Pance Medicines

Front 1

Tetracycline and sulfonamides are examples of antibiotics that are bacteriocidal. True or false?

Back 1

False

Front 2

Tetracycline and sulfonamides are examples of antibiotics that are bacteriocidal. True or false?

Back 2

False

Front 3

This class of antibiotics works by disrupting or inhibiting cell wall growth:
1. Cephalosporins
2. Aminogycosides
3. Fluoroquinolones

Back 3

Cephalosporins

Front 4

This class of antibiotics works by disrupting or inhibiting cell wall growth:
1. Cephalosporins
2. Aminogycosides
3. Fluoroquinolones

Back 4

Cephalosporins

Front 5

If the patient is immunocompromised (i.e. neutropenic), it is preferable to us a bacteriostatic antibiotic?

Back 5

False

Front 6

If the patient is immunocompromised (i.e. neutropenic), it is preferable to us a bacteriostatic antibiotic?

Back 6

False

Front 7

Tetracycline and sulfonamides are examples of antibiotics that are bacteriocidal. True or false?

Back 7

False

Front 8

This class of antibiotics works by disrupting or inhibiting cell wall growth:
1. Cephalosporins
2. Aminogycosides
3. Fluoroquinolones

Back 8

Cephalosporins

Front 9

If the patient is immunocompromised (i.e. neutropenic), it is preferable to us a bacteriostatic antibiotic?

Back 9

False

Front 10

What antibiotic can be associated with permanent hearing loss?

Back 10

Aminoglycosides (gent)
Get drug levels!

Front 11

What antimicrobial is associated with >80% of patients experiencing nephrotoxicity?

Back 11

Amphotericin-B ("AmphoTerrible")

Front 12

This antibiotic can cause Fanconi syndrome (reversible renal)?

Back 12

Tetracycline

Front 13

What is Red Lobster Syndrome?

Back 13

Ass w/ rifampin and causes red-orange urine, tears, sweat, contact lens

Front 14

What antibiotic can cause kernicterus (jaundice causing brain damage) in newborns?

Back 14

Sulfonamides

Front 15

Antibiotic causing darkening of teeth; contraindicated in kids < 8 yrs

Back 15

Tetyracycline

Front 16

Red Man/ Red Neck Syndrome?

Back 16

Caused by rapid infusion of vancomycin (histamine release causes flushing)

Front 17

Causes loss of red/green color perception

Back 17

High dose ethambutol (optic neuritis)

Front 18

Causes disulfiram-like (tachycardia, flusing, HAs, cramps, NVD) reaction when taken with alcohol?

Back 18

Metroidazole (No ETOH for 2 days after therapy)

Front 19

Ass w/ hyperkalemia by blocking tubular reabsorption of Na and secretion of K?

Back 19

TMP-SMX

Front 20

Antibiotic with highest incidence of Clostridium difficile diarrhea?

Back 20

Clindamycin

Front 21

Antibiotic assc w/ hypokalemia

Back 21

Pencillins especially nafcillin and piperacillin

Front 22

Antibiotic with highest incidence of Clostridium difficile diarrhea?

Back 22

Clindamycin

Front 23

Antibiotic assc w/ rash when used concurrently in Mononucleosis (Epstein Barr Virus)

Back 23

Ampicillin

Front 24

Antibiotic assc w/ hypokalemia

Back 24

Pencillins especially nafcillin and piperacillin

Front 25

Antibiotics ass w/ CN8 toxicity (hearing loss) in fetus. Category D risk to fetus

Back 25

Aminoglycosides

Front 26

Antibiotic assc w/ rash when used concurrently in Mononucleosis (Epstein Barr Virus)

Back 26

Ampicillin

Front 27

Antibiotic causing tooth/bone problems for infant and hepatotoxic to mom. Cat D

Back 27

Tetracycline

Front 28

Antibiotics ass w/ CN8 toxicity (hearing loss) in fetus. Category D risk to fetus

Back 28

Aminoglycosides

Front 29

Antibiotic with highest incidence of Clostridium difficile diarrhea?

Back 29

Clindamycin

Front 30

Antibiotic causing tooth/bone problems for infant and hepatotoxic to mom. Cat D

Back 30

Tetracycline

Front 31

Antibiotic assc w/ hypokalemia

Back 31

Pencillins especially nafcillin and piperacillin

Front 32

Antibiotic assc w/ rash when used concurrently in Mononucleosis (Epstein Barr Virus)

Back 32

Ampicillin

Front 33

Antibiotics ass w/ CN8 toxicity (hearing loss) in fetus. Category D risk to fetus

Back 33

Aminoglycosides

Front 34

Antibiotic causing tooth/bone problems for infant and hepatotoxic to mom. Cat D

Back 34

Tetracycline

Front 35

ADR (Adverse Drug Reactions) for aspirin

Back 35

GI bleeding

Front 36

A clinical use for aspirin

Back 36

Analgesia

Front 37

Cardiovascular indications for aspirin

Back 37

AMI prophylaxis / AMI / PCI / TIA

Front 38

Clopidogrel cardivascular indications

Back 38

Unstable angina / ACS / AMI pts who undergo PCI / TIA / CVA, PAD

Front 39

Clopidogrel ADRs

Back 39

GI upset, bruising, bleeding - TTP (uncommom)

Front 40

Antibiotic w/ potential for arthropathy in children. Cat C

Back 40

Fluouroquinolones

Front 41

Antibiotic w/ teratogenic potential. Cat C

Back 41

Clarithromycin

Front 42

Antibiotic potentially hepatotoxic in pregnant women receiving high IV doses

Back 42

Erythromycin

Front 43

Gell & Coombs Classification of Hypersensitivity to B-Lactams Type II reaction?

Back 43

Bone Marrow Suppression

Front 44

Gell & Coombs Classification of Hypersensitivity to B-Lactams Type IV reaction?

Back 44

Delayed reactions=SJS/TEN

Front 45

Clopidogrel interactions cautions

Back 45

caution with drugs that cause bleeding

Front 46

Warfarin MOA

Back 46

inhibits vitamin K-dependent Y-carboxylation of coagulation factors II,VII,IX, & X (procoagulants)

Front 47

Warfarin drug specifics

Back 47

Measure INR (PT) - value depends on situation
- half-life = 4-hrs ? takes ~ 2d to see effect in PT (INR)

Front 48

Warfarin reversal

Back 48

Reverse with vitamin K1 (phytonadione) / FFP

Front 49

Warfarin prolongation of PT during first few days

Back 49

Caused from depression of factor VII (low and slow)

Front 50

Can you use cephalosporins if patient has a maculopapular rash from penicillin?

