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Pharmacy 255 > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis?

A

inflammation of membranes around spine and brain

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2
Q

What age does meningitis appear? What gender?

A

children and males

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3
Q

What are the 2 general causes of meningitis?

A

Bacteria-PMN response
Aseptic- no evidence of bacterial

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4
Q

What could cause aseptic meningitis?

A

viral, fungal, or atypical bacteria that are not easily grown, chemical irritation

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5
Q

What routes can introduced pathogen for meningitis?

A

from blood, trauma, from URTI

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6
Q

What bacteria commonly cause meningitis?

A

H influenza, meningitidis, S pneumoniae, Group b strep, listeria monocytogenes

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7
Q

What is the process of meningitis?

A

colonization
replicate in subarachnoid space
inflammation by cytokine into CSF= neutrophils come
increased pressure=damage

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8
Q

Of the bacteria that cause meningitis, what do they all share?

A

polysaccharide capsule- stops phagocytosis
make immunoglob A protease

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9
Q

Why cant the brain stop these pathogens?

A

only BBB
no antibodies inside

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10
Q

What are the risk factors for meningitis?

A

> 60
<5
trauma
crowding
low money
recent colonize

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11
Q

What is the CSF? Where is it produced?

A

produces in ventricles of choroid plexus
have some protein and glucose

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12
Q

If >50 what is the likely organism?

A

Pneumoniae, meningitides, monocytogenes

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13
Q

Why isnt H influenzae not seen as much anymore?

A

vaccine has lowered alot

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14
Q

What are the sx of meningitis?

A

headache, fever, stiff neck, change in mental, malaise, seizure

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15
Q

What is the classic triad of meningitis?

A

Stiff neck, altered mental status, malaise

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16
Q

How often do kernig and brudzinski signs happen in meningitis? What is this?

A

50%
kernig=pain with passive extension of knee
B=flex neck and if it moves hip it is positive

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17
Q

How can we determine for sure if meningitis?

A

lumbar puncture

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18
Q

When cant you do lumbar punture?

A

if high intracranial pressure

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19
Q

After diagnosis, when do you start antibiotics?

A

within 1 hour

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20
Q

What is CSF chemistry test? What is abnormal?

A

Glucose-serum ratio <50-60%
protein >0.5g/L

21
Q

What CSF WBC count indicates meningitis?

A

> 500= mostly PMNs(neutrophils)

22
Q

WHat organisms are for 2-50 years?

A

Pneumonia, meningitidis

23
Q

What organisms for 1-23 months?

A

same as 2-50 but also influenza

24
Q

What are the complications of meningitis?

A

respiratory failure
seizures
abscess
death
high pressure
neurologic deficits- blind, deaf, paralysis

25
Q

What are the chances of death for meningitis for each age? What increases this risk?

A

10%- children
25%-adults
50%-elderly
risk increased if ICP, seizure, YOUNG or OLD, lower consciousness

26
Q

What routes can we give antibiotics? Which is best?

A

Intralumbar-subA space
Intracisternal
Intraventricular-GOOD

27
Q

What part of drug could cause chemical irritation to meninges?

A

preservatives-dont use

28
Q

When should you repeat lumbar puncture?

A

1-2 days to ensure sterilization

29
Q

For each of the common pathogens, What is duration of therapy?

A

Pneumonia- 10-14 days
Meningitidis- 5-7
Influenza- 7-14 days
B strep- 14-21
abcess-4-6 weeks

30
Q

What are the empiric antibiotics for each age?

A

<1 month= Amp+cefotaxime
1-50=Vanco+ Cetriaxone/cefotaxime
>50= Vanco+ampicilic+ ceftriaxone/cefotaxime

31
Q

What antibiotics for Pneumoniae?

A

Vanco+ Cetriaxone/Cefotaxime
OR Penicillin if susceptible

32
Q

What antibiotics for monocytogenes?

A

Amp/pen + AMG

33
Q

What antibiotics for Meningitidis?

A

Ceftriaxone/cefotaxime, Pen G, amp

34
Q

What antibiotic for H influenza?

A

cefotaxime/ceftriaxone

35
Q

What is an issue with AMG? How can we improve effeectiveness?

A

need direct CSF administration
add with penicillin=Increase synergy

36
Q

Why cant you use other cephalosporins?

A

1st gen= dont penetrate
2nd= delayed and can fail
3=AMAZINE for gram negative bacillus

37
Q

What are some supportive therapy for meningitis?

A

mannitol- diuretic to lower pressure
shunts= drain
steroids

38
Q

How doe shunts work?

A

catheter into ventricle to drain into peritoneal cavity to be resorbed

39
Q

How do CS help for meningitis?

A

death of organisms release cytokines so it stops this
lowers mortality and complications such as hearing loss in kids

40
Q

Why is CS controversial for meningitis?

A

decrease inflam lowers penetration of antibiotics

41
Q

What CS is given for meningitis? When is it given?

A

Dex 0.15mg/kg q6h for 2-4 days
give before or within 2 hours of antibiotics

42
Q

When do you d/c CS?

A

within 2 days if influenza or pneumonia not cultured

43
Q

DO we need to give prophylaxis if in contact with patient with meningitis?

A

Only if high risk= inmates, houshold or very close contact, exposure to secretions (kissing), school and daycare
contact within 7 days of patient sick

44
Q

Do HCP need prophylaxis?

A

NO

45
Q

What are the regimens for prophylaxis of meningitidis meningitis?

A

Rifampin: Adult= 600mg BID for 2 days
Kid(1-12)= 10 mg/kg q12h for 2 days
ALT
Cipro 500mg once- only for adults
Ceftriaxone 250 mg IM if >12 years

46
Q

Which strain of meningitis needs no prophylaxis?

A

pneumonial

47
Q

What are the regimens for prophylaxis of Influenza meningitis?

A

rifampin: A=600 mg OD for 4 days
K= 20mg/kg/d for 4 days

48
Q

What can we also do to prevent spread of meningitis?

A

Vaccine for meningococcus, influenza, and pneumococcal

Pharmacy 255 (16 decks)

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