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Pharm 6-8

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mhewett's version from 2016-06-22 22:15

Chapter 6 DOC

Question Answer
What is the first line treatment for osteomyelitis in a patient <4 months old?Nafcillin (or oxacillin) + Ceftazidime (or cefepime)
What is the first line treatment for osteomyelitis in a patient 4 months to 21 years old?Nafcillin or oxacillin (add cefepime if infection is suspected to be due to a gram -)
What is the first line treatment for osteomyelitis in a patient >21 years old?Nafcillin (or oxacillin) + Ceftazidime (or cefepime)
For anyone suspected to have a MRSA infection causing osteomyelitis, what should be used in place of the penicillin drugs (nafcillin/oxacillin)?Vancomycin
What is used to treat any encephalitis before CSF or PCR results return?Acyclovir
What two drugs are first line treatments for neonates suspected to have meningitis?Ampicillin + Cefotaxime
What three drugs are used to treat children or adults suspected to have meningitis?Cefotaxime/ceftriaxone + dexamethasone + vancomycin
What are the 4 drugs used to treat a patient, suspected to have meningitis, who is either 1. >50yo, 2. alcoholic of any age, 3. Anyone with severe debilitating comorbid disease, 4. ImmunocompromisedCefotaxime/ceftriaxone + dexamethasone + vancomycin + ampicillin
What is the preferred treatment for meningitis prophylaxis of close contacts if the meningitis is due to either H. Influenzae or N. Meningitidis?Rifampin
What three things are given to treat otitis externa?Acetic acid, propylene glycol, hydrocortisone drops
What is used to treat otitis media in a patient <2 years old?Amoxicillin
What is used to treat a patient with otitis media who is >2 years old and is afebrile?Analgesics
What is the first-line treatment for viral conjunctivitis in a non-neonate?Supportive (Nothing or chilled artificial tears)
What is the first line treatment for bacterial conjunctivitis in a non-neonate?Fluoroquinolones (drops)
If a patient presents with meningitis symptoms (fever, HA, stiff neck), and a focal neurologic deficit you need to give them the drug of choice empirically, then obtain what?Head CT (no contrast, do this before CSF)
What is the treatment for conjunctivitis in a newborn that presents within the first day?Nothing
What is the treatment for conjunctivitis in a 2-4 day old newborn?Ceftriaxone (IV for N. gonorrhoeae), Erythromycin (PO for chlamydia) (Also treat mom/sexual partners for STIs)
What is the treatment for a 3-10 day old neonate who develops conjunctivitis?Erythromycin (for chlamydia, treat mom/partners too)
What is the treatment for a 2-16 day old neonate who develops conjunctivitis?topical antivirals, acyclovir (IV)
What is the prophylaxis against ophthalmia neonatorum?tetracycline ointment OR erythromycin ointment
memorize

 

