Pharm week 2 (infection) Flashcards
(144 cards)
1
Q
4 things to assess on the tympanic membrane?
A
- Color (red)
- Position (displaced/bulging)
- Translucency (opaque)
- Mobility (immobile)
2
Q
Criteria for “watchful waiting” in otitis media (4 things)
A
> 6 months old
Non severe illness (fever < 39, mild otalgia)
Uncomplicated
Parent can recognize worsening sx and seek care
3
Q
Criteria of uncomplicated otitis media?
A
- no episode in preceding month
- no acute facial nerve palsy
- no mastoiditis
- no meningitis
- no labyrinthitis (inflammation of middle ear (labyrinth), causes vertigo, hearing loss
- No craniofacial abnormalities, immunodeficiencies, cardiac/pulmonary disease, Down syndrome, or hx of complicated AOM
4
Q
What does H. influenzae and M. catarrhalis produce?
A
beta-lactamases
5
Q
How does penicillin work?
A
Prevents cell wall synthesis in dividing organisms
6
Q
Where does Penicillin target? (8)
A
body fluids joints pleural cavities pericardial cavities bile saliva milk placenta
7
Q
Dorsal versus palmar of hand
A
Dorsal= top Palmar= underside
8
Q
Pathogenic organism in osteomyelitis in newborn?
most common, and high risk infants
A
Staphylococcus aureus (S. aureus)
Some cases:
- Group B. Streptococcus
- Escherichia coli (especially with multiple bone involvement and high risk infants)
9
Q
What drugs to avoid in pyelonephritis? (4)
A
- Nitrofurantoin (not adequate tissue or renal concentration)
- Fosfomycin : same as above
- Moxifloxacin: inadequate urinary levels
- amoxicillin and cephalexin (high e. coli resistance)
10
Q
Examples of atopic illness? (6)
A
Anaphylaxis allergic rhinitis allergic asthma Hives eczema (atopic dermatitis) Some food sensitivities
11
Q
Explain mechanism of Type I reactions? (3 points)
A
- IgE antibody mediated
- Runs in families
- Hypersensitivity of an end organ (i.e. nose, bronchi) to MAST CELL production
12
Q
Explain beta-lactam allergy and related concerns?
A
Negatives:
- longer hospital stays
- use of less desirable abx
- True PCN allergy doesn’t need to avoid all beta-lactams/cephalosporins (97%) are fine
- anaphylaxis in < 1%
- family hx not significant factor
13
Q
What is negative predictive value?
A
Negative predictive value is the probability that subjects with a negative screening test truly don’t have the disease.
14
Q
Positive Predictive Value?
A
Positive predictive value is the probability that subjects with a positive screening test truly have the disease.
I.e.: you test positive for PCN allergy, you actually have a PCN allergy
15
Q
DRESS stand for?
A
D-drug R-rash E-eosinophilia S-systemic S-symptoms
16
Q
What factors affect the type of reaction a patient may have to a drug?
A
1- type of antigen
2- route of exposure (IV, topical > oral)
3-end organ affected
17
Q
End organ affected by PCN and food allergies?
A
Blood vessels
18
Q
Example of a allergic rhinitis Type I reaction antigen?
A
Ragweed pollen
19
Q
What is the effect of leukotrienes?
A
- Increased vascular permeability
- leukocyte recruitment (increase WBC adhesion to endothelium, act as a chemotactic factor)
- Bronchoconstriction (ie. astham, allergies, anaphylaxis)
20
Q
What does histamine do in a Type I reaction? (4)
A
- vasodilation
- bronchoconstriction
- itching
- chemotaxis of eosinophils to the site
- RAPID
21
Q
What drug blocks leukotriene receptors? (2)
A
Zafirlukast
Montelukast
22
Q
Histamine receptors blocked by?
A
H1 and H2 antihistamines
23
Q
Histamine release blocked by?
A
Cromolyn sodium
24
Q
Anaphylactoid reactions are? Causes?
A
- resemble anayphylaxis
- NOT mediated by IgE
- causes: radiocontrast dye, opioids
- these release histamine and other compounds from mast cells
- produce the same clinical picture with anaphylaxis but are not IgE mediated, occur through a direct nonimmune-mediated release of mediators from mast cells and/or basophils or result from direct complement activation.