Back 50

Yes

Front 51

Can you use cephalosporin if patient has urticaria and bronchospasm from penicillin?

Back 51

No

Front 52

Do agents containing sulfur, sulfites and sulfates cross-react with sulfonamides?

Back 52

No

Front 53

Name some effective oral antibiotics for staph

Back 53

Dicloxacillin (gold standard)
Cephalexin
(Minocycline/doxyclycline TMP-SMX use if allergic to B-lactams)

Front 54

MRSA oral antibiotics?

Back 54

Linezolid
M (fairly effective)inocycline/doxycycline>TMP-SMX

Front 55

Pseudomonal oral ABX?

Back 55

Ciprofloxacin & levofloxacin

Front 56

VRE oral ABX?

Back 56

Linezolid (leave alone unless in blood and then refer)

Front 57

Anaerobic oral ABX?

Back 57

Metronidazole or amoxicillin/clavulanate (gold std)
Clindamycin (silver std)

Front 58

Staph IV ABX?

Back 58

Nafcillin (gold std)
Cefazolin (silver std)
Vanc (bronze std-use if allergic to B-lactams)

Front 59

MRSA IV ABX?

Back 59

Vancomycin (gold std)
Others include linezolid, daptomycin, tigecycline, telavancin

Front 60

Urgent Warfarin anticoagulation method

Back 60

Overlap warfarin / heparin 5-7d if needed

Front 61

Warfarin clinical uses

Back 61

Prevention and treatment of thrombosis / embolisim
- atrial fibrillation
-may be used with recurrent TIA for pts resistant to ASA & clopidogrel

Front 62

Warfarin interactions

Back 62

Substrate of mulyiple CYP enzymes

Front 63

Warfarin ADRs

Back 63

Bleeding / Purple (blue) toe syndrome / Warfarin-induced skin necrosis

Front 64

Heparin MOA

Back 64

Indirect thrombin inhibitor
COmplexes with AT (inactivator of thrombin, factor Xa (lesser extent factors XIIa, XIa, & IXa)

Front 65

Pseudomonal IV ABX?

Back 65

Piperacillin/Tazobactam
Aztreonam
Ceftazidime & cefepime
Ciprofloxacin & levofloxacin
tobramycin
Carbapenems

Front 66

VRE IV ABX?

Back 66

Linezolid, daptomycin, tigecycline, & telavancin

Front 67

What antibiotic is assc w/ Hoignes Syndrome?

Back 67

Penicillin C procaine (single IM dose for GAS pharyngitis)

Front 68

An immediate but transient (5-30 min after injection) reax w/ bizarre behavior/neuro reax?

Back 68

Hoignes Syndrome

Front 69

What penicillin is used for both GAS pharyngitis and various stages of syphilis?

Back 69

Pencillin G benzathine (IM)

Front 70

Heparin drug specifics

Back 70

Check aPTT
Reverse by turning down / stopping heparin
- Protamin if urgent reversal required (watch with DM & vasectomy)

Front 71

Heparin clinical use

Back 71

- DVT prophylaxis
- Sytemic anticoagulation
- ACS / AMI

Front 72

Heparin ADRs

Back 72

Heparin-induced thrombocytopenia (HIT)

Front 73

Low Molecular Weight Heprin (LMWH) specific drugs

Back 73

Enoxaparin

Front 74

LMWH MOA

Back 74

- inactivates factor Xa
- doesn't prolong aPTT

Front 75

LMWH drug specifics

Back 75

Don't measure PT / PTT - can measure anti-Xa levels to check anticoagulation (pregnant women)
- reverse with protamine

Front 76

LMWH clinical use

Back 76

DVT prophylaxis & treatment (surgery & medical pts)

Front 77

Fibric Acid Derivatives specific drugs (fibrates)

Back 77

- Gemfibrozil
- Fenofibrate
- Fenofibric acid

Front 78

Fibric Acid Derivatives clinical use

Back 78

use for increased triglycerides

Front 79

FIbric Acid Derivatives interactions

Back 79

Careful with stains dur to overlappingtoxicity profiles

Front 80

Name anti-staph penicillins still clinically used for SSTI (skin and soft tissue infex)

Back 80

Nafcillin (IV)
Dicloxacillin (po)

Front 81

Ampicillin may be used to treat listeria monocytogenes.
T/F?

Back 81

True

Front 82

Amoxicillin is commonly used for URTIs T/F?

Back 82

True

Front 83

May be used for dental endocarditis prophylaxis & lyme disease

Back 83

amoxicillin

Front 84

Amoxicillin/clavanate is used for:
1. Animal/human bites
2. Amoxicillin failure URTIs
3. Dental Infex
4. All of the above

Back 84

4.

Front 85

Zosyn is never used for nosocomial infections T/F?

Back 85

False

Front 86

Which grp of antibiotics arrests cell wall synthesis by binding to penicillin-binding proteins?

Back 86

Cephalosporins

Front 87

Which is one of the 3 mechanisms of bacterial resistance?
1) destruction of ABX by B-lactams
2) High-affinity binding of ABX to PBP

Back 87

1.

Front 88

A rash after cephalosporin usage is expected T/F?

Back 88

False=immediate anaphylaxis

Front 89

Which cephalosporin covers enterococci or listeria?

Back 89

None

Front 90

Fibric Acid Derivatives ADRs

Back 90

- Reversible hepatoxicity
- Myopathy
- May precipitate gallstones

Front 91

HMG-COA Reductase Inhibitors specific drugs ("stains")

Back 91

- Atorvastatin
- Simvastatin gemeric (more likely to cause ADRs)
- Pravastatin

Front 92

What is the clinical use for HMG-COA Reductase Inhibitors?

Back 92

Use for increased LDL

Front 93

What is a common interaction with HMG-COA Reductase Inhibitors?

Back 93

- grapefruit juice & simvastatin

Front 94

HMG-COA ADRs

Back 94

- Myalgia - myopathy, rhabdo (very rare)
- reversabile hepatotoxicity

Front 95

Cephalosporin commonly used for perioperative prophylaxis

Back 95

cefazolin

Front 96

ceephalosporin po commonly used for SSTIs

Back 96

Cephalexin

Front 97

Bilary sludging (pseudocholelithiasis) is possible with this cephalosporin

Back 97

ceftriaxone

Front 98

An example of a 2nd generation cephalosporin & cephamycin

Back 98

cefuroxime
cefaclor
cefprozil

Front 99

A 2nd generation cephalosporin that might be used to treat an amoxicillin failure URTI

Back 99

cefuroxime
cefaclor

Front 100

What is the chemical form of Niacin (vitamine B3)

Back 100

nicotonic acid & nicotinamide

Front 101

What are some available options

Back 101

- immediate release(OTC) - flushing
- sustained release (Slo-Niacin) - hepatoxicity
- Extended-release (Niaspan) - least flushing & hepatoxicity

Front 102

What are Niacin clinical uses

Back 102

Modifies all plasama lipoprotiens & lipids favorablely

Front 103

Niacin interactions

Back 103

- Careful with coadministration of "stains" & other fibric acid derivatives

Front 104

Niacin ADRs

Back 104

- flushing
-aggravated glucose intolerance / gout

Front 105

Cephamycin usually used for surgical abdominopelvic prophylaxis

Back 105

cefocitin (IM/IV)
cefotetan (IM/IV)

Front 106

A 3rd generation cephalosporin with excellent S. Pneumoniae coverage

Back 106

cefpodoxime (IM/IV)

Front 107

3rd generation cephalosporin used for single-dose gonorrhea treatment

Back 107

cefpodoxime (IM/IV)

Front 108

Cephalosporin (3rd generation) single dose po gonorrhea treatment

Back 108

cefixime

Front 109

Rocephin (ceftriaxone) is an example of a 3rd generation cephalosporin T/F?

Back 109

true

Front 110

3rd generation cephalosporin used more frequently in pregnant women

Back 110

cefotaxime

Front 111

Uses for 3rd generation cephalosporin include
1. refractory AOM
2. meiningitis
3. gonorrhea
4. all of above

Back 111

4.

Front 112

A momobactam such as aztreonam should not be used w/ pts allergic to penicillin T/F?

Back 112

false

Front 113

An example of a glycopeptide antibiotic?

Back 113

vancomycin

Front 114

Oral vancomycin use

Back 114

severe or refractory CDAD (C diff assc disease)

Front 115

Does vancomycin cover G+ organisms?

Back 115

No

Front 116

An example of a lipoglycopeptide?

Back 116

telavancin

Front 117

What is telavancin used for?

Back 117

complicated skin & soft tissue infex caused by Gm+, including MRSA

Front 118

An example of a cyclic lipopeptide?

Back 118

daptomycin (IV)

Front 119

Why is it prudent to hold statins while on daptomycin?

Back 119

Both can cause muscle discomfort/weakness

Front 120

Daptomycin is used for MRSA & VRE T/F?

Back 120

True

Front 121

Tetracyclines inhibit protein syntheis by binding to 30S ribosomal unit T/F?

Back 121

True

Front 122

Take tetracyclines with a full glass of milk

Back 122

False

Front 123

What is a special side effect ass w/ minocycline?

Back 123

Vestibular(vertigo)
Purplish/blue hyperpigmentation of skin (esp. scars)
drug-induced lupus

Front 124

Doxycycline is used to teat comminity acquired pneumonia T/F?

Back 124

True

Front 125

Class Ia Anti-Arrhythmics
Quindine ADRS

Back 125

- sudden death (increased QT & Torsade de Pointes)
- Cinchonism (urinary retention, vascular flushing, blurred vision (mydriasis), delerium, psychosis, anhidrosis)

Front 126

Class Ia Anti-Arrhythmics
Procainamide ADRs

Back 126

revesible Lupus-like syndrome

Front 127

Class Ib Anti-Arrhythmics
Lidocaine ADRs

Back 127

GI upset, CNS toxicity, cardiac hypotension

Front 128

Class Ic Anti-Arrhythmics

specific drugs

Back 128

- Flecanide & propafenone

Front 129

Class Ic Anti-Arrhythmics
ADRs

Back 129

- CNS toxicity (dizziness and blurred vision)
- Cardiac (pro-arrhythmic, (-) inotropic effect

Front 130

Tetracyclines can not be used to treat Lyme disease T/F?

Back 130

False

Front 131

An example of a glycylcine abx

Back 131

tigecycline

Front 132

An advantage of tigecycline

Back 132

Extrememly broad coverage
Useful for nosocomial infex

Front 133

Tigecycline does not cover pseudomonas aeruginosa T/F?

Back 133

True

Front 134

Macrolides inhibit bacterial protein synthesis by binding to 50S bacterial ribosomal subunit T/F?

Back 134

True

Front 135

An advantage of clarithromycin and erythromycin is that there are few drug interactions with them T/F?

Back 135

False. Both are potent inhibitors of CYP3A4

Front 136

An example of a macrolide

Back 136

Erythromycin
Clarithromycin
Azithromycin

Front 137

Azithromycin can be used to trreat non-gonococcal urethritis/cervicitis T/F?

Back 137

True

Front 138

An example of a lincosamide

Back 138

clindamycin

Front 139

Most common adverse effect of clindamycin

Back 139

diarrhea, including c. diff colitis

Front 140

A common use of clindamycin

Back 140

1. substitute for b-lactam allergy for SSTIs & strep pharyngitis
2. anaerobic infex/abscesses (+ b-lactam or fluoroquinolone)

Front 141

An example of a oxazolidinone

Back 141

linezolid (PO/IV)

Front 142

Linezolid uses

Back 142

MRSA & VRE

Front 143

Aminoglycosides inhibit bacterial protein synthesis by binding to 50S bacterial subunit T/F

Back 143

False. They bind to 50S not 30S

Front 144

Major adverse effects with aminoglycosides

Back 144

Ototoxic
Nephrotoxic
Neuromuscular blockade in MG pts

Front 145

Which aminoglycoside has the best pseudomonal activity?

