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MS3 > Peds 5 > Flashcards

Peds 5 Flashcards

1
Q

MOA of Vancomycin

A

Inhibition of cell wall synthesis by directly binding to D-alanyl-D-alanine oligopeptide

Binds directly to peptidoglycan instead of PBP

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2
Q

What type organisms (not specific) does Vancomycin work againse

A

Only against gram POSITIVE bacteria

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3
Q

Describe Vancomycin’s susceptibility to beta-lactamase

A

Resistant to beta-lactamase since they are not beta-lactams

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4
Q

Specific organisms that Vanc is used for

A

MRSA, meningitis (often combined with CTX), MRSA osteomyelitis, staph epidermidis, endocarditis

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5
Q

Common empiric tx of meningitis

A

Ceftriaxone + Vancomycin

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6
Q

Describe resistance to Vancomycin

A

Due to modification of D-ala-D-ala binding site within peptidoglycan structure (D-ala replaced with D-lac)

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7
Q

Adverse effects of Vancomycin

A

Red man syndrome, thrombophlebitis at injection site, ototoxicity, nephrotoxicity, DRESS syndrome

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8
Q

How do you treat Red man syndrome

A

Anti-histamines (flushing is due to release of histamine)

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9
Q

What is DRESS syndrome

A

Drug reaction with eosinophilia and systematic symptoms (fever, generalized lymphadenopathy, skin rash)

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10
Q

MOA of Daptomycin

A

Daptomycin is a cyclic lipopeptide that inserts lipid tail into cell membrane, leading to depolarization of the cell and cell death

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11
Q

What type of organisms (not specific), does Daptomycin work against

A

Gram positives only (recall that they work via insertion into cell wall and gram positives have thick cell wall)

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12
Q

Uses of Daptomycin (specific)

A

Vancomycin resistant bug (enterococcus), staph species (MRSA, VRSA, endocarditis)

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13
Q

What disease will Daptomycin NOT work for

A

Pneumonia (Daptomycin is antagonized by pulmonary surfactant)

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14
Q

Adverse effects of Daptomycin

A

Myopathy and rhabdomyolysis

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15
Q

Describe MOA of Tetracyclines

A

o Inhibition of bacterial protein synthesis by binding to and interfering with ribosomes – this inhibits translation

  • Bind reversibly to 30S ribosome subunit, inhibiting translation – bacteriostatic
  • Only other 30S ribosome binder is Aminoglycoside
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16
Q

What organisms (not specific) do tetracyclines work against

A

Both gram positive and gram negative

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17
Q

What are tetracyclines used for (specific)

A

MRSA, Rickettsia, Brucella, Coxiella, Yersinia, Chlamydia, Mycoplasma pneumonia, Acne

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18
Q

Adverse effects of Tetracyclines

A 
♣	Tooth discoloration in children
♣	Teratogenic (bone deformation)
♣	GI side effects (N/V/D)
♣	Photosensitivity
♣	Fanconi Syndrome – Type II renal tubular acidosis caused by administration of expired Tetracyclines
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19
Q

Describe resistance to Tetracyclines

A
  • Production of efflux pumps to move the drug out of bacterial cell
  • Alteration of ribosome
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20
Q

What type of drug is Azithromycin

A

Macrolide

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21
Q

MOA of Macrolides

A

Interferes with 50S ribosome – inhibiting translocation

22
Q

Uses of Macrolides

A
  • Bordatella pertussis
  • Community acquired pneumonia caused by Strep Pneumo, H. flu, Moraxella
  • Atypical pneumonia caused by Mycoplasma, Legionella, Chlamydia
  • Urethritis and cervicitis caused by Chlamydia and Gonorrhea
  • Bartonella
  • Diptheria
  • Mycobacterium Avium
  • H. Pylori
23
Q

Adverse effects of Macrolides

A
  • Increased GI motility
  • Acute cholestatic hepatitis
  • Prolonged QT (torsades)
24
Q

MOA of Clindamycin

A

♣ Inhibits 50S ribosome, blocking translocation and protein synthesis – bacteriostatic

25
Q

What broad categories of organisms are treated by Clindamycin

A

Gram positives, Anaerobes

26
Q

What is the general rule of thumb for treatment of anaerobes

A

Clindamycin treats anaerobic infections above the diaphragm and Metronidazole treats anaerobic infections below the diaphragm

