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Clin Med > ID: diseases and treatments > Flashcards

ID: diseases and treatments Flashcards

1
Q

empiric ABX treatment for septic shock (harrisons table 15-5)

A

Vancomycin + a broad spectrum antipseudomonal B-lactam (piperacillin-tazobactam, imipenem, meropenem, or cefepime)

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2
Q

empiric ABX tx for Meningitis (harrisons table 15-5)

A

Vancomycin + ceftriaxone

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3
Q

Empiric ABX tx for CNS abscess (harrisons table 15-5)

A

Vancomycin + ceftriaxone + Metronidazole

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4
Q

Empiric ABX tx for acute endocarditis (harrisons table 15-5)

A

Vancomycin + Cefepime

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5
Q

Empiric tx for pneumoina–CAP, outpatient or inpatient NON ICU (harrisons table 15-5)

A

Azithromycin + respiratory fluoro (moxifloxacin, gemifloxacin or levofloxacin)

OR

B-lactam (cefotaxime, ceftriaxone or ampicillin-sulbactam) + azitrhomycin

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6
Q

Empiric tx for pneumonia for ICU inpatient (harrisons table 15-5)

A

B-lactam plus azitrhomycin or a respiratory fluoro

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7
Q

hosp aquired pneumonia empiric tx (harrisons table 15-5)

A 
Antipseudomonal b-lactam (cefepime, ceftazidime, imipenem, meropenem, piperacillin-tazobactam) 
\+ 
antipesudomonal fluroro (levofloxacin or ciprofloxacin) OR an aminoglycodise (amikacin, gentamicin, or tobramycin)
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8
Q

complicated intraabdominal infection empiric tx thats mild-moderate (harrisons table 15-5)

A

Cefoxitin
or
combination of: metronidazole + one of the following: cefazolin, cefuroxime, ceftriaxone, cefotaxime

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9
Q

empirix tx for high risk patient or high degree of severity for intraabdonial infection (harrisons table 15-5)

A 
Carbapenem 
or 
Piperacillin-tazobactam 
or
combination of metronidazole + either an antipseudomonal cephalosprin (cefepime, ceftazidime_ OR an antipseudomonal fluoro (ciprofloxacin, levofloxacin)
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10
Q

empiric tx for skin anf soft tissue infection

with and without MRSA

A 
Dicloxacillin PO
or 
cephalexin PO
or 
clindamycin PO
or 
Nafcillin/oxacilin

If possible MRSA:
clindamycin
vancomycin
linezolid

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11
Q 
MRSA 
po (4)
iv (4) 
**HA-MRSA 
**CA-MRSA
A

PO: doxycycline (CA-MRSA), clindamycin** second DOC (CA-MRSA), trimeothprim-sulfamethoxazole*** DOC for boards (CA-MRSA) or linezolid

IV: vancomycin (DOC for HA-MRSA) , ceftaroline, daptomycin or linezolid

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12
Q

sepsis

A

ID and remove cause of infection
PT MC will need ICU admission

  1. fluid resuscitation is priority in early mng—IV crystalloid at 30mL per kg w/in first three hours
  2. empiric ABX within one hour—- Piperacillin-tazobactam + vancomycin for adults
  3. vasopressors: if hypotensive after fluid resuscitation—–norepinephrine is DOC
  4. send blood cultures (draw b4 ABX tx)
  5. remove all existing caths, IV lines and central lines
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13
Q

scarlet fever

A

TX:

  1. PCN first line (po or im)
    * **Macrolide (azithromycin) or clindamycin if PCN allergic
  2. Amoxicillin

**kids can return to school 24 hrs after start of ABX

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14
Q

Diphtheria

  • tx
  • prophylaxis for close contact
  • prevention
A

TX:
1. Diphtheria antitoxin immunoglobulin (horse serum)—GIVEN PROMPTLY— most important***
DO NOT WAIT FOR CULTURES TO COME BACK—GIVE ANTITOXIN IMMEDIATELY

  1. Erythromycin IV or PCN IM x2 weeks–switched to PO when PT can tolerate
  2. PT needs to be placed in isolation room
  3. cardiac monitoring–serial EKGs

Prophylaxis:
1. erythromycin PO 7-10 days
OR
2. PCN G x1 dose

PREVENTION: 
1. DTaP sched: 5 doses given at 
2MO
4MO
6 MO
b/w 15-18MO 
b/w 4-6 Yrs

Tdap booster:
11-12 YO
pregnant mothers and those around them
10 year intervals after 11-22 yrs of age OR after any major injury if the last booster was 5 yrs ago or longer

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15
Q

tetanus

  • tx
  • prevention
A

TX:

