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GI 2 > Tx of Infectious Diarrhea > Flashcards

Tx of Infectious Diarrhea Flashcards

1
Q

What are the major causes of watery diarrhea? Why are most of these clinically insignificant?

A

norovirus, rotavirus, ETEC, and V. choleraare self-limited.

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2
Q

What are the major causes of dysentery?

A

C. jejuni, C. difficile, salmonella, shigella, EHEC, Yersinia

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3
Q

What are reasons for microbial investigation of diarrhea?

A

Persistent, bloody, dehydrated

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4
Q

Bloody diarrhea with recent history of visiting Africa, Latin America, or Asia?

A

Entamoeba Hemolytica

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5
Q

Bloody diarrhea and recent Abx therapy?

A

C. difficile

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6
Q

What is the general Tx approach to diarrhea, mild and severe?

A

Mild to Moderate = oral rehydration and easily digestible foods (chicken soup and crackers)

Severe or Dysenteric = Anti-motility PRN, IV rehydration, and Abx therapy

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7
Q

What are the components of oral rehydration therapy? Why are fruit juices and gatorade inadequate?

A

Oral Rehydration Solution = glucose, sodium, potassium, chloride, and water

ORS takes advantage of the co-transport of sodium and glucose, so these should be equimolar

Fruit juices and gatorade are not sufficient because they may induce osmotic diarrhea by glucose being present in higher concentrations of sodium.

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8
Q

What are examples of cases where Abx therapy is indicated?

A

Shigella, Traveler’s Diarrhea, C. difficile, C. jejuni, and persistent diarrhea

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9
Q

What are the benefits to Abx Tx in shigellosis?

A

Reduces duration, tenesmus, fever, and shedding

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10
Q

What are the MC causes of traveler’s diarrhea? How is this best Tx.d?

A

MC cause is ETEC and EAEC, but shigella, salmonella, and campylobacter have been implicated.

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11
Q

What is the best way to prevent traveler’s diarrhea?

A

Peel it, boil it, cook it, or forget it

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12
Q

What is the recommended Tx of traveler’s diarrhea, mild and severe?

A

Tx

Mild = loperamide -OR- bismuth subsalicylate w/ -OR- w/o fluorquinolones

Severe = 3 day course of fluoroquinolones

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13
Q

What is C. Difficile and how does it cause dysentery?

A

C. difficile is a gm(+), spore-forming, anaerobic bacillus.

It produces toxins which cause exudative necrosis and the formation of a pseudomembrane.

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14
Q

What is C. Difficile infection associated with?

A

Recent Abx therapy or PPIs

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15
Q

How does C. Difficile resolve in reference to classic strains and the NAP1 strain?

A

Most cases resolve without Tx. NAP1 strain is associated with increased mortality.

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16
Q

What are the two drugs of choice for C. difficile infection?

A

Vancomycin, which must be given PO, is used for severe infections.
Metronidazole is used to Tx mild infections. This can be given PO or IV.

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17
Q

What is the Tx regimen for CDI in mild, severe, complicated, and recurrent cases?

A 
Mild = Metronidazole
Severe = Vancomycin
Complicated = Presents with shock, illeus, or megacolon = vancomycin and metronidazole

1st recurrence = Same Tx as initial
2nd recurrence = Tapered or pulsed vancomycin regimen

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18
Q

What is the Tx regimen of campylobacteriosis?

A

Erythromycin or azythromycin. Reduces duration. Can reduce diarrhe if begun w/i 4 days of onset.

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19
Q

What is suspected in persistent diarrhea? How can this be Tx.d? What might occur in HIV (+) patients?

A

If sx.s persist for over 7-10 days, suspect protozoal pathogens.

Suspect Giardia Lambia and tx with metronidazole

In an HIV patient, this is most likely cryptosporidium, which is difficult to tx and requires antiretroviral therapy.

20
Q

Which two infections should not be Tx.d with Abx and why?

A

EHEC = can increase the release of shiga-like toxin and the risk of HUS

Salmonella = can increase carriage and recurrence
NOTE: give Abx in immunocompromised to prevent sepsis

21
Q

Describe the empiric therapy of diarrhea?

A

Mild to severe diarrhea = fluoroquinolone

Febrile diarrhea = fluoroquinolone

Nosocomial Diarrhea = metronidazole

Persistent Diarrhea = Metronidazole

22
Q

How should non-choleraic and cholera be tx.d?

