Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Micro Exam 1 > Pogue: Clinical Treatments > Flashcards

Pogue: Clinical Treatments Flashcards

1
Q

JP is a 31 y/o male with blood cultures positive
for P.aeruginosa. Which of these agents would
not be appropriate empirically?
– A) cefepime
– B) tigecycline
– C) piperacillin
– D) meropenem

A

B) tigecycline

Will get a question like this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

LL is started on ampicillin for an urinary tract
infection with e.faecalis which of the following
adverse events is most likely
– A) nephrotoxicity
– B) increased LFT
– C) allergic reaction
– D) Infusion site reaction

A

C) allergic reaction

Beta Lactams and allergic rxns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q 
Linezolid’s therapy limiting side effect is
– A) a high rate of nephrotoxicity
– B) allergic reactions
– C) thrombocytopenia
– D) drug interactions, lots of ‘em!
– E) hepatotoxicity
A

C) thrombocytopenia

Will get a question like this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
Which of the following lacks activity against
VRE
– A) tigecycline
– B) doripenem
– C) daptomycin
– D) linezolid
A

B) doripenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Skin and Soft Tissue Infections

Most common agents

A

S.aureus

S.pyogenes (Group A Strep)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Skin and Soft Tissue Infections

Common disease states (3):

A 
o	Impetigo
o	Erysipelas (Strep)
o	Cellulitis (Staph, Group B Strep)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Streptococcus Pyogenes Infections:
DOC:
What type of resistance is increasing?

A

Penicillin (only if it is strep pyogenes alone!)

Erythromycin resistance increasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Staphylococcus Aureus Infections:

Empiric coverage:
Recently need to cover:

A

EMPIRIC COVERAGE WILL USUALLY NEED TO COVER STAPH!!

Increase in CA-MRSA over the past few years requires that we routinely cover for MRSA as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Oral MSSA Agents (3):

A

Amoxicillin/clavulanic acid

Dicloxacillin (Negative- needs to be dosed 4x per day)

Cephalexin (Negative- needs to be dosed 4x per day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Oral MRSA Agents (5):

A 
Doxycyline
TMP/SMX
Linezolid
Clindamycin (remember to do D test if erythromycin resistant and clindamycin susceptible)
Quinolones?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why are Quinolones last line against MRSA?

A

Quinolones (maybe respiratory quinolones, which have good activity; BUT really last line!!)

Why? One-step, rapid mutation against staphylococcus resulting in resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Worried about Staph and Strep Together?

TMP/SMX and doxycycline?
All other MSSA/MRSA agents?

A

TMP/SMX and doxycycline are NOT RELIABLE against GAS

All other oral MSSA/MRSA agents could be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Skin and Soft Tissue Infections

Treatment Basics:

A

Use agent with most narrow spectrum

Follow-up at 24-48 hours is crucial: assess success of regimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Use agent with most narrow spectrum:

MSSA:
MRSA:

TMP/SMX?

A

MSSA: beta-lactam

MRSA: doxycycline, clindamycin are good options; ED physicians often use TMP/SMX if they are sure it is MRSA

Remember: TMP/SMX will NOT cover GAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Severe Cellulitis

MSSA:
MRSA:

A

Severe Cellulitis: IV therapy is indicated

o MSSA: nafcillin is DOC
o MRSA: vancomycin is DOC (Note: empiric coverage often for MRSA due to increasing prevalence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cellulitis
Duration of Therapy:

Uncomplicated vs. severe

A

Duration of Therapy:

Tailored to clinical scenario: this is why follow up assessment is necessary

Uncomplicated Cellulitis: 5 days

Severe Cellulitis: up to 14 days (IV therapy; can step down to oral treatment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Necrotizing Faciitis

Causative Agent:
Polymicrobial Infections:

A

Causative Agent: S.pyogenes (most commonly); can also be Vibrio, aeromonas and MRSA (more recently)

Polymicrobial Infections: can be seen in at risk populations (PVD, DM, decubitis ulcers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Gas Gangrene

Causative Agent:

A

Clostridium spp. (most commonly C.perfringens)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Necrotizing Infections
Treatment:

Group A Strep and Clostridial Infections:

Clindamycin?

