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Symptoms Midterm > GI: Non-Blood Diarrhea > Flashcards

GI: Non-Blood Diarrhea Flashcards

1
Q

What labs do we order for acute onset, non toxic, non-bloody diarrhea

A

dont need to order them

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2
Q

What medications can cuse acute non-bloody diarrhera

A 
Medications (some with osmotic effect)
– Sorbitol (gum, mints, pill fillers)
– Mannitol
– Fructose (fruits, soft drinks)
– Fiber (bran, fruits, vegetables)
– Lactulose
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3
Q

What Mg+ containing meds can cause acute, non bloody diarrhea

A

– Nutritional supplements
– Antacids
– Laxatives

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4
Q

What drugs cause diarrhea through non-osmotic means

A 
– Metformin
– Antibiotics
– Colchicine
– Digoxin
– Selective serotonin reuptake inhibitor antidepressants
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5
Q

• Caliciviruses (including Norovirus)
• Rotovirus
Cause what kind of diarrhea

A

acute, non bloody

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6
Q 
• Vibrio cholera
• Escherichia coli
• Shigella species
• Salmonella species
• Campylobacter species
• Yersinia enterocolitica
Cause what kind of diarrhea?
A

acute, non bloody

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7
Q 
– Shigella species
What kind of diarrhea does this cause
– Ecoli
– Campylobacter species
– Salmonella species
– Y enterocolitica
– Klebsiella oxytoca
A

infectious inflammatory colitis

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8
Q

What types of bacterial acute non bloody diarrhea should be considered to treat with antibiotics

A
  • Vibrio cholera
  • Escherichia coli
  • Shigella species
  • Salmonella species
  • Campylobacter species
  • Yersinia enterocolitica
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9
Q

What types of Infectious diarrhea from inflammatory colitis can be tx with antibiotics

A 
– Shigella species
– Ecoli
– Campylobacter species
– Salmonella species
– Y enterocolitica
– Klebsiella oxytoca
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10
Q

Drug that Inhibits DNA gyrase and/or topoisomerase IV

A

quinolones, e.g. ciprofloxacin

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11
Q

Binds 50S ribosomal subunit, blocking mRNA translocation,

A

e.g. azithromycin, erythromycin

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12
Q

What meds do we treat campylobacter jejunum with?

A

Ciprofloxacin (quinolones)

Macrolides (azithromycin)

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13
Q

Campylobacter is inherently resistant to

A

penicillins, most cephalosporins, trimethoprim

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14
Q

Pro kinetic, risk for arrythmias and cardiac arrest, lots of CYP3A inhibition and more frequent dosing needed

A

erythromycin

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15
Q

Low incidence of GI effects, lower incidence of cardiac effects, few drug interactions, less frequent dosing

A

Azithromycin

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16
Q

What are we seeing increasing drug resistance to for campylobacter?

A

Ciprofloxacin

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17
Q
  • Gram-neg rods
  • Facultative anaerobes
  • Members of the Enterobacteriaceae family
  • B-lactamase (often transmissable) has become quite common in this family
A

Shigella and Salmonella

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18
Q

What drugs are approved to tx Shigella and Salmonella

A
  • Ampicillin (both)
  • TMP/SMX (Shigella)~ dont use this much
  • Ciprofloxacin (both)
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19
Q

Why is trimethoprim sulfate a bad choice to tx Shigella or Salmonella?

A

high drug resistance

use Ciprofloxacin or Azithromycin (not yet approved, but works great)

20
Q

This march we saw increasing outbreak of Shigella sonnei restistant strain to which drug?

A

Ciprofloxacin

shigella is high contagious and can be carried for weeks/months

21
Q

What is a key barrier to infection with enteric pathogens like Salmonella?

A

NOrmal flora

22
Q

Pt had acute non bloody diarrhea and was tx with Amoxicillin for 5 days. Come to ED with bloating, pain, bloody diarrhea 6-8 x/day with low grade fevers. What test should we order?

A

Stool testing for C.Diff!

23
Q

What two drugs are best choice to tx C.diff?