Back 145

tobramycin

Front 146

An example of an aminoglycoside

Back 146

Gentamicin tobramycin amikacin, etc

Front 147

Which is true re fluoroquinolones?
1. Don't take w/ anatacids & dairy
2. Don't mix w/ QTc prolonging drugs
3. Contraindicated in kids <18
4. All are true

Back 147

4.

Front 148

Non-respiratory Fluoroquinolones uses

Back 148

Upper & lower UTI
Traveler's diarrhea/ enteric infex

Front 149

Examples of non-respiratory fluoroquinolones

Back 149

ciprofoxacin
ofloxacin
lomefloxacin

Front 150

Example of 3rd generation respiratory fluoroquinolone

Back 150

levofloxacin
moxifloxacin
gemifloxacin

Front 151

A common use of levofloxacin (levaquin)

Back 151

upper & lower UTI
traveler's diarrhea/enteric
upper & loer RTI

Front 152

Sulfa drugs interfere with bacterial folic acid synthesis by inhibiting T/F?

Back 152

True

Front 153

One problem with sulfonamides & trimethoprim is that both can inhibit CYP2C9 T/F?

Back 153

True. watch warfarin

Front 154

Major adverse effects of sulfonamides & trimethoprim

Back 154

Severe rash (exfoliative dermatitis)
Reversible myelosuppression
Hemolytic anemia in pts w/ G6PD deficiency

Front 155

Example of sulfonamide/trimethroprim

Back 155

bactrim
septra

Front 156

Common use of bactrim

Back 156

URTIs
lower UTIs (usually 2nd line)
PCP
MRSA (not serious)

Front 157

Can trimethroprim be used when allergic to sulfa?

Back 157

yes

Front 158

An example of a nitroimidazole

Back 158

Metronidazole (flagyl)
Tinidazole

Front 159

Microbial coverage of nitroimidazole (metronidazole & tinidazole)

Back 159

Most strict anaerobes & some protozoa (trich, giardia)

Front 160

Uses of metronidazole (flagyl)

Back 160

bacterial vaginosis
C diff infex
amebiasis, giardiasis, tric

Front 161

Long term usage of a nitrofuran will not lead to pulmonary fibrosis

Back 161

False. It may lead to pulmonary fibrosis so don't use long term

Front 162

An example of a nitrofuran

Back 162

macrobid
macrodantin

Front 163

Common use of macrobid or macrodantin

Back 163

lower UTI & prophylaxis of recurrent UTIs

Front 164

Non-absorbed oral antibiotic derived from rifampin

Back 164

rifaximin

Front 165

Rifaximin is used for:

Back 165

Travelers' diarrhea by non-invasive E coli (not effective if fever & blood)

Front 166

TB 1st line drugs

Back 166

R.I.P.E=
Rifampin
Isoniazide (INH)
Pyrazinamide
Ethambutol

Front 167

TB 2nd line agents

Back 167

streptomycin
kanamycin
amikacin
capreomycin
cycloserine
ethionamide
levofloxacin
moxifloxicin
ASA

Front 168

The drug of choice for latent TB for 9 months=

Back 168

Isoniazide (INH)

Front 169

Vitamin B6 helps decrease risk of peripheral neuropathy & drug induced lupus when used with ____TB agent

Back 169

Isoniazide (INH)

Front 170

Rifampin is a weak inducer of most CYP enzymes T/F?

Back 170

False--a strong inducer

Front 171

Common uses of rifampin

Back 171

1. component of active tb tx
2. latent tb tx (if intolerant of INH)
3. Meningococcal Meningitis prophylaxis

Front 172

ADRs ass w/ pyrazinamide

Back 172

Non-gouty polyarthralgia (up to 40%0
Asymptomatic hyperuricemia
Dose-related hepatitis

Front 173

Pyrazinamide use

Back 173

component of active tb tx

Front 174

Ethambutol use

Back 174

component of active tb tx

Front 175

Class III Anti-Arrhythmics

Amiodarone (Cordarone) drug specifics

Back 175

- FDA approved for life-threatening arrhythmias and also used for atrial fibrillation
- highly lipid soluble with long elimination 1/2 half life

Front 176

Amiodarone (Cordarone) interactions

Back 176

- substrate of CYP2C9 & 3A4
- likely inhibits P-glycoprotein (digoxin transport, digoxin excretion blocked)
- avoid other QT prolongators (Quinilones)

Front 177

Class III Anti-Arrhythmics ADRs

Back 177

- Pulmonary toxicity
- Thyroid toxicity (hypothyroidism>>hyperthyroidism
- Ocular toxicity
- Optic Neuritis
- bluish skin discoloration with recurrent sun exposure
- Bradycardia

Front 178

Class III Anti-Arrhythmics

Sotalol (Betapace) ADRs

Back 178

- Cardiac (pro-arrhythmic, bradycardia)
- Bronchospasm
- Hypoglycemia

Front 179

Class IV Anti-Arrhythmics

Specific drugs

Back 179

- Verapamil
- Diltaizem

Front 180

Side effect w/ Ethambutol (ETH)?

Back 180

Dose related optic neuritis

Front 181

Examples of anti-herpetic antivrals

Back 181

acyclovir
famciclovir
valacyclovir

Front 182

Uses of anti-herpetic anti-virals

Back 182

HSV & VZV infex

Front 183

Anti-CMV Antivirals

Back 183

Ganciclovir
valganciclovir

Front 184

An adverse reax of an anti-CMV antiviral

Back 184

myelosuppression

Front 185

Anti-flu antivirals

Back 185

Amantidine/rimantidine
Oseltamivir (tamiflu)
Zanamavir (relenza)

Front 186

Oseltamivir & zanamavir used for

Back 186

Influenza A & B prophylaxis & tx

Front 187

An example of a polyene antifungal

Back 187

amphotericin B
nystatin

Front 188

Nystatin use

Back 188

topical orophayngial candidiasis (Thrush)

