Quiz 4 Flashcards
what kind of gram stain are cocci? rods?
cocci are Gram +
rods are Gram -
Main cause of bacterial resistance in certain antibiotics
name is enzyme
Hydrolysis of beta-lactam ring of basic penicillin structure. This opens up the ring, thus making the drug ineffective
Beta Lactamase
3 examples of Beta-lactam antibiotics
penicillins (including amoxicillin, ampicillin), cephalosporins, & cabapenems
what does ERBL stand for?
Extended Release Beta Lactamase
What have the addition of clauvonic acid & tazobactam done for some beta-lactam antibiotics? (1 good 1 bad)
Good News:
Beta-lactamaseinhibitors inhibit the beta lactamase thereby not allowing the molecule to hydrolyze the antibiotic. Most ESBLS remain susceptible to Beta-lactamaseinhibitors
Bad
News:some ESBL producing bacteria produce large amounts of beta-lactamase thereby overwhelming the beta-lactamaseinhibitors
do 1st and second generation cephalosporins have a narrow or broader spectrum? 3rd and 4th and 5th?
1st and second have narrower
3rd 4th and 5th have broader
Nitrofurantoin has a good spectrum of coverage for both what?
what is this used to treat?
when not to use?
gram + and gram - bacteria effects
UTI’s
renal insufficiency/failure
Bactrim is a combo of sulfa & trimethoprim. It’s got effects on what kind of bacteria?. what is it good to treat? (3)
gram+ and gram- bacteria effects
A good choice for wounds, milder cellulitis and UTIs while awaiting culture results
Vancomycin has effects on what kind of bacteria?
Gram + only
To treat C-Diff how is vancomycin administered?
orally or feeding tube
IV does not work!
When is IV vanco administered?
what does it require?
what syndrome does this cause?
all serious gram + infections (oral does not work here)
blood level monitering
red man syndrome (not an allergy)
severe allergy due to Vanco can cause what condition to occur in the skin?
sloughing
What kind of bacteria does Zyvox work on?
Gram +
give to patients who cant tolerate Vanco
Zyvox has an MAOi like risk causing what kind of crisis?
what kind of meds should a patient NOT be on if taking zyvox?
hypertensive
serotonergic medications, antidepressants, stimulants and other medications
Aminoglycosides are what kinds of toxic?
what kind of bacteria do these treat?
nephrotoxic and ototoxic (need blood monitoring)
Gram -
how to treat pseudomononas?
2 antibiotic agents from 2 different classes
For example: Zosyn or ceftriaxone with an aminoglycoside.
What does bacteria colonization mean? Can one patient which colonized bacteria infect another patient who’s currently infection free?
a person can have the bacteria but not experiance symptoms
yes
what is given to treat acute viral infections such as herpes simplex, herpes zoster, or viral meningitis?
Acyclovir PO or IV
most antiobiotics can induce what kind of reactions? (4)
allergic reaction (as severe as anaphylaxis), renal impairment (watch serum creatinine), blood dyscrasias, GI distress
what is C-Diff?
what are its risk factors?
Gram+ anaerobe affecting GI system
PPIs, Currently taking or having recently taken antibiotics
Taking broad-spectrum antibiotics that target a wide range of bacteria
Using multiple antibiotics
Taking antibiotics for a long time
Not too sick with c-diff We give what?
metronidazole (Flagyl).
Very sick with C-diff we give what?
PO Vanco
Persistent, resistant C-Diff?
We give PO Vanco and Flagyl.
Steroids increase risk of what?
Fungal infection
what do we use to combat systemic fungal infections?
topical fungal infections?
Systemic -Amphoterecin B (IV) & Itraconazole (PO)
Topical - Griseofulvin (PO), Nystatin (topical), & azoles
Azols can cause what type of impairment?
liver
How do we treat sepsis of unknown source upon presentation? (3)
Get cultures, then broad spectrum gram+ & gram- coverage. Continue both until the culture results are known.
if severe fungal infection of lungs, urine, blood or brain (cryptococcal meningitis) is suspected give what drugs? (2)
Amphotericin or IV azoles
what two tests are done if meningitis is suspected?
If it looks bacterial, we give what for gram -? gram +?
If Cryptococcus is suspected (AIDs patients) give what?
lumbar puncture and CSF culture
as IV Ceftriaxone (for gram-)
IV Vanco (for gram +)
IV azol added
if a patient presents with chills there is a high suspicion of what?
sepsis
what 3 cultures should be done in cases of suspected sepsis?
what other test?
If in doubt, start what antibiotics?
Culture urine, sputum & blood
Xray
IV gram neg and gram pos coverage.
during a UTI what 4 things will be increased?
