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57 Cards in this Set
- Front
- Back
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Ampicillin, Amoxicillin best initial TX for?
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Otitis media
dental infection, endocarditis prophylaxis lyme disease in pregnancy UTI in pregnancy Listeria monocytogenes enterococcal infection |
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Penicillinase resistant penicillin are used to treat?
(dicloxacillin, nafcillin, oxacillin, cloxacillin) |
skin infection (cellulitis, impetigo, erysipelas)
staphylococcal endocarditis, meningitis, bacteremia osteomyelitis, septic arthritis ONLY when proven sensitivity NOT effective against MRSA |
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methicillin SE?
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renal failure from allergic interstitial nephritis
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Piperacillin Ticarcillin, azlocillin, mezlocillin
best initial for? usually with beta-lactamase inhibitor (tazobactam, clavulanate) |
cholecystitis, ascending cholangitis
pyelonephritis bacteremia hospital acquired, ventilator associated pneumonia neutropenia with fever |
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all cephalosporins cover which organism?
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group A, B, C streptococcus
E coli Klebsiella Proteus |
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cefotetan, cefoxitin
cefaclor, cefprozil ceftriaxone cefotaxime ceftazidime cefepime |
-cefotetan, cefoxitin (2nd gen): PID with doxycyclin
-cefaclor, cefprozil (2nd gen): respiratory infection like bronchitis, otitis media, sinusitis -ceftriaxone: first line for pneumococcus, meningitis, gonorrhea, lyme involving heart, brain, community acquired pneumonia (with macrolide) -cefotaxime: spontaneous bacterial peritonitis -ceftazidime: pseudomonas -cefepime: neutropenia with fever, ventilator associated pneumonia |
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SE of
cefotetan, cefoxitin? ceftriaxone? |
-cefotetan, cefoxitin: disulfiram like reaction, increased risk of bleeding (deplete prothrombin)
-ceftriaxone: impaired biliary metabolism, avoid in neonate |
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rash after penicillin?
anaphylaxis after penicillin? |
-try cephalosporin
-non-beta lactamase antibiotic |
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aztreonam
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exclusive for gram negative bacilli including pseudomonas
no cross reaction with penicillin |
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fluoroquinolones: levofloxacin, ciprofloxacin, Gemifloxacin, Moxifloxacin
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community acquired pneumonia
Ciprofloxacin: cystitis, pyelonephritis fluoroquinolone + macrolide: diverticulitis, GI infection (Moxifloxacin can be used without macrolide) |
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SE fluoroquinolones
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bone growth abnormality
tendonitis, achilles tendon rupture |
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Aminoglycoside (gentamicin, neomycin, amikacin, tobramycin)
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gram negative bacilli
no effect on anaerobes ototoxicity, nephrotoxicity |
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doxycycline
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chlamydia
lyme dz (rash, joint, CN7 palsy) rickettsia syphilis allergic to penicillin |
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SE doxycycline
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teeth discoloration
fanconi syndrome (RTA type2) |
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TMP-SMX
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cystitis
PCP Toxo prophylaxis |
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SE TMP-SMX
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rash
bone marrow suppression hemolysis in G6PD deficiency |
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nitrofurantoin
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cystitis in pregnancy
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MRSA tx?
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vancomycin,
linezolid daptomycin |
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minor MRSA of skin TX?
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TMP-SMX + doxycycline
clindamycin + doxycycline |
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anaerobes TX?
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above diaphragm: clindamycin
abdominal/ GI: metronidazole |
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gram negative bacilli TX?
(peritonitis, diverticulitis, pyelonephritis, cholecystitis, cholangitis) |
fluoroquinolone, aminoglycoside, carbapenem, piperacillin, aztreonam, cephalosporin
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meningitis symptoms with
-AIDS, CD<100 -rash from arm/leg to trunk -adolescent, petechial rash |
-cryptococcus
-RMSF -Neisseria |
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most common encephalitis? TX?
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Herpes Simplex
Acyclovir Foscarnet if acyclovir resistent |
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fever, abd pain, bloody diarrhea, hemochromatosis
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Yersinia enterolytica
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SE of interferon
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myalgia, arthralgia
flu like symptoms leukopenia, thrombocytopenia depression |
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UTI TX?
Cystitis DX?TX? Cystitis in pregnancy? |
-fluoroquinolone
-DX: urinalysis (>10 WBC) best initial, urine culture most accurate -TX:TMP-SMX, ciprofloxacin, nitrofurantoin -nitrofurantoin |
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pyelonephritis tx?
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Amp + Gent until culture
ciprofloxacin |
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acute prostatitis
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dysuria, perineal pain, tender prostate
TX: acute: Amp + Gent till culture result, ciprofloxacin chronic prostatitis: TMP-SMX for 6-8 wks |
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fever + murmur
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endocarditis
best initial: blood culture, echocardiogram |
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endocarditis best initial TX?
viridans strep? fungal? enterococci? HACEK group |
Vancomycin + Gentamicin then by culture results
-ceftriaxone 4 wks -amphotericin and valve replacement -vancomycin + gentamicin -ceftriaxone |
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why prophylaxis for endocarditis?
what prophylaxis? |
-cardiac defect or surgery (dental, respiratory)
-amoxicillin, -if penicillin allergic: clindamycin, azithromycin |
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lyme disease TX?
