Brainscape's Knowledge GenomeTM

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


See full index

Clinical Pharmacy 2 > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

What is the most common pathogen in skin abscesses?

A

S. aureus (75%)

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

What ate the main kinds of skin abscesses?

A
  • nodules, carbuncles and furuncles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a nodule?

A
  • painful and red in the dermis and deeper structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a furuncles?

A
  • boils in the hair follicle

- inflammatory nodule with overlying pustule collection in the dermis and the deeper structures

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

What are carbuncles?

A
  • collection of furuncles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where are skin abscesses usually located?

A
  • on the back of the neck, face and axillae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between an abscess and cellulitis?

A

Abscess - kind of like a pocket

Cellulitis - goes into the structure of the fat and the hair glands

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

Where does an abscess usually start?

A
  • typically in the hair follicle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the general approach to treating skin abscesses?

A
  • drainage plus/minus heat compresses by 30 minutes, 3-4 times daily for small lesions, or surgical incision and drainage for larger lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is antimicrobial therapy needed to treat a skin abscess?

A
  • for abscesses larger than 2 cms, multiple lesions, extensive cellulites, systemic signs of infection, indwelling medical device or immunocompromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 2 most common antibiotics for treating skin abscesses?

A

Cloxacillin

Cephalexin

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

What is the alternative therapy for treating skin abscess in a severe beta lactam allergy?

A

clindamycin

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

What is the risk of using Clindamycin to treat a skin abscess?

A

increasing resistance in S. aureus

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

What are the risk factors for a MRSA infection?

A
  • MRSA colonization, close contact with MRSA infection, previous antimicrobials or S aureus infection particularly is treatment failure with regimen that lacked MRSA coverage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In what facilities are hospital acquired MRSA infections generally spread?

A
  • medical procedures
  • dialysis
  • hospitalization
  • long term care facilities
  • higher antimicrobial resistance rates than CA strains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What antibiotics are MRSA resistant to? What causes this resistance

A
  • penicillins
  • cephalosporins
  • carbapenams

– alterations in the penicillin binding protein causes this resistance to occur

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

How can S. aureus get into the body?

A
  • natural bug on the skin- if a patient is immunocompromised or in the case of a cut it can get into the skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What medications are used to treat community acquired skin and soft tissue infections?

A
  • Clindamycin (if macrolide resistant there will be an increased risk of inducible clindamycin resistance developing during therapy)
  • Doxycycline
  • TMP-SMX
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Explain an approach to managing patients with recurrent furuncles or carbuncles?

A
  • S. aureus colonized (positive nasal swabs) - mupirocin 2% applied 2-3 time daily for 5 days every month
  • decolonize their nose as a way to get rid of the staph where it is colonized. This can get rid of the skin and staph infections and these patients are susceptible to
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the characteristics and most common pathogens of impetigo?

A
  • highest incidence in children 2-5 years old

- superficial infection of epidermis, 90% non-bullous, 10% bullous

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

What bacteria are potentially in non-bullous impetigo?

A

S aureus and S pyogenes

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

What bacteria are potentially in bullous impetigo?

A

S aureus

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

Gram positive cocci in clumps are _____

A

Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Gram positive cocci in a chain are _____

A

Strep pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Is antimicrobial therapy always indicated?

A
  • moderate to severe non-bullous, and bullous infection
  • mild, non-bullous infections often resolve spontaneously within weeks, however antimicrobial therapy reduces transmission, hastens symptoms and progression, prevents complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Where is strep. viridans usually found?

A

in the mouth and in endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What factors influence the selection of topical antimicrobial therapy?

A
  • non-bullous infections with limited area and number of lesions and low risk of complications
  • mupirocin 2% applied bid for 5 days - mono carboxylic acid inhibits RNA synthesis, more effective than the alternatives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the anti-staph antibiotics used to treat impetigo?

