Exam 4 - CNS Infections Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 4 - CNS Infections > Flashcards

Flashcards in Exam 4 - CNS Infections Deck (64):
1

what 5 things make up CSF composition/things you look at to figure out infection

Protein
Glucose
pH
WBCs
Fluid

2

CSF is made by ________

choroid plexus

3

Normal pH in CSF?

7.4

4

Normal Protein in CSF?

< 50 mg/dL

5

Normal Glucose in CSF?

50 - 66 % of serum glucose

6

Normal WBCs in CSF?

< 5 WBC/mL

7

normal fluid appearance CSF?

clear

8

3 layers of meninges?

dura mater
arachnoid
pia mater

9

BBB (blood brain barrier) or BCSFB (blood CSF barrier):
is 5000 x larger than the other

BBB is bigger

10

where is CSF found?

subarachnoid

11

BBB (blood brain barrier) or BCSFB (blood CSF barrier):
has ependymal cells to act as active transport system?

BCSFB

12

What characteristics make an abx penetration into the CSF easier:
Lipid phobic or phillic?

lipidphilic is better

13

What characteristics make an abx penetration into the CSF easier:
Ionized or unionized?

unionized is better

14

What characteristics make an abx penetration into the CSF easier:
low or high molecular weight

low is better

15

What characteristics make an abx penetration into the CSF easier:
high or low protein binding

low protein binding better b/c only free drug can penetrate

16

meningeal inflammation: help or hurt penetration into CSF?

help!

17

what drugs have therapeutic concentrations into CSF withOUT meningeal inflammation?

Acyclovir
Chloramphenicol
Fluconazole
Ganciclovr
Linezolid
metronidazole
rifampin
FQs

(MR LAG FFC)

18

what drugs have therapeutic concentrations into CSF with meningeal inflammation?

PCNs
3rd/4th gen cephs
aztreonam
meropenem
colistin
vanc

(CV PAM 3rd/4th gen)

19

what drugs do not get into the CSF no matter if meninges are inflamed?

AGs
Amphotericin-B
beta lactamase inhibitors
Some cephs (1st and 2nd gen)
Clindamycin
Tetracyclines
(SCAT BA)

20

3 main ways bacteria gains access into the CSF?

hematogenous spread
contiguous spread
direct inoculation

21

what bugs are common cause of bacterial meningitis:
In adults (30 - 50 years old)

S Pneumonaie, N meningitidis

22

what bugs are common cause of bacterial meningitis:
older adults (>50 years old)

S pneumo
N mening
GNR
Listeria

23

3 most common causes of bacterial meningitis?

H. influenzae
Neisseria meningitidis
s. pneumoniae

24

3 most common signs of bacterial meningitis

fever
headache
stiff neck

25

CSF gets obtained via ______
need __#___ tubes for what tests?

LP: lumbar puncture
need 3 tubes: chemistry/hematology/microbiology

26

Bacterial Findings in CSF for Meningitis:
WBC value?

400 - 5000

27

Bacterial Findings in CSF for Meningitis:
Differential?

> 80% neutrophils

28

Bacterial Findings in CSF for Meningitis:
Protein?

elevated:
100 - 500

29

Bacterial Findings in CSF for Meningitis:
glucose?

< 50%

30

when should empiric therapy be started?

immediately administered after LP is performed --- do not wait to get culture results!

31

Empiric Treatment options for bacterial meningitis:
Head trauma?