  1. entry wound should be ID, cleaned and debrided of necrotic material
  2. IM Human tetanus immune globulin (TIG) EARLY ON
  3. Metronidazole DOC—alterntive is PCN
  4. Benzos like Diazepam for spasms
  5. IV mag has been shown to improve muscle spasm
  6. airway protection

Prevention:

  1. DtaP vaccine
    * 2MO
    * 4MO
    * 6MO
    * b/w 15-18 MO
    * b/w 4-6 TO
  2. Tdap booster
    * 11-12 YO
    * then every 10 yrs
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16
Q

Botulism

adult and infant

A

TX:

  1. Antitoxin first line tx
    * if >1 YO: equine-derived heptavalent antitoxin
    * if <1 YO: human-derived botulism immune globulin (BIG-IV)
  2. NO ABX for foodborne or infantile ****
  3. YES ABX for wound botulism
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17
Q

Clostridial Myonecrosis

A

TX

  1. IV ABX– PCN + Clindamycin (metronidazole and tetracycline for PCN allergic OR just clindamycin alone)
  2. emergent surgical debridement
  3. possible amputation
  4. hyperbaric O2 can improve survival
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18
Q

cholera

A

tx:
1. prompt and adequate water and electrolyte replacement
2. ABX: tetracyclines, fluoroquinolones or macrolides ​not really necessary but shorten the duration of s/s

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19
Q

Lyme Disease

  1. early disease
  2. late or severe
  3. prophylaxis
  4. pregnancy
A
  1. early dz
    *Doxycycline BID x 10-21 days for early localized
    *Doxycycline BID x 14-28 days for early disseminated
    Amoxicillin and Cefuroxime are alternative
    PREGNANT: Amoxicillin x 14-21 days
    can also use Azithromycin or Erythromycin
  2. Late or severe (heart block, syncope, dyspnea, CP, CNS symps)
    * IV Ceftriaxone
  3. Prophylaxis—given w/in first 72 hours of tick removal if tick present for >36 hours and in endemic area
    * Doxycycline 200mg X1 dose
    * if allergic to doxy or cannot be used, no prophylaxis given

DOXY IS CONTRA IN PREGNANCY

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20
Q

RMSF

*pregnant and not pregnant

A

TX:
Doxycycline DOC (even if under 8***)
Chloramphenicol is 2nd line and for pregnancy

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21
Q

Gonorrhea

Disseminated Gonococcal

A

Gonorrhea:

  1. Ceftriaxone 250 mg IM**** and Azithromycin 1gram PO once
  2. if suspected PID: ceftriaxone + doxycycline x1 week
  3. Partner is tx as well

Disseminated gonococcal infection:
1. IV Ceftriaxone

**condoms MAY limit transmissino

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22
Q

GC/Chlamydia

A

Ceftriaxone IM x1 dose
and
Doxycycline 100 mg BID x7 days

Boards love the combo question*

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23
Q

syphilis

A

PCN is DOC for all stages

  1. primary, secondary or early latent
    * **PCN G Benzathine IM one dose
    * *PCN allergic: Doxycycline (PO) or ceftriaxone (IM/IV)
  2. Late
    * **PCN G Benzathine IM once weekly x3 weeks
  3. neurosyphilis
    * **IV PCN G potassium x10-14 days
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24
Q

Jarish-Herxheimer rxn

A

self limited
resolves w/o intervention in 12-24 hours
+NSAIDS or anti-pyretics if needed

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25
Q

Chlamydia

A
  1. Azithromycin 1gm PO—– on “outside”
    OR
    Doxycycline 100mg BID x10 days—- on “inside” (PID, salpingitis)
  2. partner is tx too— no sex for 7 days after taking meds
  3. high risk PT–consider gonorrhea tx too
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26
Q

Lymphogranuloma Venereum (LGV)

A

Doxycycline 100mg BID x 21 days

27
Q

Trichomoniasis

A

TX:

  1. Metronidazole 2g PO once OR 500mg BID x7 days (best this route if recurrent)
  2. partner needs to be tx
  3. condoms MAY limit transmission
28
Q

prevention of congenital varicella syndrome

A

Prevention:

  1. Varicella Immune Globulin (VZIG) reduces severity of infection after exposure to VV in patients at high risk–which are:
    - Pregnnt women who lack evidence of immunity to VZV
    - newborns of mothers with varicella 5 days before to 2 days after delivery
    - premature infants at or greater than 28 weeks who are exposed and whose moms has no evidence of immunity
29
Q

congential syphilis

A

TX:

*IV PCN G X 10 days

30
Q

congenital HSV

A

TX:
*infected moms: given meds prior to birth and during birth
OR infant is delivered c-section

