Exam 2 Study Guide Flashcards
An infection of the dermis and subcutaneous tissue. Can occur on any part of the body, but most common on the leg. Most commonly caused by streptococci, mainly group A and sometimes S. Aureus including MRSA. Vascular and lymphatic insuffiencies increase the risk of recurrences; obesity, tobacco use, history of cancer, and homelessness increase risk.
Cellulitis
UTI’s can either be uncomplicated or complicated. Complicated infections usually occur in patients who have structural or function abnormalities of GU tract and may involve the bladder or kidneys. Male patients and older patients are also considered complicated. Uncomplicated and complicated are treated the same, but complicated are treated for a longer duration. Uncomplicated occur in women of childbearing age.
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Clinical presentation of UTI’s include increased urinary frequency, urgency, dysuria, nocturia, and suprapubic heaviness. Systemic signs are uncommon with UTI’s. Patients with pyelonephritis have fever, chills, flank pain, nausea, vomiting, and elevated WBC’s. Older adults often do not present with tradition s/s. Instead may experience altered mental status, poor appetite, and incontinence.
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Uncomplicated UTIs are usually managed with a short course antimicrobial therapy involving 1 dose, 3 day or 5 day regimens including: Fosfomycin (1 dose), TMP/SMX (3 day), Nitrofurantoin (5 day). TMP/SMX isn’t used as often due to microbial resistance. Should only be considered if resistance rate to E coli is less than 20%. Fluroquinolone (3 day) and Betalactam (3-7 day) can be used but only when the 3 primary treatments can’t be used.
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Pregnant women can use Nitrofurantoin (except in the last 30 days), Betalactam, and Fosfomycin for UTI’s.
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Key Concept: In addition to coverage for staph and strep ABSSI, patients with severe infections should receive treatment for gram-negative bacilli such as E coli and Pseudomonas aeruginosa with or without anaerobic coverage. Empiric broad spectrum antimicrobial coverage including coverage for resistant organisms such as health care associated MRSA and P. aeruginosa is appropriate for severe ABSSSI and or severe systemic illness.
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MRSA and VRE common in patients that have been hospitalized. S. pyogenes are a common cause of skin infections but is very susceptible to penicillin. Enterococcus faecium is highly resistant and causes most disease in the immunocompromised. E. Coli commonly causes UTI’s.
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Treatment for LRTIs (adults only, non-ICU) (table 71-2) based on patient specific characteristics such as co-morbidities (eg diabetes, COPD), allergies (eg. PCN, macrolides, sulfa), drug interactions (quinolones + antacids/dairy, macrolides inhibit P450), CIs (tetracyclines in children), ADRs (clindamycin > c diff, quinolones > tendon rupture, QT prolongation, tetracyclines > photosensitivity), etc
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ABRS (Sinusitis) is the most common diagnosis associated with ABT prescriptions. Risk factors include prior viral URI, allergic rhinitis, and dental infections or procedures. Caused by S. pneumoniae and H. influenzae. ATB are given if ABRS is most likely and when the benefits of treatment outweigh the potential harms. Can use humidifiers, nasal saline spray/drops, and irrigation. Decongestants can relieve congestion but avoid in children younger than 4 or patients with ischemic heart disease or uncontrolled HTN. Avoid antihistamines because they thicken mucus. Standard dose amoxicillin or amoxicillin-clavulanate is recommended for most patients.
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AOM is most common between 6 and 18 months of age. Occurs frequently with viral URI’s. Do not usually require ATB. H. influenzae causes 60% of bacterial cases. S. pneumoniae was the most common organism. Treatment should be aimed at S. pneumoniae because pneumococcal AOM is unlikely to respond spontaneously and commonly results in more ear pain and fever. Give analgesics for mild to moderate pain. Alternating Ibu and APAP is not recommended because of the potential for dosing error and a lack of safety and efficacy data. Amoxicillin is the drug of choice in most patients because it is effective, high middle ear concentrations, excellent safety profile, low cost, palatable suspension, and relatively narrow spectrum. High dose (80-90mg/kg/day) is preferred.
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When is prophylaxis for gout indicated, what agents are available and when should therapy start (in relation to an acute flare). : patients with recurrent attacks (2 or more per year), evidence of tophus or tophi, CKD stage 2 or wrose, or past urolithiasis for candidates for prophylactic therapy with allopurinol, febuxostat, lesinurad, probenecid and or pegloticase to lower SUA levels.
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Colchicine was the tx of choice but is less common now d/t low therapeutic index and increased cost. Given within 36 hours of attack onset. GI effects are more common and are considered a forerunner of more serious systemic toxicity include myopathy and bone marrow suppression. Toxicity can occur in patients with renal insufficiency. Should NOT be used for acute attack if the pt is receiving for prophylaxis.
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