Week 3--even more Flashcards
1
Q
define SIDS
A
the sudden death of an infant under one year of age which remains unexplained after thorough case investigation, including the performance of a complete autopsy, examination of the death scene and review of the clinical history
generally agreed that takes places during sleep
multifactorial disorder arising from a combination of genetic, metabolic, and environmental factors
overlap in risk factors for suffocation/entrapment
2
Q
describe a model for SIDS risk
A
the triple-risk model
vulnerable infant + critical development period (0-12 post natal months) + exogenous stressor
3
Q
intrinsic risk factors for SIDS
A
male gender (65%)
prematurity (30%)
genetic polymorphisms (35%)
prenatal exposures to cigarettes and/or alcohol (54% prenatal exposure to smoke–the more the mother smokes, the higher the risk of SIDS)
4
Q
extrinsic risk factors for SIDS
A
prone or side sleep position
bed sharing
over bundling
soft bedding
face covered
**majority of deaths associated with a new sleeping arrangement
5
Q
where does SIDS rank in the causes of infant death
A
third top cause
top is perinatal conditions, then congenital abnormalities
6
Q
when is the peak of SIDS death (infant age wise)
A
peaks between 2-4 months–fewer SIDS deaths occur after 6 mo
7
Q
where is the safest place for an infant to sleep
A
a crib, cradle or bassinet that meets current Canadian regulations
avoid loose bedding, pillows, toys and bumper pads
avoid caregiving, especially if caregiver smokes, is under the influence of drugs/alcohol or is over tired, or if the infant is under 4 mo
baby should sleep supine
*infants who share a room with a parent or caregiver (but not the same bed–crib next to adults bed) have a lower risk of SIDS
8
Q
how are breastfeeding and SIDS related
A
breastfeeding is protective
exclusive breastfeeding may decrease the risk of SIDS by as much as 50%
9
Q
how do you diagnose diabetes mellitus
A
- symptoms of hyperglycemia AND random plasma glucose above 11.1 mmol/L
- fasting plasma glucose above 7 mmol/L
- plasma glucose above 11.1 mmol/L 2 hours post 75g oral glucose load (GTT)
- HbA1c above 6.5%
10
Q
what investigations should be done when working up DM
A
CBC BUN ACR Cr lipids UA
11
Q
how to manage DM in new diagnosis
A
- lifestyle modifications
- patient education–> wider health problems, like smoking, elevated cholesterol, obesity, HTN (may accelerate bad effects of DM)
- medications
- vaccinate for pneumococcus and influenza
12
Q
name the 6 types of anti-hyperglycemics used in DM
A
- sulfonylureas
- meglitinides
- thiazolidinediones
- alpha-glucosidase inhibitor
- peptide analogues
- biguianides
13
Q
name two sulfonylureas
A
glyburide
diamicron
14
Q
how do sulfonylureas like glyburide and diamicron work
A
are insulin secretagogues which trigger insulin release (can cause hypoglycemia)
15
Q
name one meglitinide
A
replaglinide
16
Q
how do meglitinides like replaglinide work
A
are short acting insulin secretagogues
17
Q
name one biguanide
A
metformin
18
Q
how do biguanides like metformin work
A
insulin sensitizer–reduces hepatic glucose output and increases glucose uptake by cells
19
Q
name two thiazolidinediones
A
rosiglitazone, pioglitazone
20
Q
how do thiazolidinediones like rosiglitazone, pioglitazone work
A
insulin sensitizers
bind PPARy leading to better glucose use by the cell
21
Q
how do thiazolidinediones like rosiglitazone, pioglitazone work
A
insulin sensitizers
bind PPARy leading to better glucose use by the cell
22
Q
name one alpha-glucosidase inhibitor
A
acarbose
23
Q
how do alpha-glucosidase inhibitors like acarbose work
A
slow digestion of starch in the small intestine so that glucose from the meal enters the blood stream more slowly and can be matched more effectively by impaired insulin response or sensitivity
24
Q
name two peptide analogues used int he treatment of DM
A
GLP-1
GIP
25
how do peptide analogs like GLP-1 and GIP work
insulin secretagogues that inhibit glucagon release and may also decrease gastric motility
26
who should receive a yearly mammogram
women between ages 40-79 of normal risk
| under or over that by special request
27
generalized menopause sx
hot flashes
mood
cognitive changes
28
focal menopause sx
dyspareunia
pruritis
urethritis
29
when is HRT indicated for menopause
for osteoporosis and hot flashes
30
when is HRT contraindicated for menopause
pregnancy
hepatic disease
clots
postmenopausal bleeding
31
what are the risks of HRT treatment for menopause
increase breast ca risk if over 5 years of use
increased risk VTE if over 5 years use (less with transdermal vs oral route)
CVD risk if started when over 70 or if more than 10 years since menopause onset
controversial stroke risk
