Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics III > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Grams Stain

A

Bacteria only
Cell wall either takes up stain (gram positive) or doesnt (gram negative)
Guides initial antibiotic choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Gram stain positive

A

purple/ blue stain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Gram stain negative

A

pink/red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gram stain sample

A

Can be performed on any body fluid or tissue biopsy.

Most common- sputum (want mucus not spit), blood, wound, urine, tissue, sterile body fluids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Information obtained from gram stain

A

Cell wall form: Gram positive, gram negative
Shape- cocci, bacilli, diplococci, clusters, pairs, chains
Quantity of bacteria
Other cells in sample- WBCs, RBCs, eosinophils, inclusion bodies, casts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Gram stain: Bad samples will be full of

A

Epithelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gram stain: Bad CSF cultures will contain

A

Multiple RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acid-fast stain

A

For bacteria resistant to traditional gram staining
Largely used for the detection of mycobacterium and Nocardia
Cell wall: composed of a thin layer of peptidoglycan and large amount of mycolic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non-selective media

A

Contains no inhibitory substance and supports the growth of most bacterial species

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Selective media

A

Contains inhibitory substances or antimicrobials which allow growth of some organisms and suppress growth of others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Differential media

A

Contains substances which allow detection of organism characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Broth media

A

Very small numbers of organisms or hard to grow pathogens can be propagated
HIgh risk of growing contaminants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MIC90

A

The lowest concentration of tested antibiotic that inhibits visible growth in 90% of the tested isolates
Same as MIC, except MIC 90 refers to the study of many isolates
Guides empiric therapy although a better guide is to use the institutions antibiogram. Definitive therapy based on patient-specific MIC values

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rationale for Abx combinations

A 
Empiric therapy- broaden spectrum
Synergy- enterococcal endocarditis 
prevent resistance
Mixed aerobic-anaerobic infections
Lower dose of toxic drug (only theory)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why the increase in antimicrobial resistance?

A

Increased consumption of antibiotics (humans and animals)

Overuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Intrinsic resistance

A

Bacteria naturally resistant to an antibiotic due to physical characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acquired resistance

A

Developed through mutation or transfer of genetic material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cephalosporinases (AmpC)

A

If AmpC is present, 1st line treatment is cefepime (4th gen cephalosporin) or a carbapenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Mutation of AmpD protein

A

Leads to binding to AmpR and constant high-level expression of AmpC. Leading to clinical resistance to most beta lactams except carbapenems and cefepime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ESBLs

A

Hydrolyze penicillins and cephalosporins but not carbapenems

1st line treatment- carbapenems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Carbapenemases

A

Classes:
A, C, and D contain a serine residue in the active region
B requires a zinc for enzymatic activity
Risk factors: invasive medical devices, open wounds, long courses of abx, ICU, diabetes, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is ESBL resistant to?

A

Inhibition by clavulante
Hydrolyzes 1st-3rd gen cephalospotins
Cefepime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is ESBL susceptible to?

A

Cephamycins (cefoxitin/cefotetan)

Carbapenems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is AmpC resistant to?

A

hydrolyzes 1st-3rd gen cephalosporins

Cephamycins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is AmpC susceptible to?

A

Inhibited by clavulanate
Cefepime
Carbapenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is CRE resistant to?

A

Everything

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

___ out of every 3 antibiotic prescriptions are unnecessary

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Antimicrobial stewardship programs

A

ASPs improve abx use and the need is recognized nationally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Antimicrobial Stewardship initiatives

A

Preauthorization and prospective audit with feedback
Antibiotic time-outs
Antibiograms
others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Antimicrobial Stewardship Program Goals

A

Improve patient care and health care outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Antimicrobial stewardship patient care rounds/ chart reviews

A

Involvement in rounds is dependent on hospital

Antibiotic time-outs at 48-72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Advantages of combination therapy

A 
Empiric therapy to broaden spectrum
Polymicrobial "mixed" infections
Synergy
Prevent emergence of resistance
Reduce dosage of toxic drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Disadvantages of combination therapy

A

Antagonism
Induction of beta lactamase (resistance)
Increased cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Cystitis