  • IV acyclovir x14 days followed by PO suppressive Acyclovir x6 MO
  • Topical ophthalmic solution added if needed
31
Q

zika virus prevention measures

A
  • men with exposure should wait at least 3 MO to have unprotected sex
  • women should wait at least 8 weeks after symptom onset or last possible exposure b4 unprotected sex
  • pregnant women should avoid or consider postponing travel to areas below 6500 ft where mosquito transmission is ongoing
32
Q

chicken pox
tx
prevention

A

TX:
1. health children <12 YO= supportive and sympto tx–tylenol and calamine lotion–NO NO NO NSAIDS it can cause superinfection

  1. Adults/adolescents >12, and immunocomp: Acylovir to help prevent complications— win 72 hrs of onset

PREVENTION:

  1. Varicella (VAR) vaccine: live attenuated
    * 1st dose=12-15MO
    * 2nd dose=4-6 YO
33
Q

shingles

  • tx
  • prevention
A

TX

  1. Acyclovir, Valacyclovir, famicilovir
    * **Valacyclovir used MC bc of the dosing
  2. Analgesics for pain–narcotics for serious cases
  3. can be transmited until all the lesions crust over

PRevention: the following are both good for 5 years

  1. recombinant vaccine (RVZ): adults >50 YO, 2 doses
    * **second dose is given 2-6 MO after first
  2. Zostavax: live attenuated vaccine–no longer in US
34
Q

infectious mononucleosis

A

TX:

  1. supportive measures–rest, analgesia
  2. increased risk of splenic rupture–>avoid contact sports*** for at least 3-4 weeks
35
Q

CMV

A

TX:

  1. primary dz for immunocompetnet= supportive
  2. tx for reactivation
    * Ganciclovir is first line and TOC
    * others: Foscarnet, Cidofovir, Valacyclovir
  3. HIV PT w/ CD4< 50 cell/uL–>Valganciclovir is given prophylactically
36
Q

roseola infantum HHV-6

A

TX:

  • supp
  • self limitng
37
Q

fifth’s dz or erythema infectiosum

A

TX:

  • Symptomatic
  • self limiting
38
Q

Measles (rubeola)
tx
prevention

A

tx:
1. supportive care
2. superinfection preventions
* Vit A high doses
* ribavirin–in cases of pneumonia
* Mealses immune globulin (if high risk PT)

Prevention 
MMR vaccine-- live attenuated 
2 doses 
1st: 12-15 MO 
2nd: 4-6YO
39
Q

Rubella or german measles

  • tx
  • prev
A

TX:

  • supportive
  • Prognosis: not assoc with complications in children (compared to rubeola)
  • BUT it is teratogenic in first trimester

Prevention: MMR

1st: 12-15MO
2nd: 4-6 YO

40
Q

rabies post-exposure tx

A

EXPOSURE:

  1. first episode: Rabies vaccine AND rabies Immune Globulin (RIG)
    * vaccine—if healthy: days 0, 3, 7, 14, (add 5th dose, day 28 if immunocomp*
    * RIG—-half direclty into the wound and surrounding areas… other 1/2 IM distal frm wound
  2. second exposure or more: vaccine alone on days 0 and 3–NO immunoglobulin
41
Q

influenza

  • tx
  • prevention
A

TX: given w/in 48 hours of onset of s/s
**mostly supportive but can give antivirals
THREE DRUGS FDA APPROVED FOR A and B:
1. Oseltamivir (tamiflu) PO ** DOC for anyone even pregnant/elderly/hospitallized/complicated infections
2. Zanamivir–inhaled nose
3. Peramivir–IV

M2 inhibitors: given within 48 hours of onset of s/s

  1. Amantadine***
  2. Rimantadine
    * **act only against influenza A
    * *high resistance to these drugs—not recc for tx or prophylaxis

Prevention
1. chemoprophylaxis–>antivirals if contact with infected
2. Influenza vaccine–ANNUALLY for everyone >6MO who dont have contraindications
**contains both A and B strains
**two types avail in US:
A) inactivated vaccine–70% efficiacy
B) A live, attenuated vaccine–recc for kids with 90% efficacy, 85% in adults, given intranasally–NEVER GIVE TO PREGNANT OR IMMUNOCOMP

42
Q

genital warts

A

TX:

  1. antivirals: Acyclovir, valacyclovir or famciclovir
  2. first episode: PO acyclovir (5x/day) or valacyclovir (BID)
  3. recurrent: PO acyclovir (TID) and valacyclovir (BID)
    * *can also give the antivirals daily for suppression
43
Q

HPV tx and prevention

A

TX:
1. wart removal–cryoablation with liquid nitrogen, topical Imiquimod and Podofilox are PT applied at home vs Podophyllin, Bichloroacetic acid and Trichloroacetic acid are clinical applied

  1. prevention:
    *Gardasil 9–> first dose age 1–12 and 2nd dose 6-12 MO later
    *if starting after age 15: then 3 doses is reccomended
    DO NOT GIVE TO PREGNANT OR BF MOMS
44
Q

