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65 Cards in this Set

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Common pathogens for infection
AGE < 1 month old?

Empiric Treatment?
Group B Strep
E. COLI
Listeria
Viral (herpes)
COAG (-) staph
Gram (-) nosocomial bugs

Tx: Amp + (gent or cefotaxime)
Common pathogens for infection
AGE 1-3 months?

Empiric Treatment?
Same as < 1 month olds (plus)
H. influenzae B
Neisseria Meningitidis
Strept. Pneumo

Tx: Amp+(cefotaxime/ceftriaxone)
Common pathogens for infection
AGE 3 months - 12 years?

Empiric Treatment?
H. influenzae B
Neisseria Meningitidis
Strept. Pneumo

Tx: Ceftriaxone +/- vanco
Common pathogens for infection
AGE > 12 years?

Empiric Treatment?
Neisseria Meningitidis
Strept. Pneumo

Tx: Ceftriaxone +/- vanco
Who gets drug treatment for Bacterial meningitis Prophylaxis?

Whats the drug and dose?
Household contacts, nursery centers, direct contact with secretions
regimen: rifampin for either neisseria or haemophilus
ceftriaxone IM for
only haemophilus
Respiratory syncytail virus (RSV)
Treatment?
Supportive care
Respiratory syncytail virus (RSV)
Prophylaxis
(Synagis)
Synagis (Palivizumab) 15 mg/kg/dose IM given monthly
reduction in hospitalizations but not mortality. wont prevent nosocomial infections
Indications for Synagis (palivizumab)
< 32 weeks GA who are < 6 MO
at start of RSV season
5 dose max
must repeat dose if Cardiac surgery patient
Extra risk factors for RSV and need Synagis
*32-35 Week GA < 3 MO during season + daycare/ smoking parents or has young siblings.
*kids< 2 yo with heart disease
*Kids < 1yo with lung /muscle/neurologic diseases
Ribavirin, corticosteroids, B2 agonists and antibiotics for RSV?
Not considered standards of care or reduce mortality or vent days. except maybe with lung / heart disease patients.
Otitis Media
Common pathogens?
Viral,
S. Pneumo,
Non-type H. Influenae
Moraxella Catarrhalis
Otitis Media
Treatment?
Not warranted unless both ears for greater than 72 hours
Tx: Amox, Augmentin, Cefuroxime, cefdinir, cefpodoxime
5-10 days
Prophylaxis not recommended
Immunizations
Whats are the new vaccines added to the most recent guidelines?
HepA, meningococcal conjugate, pertussis booster, rotavirus and human papillomavirus
What are the latest Recommendations for influenza vaccination?
Vaccinate all children 6 month to 18 years old
What is the concern with IVIG and vaccinations?
Unable to give live vaccines b/c they wont work.
DTaP-Hib (TriHIBit)
combo vaccine effectiveness?
Not as effective as individual products
DTaP-IPV (Kinrix)
effectiveness?
No consistent effects
Inactivate Polio virus
DTaP-HepB-Hib combos
Not as effective as separate vaccines
DTaP-HepB-IPV (Pediarix)
Good TO GO. at least as effective as individual products.
Give at 2,4 and 6 month
HepB-Hib (Comvax)
Not for those < 6 weeks b/c it wont work as well
Hib-DTaP-IPV (Pentacel)
ok for 6 wk to 4 yrs old
HepA-HepB (Twinrix)
ok for 18+ yo
MMR and varicella vaccine
(Proquad)
ADR?
More febrile seizures in 1-2 year olds. not recommended
ENGERIX-B and
RECOMBIVAX HB
Equivalent?
HepB vaccines that are interchangeable
Polio Vaccine issues
Live and inactivated are equally effective, but live vaccines associated with higher poliomyelitis and oral polio is therefore not recommended
What are the Barriers to immunizations?
*allergy
*Acute"mod-severe"febrile illness
*Immunodef. and live vaccines