A

Infection of the bladder (lower UTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pyelonephritis

A

Infection involving the kidneys (upper UTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Prostatitis

A

Infection of the prostate gland

Can be acute or chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Uncomplicated UTI

A

Requires an otherwise healthy, premenopausal female with no structural or functional abnormalities of the urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Complicated UTI

A 
Does not meet criteria for uncomplicated UTI
Often involves: 
Indwelling urethral catheters
Urinary obstruction or stones
Prostatic involvement
Neurologic deficits
Recurrence and MDRO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Presentation of UTI

A

Urinary symptoms (not always present)
Urinalysis- leukocyte esterase, nitrites, bacteria, WBCs
Urine culture- bacteria >100,000CFU/mL, lower counts are considered if pt is symptomatic
Altered mental status
Systemic signs of infection (uncommon with cystitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Etiology of UTI

A

Most often related to GI flora
E. coli causes most
Complicated UTIs are more likely to be caused by resistant organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Asymptomatic Bacteriuria

A

Positive urine culture w/o infections or urinary symptoms
Screening and treatment indicated ONLY for pregnant women and patients with planned urologic procedures with anticipated bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Uncomplicated cystitis first-line treatment

A

Typically treated with short courses of antibiotics
Nitrofurantoin (macrobid) 100mg BID for 5-7 days
Bactrim DS 800/160mg for 3 days
Fosfomycin (Monurol) 3g for 1 dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Nitrofurantoin

A

Macrobid
Contraindicated in CrCL < 60mL/min
Macrodantin= QID
Macrobid= BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Sulfamethoxazole/ Trimethoprim

A

Bactrim DS
Need to assess for sulfa allergy
Decrease dose to 1/2 if CrCl 15-30mL/min
Contraindicated if CrCl <15mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Does fosfomycin have renal or hepatic adjustments?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Uncomplicated cystitis alternative treatments

A

Fluoroquinolones
Levofloxacin 250mg QD for 3 days
Ciprofloxacin 250mg BID for 3 days
Beta lactams

47
Q

Uncomplicated pyelonephritis management

A

Urine culture should ALWAYS be performed if pyelonephritis is suspected.
Initial dose of parenteral abx is preferred.
Ceftriaxone 1g or 5-7mg/kg tobramycin/gentamycin

48
Q

Uncomplicated pyelonephritis management for non-hospitalized patients

A 
Oral fluoroquinolone for 7 days
-Ciprofloxacin 500mg BID
-Levofloxacin 750mg QD
Oral bactrim
Oral beta lactams
49
Q

Uncomplicated pyelonephritis management for hospitalized patients

A

Definitive therapy guided by susceptibility tests
Fluoroquinolone
Aminoglycoside +/- penicillin/ cephalosporin
Carbapenem

50
Q

Acute bacterial prostatitis management

A 
Typically involves sudden fever, tenderness, and urinary symptoms
2-4 week duration oral therapy
Bactrim BID
Ciprofloxacin 500mg BID
Levofloxacin 500mg QD

Severely ill patients need IV cipro or bactrim

51
Q

chronic bacterial prostatitis management

A

4-6 weeks of systemic abx recommended
Fluoroquinolones preferred
Surgery may be required

52
Q

UTI in pregnant women

A

Avoid fluoroquinolones, caution with nitrofurantoin, avoid bactrim after 32 weeks gestation

53
Q

UTIs in patients with indwelling catheters

A

Remove short-term catheters if possible

Initiate therapy if symptoms occur, prophylaxis not recommended

54
Q

UTIs in patients with more than 3 episodes/ year

A

Self-administered short course therapy

Low dose continuous therapy should be avoided

55
Q

Avoid nitrofurantoin for what?

A

Pyelonephritis and prostatitis

56
Q

Syphilis etiology

A

Treponema pallidum spirochete

57
Q

Syphilis presentation by stage

A

Primary- single lesion (chancre) that heals spontaneously
Secondary- Multiple mucocutaneous eruptions, rash, flu-like symptoms
Latent- no symptoms
Tertiary- progression to other organ symptoms. Occurs 10-30 years after infection

58
Q

How is syphilis diagnosed?