A
  • cloxacillin, cephalexin (these are anti-staph - clindamycin in the case of severe beta lactic allergies)
  • – duration of 7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the po antimicrobial options for pathogen-directed therapy?
(MSSA)

A

cloxacillin and cephalexin

Clindamycin in the case of severe beta lactic allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the po antimicrobial options for pathogen directed therapy? (MRSA)

A

Clindamycin and doxycycline or TMP-SMX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the po antimicrobial options for pathogen directed therapy to treat S. pyogenies?

A

Pen V or Amoxicillin

Clindamycin in the case of a severe beta lactam allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Doxycycline does not cover ______ infections

A

Strept. pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Who can you not give doxycycline to? Why?

A
  • You cannot give doxy to pregnant women and children- it affects the bone and teeth formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the main side effect associated with TMP-SMX?

A

-severe allergy or sensitivity reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Describe cellulitis

A
  • diffuse, superficial skin infection of epidermis and dermis that can extend to cutaneous lymphatics and SC fat; erysipelas synonymous with cellulitis, with various definitions but generally superficial involving upper dermis or lower superficial lymphatics with more delineated borders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What bug is the most common in cellulitis?

A
  • S pyogenes and other beta hemolytic streptococcus including Group B, C, F or G, or less common S aureus (typically associated with purulence abscess, wound, trauma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the clinical presentation of cellulitis?

A
  • appearance can include orange-peel-like, vesicles, bullae, petechiae or ecchymoses, phlebitis or lymphangitis (streaking)
  • local pain, erythema, warmth, deem with systemic sings of infection (fever, chills and malaise)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the risk factors for cellulitis?

A
  • skin disruption (abrasion, insect bite, ulcer, wound, trauma, IVDU), inflammation (eczema, radiation)
  • advanced age, obesity
  • diabetes mellitus, immunocompromised
  • peripheral vascular disease, lymphatic obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the important adjuvant, non-pharm measures for treating cellulitis?

A
  • immobilization
  • elevation
  • cool and warm dressing
40
Q

Why would we use rifampin to treat a staphylococcal infection?

A
  • used in combination with other medications because on its own it can lead to resistance
  • we use rifampin to treat some STAPH infections but only in combination with other antibiotics
  • also use in the case of prosthetic join replacement
41
Q

What enzyme does rifampin induce?

A
  • Cyp P450
42
Q

What is the interaction between TMPSMX and spironolactone?

A
  • affects the renal elimination of potassium so it will increase the K in the body
  • doxy does not have this interaction with spironolactone
43
Q

What factors are considered in selecting po vs IV antimicrobials for treating cellulitis?

A
  • severity of cellulitis based on location, area and progression
  • systemic signs of infections (fever, chills, confusion)
  • po tolerability
44
Q

What is the drug indicated for treating a mild cellulitis infection with S. pyogenes? (po)

A

Pen V
Amov
[Clinda]
— TMPSMX and Doxy both lack strept coverage so therefore clinda is our drug

45
Q

What are the medications that are used for severe cellulitis with suspected pyogenes and/or MSSA?

A
  • cloxacillin
  • cephazolin, cephalexin
    [clinda]
46
Q

You can never give _____ and ______ with an MSSA infection? (do not want to miss the chance that the patient is infected with staph)

A

penicillin and amoxicillin

47
Q

What antibiotic (IV) us used to treat severe cellulitis in outpatient IV programs?

A
  • ceftriaxone (can be given OD)
48
Q

What are the drugs that could be used in treating moderate cellulitis for treating suspected s.pyogenes and/or MRSA?

A
  • clindamycin
  • doxy + (pen and amox)
  • TMP-SMX + (pen and amox)
49
Q

What are the risk factors for MRSA?

A
  • MRSA colonization, close contact with MRSA infection, previous antimicrobials or S.aureus infection particularly if treatment failure with regimen that lacked MRSA coverage
50
Q

What is used for severe cellulitis with suspected S.pyogenes and/or MRSA?

A
  • vancomycin (this is the drug of choice)

[linezolid (also po) or daptomycin]

51
Q

What are the potential disadvantages of using Levo or Moxi?

A
  • quinolines should never be used for a SSTI
  • less effective than the alternative due to unreliable strept and staph activity from intrinsic or acquired resistance during therapy
  • unnecessarily broad Gram negative coverage
  • increasing resistance and significant cover regarding collateral resistance
52
Q

Why might a cellulitis infection get worse after you start antibiotics?