Who can't get live vaccines?
Immunodeficient patients
Pregnant
Recent IVIG
Examples of LIVE vaccines
MMR, Varicella, oral polio, nasal influenza
What are the important allergies with regard to vaccines?
Egg proteins (MMR and influenza)
Neomycin (polio, MMR, varicella)
Immunize based on which age, GA or chronological age?
Chronological age
except with HepB and
Premature babies < 2kg or 30 days old
Ok to give live vaccines to those taking low to moderate dosed steroids?
Yes if < 2 mg/kg of prednisone equivalent
wait 1 month if giving high dose steroids and live vaccines
HIV patient's and vaccinations
Ok to give if patient not severely immunocompromised (look at CD4 count)
inactivated should be given regardless
(3 series) vaccine recommended at 2,4 and 6 months of age
Rotavirus (RV)
(4 series) vaccine recommended at 2,4, 6-18 months and 4 of age
Inactivated poliovirus (IPV)
(3 series) vaccine recommended for birth, 1-2, 6-18 months
HepB
(5 series) vaccine recommended for 2,4,6,15-18 months and again at 4-6 years old
Diphtheria, Tetanus, Pertus
(DTaP)
(4 series) vaccines recommended for 2,4,6 and 12-15 months old
Haemophilus influenzae B (Hib)
Pneumococcal (PCV)
When to give influenza vaccine?
yearly after 6 months old
When to give MMR?
12-15 months old and again at 4-6 years old
When to give Varicella?
12-15 months old and again at 4-6 years old
When to give HepA?
2 doses (12-23 months old) and again between 2-6 years old
When to give MCV meningocccal?
High risk groups only
once (2-6 years old)
all others (11-12 years old)
When to give Tdap?
tetanus diphtheria, pertussis
11-12 years old
When to give HPV?
Human papillomavirus
3 doses (11-12 years old)
Drugs of choice for
Partial seizures?
Valproic acid
carbamazepine
Phenytoin
Alternative drugs for Partial seizures?
any of them
Drugs of choice for
Tonic-clonic seizures?
Valproic acid
carbamazepine
Phenytoin
Alternative drugs for
Tonic-clonic seizures?
Lamotrigine
topiramate
zonisamide
Levetiracetam
Drugs of choice for
Myoclonic seizures?
Valproic Acid
Alternative drugs for
myoclonic seizures?
Topiramate
zonisamide
levetiracetam
Drugs of choice for
Absence seizures?
Ethosuximide
Valproic acid
Alternative drugs for
Absence seizures?
Lamotrigine
Zonisamide
Levetiracetam
Drugs of choice for
Lennox-gastaut seizures?
Valproic Acid
topiramate
lamotrigine
Alternative drugs for
Lennox-gastaut seizures?
Felbamate
zonisamide
Drugs of choice for
infantile spasms?
Adrenocorticotropic hormone
ACTH
Alternative drugs for
infantile spasms?
Vigabatrin, lamotrigine, tiagabine, topiramate, valproic acid, zonisamide
Methylphenidate immediate release (Ritalin)
BID-TID
50-50 ratio of active d-threo isomer and inactive 1-threo
Dexmethylphenidate (Focalin)
BID-TID
only active d-threo isomer
1/2 the dose of Ritalin
*no benefit over Ritalin
Methylphenidate Sustained release/ extended release
(Metadate ER or Ritalin SR)
BID
or QDAY with immediate release dose in afternoon
Methylphenidate (OROS) (Concerta)
ADHD if over 6 years old
ONCE DAILY DOSING
with or without food
Dexmethylphenidate ER
(Focalin XR)
faster onset but doesnt last all day
Methylphenidate modified release
(Metadate CD)
doesnt last all day
ok to open and sprinkle
Methylphenidate ER
Ritalin LA
Once daily
but not all day
ok to open and sprinkle
Methylphenidate transdermal system (Daytrana)
Apply to hip
all day strong
ADR of stimulants
Decreased appetite
stomachache
headache
insomnia