Related to infections disease

Question 1

Difference between Contraindication and precaution

Answer 1

Contraindication: Greatly increases chance of serious adverse reaction when vaccine given.
Precaution: Might increase the chance of serious adverse reaction when vaccine given.

Question 2

What is the most common allergy to the influenza vaccine? Recommend what should be done based on allergy severity

Answer 2

Egg. If patient develops hives, they can receive the vaccine with close monitoring (precaution). If patient develops anaphylaxis (contraindication) the patient should not receive inactivated flu shot and instead should get the Flublok.

Question 3

How does one get C. Diff

Answer 3

Taking antibiotics kills gut bacteria that keeps C. Diff growth in check. Overgrowth of C. Diff can cause CDAD and other consequences.

Question 4

Define and recommend treatment for initial episode of CDAD (mild-mod, severe, and severe complicated)

Answer 4

Mild-moderate: WBC <15, SCr < 1.5 x premorbid level (Treat with metronidazole 500mg PO TID x10-14 days)
Severe: WBC >15 and SCr > or = 1.5 x premorbid level (Vanco 125mg PO QID x 10-14 days)
Severe complicated: Hypotension, shock, ileus, megacolon (Treat with Vanco 500mg PO QID x 10-14 days AND IV metronidazole 500mg Q 8 h)

Question 5

Recommend appropriate treatment for first and second recurrence of CDAD

Answer 5

First recurrence: Treat the same as initial episode based on severity
Second recurrence: Vancomycin in tapered/pulsatile fashion

Question 6

Explain the benefits of probiotics and when they should be taken

Answer 6

Probiotics replace bacteria killed by antibiotics and prevent overgrowth of harmful bacteria by replacing them with good bacteria. Separate either 2 hours before or after administration with antibiotics

Question 7

Recommend antibiotics safe in pregnancy and lactation

Answer 7

Generally: Tetracyclines, FQNs, rifampin and gentamicin should be avoided in preg/lactation. (C or D)
Generally: B-lactams, vancomycin and clindamycin are safe in pregnancy (B or C with good evidence)

Question 8

Describe a disulfiram like reaction and list the 2 medications that can cause this reaction when they are mixed with EtOH?

Answer 8

Metronidazole and tinidazole cause flushing, sweating, N/V, HA, tachycardia when mixed with alcohol.

Question 9

Adverse effects of linezolid

Answer 9

Myelosuppression (anemia, thrombocytopenia, pancytopenia, leukopenia), lactic acidosis, peripheral and optic neuropathy, serotonin syndrome when combined with other pro-serotinergic medications, hypertension

Question 10

Adverse effects of FQN’s

Answer 10

Don’t use in children < 18, tendon rupture in > 60, QTc prolongation, CNS (HA, dizzy, seizures), peripheral neuropathy, avoid in MG, photo/hepatotoxicity, hyper/hypoglycemia, chelation w/ cations