A

Non-choleraic = ciprofloxacin or azythromycin

Cholera = doxycycline

23
Q

How should cyclosporosis be Tx.d?

A

Begin patient on ART and trimethoprim-sulfamethoxazole (TMP-SMX; Bactrim D)

24
Q

What are the prototype fluoroquinolones?

A

Levofloxacin and ciprofloxacin

25
Q

What is the MOA of fluoroquinolones?

A

Binds and inhibits DNA gyrase and topoisomerase IV

26
Q

What is the spectrum of activity for fluoroquinolones?

A

Mostly G (-) = E. Coli, Shigella, Salmonella, enterobacteriaceae, campylobacter, Pseudomonas, Neisseria, S. aureus (Not MRSA), and some Streptococci

27
Q

What are the ADRs of fluoroquinolones?

A

Rash, GI/CNS disturbances, and Tendon rupture (CI in children)

28
Q

What is the prototype aminoglycoside and its MOA?

A

Gentamycin. Blocks the 30S ribosomal subunit

29
Q

What is the spectrum of activity and notable resistance to gentamycin?

A

Spectrum of Activity = Gm (-)

Resistance = Gm (+)

30
Q

What are the ADRs of gentamycin?

A

Nephrotoxicity, ototoxicity, and neuromuscular block

31
Q

What is the MOA, uses, and CIs for TMP-SMX?

A

Sulfonamides inhibit the use of PABA for folate synthesis while trimethoprim inhibits DHF reductase

Uses = UTIs, bacterial prostatitis, shigella, salmonella, P. jirovecii prophylaxis, Stenotrophomonas maltophilia

CI = streptoccoal pharyngitis

32
Q

What are the ADRs of TMP-SMX?

A

GI disturbances, painful/frequent micturition, rash, albuminuria and hematuria

33
Q

What is the MOA of metronidazole?

A

Metronidazole is a pro-drug which produces nitro free radicals and damages DNA

34
Q

What is the spectrum of activity for metronidazole?

A

Anearobic cocci, anaerobic gm (-) bacilli, and anaerobic spore-forming gm (+).

Trichomonas, E. hemolytica, G. lambia, H, pylori, Campylobacter

35
Q

What are the ADRs of metronidazole?

A

GI disturbances, disulfiram effect, and metallic taste

36
Q

What are the prototypes, MOA and uses of macrolides?

A

Clarithromycin, azythromycin, and erythromycin

MOA = inhibition of the 50S ribosomal subunit

Uses = URT infections and enteritis

37
Q

What are the ADRs of macrolides?

A

GI disturbance, hepatotoxicity, and QT prolongation

38
Q

What are the protoypes and MOA of tetracyclines?

A

Doxycyline

MOA = inhibition of the 30s ribosomal subunit

39
Q

What is the spectrum of activity of doxycycline?

A

Most aerobic and anaerobic Gm (+) along with rickettsia, borrelia, legionella, chlamydia, mycoplasma, and treponema

40
Q

What are the adverse effects of doxycycline?

A

GI disturbances, photosensitivity, teeth discoloration, and c. difficile superinfection

41
Q

What drug class is vancomycin and describe its MOA?

A

Glycopeptide

MOA = inhibits cell wall synthesis by binding D-Ala-D-Ala

42
Q

What is the spectrum of activity, notable resistance, and uses of vancomycin?

A 
Spectrum = Gm (+)
Resistance = mycoplasma and Gm (-)
Uses = osteomyelitis, endocarditis, MRSA, and C. difficile
43
Q

What are the ADRs of Vancomycin

A

Macular rash

Redman syndrome = flushing, hypotension, and tachycardia

44
Q

What is the MOA, use, and ADR of loperamide?

A

Loperamide is a mu-opioid receptor agonist. It increases transit time and fecal water absorption while decreasing motility.

Use = diarrhea

ADRs = well-tolerated, except at high doses it has a CNS effect, so it is combined with atropine

45
Q

What is the MOA, uses, and ADR of bismuth subsalicylate?

A

MOA = Bismuth coats ulcers in the stomach and stimualtes intestinal PG, bicarbonate, and mucus production. Salicylate inhibits chloride secretion.

Uses = PUD and diarrhea

ADR = harmless blackening of the tongue and stool. Salicylate can cause toxicity

GI 2 (1 decks)

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