Quiz 4 Flashcards by Eric Johnson

what kind of gram stain are cocci? rods?

cocci are Gram +

rods are Gram -

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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

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3 examples of Beta-lactam antibiotics

penicillins (including amoxicillin, ampicillin), cephalosporins, & cabapenems

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what does ERBL stand for?

Extended Release Beta Lactamase

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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

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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

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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

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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

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Vancomycin has effects on what kind of bacteria?

Gram + only

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To treat C-Diff how is vancomycin administered?

orally or feeding tube

IV does not work!

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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)

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severe allergy due to Vanco can cause what condition to occur in the skin?

sloughing

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What kind of bacteria does Zyvox work on?

Gram +

give to patients who cant tolerate Vanco

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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

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Aminoglycosides are what kinds of toxic?

what kind of bacteria do these treat?

nephrotoxic and ototoxic (need blood monitoring)

Gram -

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how to treat pseudomononas?

2 antibiotic agents from 2 different classes

For example: Zosyn or ceftriaxone with an aminoglycoside.

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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

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what is given to treat acute viral infections such as herpes simplex, herpes zoster, or viral meningitis?

Acyclovir PO or IV

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most antiobiotics can induce what kind of reactions? (4)

allergic reaction (as severe as anaphylaxis), renal impairment (watch serum creatinine), blood dyscrasias, GI distress

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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

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Not too sick with c-diff We give what?

metronidazole (Flagyl).

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Very sick with C-diff we give what?

PO Vanco

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Persistent, resistant C-Diff?

We give PO Vanco and Flagyl.

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Steroids increase risk of what?

Fungal infection

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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.

Quiz 4 Flashcards

(68 cards)