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Neurology Week 4 > Tx of Meningitis > Flashcards

Tx of Meningitis Flashcards

1
Q

How should meningitis be empirically tx in a 0-4 week old?

A

ampicillin + either cefotaxime or an aminoglycoside

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2
Q

How should meningitis be empirically tx in a 1 mo-50 yo?

A

Vanco + cefotaxime or ceftriaxone

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3
Q

How should meningitis be empirically tx in a 50+ yo?

A

Vanco + ampicillin + ceftriaxone or cefotaxime

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4
Q

How should meningitis be empirically tx in a pt with impaired cellular immunity?

A

Vanco + ampillicin + either cefepime or meropenem

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5
Q

How should meningitis be empirically tx in a pt with recurrent meningitis?

A

Vanco + cefotaxime or ceftriaxone

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6
Q

How do aminoglycosides work?

A

bind to 30S ribosomal subunit but a site that stabilizes a normal mismatch in codon-anticodon pairing, leading to mistranslations (thus, bactericidal)

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7
Q

What are the AEs of aminoglycosides?

A

nephrotoxicity + ototoxicity

dose adjust with renal impairment

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8
Q

Administration of dexamethasone as adjucntive tx for bacterial meningitis improves outcomes how?

A

by attenuating the detrimental effects of host defenses and inflammatory chnages induced by meningitis that lead to hearing loss. Steroids reduce CSF concentrations of TNF-alpha and IL-1, CSF inflammation, and cerebral edema

NOTE: Steroids might decrease ability of drugs like Vanco to penetrate the BBB

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9
Q

How is aspergillosis tx?

A

voriconazole IV (or ampho B)

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10
Q

How is blastomycosis tx?

A

mild: Itraconazole PO
severe: ampho B IV then itra PO

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11
Q

How is candidiasis tx?

A

fluconazole PO

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12
Q

How is mucormycosis tx?

A

ampho B

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13
Q

How is cryptococcus tx?

A

ampho B IV + flucytosine PO, then fluconazole PO

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14
Q

How does ampho B work?

A

formes pores in fungal cell membranes (fungicidal)

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15
Q

What are the AEs of ampho B?

A

nephrotoxic (liposomal formulation helps)

poor CNS entry if given IV

infusion rxns

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16
Q

How do -AZOLES work

A

block 14a-sterol demethylase disrupting fungal cell membrane phospholipids (fungistatic)

17
Q

What AZOLEs penetrate the CNS?

A

fluconazole and voriconazole only

18
Q

How does Flucytosine work?

A

converted by fungal cytosine deaminase to 5-FU, which blocks thymidylate synthease and disrupts DNA synthesis

19
Q

What are the AEs of Flucytosine?

A

not used alone (resistance rapdily develops)

enters CSF if given PO

bone marrow toxicity with anemia, leukopenia, and thrombocytopenia

elevated LFTs

Neurology Week 4 (26 decks)

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