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PHM603 > Exam III - Bodily Infections/Vaccines > Flashcards

Exam III - Bodily Infections/Vaccines Flashcards

(92 cards)

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1
Q

Most sinusitis is?

A

viral (90%)

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2
Q

When are antibiotics used in sinusitis? (3)

A

persistent symptoms, severe symptoms, and worsening symptoms

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3
Q

What is first-line for sinusitis?

A

amoxicillin-clavulanate

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4
Q

What is a rare side effect of fluoroquinolones in children?

A

tendonitis

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5
Q

What is the duration of antibiotics in acute sinusitis?

A

adults 5-7days, children 10-14days

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6
Q

What are characteristics of chronic sinusitis? (2)

A

symptoms persist >12 weeks, often not infectious

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7
Q

What is first-line for pharyngitis? (2)

A

penicillin VK or amoxicillin

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8
Q

What is the duration of antibiotics in pharyngitis?

A

10 days (5 days for azithromycin)

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9
Q

What are alternative treatments for pharyngitis?

A

first gen cephalosporins (cephalexin) for previous rash, clindamycin or azithromycin for previous anaphylaxis

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10
Q

When is the highest incidence of acute otitis media?

A

between 6-24 months

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11
Q

When can you use antibiotics for AOM?

A

6mo - 12yr plus moderate-severe pain or temp 102.2, 6mo - 23mo plus nonsevere bilateral acute OM

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12
Q

When can you consider using antibiotics for AOM?

A

6mo - 23mo plus nonsevere unilateral, 2-12yr plus nonsevere acute OM

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13
Q

What is first-line for AOM?

A

amoxicillin-clavulanate (90mg/kg)

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14
Q

What are signs and symptoms of pneumonia? (11)

A

cough, sputum, dyspnea, fever/chills, hemoptysis, pleuritic chest pain, tachypnea, tachycardia, diminished breath sounds, egophony, increased WBCs

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15
Q

What are some diagnostics used for pneumonia? (6)

A

BAL, blood cultures, procalcitonin, O2%, urinary antigen testing, and viral panels

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16
Q

Hospital-acquired and ventilator-associated pneumonia occur after?

A

48 hrs

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17
Q

What are characteristics of typical pneumonia? (5)

A

abrupt onset, unilateral well-defined infiltrate, significant fever/chills, purulent sputum, primarily pulmonary symptoms (pleuritic chest pain)

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18
Q

What are characteristics of atypical pneumonia? (5)

A

gradual onset, diffuse infiltrates, mild fever, dry cough, extrapulmonary symptoms (GI, myalgias)

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19
Q

What are treatments for outpatient CAP? (3)

A

amoxicillin, doxycycline, macrolides (azithro/clarithromycin)

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20
Q

What are treatments for outpatient CAP w/comorbidities?

A

amoxicillin-clavulanate or cephalosporin plus macrolide (azithro/clarithromycin), fluoroquinolone

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21
Q

What are treatments for non-severe inpatient CAP?

A

IV beta-lactam (amp/sul, ceftriaxone) PLUS macrolide or fluoroquinolone

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22
Q

What are treatments for severe inpatient CAP?

A

IV beta-lactam PLUS macrolide or PLUS fluoroquinolone

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23
Q

What is the duration of therapy for CAP?

A

> /= 5days

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24
Q

What are risk factors for VAP? (4)

A

prior antibiotics, colonization, hospitalization, or chronic care immunosuppresive diseases/therapy

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25
What antibiotics are used
ceftriaxone, levo/moxifloxacin, ampicillin/sublactam, ertapenem
26
When to empirically cover for pseudomonas? (4)
prior IV antibiotics within 90 days, severe presentation (sepsis), previous infection/colonization, immunosuppression
27
What antibiotics are used for pseudomonas? (5)
piperacillin/tazobactam, cefepime, ceftazidime, imi/meropenem, aztreonam
28
What other antibiotics are used for pseudomonas? (3)
cipro/levofloxacin, aminoglycosides, colistin + polymyxin B
29
What is the duration of therapy for HA/VAP?
7days
30
What are clinical implications of complicated UTIs? (5)
recurrence, SIRS/sepsis, extensive antimicrobial resistance, immunosuppression, instrumentation/catheters
31
What are signs/symptoms of cystitis? (3)
dysuria, frequency/urgency, hematuria
32
What are signs/symptoms of pyelonephritis? (5)
same as cystitis, costovertebral angle tenderness, fever, chills, N/V
33
What are laboratory findings used for UTI diagnosis? (8)
pyuria, leukocyte esterase, nitrites, WBCs, hematuria, WBCs casts, protenuria, bacteria
34
What are the thresholds for significant bacteriuria?
traditional >10^5 CFUs/mL, women >10^2, men >10^3
35
What is a clinical UTI defined as?
bacteruria PLUS pyuria and signs/symptoms of infection
36
What is used for uncomplicated UTIs? (2)
trimethoprim-sulfamethoxazole x3days, nitrofurantoin monohydrate/macrocrystals x5days
37
What is used for uncomplicated acute pyelonephritis? (4)
trimethoprim-sulfamethoxazole x14days, po beta-lactams with initial IV dose x10-14days, ciprofloxacin, fluroroquinolones
38
What is used for complicated acute pyelonephritis? (3)
extended-spectrum cephalosporin or penicillin derivative +/- aminoglycoside, fluoroquinolones, carbapenems
39
One should not treat asymptomatic bacteruria unless? (3)
pregnant, prior to invasive UT procedures, prior to renal transplants
40
What is first-line for pregnant w/UTI and duration? (2)
amoxicillin-clavulanate x7days, cephalexin x3-7days
41
What is first-line for pregnant w/pyelonephritis?
IV beta-lactams (ceftriazone, cefazolin) x14days
42
What should NOT be given during pregnancy for pyelonephritis?
fluoroquinolones and tetracyclines
43
What is used for acute bacterial prostatitis?
trimethoprim-sulfamethoxazole, quinolones (by urologists), gentamicin/ampicillin (for enterococcus) all 2-4weeks
44
What is used for chronic bacterial prostatitis?
trimethoprim-sulfamethoxazole, quinolones both 4-6weeks
45
What is used for traveler's diarrhea and for how long?
loperamide x2 days
46
What is used for enterocoxic E. coli and for how long? (3)
ciprofloxacin, azithromycin, and rifamixin x1-3days
47
Evaluation of water loss (mild)?
<5% body weight loss, alert and restless, moist to slightly dry mucus membranes, normal/slightly decreased urinary output
48
Evaluation of water loss (moderate)?
6-9% body weight loss, lethargic and restless, low BP and high HR, dry mucus membranes, dark urine
49
Evaluation of water loss (severe)?
>10% body weight loss, drowsy and limp and LOC, bradycardia, cyanotic, skin tenting, no urine
50
What is the most common microbial cause of healthcare-associated infections in US?
CDI
51
Differentiate Toxin A and Toxin B?
Toxin A = enterotoxin and damages epithelium, Toxin B = cytotoxin and cell death
52
What are patient specific risk factors for CDI? (4)
Age >65, GI surgery, tube feeding, immunocompromised
53
What are facility related risk factors for CDI? (3)
length of stay, ICU admission, exposure
54
What are medication related risk factors for CDI? (3)
acid-suppressing agents, chemo, antibiotics
55
Severity of disease CDI (non-severe)?
leukocytosis WBC < 15k cells/mL AND SCr < 1.5 mg/dL
56
Severity of disease CDI (severe)?
leukocytosis WBC > 15k cells/mL OR SCr < 1.5 mg/dL
57
Severity of disease CDI (fulminant)?
hypotension or shock, ileus, megacolon
58
What should be avoided and given for CDI, respectively?
loperamide and narcotics (anti-peristaltic agents), hydration and electrolyte correction
59
What is used for non-severe CDI?
vancomycin 125mg PO QID, fidaxomicin 200mg PO BID, or metronidazole 500mg PO TID all x10days
60
What is used for severe CDI?
vancomycin 125mg PO QID, fidaxomicin 200mg PO BID both x10days
61
What is used for complicated/fulminant CDI?
vancomycin 500mg PO or NG QID (PLUS metronidazole 500mg IV q8hr if ileus present)
62
What transplant method is extremely successful?
fecal microbiota transplantation (FMT)
63
What vaccination rate is needed for herd immunity (measles)?
83-94%
64
What vaccination rate is needed for herd immunity (pertussis)?
92-95%
65
PCV13 and PPSV23 should be spaced?
8 weeks apart
66
PCV13 and MenACWY-D should be spaced?
>4 weeks apart
67
Which vaccine combination MUST be spaced and for how long?
2 or more live parenteral, 28days
68
What trimester should you wait for to give most vaccines?
2nd trimester
69
Live vaccination delay time for patient receiving chemo/radiation?
2 weeks before or 3 months after treatment
70
What type of systemic corticosteroids are of import in vaccinations?
2+ mg/k/d or 20+ mg/d prednisone for 14+ days
71
How long to wait after live vaccination for IVIG administration?
14+ days
72
How long to wait after live vaccination for PPD skin test?
simultaneous administration or 4-6 weeks after
73
Which vaccinations are SQ only?
herpes zoster (Zostavax brand), MMRV containing vaccines, MPSV-4, and PPSV-23
74
What are the primary goals of ART? (5)
maximal an durable viral suppression, restoration and preservation of immune function, improved QoL, reduced opportunistic infections, reduced morbidity and mortality
75
What is the recommended treatment combo for most people with HIV?
INSTI + 2 NRTIs
76
What are the top two most common INSTI + NRTI treatments?
BIC/FTC/TAF, DTG/ABC/3TC
77
What are adverse events associated with integrase inhibitors?
GI, CNS disturbances, rash, false elevation in SCr, weight gain
78
What are drug interactions with integrase inhibitors?
cations (acid reducers), metformin
79
bictegravir advantages?
single tablet regimen, high resistance barrier
80
bictegravir disadvantages?
limited safety data in pregnancy
81
dolutegravir advantages?
single tablet regimen, high resistance barrier, preferred for pregnant women regardless of trimester
82
dolutegravir disadvantages?
ABC coformulation requires HLA-B*5701 testing, increases metformin levels
83
raltegravir advantages?
longest experience
84
raltegravir disadvantages?
multiple pills, lower barrier to resistance
85
Which INSTI should not be used if RNA levels are greater than 500k?
Dovato
86
Which INSTI should not be used if HLA-b*5701 positive?
Triumeq (w/abacavir)
87
Which NNRTI should not be used if RNA levels are >100k or CD4+ <200
one with rilpivirine (alefenamide)
88
Which integrase inhibitors should not be combined with acid reducers?
dolutegravir/rilpivirine combinations
89
What is the preferred regimen for ART in pregnancy?
dual NRTI backbone plus INSTI or boosted PI
90
Pfizer monovalent products explanation?
maroon/orange/gray caps = 3/10/30mcg = <4/5-11/12+ yrs
91
Moderna monovalent products explanation?
magenta/purple/blue labels = 25/50/100mcg = <5/6-11/12+ yrs
92
Moderna bivalent products explanation?
yellow/gray labels = 10/25 or 50mcg =

PHM603 (3 decks)

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