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PHRM 865 > Exam 4 - CNS Infections > Flashcards

Exam 4 - CNS Infections Flashcards

1
Q

what 5 things make up CSF composition/things you look at to figure out infection

A 
Protein
Glucose
pH
WBCs
Fluid
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2
Q

CSF is made by ________

A

choroid plexus

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3
Q

Normal pH in CSF?

A

7.4

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4
Q

Normal Protein in CSF?

A

< 50 mg/dL

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5
Q

Normal Glucose in CSF?

A

50 - 66 % of serum glucose

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6
Q

Normal WBCs in CSF?

A

< 5 WBC/mL

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7
Q

normal fluid appearance CSF?

A

clear

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8
Q

3 layers of meninges?

A

dura mater
arachnoid
pia mater

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9
Q

BBB (blood brain barrier) or BCSFB (blood CSF barrier):

is 5000 x larger than the other

A

BBB is bigger

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10
Q

where is CSF found?

A

subarachnoid

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11
Q

BBB (blood brain barrier) or BCSFB (blood CSF barrier):

has ependymal cells to act as active transport system?

A

BCSFB

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12
Q

What characteristics make an abx penetration into the CSF easier:
Lipid phobic or phillic?

A

lipidphilic is better

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13
Q

What characteristics make an abx penetration into the CSF easier:
Ionized or unionized?

A

unionized is better

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14
Q

What characteristics make an abx penetration into the CSF easier:
low or high molecular weight

A

low is better

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15
Q

What characteristics make an abx penetration into the CSF easier:
high or low protein binding

A

low protein binding better b/c only free drug can penetrate

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16
Q

meningeal inflammation: help or hurt penetration into CSF?

A

help!

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17
Q

what drugs have therapeutic concentrations into CSF withOUT meningeal inflammation?

A 
Acyclovir
Chloramphenicol
Fluconazole
Ganciclovr
Linezolid
metronidazole
rifampin
FQs

(MR LAG FFC)

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18
Q

what drugs have therapeutic concentrations into CSF with meningeal inflammation?

A 
PCNs
3rd/4th gen cephs
aztreonam
meropenem
colistin
vanc

(CV PAM 3rd/4th gen)

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19
Q

what drugs do not get into the CSF no matter if meninges are inflamed?

A 
AGs
Amphotericin-B
beta lactamase inhibitors
Some cephs (1st and 2nd gen)
Clindamycin
Tetracyclines
(SCAT BA)
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20
Q

3 main ways bacteria gains access into the CSF?

A

hematogenous spread
contiguous spread
direct inoculation

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21
Q 
what bugs are common cause of bacterial meningitis:
In adults (30 - 50 years old)
A

S Pneumonaie, N meningitidis

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22
Q 
what bugs are common cause of bacterial meningitis:
older adults (>50 years old)
A

S pneumo
N mening
GNR
Listeria

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23
Q

3 most common causes of bacterial meningitis?

