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Therapeutics P3 Spring > Exam 5 Lecture 8 > Flashcards

Exam 5 Lecture 8 Flashcards

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1
Q

candidiasis risk factors

A

broad spectrum antibiotics
PN
Neutropenia (ANC<500)
Receipt of immunosuppressive agents
Surgery
Intrabdominal perforation

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2
Q

candida tx

A

Echinocandin
- micafungin (back up to flucanozole in not susceptible to flucanozole)
caspofungin
Anidulafungin

Once we know species, use flucanozole (albicans, tropicalis etc)

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3
Q

candidiasis signs

A

Fever
Tachycardia
Tachypnea
Chills
Hypotension

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4
Q

How long to treat candidemia

A

14 days after 1st negative blood culture

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5
Q

What things do we need before we narrow candida tx to oral therapy

A

-Need susceptibilities
- Patients needs to be clinically stable
- Negative repeat blood cultures
- Been in appropriate therapy for 48 hrs
- Chose the most narrow agent (ideally flucanozole)

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6
Q

How often to repear blood cultures for candidemia tx

A

48 hrs

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7
Q

candidemia tx in neutropenic pts

A

Echino candins
- caspofungin
-Micafungin
-Anidulafungin

AMPHOTEREFCIN B 3-5 mg/kg/day

choose one

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8
Q

What is flucanozole preferred in

A

C albicans
C parapsilosis
C tropicalis
C lustainae

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9
Q

What is voriconazole preferred in

A

Krusei

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10
Q

WHat are echinocandins preferred in?

A

C glabrata
C krusei
C lustainae
C auris

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11
Q

Histoplasmosis clinical presentation

A

fevers, chills, fatigue, weightloss (big one), night sweats (big one), hepatosplenomegaly, cough, chest pain, dyspnea

CNS histoplasmosis sx- fever, headache, seizure, mental status changes

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12
Q

Histo tx of acute pulmonary histo asymptomatic/mild immunocompetent host

A

No therapy

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13
Q

Mild/moderate disease with symptoms of histo tx in immunocompetent host

A

Itraconazole 200 mg TID x 3 days , 200 mg BID for 6-12 wks

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14
Q

Mod- severe disease of histoplasmosis tx in immunocompetent patients

A

Lipid amphoterecin B 3-5 mg/kg/day x 1 week, then itraconazole 200 mg TID x 3 days followed by 200 mg BID for 12 wks

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15
Q

Histoplasmosis tx in immunocompromised hist

A

amphoterecin 3-5 mg/kg/day x 1-2 wks then itra 200 mg TID x 3 days followed by 200 mg BID for at least 12 months

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16
Q

coccidioidomycosis tx of primary pulmonary disease

A

Most recover without therapy

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17
Q

coccidiodomycosis treatment of primary respiratory infection when to treat

A

Large inocul, severe infection or concurrent risk factors (HIV, organ transplant, pregnancy, or high dose corticosteroids)

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18
Q

How to treat primary respiratory infection? duration

A

Flucanozole 400-800 mg PO/IV daily

3-6 months

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19
Q

symptomatic chronic cavitary pneumonia treatment? duration

A

flucanozole 400-800 for 12 months

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20
Q

Diffuse pneumonia with bilateral or military infiltrate occidioides tx

A

Amphoterecin B treated for 12 months

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21
Q

Causative pathogens for cryptococcus? Where do we see each one

A

C neoformans- immunocompromised host

C gaattii- immunocompetent host

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22
Q

What infection plays a major role in host defence against cryptococcus

Study These Flashcards
A

Cell mediated immunity

23
Q

difference we see in cryptococcus patients with and without HIV

Study These Flashcards
A

patients with HIV have less sx due to reduced immune system

24
Q

Most common presentation in cryptococcus

25
How is cryptococcus diagnosed
Lumbar puncture
26
cryptococcal meningitis tx of Non HIV infected, non transplant host
Induction- Amphoterecin + flucytosine 4 wks Consolidation- flucanozole 400-800 mg PO daily x 8 wks Maintenance- Flucanozole 200-400 PO daily 6-12 months
27
Alternative cryptococcal meningitis tx in order
Ampho +flucytosine Ampho + Flucanozole Flucytosine + Flucanozole High dose flucanozole Amphoterecin alone
28
Aspergillosis tx and duration
Voriconazole for 6-12 wks
29
Aspergillosis prophylaxis
Posaconazole
30
Antibiotic characteristics that influence CSF/CNS penetration
Lipid solubility- Lipid soluble drugs penetrate Ionixation- unionized drugs penetrate Protein binding- Only free drug Molecular weight- Low MW penetrate Degree of meningeal inflamation- some drugs penetrate into CSF with inflammation
31
Name drugs that need meningeal inflammation to achiever CSF concentrations
Penicillins Some cephalosporins Aztrenam Meropenem Collistin Vancomycin
32
Therapeutic antibiotics that do NOT achieve therapeutic concentrations with or without meningeal inflammation
Macrolides Aminoglycosides B lactamases Clindamycin Tetracyclines Echinocandins
33
How do bacteria gain access to CSF in meningitisq
Hematogenous ( through bloodstream)- common Direct inoculatoon (skull fracture etc)
34
cliunical signs and wx of meningitis
Brudzinski and kernig sign in adults Bulging fontanel in children Meningococcal rash
35
diagnosis of bacterial meningitis
CSF 3 tubes via lumbar (microbiology, hematology and chemistry)
36
When should antibiotics be given in bacterial meningitis
Should be given after LP and not before
37
For bacterial meningitis, what do CSF labs look like
WBC>1000-5000 Differential >80% neutrophils Proten >150 Glucose <50
38
empiric antibiotics of neonates, infants, children and adults, older adults >50
Neonates- ampicillin + ceftriaxone/cefepime or ampicillin + Aminoglycoside infants (1-23 months) and children- adults (2-50)- vanc + Ceftriaxone >50- Vanc + Ceftriaxone + Ampicillin
39
What does ceftriaxone do in neonates
Causes billiary sludging
40
if pt with bacterial meningitis has streptococcus spp and is sensitive to pen, intermediate/resistant to pen, cephalosporin resistant
Sensitive to pen- penicillin or amp PCN intermediate/resistant- ceftriaxone Cephalosporin resistant- vanc
41
What to use for bacterial meningitis for reduction in neurologic sequale
Steroids before antibiotic
42
Bacterial meningitis MSSA, MRSA tx
MSSA- nafcillin MRSA- vanc
43
bacterial meningitis with listeria monocytogenes tx
Ampicillin/gentamycin
44
H influenzae bacterial meningitis tx
B lactamase negative- ampicillin B lactamase positive- Ceftriaxone
45
Bacterial meningitis tx with enterobacteriae (E coli etc)
Ceftriaxone Cefepime Neropenem
46
Bacterial meningitis with N meningitidis tx
Pen or ceftriaxone
47
Bacterial meningitis with S pneumoniae tx
Pen susceptoble- pen G or amp Pen Resistant- vanc + Ceftriaxone
48
When does dexamethasone decrease mortality and unfavorable outcome in adults with bacterial meningitis
only with S pneumo
49
CSFinterpretation of fungal meningitis
WBC- 10-500 Differential- >50% lymphs Protein- 40-150 Glucose- <30-70
50
Treatment of fungal meningitis
induction- Ampho + Flucytosine for 2 wks COnsolidation- Flucanozole 400-800 8 wks Maintenance- flucanozole 200-400 mg 12 months (atleast 12 months AND CD4 > 200 cells/ml AND suppression of viral load on ART
51
For patients living with HIV/AIDS, when should ART be initiated for cryptococcus patients
Not until 5 wks after initiation of tx for cryptococcal meningitis due to IRIS risk
52
Viral meningitis often characterized by
Altered mental status
53
CSF interpretation of viral meningitis
WBC- 5-300 Differential- 50% lymphs protein- 30-150 Glucose- <40-70

Therapeutics P3 Spring (33 decks)

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