A

PROMPT SURGICAL DEBRIDEMENT

Group A Strep and Clostridial Infections: penicillin + clindamycin

Clindamycin: although it has decent activity against these agents, really given to suppress toxins (via inhibition of protein synthesis); hypothetically, other ribosomal Abx would work as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Animal Bites

Empirical treatment:
Skin bugs:
Mouth bugs:

A

Animal Bites:
• Need to cover Pasturella multocida empirically!!
- Also staph and strep (because these are on the skin)
- Also anaerobes (because these are in the mouth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Animal Bites
Treatment:

PO:
IV:

A

Pasturellla often has a beta-lactamase: therefore, B-lactam/B-lactamase inhibitors are the mainstay of therapy

Amoxicillin/Clavulanic Acid: PO

Ampicillin/Sulbactam: IV

Alternatives: doxycycline, moxifloxacin (especially in penicillin allergies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment of human bites:

A

Human bites (and fists to the mouth) should be treated the same way (minus the need for Pasturella coverage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Diabetic Foot Ulcers

Causative Agents:

A

G(+) cocci, predominantly S.aureus; as time goes on, GNR and anaerobes as well

24
Q

Diabetic Foot Ulcers

Treatment of uninfected ulcers:

A

Treatment: UNINFECTED ULCERS SHOULD NOT BE TREATED; ONLY TREAT UNTIL INFECTION RESOLVES Empiric

25
Q

Diabetic Foot Ulcers

Therapy:

A

Therapy:
o IV therapy initially
o Commonly with vanomycin + amp/sulbactam (however, a wide variety of regimens can be used to cover the likely pathogens)

26
Q 
Diabetic Foot Ulcers
Duration:
Mild
Moderate to severe
osteomyelitis
A

Duration: only treat until infection is gone (not until ulcer heals)
o Mild Infections: 1-2 weeks
o Moderate to Severe Infections: 2-4 weeks
o Osteomyelitis: 4-6 weeks

27
Q

BONE AND JOINT INFECTIONS
Basics:
The most common agents:

A

Most common causative agents: staphylococcus spp. (MSSA, MRSA, coagulase-negative staph); in certain scenarios, anything can play a role.

28
Q

BONE AND JOINT INFECTIONS

Duration of Therapy:

A

o At least 3 weeks of therapy for joint infections (4+ weeks for S.aureus or pseudomonas)
o At least 4-6 weeks of therapy for bone infections (possibly followed by suppressive therapy)

29
Q

BONE AND JOINT INFECTIONS

Therapy Basics:

A

o Long duration
o Maximum doses (IV)
o Bactericidal drugs

30
Q

BONE AND JOINT INFECTIONS
Staphylococcus Aureus Infections
Therapy:
IV

A

IV therapy to start:
o MSSA: nafcillin is the DOC
o MRSA: vancomycin is the DOC

31
Q

BONE AND JOINT INFECTIONS
Staphylococcus Aureus Infections
Therapy:
Oral

A

Oral Therapy:

Linezolid: option for patients with limited IV access (not first line)

32
Q

BONE AND JOINT INFECTIONS
Staphylococcus Aureus Infections

Suppressive Therapy:

Commonly used drugs:

A

Often used for staph infections

Commonly used drugs:

  • Doxycycline
  • TMP/SMX
  • Clindamycin
33
Q

BONE AND JOINT INFECTIONS
Staphylococcus Aureus Infections

Note About Rifampin:
Monotherapy:

However, commonly used when hardware is involved (prosthetic valves, hips etc.) Why?
What is used in these scenarios?

