Week 1 Lectures: Limp, Asthma, Abx Flashcards
Main toxicity/side effect of
(a) Penicillins
(b) Augmentin
(c) Vancomycin
(d) Bactrum
Main toxicity
(a) Penicillin- anaphylaaxis in 1/1,000
(b) Augmentin- diarrhea
(c) Vancomycin- red man’s syndrome due to histamine release => need to slow down rate of infusion
(d) Bactrum side effect = bone marrow suppression
What does vanco coverage?
Vanco covers MRSA, staph, and Strep (all gram positive cocci)
Describe the two types of tx for asthma
Rescue:
- albuterol (short acting beta agonist)
- oral corticosteroid
Controllers
- inhaled corticosteroids
- leukotriene inhibitors (Montelukast)
What can amox be used in combination w/ for Enterococcal infxn coverage
Amox + aminoglycosides (ex: gentamicin) for enterococcal coverage
Which of the 3rd gen cephalosporins covers pseudomonas
Only one: Ceftazidime
NOT Cafotaxime or Ceftriaxone
Pt has AKI on Vancomycin, what are they switched to next?
(a) Why is this drug second line
Assuming Vanco is used for coverage of MRSA (ex: MRSA cellulitis/abscess)
-side effect of Vanco = AKI => switch to Linezolid
(a) Linezolid is second line b/c it’s so expensive
Indications for trimethoprim/sulfa
Bactrim
- outpatient MRSA coverage after transition off IV Vanco: cellulitis
- UTI b/c covers E. Coli
Which abx can cause eosinophilia?
Macrolides: erythromycin/azithromycin
Indication for Daptomycin
VRSE = Vanco resistant staph species
Juvenile Idiopathic Arthritis
a) Indication of ANA (+
(b) When is RF sent?
JIA
(a) ANA (+) predicts higher risk for anterior uveitis
(b) Send RF in older children w/ poly-arthritis
Why is bactrum a great drug?
Bactrum = TMP + SMX (both folic acid synthesis inhibitors) is great b/c it covers for MRSA and is oral => can be given outpatient
Features of septic arthritis
Septic arthritis
- refusal to bear weight
- febrile
- ill-appearing
- worse at night
- autonomic instability: tachy, tachypnic, resting position of the limb is w/ hip abducted
What to use in an acute asthma exacerbation where albuterol isn’t enough
Systemic (oral/IV) corticosteroids
Describe proposed pathophysiology of Henoch Schonlein Purpura
IgA vasculopathy
-IgA deposition
Supportive biopsy of affected organ (ex: skin, kidney) shows IgA deposition
Rash + limp + episodic severe belly pain + patches of purple raised skin over legs and but
HSP = Henoch Shonlein Purpura
-immunoglobulin A vasculitis (IgA deposition)
- rash = non-thrombocytopenic (normal platelet count) purpura
- limp b/c of arthralgia/arthritis = swollen ankle
- episodic severe belly pain- ileoileal intussusception
Common side effects of albuterol in children
Kids get very hyper/jumpy
-anxiety, palpitations, tremor, headache
CC: Limp + knee pain
-worse at night, ill-appearing, febrile to 104, carried into the ER
Septic arthritis
- unable to weight bear => carried in
- knee pain due to referred hip pain
Define SIRS
Autonomic instability + elevated white count
SIRS = systemic inflammatory response syndrome
First line tx for mild persistent asthma
Mild persistent asthma tx
test answer = low dose inhaled corticosteroid
-real life: often try leukotriene inhibitor (montelukast) first b/c simple small QD chewable
+ SABA PRN (for all asthmatics)
First line tx for intermittent asthma
Intermittent asthma: tx w/ SABA (albuterol) for symptom control
Petechiae + Limp
Leukemia
Dangerous side effects of albuterol
Sudden death: 2 causes
- cardiac: arrhythmia
- airway plug: build up of underlying mucous/inflammation
Which abx do we give to GBS (+) moms who are allergic to Penicilin
Azithromycin (Macrolide)
-wouldn’t give Amox b/c that’s a type of Penicillin!!
Cefepime
(a) Coverage
(b) What doesn’t it cover?
(c) Main indication
Cefepime = 4th gen cephalosporin
(a) G(+) activity of 1st gens + G(-) activity of 2nd gens = the big guns!!!
(b) BUT no anaerobe or MRSA coverage
(c) Indication = fever in neutropenic pt
2 Oral abx for C. dif
Oral Vancomycin OR metronidazole (Flagyl)
Do asthma pts have to stay on controllers for their entire life?
Controllers are just that, just controllers (not a cure) => only work while the pt is on them
-work to prevent fibrosis/scaring
Indication for PenG
Syphilis
-b/c most strep is now resistant
Which abx causes Red Man Syndrome?
(a) What is Red Man Syndrome?
(b) How do we prevent this
Red Man Syndrome = chills, fever, phlebitis (venous inflammation), ototoxicity, nephrotoxicity
-due to Vanco b/c of the way Vanco is made that it causes histamine release throughout the body
(a) Histamine release during infusion =>
(b) Have to really spread out Vanco doses, infuse slowly to prevent Red Man Syndrome
Juvenile Idiopathic Arthritis
(a) gender
(b) asymmetric or symmetrical?
(c) acute or gradual onset?
(d) constitutional symptoms?
Juvenile Idiopathic Arthritis
(a) F > M
(b) symmetrical
(c) gradual onset- usually indolent until infection precipitates dramatic increase in symptoms
(d) Constitutional symptoms (fever etc) usually not present
Why don’t you want to keep asthmatics on chronic oral corticosteroids?
Side effects of steroids
- weight gain (moon face)
- immunosuppression
- growth suppression (so super bad for kids!!)
- aseptic necrosis of femoral head + osteonecrosis
- suppressed HPA => knock out the adrenal gland’s response to stress
Define SIRS: 2 out of 4 criteria
SIRS = presence of 2+
-temp > 38.5 or
What would you add to Cefepime to cover for
(a) MRSA
(b) anerobes
Add to Cefepime to cover
(a) MRSA = add Vanco
(b) Anerobes- add Flagil
Define asthma
Chronic inflammatory disease of the lungs
Aminoglycosides
Give examples
(a) reversible toxicity
(b) irreversible toxicity
Aminoglycosides = Gentamycin, Tobramycin
(a) Reversible toxicity = renal
(b) Irreversible toxicity = ototoxicity