A

Vancomycine and Fidacomicin

Metronidazole is commonly used, but not FDA approved

24
Q

What type of bug is C.Diff?

A

Gram +
anerobe
spore forming

25
Q

What drug is a common cause of C.diff infections?

A

Clindamycin!

26
Q

Why can’t we use cefepime and clindamycin for C.Diff?

A

they work for some anaerobes, not C.Diff

27
Q

Pt has C.diff and you culture it.. you find Mutations in RNA polymerase B (rpoB)
What drug will have decreases sensitivity for C.diff now?

A

Fidaxomicin

28
Q

What is the mechanicms of Fidacomicin?

A

– Macrocyclic that blocks formation of RNA polymerase open promoter complex
– No cross-resistance with other RpoB inhibitors (e.g. rifamycins)

29
Q

explain why we see metronidazole resistance in C.diff

A

– often transient, lost in storage, or after freeze/thaw
– Some changes noted in electron transport, energy generation, iron utilization
– No association with mutations in nitroreductase

30
Q

Explain why we see Vancomycin resistance in C.Diff

A

– Not common, diverse mutations, not well-defined
– In vitro resistance studies: mutations in various cell wall enzymes (N-acetylglucosamine transferase, L-serine deaminase), but no clinical link

31
Q

What are three different times we see C.Diff infections?

A

relapse with original, re-infection with another strain or antibx use that fucks with normal flora

32
Q

What is the coverage spectrum for Metronidazole

A

Anaerobes: both +/-

33
Q

What is the coverage spectrum for Clindamycin

A

gram + aerobes;

gram+/- anerarobes

34
Q

What is the coverage spectrum for fidaxomicin

A

– Primarily Clostridium only
– Some effects on Peptostreptococcus
– No effects on other gram-pos. (Enterococcus, Streptococcus, Lactobacillus, Bifidobacterium) or gram-negs

35
Q

What is the coverage for Vancomycin

A

Many gram +(aerobes and anaerobes)

36
Q

Which leads to less recurrance of C.Diff: vancomycin or fidoxomicin?

A

Fidoxomicin

37
Q

What is the reason that Fidoxomicin has less recurrence to C.Diff then Vancomycin

A
  • less disruption of normal flora
  • cidal (time-dependent) vs. static effect of vancomycin on C. diff.
  • fidaxomicin has an active metabolite OP-1118
  • fidaxomicin has post-antibiotic effect (6–10 hr)
38
Q

What side effect will you see when tx pt with ORAL vancomycin for C.Diff and why?

A

Nausea and abdominal pain: d/t poor absorption which is what we want, then targets the colon and is highly concentated

39
Q

What side effects do we see with IV vancomycin

A

red man, ototoxic, nephrotoxic and phlebitis at injection site

40
Q

What drug can be given IV to treat C.Diff?

A

Metronidazole: enough metronidazole is excreted in bile and there is increased exudation across intestinal mucosa during CDI
For severe CDI: IV metronidazole can be added to oral vancomycin

41
Q

Pt is being tx with metronidizole for 3 days for C.Diff infection; now has fever of 102, tachycardia, no BM in 24 hrs, with distended abdomen and + rebound and guarding; on xray the colon is large, distended and lack haustra. What’s going on?

A

Toxic megacolon: need to resect the colon immediately!

42
Q

How does C.diff get into the large intestine

A

vegitative cells are killed off in the stomach d/t acid and spores move along to intestine and germinate once they are exposed to bile acids–> the mult in colon and gut mucosa faciliates adherance

43
Q

Why do we get C.diff infections from antibx?

A

Antibx kill off gut flora, C.Diff grows and secretes toxins and ulcerates mucosa–> damaged mucosa secretes fluid = diarrhea

44
Q

What do we use to tx initial episode of mild/moderate C.Diff infection?

A

Metronidazole, 3xs day/ po

45
Q

What do we use to tx initial episode of C.Diff that is severe?

A

Vancomycin 4x day po

46
Q

What do we use to treat initial episode of C.Dif that is severe and complicated?

A

Vanco 4xs day po AND metonidazole IV

Symptoms Midterm (12 decks)

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