TX HIV

  • list the MC classes
  • regimen for newly diganosed?
  • post-exposure prophylaxis
  • pre-exposure prohyplaxis
A

Antiretroviral therapy for ALL patients

  • *highly active retroviral therapy (HAART) is mainstay in US
  • *over 26 drugs
  • *6 major classes

MC ones are:

  1. Nucleoside Reverse Transcriptase Inhibitor (NRTI)
  2. Non-nucleoside reverse transcriptase inhibitor (NNRTI)
  3. Integrase strand transfer inhibitor (INSTI)
  4. Protease inhibitor

Regimens for newly diagnose PT:
*2 different NRTIs + INSTI

POST-EXP Prophylaxis:
1. within 72 hours of exposure–3 drug regimen x28 days

PRE-EXP Prophylaxis:

  1. reduce the risk in uninfected high-risk individuals
    * 2 drug regimen
45
Q

Pneumocytis (PCP) in HIV PT

-prophylaxis?

A

Bactrim DS

if CD4 <100 give fluconazole for prophylaxis

46
Q

Histoplasmosis (if living in edemic area) in HIV PT

A

Itraconazole

47
Q

Toxoplasmosis if HIV PT

A

Bactrim DS

48
Q

Crptococcus in HIV PT

A

Fluconazole

49
Q

Mycobacterium Avian Complex in HIV pT

A

Azithromycin or Clarithromycin

50
Q

CMV retinitis in HIV PT

A

Valganciclovir

51
Q

first line tx for uncomplicated P. falciparum malaria

  • alternative?
  • add on agent to kill latent species to prevent recurrence
A

Chloroquine

Hydroxychloroquine is alternative

Add on: Primaquine

52
Q

TX for chloroquine-resistant P. Falciparum

1st and 2nd line

A

first line: Atovaquone/Proguanil or Artemisinin combination therapy

second: doxycycline, tetracycine, or clindamycin PLUS quinine sulfate

53
Q

prophylaxis for malaria if traveling

A

Chloroquine or hydroxychloroquine for the chloroquine sensitive areas

chloroquine resistant areas: doxycycline, mefloquine or atovaquone-proguanil

54
Q

chagas DZ

A

acute phase or PT without significant cardiac or GI disease:
*****benznidazole or Nifurtimox for 90-120 days

No treatment for chronic form with signiicant cardiac or GI dz

55
Q

african sleeping sickness

A

Trypanosoma brucei gambiense

  • early=Pentamidine
  • late=Eflornithine and Nifurtimox

Trypanosoma brucei rhodesiense

  • early= Suramin
  • late=Melarsoprol +/- Nifurtimox
56
Q

toxoplasmosis

  • tx
  • prophylaxis
A

tx:
1. Sulfadiazine or clindamycin PLUS Pyrimethamine
* *add folic acid/leucovorin to prevent depletion

  1. if pregnant: spiramycin

Prophylaxis: for PT with CD4 <100

  1. Trimethoprim-sulfamethoaxazole (Bactrim DS)
  2. Alternative: Dapson + Pyrimethamine & Leucovorin
57
Q

Ascariasis

-preg and not preg

A

TX:

  1. albendazole or Mebendazole
  2. pregnant: pyrantel (only after 1st trimester)
58
Q

hookworm

A

TX:

  1. ***Albendazole or Mebendazole or Pyranetel
  2. iron supplements and vitamins
59
Q

tx for candida–DOC?

  • oral thrush?
  • vaginitis
  • chronic mucocutaneous candidiasis
A

DOC=fluconazole

  • oral thrush— nystatin swish and swallow
  • vaginitis– azole drugs– po fluconazole or topical clotrimazole or minoconazole
  • CMC: fluconazole or itraconazole
  • disseminated candidiasis: fluconazole or capsofungin
60
Q

Leprosy

-both kinds

A

tx:
* lepromatous: dapsone, rifampin, clofazimine x2-3 years
* tuberculoid: dapsone + rifampin 6-12MO and then dapsone for 2 years

61
Q

MAC

A

TX:

  • *very drug resistant and usually includes MANY (up to 6) drugs for tx
    1. Clarithromycin + Ethambutol + a Rifamycin (rifampin or rifabutin)
    2. add aminoglycoside to tx if it is a life threatening case
    3. SECOND LINE: ethambutol + rifamycin + Aminoglycoside

Prophylaxis if CD4 <50
*Clarithromycin or Azithromycin

62
Q

latent tb
HIV pt
non HIV

A

INH and Pyridoxine x 9 mo

HIV= same drugs but for 12 MO

63
Q

Active TB

A 
R
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P
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(S)

Clin Med (52 decks)

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