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Neuro 2 > Pharm: Meningitis > Flashcards

Pharm: Meningitis Flashcards

1
Q

Meningitis Tx

  1. age 1 mo- 50 yr; recurrent meningitis; basilar skull fracture; greater than 50 yr
  2. impaired cellular immunity; head trauma, neurosurgery or CSF shunt
  3. age 0-4 wk
  4. what should you add if Listeria is suspected
A
  1. vancomycin + cefotaxime or ceftriaxone (add ampicillin if over 50 yr)
  2. vancomycin + ampicillin + cefepime or meropenem (or ceftazidime)
  3. ampicillin + cefotaxime or aminoglycoside
  4. ampicillin
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2
Q

aminoglycosides

A

bactericidal
bind 30s
AE: nephrotoxic, ototoxic, teratogen

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3
Q

3rd generation cephalosporins

A

PBP inhibition

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4
Q

gentamicin

A

aminoglycoside

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5
Q

tobramycin

A

aminoglycoside

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6
Q

ampicillin

A

PBP inhibition

AE: pseudomembranous colitis

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7
Q

cefotaxime

A

PBP inhibition

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8
Q

ceftriaxone

A

PBP inhibition

AE: eosinophilia, thrombocytosis

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9
Q

meropenem

A

PBP inhibition

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10
Q

vancomycin

A

inhibition of transpeptidation and transglycosylation

AE: nephrotoxic, ototoxic

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11
Q

dexamethosone

A

adjunct Tx for bacterial meningitis: decrease TNF-a, IL-1, CSF inflammation, cerebral edema
attenuates detrimental effects of host defense that lead to hearing loss

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12
Q

amphotericin B

A

IV: poor CNS entry
fungicidal
pores in fungal cell membrane
AE: nephrotoxic (reduce with liposomal); infusion rxn (prophylaxis with NSAID, steroid, antihistamine)

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13
Q

-azoles

A

oral, IV
CYP
fungistatic (-cidal at high dose)
block 14a-sterol demethylase: disrupts fungal cell membrane

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14
Q

fluconazole

A

azole that can penetrate CSF

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15
Q

voriconazole

A

azole that can penetrate CSF

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16
Q

flucytosine

A

oral
converted to 5-FU by fungal cytosine deaminase
blocks thymidylate synthase and disrupts DNA synthesis
enters CSF
do NOT use alone: RESISTANCE
AE: BONE MARROW (anemia, leukopenia, thrombocytopenia), liver enzymes

Neuro 2 (10 decks)

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