FINAL FALL 14 Flashcards
In geriatrics, what happens to: gastric pH? dermal absorption? IM absorption? distribution of water/lipid soluble? renal clearance? liver mass?
pH- incr derm- inc IM- dec water soluble- dec lipid soluble- inc renal- dec liver- dec (so dec in enzymes that degrade)
Which vitamins/minerals are decreased in geriatrics?
Fe, VitB12, Ca
metformin inc risk of B12 deficiency
What happens to the half life of sedatives? opioids? phenytoin? propranolol? p-glycoprotein?
increases (lipid soluble) increases (clearance reduced) inc (dec albumin) dec dec so higher brain concentration
In pediatrics, what physiologic changes occur in enzyme activity in neonates v young kids? GFR?
dec enzyme capacity in neonate but inc in young kids
What is the dose for ibuprofen and tylenol?
ibuprofen (6-10 mg/kg q 6 hrs)
tylenol (10-15 mg/kg q 4 hrs)
What are the most common causes for meningitis newborn-1mo? 1 mo to 4 years?
neonate- group B strep, e coli, listeria
young kid- strep pneumo, hflu, n. meningitidis
What are the treatments for bacterial meningitis?
neonate- Ampicillin + Cefotaxime (or ceftriaxone or amnioglycoside)
young kid- Vancomycin + Cefotaxime (or ceftriaxone)
What do you have to remember about codeine and morphine in kids?
no anti-inflammatory after tonsillectomy- need to alternate with ibuprofen
what is a side effect of meperidine
seizures
What are the anticholingerics on Beers criteria? advice?
hydroxyzine and promethazine
avoid
What are the antiparkinson agents on Beers criteria? advice?
benztropine
avoid
What are the antispasmodics on Beers criteria? advice?
scopolamine
avoid except in short term
What are the anti infectives on Beers criteria? advice?
nitrofuratoin
avoid long term and if CrCl <60
What are the cardiovascular agents on Beers criteria? advice?
alpha blockers (clonidine, doxazosin, prazosin, terazosin) avoid d/t risk for orthostatic hypotension
What does Beers criteria say about benzos and barbituates? non-benzo sedatives?
avoid
but can use benzos for anxiety short term
zolpidem- use less than 90 days
What does Beers criteria say about E and P?
avoid
What does Beers criteria say about mm relaxants?
avoid
carisoprodol, cyclobenzaprine, metaxalone
Which organisms are involved in kids for peritonitis?
e coli, group A strep, pneumococci
What organisms are involved in cirrhotic ascites for peritonitis? dialysis?
-e coli, klebsiella, pneumococci
(cefotaxime-3rd)
-ecoli, klebsiella, pseudomonas, staph aureus, strep
(cefazolin-1st + ceftazidime-3rd or cefepime-4th)
What organisms are involved in gastroduodenal?
e coli, strep
1st gen ceph
What organisms are involved in biliary tract?
e coli
klebsiella
enterococci
clost, bact
What organisms are involved in bowels?
e coli
klebsiella
proteus
clost, bact
What organisms are involved in appendicitis? abscess?
- e coli, pseudomonas, bacteroides
- e coli, kleb, entero, bacteroides, clostrid (same as for biliary tract)
What organisms are involved in liver? spleen?
-e coli, kleb, entero, staph, amoeba
-staph, strep
both (same as general abscess but +aminoglycoside and PCN resistant PCN)
What covers e.coli (gram-)?
2nd or 3rd gen ceph
Which agents for CA mild to mod?
unasyn, timentin, ertapenem,
cefazolin-1st or cefuroxime-2nd + metro
cipro, levo, moxi +metro
Which agents for CA severe?
zosyn, imipenem, meropenem
3rd or 4th gen ceph + metro
cipro + metro
aztreonam +metro
Tx for abscess?
imipenem, meropenem, entrapenem
ext spectrum beta lactamase inhibitors
Tx for appendicits?
anti-anaerobic cephalosporin (cephamycins)
Tx for PID?
clindamycin + gentamycin
cipro+doxy+metro
tx travelers diarrhea
azithro, cipro, levo, or rifaximin
tx cholera? shigella?
doxy
azithro
tx for e coli?
tx for salmonella?
tx for campylobacter?
azithro, cipro, levo, rifaximin,
azithro, cipro, bactrim
azithro, erythro
tx c diff complicated?
uncomplicated?
oral vanco or IV metro
oral vanco or oral metro
What is the first choice for treating strep penumo?
PCN S- PCN G or ampicillin
PCN int- Cefotaxime or ceftriaxone
PCN R- Vanco+ cefotaxime or ceftriaxone
What are the first choice and alternatives for treating group B strep?
PCN G or Ampicillin + Gentamycin (ceftriaxone or ceftaxime)
What is the first choice for treating staph aureus?
S- nafciliin or oxacillin
R- vanco
What are the first choice and alternatives for treating Staph epidermidis?
vanco (linezolid)
What is the first choice for treating listeria?
PCN G or Ampicillin + Gentamycin
What is the first choicefor treating N. meningitis?
S- PCN G or Ampicillin
R- Cefotaxime or ceftriaxone
What is the first choice for treating hflu?
B lactamase negative- ampicillin
B lactamase positive- cefotaxime or ceftriaxone
Alternatives for treating Hflu?
B lactamase negative- cefotaxime, ceftriaxone, cefepime, FQ
B lactamase positive- cefepime, FQ
Alternatives for treating N meningitis?
S- cefotaxime or ceftriaxone
R- meropenem, FQ
Alternatives for treating listeria?
bactrim, meropenem
Alternatives for treating staph a.?
S- vanco, meropenem
R- Bactrim, linezolid
Alternatives for treating strep pneumo?
PCN S- cefotaxime or ceftiaxone
PCN int- cefepime, meropenem, moxi, linezolid
PCN R- cefepime, meropenem, moxi, linezolid