A
  • if the patient receives appropriate therapy and the bacteria break open - release all of the toxins that were inside of the cells so you can notice that the site of infection may not get better in 2 days and might actually get worse
  • should notice that fever and fatigue are better however
53
Q

What is the typical response and duration of therapy for uncomplicated cellulitis?

A

Response: clinical improvement within 24-48 hours, visible improvement may be delayed for 72 hours
Duration: 5 days (for 14 days for severe infection, slow response, immunocompromised)

54
Q

Describe type 1 necrotizing cellulitis

A
  • Type 1 (80%) associated with surgery or trauma; polymicrobial mixed infection with GP, GN and anaerobes
55
Q

Describe type 2 necrotizing cellulitis

A
  • Type 2 (streptococcal gangrene, flesh eating bacteria) caused by virulent S.pyogenes, very rapid progression with severe systemic signs of infection including septic shock
56
Q

Describe type 3 necrotizing cellulitis

A

Type 3 (clostridial gas gangrene- C.perfringens, myonecrosis- C.septicum) associated with surgery or trauma, very rapid progression with gas production and myonecrosis

57
Q

What is used as empirical broad-spectrum antimicrobial therapy for necrotizing cellulitis?

A
  • pip-tazo or meropenum + vanco + clinda
58
Q

S.pyogenes is treated with what?

A
  • PenG and clinda and IVIG for toxic shock
59
Q

Clostridium is treated with what?

A
  • PenG and clinda and IVIG for toxic shock
60
Q

Aeromonas hydrophila (fresh water) is treated with what?

A
  • TMPSMX or Cipro and Ceftriaxone for Doxy
61
Q

Vibrio vulnificus (sea water) is treated with what?

A
  • ceftriaxone and doxy/cipro
62
Q

Why do we want to save carbapenems for last resort?

A
  • broadest antibiotics that we have - carbapenams are the last line of antibiotics and we want to save these antibiotics for when we absolutely need them- we are very worried about resistance
63
Q

Clindamycin is a _____ inhibitor?

A
  • ribosomal- therefore it is inhibiting the synthesis of proteins in the body
  • – macrolides and tetracyclones are also ribosomal inhibitors of protein synthesis
64
Q

What bugs are typically present in a dog or cat bite wounds?

A
  • pasteurella multocida. steptococcus or S.aureus, fusobacteria, prevotella, porphyromonas, bacteroides spp
65
Q

P. multocida is typically susceptible to Pen, Doxy, FQ, TMPSMA and is resistant to what?

A
  • Clinda
66
Q

How many days before do you give antibiotics prophylactically for animal bite wounds?

A
  • 3-5 days before to prevent infection of high risk wounds from a moderate to severe bite, on face, on hands involving joins, significant edema or immunocompromised
67
Q

What is the duration of therapy when treating a bite wound that is already infected?

A

5 to 10 days

68
Q

What is the first line antibiotic for treating an animal bit wound?

A
  • amoxi-clav 875/125 mg q12h, children 20 mg/kg
69
Q

What are the alternatives that are used to treat animal bite wounds?

A
  1. Doxy + (clinda or metro)
  2. Cipro/levo/moxy) + (clinda or metro)
  3. TMPSMX + (clinda or metro)
  4. Macrolide/azolide (if susceptible pasteurella) +clinda
  5. Macrolide/azolide (susceptible pasteurella) + clinda
70
Q

What is used in the case of a severe animal bite infection?

A
  • pip-tazo
  • ceftriax + metro
  • cipro/levo/moxi and clinda/or metro
71
Q

Why can you not use doxy in pregnancy or children?

A
  • has effects on the bones or calcification of the teeth
72
Q

Why can you not use cipro and quinolones in pregnancy?

A
  • tendon issues
73
Q

Why can you not used TMPSMA in pregnancy?

A
  • displaced bilirubin and can cause babies to be born with jaundice
74
Q

What bacteria is cat scratch disease caused by??

A

bartonella henselae

75
Q

What does cat scratch disease appear as?

