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Therapeutics IV > Meningitis - Block 2 > Flashcards

Meningitis - Block 2 Flashcards

1
Q

What is meningitis?

A

Inflammation of the subarachnoid space or spinal fluid

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2
Q

What are the characteristics of normal CSF?

A
  1. Clear protein content <50 mg/dL
  2. WBC <5
  3. Lack of antibodies or complements
  4. BBB is tightly joined by capillary endothelial cells
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3
Q

What are the 4 processes of bacterial meningitis?

A
  1. Mucosal colonization and bacterial invasio of the CNS
  2. Bacterial replication
  3. Inflammation from bacterial cell lysis -> ativating inflammatory pathway -> increase permeability of BBB by vasodilation
  4. Neurological damage -> increase intracranial pressure and cerebral edema
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4
Q

What is the meningitis triad?

A
  1. Fever
  2. Nuchal rigidity
  3. ALtered mental status
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5
Q

What are the presentations of meningitis apart from the triad?

A
  1. Chills
  2. Fever
  3. Photophobia
  4. Kerning/Brudzinski
  5. Abnormal CSF chem

2 of the following
1. Fever
2. Nuchal rigidity
3. ALtered mental status
4. Severe HA

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6
Q

What are the common pathogens associated with meningitis?

A
  1. S. pneumoniae
  2. Group B strep (agalactiae)
  3. N. men.
  4. H flu
  5. Listeria
  6. G-
  7. Staph spp
  8. HSV
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7
Q

What are the RF of meningitis?

A
  1. Age with immune decline
  2. Large communal groups
  3. Traveling in areas o high prevalence
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8
Q

What are the common causes of CA bacterial meningitis? How can infection be prevented?

A

Strep. pneumoniae -> Prevnar 20
Strep. agalactiae
Neisseria -> Meningococcal conjugate vaccine
H. Flu -> Hib vac
Listeria

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9
Q

What are the diagnostic tools for meningitis?

A

Lab:
* CSF: Culture sensitivities (gold standard), Gram stain, PCR (Biofire)
* Blood culture

Imaging:
* MRI
* Computer tomography

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10
Q

How do we test CSF?

A

Lumbar puncture
* CSF and blood culture is taken before ABX
* If puncture is delayed still intiate ABX immediately

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11
Q

What are the objective findings of bacterial meningitis?

A

WBC: 1000-5000
Neutrophils
Elevated proteins
Low glucose (bacteria is using it)

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12
Q

What ABX cross CNS?

A
  1. Lipophillic
  2. Noncharged
  3. Small
  4. Low PPB
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13
Q

What are ABX properties that should be considered?

A
  1. -cidal
  2. definitive
  3. No high resistant empiric coverage
  4. Avoid ABX that worsen CNS sx -> Merrem causes sz
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14
Q

Drug that targets Listeria?

A

Ampicillin

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15
Q

Drugs that target GBS?

A

Ampicillin + 3rd gen or AG
Vanc + 3rd gen

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16
Q

Drugs that target Strep. pneumoniae?

A

Vanc + 3rd gen

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17
Q

Drugs that cover GNR?

A

3rd gen (Ceftriazone and Cefotaxime)

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18
Q

Treatment and pathogens of <1 month?

A

G+: Listeria, GBS
G-: E. coli, Kleb, Enterobacter

**TX: **
* Ampicillin + Cefotaxime
* Ampicillin + Gentamicin

19
Q

Tx and pathogens of 1-23 months?

A

G+: Strep pneumoniae
G-: Neisseria

Tx:
+ Vanc + 3rd gen (Ceftriaxone, Cefotaxime)

20
Q

Tx and pathogens of 2-50 YO?

A

G+: Strep. pneumoniae
G-: Neisseria

Tx:
* Vanc + 3rd gen (Ceftriaxone, Cefotaxime)

21
Q

Tx and pathogens of >50YO?

A

G+: Step. pneumooniae, Listeria
G-: Neisseria, E. coli, Kleb, Enterobacter

Tx:
* Vanc + 3rd gen ceph + ampicillin

22
Q

When do you initiate empiric ABX tx?

A

within 48-72 H

23
Q

What are the supportative tx for meningitis?

A

Critical for early stages of tx:
* Fluids
* Electrolytes
* Antipyretics
* Analgesics
* Mannitol or Hypersol for ICP

24
Q

What is the vanc trough in mengingtis patients?

A

15-20 mcg/mL

25
S. pneumonia PCN sesceptible tx and DOA?
PCN or ampicillin for 10-14 days
26
S. pneumonia PCN resistant tx and DOA?
Vanc + 3rd gen for 10-14 dyas
27
S. pneumonia ceftriaxone resistance tx and DOA?
Vanc + 3rd gen for 10-14 days
28
GBS tx and doa?
PCN or Ampicillin + gentamicin for 14-21 days
29
Listeria tx and DOT?
Pcn G or ampicillin +/- Gentamicin for ≥21 days
30
Neisseria tx and DOT?
PCN susceptibe: PCN G or ampicillin Resitant: cetriaxone or cefotaxime 7-10 days
31
Tx for H flu and DOT?
b-lactamase negative: ampicillin b-lactamase postive: cefotaxime or ceftriaxone
32
E. coli tx and DOT?
Cefotaxime or ceftriaxone for 21 days
33
What are the benefits of using steroid adjuct?
1. Reduces inflammation 2. Reduces hear loss
34
How do we initiate steroids?
Dexmethasone -> start before or simultaneously with first dose of ABX
35
Types of meningicoccal vaccines?
1. MenACWY 2. MenB
36
Types of pneumococcal vaccines?
PCV15 or PCV20
37
H flu vaccines?
1. ActHib 2. Hiberix 3. PedvaxHIB 4. Pentacel
38
Chemoprophylaxis for H. flu?
Incompletely vaccinated <48 MO * Rifampin
39
Chemoprophylaxis for Neisseria?
Close contact ≥8H or contact with oral secretions: * Rifampin 600 mg Q12 for 2 days * Cipro 500mg once * Ceftriaxone 250 mg once
40
Pathogen that causes viral encephalitis?
HSV 1 and 2
41
Objective results of viral encephalitis?
WBC: increases but <250 Lymphocytes Proteins: Increased but <150 Normal glucose
42
Sup[portive care for VE?
1. Sz prophylaxis 2. ICP management 3. DVT prophylaxis 4. Secondary bacterial meningitis management
43
What is the tx for HSV VE?
Acyclovir 10mg/kg IV Q8H for 2-3 wks | HSV is the most treatable etiology of VE

Therapeutics IV (39 decks)

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