A

H. influenzae
Neisseria meningitidis
s. pneumoniae

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24
Q

3 most common signs of bacterial meningitis

A

fever
headache
stiff neck

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25
CSF gets obtained via ______ | need __#___ tubes for what tests?
LP: lumbar puncture | need 3 tubes: chemistry/hematology/microbiology
26
Bacterial Findings in CSF for Meningitis: | WBC value?
400 - 5000
27
Bacterial Findings in CSF for Meningitis: | Differential?
> 80% neutrophils
28
Bacterial Findings in CSF for Meningitis: | Protein?
elevated: | 100 - 500
29
Bacterial Findings in CSF for Meningitis: | glucose?
< 50%
30
when should empiric therapy be started?
immediately administered after LP is performed --- do not wait to get culture results!
31
Empiric Treatment options for bacterial meningitis: | Head trauma?
Vanc + 3rd/4th gen cephs (want pseudomonas coverage)
32
``` Empiric Treatment options for bacterial meningitis: Older adults (> 50 years old) or Immunosuppressed ```
Amp + 3rd gen ceph + Vanco *do 4th gen ceph if immunosuppressed
33
Empiric Treatment options for bacterial meningitis: | Postneurosugery?
same as head trauma! | Vanc + 3rd/4th gen cephs
34
Empiric Treatment options for bacterial meningitis: | adults (30 - 50 years old)
3rd gen ceph + vanc | same as kids/adults 4- 29 and infants - kids (1 mo - 4 years
35
Empiric Treatment options for bacterial meningitis: | children/adults (> 4 - 29 yr)
3rd gen ceph + vanc
36
Empiric Treatment options for bacterial meningitis: | infants/kids (1 mo - 4 years)
3rd gen ceph + vanc
37
Empiric Treatment options for bacterial meningitis: | neonates (< 1 month)
ampicillin + cefotaxime
38
Directed Treatment options for bacterial meningitis: | if S. pneumoniae?
PSSP: PCN G or Ampicillin PRSP: Vanc + Ceftriaxone
39
Directed Treatment options for bacterial meningitis: | Group B Strep
Ampicillin (+/- gent)
40
Directed Treatment options for bacterial meningitis: | S. Aureus
MSSA: Nafcillin!! (Not Cefazolin bc doesnt get into CSF!) MRSA: Vanc!
41
Directed Treatment options for bacterial meningitis: | Listeria monocytogenes
Ampicillin (+/- gent)
42
Directed Treatment options for bacterial meningitis: | Neisseria meningitidis
PCN or Ceftriaxone
43
Directed Treatment options for bacterial meningitis: | H. influenzae
BL (?) + ampicillin | BL + ceftriaxone
44
Directed Treatment options for bacterial meningitis: | Gram Negative
Ceftriaxone or Cefepime
45
when do you use steroids with bacterial meningitis?
use as adjunctive therapy with H. influenzae or pneumococcal meningitis
46
possible concern of steroid use in bacterial meningitis?
it will decrease inflammation of meninges --- may decrease penetration of antibiotic into the CSF
47
When to do bacterial meningitis prophylaxis: | For _________ or _______ infections only
H. influenzae or N. meningitidis
48
When to do bacterial meningitis prophylaxis: | Do for people that are _______ to the patient with the infection
``` close contacts (household members, sharing sleeping quarters, daycare attendee, NH resident, anyone in crowded confined area with index case) ```
49
When to do bacterial meningitis prophylaxis: | Greatest risk for development develops in the _______ following exporsure
week
50
Bacterial meningitis prophylaxis regimens: | what drug is used?
rifampin
51
most common cause of fungal meningitis
cryptococcus
52
Cryptococcal meningitis treatment?
NON-HIV infected: amphotericin PLUS flucytosine x 2 weeks then fluconazole x 12 weeks HIV infected: amphotericin PLUS flucytosine x 2 weeks then fluconazole x 8 weeks then for one year
53
Diagnosis of Viral Encephalitis: | Clear or cloudy?
clear!!
54
Diagnosis of Viral Encephalitis: | what type of gram stain?
negative because it aint bacteria
55
what drug is used for Viral encephalitis herpes simplex/varicella infections?
acyclovir | renally adjust
56
what drug is used for Viral encephalitis CMV infections?
ganciclovir and foscarnet
57
what is contiguous spread?
bacteria spread into brain tissue from nearby focus of infections
58
If HIV infected person: what bugs are we worried about that would cause a brain abscess?
toxoplasma nocardia cryptococcus
59
Brain Abscesses: Empiric Abx of Choice: | If Lung abscess, empyema
PCN + Metronidazole | add sulfonamide for norcardia
60
Brain Abscesses: Empiric Abx of Choice: | dental sepsis
PCN + Metronidazole
61
Brain Abscesses: Empiric Abx of Choice: | Otitis Media or Mastoiditis
3rd gen ceph + metronidazole
62
Brain Abscesses: Empiric Abx of Choice: | sinusitis
3rd gen ceph + metronidazole
63
Brain Abscesses: Empiric Abx of Choice: | trauma/neurosurgery?
Vanc + 3rd/4th gen ceph (cover psuedomonas)
64
Brain Abscesses: Empiric Abx of Choice: | bacterial endocarditis
Vanc + gentamicin

PHRM 865 (59 decks)

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