NEW lec 6 - oct 28 Flashcards
Mastitis cause
-milk stasis, bacterial infection (staph aureus on skin), most common in 1st 6 weeks pp
mastitis risk factors
previous infection, improper latch (improper flow), anibiotic therapy (reduced good bacteria to naturally compete with fungi)
mastitis diagnosis
classic signs of inflammation, likely thrush/candida albicans if does not improve after 24 h or antibiotics
mastitis treatment
-cephalexin 500mg qid for 10-14 days, 2nd line is clindamycin
-treat like engorgemt but more urgent
–rest, warm/cold compress, massage to losen, remove milk, vary babys positions, hydrate, take analgesics, antibtiocs
enrogement chart
Cloxacillin:
-1st line mastitis
-beta lactam antibitonc (penicllin class)
-narrow spectrum (only staphyloccossu)
-good bioavailability
-**amoxicllin-clavulanic acid better to kill staph and strep infection
Cephalexin:
-1st line mastitis
-beta lactam antibotoic (cephalosopirn)
-cell wall synthesis inhibitor
-generally safe in pregnancy
-betalactamse resistant
-good if they have penicillin allergy
clindamycin
-2nd line mastitis
-lincosamide antibitoic
-protin synthesis inhbot 50s, macrolide
-safe for BF people
-reacts with erythromycin
-mostly kills gram +
Sulfamethoxazole-trimethoprim:
-folate synthesis inhibitor (use later in gestation) and not at term (hemolytic anemia of newborn like nitrofurantoin)
-antibitoic
-can cause crystaluria (urine crystals at low pH so be hydrated, not for impaired renal function)
-avoid longerm use and should supplement with folate
Trimethoprim:
-folate syntehsi inhibotr
-antibitoic often uti
-lipi soluble and absorbed reasdlu
-generaly well tolerated
-inhibits some cyp enzymes
Amoxicillin-clavulanic acid:
-beta lactam antibiotic, penicillin class
-gram + and -
-amoxicclin sensitive to betalactama so its given with claulc acid which inactvates betalactmaese
Ciprofloxacin:
-dna synthesis inhibitor, fluroquinolone antibiotic
-all gram +, some -
-safe in penicillin allergic client
-avoid in prengancy if possible, teratigenic in 1st trimester
-gi symptoms
-reacts with some - tums, magnesium, calcium, iron
UTI urinary tract infections:
-female anatomy has short urethra and warm mosti vuvla and rectum in close proximity
-urethral dilation leads to urinary stasis in 2nd/3rd trimestes
- relaxing effect of progetson and compression f urteres lead to incompelte bladder emptying
-can be asymptomatic but associated with PPROM, premature birth, pyelonephrits, choriamnionitis
-give nitrofuranotin or cephalexin
-**avoid ciprofloxacin, sulfamethoxazole and trimethoprin in 1st trimester, teratogenecity
Nitrofurantoin:
-antibiotic
-prodrug
-NVD, anorexia
-never give after 36 weeks - hemolytic anemia of newborn
-safe in lactation and early-mid pregnancy
-damage bacterial DNA, inhibit protein synthesis, inhibit rna synthes, inhibit cell wall synthesis, inhibit aerobic metabolsim
GBS Bacteriuria:
-gbs enters urine (rare)
-should always be treated
-clients + dont need to be rescreened in 3rd trimester
-penicllin v for treatment
Penicllin V:
-cell wall synthesis inhibitor
-for gbs bacteruori 300mg po qid for 5-7d
-gi symptoms
-best talen on empty somach
Abnormal vaginal secretions:
-imbaalnce of microfora or infection
3 common causes:
Bacterial vaginosis BV - prokaryoic
-often gardnerella or mobiluncus spp
-clindamycin or metrondatolze
Vulvogainl canidaiasis - yeast, eukaryotic
-often candida albicans
-otc tratemtn such as monstat 7days
Trichomainas vaginalis - prtozoa eukaryotic
Metronidaloze/FLAGYL:
-prodrig
-antibiotic
-inhibits lipid synthesis
-avoid 1st trimester
Headache, nause, dry mouth
-avoid with alcohol
Trichomoniasis:
-sti
-often no symptoms but can be vaginal discharge, dysuria
-metronidazole for treatment
Chlamydia:
-sti
-screening renounced in 1st trimester
-azythomicn or amoxicillin to treat
-test of cure recommended 3w after completion of treatment
Gonorrhea:
-sti
-screening recommended in 1st trimester
-high antibiotic resistance
-ceftriaxone and azithromycin
-test of cure 3-7d after completion of treatment
Syphilis:
-screening recommended in pregnancy
-sometimes test of cure
-penicillin g
IAP of GBS intrapartum antibiotic prophylaxis of early onset group b streptococci
-pen g 5million units IV then 2.5-4 million every 4 hours until delivery or
Penicillin allergy but low anaphylaxis risk: cefazolin 2g IV then 1g every 8 hours until delivery
Anaphylaxis risk with penicllin then clindamycin 900 ng iv every 8 hours until delivery on vancomycin 1g iv every 12 hours until delivery
-gbs = streptococcus agalactiae, gram +, aerobic diplococci
-can cause nebrown pneumonia, meningitis, sepsis, death
-only iv antibiotic legalised for midwives
-midwives on own authority: penicillin g, ampicillin, cefazolin (if penicillin allergy), clindamycin (if beta lactam sensitivity), erythromycin
-GBS test between 35-37 weeks
-give iv antibiotics in labour for: gbs positive screening at 35-37 weeks, previous gbs infection, gbs bacteriuria
-penicillin g million units IV then 2.5-4 million every 4 hours until delivery or
Penicillin allergy but low anaphylaxis risk: cefazolin 2g IV then 1g every 8 hours until delivery
Anaphylaxis risk with penicllin then clindamycin 900 ng iv every 8 hours until delivery on vancomycin 1g iv every 12 hours until delivery
Penicillin allergy:
-immediately or within 1 hour
-hives
-wheezing SOB
-anaphylaxis
-local edema
-there penicillin can be used safely (rash, nausea. vomiting, diarrhea, reaction days after is not an allergy)
vancomycin
-often GBS prophylaxis if penicillin allergy and gbs strain is resistant to both clindamycin and erythromycin
-vancomycin cannot be used in home birth, midwives must consult with physician for medication order
-administered by IV at not more than 10 mg/min at no less than 60 minutes
-can cause hypoeins, cercosis, cardiac arrest
penicllin excretion
-primary route is renal - tubular secretion and glomerular filtration
-end up in urine unchanged mostly
-renal function in newborn is poor so half life of penicllcin is longer
-kidney remove from blood and secrete in urine
-gf = small water soluble substances from blood to tubule at glomerulus
-ts = substances move from peritubular capillaries to isf to tubule
penicllin adverse effects
-little effects, maybe diarrhea due to disruption in gut flore (not common in gbs prophylaxis)
-some show hypersensitivity - rash, resp issues, hypotension
-cephalosporin is contraindication
gbs prophylaxis
penicllin, then cephalosporins (if mild hypersensitiivty to penicliin)
cefazolin for gbs prophylaxis
-cefazolin can be used for gbs prophylaxis
-beta lactam antiiobitic if slight hypersensitive to penicillin
-borad spectrum
-longer half life
-like penicllins ens up unchanged in urine
cefazolin
-gbs prophylaxis if not penicllin
-some hypsenesitivty, long term course can cause diarrhea
-do not use if sever issue with penicllin or other cephalosporin
gbs prophylaxis clindamycin and erythromycin
-if serious hypersensitivity to beta lactam (penicllin/cephalosporin) use clindamycin or erythromycin
-inhibit prptein synthss and narrow spectrum
-significant bacterial resistance and cross resistance so dont bother switching between 2
gbs prophylaxis for clindamycin
-clindamycin is 2nd lineish for mastitis and gbs proph.
-mostly done at liver but some unchanged in urine
-dont give with eryhtromhycin
wound care
-cesarean rate 28 in canada, who reccoments 10
-seromas (serous fluid accumulating), heamtomas (blood accumaulating), infections, dehisence (reopening of incision)
-risk factors: diabetes, obesity, tobacco use, malnutrion, immunosupression
-often cephalexin/keflex, then amoxicllin-clavulanic acid
beta lactams and cell wall synthesis
-beta lactam ring = penicillin/cephalosporins
-bacteria have cell wall made of peptidoglycan and cross brudges. penicliin-binding proteins synthesize crossbrifges for good cell structure
-beta lactam rng emters bacterial cell and binds to pbps inhibiting pbp ability to form cross bridges betweeen peptiodglcyan strings
-so bacterial cell is weakened and lysis will occur