A

Organism visualization on microscopy or serology for antibodies
Serologic tests unreliable if HIV coinfection present

59
Q

Primary, secondary, or latent syphilis <1 year treatment

A

Benzathine penicillin G 2.4 million units IM once
Alternatives-
Doxycycline 100mg PO BID for 14 days
Ceftriaxone 1g IM/IV daily for 8-10 days

60
Q

Latent syphilis > 1 year (or unknown duration) and tertiary treatment

A

Benzathine penicillin G 2.4 million units IM weekly for 3 weeks
Alternative-
Doxycycline 100mg BID for 28 days

61
Q

Neurosyphilis treatment

A

Normal penicillin G 18-24 million units/day IV for 10-14 days

62
Q

Jarisch-Herxheimer reaction

A

Fever and flu like symptoms are common in the first 24 hours of syphilis treatment

63
Q

Chlamydia etiology

A

Most common bacterial ID in the US

Caused by C. trachomatis

64
Q

Untreated chlamydia infections can result in

A

pelvic inflammatory disease

65
Q

Chlamydia presentation

A

Often asymptomatic
Symptom onset= 7-21 says
Most common S/S- urethral discharge, dysuria

66
Q

When do you retest with chlamydia?

A

3 months

67
Q

Chlamydia first line treatment

A

Azithromycin (Zithromax) 1g PO once (counsel about GI upset)

Doxycycline 100mg BID x 7 days

68
Q

Chlamydia treatment for neonates and infants

A

Erythromycin base 12.5mg/kg QID for 14 days

69
Q

How long must you not have sex after chlamydia?

A

7 days

70
Q

Trichomoniasis etiology

A

Trichomonas vaginalis- protozoan

71
Q

Trichomoniasis presentation

A

Frequently associated with STI coinfection
Can be asymptomatic
Dysuria, urethritis, vaginal or urethral discharge

72
Q

Untreated trichomoniasis infections lead to

A

pelvic inflammatory disease

73
Q

Bacterial vaginosis etiology

A

Disruption of normal vaginal flora

- replacement of lactobacillus with various anaerobes

74
Q

Clinical diagnosis of BV

A 
Requires 3 of the following 4 criteris: 
Presence of thin, white vaginal discharge
"Clue cells" on microscopy
Vaginal pH > 4.5
Fishy odor of vaginal discharge
75
Q

BV and trichomoniasis are both what?

A

Frequent coinfections with HIV and other STIs

76
Q

When do you treat BV?

A

If symptomatic

77
Q

Trichomoniasis 1st line treatment

A

Metronidazole (Flagyl) 2g PO once (same in pregnancy)

7 day treatment recommeded in pts with HIV

78
Q

BV treatment

A

Metronidazole 500mg BID for 7 days or 0.75% gel- 5g applicators for 5 days
Clindamycin 2% cream for 7 days

79
Q

Gonorrhea etiology

A

Neisseria gonorrhoeae (gram negative cocci)

80
Q

Gonorrhea presentation

A

May be asymptomatic

Symptom onset within 2-8 days in males and 10 days in females

81
Q

Gonorrhea coinfection

A

Gonorrhea is often coninfected with asymptomatic chlamydia

82
Q

Gonorrhea diagnosis

A

Gram stain

83
Q

Gonorrhea treatment

A

Oral cephalosporins are no longer first line
Ceftriazone 250mg IM once PLUS doxycyline 100mg BID for 7 days
Azithromycin also added to cover chlamydia coninfection

84
Q

PID treatment

A

Broad IV abx switching to oral to complete 14 days

Ceftriaxone 250mg IM x1 PLUS Doxycycline 100mg BID +/- Metronidazole 500mg BID for 14 days

85
Q

Genital herpes etiology

A

Herpes simplex virus 2

86
Q

Genital herpes presentation

A

Most initial infections are symptomatic, but many people are typically asymptomatic after

87
Q

Genital herpes treatment

A 
No cure
Antiviral treatment (7-10 days primary episode)
Acyclovir 400mg TID 
Valacyclovir 1g BID
Famciclovir 250mg TID
88
Q

