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PHM603 > Exam III - Bodily Infections/Vaccines > Flashcards

Exam III - Bodily Infections/Vaccines Flashcards

1
Q

Most sinusitis is?

A

viral (90%)

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2
Q

When are antibiotics used in sinusitis? (3)

A

persistent symptoms, severe symptoms, and worsening symptoms

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3
Q

What is first-line for sinusitis?

A

amoxicillin-clavulanate

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4
Q

What is a rare side effect of fluoroquinolones in children?

A

tendonitis

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5
Q

What is the duration of antibiotics in acute sinusitis?

A

adults 5-7days, children 10-14days

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6
Q

What are characteristics of chronic sinusitis? (2)

A

symptoms persist >12 weeks, often not infectious

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7
Q

What is first-line for pharyngitis? (2)

A

penicillin VK or amoxicillin

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8
Q

What is the duration of antibiotics in pharyngitis?

A

10 days (5 days for azithromycin)

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9
Q

What are alternative treatments for pharyngitis?

A

first gen cephalosporins (cephalexin) for previous rash, clindamycin or azithromycin for previous anaphylaxis

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10
Q

When is the highest incidence of acute otitis media?

A

between 6-24 months

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11
Q

When can you use antibiotics for AOM?

A

6mo - 12yr plus moderate-severe pain or temp 102.2, 6mo - 23mo plus nonsevere bilateral acute OM

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12
Q

When can you consider using antibiotics for AOM?

A

6mo - 23mo plus nonsevere unilateral, 2-12yr plus nonsevere acute OM

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13
Q

What is first-line for AOM?

A

amoxicillin-clavulanate (90mg/kg)

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14
Q

What are signs and symptoms of pneumonia? (11)

A

cough, sputum, dyspnea, fever/chills, hemoptysis, pleuritic chest pain, tachypnea, tachycardia, diminished breath sounds, egophony, increased WBCs

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15
Q

What are some diagnostics used for pneumonia? (6)

A

BAL, blood cultures, procalcitonin, O2%, urinary antigen testing, and viral panels

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16
Q

Hospital-acquired and ventilator-associated pneumonia occur after?

A

48 hrs

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17
Q

What are characteristics of typical pneumonia? (5)

A

abrupt onset, unilateral well-defined infiltrate, significant fever/chills, purulent sputum, primarily pulmonary symptoms (pleuritic chest pain)

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18
Q

What are characteristics of atypical pneumonia? (5)

A

gradual onset, diffuse infiltrates, mild fever, dry cough, extrapulmonary symptoms (GI, myalgias)

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19
Q

What are treatments for outpatient CAP? (3)

A

amoxicillin, doxycycline, macrolides (azithro/clarithromycin)

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20
Q

What are treatments for outpatient CAP w/comorbidities?

A

amoxicillin-clavulanate or cephalosporin plus macrolide (azithro/clarithromycin), fluoroquinolone

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21
Q

What are treatments for non-severe inpatient CAP?

A

IV beta-lactam (amp/sul, ceftriaxone) PLUS macrolide or fluoroquinolone

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22
Q

What are treatments for severe inpatient CAP?

A

IV beta-lactam PLUS macrolide or PLUS fluoroquinolone

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23
Q

What is the duration of therapy for CAP?

A

> /= 5days

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24
Q

What are risk factors for VAP? (4)

A

prior antibiotics, colonization, hospitalization, or chronic care immunosuppresive diseases/therapy

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25
Q

What antibiotics are used

A

ceftriaxone, levo/moxifloxacin, ampicillin/sublactam, ertapenem

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26
Q

When to empirically cover for pseudomonas? (4)

A

prior IV antibiotics within 90 days, severe presentation (sepsis), previous infection/colonization, immunosuppression

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27
Q

What antibiotics are used for pseudomonas? (5)

A

piperacillin/tazobactam, cefepime, ceftazidime, imi/meropenem, aztreonam

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28
Q

What other antibiotics are used for pseudomonas? (3)

A

cipro/levofloxacin, aminoglycosides, colistin + polymyxin B

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29
Q

What is the duration of therapy for HA/VAP?

A

7days

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30
Q

What are clinical implications of complicated UTIs? (5)

A

recurrence, SIRS/sepsis, extensive antimicrobial resistance, immunosuppression, instrumentation/catheters

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31
Q

What are signs/symptoms of cystitis? (3)

A

dysuria, frequency/urgency, hematuria

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32
Q

What are signs/symptoms of pyelonephritis? (5)

A

same as cystitis, costovertebral angle tenderness, fever, chills, N/V

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33
Q

What are laboratory findings used for UTI diagnosis? (8)

A

pyuria, leukocyte esterase, nitrites, WBCs, hematuria, WBCs casts, protenuria, bacteria

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34
Q

What are the thresholds for significant bacteriuria?

A

traditional >10^5 CFUs/mL, women >10^2, men >10^3

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35
Q

What is a clinical UTI defined as?

A

bacteruria PLUS pyuria and signs/symptoms of infection

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36
Q

What is used for uncomplicated UTIs? (2)

A

trimethoprim-sulfamethoxazole x3days, nitrofurantoin monohydrate/macrocrystals x5days

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37
Q

What is used for uncomplicated acute pyelonephritis? (4)

A

trimethoprim-sulfamethoxazole x14days, po beta-lactams with initial IV dose x10-14days, ciprofloxacin, fluroroquinolones

38
Q

What is used for complicated acute pyelonephritis? (3)

A

extended-spectrum cephalosporin or penicillin derivative +/- aminoglycoside, fluoroquinolones, carbapenems

39
Q

One should not treat asymptomatic bacteruria unless? (3)

A

pregnant, prior to invasive UT procedures, prior to renal transplants

40
Q

What is first-line for pregnant w/UTI and duration? (2)

A

amoxicillin-clavulanate x7days, cephalexin x3-7days

41
Q

What is first-line for pregnant w/pyelonephritis?

A

IV beta-lactams (ceftriazone, cefazolin) x14days

42
Q

What should NOT be given during pregnancy for pyelonephritis?

A

fluoroquinolones and tetracyclines

43
Q

What is used for acute bacterial prostatitis?

A

trimethoprim-sulfamethoxazole, quinolones (by urologists), gentamicin/ampicillin (for enterococcus) all 2-4weeks

44
Q

What is used for chronic bacterial prostatitis?

A

trimethoprim-sulfamethoxazole, quinolones both 4-6weeks

45
Q

What is used for traveler’s diarrhea and for how long?

A

loperamide x2 days

46
Q

What is used for enterocoxic E. coli and for how long? (3)

A

ciprofloxacin, azithromycin, and rifamixin x1-3days

47
Q

Evaluation of water loss (mild)?

A

<5% body weight loss, alert and restless, moist to slightly dry mucus membranes, normal/slightly decreased urinary output

48
Q

Evaluation of water loss (moderate)?

A

6-9% body weight loss, lethargic and restless, low BP and high HR, dry mucus membranes, dark urine

49
Q

Evaluation of water loss (severe)?

A

> 10% body weight loss, drowsy and limp and LOC, bradycardia, cyanotic, skin tenting, no urine

50
Q

What is the most common microbial cause of healthcare-associated infections in US?

A

CDI

51
Q

Differentiate Toxin A and Toxin B?

A

Toxin A = enterotoxin and damages epithelium, Toxin B = cytotoxin and cell death

52
Q

What are patient specific risk factors for CDI? (4)

A

Age >65, GI surgery, tube feeding, immunocompromised

53
Q

What are facility related risk factors for CDI? (3)

A

length of stay, ICU admission, exposure

54
Q

What are medication related risk factors for CDI? (3)

A

acid-suppressing agents, chemo, antibiotics

55
Q

Severity of disease CDI (non-severe)?

A

leukocytosis WBC < 15k cells/mL AND SCr < 1.5 mg/dL

56
Q

Severity of disease CDI (severe)?

A

leukocytosis WBC > 15k cells/mL OR SCr < 1.5 mg/dL

57
Q

Severity of disease CDI (fulminant)?