A
  • presents as papule or pustule with lymphadenopathy within 3-30 days
76
Q

What is cat scratch disease treated with?

A
  • azithromycin 500mg then 1 250mg q24h for 4 days
77
Q

What bacteria are commonly found in human bite wounds?

A
  • B hemolytic streptococcus in over 80%, eikenella corrodens in 30%, then S. aureus and oral anaerobes
78
Q

E. corrodens is susceptible to what antibiotics?

A
  • penicillins, doxy, TMPSMX, and is resistant to clinda and metronidazole
79
Q

How long does antimicrobial treatment for human bite infections last?

A

7-14 days or 4-6 weeks for septic arthritis

first line is amoxi-clav

80
Q

What are the alternatives used to treat human bite wounds?

A
  • doxy + (clinda or metro)
  • cipro/levo/moxi + clinda or metro
  • TMPSMX + clinda or metro
81
Q

What diabetes related factors increase the risk of diabetic foot ulcers and infections?

A
  • angiopathy with peripheral vascular disease and schema
  • neuropathy with sensory, motor and autonomic dysfunction
  • immune dysfunction
82
Q

What are the adjuvant (non-antimicrobial) measures for treating diabetic foot ulcers?

A
  • glycemic control
  • wound care including debridement, dressing changes
  • pressure relief, off-loading, elevation
83
Q

What ar the clinical features of a diabetic foot infection?

A
  • erythema, swelling (edema), warmth and purulent discharge

- little to no pain or systemic signs of infection in >50%

84
Q

What is the classification of a mild diabetic foot infection?

A
  • superficial skin with erythema <2 cm, swelling, heat or pain; no systemic signs of infection
85
Q

What is the classification of a moderate diabetic foot infection?

A
  • deep localized with erythema >2 cm, abscess, fasciitis, septic arthritis or osteomyelitis, no systemic signs of infection
86
Q

What is the classification of a severe diabetic foot infection?

A
  • significant systemic signs of infection, eg. tachycardia, tachypnea, leukocytosis, hypotension
87
Q

Describe the most common pathogens in DFIs?

A
  • superficial, acute cellulitis and/or infected ulcer not treated with antimicrobials in the previous month - strept and staph
88
Q

What is the most common pathogen in a deep, chronic infected ulcer and treated with antimicrobials int he previous month?

A
  • mixed polymicrobial with gram positive aerobes, gram negative aerobes and anaerobes in 25-40%
89
Q

What are the common complications of DFIs?

A
  • spread to joints or bone

- amputation in 10-20% of cases at one year and 25-50% at 5 years

90
Q

What factors are considered in using antimicrobials in treating DFIs?

A
  • infected wound vs colonized ulcer
  • adequate wound debridement and care
  • severity of infection and clinical status
  • bone involvement
  • risk factors for antimicrobial resistance: chronic infections, repeat antimicrobial exposure, low antimicrobial concentrations at the infection site, MDR pathogens that limit options for antimicrobial therapy
91
Q

What antibiotics are used for a mild DFI with suspected gram positive?

A
  • cloxacillin (plus/minus doxy or TMPSMX)
  • cephalexin (plus/minus doxy or TMPSMX)
    [clindamycin]
92
Q

What antibiotics are use for moderate acute or chronic infection with suspected mixed, polymicrobial?

A
  • amoxi-clav (plus doxy or TMPSMX)

[clindamycin plus cipro/levo/moxi]

93
Q

Clindamycin has _____ coverage

A

anerobic

94
Q

What other Ab has anaerobic coverage?

A
  • metronidazole

- moxifloxacin also has some anaerobic coverage

95
Q

What is used in a severe, chronic infection that is mixed polymicrobial?

A
  • piptazo
  • meropenum
  • cefriaxone+ metro
  • ceftazidime + metro
96
Q

What factors do you consider when choosing a dose for an antibiotic?

A
  • severity
  • limiting toxicity
  • body weight
  • kidney function
  • generation into the bone or the CSF to limit the growth of bacteria in these cases

Clinical Pharmacy 2 (18 decks)

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