A

Not good as monotherapy (due to easy mutation)

Staph aureus produces a biofilm on foreign material
Rifampin has excellent biofilm penetration

Nafcillin/Vancomycin + Rifampin used in these scenarios

34
Q

BONE AND JOINT INFECTIONS
Staphylococcus Aureus Infections

What is given to manage pain?

A

Anti-inflammatory drugs given to relieve pain

Standard antibiotic treatment often effective

35
Q

Gram Negative Infections:

First line therapy:
Oral Step Down:

A

First line therapy: IV B-lactam against causative agent

Oral Step Down: FQ (due to good oral availability; also good for penicillin allergy)

36
Q

JJ is a 32 y/o with uncomplicated cellulitis. He
has a history of anaphylaxis with penicillin.
Cultures show s.aureus susceptible to all of
the following antibiotics. Which treatment
should be chosen? Why?
– A) cephalexin
– B) linezolid
– C) vancomycin
– D) doxycycline

A

D) doxycycline

It is less expensive.
Cephalexin-penicillin
linezoild - more narrow

37
Q

Rifampin‐ remember the pearls
• Drug interactions‐ Why?
• Your patient is crying blood?
• Watch alcohol intake‐ why?

A

CYP inhibitor

Colorizes urine and tears

Hepatotoxicity

38
Q

PSEUDOMONAS:

G+/-?
What do some physicians do?

A

Gram negative that clinicians worry about because it is virulent and develops resistance easily

Some physicians try to use 2 agents to double cover pseudomonal infections- there is no clinical evidence that this is effective in vivo

39
Q

Pseudomonal Treatment:

A

IV B-lactam for 4-6 weeks

  • Joint: 4 weeks
  • Bone: 6 weeks

Can also add anti-pseudomonal Aminoglycoside (gentamicin, tobramycin, amikacin) or FQ (cipro, levo) for 2 weeks

40
Q

Review: antipseudomonal agents

A
  • Piperacillin, Piperacillin/tazobactam
  • Cefepime, Ceftazadime
  • Aztreonam
  • Imipenem, Meropenem, Doripenem
  • Gentamicin, Tobramycin, Amikacin
  • Ciprofloxacin, Levofloxacin
  • Polymyxins
41
Q

Disseminated Infections Attacking Joints:

DOC:

A

Neisseria Gonorrhea: Cetriaxone is the DOC.

42
Q

BACTERIEMIAS
Basics:
Source Control:

Skin/bone/joint:
Catheter-related:
Pulmonary:
Urosepsis:

A

Source Control: the appropriate therapy differs based on the source of the infection; if you can manage the source you can manage the bacteremia

o Skin/Bone/Joint: Gram (+)
o Catheter-Related: Gram (+), Gram (-), candida spp.
o Pulmonary: organisms associated with pneumonia
o Urosepsis: urinary pathogens

43
Q

Catheter-Related Bloodstream Infections:
Basics:

Therapy:

A

Basics:
o The longer the line is in, the higher the chance (don’t leave it in longer than it has to be)
o If you can, remove infected catheter (not always possible)

Therapy: antibiotic lock therapy (high concentrations of Abx placed directly in the catheter)
- Almost never works

44
Q

Catheter-Related Bloodstream Infections

Duration:
Coagulase-Negative Staph:
Most bacteria and fungi:
S.aureus (seeding):

A

Duration:
o Coagulase-Negative Staph: 5-7 days
o Most bacteria and fungi: 14 days
o S.aureus (seeding): at least 14 days

45
Q

Catheter-Related Bloodstream Infections

Candida in the Blood:
Empiric therapy: depends on:
Risks:
No/Low-Risk for C.glabrata:
C.glabrata:
A

Empiric therapy depends on risk for fluconazole-resistant organisms (C.glabrata)

Risks: recent azole exposure, known carrier of C.glabrata

No/Low-Risk for C.glabrata: use fluconazole
C.glabrata: use an echinocandin

46
Q

ENDOCARDITIS
Basics:
Causative Agents:

A

Basics:
- Difficult to treat (often needs surgical intervention)

