Test #2 Flashcards
Most common bacteria in the GI GU track
E-Coli
What led to drug resistant drugs?
The overuse and many times abuse of antibiotics have led to drug resistance bacteria and are leading us to return to a possible day where we are powerless to fight infections
When to choose anti microbial treatment
Age
Allergies
Bacteria
What is the recommended dose of folic acid
3mg Dose
Ace-inhibitors common side effect
Dry cough
Are Most respiratory infections viral?
True
Women with UTI - 1st Step
C&S
Fluoroquinolones 6 & Black Box
- Permanent peripheral neuropathy
- Tendon ruptures
- Tinnitus
- Tachycardia, shortness of breath
- Rashes, hair loss
- Nausea, vomiting, diarrhea
FDA Black Box Warnings: Disabling CNS effects, tendinitis, tendon ruptures, peripheral neuropathy. Exacerbation of myasthenia gravis and severe muscle weakness. **Newest warning and concern that oral fluoroquinolone use is associated with an increased risk of aortic aneurysm or dissection.
Fluoroquinolones
Ciprofloxacin (Cipro) Levofloxacin (Levaquin) Gemifloxacin (Factive) Moxifloxacin (Avelox) Norfloxacin (Noroxin) Ofloxacin (Floxin)
Abx Best practice
Best practice is to confirm the diagnosis of bacterial infections before placing a patient on an antibiotic. Viral infections should NOT be treated with an antibiotic.
Selecting an antibiotic
- Narrowest spectrum
- Most effective
- Lowest toxicity
- Lowest potential for allergy
- Most cost-effective
Penicillin
Ampicillin, Amoxicillin, Augmentin (Amoxicillin and Clavulanate), Dicloxacillin, Penicillin V, Penicillin G (IM).
Cephalosporins
Cefadroxil, Cephalexin (1st generations), Cefdinir (Omnicef) Ceftriaxone (Rocephin) (IM) (3rd generation)
Macrolides
Azithromycin,
Erythromycin
Clarithromycin.
Abx Inhibitor to 3A4
Macrolides
Clindamycin and erythromycin
Heavily metabolized by the liver.
Type I hypersensitivity
Immediate or anaphylactic hypersensitivity.
Skin (urticaria and eczema),
Eyes (conjunctivitis)
Nasopharynx (rhinorrhea,rhinitis),
Bronchopulmonary tissues (asthma)
Gastrointestinal tract (gastroenteritis).
Usually takes 15 - 30 minutes from dose Delayed onset (10 - 12 hours).
Type 1 reaction to PCN, but in reality it is rare <2%.
**Only ~2% cross reactivity with cephalosporins)
Type II hypersensitivity
Cytotoxic hypersensitivity affect a variety of organs.
Drug-induced hemolytic anemia,
Granulocytopenia
Thrombocytopenia
The reaction time is minutes to hours.
Type III hypersensitivity
Immune complex hypersensitivity
General (e.g. serum sickness, fever, rash, arthralgia)
Skin (e.g., systemic lupus erythematosus, Arthus reaction)
Kidneys (e.g., lupus nephritis)
Lungs (e.g., aspergillosis)
Blood vessels (e.g., polyarteritis)
Joints (e.g., rheumatoid arthritis)
3 - 10 hours after dose
Rule this out in a patient who presents with fever of unknown origin! Look at the drugs the patient is on currently or any newly added drugs to their regimen
Type IV hypersensitivity
Mediated or delayed type hypersensitivity.
The classical example of this hypersensitivity is tuberculin (Mantoux) reaction (figure 5), which peaks 48 hours after the injection of antigen.
PPD
B-lactamase Inhibitors (e.g., Augmentin)
(e.g., Augmentin)
An enzyme called beta-lactamase is present in many different types of bacteria, which serves to ‘break’ the beta lactam ring, which effectively nullifies the antibiotic’s effectiveness.
PCN allergies with children
Use Cephlasporins
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Cefadroxil
Cephalexin (1st generations
Cefdinir (Omnicef)
Ceftriaxone
Rocephin) (IM) (3rd generation)
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Med Cause Prolonged QT
Fluoroquinolones?
Abx and pregnancy
Clindamycin?
Macrolides, Azalides, Ketolides?
Common Antihypertensive Drugs in Pregnancy
Labetalol.
2nd Choice of HTN (moderate to high) is Methyldopa (Aldomet)and Procardia.
