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Therapeutics V Spring 2019 (P3 Spring) > 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
Q

CSF gets obtained via ______

need __#___ tubes for what tests?

A

LP: lumbar puncture

need 3 tubes: chemistry/hematology/microbiology

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26
Q

Bacterial Findings in CSF for Meningitis:

WBC value?

A

400 - 5000

27
Q

Bacterial Findings in CSF for Meningitis:

Differential?

A

> 80% neutrophils

28
Q

Bacterial Findings in CSF for Meningitis:

Protein?

A

elevated:

100 - 500

29
Q

Bacterial Findings in CSF for Meningitis:

glucose?

30
Q

when should empiric therapy be started?

A

immediately administered after LP is performed — do not wait to get culture results!

31
Q

Empiric Treatment options for bacterial meningitis:

Head trauma?

A

Vanc + 3rd/4th gen cephs (want pseudomonas coverage)

32
Q 
Empiric Treatment options for bacterial meningitis:
Older adults (> 50 years old) or Immunosuppressed
A

Amp + 3rd gen ceph + Vanco

*do 4th gen ceph if immunosuppressed

33
Q

Empiric Treatment options for bacterial meningitis:

Postneurosugery?

A

same as head trauma!

Vanc + 3rd/4th gen cephs

34
Q

Empiric Treatment options for bacterial meningitis:

adults (30 - 50 years old)

A

3rd gen ceph + vanc

same as kids/adults 4- 29 and infants - kids (1 mo - 4 years

35
Q

Empiric Treatment options for bacterial meningitis:

children/adults (> 4 - 29 yr)

A

3rd gen ceph + vanc

36
Q

Empiric Treatment options for bacterial meningitis:

infants/kids (1 mo - 4 years)

A

3rd gen ceph + vanc

37
Q

Empiric Treatment options for bacterial meningitis:

neonates (< 1 month)

A

ampicillin + cefotaxime

38
Q

Directed Treatment options for bacterial meningitis:

if S. pneumoniae?

A

PSSP: PCN G or Ampicillin
PRSP: Vanc + Ceftriaxone

39
Q

Directed Treatment options for bacterial meningitis:

Group B Strep

A

Ampicillin (+/- gent)

40
Q

Directed Treatment options for bacterial meningitis:

S. Aureus

A

MSSA: Nafcillin!! (Not Cefazolin bc doesnt get into CSF!)
MRSA: Vanc!

41
Q

Directed Treatment options for bacterial meningitis:

Listeria monocytogenes

A

Ampicillin (+/- gent)

42
Q

Directed Treatment options for bacterial meningitis:

Neisseria meningitidis

A

PCN
or
Ceftriaxone

43
Q

Directed Treatment options for bacterial meningitis:

H. influenzae

A

BL (?) + ampicillin

BL + ceftriaxone

44
Q

Directed Treatment options for bacterial meningitis:

Gram Negative

A

Ceftriaxone
or
Cefepime

45
Q

when do you use steroids with bacterial meningitis?

A

use as adjunctive therapy with H. influenzae or pneumococcal meningitis

46
Q

possible concern of steroid use in bacterial meningitis?

A

it will decrease inflammation of meninges — may decrease penetration of antibiotic into the CSF

47
Q

When to do bacterial meningitis prophylaxis:

For _________ or _______ infections only

A

H. influenzae or N. meningitidis

48
Q

When to do bacterial meningitis prophylaxis:

Do for people that are _______ to the patient with the infection

A 
close contacts
(household members, sharing sleeping quarters, daycare attendee, NH resident, anyone in crowded confined area with index case)
49
Q

When to do bacterial meningitis prophylaxis:

Greatest risk for development develops in the _______ following exporsure

50
Q

Bacterial meningitis prophylaxis regimens:

what drug is used?

51
Q

most common cause of fungal meningitis

A

cryptococcus

52
Q

Cryptococcal meningitis treatment?

A

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
Q

Diagnosis of Viral Encephalitis:

Clear or cloudy?

54
Q

Diagnosis of Viral Encephalitis:

what type of gram stain?

A

negative because it aint bacteria

55
Q

what drug is used for Viral encephalitis herpes simplex/varicella infections?

A

acyclovir

renally adjust

56
Q

what drug is used for Viral encephalitis CMV infections?

A

ganciclovir and foscarnet

57
Q

what is contiguous spread?

A

bacteria spread into brain tissue from nearby focus of infections

58
Q

If HIV infected person: what bugs are we worried about that would cause a brain abscess?

A

toxoplasma
nocardia
cryptococcus

59
Q

Brain Abscesses: Empiric Abx of Choice:

If Lung abscess, empyema

A

PCN + Metronidazole

add sulfonamide for norcardia

60
Q

Brain Abscesses: Empiric Abx of Choice:

dental sepsis

A

PCN + Metronidazole

61
Q

Brain Abscesses: Empiric Abx of Choice:

Otitis Media or Mastoiditis

A

3rd gen ceph + metronidazole

62
Q

Brain Abscesses: Empiric Abx of Choice:

sinusitis

A

3rd gen ceph + metronidazole

63
Q

Brain Abscesses: Empiric Abx of Choice:

trauma/neurosurgery?

A

Vanc + 3rd/4th gen ceph (cover psuedomonas)

64
Q

Brain Abscesses: Empiric Abx of Choice:

bacterial endocarditis

A

Vanc + gentamicin

Therapeutics V Spring 2019 (P3 Spring) (27 decks)

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