Infectious Disease Tst6 Set2

Front 1

Types of ACTIVE Tb (3)

Back 1

1)progressive primary Tb
2)reactivation Tb
3)Extrapulmonary Tb

Front 2

Progressive Primary Tb

Reactivation Tb (2)

Back 2

a)disease continues to spread and cause illness

b)1/2 of em will happen within 2yrs of primary infexn
b)most common in lung apices

Front 3

Extrapulmonary Tb (2 and can occur where (3))

Back 3

1)most common in immunocomp
2)MILIARY is large inoculum in blood leading to disseminated disease (emergency)

1)pleural disease
2)lymphatic
3)bone/joint

Front 4

S/sx of ACTIVE Tb (6)

Back 4

1)wt loss
2)fatigue
3)productive cough
4)fever
5)night sweats
6)hemoptysis

Front 5

HIV presentation w/ ACTIVE Tb (4)

Back 5

1)minimal CXR changes
2)negative skin test
3)decr s/sx
4)extrapulmonary disease

Front 6

Basics of medication regimens for ACTIVE pulmonary Tb (3)

Back 6

1)initially 4 drugs for first 8wks to prevent selection of resistant MOs
2)then con't phase w/ isoniazid and rifampin, when resistant is not a prob
3)tailor regimens to susceptibility results

Front 7

4 Drug Active Tb regimen
a)initial phase
b)con't phase

Back 7

a)isoniazid, rifampin, pyrazinamide, ethambutol FOR 2MONTHS (ethambutol can be cut AT ANY TIME if strain is found to be fully susceptible)

b)isoniazid and rifampin FOR 4-7MONTHS

Front 8

3 Drug Active Tb regimen
a)initial phase
b)con't phase
c)when to use

Back 8

a)Isoniazid, Rifampin, Ethambutol 2months (no cutting off ethambutol)
b)isoniazid, rifampin

c1)liver disease
c2)gout
c3)pregnancy

Front 9

If initial phase is
a)Isoniazid
b)Rifampin
c)Ethambutol
d)Pyrazinamide
DAILY x 2months OR 5d/wk x 2months what are possible continuation phases (3)

Back 9

Isoniazid and Rifampin daily x18wks or daily 5d/wk x18wks

Isoniazide and Rifampin twice weekly x18wks

Isoniazid and Rifapentin once weekly x18wks

Front 10

If initial phase is
a)Isoniazid
b)Rifampin
c)Ethambutol
d)Pyrazinamide
Daily x2wks then twice weekly for 6wks OR daily 5d/wk x 2wks then twice weekly x6wks then what are possible continuation phases (2)

Back 10

Isoniazid and Rifampin twice weekly for 18wks

Isoniazid and Rifapentine once weekly for 18wks

Front 11

Active Tb therapies that are ALWAYS DOT (3)

Back 11

1)5d/wk
2)2x weekly
3)3x weekly

Front 12

1x weekly Rifapentine can only be used if pt is.... (4)

Back 12

1)HIV-
2)no cavitary disease on initial CXR
3)2month sputum smear (-) for AFB
4)no extrapulmonary Tb

Front 13

Who gets 7month conintuation phase (4)

Back 13

1)caviatation on initial CXR (and 2month sputum culture is +)
2)HIV+
3)whose initial phase did NOT include pyrazinamide
4)treated w/ once-weekly isoniazid and rifapentine (and 2 months sputum culture is still +)

Front 14

Most people get what regimen? (most = what?)

Back 14

2months of isoniazid, rifampin, ethambutol, pyrazinamide daily THEN

4months of isoniazid/rifampin daily or 2x/wk

specimen collected @ end of initial phase is NOT + or is + but pt is NOT HIV+ or had cavitation on initial CXR

Front 15

Active Therapy for Tb is ultimately determined by...

