ID 2 (Bacterial Infections) Light Bulbs + Other things Flashcards
Recommended Pre-op antibiotic for a Cardiac/Vascular procedure:
Cefazolin or Cefuroxime
BL allergy: Vanco or Clinda
Recommended Pre-op antibiotic for a Orthopedic Procedure:
Cefazolin
BL Allergy: Vanco or Clinda
Recommended Pre-op antibiotic for a GI procedure:
Cefazoline + Flagyl, Cefotetan, Cefoxitin, or Unasyn
In a CA meningitis patient, what should be administered before their first antibiotic dose and why?
Dexamethasone - aids in preventing neurological complications (hearing loss)
What are the most common bacteria in adults for meningitis?
Strep. Pneumonia
Neisseria Meningitidis
What populations should have Listeria Monocytogene coverage in empiric meningitis treatment?
Neonates, > 50 yo, immunocompromised
In patients >1 month old, what do you add for streptococcus pneumoniae coverage?
Vanco
A neonate of 20 days presents to the ER with suspected meningitis. What empiric treatment should be used?
Pt < 1 month
Ampicillin (Listeria)
+
Cefotaxime (no rocephin in this age - CI for shit in bag)
Or Gentamicin
A 31 year old female is admitted for meningitis. What Empiric therapy should be given?
1st: DONT Forget dexamethasone before 1st dose!!!!
Ceftriaxone or Cefotaxime
+
Vancomycin
(Age: 1 m - 50 y)
Mr. Hermit the Crab just turned 51. The ID doc wants to empirically treat for Meningitis. What do you recommend?
(dont forget dexamethasone)
Ampicillin (listeria coverage)
+
Ceftriaxone or Cefotaxime
+
Vanco
A physician gives a prescription for amoxicillin to parent whose son has a non-severe AOM on the right side only, and advises the parent to
” dont fill right away. wait a few days and see if he improves without medication. If he doesn’t improve go ahead and fill it”
WHY DID THE DOCTOR DO THIS?
Most AOM are viral > Bacterial
Observation for 2-3 days is in option in patient >6 months that are non severe.
Non severe is: otalgia < 48h, no otorrhea, temp < 102.2
And:
If 6m - 23m: sx’s only in one ear
If 2 +y : so’s in one or both ears
The screaming crying 5 year old is diagnosed with AOM. The doctor asks you what the 1st line treatment options are and what the dosing is.
1st Line: Amoxicillin or Augmentin
Dose: 90 mg/kg/d (divde doses)
The mother of a screaming 5 yo with AOM tells you their kid is allergic to PCN. What can they get instead?
Second or Third gen cephalosporins
Cefdinir (omnicef)
Cefuroxime
Cefpodoxime
Ceftriaxone
The screaming 5 yo with AOM returns back to the clinic after 2-3 days saying they have not improved. What can we try?
IF amoxicillin was used try augmentin
OR
Ceftriaxone 50 mg/kg IM x 3 d
Pertussis (whooping cough) is caused by bordetella pertussis … What do you use to treat this highly contagious infection?
Macrolide (Azithro or Clarithro)
What viral infections trigger a COPD Exacerbation? (3)
H. Influenzae
M. Catarrhalis
S. Pneumoniae
Please list the 4 types of antibiotics that are preferred in a COPD exacerbation.
AUGMENTIN
Respiratory Quinolone
Doxy
Azithro
What comorbidities make a patient high risk in the CAP OP treatment algorithm?
CHF, CKD, RD, DM, AUD
If a patient is classified as “healthy” what OP CAP TX could be utilized?
Amoxicilline 1 g TID
or
Doxy
or
Macrolides (if resistance is < 25% )
If a patient is classified as “high risk” what OP CAP TX should be utilized
BL + Macrolide or Doxy
Augmenting or Cephalosporin
+
Macrolide or Doxy
OR
Resp Quinolone Monotherapy: MLG (breathy men love girls)
Inpatient CAP. What should we use if a patient has a pseudomonas risk factor ?
Zosyn, Cefepime, or Meropenem
LJ is a 87 yof who is admitted to the hospital for CAP. You find out that she just left Flower hospital 3 weeks ago for UTI. She did receive parental antibiotics. What should we do?
Hospitalization and parental Abx use in the past 90 days = cover for MRSA and Pseudomonas
EX: cefepime + Vancomycin
All patients with HAP/VAP need Pseudomonas and MSSA coverage. Give three examples
Cefepime
Zosyn
Levofloxacin
Use two antibiotics for pseudomonas if risk for MDR gram negative pathogens is presents.
Give 2 example regimens that could be utilized if MRSA coverage is also needed.
Zosyn + Cipro + Vanco
Cefepime + Gentamicin + Linezolid
Use two antibiotics for pseudomonas if risk for MDR gram negative pathogens is presents. (Do not use two BL together)
BL: Zosyn, Cefepime, Ceftazidime, imipenem/cilastatin, meropenem
+
Levoflox or Cipro
OR
Aztreonam
OR
Tobramycin, Gentamicin, or Amikacin
Describe Latent TB
TB is present but does not grow in the body
No sx, not contagious
Treat with 1-2 meds for 3-4 months
** can advance to active TB **
Describe Active TB
Suspected with a positive AVFB smear but diagnosis requires a PCR or positive culture
Sx: chest pain, hemoptysis, dyspnea, shaking/chills, night sweat, fatigue
RIPE Treatment
KL is a 55 yom found to have latent TB. The ID doctors want to know what regimen options are available.
