Vignettes And Commonly Confused Topics Flashcards
A patient comes into the clinic with mild and painful erythema on her leg. It is non-purulent. Given your suspected causative pathogen, what would treat it with?
Beta hemolytic group A strep
PO beta lactams: dicloxacillin
A patient comes into the clinic with a mild red, purulent abscess, what is your first treatment modality?
How would that change if it was moderate?
Mild: I&D only
Moderate:
I&D, culture then PO abx
Doxycycline (BID)
TMP/SMX
A young boy presents to the clinic with honey crusted lesions around his mouth, what is your first line treatment?
Impetigo
Topical mupirocin
A vet comes to the clinic, she has been bitten by a cat, she tells you that she washed it ASAP but is concerned because the bite penetrated quite deeply and the cat was a stray. What treatment would you prescribe and for how long?
amoxicillin-clavulanate
PO
5 days
OR
Ampicillin-sulbactam IV
During a clinic visit, you inspect your patient’s feet because she is diabetic. You notice a moderate ulcer on the sole of her right foot. Given what you know about the likely causative pathogen(s), you prescribe….
Most likely to be polymicrobial and include gram negatives as well as anaerobes
Moderate:
—amox-clav (Augmentin)
—or, amp-sulbactam
—or, ceftriaxone + metro
You HIV patient comes to the clinic complaining of fever, cough and chest pain, you suspect a fungal infection in his lungs. Knowing the causative pathogen, which anti-fungal is recommended for this patient?
Aspergillus
Voriconazole PO
if invasive, voriconazole + amphotericin B
A patient has been diagnosed with invasive aspergillosis and you are considering the best treatment options. His medical record shows a history of QTc prolongation, which medication would you avoid? Which would you select?
Avoid: voriconazole
Select: Isavuconazole
Which fibrate do you NOT give w/ statins d/t risk of myopathy
Gemfibrozil
Which non-statin lipid lowering medication do you have to discontinue w/ tendon rupture?
Bempedoic acid
(think about the acid tearing through the tendon)
Which non-statin lipid lowering medication CANNOT be taken with simvastatin >20mg or Pravastatin >40mg
Bempedoic acid
A patient has TGs >500, which non statin lipid lowering medication can you NOT give?
Bile acid sequestrant (meds beginning with Chole/cole)
All azoles prolong QTc except?
Isavuconazole
You can’t give a patient with gout………. ?!?! You idiot!!
Loop and thiazide diuretics
Which TB med should you supplement with B6
Isoniazid
Which HIV med has an ADR of a rash?
Abacavir
Which antifungal has a BBW to exercise extreme caution in pts w/ impaired renal function?
FluCYtosine (5-FU)
Think renal, close to bladder > CY part of Flucytosine
Which antifungal do you always use in combination with another antifungal?
Flucytosine (5-FU)
Don’t eat/drink grapefruit juice and red yeast rice with?
STATINS (esp. Simvastin)
ALL ~azoles have these 3 main ADRs
—QTc prolongation (except isavoruconazole)
—hepatotoxicity
—CYP INHIBITORS
For the treatment of CMV retinitis, which would be the better ORAL medication?
VALganciclovir
ganciclovir is available parenterally
Most common NNRTI is efavirenz but what do the others end in so you can recognise them?
~ine
I.e nevirapine, delaviridine, etraviridine etc
Patient with asthma, you’re going to put them on a BB, which do you NOT choose?
Propanalol (B1 & B2)
B2 vasoconstricts bronchioles
Which is the only DOAC you can give for DVT prophy in medical patients?
Rivaroxaban
Which DOAC must be given with food?
Rivaroxaban
Which DOACs are major CYP34A substrates?
Rivaroxaba (Xarelto)
Apixaban (Eliquis)
All DOACs can be used post hip/knee surgery except?
Edoxaban
(think E = except)
Mainstay treatment for stroke prevention a/w afib or cardiac valve replacement
Warfarin (Coumadin)
For VTE treatment, which DOACs do you need to give LMWH for 7d first? 2
Edoxaban
Dabigatran
What are the two K-sparing diuretics that inhibit renal epithelial Na+ channels?
Triamterene
Amiloride
Patient has a sub segmental PE without proximal DVT of the legs. She is high risk. What is the best management?
Anticoagulate and then observe
Patient has an acute PE, what is the best course of action?
Administer a fibrinolytic
A patient as a superficial DVT but you are concerned it could travel and progress to a deep DVT or a proximal DVT, what course of action do you take? Which 2 medications could you administer?
Low dose fondaparinux
Rivaroxaban
An 86 year old lady is going into hospital for a knee replacement surgery, does she need prophylaxis for VTE? Why, why not?
Yes! Because a) she is being hospitalised and b) she is having a knee replacement surgery (also valid for hip surgery)
You prescribe amphotericin B w/ Flucytosine for a patient with cryptococcus meningitis. The patient starts to deteriorate, what could be going wrong? 3
Rigors and phlebitis
Nephrotoxicity
Electrolyte imbalances
You have a patient w/ primary / homozygous familial HLD, what are your mono therapy options? 3
Ezetimibe
PCSK9 inhibitors
Bile acid sequestrant
Diabetic patient comes in complaining of sudden irregular sweating.
History of DM
Recently started anti-HTN med, which class could it be?
Beta blockers
IE culture comes back w/ viridans strep
How do you treat?
Penicillin G
or
Ceftriazone
+/- gentamicin
IE culture comes back w/ enterococcus
Treat with?
Penicillin G
or
Ampicillin
+/- gentamicin
IE culture comes back w/ staph aureus MSSA, treat w? 3
Nafcillin
Oxacillin
Cephazolin IV
IE culture comes back w/ MRSA, treat with?
Vanco
Or dapto if VRE
IE culture comes back w/ coag neg staph, treat with?
Vanco
+/- gentamicin
+/- rifampin if prosthetic valve
IE culture comes back w/ HACEK, treat with?
Ceftriaxone
+/- surgery
IE culture comes back w/ funghi, treat with?
Nystatin if candida
Voriconazole if aspergillosis