Back 15

NUMBER OF DOSES GIVEN

Front 16

Pts are no longer considered infectious if: (3)

Back 16

1)are on adequate therapy
2)have a sig clinical response to therapy
3)have had 3 straight (-) sputum smears

Front 17

HIV+ considerations in Active Tb tx (5)

Back 17

1)9months total of tx
2)NO 2x/wk therapy if CD4 is under 100
3)CI to 1x/wk rifapentine
4)use rifabutin in place of rifampin if pt is on retrovirals
5)have poorer prognosis

Front 18

Pregnancy/lactation considerations in Active Tb tx (5)

Back 18

1)9months of tx (w/o pyrazinamide)
2)NO use of AG's
3)caution w/ ethionamide and FQ's
4)LTB can be deferred until 2nd trimester
5)most antimycobacterial's are in breast milk, but are safe

Front 19

Kids considerations in Active Tb tx (3)

Back 19

1)tx similar to adults
2)therapy often extended for 9months
3)all first line agents except rifapentine are safe

Front 20

Tb Tx Failure if: (and what to do) (3)

Back 20

1)sputum (+) after 5-6mon
2)reassess susceptibility and add 3 NEW bactericidal drugs
3)DOT is advised

Front 21

If Tb Tx Relapse do what? (3)

Back 21

1)perform sensitivity
2)consider DOT
3)use same regimen; change as C&S show resistance

Front 22

General info about resistance in Tb (4)

Back 22

1)multi drug therapy needed to prevent resistance
2)resistance higher in HIV+
3)resistance higher in foreigners
4)isoniazid and rifampin are best meds for preventing resistance

Front 23

Suspect the following pts of Tb resistance (7)

Back 23

1)prior Tb tx
2)pt from high prevalence areas (NYC, mexico)
3)homeless
4)institutionalized
5)IVDU
6)HIV+
7)exposure to resistant strain

Front 24

Tests that tell you pt is Tb resistant (3)

Back 24

1)AFB smears + @ 2mon of tx
2)AFB cultures + @ 2-4mon of tx
3)pt who fail or relapse

Front 25

MDR-Tb is resistant to... (2)

XDR-Tb is resistant to... (4)

Back 25

Isoniazid and Rifampin

Isoniazid, rifampin, FQ's, AG's

Front 26

Tx of MDR/XDR Tb (3)

Back 26

1)REQUIRES CARE FROM A SPECIALIST****
2)no standard regimen
3)generally prolonged isolation and tx

Front 27

Monitoring Pts w/ AFB+ Smears (4)

Back 27

1)smears should be repeated every 1-2wks until 2 strait (-) smears
2)sputum cultures performed monthly until 2 strait (-) cultures
3)if smears are (+) after 2wks, susceptibility should be repeated
4)Chem/LFT/CBC @ baseline and periodically

Front 28

Monitoring Pts w/
a)(-) pretx smears
b)other monitoring parameters (3)

Back 28

a1)check CXR and s/sx improvement

b1)audiometric testing @ baseline/monthly for streptomycin pts
b2)vision testing on all pts who receive ethambutol
b3)all pts (+) for Tb should be tested for HIV******

Front 29

Most important monitoring parameter

Back 29

ADHERENCE AT EVERY CONTACT W/ PT

Front 30

Isoniazid ADR's (5)

Back 30

1)hepatoxicity
2)peripheral neuropathy
3)CNS effects
4)lupus-like syndrome
5)hypersensitivity

Front 31

Rifampin ADR
Ethambutol ADR
Rifabutin ADR

Back 31

red-orange discoloration (will stain contacts)

retrobulbar neuritis (decr red-green discrimination)

uveitis (hazy vision, floaters)

Front 32

Hepatoxicity in isoniazid, pyrazinamide and rifampin manifests how? (6)

Back 32

1)ab pain
2)incr LFTs
3)n/v
4)loss of appetits
5)fatigue
6)dark colored urine

Front 33

Peripheral neuropathy in isoniazid manifests how? (3)

Back 33

1)tingling/burning in hands/feet
2)numbness
3)weakness

Front 34

How to prevent peripheral neuropathy w/ isoniazid and in whom is at risk (6)

Back 34

PYRIDOXINE 25-50MG/D******

1)DM
2)HIV
3)renal failure
4)alcoholism
5)nutritional deficiency
6)pregnancy

Front 35

Isoniazid Hepatotoxicity
a)is worse in... (4)
b)avoid in...

