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Pharm I > Meningitis > Flashcards

Meningitis Flashcards

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1
Q

Causes of meningitis

A 
Bacterial
Fungal
Mycobacteral
Viral
Parasitic
Spirochetes
Drug-induced
-Sulfonamides, NSAIDs, IV immunoglobulin
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2
Q

Common bacterial pathogens

A 
Strep pneumoniae
Neisseria meningitidis
Group B Strep
Hemophilus influenzae
Listeria monocytogenes
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3
Q

To discern what bugs to target, consider…

A 
Environmental exposures (sick contacts, endemic fungi)
Recent infections
Immunosuppression
-HIV/AIDS (Cryptococcus)
-Asplenia
-Cancer
Surgery or trauma
Non-infectious causes
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4
Q

To discern what drugs to use, consider…

A 
Age
Medication allergies
Medication properties
-CNS penetration
-Spectrum of activity
-Adverse effects
-Resistance patterns
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5
Q

Tx for CNS infections- characteristics of medications

A 
Microcidal
High-dose
Parenteral
Low molecular weight
Lipophilic
Unionized at physiologic pH
Not highly protein bound
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6
Q

First steps of tx

A

Supportive care
LP
-Usually done prior to abx
-Do not delay abx is there is a delay getting LP
High dose, parenteral abx
-Age
-Risk factors for MDR bacterial, fungal, viral, etc infection

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7
Q

Lab results in nl pt: CSF

A 
WBC <5
Differential: monocytes
Protein: <50
Glucose: 45-80 (50-60% of the blood glucose)
CSF: BG ratio: 50-60%
CSF stain: Neg
Opening pressure: <20 mm Hg
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8
Q

Bacterial CSF lab results

A 
WBC: 1,000-5,000
Differential: Neutrophils
Protein: Elevated
Glucose: Low
CSF:BG ratio: Decreased
CSF stain (+) Gm stain
Opening Pressure: >20 mmHg
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9
Q

Viral CSF lab results

A 
WBC: 5-500
Differential: Lymphocytes
Protein: Mild elevation
Glucose: Normal
CSF: BG ratio: Normal
CSF stain: Neg
Opening pressure: <20 mmHg
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10
Q

Fungal CSF lab results

A 
WBC: 100-400
Differential: Lymphocytes
Protein: Elevated
Glucose: Low
CSF: BG ratio: Decreased
CSF stain: (+) Indian ink stain (Crytpo)
Opening Pressure: >20 mmHg
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11
Q

TB CSF lab results

A 
WBC: 25-50
Differential: Variable
Protein: Elevated
Glucose: Low
CSF:BG ratio: Decreased
CSF stain: Pos AFB
Opening Pressure: >20 mmHg
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12
Q

Common therapy for bacterial meningitis for < 1 mo

A

Ampicillin + Cefataxime or Ampicillin + aminoglycoside

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13
Q

Common pathogens for bacterial meningitis <1 mo

A

S. agalactiae
E. coli
L. monocytogenes
Klebsiella species

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14
Q

Common pathogens for bacterial meningitis 1-23 mos

A 
S. pneumoniae
N. meningitidis
S. agalactiae
H. influenzae
E. coli
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15
Q