UA elevated WBCS (pyuria), may have +blood, +leukocyte esterase & nitrate
most, but not all UTIs are gram what?
negative
if a patient is very sick with UTI give what?
IV antibiotics
What is the leading cause of sepsis?
UTI
what is a common cause of death in the elderly?
UTI Sepsis
what is the leading cause of UTIs in hopsitals?
Indwelling catheters (Foley)
how to wash your hands after seeing a C-Diff patient?
soap and water
PUREL/HAND SANITIZER DOES NOT WASH OFF C DIFF
SIADH means you have too much of what?
ADH (serum hyponatremia, hypo-osmolarity) (Elevated Urine sodium & osmolarity)
SIADH can be caused by (4)
neuro injury, lung cancers, pituitary or hypothalamic dysfunction & meds (SSRIs).
why is SIADH treated slowly?
osmotic demyelination syndrome
neurological disease caused by severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the pons
SIADH treated with what?
what drug is great, what drug is not so great for treatment?
fluid restriction, discontinue offending medication, possibly demeclocycline (not so great) or Tolvaptan (works great. ADH antagonist)
what is diabetes insipidus caused by?
Most commonly due to brain trauma or pituitary tumor
what are symptoms of Diabetes insipidus? (3)
serum hypernatremia, hyperosmolarity. Copious dilute urine output with low urine sodium and osmolarity.
how to treat DI?
Vasopressin (DDAVP) which is an antidiuretic hormone to replace lost fluid
most hypothyroidism is due to what kind of pathology?
Primary thyroid pathology
Regardless of cause, hypothyroidism is treated with what?
synthroid
Primary thyroid hypothyroidism will show what levels?
High serum TSH, low T3, low T4.
hypothyroidism due to pituitary pathology will show what levels?
low or normal TSH, Low T3, low T4.
when treating with synthroid one must keep getting TSH levels checked. what to do if levels are too high? steadily decreasing? if too low?
increase synthroid
continue same dose
decrease synthroid
Pituitary disorder causing hypothyroidism how should synthroid be manipulated to treat the patient?
titrated based on serum T3 & T4. If they are still low, more synthroid may be needed. If they’re coming up nicely, leave synthroid dose alone. If they are high, synthroid dose should be decreased. Pituitary tumor should be dealt with if possible
myxedema coma occur in what patient population?
what 6 things can trigger this?
older women
Bradycardia. Medications, stress, trauma, sepsis & surgery can trigger this.
how to treat hyperthyroidism?
some meds may help, but will eventually need thyroidectomy followed by synthroid for life
what is a thyroid storm?
what is it induced by?
hyperthyroid crysis.
Induced by stress, trauma, infection, surgery,
How to treat a thyroid storm?(3) what meds? (3)
IV fluids, Beta Blockers, glucocordicoids
PTU which prevents T3 & T4 production
Tapazole which prevents thyroid hormone production
Iodides which block release of stored thyroid hormone
What gland is overactive during cushings syndrome?
excess adrenal gland release
what are the common symptoms of cushings disease
fatty deposits such as moon face or buffalo hump
purple stretch marks on abs, thighs, breasts, and arms
thin fragile bruising skin
slow healing cuts/infections
acne
high blood sugar/pressure
excess hair in women/reduced sex drive in men
what is Cushingoid? what causes this?
You don’t have the disease, just the same symptoms of the disease. Most commonly due to steroids.
Addrenal Insufficiency is life threatning because it causes what two hypo conditions>?
what is it due to?
how to treat?
hypotension & hypoglycemia
abrupt cessation of steroid therapy
Treatment: resume steroids. May need medication or fluid to bring BP up and glucose for low blood sugar.
what is Addisons disease?
how to treat?
autoimmune disorder of chronic adrenal insufficiency
steroid therapy
What’s the difference between DM I & DM II?
DM I always needs insulin therapy
how does glucophage work?
what are the side effects of glucophage?(6)
reduces hepatic glucose production/ reduces glucose absorption
if combined with other agents > hypoglycemia
nausea, cramps, diarrhea
renal failure
lactic acidosis
what are the less common side effects of glucophage
Metallic taste, agitation, sweating, headache, may reduce B-12 level
Secretagauges work by increasing what?
what is an example of a longer acting secretagauges? short acting?
insulin secretion
Sulfonureas are longer acting. Meglitinides are short acting (starlix & prandin) and usually taken TID with meals.
which type of diabetics may “burn out” and require insulin for adequate glucose control
type II diabetics
what is the most important side effect to remember with r/t insulin and oral agents (especially in combination with each other).
hypoglycemia
in a patient with unexplained change in mental status. what should always be checked
blood sugar
what activity decreases insulin requirements?
exercise, However, the patient may develop hypoglycemia during your session as the body responds to exercise on the old diabetic medication regime.