Vanc + 3rd/4th gen cephs (want pseudomonas coverage)

32

Empiric Treatment options for bacterial meningitis:
Older adults (> 50 years old) or Immunosuppressed

Amp + 3rd gen ceph + Vanco

*do 4th gen ceph if immunosuppressed

33

Empiric Treatment options for bacterial meningitis:
Postneurosugery?

same as head trauma!
Vanc + 3rd/4th gen cephs

34

Empiric Treatment options for bacterial meningitis:
adults (30 - 50 years old)

3rd gen ceph + vanc
(same as kids/adults 4- 29 and infants - kids (1 mo - 4 years)

35

Empiric Treatment options for bacterial meningitis:
children/adults (> 4 - 29 yr)

3rd gen ceph + vanc

36

Empiric Treatment options for bacterial meningitis:
infants/kids (1 mo - 4 years)

3rd gen ceph + vanc

37

Empiric Treatment options for bacterial meningitis:
neonates (< 1 month)

ampicillin + cefotaxime

38

Directed Treatment options for bacterial meningitis:
if S. pneumoniae?

PSSP: PCN G or Ampicillin
PRSP: Vanc + Ceftriaxone

39

Directed Treatment options for bacterial meningitis:
Group B Strep

Ampicillin (+/- gent)

40

Directed Treatment options for bacterial meningitis:
S. Aureus

MSSA: Nafcillin!! (Not Cefazolin bc doesnt get into CSF!)
MRSA: Vanc!

41

Directed Treatment options for bacterial meningitis:
Listeria monocytogenes

Ampicillin (+/- gent)

42

Directed Treatment options for bacterial meningitis:
Neisseria meningitidis

PCN
or
Ceftriaxone

43

Directed Treatment options for bacterial meningitis:
H. influenzae

BL (?) + ampicillin
BL + ceftriaxone

44

Directed Treatment options for bacterial meningitis:
Gram Negative

Ceftriaxone
or
Cefepime

45

when do you use steroids with bacterial meningitis?

use as adjunctive therapy with H. influenzae or pneumococcal meningitis

46

possible concern of steroid use in bacterial meningitis?

it will decrease inflammation of meninges --- may decrease penetration of antibiotic into the CSF

47

When to do bacterial meningitis prophylaxis:
For _________ or _______ infections only

H. influenzae or N. meningitidis

48

When to do bacterial meningitis prophylaxis:
Do for people that are _______ to the patient with the infection

close contacts
(household members, sharing sleeping quarters, daycare attendee, NH resident, anyone in crowded confined area with index case)

49

When to do bacterial meningitis prophylaxis:
Greatest risk for development develops in the _______ following exporsure

week

50

Bacterial meningitis prophylaxis regimens:
what drug is used?

rifampin

51

most common cause of fungal meningitis

cryptococcus

52

Cryptococcal meningitis treatment?

NON-HIV infected:
amphotericin PLUS flucytosine x 2 weeks then fluconazole x 12 weeks

HIV infected:
amphotericin PLUS flucytosine x 2 weeks then fluconazole x 8 weeks then for one year

53

Diagnosis of Viral Encephalitis:
Clear or cloudy?

clear!!

54

Diagnosis of Viral Encephalitis:
what type of gram stain?

negative because it aint bacteria

55

what drug is used for Viral encephalitis herpes simplex/varicella infections?

acyclovir
(renally adjust)

56

what drug is used for Viral encephalitis CMV infections?

ganciclovir and foscarnet

57

what is contiguous spread?

bacteria spread into brain tissue from nearby focus of infections

58

If HIV infected person: what bugs are we worried about that would cause a brain abscess?

toxoplasma
nocardia
cryptococcus

59

Brain Abscesses: Empiric Abx of Choice:
If Lung abscess, empyema

PCN + Metronidazole
(add sulfonamide for norcardia)

60

Brain Abscesses: Empiric Abx of Choice:
dental sepsis

PCN + Metronidazole

61

Brain Abscesses: Empiric Abx of Choice:
Otitis Media or Mastoiditis

3rd gen ceph + metronidazole

62

Brain Abscesses: Empiric Abx of Choice:
sinusitis

3rd gen ceph + metronidazole

63

Brain Abscesses: Empiric Abx of Choice:
trauma/neurosurgery?

Vanc + 3rd/4th gen ceph (cover psuedomonas)

64

Brain Abscesses: Empiric Abx of Choice:
bacterial endocarditis

Vanc + gentamicin