hammer19 Flashcards
What do carbapenems cover? What do they treat?
(imipenem, meropenem, ertapenem, doripenem) gram negative bacilli, including many that are resistant, anerobes, streptococci and staphyllcocci. Used to treat neutropenia and fever.
What antibiotic for cystitis and pyelonephritis?
Ciprofloxacin
What fluoroquinolone can be used as a single agent for diverticulitis?
Moxifloxacin. The others need to add metronidazole.
What is the sideeffect of quinolones?
Bone growth abnormalities in children and pregnant women, tendonitis and achilles tendon rupture,
What are some aminoglycosides? What can’t they treat?Sideeffects?
Gentamicin, amikacin, tobramycin, Treat gram negative bacilli but not anerobes because they need oxygen. Nephrotoxic and ototoxic.
What are indications for doxycycline and what are adverse effects?
Borrelia, ehrlichia, mycoplasma. Lyme disease, Tooth discoloration, fanconi syndrome (type 2 RTA), photosensitivity, esophagitis/ulcer.
What are the adverse effects of TMP/SMX?
Rash, G6PD hemolysis, bone marrow suppression (folate antagonist)
What are treatments for MRSA?
Vancomycin, Linezolid (reversible BM toxicity), daptomycin (elevated CPK), tigecycline, ceftaroline), telavancin
Which antibiotics cover anerobes above diaphragm?
Penicillin, Clindamycin
Which antibiotics cover anerobes below diaphragm?
Metronidazole, betalactam/lactamase combinations
Whic antibiotics cover gram negative bacilli?
Quinolones, aminoglycosides, carbapenems, piperacillin, ticarcillin, aztreonam, cephalosporin
What is unique about CSF findings for TB meningitis?
Protein level is markedly elevated. Glucose level may be low.
When do you do a bacterial antigen detection (latex agglutination test)?
When th epatient has received antibiotics prior to LP and the culture may be falsely negative
What are diagnsotic tests for cryptococcus?
INdia ink (60-70% sensitive), cryptococcal antigen (more than 95% sensitive and specific), Fungal culture (100% specific)
What is the best initial treatment for bacterial meningities? Most common neurological deficit?
Ceftriaxone, vanco, steroids. Add ampicillin if immunocompromised for Listeria. .CN8 nerve deficit or deafness.
What is additional managment of Neisseria meningitis?
Respiratory isolation. Rifampin, ciprofloxacin or ceftriaxone to close contacts.
What is the most accurate test for hepres encephalitits? What is the best treatment?
PCR of CSF. Acyclovir. Foscarnet for acyclovir resistant herpes.
What is the most sensitive finding for otitis media? What meds besides amoxicillin if they are resistant or recently treated?
Tympanic immobility. Amoxicillin/clavulanate, azithromycin, cefuroxime, loracarbef, levofloxacin, gemifloxacin
What is the first line treatmetn for both otitis and sinusitis?
Amoxicillin/clavulanic acid, doxycycline, TMP/SMX
What is the treatment for pharyngitis? If allergic or anaphlyactic?
Penicillin or amoxicillin, IF allergic cephalexin only if rash is reaction. Clindamycin or macrolide if reaction is anaphylaxis.
When do you treat the flu with oseltamivir and zanamivir?
Less than 48 hours of symptoms.
Which one is the most accurate test for infectious diarrhea? What are other tests?
Stool culture. Stool lactoferrin which has a better sensitivity than stool leukocytes
What is the presentation and treatment of scromboid?
Rapid onset. Wheezing, flushing rash. Found in fish. Treat with antihistamines.
What is the treeatment for Giardia? Cryptosporidiosis?
Netronidazole, tinidazole. For Cryptosporidiosis, nitazoxanide
What is the best initial diagnostic for Hepatitis A,C,D,E?
IgM antibody for acute infection and IgG to detect resolution of infection
What is the only negative value in Hep B for acute or chronic infection?
Surface antibody
What is the only positive value in Hep B after vaccination?