Question Answer
What is the treatment for diarrhea associated with post antibiotic use?Metronidazole
What are the two drugs used to treat travel associated diarrhea in non-pregnant adults?Fluoroquinolones (or) rifaximin
What drug is used to treat travel associated diarrhea in children or pregnant women?Azithromycin
What two drugs can be used as prophylaxis for diarrhea during travel?Fluoroquinolone (-floxicin), imodium (with first loose stool)
What is the first line treatment for mild to moderate diarrhea?
What can you add if there are 4+ unformed stools/day?Fluids, lactose, caffeine free diet (can add anti-diarrhea agents if 4+ unformed stools/day)
What 5 things are you going to give an adult patient with severe diarrhea? (hint: 2 are antibiotics)Ciprofloxacin (or levofloxacin), metronidazole, fluids, lactose, caffeine free diet
What antibiotic are you going to give a child with severe diarrhea?TMP-SMX (also give fluids, lactose and caffeine free diet)
What two things can be given to treat acute bronchitis?Antitussives (cough meds), inhaled B2 agonists
What is given to treat anthrax prophylactically, post-exposure?Doxycycline (or ciprofloxacin), Biothrax vaccine
If there is suspicion of what disease should you not use anti-diarrheal agents?HUS (hemolytic uremic syndrome)
What are some anti-diarrheal agents?loperamide or bismuth subsalicylate
What drugs are given to treat a community acquired pneumonia in a patient <1 month old who is hospitalized?Ampicillin, gentamicin (+/- cefotaxime) (+ vancomycin if MRSA suspected)
What drug is given to treat a community acquired pneumonia in a patient 1-3 months old?Erythromycin (or azithromycin) (Add cefotaxime if febrile)
What drug is given to treat a community acquired pneumonia in a patient 3 months - 18 years old whose vaccinations are up to date?Ampicillin (+/- azithromycin, vancomycin)
What drug is given to treat a community acquired pneumonia in a patient 3 months - 18 years old whose vaccinations are NOT up to date?cefotaxime (+/- azithromycin, vancomycin)
What two drugs are given to treat a community acquired pneumonia in patients >18 years old (adults)?Ceftriaxone (or ertapenem), azithromycin
What drugs are used to treat prostatitis in patients <35 years old?Ceftriaxone, (or cefixime), doxycycline
What two drugs can be used to treat prostatitis in an adult >35 years old?Fluoroquinolone (or TMP-SMX)
What are the criteria for SIRS?SIRS = systemic inflammatory response syndrome
SIRS >= 2 of the followingT>38 or <36; HR>90; RR>20; WBC>12K or 10% bands
What is the criteria for sepsis?SIRS + a documented infection (e.g. culture)
What is the criteria for severe sepsis?Sepsis + dysfunction of organs (low BP or lactic acidosis or oliguria or decreased mental status)
What is the criteria for septic shock?sepsis + BP<90 mmHg not responsive to 500 mL IV fluids
What two drugs are given to treat sepsis in a neonate <1 week old?Ampicillin, cefotaxime
What two drugs are given to treat sepsis in a neonate >1 week old?Ampicillin, cefotaxime (or ceftriaxone)
What two drugs are given to treat sepsis in a child?Vancomycin, cefotaxime (or ceftriaxone)
What two drugs are given to treat sepsis in an adult?Carbapenem (or piperacillin-tazobactam), vancomycin
What 5 things are given to treat septic shock?ABx to treat organism, IV fluids, NE, blood glucose control (target 140-180), later low dose steroids
What is used to treat outpatient UTIs?TMP-SMX
What is used to treat inpatient UTIs?Ciprofloxacin (or levofloxacin)
What is used to treat UTIs in pregnant patients?Nitrofurantoin
What two drugs are given to treat an animal or human bite?Amoxicillin-clavulanic acid, tetanus prophylaxis (+/- rabies prophylaxis... add acyclovir if non-human primate bite)
What is the drug of choice to treat bacillus cereus (food poisoning)?Vancomycin (or clindamycin)
What is the drug of choice to treat borrelia burgdorferi (Lyme's disease)?Doxycycline
What is the drug of choice to treat Campylobacter jejuni (GI problems)?Azithromycin
What is the drug of choice to treat a vaginal or skin candida infection?Miconazole
What is the drug of choice to treat a systemic candida infection?Fluconazole
What is the drug of choice to treat chlamydia trachomatis infections in non-pregnant patients and those >8 years old?Doxycycline
What is the drug of choice to treat chlamydia trachomatis in patients who are pregnant or < 8 years old?Azithromycin
What is the drug of choice to treat clostridium difficile?Metronidazole (PO)
What are the drugs of choice (2) to treat corynebacterium diphtheriae?Erythromycin, antitoxin
What is the drug of choice to treat Gardnerella vaginalis (bacterial vaginosis)?Metronidazole
What is the drug of choice to treat haemophilus ducreyi (chancroid)?Azithromycin (or ceftriaxone)
What is the drug of choice to treat haemophilus influenzae for life threatening infection?Cefotaxime (or ceftriaxone)
What is the drug of choice to treat haemophilus influenzae for non-life threatening infection?amoxicillin-clavulanate
What is the drug of choice to treat Mycoplasma pneumoniae?Doxycycline (or azithromycin)
What are the drugs of choice to treat Neisseria gonorrhoeae?Ceftriaxone & doxycycline (or azithromycin)
What is the drug of choice to treat neisseria meningitidis?Ceftriaxone
What are the drugs of choice to empirically treat bacillus anthracis?ciprofloxacin (or levofloxacin or doxycycline) + clindamycin (and/or rifampin) +/- raxibacumab (antitoxin antibody)
What do you treat Bacillus anthracis with after proven sensitive to this drug?Penicillin G
What two drugs are used to treat listeria monocytogenes?Ampicillin, gentamicin
What is the drug of choice to treat Pasteurella multocida?Amoxicillin (or cefuroxime)
What is the drug of choice to treat salmonella typhi?Ciprofloxacin
What is the drug of choice to treat shigella species?Azithromycin (or any fluoroquinolone)
What is the drug of choice to treat treponema pallidum (syphilis)?Penicillin G
What is the drug of choice to treat trichomonas vaginalis?Metronidazole
What is the drug of choice to treat non-MRSA S. aureus that is not on the skin?Oxacillin (or nafcillin)
What is the drug of choice to treat non-MRSA S. aureus on the skin?Dicloxacillin
What is the drug of choice to treat MRSA S. Aureus?Vancomycin
What is the drug of choice to treat strep pyogenes (Group A Strep)?Penicillin (G or V)
What two drugs can be used to treat genital warts?Podophyllin resin OR cryotherapy OR trichloroacetic acid)
What drug is given during labor for group B strep prophylaxis?Penicillin G
What are the drugs of choice for staphylococcus saprophyticus?Cephalosporin (or amoxicillin-clavulanic acid)
What is the drug of choice to treat strep pneumoniae?Penicillin G
What are the two drugs of choice for vibrio cholerae?IV ringer's lactate, doxycycline (or azithromycin)
What is the drug of choice to treat giardia lamblia?Tinidazole (or nitazoxanide)
What are the drugs of choice for treating Entamoeba histolytica?Metronidazole (or tinidazole) then paromomycin (or iodoquinol)
What is the drug of choice for ascaris lumbricoides?Albendazole (or mebendazole
What is the drug of choice for necator americanus?Albendazole
What are the drugs of choice (2) for trichinella spiralis?Albendazole, prednisone
What is the drug of choice to treat enterobius vermicularis?Mebendazole
What is the drug of choice to treat schistosoma?Praziquantel
What is the drug of choice to treat diphyllobothrium latum?Praziquantel
What are the drugs of choice (2) to treat Adenovirus (severe)?Cidofovir, probenecid
What drugs can be used to treat Influenza A (seasonal), Influenza B, and avian (H5N1) influenza?Zanamivir (or oseltamivir)
What can be used to treat measles in children?Vitamin A
What can be used to treat measles in adults?Ribavirin
What is used to treat smallpox?smallpox vaccine (w/in 4 days of exposure) + cidofovir + probenecid
memorize

