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Flashcards in Drugs & Bugs Deck (119):
1

pt with oral candidiasis

nystatin or fluconazole

2

pt with oral candidiasis who is allergic to azole

caspofungin

3

pt w/ vaginal candidiasis

nystatin or topical fluconazole

4

pt with invasive candidiasis (sepsis)

fluconazole

5

pt with disseminated candidiasis (multi-organ involvement)

amphotericin B

6

pt with invasive or disseminated candidiasis who is allergic to azole

caspofungin

7

pt w. cystitis candidiasis

fluconazole or amphotericin (did not specify)

8

pt w. aspergillus

voriconazole + surgical debridement w/ good response rates

9

pt w. aspergillus who is allergic to azoles

caspofungin

10

cryptococcus

serial lumbar puncture to reduce ICP

amphotericin B + 5 flucytosine + fluconazole

11

mucormycosis in DKA patient

posconazole + surgical debridement + reverse hyperglycemia and acidosis

12

severe systemic mucormycosis

amphotericin B

13

pneumocystis jirovecii

TMP/SMX (both trmt and prophylaxis)

14

histoplasmosis in a HIV pt (usually a systemic dz)

Amphotericin B

15

histoplasmosis in a pt w/ emphysema (usually a chronic lung dz)

itraconazole

16

histoplasmosis in a normal patient

√ł treatmentfluconazole (mild)

17

blastomycosis in a HIV pt (w/ meningeal involvement)

amphotericin B

18

blastomycosis in a non-HIV pt (no meningeal involvement)

√ł treatmentfluconazole (mild)

itraconaozle (moderate)

19

coccidiomycosis

√ł treatmentfluconazole (mild)

amphotericin B (severe)

20

sporotrichosis

itraconazole or KI

21

Norovirus

supportive

22

Rotavirus

supportive

23

Shigella

Ampicillin

(remember Ampicillin HELPSS to kill enterococci)

24

Salmonella enteritidis 

supportive because antibiotics may prolong fecal excretion of organisms immunocompromised/severe cases: TMP/SMX or cipro

25

salmonella typhi

Ampicillin 

(remember Ampicillin HELPSS to kill enterococci)

26

EIEC

supportive 

27

ETEC

loperamide(slows down gut motility) Fluoroquniolones (inhibits DNA gyrase and DNA topo) Azithromycin (macrolide, blocks 50s) Rafaximin (rifamycin derivative - RNA pol inhibitor)Notice this spells FAR - as travelers like to travel far...

28

EHEC

supportive

antibiotics can lead to HUS

29

Clostridium difficile (2)Bonus: which antibiotics typically cause this?

Metronidazole or Vancomycin (severe)

generally caused by ampicillin + clindamycin

30

Yersinia enterocolitica (2)

Tetracycline

TMP/SMX

(enTerocoliTica)

31

Vibrio parahemolyticus

Supportive

32

Vibrio cholera

Supportive orTetracycline

33

Listeria Monocytogenes

Ampicillin

(remember Ampicillin HELPSS to kill enterococci)

34

MSSA in acute infectious endocarditis

Nafcillin

35

MRSA in acute infectious endocarditis

Vancomycin

36

ß hemolytic Streptococci in acute infectious endocarditis

Penicillin + Gentamicin

37

Viridans Streptococci in sub-acute infectious endocarditis

Pencillin 

38

HACEK organisms in endocarditisHaemophilusActinobacillusCardiobacterium hominisEikenellaKingella

Ceftriaxone

39

streptococci in a prosthetic valve patient with endocarditis

gentamicin (AG that blocks 30S)

40

enterococci in a prosthetic valve patient with endocarditis

gentamicin (AG that blocks 30S)

41

MSSA or MRSA in a prosthetic valve patient with endocarditis

gentamicin + rifampin

42

Rhinovirus

supportive
* nasal sx: ipratropium bromide or cromolyn
* decongestants: phenylephrine
* sore throat: ibuprofen
* cough: antitussives 

43

RSV

supportive
* nasal sx: ipratropium bromide or cromolyn
* decongestants: phenylephrine
* sore throat: ibuprofen
* cough: antitussives 