Front 189

ADR of amphotericin-B

Back 189

F/C, nephrotoxicity

Front 190

Uses of amphotericin-b

Back 190

invasive aspergillosis and other deep fungal infex

Front 191

Examples of antifungal azoles

Back 191

Clotrimazole
miconazole
fluconazole, etc

Front 192

Topical skin azole antifungals

Back 192

clotrimazole
econazole
miconazole

Front 193

Topical vaginal azole antifungals

Back 193

terconazole
miconazole
ticonazole

Front 194

Systemic azole antifungals

Back 194

ketoconazole
itraconazole
fluconazole
voriconazole
posaconazole

Front 195

Fluconazole is highly concentrated in the urine

Back 195

True

Front 196

Main use of fluconazole (po/iv)

Back 196

Candida infex (thrush, esophagitis, vulvovaginitis)

Front 197

Example of echinocandin antifungal

Back 197

casofungin
micafungin
anidulofungin

Front 198

Uses for echinocandin antifungals

Back 198

Nosocomial fungal infex
Immunocompromised pts

Front 199

Example of an allylamine antifungal

Back 199

lamisil

Front 200

CCBs ADRs

Back 200

- Cardiac (hypotension, bradycardia, (-) ionotrope, flushing, peripheral edema)
- CNS (HA, dizziness / lightheadedness)
- Note Verapamilcan cause constipation

Front 201

Digoxin

Interactions

Back 201

- many drug interactions based on P-gp

Front 202

Digoxin

ADRs

Back 202

- Cardiac (arrhythmigenic / AV block)
- oral steroids & diuretics lower K and increase toxicity
- Gynecomastia
- Yellow vision

Front 203

Thiazide-type & Loop Diuretics

Specific drugs

Back 203

- Thiazide type - HCTZ, chlorthalidone
- Loop - furosemide, bumetanide (closer to kidneys, stronger med)

Front 204

Thiazide-type & loop diuretics

Interactions

Back 204

- Digoxin & Lithium toxicity via electrolyte alterations
- antagonizes diabetes and gout medications

Front 205

Terbinafine (lamisil) use

Back 205

onychomycosis
cutaneous dermatophyte infex

Front 206

ADR of terbinafine

Back 206

Hepatotoxicity

Front 207

Thiazide-type & Loop Diuretics

ADRs

Back 207

- electrolite disturbances (hypokalemia, hypoatremia, hypercalcemia-thiazides)
- SNHL (ringing) - furosemide

Front 208

Potassium Sparing Diuretics

Specific drugs

Back 208

- Spironolactone, amiloride, triamterene (kidney stones - weakest diuretics)

Front 209

Potassium Sparing Diuretics

Interactions

Back 209

- avoid potassium supplements / salt substitutes
- Digoxin & lithium toxicity

Front 210

Potassium Sparing Diuretics

ADRs (based on spironolactone)

Back 210

- Hyperkalemia
- Hormone-like effects
- Estrogenic effects (gynecomastia, menstraul irregularities)
- Anti-androgen effects (impotence & reduced libido)

Front 211

ACE Inhibitors

Spcific Drugs

Back 211

- Ex. lisinopril

Front 212

ACE Inhibitors

ADRs

Back 212

- cough
- hyperkalemia
- angioedema
- birth defects (contrindicated)

Front 213

Angiotensin-II Receptor Blockers (ARBs)

Specific drugs

Back 213

- "sartan" drugs (losartan)

Front 214

ARBs

Interactions

Back 214

- other K+ sparing drugs (ACEIs, spironolactone)

Front 215

ARBs

ADRs

Back 215

- Hyperkalemia
- birth defects (contraindicated)

Front 216

alpha-Adrenergic Blockers

specific drugs

Back 216

- Systemic (nonselective) / Prazosin, terazosin, Doxazosin
- Non-systemic (selective- BPH) / Alfuzosin, Silodasin

Front 217

alpha-Adrenergic Blockers

ADRs

Back 217

- Nonselective agents cause drowsiness / fatigue, nasal congestion, postural hypotension
- Selective agents cause retrograde ejaculation

Front 218

beta-Blockers

Specific drugs

Back 218

- non beta1 - selective agents (propranolol - don't use in patients with asthma, COPD, & Raynaud's phenomenon)
- beta1 - Selective Agents (atenolol, metoprolol -less likely to cause bronchospasm)

Front 219

beta-Blockers

Specific drugs (con't)

Back 219

- beta-Blockers with Intrensic Sympathomimetic Activity (ISA) (pindolol, acebutolo-lowers blood pressure with less decrease in hart rate)

Front 220

beta-Blockers

Specific drugs (con't)

Back 220

- beta-Blockers with alpha-1 b;ocking activity (carvedilol-beta & alpha blockade, more for CHF, than HTN

Front 221

beta-Blockers

Interactions

Back 221

- Hypotension with other anti-hypertensives

Front 222

beta-Blockers

ADRs

Back 222

- Bradycardia
- Bronchospasm

Front 223

Calcium Channel Blockers (CCBs)

Specific drugs

Back 223

- ("pines")
- 1st generatio dihydropyridines (nifedipine)
2nd generation dihydropyridines (amlodipine)

Front 224

CCBs

ADRs

Back 224

- Flushing
- peripheral edema
- reflex tachycardia
Gingival hyperplasia (also phenytoin, dilantine)

Front 225

Central alpha-Adrenergic Agonists

Specific drugs

Back 225

- Clonidine (Catapres)
- Methyldopa (Aldomet) - pregnancy

Front 226

Central alpha-Adrenergic Agonists

ADRs

Back 226

- Sedation
- Dry moth
- Depression

Front 227

Direct Vasodilators

Specific drugs

Back 227

- Hydralazine - pregnancy
- Minoxidil

Front 228

Direct Vasodilators

ADRs

Back 228

- Hydralazine (lupus-like reaction)
- Minoxidil (hirsutism & severe fluid retention, refactory BP)

Front 229

Erectile Dysfunction (ED) Medications

Specific drugs

Back 229

- Sildenafil - 4hrs 1/2 life
- Vardenafil - 4 hrs 1/2 life
- Tadalafil - 18 hrs 1/2 life

Front 230

ED Medications

Interactions

Back 230

- alpha-blockers - postural hypotension & dizziness
- nitrates - hpotension

Front 231

ED Medications

ADRs

Back 231

- HA & flushimg common to all
- Slidenafil associated with bluish vision

Front 232

Anti-Platelet Agents (weakens platelets)

