol)
  • uricosuric agents ( probenecid)
108
Q

Alendronate teaching

A
  • take on empty stomach in the morning with full glass of water ( other beverages can reduce the absorption of med)
  • sit upright for 30 min after taking to prevent esophagitis
109
Q

What level is considered to be hyperuricemia?

A

Above 7 mg/ dl

110
Q

What happens when uric acid levels exceed 7 mg/dl?

A

Body fluids ( luke synonival joints) become saturated ——> uric acid then precipitates——> urate crystals form ——> gout

111
Q

If a patient has an allergy to morphine, what would you prescribe and not prescribe?

A
  • alternatives: hydromorphine ( Dilaudid), fentanyl, oxycodone, codeine

NOT prescribe : meperidine, methadone,

112
Q

How do triptans work? What are side effects of them?

A

Bind to serotonin receptors on blood vessels and nerve endings in the brain- this leads to vasoconstriction and inhibition of inflammatory release

Side effects : chest tightness or pressure, flushing, dizziness, drowsiness, nauseas. Contraindicated in patients with uncontrolled hypertension, ischemic heart disease, or hx of stroke

113
Q

What medications cause hyperuricemia?

A
  • diuretics ( thiazides)
  • immune suppression
    -low dose aspirin
  • chemo drugs
114
Q

What meds are uricosuric ( help reduce uric acid levels)?

A

-fenofibrate
- losartan

115
Q

What gout meds to avoid in patients with renal failure

A

Colchicine and NSAIDS

116
Q

Dosaging for colchicine

A

1mg followed by 0.5mg after 1 hr

117
Q

Difference between OA and RA

A

-OA: osteoarthritis- degenerative joint disease. Occurs due to wear and tear of cartilage over time

  • RA: rheumatoid arthritis- autoimmune disease where immune system attacks the synovium joint lining
118
Q

Treatment for gout

A

NSAIDS, colchicine, corticosteroids

119
Q

Does asymptomatic hyperuricemia require treatment?

A

No

120
Q

Does asymptomatic hyperuricemia require treatment?

A

No

121
Q

What is a gram stain

A

Lab technique used to classify bacteria into 2 broad categories: gram positive and gram negative

122
Q

What are normal floras in the body?

A

Staphylococcus epidermis
Streptococcus pneumonia
Staphylococcus aureus

123
Q

What are the typical pathogenic organisms at the sites of infection?

A

Staphylococcus aureus
Streptococcus pyogenes
Haemophulus influenza

124
Q

Describe : resistance, susceptibility, pathogenicity, virulence, MIC, empirical

A
  • Resistance: ability of bacteria to withstand antibiotic treatment
  • susceptibility: vulnerability of bacteria to antibiotic action
  • pathogenicity: ability of bacteria to cause disease
  • virulence: degree of pathogenicity
  • MIC ( minimum inhibitory concentration) : lowest concentration of antibiotic inhibiting bacterial growth
  • empirical : treatment based on experience rather than specific diagnosis
125
Q

What are LRTIs?

A

Lower Respiratory Tract Infections

Preventative strategies: vaccination, hand hygiene, stop smoking

Etiologies: common bugs including streptococcus pneumonia, haemophilius influenza, and mycoplasma pneumonia

126
Q

What organism causes different types of pneumonia

A

Streptococcus pneumoniae (CAP)
Haemophilius influenzae ( in smokers)
Mycoplasma pneumoniae ( atypical)

127
Q

Treatment for community acquired pneumonia (CAP)

A
  • healthy adults without comorbidities:
    Amoxicillin 1g TID or
    Doxycycline 100mg BID or
    A macrolide ( azithromycin, clarithromycin)

Pt with comorbidities:
Combo therapy
Amoxicillin with macrolide ( azithromycin)

128
Q

Itchiness and rash with opioids

A

Are side effects, NOT allergy!!

If truly allergic: tramadol or fentanyl can be used. Treat with epi and steroids initially then discontinue opioid

129
Q

Prophylaxis treatment for migraines

A

Beta blockers ( if not contraindicated )
Low dose TCAs ( amitriptyline, venlafaxine)
Anticonvulsants ( topiramate, valporic acid, depakote)

130
Q

What class of migraine prophylactic should be avoided in asthma

A

Beta blockers

131
Q

Treatment for CAP

A

1st line: macrolides ( azithromycin)
Alternatives: amoxicillin, fluroqunilones only in specific circumstances or if there is resistance to first line agents

Recommended duration 5-7 days

132
Q

What are URTIs?