A

hypotension or shock, ileus, megacolon

58
Q

What should be avoided and given for CDI, respectively?

A

loperamide and narcotics (anti-peristaltic agents), hydration and electrolyte correction

59
Q

What is used for non-severe CDI?

A

vancomycin 125mg PO QID, fidaxomicin 200mg PO BID, or metronidazole 500mg PO TID all x10days

60
Q

What is used for severe CDI?

A

vancomycin 125mg PO QID, fidaxomicin 200mg PO BID both x10days

61
Q

What is used for complicated/fulminant CDI?

A

vancomycin 500mg PO or NG QID (PLUS metronidazole 500mg IV q8hr if ileus present)

62
Q

What transplant method is extremely successful?

A

fecal microbiota transplantation (FMT)

63
Q

What vaccination rate is needed for herd immunity (measles)?

A

83-94%

64
Q

What vaccination rate is needed for herd immunity (pertussis)?

A

92-95%

65
Q

PCV13 and PPSV23 should be spaced?

A

8 weeks apart

66
Q

PCV13 and MenACWY-D should be spaced?

A

> 4 weeks apart

67
Q

Which vaccine combination MUST be spaced and for how long?

A

2 or more live parenteral, 28days

68
Q

What trimester should you wait for to give most vaccines?

A

2nd trimester

69
Q

Live vaccination delay time for patient receiving chemo/radiation?

A

2 weeks before or 3 months after treatment

70
Q

What type of systemic corticosteroids are of import in vaccinations?

A

2+ mg/k/d or 20+ mg/d prednisone for 14+ days

71
Q

How long to wait after live vaccination for IVIG administration?

A

14+ days

72
Q

How long to wait after live vaccination for PPD skin test?

A

simultaneous administration or 4-6 weeks after

73
Q

Which vaccinations are SQ only?

A

herpes zoster (Zostavax brand), MMRV containing vaccines, MPSV-4, and PPSV-23

74
Q

What are the primary goals of ART? (5)

A

maximal an durable viral suppression, restoration and preservation of immune function, improved QoL, reduced opportunistic infections, reduced morbidity and mortality

75
Q

What is the recommended treatment combo for most people with HIV?

A

INSTI + 2 NRTIs

76
Q

What are the top two most common INSTI + NRTI treatments?

A

BIC/FTC/TAF, DTG/ABC/3TC

77
Q

What are adverse events associated with integrase inhibitors?

A

GI, CNS disturbances, rash, false elevation in SCr, weight gain

78
Q

What are drug interactions with integrase inhibitors?

A

cations (acid reducers), metformin

79
Q

bictegravir advantages?

A

single tablet regimen, high resistance barrier

80
Q

bictegravir disadvantages?

A

limited safety data in pregnancy

81
Q

dolutegravir advantages?

A

single tablet regimen, high resistance barrier, preferred for pregnant women regardless of trimester

82
Q

dolutegravir disadvantages?

A

ABC coformulation requires HLA-B*5701 testing, increases metformin levels

83
Q

raltegravir advantages?

A

longest experience

84
Q

raltegravir disadvantages?

A

multiple pills, lower barrier to resistance

85
Q

Which INSTI should not be used if RNA levels are greater than 500k?

A

Dovato

86
Q

Which INSTI should not be used if HLA-b*5701 positive?

A

Triumeq (w/abacavir)

87
Q

Which NNRTI should not be used if RNA levels are >100k or CD4+ <200

A

one with rilpivirine (alefenamide)

88
Q

Which integrase inhibitors should not be combined with acid reducers?

A

dolutegravir/rilpivirine combinations

89
Q

What is the preferred regimen for ART in pregnancy?

A

dual NRTI backbone plus INSTI or boosted PI

90
Q

Pfizer monovalent products explanation?

A

maroon/orange/gray caps = 3/10/30mcg = <4/5-11/12+ yrs

91
Q

Moderna monovalent products explanation?

A

magenta/purple/blue labels = 25/50/100mcg = <5/6-11/12+ yrs

92
Q

Moderna bivalent products explanation?

A

yellow/gray labels = 10/25 or 50mcg =

PHM603 (3 decks)

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