INH and Rifapentine QW x 12 via (DOT)
INH with Rifampin QD x 3 months
Rifampin QD x 4 months
INH (isoniazid) QD x 6 -9 months
KL is a 55 yom found to have latent TB. The ID doctors want to know what regimen options are available…
BUT! this patient has known adherence issues. What therapy would be best for him?
INH + Rifapentine QW x 12 weeks via DOT (direct observation therapy)
KL is a 55 yom found to have latent TB. The ID doctors want to know what regimen options are available….
BUT!!! This patient is also HIV positive. What therapy would be best for him?
INH QD x 6 - 9 months is preferred in HIV positive patients due to less DDI. (9 months is recommended)
A patient is diagnosed with ACTIVE TB. He currently takes Reyataz at home. With the patient about to start RIPE therapy what intervention should be made?
Due to Reyataz being a protease inhibitor (-navir) it is recommended to change Rifampin to Rifabutin
(less DDI)
Which agent in the RIPE therapy is associated with peripheral neuropathy?
Isoniazid
Can give with B6 to avoid (25 - 50 mg QD)
This witch also can cause DILE (WOW)
What agents of RIPE have a risk of hemolytic anemia?
Rifampin and Isoniazid
A patient came in with an elevated UA level. What agent of the RIPE therapy is causing this.
Pyrazinamide (avoid in acute gout)
Ethambutol is known to cause (2 things)
Visual Damage (monthly eye exams)
Confusion/Hallucinations
The patient in 301 that was having 12 bowel movements a day received a positive C diff culture. This is her first episode. Please give some treatment options. :)
Fidaxomicin (Dificid): 200 mg PO BID x 10 D
Vancomycin 125 mg QID x 10 D
Metronidazole 500 mg PO TID x 10 D (only if non severe and no other options are available)
The patient in 301 that was having 12 bowel movements a day received a positive C diff culture. This is her SECOND episode. Please give some treatment options. :)
Dificid (Fidaxomicin) 200 mg PO BID x 10 D
or
Vancomycin 125 mg QID x 10 days following by a prolonged pulse/taper dosing.
- A prolonged taper is acceptable if flatly was used for the first episode
The patient in 301 that was having 12 bowel movements a day received a positive C diff culture. This is her FIFTH episode. Please give some treatment options. :)
3 + Episodes:
Dificid (Fidaxomicin) 200 mg PO BID x 10 D
or
Vancomycin 125 mg QID x 10 days following by a prolonged pulse/taper dosing.
or
Vanco standard dosing + Rifaxamin 400 mg TID x 20 d
OR
Fecal microbiota transplantation
The patient in 301 that was having 12 bowel movements a day received a positive C diff culture.
Along with this she has started presenting with hypotension, shock, ileus or possibly toxic megacolon….
The doctor has diagnosed her with Fulminant/Complicated Cdiff disease.
What do we need to do to treat her?
Vancomycin 500 mg PO / NG / PR QID
+
Flagyl 500 mg IV Q 8H
A patient comes in with Zinplava on their PTA med list. What should you assume about this patient?
Zinplava = Bezlotoxumab
bind to toxin B and neutralizes its ADE in C.diff
Decreases the CDI recurrence but DOES NOT TREAT an active infection
Mark is having genital discharge. What may he possibly have?
Chlamydia or Gonorrhea
Both can be present with No symptoms as well
Justin presents to the clinic with a CC of having pink/skin toned lesions in the downstairs area. What may Justin possibly have?
Genital Warts
(HPV - check to see if patient needs the Gardasil vaccine. Imiquimod Cream - Aldara, Zyclara)
A patient asks if he could have latent syphilis even though he feel completely fine….
Yes, latent syphilis is usually asymptomatic. But Pen G should knock it right out.
Paul comes to the pharmacy and asks about some painless, genital sores that are smooth (Chancre). What may Paul have?
Primary Syphilis
Suzie Q comes in with a CC of vaginal discharge (clear, white-gray) that she says smells like “fish”.
There is no pain when she urinates
Suzie also has home vaginal pH strips and said that it was reading > 4.5
What could Suzie have?
Bacterial Vaginosis - DO NOT DOUCHE
Alli comes into the clinic presenting with soreness and pain while have sexual intercourse with her partner.
Upon further evaluation you also find out the Alli has been having a yellowish/ green discharge.
What is your initial diagnosis?
Trichomoniasis - Flagyl
Alli is diagnosed with trichomoniasis. You recommend Flagyl but the provider says “but the patient is pregnant”. What do you say?
While flagly is CI in the 1st trimester the R vs B is outweighed due to the effects the untreated infection can cause.
The CDC recommends flagyl in the treatment of trich in all trimesters.
A pregnant patient with a PCN allergy is diagnosed with syphilis… what can she not take doxycycline as an alternative?
Doxy = Teratogenic.
Can suppress bone growth and skeletal development
What is another name for Ring worm?
Tinea Corporis
What does Tinea Corporis present as?
- Fungal
- 1+ reddish raise rings
- can be itchy
TX: clotrimazole or another topical anti fungal
Tell me about Lyme disease (type, presentation, diagnosis, tx)
- Bacterial infection (borrelia)
- Bullseye rash (round and red), achy joints, fever
Diagnose: EIA to identify antibodies
TX: doxycycline 100 mg PO BID PO/IV