32
what two cancers are decreased in risk with HRT for menopause
colon and ovarian
33
in addition to HRT, what other meds can be used to help with menopause sx
SSRI
SNRI
clonidine
34
what % fractures in women over 50 are fragility fractures
80%
35
what history suggests possible colon ca
change in bowel habits
blood in stool or rectum
thin stools
weight loss
fever
night sweats
general stomach discomfort
frequent gas pains
36
risk factors for colon ca
family history
IBD
polyps
post radiation therapy
obesity
age above 50
family history of inherited cancers
37
when should you start screening for colon ca
men over 50
FOB q2years (low sens and spec)
can use colonoscopy for screening q10 years after 50 years old
38
when do you start paps
within 3 years of first sexual contact (includes touching and intercourse)
yearly until 3 normal tests in a row then every 2 years
stop at age 69 if 3 or more normal results in a row in last 10 years and no history of moderately or severely abnormal paps
39
what does "mild atypia" represent on a pap result
low risk lesion
repeat pap in 6 months then follow for 2 years
may resolve spontaneously
if still present at 2 years, follow with colposcopy and biopsy
40
how do you manage moderate or severe atypica on pap result
refer for colposcopy and biopsy
41
who should get PSA testing
recommend for asymptomatic men who are well informed about the risks of over diagnosis and over treatment but still wish to pursue the benefits of early diagnosis of prostate cancer
evidence from RCTs suggest that mortality decreases with PSA screening for early detection but that significant number of men will need to be treated (with all those risk) who would otherwise not have had a problem
decision should be individualized
offer to asymptomatic men over 50
abnormal--refer to uro
42
what factors influence abx selection
1. agent factors
- type of bacteria suspected
- suspected resistance patterns
2. host factors
- site of infection
- abx aimed at certain site
- pregnancy
- renal failure
- allergy
- immunocompromised
3. enviro factors
- nosocomial vs community
- travel
- exposures
- IVDU
43
what is the abx target usually when u are treating gram + bugs
the cells wall is it is large
44
what is the target of abx in most gram - bugs
inner and outer membrane
can also target intrecellularly
45
name 4 classes of abx that are cell wall synthesis inhibitors
penicillins
cephalosporins
carbapenems
glycopeptides
46
name 5 classes/drugs of abx that are protein synthesis inhibitors
aminoglycosides
tetracyclines
macrolides
clindamycin
linezolid
47
name 3 meds/classes of abx that are DNA gyrase inhibitors
quinolones
flagyl
rifampin
48
name one abx that is an antimetabolite
sulphonamides
49
what is the general structure of the B lactam/cell wall agent abx
all contain a B-lactam nucleus in molecular structure
work by inhibiting cell wall synthesis
there is cross reactivity between classes
engage in TIME DEPENDENT killing of bugs (need frequent dosing to keep around for a sustained time)
50
how do penicillins work
stop cell wall cross linking
results in loss of cell wall integrity in the bug
leads to osmotic lysis
51
what bugs do penicillins target
mainly gram + --> streptococcus species (GAS, strep. viridans) and syphilis (IM, or IV if neurosyphilis)
resistance is common
52
what are the anti-staphylococcal penicillins
cloxacillin and methicillin
| IV and PO
53
what is the drug of choice for a serious S. aureus infection
cloxacillin or methicillin
*these drugs have a very narrow spectrum, not for use if dont know whether staph or strep
54
name the animo penicillins
ampicilling
| amoxicillin
55
what do we use the aminopenicillins (ampicillin, amoxicillin) for
gram + --> strep, enterococcus, listeria
has an extended spectrum--> covers some gram - rods--> E coli, H influenzae, proteus
can combine with clavulin to get a broad spectrum oral abx that covers G+, G- and ANAEROBES
56
what diseases are often well treated by amox clav
sinus infections
otitis media
URTI
57
name the ureidopenicillin
piperacillin
58
what does piperacillin cover
broad spectrum--> G+, G- (including PSEUDOMONAS), and ANAEROBES
combine it with tazobactam for extended spectrum coverage
59
what is the empiric treatment for polymicrobial/suspected resistant /unknown source of infection
pip-tazo
60
how does coverage change for cephalosporins across the generations
as go from 1st to 3rd--> decrease gram + and increase gram -
61
name two 1st gen cephalosporins
cefazolin (ancef)--> IV
cephalexin (keflex)--> PO
62
what do the first gen cephalosporings (ancef, keflex) cover
G+
some Gram - (proteus, klebsiella, e coli)
63
what diseases are well treated by 1st gen cephalosporins (ancef, keflex)
cellulitis