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asymptomatic with ixodes tick attached > 48hr in endemic area: single dose doxycycline
rash: doxy, amox joint, CN7 palsy: doxy, amox Cardiac, neurologic: IV ceftriaxone |
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HIv TX initiate when?
what best initial TX regimen |
CD<500, high viral load (>100,000), or opportunistic infection.
best initial TX regimen: emtricitabine + tenofovir + efavirenz |
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SE HIV med
-zidovudine -stavudine, didanosine -abacavir -protease inhibitor -indinavir -tenofovir |
-zidovudine: anemia
-stavudine, didanosine: peripheral neuropathy, pancreatitis -abacavir:steven johnson syndrome -protease inhibitor: hyperlipidemia, hyperglycemia -indinavir:nephrolithiasis -tenofovir: renal insufficiency |
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dullness to percussion at base lung
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pleural effusion
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electrical alterans
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pericardial effusion
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aromatase inhibitor
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anastrazole
letrozole exemestane |
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pulsus tardus et parvus
pulsus bisferiens pulsus alternans pulsus bigeminus |
-aortic stenosis
-aortic regurgitation -left ventricular systolic dysfunction -HOCM |
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association with choanal atresia
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CHARGE syndrome
Coloboma Heart defect Atresia of choana Retardation of growth, mental GU malformation Ear defect, hearing loss |
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Association with imperforated anus
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VACTERL syndrome
Vertebral anomaly Anal atresia Cardiovascular anomaly TE fistula Esophageal atresia Renal anomaly Limb anomaly |
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Down syndrome associated with
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septal defect
duodenal atresia hirschsprung imperforated anus |
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3 types of ricket
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vitamin D deficient rickets
vitamin D dependent rickets hypophosphatemic rickets |
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Neonatal toxoplasmosis infection, DX, TX?
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chorioretinitis
hydrocephalus multiple ring enhancing lesion DX: IgM toxo, PCR TX: pyrimethamine, sulfadiazine |
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neonatal rubella infection, DX, TX?
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PDA, cataract, deafness, blueberry muffin rash
DX: maternal IgM rubella TX: supportive |
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neonatal herpes infection, DX, TX?
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week1: shock, DIC
week2: vesicular lesion week3: encephalitis DX: tzanck smear, PCR TX: acyclovir |
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neonatal CMV infection, DX, TX?
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periventricular calcification, chorioretinitis, hearing loss, petechiae
DX: viral titer, PCR TX: gancyclovir |
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community acquired PNA common pathogen
-COPD? -recent influenza? -diabetes? -Hoarseness -bullous myringitis -abdominal pain, diarrhea, headache, confusion |
-H. influenzae
-Staph aureus -Klebsiella -Chlamydophila pneumoniae -Mycoplasma pneumoniae -Legionella |
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PNA classification
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Community acquired PNA ( <2 day since hospitalization)
-typical, atypical Hospital acquired PNA (>2 day after hospitalization) Ventilation related PNA |
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atypical pneumonia
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Mycoplasma
Chlamydia Coxiella Pneumocystis Virus |
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Community acquired PNA TX?
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Inpatient vs outpatient based on
Pneumonia severity index (hypoxia<60 mmHg, hypotension<90, tachycardia>125, tachypnea>30, age>65, w/ comorbidity, fever>104, BUN>30) -Inpatient: respiratory fluoroquinolone (levo, moxi), ceftriaxone, azithromycin -Outpatient: --healthy, no abx past 30 days: macrolide, doxycyclin --comorbidity, abx use past 30 days: respiratory fluoroquinolone (levo, moxi) |
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Hospital acquired PNA TX?
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-antipseudomonal cephalosporin
cefepime, ceftazidime -or antipseudomonal penicillin piperacillin w/ tazobactam (zosyn) -or carbapenems imipenem, meropenem, doripenem |
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Ventilator associated PNA empiric TX?
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-antipseudomonal beta- lactam
Zosyn or Carbapenem -AND second antipseudomonal agent Aminoglycoside or Fluoroquinolone -AND MRSA tx Vancomycin or Linezolid |
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Imipenem SE?
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seizure
renally excreted |
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lung abscess TX?
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anaerobic coverage
Clindamycin |
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PCP pneumonia lab, DX, TX?
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Always increased LDH
DX: Bronchoalveolar lavage (most accurate) most likely in HIV pt with interstitial infiltrates TX: TMP-SMX, steroid( if O2<70) if rash -> Pentamidine, clindamycin Prophylaxis: TMP-SMX if rash -> Atovaquone, dapsone |
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SE of TB medication
-Rifampin -INH -Pyrazinamide -Ethambutol |
-red color secretion
-peripheral neuropathy (Tx:VitB6) -Hyperuricemia -Optic neuritis/ color vision (down dose for renal failure) |
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ARDS DX? TX?
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DX: PaO2/FiO2 < 200, PCWP< 18
TX: low tidal volume mech ventilation (6 ml/kg) PEEP to decrease FiO2 Plateau pressure < 30 cm H2O |
