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Med > Infectious-Miscellaneous > Flashcards

Infectious-Miscellaneous Flashcards

1
Q

Allergic Rhinitis

Two indications for intranasal Ipratropium

A
  1. Skiers’ Nose= Vasomotor Rhinitis
  2. Allergic rhinitis with severe rinorhea
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2
Q

Allergic Rhinitis

Recommended Tx for moderate to severe cases:

A

Intranasal Chromolyn

Or Intranasal CS like Beclomethasone

(CS is stronger than Chromolyn)

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3
Q

Allergic Rhinitis

Safety of Antihistamines in children

A

Above 6 yo is ok

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4
Q

Allergic Rhinitis

Safety of Decongestants in Children

A

Above 12 yo is ok

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5
Q

Allergic Rhinitis

Safety of Decongestants like Pseudoephedrine op Phenylephrine In Pregnancy?

A

1st trimester: not safe

Then: safe

(Note: H1 blockers are safe in Pregnancy)

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6
Q

Allergic Rhinitis

Decongestants like Pseudoephedrine or Phenylephrine: CIs:

  • HTN - MI - Hyperthyroidism - ……..?
A

With MAOIs

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7
Q

Acute Bronchitis

Dextromethorphan safety:

  1. In Pregnancy?
  2. In children?
A
  1. Safe
  2. Above 6 yo is ok
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8
Q

Influenza Vaccine is recommended to 4 groups:

  1. Everybody with systemic disease like DM
  2. Everybody above …… yo of age.
  3. All pregnant women.
  4. In children ?
A
  1. Above 65 yo
  2. From 6 months to 5 yo
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9
Q

Influenza

What if someone is egg allergic? (Vaccination)

A

No live vaccine.

but Inactive is safe.

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10
Q

Influenza

Amantadine in prophylaxis?

A

Not recommended any more.

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11
Q

Influenza Vaccines:

  1. Flu shot: TIV and QIV (Inactive) which is IM
    - in Pregnancy?
    - which age groups?
A
  • Pregnancy: ok
  • Above 6 months is ok to everyone
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12
Q

Influenza Vaccines:

  1. Flumist (LAIV): Nasal Spray (Live virus)
    - in Pregnancy?
    - which age groups?
A
  • Pregnancy: No
  • Age: Only between 2-60 yo
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13
Q

Influenza Vaccines

Which one is safe in Breastfeeding?

A

Both are safe in Breastfeeding

But no Flumist in Pregnancy.

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14
Q

Influenza

Tx 1st line ?

Duration ?

A

Oseltamivir (Tamiflu) Start early, duration is 5 days

but it is NOT a routine Tx

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15
Q

Influenza Tx

Why is Zanamivir 2nd line?

A

It may cause bronchospasm

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16
Q

Influenza Tx

Safety in Pregnancy and Breastfeeding

  • Oseltamivir
  • Zanamivir
A

Both are safe

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17
Q

Influenza Vaccines In Children:

  • below 6 months: No Vaccines
  • 6 months to 2 yo: ?
  • above 2 yo: ?
A

6 mon- 2 yo: IM (inactive) is ok

Above 2 yo: both types are ok

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18
Q

Strep Sore Throat

Initial test is RADT (Rapid Ag Detection Test) which takes up to 1 hour to respond. If (+) then?

A

Tx with ABs

because it is highly Specific for Strep Group A.

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19
Q

Strep Sore Throat

Initial test is RADT (Rapid Ag Detection Test) which takes up to 1 hour to respond. If (-) then?

A

In Children: Do Throat Culture and wait 48 h for the result. If (+) then AB, if (-) no AB

In Adults: No need for Culture.

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20
Q

Strep Sore Throat

If we do not immediately start the Tx with ABs in a Strep pharyngitis, what about the risk of RF in children?

A

Usually, up to 7-10 days of delay is safe. Therefore, a culture (48h) has no risk at all.

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21
Q

Strep Sore Throat

Initial test is RADT, but what if RADT is not available in the area we work?

A

All ages: Do a throat culture and wait for 48h.

48 h is not a risky delay. Do not prescribe ABs without RADT and Culture.

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22
Q

Strep Sore Throat How many percent of sore throats is caused by Strep beta hemolytic group A?

A

In Children: 30%

In Adults: 10%

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23
Q

Strep Sore Throat

Is RADT able to diagnose acute disease from Carriers?

A

No, Both will be (+)

Note: we do NOT need to repeat RADT after AB therapy to make sure of eradication.

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24
Q

Strep Sore Throat

Nonpharma Tx:

  1. Hand washing
  2. School?
A

Do not go to school until 24 h After starting the AB therapy.

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25
Q

Strep Sore Throat

1st line treatment:

A

Penicillin V Oral

Or Amoxicillin Oral (Syrup)

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26
Q

Strep Sore Throat

If allergic to Penicillin?

A

Mild allergy: Cephalexin

Severe allergy: Azithromycin or Clindamycin

(No Erythromycin because of GI SEs)

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27
Q

Antibiotics

Safety of Erythromycin in Pregnancy?

A

Do not use Estolate salt.

It may cause Cholestatic Hepatitis.

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28
Q

Sinusitis

1st line Tx in Canada

A

Amoxicillin

7-14 days in Adults

10-14 days in Children

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29
Q

Sinusitis

If 1st line treatment with Amoxicillin fails?

A

Amoxicillin-Clavulanate

but If intolerant to Amoxicillin: Then Fluoroquinolone (No Macrolide)

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30
Q

Sinusitis

Tx if allergic to Penicillin?

A

If <8 yo Clindamycin + Cefixime

If >8 yo Doxycycline

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31
Q

Sinusitis

If chronic (>12 weeks), DOC ?

A

Amoxicillin-Clavulanate for 3w

Or Clindamycin for 3w

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32
Q

Sinusitis

If the patient has received an AB within the last 3 months, then ?

A

Pick from another class of ABs

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33
Q

Sinusitis

Indications for HD dosing of Amoxicillin

  1. Children who go to daycare
  2. …………… 3. ……………
A
  1. Children < 2yo
  2. ABs within the last 3 months
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34
Q

AOM

1st line Tx in Canada is Amoxicillin

SD= Standard Dose= …….. mg/kg/day

HD= High Dose= …….mg/kg/day

A

SD: 40 mg/kg/day

HD: 75-90 mg/kg/day

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35
Q

AOM

Duration of Tx in Canada in Children?

A

Age < 2yo: 10 days

Age > 2yo: 5 days

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36
Q

AOM

If the child is < 6 weeks old?

A

Do not treat

Refer ASAP to ER for Sepsis workup

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37
Q

AOM

If the child is between 6w to 6 months old?

A

Tx: HD Amoxicillin (or maybe SD) For 10 days

If failure: HD Amoxicillin-Clavulanate

(Only the Amoxicillin part should be HD)

No watchful waiting below 6 months old

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38
Q

AOM

If the child is above 6 months old?

A

Tx: HD Amoxicillin (or maybe SD) For 10 days (If above 2 yo, 5 days)

If failure: HD Amoxicillin-Clavulanate

(Only the Amoxicillin part should be HD)

Consider watchful waiting in some cases

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39
Q

AOM

When would you consider a watchful waiting in Children ?

  1. Age …………..
  2. No complications, No underlying disease
  3. Parents are trustworthy
A

Age above 6 months

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40
Q

AOM

Indications for 2nd line Tx (HD Amoxicillin-Clavulanate):

  1. Failure of Amoxicillin (HD or SD)
  2. …………
A

Recurrent episodes of AOM (Also consider referring)

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41
Q

AOM

Tx if allergic to Penicillin

A

If mild: Cefixime or Cefuroxime

If severe: Azithromycin

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42
Q

Croup (Laryngo-tracheo-bronchitis)

Caused by Parainfluenza type 1,3

1st line Tx?

A

Dexamethasone Single dose, PO

(Oral is Preferred, but IM or IV is also Ok)

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43
Q

Croup

Oxygen therapy

  1. Preferably ……….
  2. Avoid ………
A

Preferably “Blow-by” Oxygen To be held in front of mouth and nose, while sitting on mother’s lap

Avoid mist tents (Increases Agitation)

Heliox might be helpful as well.

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44
Q

Croup

Tx if the child is very ill

or not responding to oral Dexamethasone

or vomiting

A

Nebulized Budenoside

+|- Nebulized Epinephrine

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45
Q

Croup

About Epinephrine:

  1. It is not a 1st line or routine Tx.
  2. It is L-Epinephrine 1:1,000
  3. Racemate is no longer available in Canada
  4. It lasts for ……
A

2 hours

Dose is 5 ml, independent of wt or age.

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46
Q

Pneumonia

Severity and risk of death: CURB65

C. new Confusion

U. Urea above ……

R. RR above ……

B. BP: SBP < 90, DBP < 60

A

Urea above 7

RR above 30

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47
Q

Pneumonia

Respiratory Quinolones 1. ? 2. ?

A
  1. Moxifloxacin
  2. Levofloxacin

ML: MaLe

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48
Q

Pneumonia

DOC if Strep Pneumoniae (Pneumococcus)

A

MIC to Penicillin:

If <2, Penicillin G or Amoxicillin

If >2, Cephalo 3rd or Resp Quinolone

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49
Q

Pneumonia

DOC if Hemophilus

A

Cephalo 3rd

or Amoxicillin-Clavulanate

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50
Q

Pneumonia

DOC if Staphylococcus

A

MSSA: Cloxacillin

MRSA: Vancomycin or Linezolide

(No Daptomycin or Tigecycline)

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51
Q

Pneumonia

DOC if Legionella

A

Macrolide or Resp Quinolone

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52
Q

Pneumonia

DOC if Mycoplasma or Chlamydia

A

Macrolide

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53
Q

Pneumonia

DOC if Q Fever (Coxiella Brunetti)

A

Resp Quinolone

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54
Q

Pneumonia

DOC if Gram negative aerobic (Like Klebsiella)

A

Cephalo 3rd

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55
Q

Pneumonia

Duration of Tx in CAP

A

If outpatient and good condition: 5 days

Otherwise: 10 days

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56
Q

Pneumonia

Tx If aspiration happens:

Pneumonitis: ……..

Pneumonia: ………

A

Pneumonitis: no AB

Pneumonia: Metronidazole or Clindamycin

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57
Q

Pneumococcal Vaccines

  • 23 Valent (Capsular, Polysaccharide)
  • 13 Valent (Conjugated)

Which one is used in HIV+ and in Infants?

A

13V: infants and HIV+

23V: children above 2 yo and adults >65 yo

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58
Q

Antibiotics

SEs of Linezolide

  1. Myelosuppression 2……..
A

Serotonin Sd with SSRIs

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59
Q

Pneumonia

Criteria for the day of discharge:

  1. SaO2> 92%
  2. RR ……. 3. HR …….
A

RR <24

HR <100

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60
Q

TB Mantoux test (PPD)

CIs:

  • Proven active TB
  • Eczema or burns (if severe)
  • ……….
A

Live viral vaccine in past 1 month (Like MMR)

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61
Q

TB

Hepatotoxic medications: PYR, INH, RIF

Definition of hepatotoxicity

  1. If asymptomatic: LFT x5 NL
  2. …….
A

If symptomatic, LFT x3 NL

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62
Q

TB Indications for CS:

  1. TB Meningitis
  2. TB Pericarditis
  3. ……..
A

IRIS in AIDS (Immune Reconstitution Inflammatory Sd)

If antiretrovirals are used with anti TBs at the same time, Fever+ malaise + local reactions

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63
Q

Diabetic Foot

DOC if infection is localized

A

Amoxicillin-Clavulanate Oral

Or Cephalexin oral

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64
Q

Diabetic Foot

DOC if infection is extensive

A

If oral: Amoxicillin-Clavulanate or Ciprofloxacin

If IV is needed: Cephalosporin + Metronidazole

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65
Q

Osteomyelitis

Empiric Tx in Neonates?

A

Cloxacillin + Cefotaxime

Or Vancomycin + Cefotaxime

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66
Q

Osteomyelitis

Empiric Tx in Children

A

Either Cloxacillin or Vancomycin

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67
Q

Osteomyelitis

Empiric Tx in adults?

A

Cloxacillin

Note: Cloxacillin can be replaced by Cefazolin

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68
Q

Osteomyelitis

Duration and route of AB therapy

A

Usually 4-6 weeks

Usually 2w IV then switch to oral

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69
Q

Bacterial Meningitis

1st line Tx In Adults

A

Vancomycin + Ceftriaxone 10-14 days

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70
Q

Bacterial meningitis

Tx in Children If > 3 months?

A

Like adults:

Vancomycin + Ceftriaxone 10-14 days

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71
Q

Bacterial meningitis

Tx in Children

  1. If between 6w to 3 months
  2. If below 6w
A

6w-3mon Ampicillin+Vancomycin+Ceftriaxone/Cefotaxime

< 6w Ampicillin + Cefotaxime

(For Listeria, GBS, Enterobacteriacea : 21 days)

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72
Q

Bacterial meningitis Tx in Adults if above 50

A

Ampicillin + Vancomycin + Ceftriaxone

(Note: the same Tx is used for alcoholics)

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73
Q

Bacterial meningitis

Use of CS:

  1. Decreases risk of neurological sequels
  2. DOC is Dexamethasone
  3. ………
A

It must be used either before the first dose of AB or together with the first dose.

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74
Q

Bacterial meningitis

Post-exposure Tx for Hemophilus:

  1. DOC is Rifampin
  2. Dosage is 20 mg/kg ………….
  3. Prophylaxis in Pregnancy ?
A
  1. Once daily for 4 days
  2. Not recommended.
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75
Q

Bacterial meningitis

Post-exposure Tx for Meningococcus:

  1. DOC is Rifampin
  2. Dosage is 20 mg/kg ………….
  3. Prophylaxis in Pregnancy ?
A
  1. Once daily for 2 days
  2. Single dose of Ceftriaxone
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76
Q

Infective Endocarditis

DOC if Staphylococcus on NL valve

A

MSSA: Cloxacillin

MRSA: Vancomycin

77
Q

Infective Endocarditis

DOC if Staphylococcus on Prosthetic valve

A

Add (Rifampin + Gentamicin) To Cloxacillin

or to Vancomycin

78
Q

Infective Endocarditis

DOC if Streptococcus (any type, any valve)

A

Vancomycin

79
Q

Infective Endocarditis

DOC if Enterococcus

  1. All sensitive
  2. Penicillin resistant
  3. Gentamicin resistant
  4. All resistant
A

1,2 Vancomycin + Gentamicin

3 Vancomycin + Streptomycin

4 Linezolide or Imipenem

80
Q

Infective Endocarditis

DOC if HACEK

A

Ceftriaxone or Cefepime

81
Q

Infective Endocarditis

DOC in Prophylaxis

A

Amoxicillin 2 g Oral

Or Ampicillin 2 g IV or IM

82
Q

Infective Endocarditis

DOC in Prophylaxis If allergic to Penicillin

A

Cephalexin 2 g PO

Or Cefazolin 1 g IV or IM

83
Q

Sepsis, Septic Shock

  1. Do not use bicarbonate, unless ……
  2. The best vasoactive is …….
A

PH < 7.15

NE (Neurepinephrine)

84
Q

Sepsis, Septic Shock

Empiric AB if the source of infection is

  • Unknown - Nosocomial - GI or GUT
A

All: Meropenem

85
Q

Febrile Neutropenia

DOC If Inpatient?

If possibly outpatient?

A

In: Meropenem or Ceftazidime

Out: Amoxicillin-Clavulanate + Ciprofloxacin

86
Q

Traveller’s Diarrhea Nonpharma Tx:

  • Na+ Hypochlorite, filters, iodine are good
  • Alcohol is not disinfectant for water
  • No ABs for prophylaxis is needed
  • Boil it, cook it, ……….
A

Peel it or forget it!

87
Q

Traveller’s Diarrhea

BSS: Bismuth Sub Salicylate is a good choice, but caution:

  1. Do not use if taking Warfarin
  2. ……….
A

Do not use if taking Salicylates Or in Children < 3 yo Risk of Rey’s Sd or Encephalopathy

88
Q

Traveller’s Diarrhea

AB therapy?

A

Is not always needed

If needed: DOC is Quinolone

89
Q

Traveller’s Diarrhea

Tx in Children

  1. AB ?
  2. Loperamide?
A
  1. Quinolones are CI, use Azithromycin
  2. Loperamide is CI below 3 yo
90
Q

Traveller’s Diarrhea

Tx in Pregnancy

  1. AB?
  2. BSS, Loperamide ?
  3. Iodine ?
A
  1. Quinolones are CI, use Azithromycin
  2. BSS is CI, Loperamide is ok.
  3. Iodine is CI
91
Q

Traveller’s Diarrhea

How to prepare an ORS by ourselves?

A

5 mL salt + 30 mL sugar In 1 Liter of water

92
Q

HIV

  1. All patients should take an allergy test to ………
  2. All patients are recommended to take a tropism test for ………
A
  1. Abacavir (NRTI)
  2. Maraviroc (Entry Inhibitor)
93
Q

HIV

Vaccinations in AIDS:

Pneumococcal: Yes

Influenza: Yes

MMR? Varicella?

A

MMR, Varicella: Yes, as long as CD4 is above 200

94
Q

HIV

Protease Inhibitors SEs in general:

  1. Enzyme Inhibitors
  2. ………….
A

Hyperglycemia

Hyperlipidemia

95
Q

HIV

Common SEs of NRTIs in general:

  1. BM Suppression 2………. 3. Lactic acidosis
A

Peripheral Neuropathy

96
Q

HIV

NNRTIs general SEs

  1. Rash 2……..
A

Hepatitis

97
Q

HIV

Tenofovir (NtRTI) is infamous for?

A

Osteoporosis

98
Q

HIV

  • Indinavir (PI) is infamous for renal stones.
  • Didanosine (NRTI) is infamous for: 1. Pancreatitis 2……….
A

Gout

99
Q

HIV

Efavirenz (NNRTI) is infamous for 1. Teratogenicity 2…………

A

CNS toxicity

Psychiatric SEs

100
Q

HIV In Pregnancy:

  1. Start Tx at week …….
  2. Efavirenz is CI
  3. Cesarean?
A
  1. 14th
  2. Only if CD4 is low or Viral load is high
101
Q

HIV with Breastfeeding?

A

Breastfeeding is CI in HIV

102
Q

HIV After a needle stick?

A

4 weeks Three medications

Usually: Zidovudine + Lamivudine + Nelfinavir

103
Q

HIV

Etravirine (NNRTI) is infamous for ………

A

SJS

104
Q

HIV

Nevirapine (NNRTI) is infamous for ………

A

Hepatotoxicity

105
Q

HIV

Atazanavir (PI) Is infamous for ………

A

Increased Bil

Renal stones

106
Q

HIV

Darunavir (PI) is infamous for ………

A

Hepatotoxicity

107
Q

HIV

Fosamprenavir (PI) is infamous for ………

A

Cardiovascular risks

108
Q

HIV There is an exception in which you should not do CART with specific treatment of the opportunistic infection at the same time.

A

Cryptococcal Meningitis

109
Q

HIV There are two opportunistic infections that we don’t recommend prophylaxis

A
  1. Cryptococcal
  2. CMV
110
Q

HIV

Indication of Prophylaxis for:

  1. PCP?
  2. Toxoplasmosis?
  3. MAI?
A

CD4 <200

<100

<50

111
Q

HIV

DOC in Prophylaxis for PCP?

For Toxoplasmosis?

A

Both: SMX/TMP

112
Q

HIV

DOC in Prophylaxis of MAI?

A

Azithromycin 1 dose/week

113
Q

HIV

DOC in Prophylaxis of Candidiasis?

A

Fluconazole

114
Q

HIV

DOC in Tx of Bartonellosis

A

Doxycycline

115
Q

HIV

DOC in Tx of Cryptococcal meningitis

A

Amphotericin B +/- Flucytosin

Then Fluconazole as maintenance

116
Q

HIV

DOC in Tx of CMV infection

A

Valgancyclovir

117
Q

HIV

DOC in Tx of Candidiasis

  • Oral: Nystatin
  • Vaginal: Clotrimazole cream or tablet
  • Systemic?
A

Either Fluconazole PO or Amphotericin B IV

118
Q

HIV

DOC in Tx of Intestinal infections: Cryptosporidium?

A

Paromomycin + Nitazoxanide

119
Q

HIV

DOC in Tx of Intestinal infections:

  1. Cyclospora 2. Isospora 3. Microspora
A

1,2 SMX/TMP

  1. Albendazole
120
Q

HIV

DOC in Tx of MAI

A

Thriple: Clarythromycin + Ethambutol +/- Rifabutin

121
Q

HIV

DOC in Tx of PCP:

SMX/TMP for 21 days +|- ………………..

A

Penthamidine IV

or Prednisone PO (If PO2<70)

122
Q

HIV

DOC in Tx of Toxoplasmosis (New)

A

SMX/TMP high dose PO or IV

Old Tx was: Pyrimethamine+Sulfadiazine+Leukovorin

123
Q

Herpes Infections:

Tx is Acyclovir, if mild to moderate: PO, but if severe: IV

  1. G.Stomatitis in children
  2. Anogenital
  3. Proctitis
  4. ………
A

Eczema Herpeticom

(Eczema + Fever + LAP)

124
Q

Herpes Infections

DOC in Cold Sore (Recurrent orolabial)

A

Oral Acyclovir (Not topical)

125
Q

Herpes Infections in CNS:

  1. Encephalitis: Emergency, Acyclovir IV
  2. Aseptic meningitis: ………….
A

HSV2, usually recurring Tx: Valacyclovir (1w)

126
Q

Herpes Infections

Keratoconjunctivitis, DOC

A

Topical Trifluridine

127
Q

Herpes Infections

Shingles: -Topical AB? -Topical Acyclovir?

A

Both: No

DOC: Oral Acyclovir

128
Q

UTI in Pregnancy:

  • Routine screening: ………..

DOC: Amoxicillin or Cephalexin or ……….

A

Week 12-16

Nitrofurantoin

129
Q

UTI

DOC for Pyelonephritis in Pregnancy?

A

Ceftriaxone

130
Q

UTI in Pregnancy, safe or not?

SMX/TMP? Quinolones?

A

S: not 1st trimester, not after week 32

Q: not safe

131
Q

UTI Cystitis (Uncomplicated UTI)

  1. DOC (2)
  2. If sulfa allergic (2)
A
  1. SMX/TMP for 3 days Or Fosfomycin 3 g Single dose
  2. TMP 3 days or Nitrofurantoin 5 days
132
Q

UTI

DOC for Pyelonephritis or complicated UTI (in anatomical or functional abnormalities)

A

Mild to moderate: Quinolones PO 7-14 days

Severe: Aminoglycoside IV +|- Ampicillin IV

133
Q

UTI

Acute Prostatitis DOC

A

AG IV +|- Ampicillin IV +|- Cloxacillin IV

134
Q

UTI

Chronic Prostititis DOC

A

Quinolones PO 4-6 weeks

135
Q

STI

Tx for partners:

In Chlamydia, Gonorhea, PID, LGV ?

A

All partners within last 60 days:

Tx + No Sex for 1 week

136
Q

STI Tx for partners:

In Trichomonas, Vaginosis, Candidiasis?

A

V,C: not needed

Trichomonas: Only current partner:

AB + Avoid sex until the end of Tx

137
Q

STI

DOC for LGV

A

Azithromycin for 3w

138
Q

STI

Chlamydia and Gonorhea, DOC

A

C: Azithromycin single dose

G: Ceftriaxone single dose

(Both: ok in Pregnancy)

139
Q

STI

PID, DOC

  1. If outpatient? 2. If inpatient?
A

Out: Quinolone + Metronidazole PO

In: Quinolone + Metronidazole IV

140
Q

STI Genital warts (HPV), Tx, safety in Pregnancy:

  1. Imiquimod
  2. Podophyline, Podophylotoxin
  3. DCA, TCA
  4. Cryo, Laser
A

Non Pregnant: all ok Pregnant: 1,2 no, 3,4 ok

141
Q

Antibiotics

Metronidazole safety In Pregnancy and Breastfeeding?

A

Pregnancy: safe

Breastfeeding: ok, but 24 h interval to Breastfeeding

142
Q

Antibiotics

Safety in Pregnancy

  • Vaginal Clindamycin cream?
A

Not safe

143
Q

Malaria Nonpharma:

  1. Insect repellents containing DEET
  2. Use bed nets, impregnated with Permethrin
  3. ………..
A

Use insecticide generators containing pyrethroids.

144
Q

Malaria

Areas that are still chloroquine sensitive

A

Central America [except Panama], Haiti and parts of the Dominican Republic and Middle East

145
Q

Malaria

Two CIs for Chloroquine 1. ? 2. ?

A
  1. Epilepsy 2. Psoriasis
146
Q

Malaria Duration of Tx:

1- For Chloroquine, Mefloquine ?

2- For Doxycycline, Atovaquone/P, Primaquine ?

A

1: 1 dose/week, start 1-2w before trip, until 4w after returning
2: 1 dose/day, start 1-2 days before trip, until 1-4w after returning

147
Q

Malaria

DOC if Chloroquine resistant and no CIs:

In order of preference:

  1. Mefloquine 2. Doxycycline 3………..
A

Atovaquon/P

148
Q

Malaria Mefloquine limitations:

  1. Resistance in Thailand, Cambodia, Vietnam
  2. ?
A

SEs: Serious Neurological and Psychiatric

149
Q

Malaria

Doxycycline is a good choice after Mefloquine. What are the limitations?

  1. CI in Pregnancy and Children <8yo
  2. Photosensitivity
  3. ……………
A

Usage is daily

150
Q

Malaria

Atovaquone/Proguanil is another alternative for Mefloquine. Specially in last minute trips.

Limitations: 1. Daily usage 2. ?

A

CI in Pregnancy and Breastfeeding

151
Q

Malaria

When would you consider Primaquine for Prophylaxis?

  1. Last line alternative for Mefloquine
  2. ……..
A

Central and south America for dormant form of P.Vivax in liver Called: PART: Presumptive Anti-relapse therapy

152
Q

Malaria

Limitations of Primaquine

  1. Not 1st or 2nd choice
  2. CI in Pregnancy
  3. ………..
A

Risk of hemolysis in Favism

153
Q

Malaria Prevention

In Pregnancy, Nonpharma is more important. Medications safety?

A

Safe: Chloroquine and Mefloquine

Unsafe: the rest of medications (The same for breastfeeding)

154
Q

Thermoregulatory

Heat Cramps (Mild form) is usually caused by dilutional hypernatremia after exercise

Tx?

A

Rest

+ Oral rehydration (5 ml salt in 500 ml water)

155
Q

Thermoregulatory

Heat Exhaustion (Moderate form) is usually caused by loss of water and salt, Core body temp is 37-40

Tx?

A

Rest + Rehydration (IV)

+ External cooling (fans, ice packs)

156
Q

Thermoregulatory

Heat Stroke (Severe form) is usually associated with Core body temp > 40.6 and may result in DIC, ARF, Seizures, Neurological damage.

Tx?

A

ABC + Rehydration (IV)

+ Rapid cooling (fan evaporation, ice packs, tepid water sponging)

No cold water immersion!

157
Q

Thermoregulatory

DOC for

NMS Vs Malignant Hyperthermia

A

NMS: Bromocriptine PO

MH: Dantrolene IV

158
Q

Thermoregulatory

Three Rewarming ways:

Passive External Vs Active External Vs Active Core

A

PE: Ordinary blankets + removing wet clothes

AE: Warming blanket or Warm water immersion

AC: Warmed IV NS (40-45) or Peritoneal lavage or heated cardiopulmonary bypass

159
Q

Chemotherapy SEs

If VTE, Tx ?

If “Chemo Fog”, Tx ?

A

LMWH (Not Warfarin)

Ritalin or Modafinil

160
Q

Chemotherapy SEs

If extravasation: generally, cold compress

If with Antracyclines: ………………..

If with Meclorthamin: ……………….

A

A: DMSO or Dexrazoxane

M: Sodium Thiosulfate

161
Q

Chemotherapy SEs

In hand foot reaction,

Prophylaxis?

Tx?

A

P: Vit B6

Tx: Emolients like Bag Balm

162
Q

Chemotherapy SEs

Rash with EGFR inhibitors, Tx ?

A

Topical Clindamycin or CS

or if severe: Oral Tetracycline

163
Q

Chemotherapy SEs

Hemorrhagic Cystitis with Cyclophosphamide

Prophylaxis and Tx

A

P: Mesna + Diuresis

T: Tranexamic Acid

164
Q

Radiotherapy SEs

Proctitis ? Esophagitis?

A

P: Topical CS

E: Topical Lidocaine

165
Q

Radiotherapy SEs

Xerostomy?

Pneumonitis?

A

X: Pilocarpine

P: Prednisone

166
Q

CINV

DOC 1st and 2nd?

A
  1. Ondansetron +/- Dexamethasone
  2. Aprepitant +/- Dexamethasone
167
Q

CINV

DOC in Anticipatory Nausea?

A

BZPs: Lorazepam or Alprazolam

168
Q

CINV

Alternative Tx (other than 5HT, NK1, CS) ?

A

Dopamine antagonists:

Prochlorperazine and Metoclopramide

(Prochlorperazine has a rectal form if unable to eat)

169
Q

End of Life Care

Two medications for death rattle?

A

Scopolamine (Hyoscine) is sedative

Glycopyrolate is non-sedative

170
Q

End of Life Care

Agitation DOC

A

Sedation with Midazolam

(Do not use opioids as sedatives)

171
Q

End of Life Care

Delirium DOC

A
  1. Haloperidol
  2. Sedation with Midazolam
172
Q

End of Life Care

Respiratory problems, DOC

A
  1. Opioids
  2. CS (If Obstruction or COPD or Cancer)
173
Q

Safety in Pregnancy?

  • Statins?
  • Quinolones?
A

St: Not safe

Q: Is recently considered safe (short term)

174
Q

Safety in Pregnancy?

  • Li?
  • Valproate?
A

Li: Not safe (May be used with echography of fetal heart)

Val: Not safe.

175
Q

Safety in Pregnancy?

  • Carbamazepin?
  • Phenytoin?
A

C: Not safe (unless with high dose folate)

P: Not safe

176
Q

Safety in Pregnancy?

  • BZPs?
  • Opioids?
A

B: Preferably No (may cause cleft palate/lip) or only short term

O: Preferably No (Codeine and Meperidine not at all)

177
Q

Safety in Pregnancy?

CS Systemic

A

No for 1st trimestre

later is OK

178
Q

Safety in Breastfeeding

Codeine, Meperidine: No

Ergot derivatives: No

Li ?

A

Li, Amiodarone are OK

but serum level should be measured.

179
Q

Safety in Breastfeeding

BZP? OK

OCP? Progestin-only

Warfarin?

A

OK in breastfeeding

180
Q

Fever in children:

Definition: Rectal > 38

Standard in Canada: Oral or Rectal?

A

< 5 yo : Rectal

> 5 yo : Oral

181
Q

Fever in children:

Definition: Rectal > 38

What about Axillary and Tympanic?

A

A: All ages, screening if low risk

T: >2yo, screening if low risk

182
Q

Fever in children:

ASA? Naproxen?

A

ASA: never below 15 yo

Nap: not below 12 yo

183
Q

Nutritional Supplements

Three deficinecies in Vegans:

  1. B12

2 ?

3.Omega 3

A

Vit D and Calcium

184
Q

Nutritional Supplements

4 indications of Vit D:

  1. Osteoporosis
  2. If high risk for IHD

3,4. In elderly?

A

Falls

Cognitive impairments

185
Q

Nutritional Supplements

Calcium in Pregnant women:

-If 14-18 yo ?

If 19 yo or above?

A

14-18: 1300 mg/day

19 and above: 1000 mg/day

186
Q

Nutritional Supplements

Vitamin D in Pregnant women?

A

2,000 units/day during winter

187
Q

Dosage Adjustment

Which one(s) should not be adjusted?

  1. If the drug is nephrotoxic.
  2. If the drug is needed immediately
  3. If there is a chance to titrate
  4. If more than 50% is excreted by kidneys
A

1,2,3 No adjustment

  1. YES

(But no adjustment if <50% is excreted by kidneys)

188
Q

Dosage Adjustment

How to calculate Cr Clearance by age?

A

ClCr = 1.5 x (140-Age) / Cr Serum (Males)

Females= 0.85 x (Males)

NL is above 1

Med (6 decks)

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