ADP receptor inhibitors

Back 232

- Ticlopidine
- Clopidogrel
- Prasugrel

Front 233

Aspirin

MOA

Back 233

- ASA inhibits COX imparing transformation AA -> PGs, prostacycline, & throboxane A2 -> decreased thromboxane A2 -> decreased platelet aggregation
- irreversible plt effect

Front 234

Diabetic Drugs - Biguanides

Specific drugs

Back 234

Metformin

Front 235

Biguanides

Interactions

Back 235

other "anti-DM" drugs

Front 236

Biguanides

ADRs

Back 236

- GI upset
- Lactic acidosis (contraindicated in renal insufficiency, liver failure, CHF, major surgery, IV contrast)
-will not cause hypoglycomia

Front 237

Diabetic drugs - Sufonylureas

Specific drugs

Back 237

1st generation
-Tolazamide, tolbutamide, chlorpropamide
2nd generation
- glimepiride, glipizide, glyburide (longer 1/2 life)

Front 238

Sulfonylureas

interactions

Back 238

- other "anti-DM" agents

Front 239

Sulfonylureas

ADRs

Back 239

- weight gain
- hypoglycemia
- "Disulfiram-like" rxn with possible chlorpropamide

Front 240

Diabetic drugs - Thiazolidinediones

Specific Drugs ("glitazones")

Back 240

- Rosiglitazone
- Pioglitazone

Front 241

Thiazolidinediones

Interactions

Back 241

- Other "anti-DM" agents

Front 242

Thiazolidinediones

ADRs

Back 242

- weight gain, fluid retention (contraindicated in advanced HF pts
- Troglitazone & rosiglitazone removed or restricted 2 deg. toxicity

Front 243

Thyroid Medications

Specific drugs

Back 243

- Levothyroxine
- Methimazole

Front 244

Thyroid Medications

Specific drugs

Back 244

- Levothyroxine
- Methimazole

Front 245

Levothyroxine interactions

Back 245

- Interactions include both decreased absoption and drug-drug interactions

Front 246

Methimazole interactions

Back 246

- Potentiates anticoagulates

Front 247

Levothyroxine ADRs

Back 247

- hyperthyroidism
- decreased bone mineral density
- Transient alopecia

Front 248

Methimazole ADRs

Back 248

- rash
- bone marrow supperssion /aplastic anemia
- drug fever
- alopecia

Front 249

Respiratory Therapeutics - Corticosteroid Inhalers
- Ex. fluticasone interactions

Back 249

- none

Front 250

Corticosteriod Inhalers

ADRs

Back 250

- Dysphonia & thrush (rinse and spit)
- Long term risk of growth, cataracts, etc.

Front 251

Inhaled beta2-Agonists

- specific drugs

Back 251

- albuterol (fast onset)
- salmeterol (long acting)

Front 252

Inhaled beta2-agonists

interactions

Back 252

- avoid beta-blockers

Front 253

Inhaled beta2-agonists

ADRs

Back 253

- tachycardia (palpitations)
- paradoxical bronchospasm
- CNS effects (nevvousness, tremor)

Front 254

Leukotriene Modifiers

Specific drugs

Back 254

- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo)

Front 255

Leukotriene Modifiers

Interactions

Back 255

- CYP interactions possible (less with montelukast)

Front 256

Leukotriene Modifiers

ADRs

Back 256

- Montelukast is predominately used as it is well-tolerated & has QD dosing
- Zileuton has caused hepatotoxicity & agranulocytosis

Front 257

Theophylline

drug specifics

Back 257

- monitor drug levels

Front 258

Theophylline

interactions

Back 258

- multiple CYP interactions

Front 259

Theophylline

ADRs

Back 259

- GI upset
- CNS effects (nervousness, tremor, seizure)
- Cardiac effects (tachycardia, arrhythmias)

Front 260

Older Anti-Epileptics

Specific drugs

Back 260

- Phenytoin (Dilantin)
- Carbamazepine (Tegretol)
- Valproic acid (Depakote)

Front 261

Older anti-epileptics

interactions

Back 261

- multiple CYP interactions

Front 262

Older anti-epileptics

ADRs of Phenytoin

Back 262

- CNS effects (ataxia, slurred speech)
- liver toxicity
- bone marrow supperession
- Fetal hydantoin syndrome
- growth deficiency, craniofacial anomalies, mental retardation, nail / digital hypoplasia
- Gingival hyperplasia
- Drug fever
- decreased bone mineral density

Front 263

Older anti-epileptics

ADRs of Valproic Acid

Back 263

- hepatotoxicity / pancreatitis
- CNS effects (primary tremor)
- polycystic ovarian syndrome
- neural tube drfects (spina bifida)

Front 264

Leukotriene Modifiers

Specific drugs

Back 264

- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo)

Front 265

Leukotriene Modifiers

Interactions

Back 265

- CYP interactions possible (less with montelukast)

Front 266

Leukotriene Modifiers

ADRs

Back 266

- Montelukast is predominately used as it is well-tolerated & has QD dosing
- Zileuton has caused hepatotoxicity & agranulocytosis

Front 267

Theophylline

drug specifics

Back 267

- monitor drug levels

Front 268

Theophylline

interactions

Back 268

- multiple CYP interactions

Front 269

An example of an h2 blocker

Back 269

famotidine
nizatidine

Front 270

Example of a Proton Pump Inhibitor

Back 270

Omeprazole
Esomeprazole
Lansoprazole
Etc.

Front 271

Interaction of PPI's

Back 271

They alter absorption of pH-dependent drugs (iron, aspirin, etc)

Front 272

ADR of a PPI

Back 272

Acid Rebound

Front 273

Older anti-emetics such as prochloroperazine and promethazine may potentiate CNS depressants T/F?