27
Q

What type of gram positives does Clindamycin treat

A
  • Strep pyogenes (skin and soft tissue infection)

- MRSA

28
Q

What type of anaerobic infections does Clindamycin treat

A
  • Lung abscesses
  • Aspiration pnemonia (e.g. Bacteroides fragilis)
  • Clostridium perfringens
  • Moderate to severe inflammatory acnes
  • Endometritis caused by retained products of conception, septic abortion, abscess, or foreign body (not caused by Chlamydia or Gonorrhea)
  • Bacterial vaginosis caused by Gardnerella vaginalis
29
Q

Adverse effects of Clindamycin

A

Diarrhea, pseudomembranous colitis

30
Q

What is rickets/osteomalacia

A

♣ Defective mineralization of osteoid
• Osteoblasts still produce osteoid, but it cannot be mineralized with Ca2+ and phosphate to form bone
♣ Due to Vitamin D deficiency, which causes low calcium and phosphate
• Deficiency can be due to poor diet, decreased sun exposure, malabsorption, renal failure, liver failure

31
Q

Describe net effect of PTH on bones

A

New effect of bone resorption/breakdwin = increases calcium

32
Q

Describe effects of PTH on the kidney

A
  • Increases calcium reabsorption
  • Decreases phosphate reabsorption
  • Increases production of Vitamin D activating enzyme
33
Q

Effects of vitamin D on the kidney

A
  • Increases reabsorption of Calcium AND phosphate
34
Q

Effects of vitamin D on intestines

A

Increases absorption of calcium AND phosphate

35
Q

Effects of Vitamin D on bone

A

Increases bone turnover (both osteoclasts and osteoblasts)

36
Q

Describe effects of Vitamin D on PTH

A

Negative feedback - inhibits PTH production by the parathyroud gland

37
Q

How can biliary atresia lead to rickets?

A

Lack of bile salts = no absorption of fat-soluble vitamins (ADEK) = low vitamin D

38
Q

What is Kasai procedure

A

An operation to correct biliary atresia - bowel loop forms a duct to allow bile to drain from liver with biliary atresia

39
Q

Describe labs in Vitamin D deficiency:

  • Calcium
  • Phosphate
  • PTH
  • Alkaline phosphatase
A
  • Decreased Ca2+
  • Increased PTH
  • Decreased phosphate
  • Increased alkaline phosphatase (hyperactivity of osteoblasts)
40
Q

Tx of Vitamin D deficiency in the following age groups:

  • < 1 mont
  • 1-12 months
  • > 12 months
A

< 1 month = 100 IU Vitamin D daily

1-12 = 1000-2000 IU

> 12 = 2000 IU

41
Q

How much Vitamin D should be given as supplement in infants and children

A

< 12 months = 400 IU

1-18 years = 600 IU

42
Q

What is vaso-occlusive crisis

A

Episode of severe pain caused by increased sickling of RBCs, which leads to bone marrow ischemia and infarction

43
Q

What is dactyltitis

A

A form of vaso-occlusive crisis that involves painful swelling of hands and/or feet

44
Q

What is acute chest syndrome

A

A new pulmonary infiltration on chest x-ray in addition to one of the following signs: fever, chest pain, SOB, tachypnea, or low O2 sats

45
Q

What is aplastic anemia

A

Caused by Parvovirus B19 infection in sickle cell patients. Causes depletion of bone marrow, leading to cessation of RBC formation. Reduced lifespan of RBCs in SCD coupled with reduced production can result in profound anemia

46
Q

Tx of vaso-occlusive crisis

A

IV fluids and pain management (e.g. narcotics)

47
Q

Tx of acute chest syndrome

A

Empiric abx, supplemental O2, pain meds, and IVF

48
Q

Long term tx of recurrent sickle cell crisis

A

Hydroxyurea will increase the concentration of fetal hemoglobin, thus reducing the frequency of sickle cell crisis episodes

49
Q

Why should transcranial doppler US be performed annually in sickle cell patients

A

To monitor for signs of stroke

50
Q

Causes of unilateral kidney masses

A
  • Multicystic, dysplastic kidney
  • Hydronephrosis
  • Renal vein thrombosis
  • Mesoblastic nephroma
  • Wilms Tumor
51
Q

Causes of red urine with no RBCs

A

Myoglobinuria!

Beets, Rifampin, Blackberries, porphyrin

MS3 (88 decks)

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