Back 35

a1)pre-existing liver disease
a2)elderly
a3)postpartum/pregnancy
a4)combined w/ rifampin

b)baseline LFTs 6-8x normal

Front 36

Characterisitcs of Non-tuberculous mycobacteria (4)

Back 36

1)in environment (soil, water, animals)
2)inhalation or direct inoculation from environment
3)no evidence of person to person spread
4)less virulent than Tb (opportunistic infexn)

Front 37

Non-tuberculous mycobacteria
a)slow growing MOs (2)
b)rapid growing MOs (3)

Back 37

a1)M.avium
a2)M.interacellulare

b1)M.fortuitum
b2)M.chelonae
b3)M.abscessus

Front 38

MAC
a)MOs
b)general characteristics (4)

Back 38

a)M.avium and M.intracellualar

b1)incr'd w/ AIDS epidemic
b2)infects immunosuppressed and immunocompetent pts
b3)in environment (soil, water, food)
b4)no person to person transmission

Front 39

MAC tx (3 drugs but 5 things total)

Back 39

1)ATLEAST 2 DRUGS

clarithromycin/azith AND
Rifampin/rifabutin AND
ethambutol

Treat for 1yr after - culture

Front 40

Prophylaxis of MAC in HIV+ pts (2)

Back 40

1)if CD4 is under 50
2)azith 1200mg qweek or clarith 500mg bid

Front 41

Normal amount of WBC in CSF

Back 41

less than 5/mm

Front 42

Common pathogens in Meningitis in:
a)Newborn to 1month (3)
b)1month to 4yrs (2)
c)5-29yrs (2)
d)30-60yrs (2)
e)over 60yrs (2)

Back 42

a1)Group B strep
a2)E.coli/Kleb/Enterobacter
a3)Listeria

b1)S. pneumo
b2)N. meningitidis

c1)N. meningitidis
c2)S. pneumo

d1)S. pneumo
d2)N. meningitidis

e1)S. pneumo
e2)E.coli/Kleb/Enterobacter

Front 43

Mengitis
a)s/sx (4)
b)signs (2)

Back 43

a1)fever
a2)nuchal rigidity (hurts to turn head)
a3)altered mental status
CLASSIC TRIAD ARE ABOVE 3
a4)purpuric/petechial skin rash (in meningococcal infexn)

b1)Kernig sign
b2)Brudzinski sign

Front 44

BACTERIAL Meningitis
a)WBC
b)Differential
c)Protein
d)Glc

Back 44

a)1000-5000

b)over 80 PMNs

c)100-500

d)over 40-60% of serum

Front 45

VIRAL Meningitis
a)WBC
b)Differential
c)Protein
d)Glc

Back 45

a)100-1000

b)50 lymphocytes

c)30-150

d)over 30-70% of serum

Front 46

Fungal Mengitis
a)WBC
b)Differential
c)Protein
d)Glc

Back 46

a)40-400

b)over 50 lymphocytes

c)40-150

d)over 30-70% of serum

Front 47

Initial treatments of Mengitis (2)

Back 47

1)supportive care w/ f/e, analgesics/antipyretics
2)NOTHING SHOULD DELAY ABX ADMIN

Front 48

Abx selection for Mengitis (2)

Back 48

1)empiric coverage is needed until pathogen is found
2)based it on pt's allergies, age and medical conditions

Front 49

Abx penetration into CNS (6)

Back 49

1)inflammation of meninges incr abx penetration
2)low MW pass more easily
3)lipid soluble abx penetrate better
4)low protein binding pass into CSF (b/c higher free fraction)
5)maximize abx dosing to get adequate CSF penetration
6)use IV, intrathecal, intracisternal

Front 50

Mengitis abx
a)dosing
b)duration of tx (2)

Back 50

a1)more aggressive to achieve CSF penetration

b1)at least 48-72h or until dx of bacterial mengitis can be ruled out
b2)cont therapy should be based on clinical course, c&s

Front 51

Dosing of ____ for Mengitis
a)Cefotaxime
b)Ceftriaxone
c)PenG
d)Vanco

Back 51

a)8-12g daily (divided up q4-6h)

b)4g daily (divided up q12-24h)

c)24mU daily (divided up q4h)

d)30-45mg/kg daily (divided up q8-12h)

Front 52

Conjunctive use of corticosteroids in mengitis
a)in who? (2)
b)benefits (2)
c)disadv
d)dosing (3)

Back 52

a1)kids w/ H.flu or S.pneumo
a2)in adults w/ S. pneumo

b1)decr neurologic sequelae
b2)decr bad outcomes/death

c)decr CSF []s of abx due to decr inflammation

d1)kids 2months and older get 0.15mg/kg q6h for 4 days
d2)adults get 0.15mg/kg q6h for 2-4 days
d3)must be given 10-20min prior OR WITH first dose of abx to be effective
USE DEXAMETHASONE