A

Upper Respiratory Tract Infections
Ex : Acute Rhinosinusitis ( ARBS), acute Ottis media ( AOM)

Preventative strategies: hand hygiene, avoid close contact with infected individuals

Risk factors: crowded living conditions, immunocompromised state

133
Q

What are risk factors for otitis media? ( OM)

A

Children
Exposure to tobacco smoke
Daycare attendance

134
Q

What are risk factors for acute bacterial rhinosinustis? (ARBS)

A

Persistent upper respiratory symptoms, facial pain, purulent nasal discharge

Common bugs like streptococcus pneumonia, haemophillis infuenzae

135
Q

What are risk factors for acute bacterial rhinosinustis? (ARBS)

A

Persistent upper respiratory symptoms, facial pain, purulent nasal discharge

Common bugs like streptococcus pneumonia, haemophillis infuenzae

136
Q

Treatment for uncomplicated acute otitis media (AOM)

A
  • observation without antibiotics if mild
  • use of amoxicillin or amoxicillin- clavulante for moderate to severe cases
137
Q

Treatment for acute bacterial rhinosinustis (ARBS)

A

Observation initially for mild cases
Antibiotics ( amoxicillin, doxycycline) for persistent symptoms

138
Q

Antibiotics for treatment of acute Ottis media

A

Amoxicillin
Amoxicillin- clavulante
Ceftriaxone

139
Q

Antibiotics for treatment of acute bacterial rhinosinusitis

A

Amoxicillin ( amoxicillin for 5-7 days is effective for most infections and is less expensive)
Doxycycline
Or respiratory fluoroquinolones ( levofloxacin)

140
Q

Antibiotics for treatment of acute bacterial rhinosinusitis

A

Amoxicillin ( amoxicillin for 5-7 days is effective for most infections and is less expensive)
Doxycycline
Or respiratory fluoroquinolones ( levofloxacin)

141
Q

What antibiotic to give it patient is allergic to penicillin or fluroquinolones (levofloxacin)

A

Doxycycline

142
Q

Side effects of antibiotics in children

A

Rash, nausea, vomit

143
Q

What antibiotics can actually cause infections

A

Fluoroquinolones
TMZ

144
Q

What pathogen causes acute bacterial rhinosinusitis

A

Streptococcus pneumonia and H influenza

145
Q

What non prescription meds are for common cold

A

Decongestant ( pseudoephedrine)
Antihistamine ( loratadine)
Analgesic ( acetaminophen)

146
Q

Upper respiratory infection end in

A

Itis

147
Q

Treating CAP in patients with comorbidities ( ex: COPD, diabetes, heart failure)

A

Beta lactam plus macrolide
Respiratory fluoroquinolones

148
Q

Treating children with CAP

A

Amoxicillin for mild cases
Ceftriaxone plus macrolide ( azithromycin) for moderate to severe cases

149
Q

What is aspiration pneumonia

A

When gastric contents or oropharyngeal secretions are aspirated into the lungs which leads to an infection

150
Q

Treatment for aspiration pneumonia

A

Clindamycin
Amoxicillin- clavulante
Plus a macrolide

151
Q

What causes acute bacterial rhinitis

A

A proceeding viral infection, like rhinovirus or influenza, damages the respiratory epithelium and disrupts normal sinus drainage, which allows bacteria to colonize and cause infection

152
Q

What are the treatments for acute bacterial rhinitis?

A

Amoxicillin, amoxicillin- clavulante, and doxycycline our first line agents

If there is a penicillin allergy , fluoroquinolones or second generation cephalosporins

153
Q

What is the treatment for otitis media?

A

In children, older than six months, who are otherwise healthy, observation without immediate antibiotic treatment

Analgesic like acetaminophen or NSAID to help with ear pain and reduce fever

Antibiotics are typically recommended for children under six or a severe symptoms or signs of systemic illness like high fever

Amoxicillin is the first line antibiotic

154
Q

Common food / supplement interactions with fluoroquinolones

A
  • Dairy products ( calcium containing foods): avoid milk, yogurt, cheese within 2 hrs before and 6 hrs after
  • multivitamins ( calcium, magnesium, iron, zinc) : same with 2 hrs before and 6 hrs after
  • antacids containing aluminum or magnesium
155
Q

Common pathogens that can cause CAP

A

Streptococcus pneumonia ( most common cause)

Symptoms usually include sudden onset of fever, chills, productive cough, and pleuritic chest pain

Others: staphylococcus aureus, H influenza, mycoplasma pneumonia

156
Q

In the outpatient setting, which antibiotics are recommended for the empiric treatment of CAP in adults

A
  • healthy adults with no comorbidities:

Amoxicillin 1g TID
doxycycline 100mg BID
Macrolide

  • outpatient adults with comorbidities

Combo therapies

Amoxicillin-clavulante 500mg /125mg TID
or
Amoxicillin- clavulante 875/125mg BID
OR
Cephalosporin (cefpodoxime 200mg bid) and macrolide ( azithromycin 500mg on first day then 250mg daily)
Or
Doxycycline 100mg BID

Or monotherapy ( respiratory fluoroquinolones like Levofloxacin)

157
Q

In the inpatient setting, what antibiotics for CAP for adults without risk factors for MRSA and P aeruginosa

A

Combo therapy with a beta- lactam ( ampicillin + sulbactam), cefotaxime and a macrolide

158
Q

What pathogen can cause cellulitis

A

Streptococci ( mainly group A)

159
Q

What are risk factors for cellulitis?