25
Symptoms of serum sickness? (8)
```
rashes
itching
arthralgia
fever
lymphadenopathy,
hypotension
shock
glomerulonephritis
```
26
What type of reaction is serum sickness?
Type III : IgG or IgM immune complex formation
27
Examples of drugs that can cause serum sickness?
sulfonamides
penicillin
phenytoin
isoniazid
28
Who reacts to NSAIDS or ASA? How?
```
20% of those with asthma
urticaria
angioedema
rhinosinusitis
asthma
```
29
Patient experiences a rash from penicillin. Safe option?
Cephalosporin
30
What does epinephrine do?
* Increases peripheral vascular resistance
* Decreases mucosal edema
* Induces bronchodilation
* Increases cardiac contractility and HR
31
Acetaminophen dosage (Pediatrics)
10-15mg/kg/dose PO q4h prn (Max 75 mg/kg/day)
32
Ibuprofen dosage (Peds)
10mg/kg/dose PO q 6-8h prn (Max 40mg/kg/day)
33
What are the benefits of "watchful waiting" for AOM? (3)
1. Decreases cost
2. prevent development of resistance
3. Prevent ADR: Nausea, vomiting, rash
34
Most prevalent pathogen in AOM?
S. Pneumoniae (strep pneumoniae)
35
Standard Amoxicillin dosing for OAM?
40mg/kg/day (divided TID) x 5 days
36
S. Pneumoniae resistance risk factors?
< 2 years old
| Had abx in the last 3 months
37
How many days of abx therapy for perforated tympanic membrane?
Amoxicillin x 10 days (instead of 5)
38
High dose for Amoxicillin for AOM?
90mg/kg/day (divided BID or TID)
| Less volume/ dose may be better for kids/parents
39
Who gets high dose Amoxicillin for AOM?
Risk factors for S. Pneumonia resistance
| 6 months to 2 years old
40
Drug and dose for AOM and purulent conjuntivitis?
Amoxicillin- Clavulin (7:1, 200 or 400mg clavulin)
| 45 mg/kg/dose (divided BID) x 5 days
41
Who gets Amoxicillin-Clavulin with purulent conjunctivitis for 10 days?
< 2 years
| perforated eardrum
42
Examples of IgE Mediated Reaction to Beta-Lactam? (3)
- • Urticaria (hives)
- • Laryngeal edema
- • Angioedema
43
Examples of serious Non-IgE Mediated reactions to Beta-Lactam? (6)
```
-Serum sickness
• End organ damage
• Severe cutaneous reactions (ie: StevensJohnsons Syndrome)
• Hemolytic anemia
• hepatitis
• Interstitial nephritis
```
44
What are the first 2 steps after unresolved sx of AOM?
Check compliance
| confirm diagnosis
45
How do you prevent mastoiditis?
- following pt appropriately and
| - initiating abx therapy for those who do not improve
46
When do you treat acute sinusitis with ABX?
- worsening sx
- no improvement after 5-7 days
- fever >39 with purulent drainage OR
- facial pain for 3-4 days consecutively from start
47
When are nasal corticosteroids possibly useful for acute sinusitis? (2)
- recurrent
| - allergic
48
Pathogens responsible for acute sinusitis?
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Moraxella Catarrhalis
49
What are benefits to amoxicillin?
- good spectrum against s. pneumoniae
- well tolerated
- not expensive
50
Clinical presentation for Acute Exacerbation of Chronic Bronchitits?
Cough with absence of tachypnea or tachycardia
51
Cardinal signs of acute exacerbation of Chronic Bronchitis?
Cardinal signs:
Increased sputum volume
Increased sputum purulence
Worsening of dyspnea
52
First line option for treating community acquired pneumonia? CAP
Amoxicillin and doxycylcine
53
What needs to be done BEFORE prescribing antimicrobial therapy?
1. identlfy the pathogen
| 2. identify local resistance patterns
54
What color does the gram negative stain?
RED
55
What color does the gram positive stain?
violet or blue
56
Characteristics of Gram Positive?
- stains blue/violet
- thick outer peptidoglycan cell wall
- inner cytoplasmic membrane
57
MIC?
Minimum inhibitory concentration
58
mbc
minimum bactericidal concentration of a drug
| used for more serious infections
59
Bacteriostatic
Inhibits growth
MIC achieved but not MBC
MIC is lower than MBC
60
Bacteriocidal
MIC = MBC
| kills organism
61
Beta Lactams: Penicillins?
* Penicillin (PO/IV)
* Cloxacillin (PO/IV)
* Ampicillin (PO/IV)
* Amoxicillin (PO)
* Piperacillin (IV)
* Ticarcillin (IV)
62
Beta Lactams: Carbapenems?
* Ertapenem (IV)
* Imipenem (IV)
* Meropenem (IV
63
Beta Lactams: Glycopeptides
Vancomycin (PO/IV)
64
Beta Lactams: Cephalosporins 1st generation
Cephalexin (PO)
| Cefazolin (IV)
65
Beta Lactams:
| Cephalosporins - 2nd generation
Cefaclor (PO)
Cefuroxime (PO/IV)
Cefotetan/Cefoxitin
66
Beta Lactams:
| 3rd generation - Cephalosporins
```
Cefixime (PO)
Cefotaxime (IV)
Ceftizoxime (IV)
Ceftriaxone (IV)
Ceftazidime (IV)
```
67
Beta Lactam: 4th generation Cephalosporins
Cefepime IV
68
Beta Lactam: 5th generation Cephalosporins
Ceftobiprole (IV)
69
What are the 3 parts to the autonomic nervous system?
1. sympathetic
2. parasympathetic
3. enteric
70
What cranial nerve connect the parasympathetic nervous system to the CNS?
III
VII
IX
X (vagus nerve)
71
What does amoxicillin cover that PCN does not?
H. Influenzae
72
What does penicillin cover?
Gram Positives
Strep
Some gram negatives
Non-beta lactamase producing anaerobes
73
What is the advantage of Cephalosporins over PCN?
More stable against beta lactamase producing pathogens
74
What do Carbapenems treat?
Gram positive and gram negatives, and anaerobes
75
What do carbapenems not cover?
MRSA and enterococci (gram positive)
| C. difficile (anaerobes)
76
What does Vancomycin treat?
```
Gram positive,
Gram positive that produce beta lactamase
Penicillin allergy
Colitis r/t abx
MRSA
```
77
How does Vancomycin work?
Binds to cell wall to prevent cell wall synthesis
78
Examples of beta-lactamase inhibitors? (3)
Clavulanic acid
Sulbactam
Tazobactam
79
What pathogens do Beta-Lactamase inhibitors help fight? (6)
- Staph Aureus
- H, influenziea
- M. Catarrhalis
- E. Coli
- Klebsiella
- B. Fragilis
80
What pathogens do beta-lactamase inhibitors not help against?
- Serratia pseudomonas
- Indole + Proteus
- Citrobacter
- Enterobacter
"Spice" organisms
81
Benefits of Intensive dosing for Aminoglycosides
Once daily
advantage of PAA
Blood levels can drop below MIC
Allows some renal recovery
82
What is the spectrum for Clindamycin?
Gram positives
Many anaerobes
Not for:
Gram Negative (i.e. H. Influenzae, enterococci, Neisseria Meningitis, mycoplasma pneumonia or aerobic gram-negative bacilli)
83
3 ways that nucleic acid synthesis inhibitors work?
1. Precursor synthesis (sulfonamides, trimethoprim)
2. DNA replication (Quinolones)
3. RNA polymerase (rifampin)
84
Steven Johnson Syndrome
rare, serious disorder of the skin r/t drug reaction. Flu like symptoms followed by extensive skin blistering and pain.
85
What drug treats Parkinson's and how does it work?
Levodopa: prevents dopamine blocking
86
Things to consider when choosing the correct antibiotic?
1. Treat patient not the disease (only treat what is necessary)
2. Start narrow (reduce resistance)
3. Treat likely pathogen
- use cultures/sensitivities if available
- preferably get cultures prior to starting tx
4. limit toxicity and adverse effects
5. Is monitoring necessary/available (ie. vanco.)
6. Consider costs
87
Examples of multivalent cations? (6) what should they not be given with? (2)
```
Iron
dairy
antacids
zinc
vitamins
sucralfate
```
** Don't give with tetracyclines or fluoroquinolones
88
Cardinal sx of strep throat? (4)
Fever > 38
tender cervical lymphadenopathy
tonsillar exudate
NO cough
89
Cardinal sx of strep throat? (4)
Fever > 38
tender cervical lymphadenopathy
tonsillar exudate
NO cough
90
Drug of choice for strep throat?