Surface antibody
What is the only positive value in Hep B during window period?
Core antibody (positive IgM, then IgG)
What is the only positive values in Hep B after resolved infection?
Core and surface antibody
What value will become abnormal first after acquiring hepatitis B infection?
Surface antigen
Which is the most direct correlate with the amount of active HepB viral replication and best indication for treatment in chronic disease?
E-antigen
Which indicates a patient is no longer at risk for transmiting HepB?
No surface antigen
What is the presentation and treatmetn for cervicitis?
Inflamed strawberry cervix on physical exam. Ceftriaxone and azithromycin
What is the physical finding of chancroid and how is it diagnosed and treated?
Painful ulcer, Stain and culture on specialized media. Azithromycin
What is the physical finding of lymphogranuloma and how is it diagnosed?
Tender and suppurating lymph nodes. Complement fixation titers in blood. Nucelic acid amplification testing on swab. Doxycycline
What is the presentation of secondary syphilis?
Palmar and solar rash, alopecia areata, mucous patches, condylomata lata
What is the presentation of tertiary syphilis?
Neurosyphilis (stroke from vasculitits), tabes dorsalis, general paresis, argyll orbertson pupil), aortitis and gummas
What is the treatment for genital warts (condylomata acuminata)? Pediculosis (crabs) and scabies?
Physical removal, podophyllin or trichloroacetic acid. Imoqid to slough off lesion.
What is the treatment for Pediculosis (crabs) and scabies?
Permethrin
What is the treatment options for pyelonephritis?
- Ceftriaxone or ertapenem 2. Ampicillin and gentamicin until culture results arrive 3. Ciprofloxacin
What is the treatment for chronic prostatitis?
Ciprofloxacin or TMP/SMX for 6 to 8 weeks
What is the most common cause of culture negative endocarditis and best initial treatment? What is the treatement for HACEK organisms?
Coxiella and bartonella. Vancomycin and gentamicin. Ceftriaxone
When is prophylaxis for endocarditis? Treatment?
Significant cardiac defect (prosthetic valve, previous endocarditis) and risk of bacteremia (dental work with blood). Amoxicillin or if allergic clindamycin, azithromycin or clarithromycin,
When do you use Doxycycline vs ceftriaxone for lyme?
Use ceftriaxone for cardiac and neurologic manifestations other than CNVII palsy. Use doxycyclein and amoxicillin or cefuroxime for joint, CNVII palsy
What is the best initial test for HIV? How is it confirmed? How are infected infants diagnosed?
ELISA. Western blot testing. Infected infants are diagnosed with PCR or viral culture.
What are the indications for treatment in an HIV patient? Which classes of meds are used?
- CD4 below 500 2. Viral load is vey high 3. Opportunistic infections occur . 3 drugs from atleast 2 differetn classes (NNRTIs, RTIs, protease inhibitors)
What are the best initial drug regimen for HIV?
Emtricitabine, tenofovir and efavirenz
What is the side effect of abacavir?
Dangerous with HLA B5701 mutation
What is the use of ritonavir?
Given is small doses to boost the levels of other protesase inhibitors like Darunavir or atazanavir.
What are viral entry inhibitors in HIV?
Enfuviritide and maraviroc
What are integrase inhibitors in HIV?
Raltegravir, dolutegravir, elvitegravir with cobicistat
What is the adverse effect of zidovudine?
Anemia
What is the adverse effect of stavudine and didanosine?
peripheral neuropathy and pancreatitis
What is the adverse effect of protease inhibitors (navirs)?
Hyperlipidemia and hyperglycemia
What is the adverse effect of indinavir?
Nephrolithiasis
What is the adverse effect of tenofovir?
Renal insuficciency
What medication should the baby receive in an HIV + mother during and after delivery? Which drug should be avoided in pregnancy?
Zidovudine during delivery and for 6 weeks afterward. Efavirenzt (teratogenic in animals)
What is the viral cutoff in pregnancy for c section in HIV + patients?
Above 1000/microliter