Recommended therapy for bacterial meningitis 1-23 mos

A

Vancomycin
AND
Ceftriaxone OR Cefataxime

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16
Q

Common pathogens in bacterial meningitis for 2-50 yrs

A

S. pneumoniae

N. meningitidis

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17
Q

Recommended therapy for bacterial meningitis 2-50 yrs

A

Vancomycin
AND
Ceftriaxone OR Cefataxime

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18
Q

Common pathogens in bacterial meningitis for > 50 yrs

A

S. pneumoniae
N. meningitidis
L. monocytogenes
Aerobic gm-neg bacilli

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19
Q

Recommended therapy for bacterial meningitis for > 50 yrs

A

Vancomycin AND Ampicillin AND Ceftriaxone OR Cefotaxime

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20
Q

Ampicillin adult dose in meningitis

A

2 gm IV q4h

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21
Q

Side effects of ampicillin

A

Hypersensititvity
Rash
Interstitial nephritis

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22
Q

Adult dose in ceftriaxone

A

2 gm IV q12H

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23
Q

Side effects of ceftriaxone

A

Hypersensitivity
Pancreatitis
Gallbladder pseudolithiasis

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24
Q

Adult dose in cefotaxime

A

2 gm IV q4-6h

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25
Side effects of cefotaxime
Hypersensitivty | Rash
26
Clinical pearls of ampicillin
Renal elimination
27
Clinical pearls of ceftriaxone
Avoid in neonates Avoid use with Ca containing IV fluids Hepatic elimination
28
Clinical pearls of cefotaxime
Preferred in neonates | Renal elimination
29
Adult dose for vancomycin
15-20 mg/kg IV q8-12h | Goal trough = 15-20 mg/dL
30
Side effects of vancomycin
Neurotoxicity Infusion reactions Nephrotoxicity Ototoxicity
31
Clinical pearls for vancomycin
DTM required | Renal elmination
32
Adult dose for gentamicin, tobramycin
2-2.5 mg/kg IV q8h OR 5-7 mg/kg IV qday
33
Side effects of gentamicin, tobramycin
Nephrotoxicity Neurotoxicity Ototoxicity
34
Clinical pearls for gentamicin, tobramycin
DTM required | Renal elimination
35
Gm positive cocci
Group B streptococcus Strep pneumoniae Staph aureus
36
Gram positive rod
Listeria monocytogenes
37
Gram neg cocci
Neisseria meningitidis
38
Gm neg rod
E. coli Klebsiella species H. influenza P. aeruginosa
39
Recommended therapy for S. pneumoniae
Vancomycin plus a third-generation cephalosporin
40
Alternative therapy for S. pneumoniae
Meropenem, fluoroquinolone
41
Recommended therapy for N. meningitidis
Third-gen cephalosporin
42
Alternative therapies for N. meningitidis
Pen G, Ampicillin, chloramphenicol, fluoroquinolone, aztreonam
43
Recommended therapy for L. monocytogenes
Ampicillin or Pen G
44
Alternative therapies for L. monocytogenes
Trimethoprim-sulfamethoxazole, meropenem
45
Recommended therapy for S. agalactiae
Ampicillin or Pen G
46
Alternative therapies for S. agalactiae
Third-gen cephalosporin
47
Recommended therapy for H. influenzae
Third-gen cephalosporin
48
Alternative therapies for H. influenzae
Chloramphenicol, cefepime, meropenem, fq
49
Recommended therapy for E. coli
Third-gen cephalosporin
50
Alternative therapies for E. coli
Cefepime, meropenem, aztreonam, fq, trimethoprim-sulamethoxazole
51
Dexamethasone guidelines
Neonates- insufficient evidence to recommend use Infants and children- H. influenza meningitis, consider in S. pneumoniae Adults- S. pneumoniae Dosing: Dexamethosone 0.15 mg/kg (10 mg in adults) IV q6h x 2-4 days Give with or before 1st dose of antibiotic
52
Duration of therapy for N. meningitidis
7 days
53
Duration of therapy for H. influenzae
7 days
54
Duration of therapy for S. pneumoniae
10-14 days
55
Duration of therapy for S. agalactiae
14-21 days
56
Duration of therapy for gram-neg bacilli
21 days
57
Duration of therapy for L. monocytogenes
Greater than or equal to 21 days
58
Who do you give prophylaxis to?
Household/daycare/close contacts, shared sleeping quarters, direct exposure to secretions
59
Prophylaxis tx
``` N. meningitidis -Rifampin 600 mg PO BID x 4 doses -Ciprofloxacin 500 mg PO x 1 dose -Ceftriaxone 250 mg IM x 1 dose H. influenzae -Indicated if not received full Hib vaccine series -Rifampin 600 mg daily PO x 4 days ```
60
Common viral pathogens
``` Enteroviruses (85%) Arboviruses HSV Cytomegalovirus Varicella-zoster Rotavirus Coronavirus Influenza A and B West Nile Epstein-Barr ```
61
Treatment for viral
``` HSV or VZV suspected -Acyclovir 10 mg/kg IV q8h x 14 days --21 days if immunosuppressed --Use IBW to calculate dose --Continuous IV fluids to avoid AKI crystal nephropathy Supportive care -Seizure control -Lower ICP if necessary ```
62
Adverse effects of acyclovir
``` Nephrotoxicity TTP/ HUS Rash N/V Phlebitis ```

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