Random 2 Flashcards
What is the approach to treating osteomyelitis?
If from outside source: poymicrobial
From healthcare source: consider MRSA
Empiric coverage: gram (+) and gram (-) coverage recommended with emphasis of MRSA —> Vanc + 3rd gen cephalosporin for most
*Cefepime an option if Pseudomonas coverage needed
*Daptomycin is alternative to vancomycin
Vanc: MRSA coverage, if red man: lower infusion rate, nephrotoxicity, ototoxicity, trough and kid function are important to help guide dosing
*10-20 mcg/ml is target trough level-higher end for more life threatening infections
Levoquin or 3rd gen cephalo: commonly used to cover gram (-), quinolones have antipseudo cov, ceftriaxone does not adequately cover
Clindamycin: good coverage for most anaerobes, dose is 3-4 times daily with full glass of water to minimize esophageal ulcer risk, cdiff risk
Nafcillin or cefazolin if MSSA
Rifampin common add-on, can help precent biofilm and infection from recurring, hepatox, hyperbili, skin reactions, red secretions, notorious enzyme inducer (reduces levels of medications like warfain, phenytoin etc)
What is the treatment for nephrolithiasis or kidney stones?
Pain management: APAP, IBU, opioid short term
Open ureters to hep ease passing the stone: alpha blockers
If uric acid based stones: allopurinol, febuxostat
Alkalize urine: potassium citrate
Inc serum calcium but help reduce urine in calcium: thiazides
What is neuroleptic malignant syndrome (NMS)?
Extremely rare condition with symptoms: high BP, tachycardia, very high fever, CNS changes (agitation), muscle rigidity, tremor
Due to antipsychotic use: usually happens when initiated or dose is increased
Possible risk factor w/ use of older gen antipsychotics that have higher instances of EPS type symptoms (haloperidol, fluphenazine, etc)
How do you treat NMS?
DC causative agent, Primarily supportive care: cooling blankets, cooled IV fluids, antipyretics
-Dantrolene: skeletal muscle relaxant (can help bring down temp, possibly help with rigidity) *possible risk of liver toxicity
-Bromocriptine: dopamine agonist that can counteract activity of the dopamine antagonist (antipsychotic meds)
-Benzos: sedating and potentially can help with reducing CNS changes and associated tremor
T/F: midodrine is an alpha agonist opposite of alpha blocker
True. Midodrine is used for hypotension, may exacerbate BPH; constricts blood vessels to raise BP, thus can negatively impact urinary flow
What are the medications for organ transplant patients?
- Calcineurin inhibitors: cyclosporine, tacrolimus
- Corticosteroids: prednisone
- Antiproliferative agents: mycophenolate, azathiprine
T/F: cyclosporine and tacrolimus are notorius for CYP3A4 drug interactions
True
T/F: mycophenolate has different dosage forms that are NOT interchangeable for dosing
True.
*Mycophenalate should be taken on an empty stomach, as food can alter cmax
*GI side effects common, HTN, and edema
What are goal levels for cyclosporine and tacrolimus?
Cyclosporine trough: 100-400
Tacrolimus levels: 5-25, <20
What are some side effects of calcineurin inhibitors?
HTN, immunosuppression
Elevated TG, glucose (risk of diabetes)
Hyperkalemia, elevated uric acid
inc risk in certain cancers
GI upset
Alopecia
What antibiotics are used for sinusitis?
Augmentin
For PCN allergy: doxycycline, quinolones, macrolides
*quinolones should be avoided due to risks (tendon rupture, glucose abnormalities, CNS effects- confusion), renal adjustments needed
*macrolides, not recommended due to resistance
Supportive therapy:
analgesics - APAP, IBU
nasal steroids - flonase/nasonex; nasal saline; decongestants; nasal oxymetazoline (rebound congestion if used more than 3-5 days)