PCN
| Erythromycin if PCN allergy
91
Tx for non-limb threatening animal or human bites?
Amoxi clav 875 PO BID x 3-5 days
| PCN allergy: doxy 100mg PO BID x 3-5 days (=/- flagyl 500mg PO BID x 3-5 days, if > 8years old)
92
Stages of acne development? (4)
Follicular hyperkeratinization
microbial colonization with Cutibacterium acnes "cutie"
sebum production
innate and acquired immune response
93
Name for drug effects that are harmful and never desirable?
Adverse
Deleterious
Toxic
94
Where and when do idiosyncratic reactions occur ?
Skin, liver, haematoma poetic, and immune system‘s.
Reaction is usually delayed.
Can be life threatening.
95
What makes a toxic effect reversible ?
Depends on the tissues ability to:
- adapt
- repair
- regenerate
96
What tissues regenerate easily?
Liver
| Gastrointestinal tract
97
Toxic effects that are often not reversible?
CNS. Neurons have a limited ability to regenerate.
98
Target organs of toxicity are?
Where the chemical elicits it’s toxic effect
99
What are some bisphosphonate drugs used for modifying bone pain?
Clodronate
Pamidronate
Zolendronic acid
100
What is the dosage for clodronate?
900 mg IV q 4 weeks
or
1600-2400 mg PO daily
101
Pamidronate dosage?
60-90 mg IV q 3-4 weeks
102
Zolendronic acid dose?
4mg IV every 4 weeks
103
What are some ADEs to watch for when giving Clodronate, Pamidronate or Zolendronic acid?
- osteonecrosis of the jaw (DENTAL REVIEW BEFORE INITIATING)
- renal impairment (= extreme caution and dose adjustment)
- hypocalcemia (ca into bones, not enough in blood).
- flu-like sx for 1-2 days after administration
- **monitor renal function and Ca levels with each treatment.
104
Monoclonal antibody given for bone pain in palliative patients?
Denosumab
| 120mg SC every 4 weeks
105
Dosage for dexomethasone for bone pain in palliative care?
2-8 mg po daily tid
106
Who should avoid or be careful taking tricyclic antidepressants?
Glaucoma
Heart disease
urinary retention
orthostatic hypotension
107
Dosage of TCA's Amitriptyline and Nortriptyline for neuropathic pain? (palliative)
75-150 mg PO at bedtime
(start at 10-25 mg at bedtime.
-titrate by 10-25mg every 3-7 days.
108
Who should beware of TCAs for neuropathic pain?
- poor cardiac function
- severe prostatic hypertrophy
- glaucoma
109
Anticholinergic effects include:
- drowsiness
- constipation
- dry mouth
- urinary retention
110
Tricyclic Antidepressants (4)
• Amitriptyline (most common)
or Nortriptyline
• Imipramine
• Desipramine
111
Gabapentin dose in palliative care?
300-800mg PO q6- 8 hours
(start at 100-300mg at hs, Titrate upwards q 1-7 days.
Target dose range= 900-3600mg od
** after 1800 mg od = less bioavailability
112
Pregabalin dosage?
150-300mg PO q 12 hours
- start at 75 mg BID
- increase q 3-7 days
- target dose= 50-150mg daily- divided.
- slower titration in elderly/frail
113
What patient population requires a dose adjustment for both Gabapentin and Pregabalin?
Patients with renal impairment
114
ADE's of Pregabalin?
Somnolence
Dizziness
Ataxia
115
What is baclofen used for? Dosage?
Hiccups
| 5-20mg PO q 6-12 hours (max 40mg/day)
116
What drug can cause hiccups in the palliative care patient?
> 10mg daily dexamethasone
117
What does evidence show for treating CNCP with opioids?
- dose dependent risk for serious harm
| - insufficient to show effectiveness for improving chronic pain or function
118
Reason not to be a "dose-escalating" prescriber in CNCP?
Most patients will not have a good response to opioids for CNCP. Why chase a response by increasing the dose??
119
What are realistic goals for treating CNCP?
- meaningful reduction in pain
- increased functioning
- ensuring safety
- set measurable goals (i.e. 9 holes of golf twice per week).
120
What does the SMART approach stand for in treating CNCP?
```
Specific
Measurable
Attainable
Relevant
Time dependent
```
```
Prior to initiating an opioid
trial, highlight the importance
of realistic patient
expectations and establish
treatment goals that include
patient‐centered
improvements in function
```
121
Boundaries to set BEFORE prescribing opioids for CNCP?