44

Coronavirus

supportive
* nasal sx: ipratropium bromide or cromolyn
* decongestants: phenylephrine
* sore throat: ibuprofen
* cough: antitussives 

45

S. pyogenes pharyngitis

Penicillin

(in benzathine solution if patient is non-compliant)

46

S. pyogenes pharyngitis in a penicilin-allergic patient

Azithromycin (macrolide - blocks 50s)

47

mono

supportive

48

bronchitis due to mycoplasma pneumoniae 

erythromycin or azithromcin (macrolides; inhibits 50s)(mycoplasma pneumoniae = atypical pneumonia) 

49

bronchitis due to chlamydia pneumoniae 

erythromycin or azithromcin (macrolides; inhibits 50s)(chlamydia pneumoniae = atypical pneumonia) 

50

sinusitis due to H. influenza

amoxicillin-clavulanate (HELPSS)

51

someone who has mild CAP 

assume atypical + s. pneumo and start the patient out withazithromycin + doxycycline 

52

CAP due to strep. pneumoniae

doxycycline (tetracycline, 30S)

53

CAP due to H. influenzae

azithromycin (prototype for atypical pneumonia)

54

CAP due to chalmydophilia 

azithromycin (prototype for atypical pneumonia)

55

CAP due to mycoplasma 

azithromycin (prototype for atypical pneumonia)

56

CAP due to legionella 

azithromycin (prototype for atypical pneumonia)

57

patient admitted to the hospital due to pneumonia

since the patient is admitted, cover both atypicals (azithromycin) and other causes of serious pneumonia /hospital acquired pneumonia ie GNazithromycin + ceftriaxone

58

pneumonia due to MRSA

vancomycin

59

HAP due to S. aureus

Vancomycin + ceftriaxone(always assume MRSA in this setting until proven otherwise; also want coverage for pneumonia caused by GN bugs)

60

aspiration pneumoniae

metronidazole clindamycin (according to FA)(good for anaerobes)

61

ventilator acquired pneumonia 

pseudomonas

COMBO therapy

piperacillin + gentamycin (AG) or ceftazidime

62

Simple UTI due to E. coli

amoxicillin

(same class as ampicillin, which HELPSS to kill enterococci)

63

Simple UTI due to S. saprophyticus

Ciprofloxacin (fluroquinolone- inhibits DNA gyrase)

64

Recurring UTI

think E. coli, S. saprophyticus, Klebsiella combination (treating one with a particular antibiotic will only let the others grow so you want to use a broader-spectrum antibiotic)use: TMP-SMX (which has broader spectrum activity)

65

Chlamydia

Azithromycin (macrolide)orDoxycycline (tetracycline)

66

Gonorrhea

Ceftriaxone (3rd gen)in reality, add Azithromycin or doxycycline to cover Chlamydia since they are usually coinfected!

67

Syphillis 

Penicillin G

68

LOL in nursing home with indwelling foley

GNR (E Coli or Klebsiella) = Ceftazidimeor Pseudomonas = Piperacillin 

69

Influenza

Zanamivir

Oseltamivir

70

HSV

acyclovir

71

HSV resistant to acyclovir

Cidofovir

Foscarnet

72

VZV, uncomplicated

Famciclovir

73

VZV in pregnant women/neonates

valacyclovir 

74

CMV prophyaxis

Valganciclovir

75

CMV

Ganciclovir

76

CMV resistant to ganciclovir

Cidofovir

Foscarnet

77

HepA 

IFN-a

78

HepC - acute

IFN-a

79

HepC chronic

ribavarin

80

Molluscum contagiosum (pox)

Cidofovir

81

Kaposi Sarcoma

IFNa

82

Hairy Cell Leukemia

IFNa

83

Condyloma acuminatum (HPV)

IFN-a

84

eryspielas

grp A streppenicillin

85

impetigo

S. aureus

mild: mupirocin - reduces nasal carriage of staph/MRSA

severe: cephalexin - good for GP and GN (proteus, E. coli, and klebsiella, since it's near the mouth

if MRSA is involved: add TMP/SMX (standard protocol if there is MRSA skin + soft tissue infections; not vanco b/c that is for systemic/IV infections)