Back 273

True

Front 274

ADRs of prochloroperazine and promethazine

Back 274

Dizziness
Amenorrhea
EPS

Front 275

Examples of newer anti-emetics

Back 275

Ondanestron
Dolasetron
granisetron
palonosetron

Front 276

Indications for newer anti-emetics

Back 276

Chemo induced emesis
post op
radiation nausea

Front 277

Colchicine is a drug commonly used for

Back 277

gout

Front 278

ADRs of colchicine

Back 278

diarrhea, myelosuppression, peripheral neuritis, reversible azoospermia

Front 279

Gout med that is used for acute gout and may cause severe rash

Back 279

allopurinol

Front 280

Examples of bisphosphonates

Back 280

alendronate
risedronate
icandronate
zoledronate
Etc

Front 281

Serious ADRs of bisphosphonates

Back 281

Esophageal (ulcers, strictures, erosion, etc)
Jaw osteonecrosis
Atypical femoral fx

Front 282

Examples of DMARDS
Idisease modifying anti rheuamatic druds)

Back 282

Oral corticosteroids
hydroxychloroquine
methotrexate
sulfasalazine
Tumor necrosis factor=etanercept, infliximab, etc

Front 283

Examples of oral corticosteroids

Back 283

prednisone
methylprednisolone
dexamethasone

Front 284

Gout med that is used for acute gout and may cause severe rash

Back 284

allopurinol

Front 285

Examples of bisphosphonates

Back 285

alendronate
risedronate
icandronate
zoledronate
Etc

Front 286

Serious ADRs of bisphosphonates

Back 286

Esophageal (ulcers, strictures, erosion, etc)
Jaw osteonecrosis
Atypical femoral fx

Front 287

Examples of DMARDS
Idisease modifying anti rheuamatic druds)

Back 287

Oral corticosteroids
hydroxychloroquine
methotrexate
sulfasalazine
Tumor necrosis factor=etanercept, infliximab, etc

Front 288

Examples of oral corticosteroids

Back 288

prednisone
methylprednisolone
dexamethasone

Front 289

Newer Anti-Epileptics

specific drugs

Back 289

- gabapentin
- lamotrigine (lamictal)
- leviracetam
- oxcarbazepine
-tiagabine
-topirmate
-zonisamide

Front 290

Newer Anti-Epileptics

interactions

Back 290

- all have CYP interactions
- gabapentin & leviracetam are exceptions

Front 291

Newer Anti-Epileptics

ADRs

Back 291

- dizziness
- anorxia
- insomnia
-cognitive problems
- confusion, concentration problems

Front 292

Monoamine Oxidase Inhibitors (MAOIs)

specific drugs

Back 292

- Ex. phenylzine

Front 293

MAOIs

interactions

Back 293

- sympathomimetics
- high-tyramine foods (cheese-induced crisis)

Front 294

MAOIs

ADRs

Back 294

- orthostatic hypotension
- CNS overstimulation

Front 295

Tricyclic Antidepressants (TCAs)

specific drugs

Back 295

- Ex. amitriptyline

Front 296

TCAs

interactions

Back 296

- contraindicated with MAOIs
- overlapping toxicities with other CNS depressants

Front 297

TCAs

ADRs

Back 297

- anti-cholinergic effects (fatigue, dry mouth, etc)

Front 298

Selective Serotonin Re-Uptake Inhibitors (SSRIs)

specific drugs

Back 298

- fluoxetine
- paroxetine
-sertraline
- citalopram / escitalopram

Front 299

ADRs oral corticosteroids

Back 299

Cushingoid (fat redistr)
Osteoporosis
HPA-axis suppression (growth suppression)
Cataracts
Avascular necrosis
Poor wound healing
GI ulcers/bleeding

Front 300

An ADR of azathioprine (a DMARD)

Back 300

reversible bone marrow suppression
hepatitis/pancreatitis
alopecia

Front 301

An ADR of hydroxychloroquine (a DMARD)

Back 301

Irreversible retinopathy
Hair bleaching/skin pigmentation changes
Hemolysis w/ G6PD deficiency

Front 302

ADR of methotrexate

Back 302

Myelosuppression
Hepatitis/liver fibrosis
Hypersensitivity pneumonitis

Front 303

ADR of sulfasalazine (a DMARD)

Back 303

Rash
Myelosuppression
Lupus-like syndrome
Hemolysis w/ G6PD deficiency

Front 304

ADR of TNF inhibitors such as infliimab entercept (DMARD)

Back 304

Increased risk of infection
(check baseline TST & CXR)

Front 305

Cyclophosphamide is used for

Back 305

chemo

Front 306

ADR of cyclophosphamide

Back 306

Hemorrhagic cysititis
alopecia
myelosuppression

Front 307

Chemo drug cisplatin has ADRs similar to gentamicin T/F?

Back 307

True
(renal, ears)

Front 308

5-FU (Chemo) ADRs

Back 308

Oral mucositis/GI ulcers
Nausea
Myelosuppression

Front 309

Chemo bleomycin ADRs delayed toxicity ADRs

Back 309

Pulmonary fibrosis
Alopecia

Front 310

Doxorubicin chemo drugs has delayed ADRs:

Back 310

Cardiotoxic
Delayed emesis
Alopecia
Mylelosuppression
Stomatitis

Front 311

Paclitaxel (taxol) chemo delayed ADRs

Back 311

Neuropathy (esp palmar/plantar)
Myelosuppression

Front 312

Leukocyte Stimulating Med (help w/ chemo causing decreased WBC)

Back 312

Filgastrim

Front 313

ADR of filgastrim (used to stimulate WBCs)

Back 313

Bone pain
Fever

Front 314

SSRIs

interactions

Back 314

- CYP interactions
- potent inhibitor of CYP2D6
- paroxetine & fluoxetine most likely for interaction

Front 315

SSRIs

ADRs

Back 315

- Note FDA requires warning about antidepressants & sucide
- sexual side effects
- ED/delayed ejaculation (men)
- anorgasmia (women)
- decreased libido in both
- anorexia
- bruxism

Front 316

SSRIs


ADRs

Back 316

- Discontinuation Syndrome: N/V/D, HA, agitation, anxiety, anoxia, impared coordination, insomnia, flu-like illness
- Serotonin Syndrome: aggitation, AMS, teeth chattering, fever, resting tremor, myoclonic jerks, hyperreflexia, ataxia
- mostly with MAOIs
- possible with INH, linezolid, tramadol, St. John's Wort

Front 317

ADHD Medications

specific drugs

Back 317

- Methylphenidate
- short-acting, intermediate-acting, long acting
- dexmethylphenidate
- dextroamphetamine
- short-acting, long-acting
- amphetamine mixture

Front 318

ADHD Medications


ADRs

Back 318

- motor/vocal tics
- anorxia/weight loss
- insomnia
- tachycardia

Front 319

Erythropoietin or darbepoetin is used to

Back 319

Stimulate erythrocytes (RBCs)

Front 320

Possible ADR of erythropoetin

Back 320

AMI/CVA (with elevated Hct)

Front 321

An example of a transplant med

Back 321

cyclosporine
tacrolimus

Front 322

If allergic to sulfonamide (rash), will pt be allergic to sulfur, sulfate or sulfite

Back 322

No, not necessarily

Front 323

Meds to avoid w/ sulfa allergy

Back 323

Furosemide
HCTZ
Sulfonykureas (glyburide)

Front 324

Why drug interactions w/ grapefruit juice?