Front 53

EMPIRIC THERAPY for Mengitis
a)new born - 1month
b)1month-4yrs
c)5yrs-29yrs
d)30-60yrs
e)over 60yrs

Back 53

a)amp plus 3rd gen cephalosporin OR AG

b)vanco plus 3rd gen cephalo

c)vanco plus 3rd gen cephalo

d)vanco plus 3rd gen cephalo

e)vanco PLUS amp PLUS 3rd gen cephalo

3RD GEN CEPHALO = CEFTRIAXONE OR CEFOTAXIME

Front 54

N. Meningitidis (MENINGOCOCCUS)
a)characteristic s/sx
b)tx (3)

Back 54

a)purpuric/petechiae lesion or rash (50%)

b1)pen susceptible: penG or amp
b2)pen resistant: 3rd gen cephalo
b3)other: meropenem or FQs
FOR ATLEAST 7DAYS

Front 55

N. Meningitidis (MENINGOCOCCUS) PROPHYLAXIS (6)

Back 55

adults) rifampin 600mg q12h x4

kids 1month and OLDER) rifampin 10mg/kg q12h x4

kids under 1month) rifampin 5mg/kg x4

ALT)IM ceftriaxone 250mg/125mg for adults/kids under 12
ALT)PO cipro 500mg in adults/kids over 12

Meningococcal vaccine

Front 56

S. pneumo Meningitis tx (3)

Back 56

Pen susceptible: penG or amp
Pen intermediate: 3rd gen cephalo or meropenem
Pen resistant: Vanco PLUS 3rd gen cephalo
LAST FOR 10-14D

Front 57

S. pneumo Meningitis prophylaxis
a)for who? (4)
b)what?

Back 57

a1)over 65yo
a2)2-62yo w/ chronic illness, live in LTC or alaska, lack fxning spleen
a3)immunocompromised over 2yo
a4)college kids in dorms

b)Heptavalent conjugate vaccine for kids 2months and older

Front 58

H. flu Meningitis tx (3)

Back 58

BL negative: amp
BL positive: 3rd gen cephalo
alt: cefepime/FQs
FOR ATLEAST 7DAYS

Front 59

H. flu Meningitis prophylaxis
a)for who?
b)what? (4)

Back 59

a1)ppl not vaccinated

b1)kids: rifampin 20mg/kg/d x4
b2)adults: rifampin 600mg/d x4
b3)kids 12-48months get 1dose
b4)kids 2-11 months get 3 doses

Front 60

N. mengiditis who get prophy? (2)

Back 60

1)young kids are @ greatest risk
2)all household, daycare, military contacts

Front 61

Listeria Monocytogenes Meningitis
a)tx (3)
b)prophy

Back 61

a1)penG or amp PLUS gentamicin
a2)alt: bactrim or meropenem
a3)tx for 2-3wks after defervesence and the AG can be stopped after 10d

b)NONE

Front 62

G- Meningitis (Enterbacter/Psuedomonas/Salmonella)
a)tx (2)

Back 62

a1)for pseudomonas give cefepime, ceftazidime, OR meropenem PLUS AG

a2)others MOs you give 3rd or 4th gen cephalo

TREAT FOR 21DAYS

Front 63

Viral Encephalitis causes (4)

Back 63

1)Coxsackievirus A/B
2)Echovirus
3)Enterovirus
4)HSV (50-85% mortality w/o tx)

Front 64

Tx of viral encephalitis (2)

Back 64

FOR HSV:
a)acyclovir 10mg/kg IV q8h for 2-3wks
b)if resistant give foscarnet (watch for renal toxicity)

FOR OTHERS:
supportive care fluids, antipyretics/analgesics

Front 65

CNS Abscess tx (2)

Back 65

1)SURGERY
2)3rd gen cephalo

Front 66

HAP (hospital pneumonia)
a)org's (2)
b)drug to tx (5) (w/ best 3 starred)

Back 66

a1)pseudomonas
a2)enterobacter

b1)imipenem/meropenem****
b2)pip/tazo*****
b3)tobramycin/amikacin*****
b4)cefepime
b5)ceftazadime