86

Cellulitis due to S. pyogenes

Penicillin

87

Cellulitis due to Staph aureus

make sure to cover for MSSA/MRSA

MSSA: use semi-synthetics - nafcillin "naf for staph" or oxacillin

MRSA: use TMP/SMX since it's a skin/soft tissue infection 

if this somehow progressed to systemic infection: Vancomycin

88

Cellulitis due to Vibrio vulnificuls

GN can be acquired due to eating raw oysters/salt water exposure

Ciprofloxacin (fluoroquinolone - good GN coverage)

89

Furuncles/Carbuncles

make sure to cover for MSSA/MRSA

MSSA: use semi-synthetics - nafcillin "naf for staph" or oxacillin

MRSA: use TMP/SMX since it's a skin/soft tissue infection 

if this somehow progressed to systemic infection: Vancomycin

90

Folliculitis 

S. aureus, usually superficial only w/ √ł systemic toxicity

MupirocinPolymyxin B-neomycin-bacitracin

91

Cellulitis due to cat bite

cat/dog bite - often polymicrobial - cover for Pasturella multocia  + anaerobes in the animal's mouth

Augmentin (Amoxicillin + clavulanate) 

remember Amp HELPSS to kill enteroccocci)

92

Human bites 

often polymicrobial - cover for Eikenella Corrodens  + anaerobes in the animal's mouth

Augmentin, IV (Amoxicillin + clavulanate) 

remember Amp HELPSS to kill enteroccocci)

93

Necrotizing Fasciitis

MRI + exploratory surgery 

94

Lyme Disease (early)

Doxocycline 

95

Lyme disease (late)

Ceftriaxone

(just a fact that you have to remember..)

96

Osteomyelitis due to streptoccci

pencillin G

97

Osteomyelitis due to MSSA

nafcillin or oxacillinuse naf for staph

98

Osteomyelitis due to MRSA

vancomycin 

(not TMP/SMX b/c it is only used for skin and soft tissue infections) 

99

Osteomyelitis due to Pseudomonas (2)

Piperacillin + Gentamicin

(gentamicin has synergistic effects w/ ß-lactam antibiotics)

or Ciprofloxacin

100

Enterobius vermicularis

Bendazole + treat entiire family for 2 wks

101

Strongyloides Stercoralis

Bendazole (or Ivermectin)

shoes

102

Ascaris lumbricoides

Piperazine (both remind me of pipe-cleaners..)

103

Visceral Larva Migrans

Dog/cat Toxocariasis

Bendazole or Diethylcarbamazine

104

Schistosomiasis

Praziquantel

105

Giardia lamblia

Metronidazole (lacks mitochondria)

106

Cryptosporidium parvum

supportive

filter water

107

trichomonas vaginalis

metronidazole

108

toxoplasmosis

pyrimethamine-sulfadiazine + leucovorin (rescue) both are anti-folate

Rx:  
sulfadiazine  blocks DHF synthesis
pyrimethamine - blocks DHFR action

109

Malaria

Chloroquine

110

Malaria in a patient with eczema

atovaquone-proguanil (malarone)

111

malaria in a patient who is resistant to chloroquine

atovaquone-proguanil (malarone)

112

P. vivax treatment

Chloroquine or Malarone (atovaquone-proquanil) PLUS primaquine"preema queen" to hypnozoites (latent forms) 

(google image for "preema queen" --> indian woman --> malaria endemic area - don't judge) 

113

Babesiosis

Atovaquone + Azithromycin

114

Latent TB

INH x 9 mo

115

Active TB

RIPE x 6 mo  

116

2 drugs that you must infuse slowly

amphotericin B

Vancomycin (red man syndrome)

117

MAC treatment

Clarithromycin + rifabutin + ethambutol

(last 2 are also MTB trmts: RE) 

got RiCE??

118

MAC prophylaxis

Azithromycin

119

prophylaxis for Cryptococus in HIV patient

lifelong fluconazole