A
  • diabetes mellitus
  • immunocomprimised states ( HIV/AIDS) -peripheral vascular disease
  • injection drug use , skin trauma, obesity
  • exposure to contaminated water or soil
160
Q

What pathogens cause cellulitis?

A

Strep A
Staph Aureus ( including mrsa)

161
Q

Symptoms of cellulitis

A
  • Red, swollen, tender skin that may feel warm to the touch
  • edema and erythema
  • fever, chills, malaise
162
Q

What is the difference between MSSA and MRSA

A
  • MSSA ( methicillin- sensitive staphylococcus aureus) : susceptible to antibiotics, less virulent, low mortality rates,

-MRSA ( methicillin resistant staphylococcus aureus) : resistant to many types of antibiotics, more virulent, high mortality rates. Requires use of alternative antibiotics

163
Q

Treatment for MSSA vs MRSA

A

-MSSA: beta lactam antibiotics like cefazolin

  • MRSA: antibiotics that are effective against resistant strains like vancomycin
164
Q

What is uncomplicated UTI

A

Lower urinary tract infection ( cystitis) that occurs in an otherwise healthy individual with no functional abnormalities of the urinary tract

Causes: E. coli

Symptoms: dysuria, frequency, urgency, lower abdominal discomfort

Tx: short course antibiotics

165
Q

What is complicated UTI?

A

UTI occurring in individuals with structural or functional abnormalities of the urinary tract that predisposes them to infection or make treatment more challenging

Risk factors: anatomical abnormalities ( urinary tract obstruction) , functional abnormalities ( urinary stents), underlying conditions ( diabetes mellitus, immuno suppression)

Symptoms: similar to uncomplicated UTI but can present with more severe symptoms

166
Q

What is Pyelonephritis

A

Upper urinary tract infection involving the kidneys and renal pelvis

Symptoms: fever and chills , flank pain or back pain, nausea, vomiting, frequency, urgency

Can lead to septicemia ( bacteria in the bloodstream) and potentially life-threatening conditions if untreated

Tx: hospitalization for IV antibiotics ( fluoroquinolones, 3rd gen cephalosporin) followed by oral antibiotics

167
Q

Other things that make a patient have complicated uti

A

Male
Childhood UTI
Diabetes
Failed antibiotic course
Pregnancy
Elderly

168
Q

Symptoms of UTI in elderly patients

A

Altered mental status
Poor appetite
Incontinence
Lethargy
Confusion

169
Q

Labs for UTI

A

Urinalysis : Pyuria ( WBC or pus in urine. Greater than 10)

Bacteriuria ( E. coli)
Presence of leukocyte esterase
Presence of nitrates

170
Q

Labs for UTI

A

Urinalysis : Pyuria ( WBC or pus in urine. Greater than 10)

Bacteriuria ( E. coli)
Presence of leukocyte esterase
Presence of nitrates

171
Q

Treatment for acute pyelonephritis

A
  • oral fluoroquinolones as a 5-7 day regimen if local E. coli resistance is less than 10% plus one time dose of ciprofloxacin

If more than 10% : initial dose of Ceftriaxone 1gram IV plus oral fluoroquinolones

TMP/SMX as 2 week treatment if susceptibly is confirmed. If not confirmed- 1 gram ceftra IV plus TMP/SMX

172
Q

How do you treat a pregnant patient who has a UTI

A

Nitrofurantoin is category B and is safe to use EXCEPT IN THE LAST 30 DAYS due to increased risk of neonatal jaundice

173
Q

Cystitis

A

Infection of lower urinary tract. Caused by E. coli

174
Q

MRSA VS MSSA

A

MSSA: strain of staphylococcus aureus that is susceptible to methicillin so that means antibiotics can effectively kill MSSA bacteria. More common in healthcare and community settings. Think of MSSA as angel

MRSA : resistant to methicillin so more difficult to treat because fewer antibiotics are effective against it. More common in healthcare settings. Think of MRSA as devil

175
Q

What antibiotics for uti to avoid in pregnant patients

A
  • fluoroquinolones ( ciprofloxaxin)
  • tetracycline ( doxycycline)
  • TMP/ SMX ( bactrim or septra)

Safe for pregnancy:

Penicillin ( amoxicillin)
Cephalosporin ( cephalexin)
Nitrofurantoin
Fosfomycin

176
Q

MRSA antibiotics

A

Vancomycin
Daptomycin
Clindamycin
Ceftaroline
Linezolid

177
Q

Nitrofurantoin

A

Used to treat cystitis caused by E. coli
Used as first line treatment for uncomplicated E. coli

178
Q

TMP/ SMX- when is it used

A

Only can be given if E. coli resistance is less than 20% in area

179
Q

Treatment for acute uncomplicated UTI

A

Nitrofurantoin, TMP/SMX, or fosfomycin for 3-5 days

NSG 533 (4 decks)

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