If this medication doesn’t work we will increase it only a few times, if it still doesn’t work we will have to discontinue it and try something else.
There will be NO early refills
122
How to limit your risks when prescribing opioids to patients?
Following strict/structured prescribing regiments
Setting rules for ALL patients
Keeping proper documentation
Follow rules/laws from prescribing authorities and colleges
123
What is classic serum sickness?
serum sickness" describes the clinical syndrome caused by immunization of the host (human) by heterologous (nonhuman) serum proteins and subsequent illness caused by formation of immune complexes.
124
What are SSLR?
Serum sickness-like reactions (SSLRs) present as rash, arthritis, and fever beginning several days to weeks following administration of a drug.
125
Management steps for serum sickness and SSLR?
●The management of these reactions primarily involves discontinuation of possible culprit agents. Typically, fever and arthralgias resolve and new skin lesions stop forming within 48 hours of this intervention. This is often all that is required for patients with mild symptoms.
●Further treatments depend upon the discomfort of the individual patient. Antihistamines may be administered for symptomatic relief of pruritus. Nonsteroidal anti-inflammatory agents and analgesics may be given for symptomatic treatment of low-grade fever and arthralgias.
126
What is bupropion?
Anti depressant. (Wellbutrin).
127
Serum sickness versus SLSR? (Serum like sickness reaction)
Serum sickness Involves the deposit of immune complexes resulting from nonhomologous proteins.
128
Isoniazid?
Antibacterial used to treat TB
129
What is ecthyma?
Ecthyma — Ecthyma is an ulcerative form of impetigo in which the lesions extend through the epidermis and deep into the dermis. They consist of "punched-out" ulcers covered with yellow crust surrounded by raised violaceous margins
130
Gram negative bacteria
```
E. Coli
Enterobacter
Pseudomonas
Proteus
Neisseria
Salmonella
H. Pylori
```
131
Gram positive
```
Staphylococcus
Streptococcus
Enterococcus
Lactobacillus
Listeria monocytogens
Clostridium
```
132
Bacteria that produce beta lactamase? 6
```
Bacteroides
Enterococcus
H. influenzae
M. catarrhalis
Neisseria gonorrhoeae
Staphylococcus
```
133
Examples of aminoglycins? 4
Poorly absorbed how?
Best way to administer?
Excreted how?
```
gentamicin
tobramycin
neomycin
streptomycin
poor gastrointestinal absorption, so intravenous or intramuscular administration is needed
```
excreted renally.
134
Drug of choice for Malaria?
Chloroquine/ Aralen
135
Prophylaxis dose for Malaria?
```
Chloroquine
500 mg po per week (same day):
2 weeks prior to leaving
during travel
8 weeks after home
```
136
Active Malaria tx:
Chloroquine:
1000 mg PO STAT
500mg at 6 hours and 8 hours
500mg PO daily x 2 days
137
ADR of Chloroquine (10)
```
Blindness if taken too long
hypotension
ECG changes
Headache
N/V/D
Anorexia
Malaise
Abd cramps
Visual changes
Pruritis
```
138
Drug that decreases the effectiveness of chloroquine?
Ampicillin
139
First line tx for COMPLICATED AECB?
Amoxicillin-Clavulanate 875 mg PO BID x 5-7 days
Cefuroxime 500mg PO BID x 5-10 days
Clarithromycin 500mg PO BID or XL 1g PO daily x 5-10 days
Azithromycin 500mg PO x 3 days
140
Reasons not to use Azithromycin and Clarithromycin to treat AECB?
Poor H. Influenzae coverage
High S. Pneumoniae resistance
141
First line tx for:
AECB
ABS
AOM?
Amoxicillin
142
Why are fluoroquinolones used as a last resort for tx of UTI?
(Cipro) can cause permanent serious side effects:
Involves tendons
Muscles
Joints
Nerves
CNS
** Have to stop immediately if this occurs and switch to another antimicrobial
143
TMP/SMX?
Trimethoprim/sulfamethoxazol
| Bactrim
1 part TMP to 5 parts SMX. 160mg/800 (DS*= double strength)
144
Cystitis tx in female
Hydrate
watch and wait
Nitrofurantoin (macrobid):
50- 100 mg PO QID x 5 days