Causative Agents:
o	G (+) organisms: most common
o	Gram (-), including pseudomonas
o	Candida spp.
o	HACEK organisms
47
Q

ENDOCARDITIS
Duration:
Regimen:

A

o Duration: usually 4-6 weeks
o Regimen: IV antibiotics (max dose, bactericidal); occasionally, highly bioavailable oral drugs may be used (as step down therapy)

48
Q

Strep Endocarditis

Causative Agents:
Duration of Treatment:

A

Causative Agents: Viridans strep and S.bovis

Duration of Treatment:
Standard: 4 weeks; Prosthetic Valve: 6 weeks

49
Q

Strep Endocarditis

Treatment:
What is preferred?
Second-line?
What can be added? Why for resistant and sensitive strains?

A

Treatment: depends on susceptibility pattern

B-Lactams Preferred: penicillin (if susceptible) or cetriaxone

Vancoycin: if penicillin allergy exists

Gentamicin can be added:

  • Resistant strains: for synergy (entire course of treatment)
  • Sensitive strains: to shorten duration of therapy (only 2 weeks)
50
Q

Staph Endocarditis:

Causative Agents:

Treatment:
MSSA/MSSE:
What if they have an allergy to penicillin? Severe? Non-severe?

A

Causative Agents: S.aureus and coagulase-negative staph (most commonly S.epidermidis)

Treatment:
MSSA/MSSE:
- Nafcillin for 6 weeks
- Gentamicin for 3-5 days (synergy; shortens duration of bacteremia)

Penicillin Allergy:
Cefazolin (non-severe)
Vancomycin (severe)

51
Q

Staph Endocarditis:

Treatment
MRSA:
Prosthetic Valve:

A

MRSA:
Vancomycin (high dose)

Prosthetic Valve:
May require more than 6 weeks of nafcillin therapy
Add rifampin (penetration of biofilm)
Gentamicin for 2 weeks

52
Q 
Enterococcal Endocarditis:
Treatment:
DOC:
If VRE (3):
What should be added to cell wall agent for synergy?
A

Ampicillin is the DOC (if sensitive); if not, vancomycin is next in line

If VRE:

  • Daptomycin
  • Quinupristin/Dalfopristin
  • Linezolid

Gentamicin should be added to cell wall agent for synergy

53
Q

Enterococcal Endocarditis:

Duration:
Ampicillin susceptible
Vancomycin
VRE

A

Duration:
o Ampicillin susceptible: 4-6 weeks
o Vancomycin: 6 weeks
o VRE: at least 8 weeks

54
Q

Miscellaneous Endocarditis Bugs

G-:
Use what if possible:
Some use:

Candida:
What is notable?
Use?

HACEK:
Common in what type of pts?
Commonly used drugs (2):

A

Gram (-):
o Use B-lactam if possible (high doses)
o Some use 2 drugs for pseudomonas

Candida:
o HIGH MORTALITY RATE
o Therefore, will always use amphotericin B + flucytosine (synergy)

HACEK Organisms:
o	Gram negatives common in patients in the community who are not IV drug users
o	Commonly Used:
-	Ceftriaxone (4 weeks)
-	Ampicillin/Sulbactam  (4 weeks)
55
Q

What is the duration of each infection:

Prosthetic valve strep endocarditis

Coag (‐) staph (Catheter-related bloodstream infection) CRBSI

Severe cellulitis

Candida bacteremia

Pseudomonal joint infection

A

Prosthetic Valve Strep Endocarditis: 6 weeks

Coag (‐) Staph CRBSI: 5-7 weeks

Severe Cellulitis: 14 days

Candida Bacteremia: 14 days

Pseudomonal Joint Infection: 4 weeks

56
Q

Major side effects:
Doxycycline
TMP/SMX
Clindamycin

A

– Doxycycline – photosensitivity and chelation
– TMP/SMX – rash/allergic reactions
– Clindamycin – diarrhea

Micro Exam 1 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions