Pharm II Lecture 3 – Flashcards
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Unlock answers-What is most dangerous complication of GI infection? -What do we think of when there is blood in stool for GI infection? -What bug is opportunistic with Abx use? -How long does someone need to have diarrhea in a hospital before we start thinking of C. diff? |
-Death by dehydration (2nd leading cod worldwide)
-E. coli (ETEC)
-C. diff
-More than 3 days after admission |
-What is the cornerstone of diarrheal illness regardless of the etiology? -Describe how you go about doing this? -What to avoid? |
-Oral Rehydration Therapy (ORT) -Small volumes at first, then larger volumes...then BANANAS APPLESAUCE, and CEREAL. -Soda, applejuice, broth, sports drinks (draw free water into gut and increase serum sodium) |
-Which of these bugs doesn't give us watery diarrhea (E. coli, C.diff, Yersinia, Cholera) ; -Where do we usually find Cholera outbreaks? ; -How do we Tx Cholera? |
-Yersinia (it is a blood or pus-filled stool with urgency..INVASIVE DIARRHEA..**Shig, Salm, and Campy also do this**) ; -S and SE Asia (endemic)...some outbreaks in Latin America. ; -Doxycyclin (Bactrim or Erythro for kids) |
-What is most common cause of TD? ; -What does its toxin resemble? ; -What strain of E. coli causes hemorrhagic diarrhea? ; -Found where? |
-E. Coli (ETEC enterotoxigenic) ; -V. cholera's toxin (watery diarrhea)
-Serotype 0157:H7
-food, water, undercooked beef, and VEGGIES |
-How do we treat ETEC?
-How do we treat EHEC? |
-FQ (cipro or moxi) or Bactrim
-Mostly supportative therapy (don't want to release more toxins by lysing bacteria) |
; -Most common cause of nosocomial diarrhea is? ; -How do you kill it? ; -What about using Pepto? |
; -CDAD ; -Metronidazole ; -Don't do it! You need to get teh bacteria cleared...diarrhea can be your friend (in small doses) |
-What differentiates Mild CDAD from Moderate CDAD?
-Treat differently? |
-Moderate has systemic symptoms (fever, ab pain, leukocytosis)
-Yes, Flagyl for Mild....Vanco for Moderate |
-What does severe CDAD require
- primarily disease of adolescents or younger, contaminated food or water, food = poultry, beef, pork, dairy, reptile pets (turtles) -Name the 4 clinical manifestations of this dz.
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-Surgical consult and Intraluminal Vancomycin with or without Flagyl
-Salmonella enterica (caused by 1 of 3 serotypes)
-Enterocolitis, Bacteremia, Enteric fever (over 104 with chills/HA/myalgia/nv) |
For Salmonellaosis Entercolitis...who doesn't get Abx? ; -How do we Tx those under 6 mo? ; -Is there a vaccine for Salmonellosis? ; -Because of the carrier state of this dz how long is it recommended you stay on FQ |
-Adults ; -FQ, Bacterim, or Rocephin ; -Yes, (Vivitif) ; -4 weeks |
-Which Salmonellosis Manifestation absolutely gets Abx? ; -How likely is it that a virus causes TD? ; -How do you prophylax for TD? ; -When do you Tx TD? |
-Bacteremia or Localized Infection (Rocephin IV for 1-2 weeks) ; -Unlikely.. ETEC;Shigella;Campy;Salm;virus ; -Bismuth subsalicyclate (Pepto) 524 mg qid...Look out for black tongue, stools, and ringing! ; -More than 3 stools in 8hr period, or blood, or fever (USE FQ x 3 days) |
What bacterias toxin is associated with Floopy baby syndrome after eating Honey? ; -Where else found?; ; -Tx? ; -What is onset like? |
-C. botulinum ; -Canned foods ; -Resp support and Antitoxin ; -GI symptoms with slow decescending paralysis...progress over days to weeks |
What is Sepsis really? ; -Define parameters of SIRS |
-SIRS secondary to infectious dz. ; -2 or more of following HR over 90 Temp 100.4 or...less than 96.8 -RR more than 20 breaths -WBC greater than 12,000 or less than 4,000 |
-What 3 things do you need to Tx Sepsis? ; -What are 4 major complications fo Sepsis ; -What do DICs lead to? |
-Fluid, Abx (broad) and vasopressors ; -DICs, ARDS, Hemodynamic effx, ARF (oligouric or anuritic) ; -Microthrombi...which can lead to end-organ failure |
-What is holy trinity of Abx and used in Sepsis due to broad spectrum effects ; -What time frame do we have to Tx Sepsis |
-Vanco, Zosyn, and Cipro ; -Must be addressed in first 6 hours (initial resucitation) |
-What vasopressors do we use for Sepsis? ; -What reverses vasopressor effects if they accidentally get into skin? ; -What is the goal MAP for vasopressors? -What is the goal CVP for using crystalloids or colloids? |
-DA or NE ; -Phentolamine (do this to avoid tissue necrosis) ; -65 mm Hg ; -8...12 if on Vent (colloids have 5% albumin..need at least 0.5 L/hr) |
-What is only recommended for adult septic shock after fluid resuscitation was a failure? ; -When can we use activated protein C (drotrecogin=promoted fibrinolysis and other anti-inflammatory properties) |
; -Steroids. ; -APACHEII score of more than 25 (VERY SICK PT) |
-Name a common secondary Peritonitis cause ; -Describe Tertiary Periotonitis ; -When do absesses often occur with peritonitis? |
-Appendicitis ; -Infection persists or recurs after adequate Tx of primary or secondary...THESE PEOPLE ARE VERY VERY SICK ; -After or concurrently with peritonitis |
;-fluid and albumin shift from circulating blood into abdomen (decreased BP, shock) ; -What 2 etiological bugs cause infections with Gallstones? ; -If they aren't getting better on broad spectrums...what agent do you need to consider? |
-Third spacing
-Klebsiella spp. and E. coli
-Anaerobes and CANDIDA |
-What is crucial to Absess Tx?
-What will abdominal auscultation reveal in primary peritonitis?
-Key features of Secondary peritonitis? |
-Drainage..Abx can't always reach them.; ; -Hypoactive Bowel sounds ; -HIGH WBC 15,000 to 20,000...Abdominal pain with guarding. |
-Primary peritonitis due to cirrhosis may be treated with what? ; -What else may have to be done? ; -Tx for absess? |
-Cefotaxime (3rd gen ceph) ; -Peritoneal dialysis ; -Drainage plus Carbapenem or extended spec plus betalctmase inhibitor (ZOSYN) |
-Tx for secondary peritonitis due to appendicitis? (normal/inflammed) -Gangrous/perforated? -If you suspect your pt has an anaerobic bug...how long should you you monitor...4-7 days -If Tx fails what do you think of? |
-Anaerobic Ceph (Cefotetan or Cefoxin) ; -Gorillacylin, Zosyn, or Antianaerobic Cep (Rocephin) ; -SPACE BUGS and Candida |
What is the the fastest TB test? ; -What is protocol once dx is made? ; -What is more highly resistent...INH (Isoniazid) or RIF (Rifampin)? |
-QuantiFERON-TB Gold (24 hours...looks for IFN-gamma responses by WBCs in response to proteins normally expressed by M. tb) ; -Place pt in isolation (negative pressure rooms...personnel must wear masks) ; -Isoniazid |
-how many days must one have acid-fast bacilli in morning sputum to have TB? ; -Where does TB like to hang out? -What are the 4 drugs used to Tx active TB? (RIPE) |
-3 consecutive days ; -Apex of lungs or upper part of lower Lobe -Isoniazide, RIF, Pyrazinamide (PZA), and Ethambutol (ETB) x 2 months...then INH/RIF for 4 more months |
-Is warfarin effectiveness blunted or potentiated by RIF? ; -How is RIF cleared? |
-it is blunted...as are BC pills and Phenytoin (watch for breakthrough seizures) ; -Hepatically (10-15% increase in transaminases...can be hepatotoxic) |
What must we adjust for with PZA? ; -What is a weird SE of ETB? ; -What do we monitor for liver fct during TB Tx? |
-Renal Dysfct (ClCr;30...administer 3x weekly) -Retrobulbular retiinitis...decreased VA OR loss of ability to see green....check VA and monitor green discrimination -Hepatotoxicity is examined by looking at tranaminases; (5x ULN)...look for concordant jaundice..also total bilirubin..if above 3 mg/dL...then stop drugs. |
-T/F; more people die of Hep B than any other vaccine preventable illness? ; -How long does it generally incubate. ; -How long shed in Adults? Kids? |
-False...more people die of flu than any other v-preventable illness. ; -2 day incubation ; -shed from day before symtoms..till 5 days after symptoms in Adults...10th day in Kids. |
-Define Flu-like symptoms:) ; -What accompanies these in Kids? ; -what 2 symptoms stick around the longest? |
-rapid onset fever, myalgia, H/A, malaise, nonproductive cough, sore throat, and rhinitis ; -OM and N/V ; -Malaise and cough (can be up to 2 weeks) |
-How long do symptoms usually last with flu? ; -Who shouldn't get Flu vaccine?
-When are the vaccinations given? |
-most symptoms only present for 7 days
-Already sick, less than 6 mo old, had GB Syndrome rxn to last vaccine
-Oct to November |
-Which Antiviral is for Influenza A only?
-What is Tamiflu (what class)
-What strains does it cover?
-Which meds is Flu A H3N2 resistant to? |
-Adamantanes (Amantidine or Rimantidine)
-Neuraminidase inhibitor (along with Zanamavir)
-A and B
-Adamantanes |
-What vascular insufficiency type dz can predispose you to osteomyelitis.
-What is most common bug causing this?
-along with S. aureus, what other bug forms biofils that impede Abx penetration? |
-DM
-S. aureus
-S. epidermidis |
What must be done to help Dx osteomyelitis?
-Will there be a skin lesion in Osteomyelitis?
-Should we rely on WBC counts?
-What is best imaging technique for dx? |
-BONE BIOPSY (not simple swab), debridement (removal of necrotic tissue), Gram Stain
-There shouldn't be, just swelling and bone pain/tenderness on palpation ; -They aren't reliable, use ESR and CRP (c-reactive protiein...elevated in inflammation)
-CT and MRI...reveals it earlier than X-ray |
-What is another method that can be very expensive, but is very effective for Dx osteomyelitis
-In kids which bones are commonly affected? In adults?
-T/F...can often be secondary to pressure sores/ulcers? |
-WBC tagging and readministeration
-Long bones (Kids), Hip/vertebrae(adults)
-True |
What joint does osteo hit for IV Drug users or those whith indwelling devices? -What about those who have had cardiac surgery?
-What do we need to watch for in vertebral manifestations?
-What part of vertebral column is most often affected. |
-sternoclavicular
-Sternum
-Cord Compression
-Lower Spine (very rare that cervical is infected) |
-What Abx do we use to prophylax against osteo 30 min before incision or within 24 hrs of closure?
What do we use for Acute Tx of Osteo |
-Cefazolin
-Abx + surgery to remove necrotic bone... CS report and Tx....IV route 4-6 Weeks Cipro or Rifampin for PO |
What might a complicated case of Vulvovaginal candiasis have as teh etiological agent?
-Which of these is not a risk factor for VVC?: Abx use, Diet, Tight clothing, IUD, condoms, virgin
-T/F...VVC is an STD? |
-Non-albican species
-Condom and Virgin
-False |
-THose with VVC should have more or less yogart?
-For infections topical azoles should be used for?
-What is the oral azole? (convenient azole)
-Should pregos do topicals or orals? |
-More...at least 240 ml yogurt.
-1-7 days
-Difluconazole (Diflucan)
-Topicals |
-How many infections of VVC must you have in a year to be considered RECURRENT?
-How do you treat antifungal-resistant VVC?
-In Esophogeal Candiasis...what part of esophagus is usually affected? |
-Four or more (fluconazole x 10 days...then once per week x 6 months)
-Boric acid intravaginally x 14 days..then twice weekly or 5-FC cream x 7 days
-Lower part |
OPC Tx?
-What requires longer Tx....OPC or EC? |
-(Tx for 7-14 days)Topical – nystatin swish and swallow 5ml qid or clotrimazole troches 5x day dissolve slowly
-EC (14-21 days...21-28 for refractory EC...Fluconazole for both) |
What are risk factors for infections of skin, nails, and hair?
-What might nails look like?
-How long do you Tx Athletes foot? |
-Lazy, fat, and dirty (sendentary lifestyle)
-Chalky, dull, yellow/white, brittle, and crumbly
-2 to 4 weeks |
HIstoplamosis...where is it found..how is it transmitted?
-Txs?
-What about Blastomycosis? |
-Ohio/Mississippi River Valleys...bird and bat droppings (a fungus)...mild to life-threatening dz. caused by Histoplasma capsulatum...it is INHALED
-LFamb or Itraconazole
-Same regions...may infect lungs or even skin/bone/joint/GU (Amp B or Itraconazole) |
Which infectious fungus is present in Lower Sonoran Zone? (desert SW)
-What common pneumonia does it cause?
-What pathogen is found in pigeon droppings and soil? |
-Coccidioiodomycosis (Coccidiodes immitus)
-CAP (1/2 to 2/3 of SUBCLINICAL CAP)
-Cryptococcus neofrmans (AIDS pts can have CNS comlications and require lifelong fluco) |
| For invasive candidiasis...what is the key factor in deciding Tx? |
-Neutropenic or not if not, fluco or echinocandin x 2 weeks after last positive blood culture -If so Tx with Candin, LFamb, or voriconazole |
Must Aspergillosis be treated immediately?
-If bronchopulmonary allergy develops? |
-If INVASIVE, YES! invasive pulmonary can result in fatal pneumonia...with spread to CNS and adjacet intrathoracic structures...Tx with Voriconazole, LFamb, and Candin for 6-12 weeks.
-Tx the asthma...and treat with Itraconazole. |
