Infectious Disease pt 2

Question 1

Perioperative Abx Prophlyaxis:
start _____ before the incision
or start ______ before if using quinolones or vanc

Answer 1

start 60 minutes before

120 mins before if quinolone or vanc

Question 2

Perioperative Abx Prophlyaxis:

If continued into post-op: typically should be discontinued within ______

Answer 2

24 hours

Question 3

Perioperative Abx Prophlyaxis:

_____ is preferred drug of choice

Answer 3

cefazolin (1st or 2nd gen cephs are good)

Question 4

Perioperative Abx Prophlyaxis:

If beta lactam allergy or MRSA concern – give what drug?

Answer 4

vanc

Question 5

Perioperative Abx Prophlyaxis:

If bowel surgery and concerned for anaerobic infection – give what for prophylaxis?

Answer 5

cefotetan, cefoxitin, ertapenem, or ceftriaxone + metronidazole
(aka drugs with broad gram - coverage AND aneraobe coverage)

Question 6

3 classic symptoms of meningitis?

Answer 6

stiff neck
severe headache
altered mental status

Question 7

How to diagnose meningitis?

Answer 7

lumbar puncture

Question 8

what drug is given 15 - 20 minutes prior to first abx for meningitis treatment (this drug will help prevent neurological complications)

Answer 8

dexamethasone

Question 9

acute otitis media: may do an observation period for ______ to assess clinical need of abx

Answer 9

48 - 72 hours

Question 10

AOM (acute otitis media) treatment:

what is 1st line (drug and dose)

Answer 10

Amoxicillin 80 -90 mg/kg/day - divided into 2 doses

or Amox/Clav 90 mg/kg/day divided into 2 doses

Question 11

what is t/he dose of clavulanate when using amox/clav for AOM

Answer 11

6.4 mg/kg/DAY

Question 12

what bug typically causes pharyngitis?

and how to treat it?

Answer 12

Respiratory viruses and S. pyogenes

if S. pyogenes - give PCN

Question 13

Acute bronchitis is primarily caused by what?

Answer 13

respiratory viruses (about 90%…)

Question 14

what is the gold standard for diagnosing pneumonia?

Answer 14

chest x-ray

Question 15

outpt CAP (community acquired pneumonia) treatment:
 what bug most commonly causes this

Answer 15

S. pneumoniae…

Question 16

outpt CAP (community acquired pneumonia) treatment:
\_\_\_\_\_\_\_ is not a respiratory quinolone/does not cover S.pneumoniae and thus would not be a good option

Answer 16

Ciprofloxacin

Question 17

outpt CAP (community acquired pneumonia) treatment:
when picking abx must look at if…
the patient has used abx in the past _______

Answer 17

3 months

Question 18

outpt CAP (community acquired pneumonia) treatment:
when picking abx must look at if…
if the pt has ______ or _____

Answer 18

comorbid conditions or immunosuppression

Question 19

outpt CAP (community acquired pneumonia) treatment:
What abx are good options if healthy pt and no abx use in the past 3 months

Answer 19

macrolides (azithromycin, clarithromycin, erythromycin)
or
doxycycline

Question 20

outpt CAP (community acquired pneumonia) treatment:
What abx are good options if risk for drug resistant S. pneumoniae (aka drug in past 3 months)
or comorbidities?

Answer 20

beta lactam + macrolide

or Respiratory quinolone monotherapy

Question 21

inpatient CAP treatment:

what drug regimens are used

Answer 21

beta lactam + macrolide

or Respiratory quinolone monotherapy

can do IV or PO drugs for these patients

Question 22

Hospital acquired pneumonia has an onset of > ______ after hospital admission

Answer 22

48 hours

Question 23

ventilator assoc. pneumonia has an onset of > ______ after mechanical ventilation

Answer 23

48 hours

Question 24

Latent TB treatment options? (drug and dosing)

Answer 24

Isoniazid twice weekly for 9 months
Rifampin daily for 4 months
INH and rifampin once weekly for 12 weeks

Question 25

test to do to check if active TB?

Answer 25

AFB stain (acid fast bacilli)

Question 26

Active TB treatment regimen?

Answer 26

4 drug regimen (RIPE) for 2 months | then continuation phase

Question 27

what drugs make up RIPE for active TB treatment?

Answer 27

rifampin isoniazid (INH) pyrazinamide ethambutol

Question 28

what is given to reduce risk of isoniazid associated peripheral neuropathy?

Answer 28

pyriodoxine

Question 29

ADEs of isoniazid?

Answer 29

``` Peripheral neuropathy HA GI upset increased LFTs DILE - drug induced lupus positive coombs test ```

Question 30

ADEs of Rifampin?

Answer 30

increased LFTs orange-red discoloration of body secretions + coombs test flu like syndrome

Question 31

what drug can replace rifampin for TB treatment if too many drug interactions?

Answer 31

rifabutin

Question 32

ADEs of pyrazinamide?

Answer 32

``` increased LFTs hyperuricemia gout GI upset malaise ```

Question 33

ADEs of Ethambutol?

Answer 33

``` optic neuritis (dose related) increased LFTs ```

Question 34

what is the drug interaction issues seen with rifampin?

Answer 34

it is a potent INDUCER of 3A4 - affects protease inhibitors - decreases INR - decreases oral contraceptive efficacy

Question 35

stopped pg 423

Answer 35

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