Genital herpes chronic suppressive therapy

A

Acyclovir 400mg BID
Famciclovir 250mg BID
Valacyclovir 500mg BID

89
Q

Does suppressive therapy reduce HSV or HIV transmission?:

A

NO

90
Q

Human Papilloma Virus (HPV)

A 
Most common viral STI
HPV-6 and 11- genital warts
HPV-16 and 18- cervical cancer
Less than 1% of infected patients develop visible warts
3 vaccines recommended aged 11-12
91
Q

GI AE

A

Tetracyclines, macrolides, clindamycin, metronidazole

92
Q

Impetigo

A

Superficial skin infection of the exposed skin (usually face)
More common during hot, humid weather)
High communicable

93
Q

Impetigo etiology

A

Gram positive organisms
S. pyogenes (Group A strep)
S. aureus (MSSA)

94
Q

Impetigo presentation

A

Vesicles develop pustules which rupture and dry into brown or golden-yellow crusts
Pruritis common, systemic symptoms rare

95
Q

Impetigo treatment

A

Topical or systemic therapy can be used
S. aureus should be covered until streptococci confirmed
Recommended:
Dicloxacillin 250mg QID for 7 days
Cephalexin (Keflex) 250mg QID for 7 daus
Mupirocin (Bactroban) ointment BID x 5 days

96
Q

If MRSA is suspected with impetigo, what tx?

A

Bactrim Ds

Doxycycline

97
Q

Erysipelas

A

St. Anthonys Fire
Superficial skin infection with cutaneous lymphatic involvement
Risk factors: lymphatic obstruction or efema

98
Q

Erysipelas etiology

A

S. pyogenes (Group A strep)

99
Q

Esypelas presentation

A

Very red, acute onset, erythema, kwarmth, edema, pain, margins
Diagnosis made on characteristic clinical picture.

100
Q

Erysipelas in children

A

Requires hospitalization

Penicillin DOC

101
Q

Erysipelas Tx

A

Pen G 600,000-1.2 million units IM Q 12 H
Pen VK 250-500mg QID
Clindamycin 300-600mg PO Q 6-7 H

102
Q

Erysipelas severe infections

A

Pen G

103
Q

Cellulitis

A

Infection of the epidermis and dermis, may reach superficial fascia
w or w/o abscess

104
Q

Cellulitis etiology

A

Most common S. pyogenes and S. auerues

105
Q

Cellulitis presentation

A

Non-elevated erythematous and edamatous skin lesion

Systemic symptoms can occur

106
Q

Cellulitis risk factors

A

IV drug use
Uncontrolled DM
Recent surgery

107
Q

Cellulitis tx

A

Oral therapy of 5 days
Pen VK or amoxicillin
initial coverage of S. aureus- cephalexin
MRSA coverage if trauma or purulence- Bactrim

I&D is primary therapy for abscess
Vanc used if severely ill

108
Q

Diabetic Foot Infections (DFIs)

A

At baseline, diabetic pts have increased neuropathy, vascular insufficiency, and impaired wound healing
Infection can arise from ulceration, minor trauma, poor nail care
Osteomyelitis occurs in 30-40%
Severe infections are polymicrobial

109
Q

DFI treatment

A

**Augmentin BID 1-2 weeks
Cephalexin 250-500mg PO Q6H
Doxycycline 100-200mg BID
IV regimen if severe

110
Q

Osteomyelitis

A

Can progress from skin/soft tissue infection
Diagnosed by MRI
MSSA most common

111
Q

Osteomyelitis tx

A 
Nafcillin/ oxacillin 2g IV Q4H or Cefazolin 2g IV Q8H for 4-6 weeks
Surgical interventions (debridement and/or amputation often required)
112
Q

Bite wounds

A

Cat bites more often to cause infection
Etiology- Pasteurella
Humans- Eikenella
Sharks- Vibrio

113
Q

Bite wounds Tx

A

Augmentin PO BID 7-14 days

3-5 day prophylactic course

Therapeutics III (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions