Infectious-Miscellaneous Flashcards
1
Q
Allergic Rhinitis
Two indications for intranasal Ipratropium
A
- Skiers’ Nose= Vasomotor Rhinitis
- Allergic rhinitis with severe rinorhea
2
Q
Allergic Rhinitis
Recommended Tx for moderate to severe cases:
A
Intranasal Chromolyn
Or Intranasal CS like Beclomethasone
(CS is stronger than Chromolyn)
3
Q
Allergic Rhinitis
Safety of Antihistamines in children
A
Above 6 yo is ok
4
Q
Allergic Rhinitis
Safety of Decongestants in Children
A
Above 12 yo is ok
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)
6
Q
Allergic Rhinitis
Decongestants like Pseudoephedrine or Phenylephrine: CIs:
- HTN - MI - Hyperthyroidism - ……..?
A
With MAOIs
7
Q
Acute Bronchitis
Dextromethorphan safety:
- In Pregnancy?
- In children?
A
- Safe
- Above 6 yo is ok
8
Q
Influenza Vaccine is recommended to 4 groups:
- Everybody with systemic disease like DM
- Everybody above …… yo of age.
- All pregnant women.
- In children ?
A
- Above 65 yo
- From 6 months to 5 yo
9
Q
Influenza
What if someone is egg allergic? (Vaccination)
A
No live vaccine.
but Inactive is safe.
10
Q
Influenza
Amantadine in prophylaxis?
A
Not recommended any more.
11
Q
Influenza Vaccines:
- Flu shot: TIV and QIV (Inactive) which is IM
- in Pregnancy?
- which age groups?
A
- Pregnancy: ok
- Above 6 months is ok to everyone
12
Q
Influenza Vaccines:
- Flumist (LAIV): Nasal Spray (Live virus)
- in Pregnancy?
- which age groups?
A
- Pregnancy: No
- Age: Only between 2-60 yo
13
Q
Influenza Vaccines
Which one is safe in Breastfeeding?
A
Both are safe in Breastfeeding
But no Flumist in Pregnancy.
14
Q
Influenza
Tx 1st line ?
Duration ?
A
Oseltamivir (Tamiflu) Start early, duration is 5 days
but it is NOT a routine Tx
15
Q
Influenza Tx
Why is Zanamivir 2nd line?
A
It may cause bronchospasm
16
Q
Influenza Tx
Safety in Pregnancy and Breastfeeding
- Oseltamivir
- Zanamivir
A
Both are safe
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
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.
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.
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.
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.
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%
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.
24
Q
Strep Sore Throat
Nonpharma Tx:
- Hand washing
- School?
A
Do not go to school until 24 h After starting the AB therapy.
25
Strep Sore Throat
1st line treatment:
Penicillin V Oral
Or Amoxicillin Oral (Syrup)
26
Strep Sore Throat
If allergic to Penicillin?
Mild allergy: Cephalexin
Severe allergy: Azithromycin or Clindamycin
(No Erythromycin because of GI SEs)
27
Antibiotics
Safety of Erythromycin in Pregnancy?
Do not use Estolate salt.
It may cause Cholestatic Hepatitis.
28
Sinusitis
1st line Tx in Canada
Amoxicillin
7-14 days in Adults
10-14 days in Children
29
Sinusitis
If 1st line treatment with Amoxicillin fails?
Amoxicillin-Clavulanate
but If intolerant to Amoxicillin: Then Fluoroquinolone (No Macrolide)
30
Sinusitis
Tx if allergic to Penicillin?
If \<8 yo Clindamycin + Cefixime
If \>8 yo Doxycycline
31
Sinusitis
If chronic (\>12 weeks), DOC ?
Amoxicillin-Clavulanate for 3w
Or Clindamycin for 3w
32
Sinusitis
If the patient has received an AB within the last 3 months, then ?
Pick from another class of ABs
33
Sinusitis
Indications for HD dosing of Amoxicillin
1. Children who go to daycare
2. ............... 3. ...............
2. Children \< 2yo
3. ABs within the last 3 months
34
AOM
1st line Tx in Canada is Amoxicillin
SD= Standard Dose= ........ mg/kg/day
HD= High Dose= .......mg/kg/day
SD: 40 mg/kg/day
HD: 75-90 mg/kg/day
35
AOM
Duration of Tx in Canada in Children?
Age \< 2yo: 10 days
Age \> 2yo: 5 days
36
AOM
If the child is \< 6 weeks old?
Do not treat
Refer ASAP to ER for Sepsis workup
37
AOM
If the child is between 6w to 6 months old?
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
38
AOM
If the child is above 6 months old?
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
39
AOM
When would you consider a watchful waiting in Children ?
1. Age ..............
2. No complications, No underlying disease
3. Parents are trustworthy
Age above 6 months
40
AOM
Indications for 2nd line Tx (HD Amoxicillin-Clavulanate):
1. Failure of Amoxicillin (HD or SD)
2. ............
Recurrent episodes of AOM (Also consider referring)
41
AOM
Tx if allergic to Penicillin
If mild: Cefixime or Cefuroxime
If severe: Azithromycin
42
Croup (Laryngo-tracheo-bronchitis)
Caused by Parainfluenza type 1,3
1st line Tx?
Dexamethasone Single dose, PO
(Oral is Preferred, but IM or IV is also Ok)
43
Croup
Oxygen therapy
1. Preferably ..........
2. Avoid .........
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.
44
Croup
Tx if the child is very ill
or not responding to oral Dexamethasone
or vomiting
Nebulized Budenoside
+|- Nebulized Epinephrine
45
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 ......
2 hours
Dose is 5 ml, independent of wt or age.
46
Pneumonia
Severity and risk of death: CURB65
C. new Confusion
U. Urea above ......
R. RR above ......
B. BP: SBP \< 90, DBP \< 60
Urea above 7
RR above 30
47
Pneumonia
Respiratory Quinolones 1. ? 2. ?
1. Moxifloxacin
2. Levofloxacin
ML: MaLe
48
Pneumonia
DOC if Strep Pneumoniae (Pneumococcus)
MIC to Penicillin:
If \<2, Penicillin G or Amoxicillin
If \>2, Cephalo 3rd or Resp Quinolone
49
Pneumonia
DOC if Hemophilus
Cephalo 3rd
or Amoxicillin-Clavulanate
50
Pneumonia
DOC if Staphylococcus
MSSA: Cloxacillin
MRSA: Vancomycin or Linezolide
(No Daptomycin or Tigecycline)
51
Pneumonia
DOC if Legionella
Macrolide or Resp Quinolone
52
Pneumonia
DOC if Mycoplasma or Chlamydia
Macrolide
53
Pneumonia
DOC if Q Fever (Coxiella Brunetti)
Resp Quinolone
54
Pneumonia
DOC if Gram negative aerobic (Like Klebsiella)
Cephalo 3rd
55
Pneumonia
Duration of Tx in CAP
If outpatient and good condition: 5 days
Otherwise: 10 days
56
Pneumonia
Tx If aspiration happens:
Pneumonitis: ........
Pneumonia: .........
Pneumonitis: no AB
Pneumonia: Metronidazole or Clindamycin
57
Pneumococcal Vaccines
- 23 Valent (Capsular, Polysaccharide)
- 13 Valent (Conjugated)
Which one is used in HIV+ and in Infants?
13V: infants and HIV+
23V: children above 2 yo and adults \>65 yo
58
Antibiotics
SEs of Linezolide
1. Myelosuppression 2........
Serotonin Sd with SSRIs
59
Pneumonia
Criteria for the day of discharge:
1. SaO2\> 92%
2. RR ....... 3. HR .......
RR \<24
HR \<100
60
TB Mantoux test (PPD)
CIs:
- Proven active TB
- Eczema or burns (if severe)
- ..........
Live viral vaccine in past 1 month (Like MMR)
61
TB
Hepatotoxic medications: PYR, INH, RIF
Definition of hepatotoxicity
1. If asymptomatic: LFT x5 NL
2. .......
If symptomatic, LFT x3 NL
62
TB Indications for CS:
1. TB Meningitis
2. TB Pericarditis
3. ........
IRIS in AIDS (Immune Reconstitution Inflammatory Sd)
If antiretrovirals are used with anti TBs at the same time, Fever+ malaise + local reactions
63
Diabetic Foot
DOC if infection is localized
Amoxicillin-Clavulanate Oral
Or Cephalexin oral
64
Diabetic Foot
DOC if infection is extensive
If oral: Amoxicillin-Clavulanate or Ciprofloxacin
If IV is needed: Cephalosporin + Metronidazole
65
Osteomyelitis
Empiric Tx in Neonates?
Cloxacillin + Cefotaxime
Or Vancomycin + Cefotaxime
66
Osteomyelitis
Empiric Tx in Children
Either Cloxacillin or Vancomycin
67
Osteomyelitis
Empiric Tx in adults?
Cloxacillin
Note: Cloxacillin can be replaced by Cefazolin
68
Osteomyelitis
Duration and route of AB therapy
Usually 4-6 weeks
Usually 2w IV then switch to oral
69
Bacterial Meningitis
1st line Tx In Adults
Vancomycin + Ceftriaxone 10-14 days
70
Bacterial meningitis
Tx in Children If \> 3 months?
Like adults:
Vancomycin + Ceftriaxone 10-14 days
71
Bacterial meningitis
Tx in Children
1. If between 6w to 3 months
2. If below 6w
6w-3mon Ampicillin+Vancomycin+Ceftriaxone/Cefotaxime
\< 6w Ampicillin + Cefotaxime
(For Listeria, GBS, Enterobacteriacea : 21 days)
72
Bacterial meningitis Tx in Adults if above 50
Ampicillin + Vancomycin + Ceftriaxone
(Note: the same Tx is used for alcoholics)
73
Bacterial meningitis
Use of CS:
1. Decreases risk of neurological sequels
2. DOC is Dexamethasone
3. .........
It must be used either before the first dose of AB or together with the first dose.
74
Bacterial meningitis
Post-exposure Tx for Hemophilus:
1. DOC is Rifampin
2. Dosage is 20 mg/kg .............
3. Prophylaxis in Pregnancy ?
2. Once daily for 4 days
3. Not recommended.
75
Bacterial meningitis
Post-exposure Tx for Meningococcus:
1. DOC is Rifampin
2. Dosage is 20 mg/kg .............
3. Prophylaxis in Pregnancy ?
2. Once daily for 2 days
3. Single dose of Ceftriaxone
76
Infective Endocarditis
DOC if Staphylococcus on NL valve
MSSA: Cloxacillin
MRSA: Vancomycin
77
Infective Endocarditis
DOC if Staphylococcus on Prosthetic valve
Add (Rifampin + Gentamicin) To Cloxacillin
or to Vancomycin
78
Infective Endocarditis
DOC if Streptococcus (any type, any valve)
Vancomycin
79
Infective Endocarditis
DOC if Enterococcus
1. All sensitive
2. Penicillin resistant
3. Gentamicin resistant
4. All resistant
1,2 Vancomycin + Gentamicin
3 Vancomycin + Streptomycin
4 Linezolide or Imipenem
80
Infective Endocarditis
DOC if HACEK
Ceftriaxone or Cefepime
81
Infective Endocarditis
DOC in Prophylaxis
Amoxicillin 2 g Oral
Or Ampicillin 2 g IV or IM
82
Infective Endocarditis
DOC in Prophylaxis If allergic to Penicillin
Cephalexin 2 g PO
Or Cefazolin 1 g IV or IM
83
Sepsis, Septic Shock
1. Do not use bicarbonate, unless ......
2. The best vasoactive is .......
PH \< 7.15
NE (Neurepinephrine)
84
Sepsis, Septic Shock
Empiric AB if the source of infection is
- Unknown - Nosocomial - GI or GUT
All: Meropenem
85
Febrile Neutropenia
DOC If Inpatient?
If possibly outpatient?
In: Meropenem or Ceftazidime
Out: Amoxicillin-Clavulanate + Ciprofloxacin
86
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, ..........
Peel it or forget it!
87
Traveller's Diarrhea
BSS: Bismuth Sub Salicylate is a good choice, but caution:
1. Do not use if taking Warfarin
2. ..........
Do not use if taking Salicylates Or in Children \< 3 yo Risk of Rey's Sd or Encephalopathy
88
Traveller's Diarrhea
AB therapy?
Is not always needed
If needed: DOC is Quinolone
89
Traveller's Diarrhea
Tx in Children
1. AB ?
2. Loperamide?
1. Quinolones are CI, use Azithromycin
2. Loperamide is CI below 3 yo
90
Traveller's Diarrhea
Tx in Pregnancy
1. AB?
2. BSS, Loperamide ?
3. Iodine ?
1. Quinolones are CI, use Azithromycin
2. BSS is CI, Loperamide is ok.
3. Iodine is CI
91
Traveller's Diarrhea
How to prepare an ORS by ourselves?
5 mL salt + 30 mL sugar In 1 Liter of water
92
HIV
1. All patients should take an allergy test to .........
2. All patients are recommended to take a tropism test for .........
1. Abacavir (NRTI)
2. Maraviroc (Entry Inhibitor)
93
HIV
Vaccinations in AIDS:
Pneumococcal: Yes
Influenza: Yes
MMR? Varicella?
MMR, Varicella: Yes, as long as CD4 is above 200
94
HIV
Protease Inhibitors SEs in general:
1. Enzyme Inhibitors
2. .............
Hyperglycemia
Hyperlipidemia
95
HIV
Common SEs of NRTIs in general:
1. BM Suppression 2.......... 3. Lactic acidosis
Peripheral Neuropathy
96
HIV
NNRTIs general SEs
1. Rash 2........
Hepatitis
97
HIV
Tenofovir (NtRTI) is infamous for?
Osteoporosis
98
HIV
- Indinavir (PI) is infamous for renal stones.
- Didanosine (NRTI) is infamous for: 1. Pancreatitis 2..........
Gout
99
HIV
Efavirenz (NNRTI) is infamous for 1. Teratogenicity 2............
CNS toxicity
Psychiatric SEs
100
HIV In Pregnancy:
1. Start Tx at week .......
2. Efavirenz is CI
3. Cesarean?
1. 14th
3. Only if CD4 is low or Viral load is high
101
HIV with Breastfeeding?
Breastfeeding is CI in HIV
102
HIV After a needle stick?
4 weeks Three medications
Usually: Zidovudine + Lamivudine + Nelfinavir
103
HIV
Etravirine (NNRTI) is infamous for .........
SJS
104
HIV
Nevirapine (NNRTI) is infamous for .........
Hepatotoxicity
105
HIV
Atazanavir (PI) Is infamous for .........
Increased Bil
Renal stones
106
HIV
Darunavir (PI) is infamous for .........
Hepatotoxicity
107
HIV
Fosamprenavir (PI) is infamous for .........
Cardiovascular risks
108
HIV There is an exception in which you should not do CART with specific treatment of the opportunistic infection at the same time.
Cryptococcal Meningitis
109
HIV There are two opportunistic infections that we don't recommend prophylaxis
1. Cryptococcal
2. CMV
110
HIV
Indication of Prophylaxis for:
1. PCP?
2. Toxoplasmosis?
3. MAI?
CD4 \<200
\<100
\<50
111
HIV
DOC in Prophylaxis for PCP?
For Toxoplasmosis?
Both: SMX/TMP
112
HIV
DOC in Prophylaxis of MAI?
Azithromycin 1 dose/week
113
HIV
DOC in Prophylaxis of Candidiasis?
Fluconazole
114
HIV
DOC in Tx of Bartonellosis
Doxycycline
115
HIV
DOC in Tx of Cryptococcal meningitis
Amphotericin B +/- Flucytosin
Then Fluconazole as maintenance
116
HIV
DOC in Tx of CMV infection
Valgancyclovir
117
HIV
DOC in Tx of Candidiasis
- Oral: Nystatin
- Vaginal: Clotrimazole cream or tablet
- Systemic?
Either Fluconazole PO or Amphotericin B IV
118
HIV
DOC in Tx of Intestinal infections: Cryptosporidium?
Paromomycin + Nitazoxanide
119
HIV
DOC in Tx of Intestinal infections:
1. Cyclospora 2. Isospora 3. Microspora
1,2 SMX/TMP
3. Albendazole
120
HIV
DOC in Tx of MAI
Thriple: Clarythromycin + Ethambutol +/- Rifabutin
121
HIV
DOC in Tx of PCP:
SMX/TMP for 21 days +|- ....................
Penthamidine IV
or Prednisone PO (If PO2\<70)
122
HIV
DOC in Tx of Toxoplasmosis (New)
SMX/TMP high dose PO or IV
Old Tx was: Pyrimethamine+Sulfadiazine+Leukovorin
123
Herpes Infections:
Tx is Acyclovir, if mild to moderate: PO, but if severe: IV
1. G.Stomatitis in children
2. Anogenital
3. Proctitis
4. .........
Eczema Herpeticom
(Eczema + Fever + LAP)
124
Herpes Infections
DOC in Cold Sore (Recurrent orolabial)
Oral Acyclovir (Not topical)
125
Herpes Infections in CNS:
1. Encephalitis: Emergency, Acyclovir IV
2. Aseptic meningitis: .............
HSV2, usually recurring Tx: Valacyclovir (1w)
126
Herpes Infections
Keratoconjunctivitis, DOC
Topical Trifluridine
127
Herpes Infections
Shingles: -Topical AB? -Topical Acyclovir?
Both: No
DOC: Oral Acyclovir
128
UTI in Pregnancy:
- Routine screening: ...........
DOC: Amoxicillin or Cephalexin or ..........
Week 12-16
Nitrofurantoin
129
UTI
DOC for Pyelonephritis in Pregnancy?
Ceftriaxone
130
UTI in Pregnancy, safe or not?
SMX/TMP? Quinolones?
S: not 1st trimester, not after week 32
Q: not safe
131
UTI Cystitis (Uncomplicated UTI)
1. DOC (2)
2. If sulfa allergic (2)
1. SMX/TMP for 3 days Or Fosfomycin 3 g Single dose
2. TMP 3 days or Nitrofurantoin 5 days
132
UTI
DOC for Pyelonephritis or complicated UTI (in anatomical or functional abnormalities)
Mild to moderate: Quinolones PO 7-14 days
Severe: Aminoglycoside IV +|- Ampicillin IV
133
UTI
Acute Prostatitis DOC
AG IV +|- Ampicillin IV +|- Cloxacillin IV
134
UTI
Chronic Prostititis DOC
Quinolones PO 4-6 weeks
135
STI
Tx for partners:
In Chlamydia, Gonorhea, PID, LGV ?
All partners within last 60 days:
Tx + No Sex for 1 week
136
STI Tx for partners:
In Trichomonas, Vaginosis, Candidiasis?
V,C: not needed
Trichomonas: Only current partner:
AB + Avoid sex until the end of Tx
137
STI
DOC for LGV
Azithromycin for 3w
138
STI
Chlamydia and Gonorhea, DOC
C: Azithromycin single dose
G: Ceftriaxone single dose
(Both: ok in Pregnancy)
139
STI
PID, DOC
1. If outpatient? 2. If inpatient?
Out: Quinolone + Metronidazole PO
In: Quinolone + Metronidazole IV
140
STI Genital warts (HPV), Tx, safety in Pregnancy:
1. Imiquimod
2. Podophyline, Podophylotoxin
3. DCA, TCA
4. Cryo, Laser
Non Pregnant: all ok Pregnant: 1,2 no, 3,4 ok
141
Antibiotics
Metronidazole safety In Pregnancy and Breastfeeding?
Pregnancy: safe
Breastfeeding: ok, but 24 h interval to Breastfeeding
142
Antibiotics
Safety in Pregnancy
- Vaginal Clindamycin cream?
Not safe
143
Malaria Nonpharma:
1. Insect repellents containing DEET
2. Use bed nets, impregnated with Permethrin
3. ...........
Use insecticide generators containing pyrethroids.
144
Malaria
Areas that are still chloroquine sensitive
Central America [except Panama], Haiti and parts of the Dominican Republic and Middle East
145
Malaria
Two CIs for Chloroquine 1. ? 2. ?
1. Epilepsy 2. Psoriasis
146
Malaria Duration of Tx:
1- For Chloroquine, Mefloquine ?
2- For Doxycycline, Atovaquone/P, Primaquine ?
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
Malaria
DOC if Chloroquine resistant and no CIs:
In order of preference:
1. Mefloquine 2. Doxycycline 3...........
Atovaquon/P
148
Malaria Mefloquine limitations:
1. Resistance in Thailand, Cambodia, Vietnam
2. ?
SEs: Serious Neurological and Psychiatric
149
Malaria
Doxycycline is a good choice after Mefloquine. What are the limitations?
1. CI in Pregnancy and Children \<8yo
2. Photosensitivity
3. ...............
Usage is daily
150
Malaria
Atovaquone/Proguanil is another alternative for Mefloquine. Specially in last minute trips.
Limitations: 1. Daily usage 2. ?
CI in Pregnancy and Breastfeeding
151
Malaria
When would you consider Primaquine for Prophylaxis?
1. Last line alternative for Mefloquine
2. ........
Central and south America for dormant form of P.Vivax in liver Called: PART: Presumptive Anti-relapse therapy
152
Malaria
Limitations of Primaquine
1. Not 1st or 2nd choice
2. CI in Pregnancy
3. ...........
Risk of hemolysis in Favism
153
Malaria Prevention
In Pregnancy, Nonpharma is more important. Medications safety?
Safe: Chloroquine and Mefloquine
Unsafe: the rest of medications (The same for breastfeeding)
154
Thermoregulatory
Heat Cramps (Mild form) is usually caused by dilutional hypernatremia after exercise
Tx?
Rest
+ Oral rehydration (5 ml salt in 500 ml water)
155
Thermoregulatory
Heat Exhaustion (Moderate form) is usually caused by loss of water and salt, Core body temp is 37-40
Tx?
Rest + Rehydration (IV)
+ External cooling (fans, ice packs)
156
Thermoregulatory
Heat Stroke (Severe form) is usually associated with Core body temp \> 40.6 and may result in DIC, ARF, Seizures, Neurological damage.
Tx?
ABC + Rehydration (IV)
+ Rapid cooling (fan evaporation, ice packs, tepid water sponging)
No cold water immersion!
157
Thermoregulatory
DOC for
NMS Vs Malignant Hyperthermia
NMS: Bromocriptine PO
MH: Dantrolene IV
158
Thermoregulatory
Three Rewarming ways:
Passive External Vs Active External Vs Active Core
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
Chemotherapy SEs
If VTE, Tx ?
If "Chemo Fog", Tx ?
LMWH (Not Warfarin)
Ritalin or Modafinil
160
Chemotherapy SEs
If extravasation: generally, cold compress
If with Antracyclines: ....................
If with Meclorthamin: ...................
A: DMSO or Dexrazoxane
M: Sodium Thiosulfate
161
Chemotherapy SEs
In hand foot reaction,
Prophylaxis?
Tx?
P: Vit B6
Tx: Emolients like Bag Balm
162
Chemotherapy SEs
Rash with EGFR inhibitors, Tx ?
Topical Clindamycin or CS
or if severe: Oral Tetracycline
163
Chemotherapy SEs
Hemorrhagic Cystitis with Cyclophosphamide
Prophylaxis and Tx
P: Mesna + Diuresis
T: Tranexamic Acid
164
Radiotherapy SEs
Proctitis ? Esophagitis?
P: Topical CS
E: Topical Lidocaine
165
Radiotherapy SEs
Xerostomy?
Pneumonitis?
X: Pilocarpine
P: Prednisone
166
CINV
DOC 1st and 2nd?
1. Ondansetron +/- Dexamethasone
2. Aprepitant +/- Dexamethasone
167
CINV
DOC in Anticipatory Nausea?
BZPs: Lorazepam or Alprazolam
168
CINV
Alternative Tx (other than 5HT, NK1, CS) ?
Dopamine antagonists:
Prochlorperazine and Metoclopramide
(Prochlorperazine has a rectal form if unable to eat)
169
End of Life Care
Two medications for death rattle?
Scopolamine (Hyoscine) is sedative
Glycopyrolate is non-sedative
170
End of Life Care
Agitation DOC
Sedation with Midazolam
(Do not use opioids as sedatives)
171
End of Life Care
Delirium DOC
1. Haloperidol
2. Sedation with Midazolam
172
End of Life Care
Respiratory problems, DOC
1. Opioids
2. CS (If Obstruction or COPD or Cancer)
173
Safety in Pregnancy?
- Statins?
- Quinolones?
St: Not safe
Q: Is recently considered safe (short term)
174
Safety in Pregnancy?
- Li?
- Valproate?
Li: Not safe (May be used with echography of fetal heart)
Val: Not safe.
175
Safety in Pregnancy?
- Carbamazepin?
- Phenytoin?
C: Not safe (unless with high dose folate)
P: Not safe
176
Safety in Pregnancy?
- BZPs?
- Opioids?
B: Preferably No (may cause cleft palate/lip) or only short term
O: Preferably No (Codeine and Meperidine not at all)
177
Safety in Pregnancy?
CS Systemic
No for 1st trimestre
later is OK
178
Safety in Breastfeeding
Codeine, Meperidine: No
Ergot derivatives: No
Li ?
Li, Amiodarone are OK
but serum level should be measured.
179
Safety in Breastfeeding
BZP? OK
OCP? Progestin-only
Warfarin?
OK in breastfeeding
180
Fever in children:
Definition: Rectal \> 38
Standard in Canada: Oral or Rectal?
\< 5 yo : Rectal
\> 5 yo : Oral
181
Fever in children:
Definition: Rectal \> 38
What about Axillary and Tympanic?
A: All ages, screening if low risk
T: \>2yo, screening if low risk
182
Fever in children:
ASA? Naproxen?
ASA: never below 15 yo
Nap: not below 12 yo
183
Nutritional Supplements
Three deficinecies in Vegans:
1. B12
2 ?
3.Omega 3
Vit D and Calcium
184
Nutritional Supplements
4 indications of Vit D:
1. Osteoporosis
2. If high risk for IHD
3,4. In elderly?
Falls
Cognitive impairments
185
Nutritional Supplements
Calcium in Pregnant women:
-If 14-18 yo ?
If 19 yo or above?
14-18: 1300 mg/day
19 and above: 1000 mg/day
186
Nutritional Supplements
Vitamin D in Pregnant women?
2,000 units/day during winter
187
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
1,2,3 No adjustment
4. YES
(But no adjustment if \<50% is excreted by kidneys)
188
Dosage Adjustment
How to calculate Cr Clearance by age?
ClCr = 1.5 x (140-Age) / Cr Serum (Males)
Females= 0.85 x (Males)
NL is above 1