pre-operative coverage
UTI
64
name one 2nd gen cephalosporin
cefuroxime--> PO/IV
65
what does cefuroxime cover
some gram + but less than 1st gen (good for s. pneumo)
increased gram - (proteus, klebsiella, e coli, h influenzae, enterobacter, neisseria)
66
what diseases are well treated by second gen cephalosporins (cefuroxime)
resp infections
67
name 3 3rd . gen cephalosporins
ceftriaxone
cefotaxime
cefixime
68
what do the 3rd gen cephalosporins cover
much more gram -, less gram +
69
what is important about the 3rd gen cephalosporins (ceftriaxone, cefotaxime, cefixime) in terms of disease coverage/treatment
cross the BBB--> used as empiric coverage for Neisseria in meningitis
has long half life, do once daily dosing
*also used for CAP, pyelonephritis
70
what covers pseudomonas
ceftazidime
71
name one 4th gen cephalosporin
cefepime
72
what does cefepime cover
powerful, broad spectrum
less anaerobic than pip-taz
73
name two carbapenems
imipenem
meropenem
74
what do the carbapenems cover
broad spectrum gram + and -
includes pseudomonas, ESBL and anaerobes coverage
75
when do you use the carbapenems
reserved for serious sepsis, nosocomial infections where resistance likely
76
name a glycopeptide abx
NOT a beta lactam
vancomycin
77
how does vancomycin (a glycopeptide abx) work
bacteriocidal
78
what does vanco cover
G+--> MRSA, coagulase - staph, enterococci
oral use for C diff
79
adverse effects of vanco
redman syndrome
nephrotoxic
rare ototoxicity with long term exposure
*measure levels at trough
80
name the cell membrane agent abx
lipopeptides--> DAPTOMYCIN
*covers cell membrane of gram + only
81
what do we use daptomycin for
VRE
MRSA
82
what are the 5 types of protein synthesis inhibitor abx
1. aminoglycosides
2. tetracyclines
3. macrolides
4. lincosamides
5. oxazolidinones
83
what ribosome do the aminoglycosides act on
30s
84
name 3 aminoglycosides
gentamycin
tobramycin
amikacin
85
how do the aminoglycosides work
protein synthesis inhibitors vs 30 s ribosome
work against gram - (good for gram - sepsis)
synergy against gram + enterococcal endocarditis with ampicillin
*concentration dependent killing--need peak and trough levels
86
adverse events of aminoglycosides (gentamycin, tobramycin, amikacin)
nephrotoxic
ototoxic
vestibulotoxic
87
what must you do if you plan to prescribe aminoglycosides for more than 4 days
CONSENT PATIENT for the nephro/oto/vestibulotoxic possible adverse effects
88
what ribosome do tetracyclines work against
30s
89
name 2 tetracyclines
doxycycline
tetracycline
90
spectrum of tetracyclines
fairly broad --> atypical cell walls or intracellular
good for mycoplasma, chlamydia, spirochetes, Rickettsia
91
who should NOT use tetracyclines
children or pregnant women
92
what ribosome do the macrolides work against
50s
93
what abx should you use in the case of a penicillin allergy
erythromycin
94
name 3 macrolides
erythromycin
clarithromycin
azithromycin
95
what diseases are well treated by clarithromycin
CAP
sinusitis
H. pylori
legionella
96
what diseases are well treated by azithromycin
```
resp tract infections
atypicals
moraxella
h influenza
legionella
```
97
what ribosome does the lincosamides work against
50s
98
name one lincosamide
clindamycin--> PO and IV, great bioavailability
99
how do the lincosamides (clindamycin) work
bacteriostatic--> decreased toxin production
100
spectrum of lincosamides (clindamycin)
G+ and anaerobes
101
what diseases are well treated by lincosamides (clindamycin)
cellulitis
abscess
some diabetic foot infections
102
what is the risk with lincosamides (clindamycin)
c diff
103
what ribosome do the oxazolidinones work against
50s
104
name one oxazolidinone
linezolid
good PO avail
105
adverse effects of oxazolidinones (linezolid)
cytopenias
drug reactions with SSRIs
possibly neurotoxic
106
spectrum of oxazolidinones (linezolid)
Staph--> MRSA, coag - staph aureus
enterococcus--> VRE
107
name 3 quinolones
cipro
levofloxacin
moxifloxacin
108
what are the quinolones often used to treat
good for RESP infections
treat intracellular pathogens--> legionella, mycoplasma and gram - bacteria
109
what does flagyl (metronidazole) treat
anaerobes and PARASITES
110
what does rifampin treat
mycobacteria (TB)
MRSA (with fusidic acid)
listeria
neisseria
h influenza
legionella
111
which antibiotics work against pseudomonas
1. gentamycin, tobramycin, amikacin (aminoglycosides)
2. cipro, levo, moxi (quinolones)
3. cephalosporins
4. anti-pseudomonal penicillins--> piperacillin, ticarcillin
5. carbapenems--> mero and imi
* all given my injection except tobramycin and quinolones
112
what is the clinical role of daptomycin
usually reserved for those with vancomycin intolerance
*does NOT work for pulmonary infection !!!!
SSTI and MSSA/MRSA bacteremia and endocarditis are all appropriate indications
113
what are polymixins and name one
cell membrane abx
colistin is one
114
what are polymixins like colistin used to treat
MDR gram - infections like CPO klebsiella
binds to outer cell membrane then acts on the cell wall and inner membrane
IV or inhaled
115
why cant quinolones be used in kids
affects cartilage
116
what is a possible side effect of quinolones like cipro in adults
QT issues
achilles tendon rupture in older adults
117
what is nitrofurantoin used for
UTI agent
good against e coli, enterococcus
less good for klebsiella and other GNB .
proteus usually resistant
118
what should you use to treat:
| SSTI due to Group A, C or G strep
PO cephalexin
119
what should you use to treat:
| invasive group A, C, G strep disease
IV Pen G
120
what should you use to treat:
| Group A, C, G pharyngitis
PO penicillin
121
what should you use to treat:
| group B strep
PO amoxicillin
| IV Pen G/ampicillin for invasive disease
122
what should you use to treat:
| strep pneumo
PO amox or amox-clav (uncomplicated disease)
IV ceftriaxone (CAP, bacteremia)
IV vanco (empiric for ?meningitis)
123
what should you use to treat:
| enterococcus species
PO amoxicillin
PO nitrofurantoin if UTI
IV ampicillin for invasive disease
IV ampicillin + gentamicin for endocarditis
124
what should you use to treat:
| MSSA
PO cephalexin, clindamycin if skin
IV cloxacillin for invasive
125
what should you use to treat:
| MRSA
IV vanco or dapto
PO linezolid
126
what should you use to treat:
| community acquired MRSA
doxycycline or TMP-SMX
127
what should you use to treat:
| gram - agents like E coli, Klebsiella, proteus
ceftriaxone (or other 3rd gen cephalosporins)
gentamicin
cipro
TMP-SMX
128
what should you use to treat:
| pseudomonas
pip-tazo
ceftazidime
cefepime
imipenem
tobramycin
cipro
129
what should you use to treat:
| anaerobes
pip tazo
imipenem
clinda
metronidazole
130
what are the likely organisms in cellulitis, impetigo and in wound infections
MSSA/GAS
MRSA
(sometimes gram - in open wounds)
treat for 7-10 days
131
what should you consider covering for in purulent cellulitis
MRSA empiric coverage
132
what are the likely organisms in CAP
atypicals (chlamydia, mycoplasma), strep pneumo, h influenza, moraxella
133
what should you use to treat CAP
macrolide (azithro or clarithro) or doxycycline
134
likely organisms for inpatient CAP
```
s pneumo
klebsiella
h influenza
gram -
atypicals
```
135
what should you use to treat inpatient CAP
ceftriazone + macrolide or doxy
136
what should you use to treat inpatient HAP
pip tazo, consider adding vanco
137
what are the likely organisms for inpatient HAP
SPACE gram -
pseudomonas
anaerobes
maybe MRSA
138
how long should you treat CAP for
minimum 5 days
AND
afebrile 48-72 hours
no clinical signs of instability
139
how long should you treat VAP for
IF demonstrated improvement at 72 hours, treat for 8 days
if pseudomonas or s. aureus, treat for 14 days
if complicated infection, treat 4-8 weeks
140
likely organisms in UTIs
e coli
klebsiella
proteus
enterococcus
141
what should you use to treat UTI
nitrofurantoin 5-7 days
Septra 3 days
cipro 3 days UTI, 7 days outpatient pyelo
142
if a women requires hospitalization for pyelo, how long should you treat for, and with what?
10-14 days of beta lactam or aminoglycoside or quinolone
IV initially then step down to PO