Chapter 7 Penicillins (PCN)

Question Answer
Are penicillins bacteri- cidal or static?bactericidal
What is the mechanism of penicillins?interfere with cell wall synthesis
What are the 3 ways that penicillin works?1. PBPs bind PCN allowing PCN to accumulate in the bacterium
2. PCN inhibits transpeptidases which is what catalyzes the cross-linking btwn peptidoglycan so the mesh formation is messed up
3. PCN stimulates autolysins which normally remodel cell wall when needed but when they work when not needed it causes damage and ultimately lysis of the bacterium
Which bacteria do not have cell walls?mycoplasmas
What are the 1st gen penicillins?narrow spec penicillins - Pen G, V effective against gram +
What are the 2nd gen penicillins?beta lactamase (penicillinase) resistant penicillins - effective against gram +; methicillin, dicloxacillin, oxacillin, cloxacillin, nafcillin
What drugs can you use to treat cellulitis?dicloxacillin, cefazolin
What are the third gen penicillins?broad spec penicillins - effective against gram + & - ; ampicillin, amoxicillin
What are the 4th gen penicillins?antipseudomonal penicillins (extended spectrum) - piperacillin, ticarcillin
How do you treat Pseudomonas?antipseudomonal penicillin AND an aminoglycoside or ciprofloxacin
memorize

Chapter 8 Cephalosporins

Question Answer
What is the mechanism of cephalosporins?cell wall inhibition
If presented with an equally good cephalosporin and penicillin, which do you pick?cephalosporins bc it is significantly more resistant to beta lactamases
What are the special sensitivities for 1st gen?(PECK +) Proteus, E. Coli, Klebsiella, gram positives
What are the special sensitivities for 2nd gen?(HEN PECK +) Haemophilus influenzae, Enterobacter aerogenes, Neisseria, Proteus, E. Coli, Klebsiella
What are the special sensitivities for 3rd gen?(HEN PECK plus) Haemophilus influenzae, Enterobacter aerogenes, Neisseria, Proteus, E. Coli, Klebsiella, plus enterics (intestinal bacteria)
What are the special sensitivities for 4th gen?pseudomonas
What are the special sensitivities for 5th gen?(MRSA plus) MRSA, complicated mixed gram pos and neg infections
What is 1st gen most effective against?some gram negatives, many gram positives
What is 2nd gen most effective against?more gram negatives, many gram positives
What is 3rd gen most effective against?many gram negatives, many gram positives
What is 4th gen most effective against?pseudomonas
What is 5th gen most effective against?MRSA and many gram positives and negatives in mixed infection
What is a 1st gen cephalosporin and what is it used for?cefazolin; 1 drug of choice for skin infections (like cellulitis); also penetrates into bone
What are some of the 2nd gen?(some are all about men and women) cefamandole, cefoxitin, cefuroxime, cefotetan
What is a side effect of cefamandole?disulfiram-like reaction when ingested with alcohol; so aldehyde dehydrogenase is inhibited resulting in build up of acetaldehyde. Causes flushing, tachy, hyperventilation, N/V, palpitations, chest pain, hypotension
What are the 3rd gen cephalosporins?used for tough organisms or infections (Tough Assassins) - cefTAzidime, cefoTAxime, cefTriAxone
What are the 4th gen cephalosporins?Pseudomonas Insults - cefePIme, cefPIrome
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