Back 324

Grapefruit juice (small amts) inhibits intestinal CYP3A4

Front 325

Can the grapefruit juice interaction be lessened by separting meds and juice?

Back 325

No

Front 326

Oral drugs w/ narrow therapeutic windows are especially problematic w/ grapefruit juice T/F?

Back 326

True

Front 327

Other citrus that can cause drug interactions

Back 327

Seville (sour) oranges
Pomelos

Front 328

Drugs to watch w/ grapefruit juice

Back 328

Amiodarone
Benzodiazepines
CCBs
Statins
Cyclosporine

Front 329

Drugs causing esophageal irrittaion

Back 329

Tetracyclines
Bisphosphonates
NSAIDS
Potassium chloride

Front 330

Dugs causing alopecia

Back 330

Chemo: bleomycin, cyclophosphamide, fluorouracil
Interferons

Front 331

2 drugs that are common offenders for drug-induced lupus

Back 331

Procainamide
Hydralazine

Front 332

Drugs ass w/ drug fever

Back 332

Anticonvulsants (phenytoin, carbamezepine)
Antimicrobial
Allopurinol
H2 blockers

Front 333

Drugs ass w/ QT issues

Back 333

Anti-arrhythmics
Cisapride
Macrolides
Droperidol
Haloperidol

Front 334

Benzodiazepines

specific drugs

Back 334

- Ex. lorazepam, alprazolam, midazolam

Front 335

Benzodiazepines

interactions

Back 335

- potentiation of CNS depression with ETOH / other CNS depressants

Front 336

Benzodiazepines

ADRs

Back 336

- sedation, dizziness, withdrawl symptoms

Front 337

Sedatives / Sleeping Agents

specific drugs

Back 337

- zolpidem
- zaleplon

Front 338

Sedatives / Sleeping Agents

interactions

Back 338

- potentiations of CNS depression with ETOH / other CNS depressants

Front 339

What are 1st semester warfarin effects on fetus?

Back 339

Hypoplastic nasal bridge, chonfrodysplasia

Front 340

Fetal Hydantoin Syndrome (phenytoin)

Back 340

Growth deficiency
Craniofacial anomalies
Mental retardation
Nail/digital hypoplasia

Front 341

Valproic acid can cause what teratogenic effect?

Back 341

neural tube defects

Front 342

DES (diethylstilbestrol) can cause what teratogenic effect?

Back 342

vaginal adenocarcinoma

Front 343

ACEI can cause what teratogenic effects?

Back 343

CV & CNS malformations

Front 344

A drug to avoid with G6PD deficiency

Back 344

Sulfa abx
Nitrofurantoin
Dapsone
Sulfasalazine
Antimalarials

Front 345

Thalidomide was ass w/ what fetal effect?

Back 345

Phocomelia (shortened limbs)

Front 346

Histoplasmosis is linked to

Back 346

bird or bat poop

Front 347

Histoplasmosis is a bacterial infex T/F

Back 347

False. Fungal

Front 348

Histoplasmosis is treated w/

Back 348

Itraconazole (mild) or amphotericin-b (severe)

Front 349

Blastomycosis is linked to

Back 349

Ohio River Valley soil/dust exposure

Front 350

Blastomycosis causes:

Back 350

Asymptomatic pulm infex
Derm issues w/ clavicles and above

Front 351

Blastomycosis is treated w/

Back 351

Itraconazole or amphotericin-b (severe)

Front 352

Coccidiodomycosis (San Joaquin Fever) linked to

Back 352

southern CA to Texas

Front 353

Coccidiodomycosis causes:

Back 353

Influenza-like illness
erythema nodosum

Front 354

Coccidiodomycosis tx

Back 354

Often no tx needed

Front 355

Pneumocystosis (PCP) is often seen in these pts

Back 355

AIDS

Front 356

PCP presents w/ these symtoms

Back 356

Fever, dyspnea, non-productive cough

Front 357

Diagnose PCP w/

Back 357

CXR
Sputum/bronch DFA

Front 358

Treat PCP w/

Back 358

TMP-SMX & use prednisone if PaO2<70

Front 359

Cryptococcus is the most common cause of fungal meningitis T/F?

Back 359

True

Front 360

Cryptococcus is seen more in these pts

Back 360

AIDS
Immunocompromised

Front 361

Cryptococcus may present w/ what symptoms?

Back 361

Altered mental state, HA, meningismus

Front 362

Treat cryptococcus w/

Back 362

Amphotericin-B or floconazole

Front 363

Dx cryptococcus w/

Back 363

CSF & serum crypto antigen
India ink may be +

Front 364

Sedatives / Sleeping Agents

ADRs

Back 364

- drugged feeling
- daytime fatigue

Front 365

Lithium

drug specifics

Back 365

- need drug level monitoring

Front 366

Lithium


interactions

Back 366

- ACEI, ARBs, NSAIDS, Thiazides

Front 367

Lithium


ADRs

Back 367

- fine, transient hand tremor
- CNS effects (HA, memoryimpairment, confusion, altered motoe skills)
- hypothyroidism
- nephrogenic diabetes insipidus

Front 368

Antipsychotic agents

specific drugs

Back 368

- 1st generation agents
- haloperidol, chlorpromazine, etc
- 2nd generation
- clozapine (most effective)
- olanzapine
- risperidone
- ziprasidone
- aripiprazole
- quetiapine

Front 369

Disease entities caused by Aspergillosis

Back 369

Allergic bronchopulmonary aspirgillosis
Aspergilloma (fungus ball looks like lung ca)
Invasive (most common in pts w/ prolonged neutropenia)

Front 370

Vag Candidiasis is tx w/

Back 370

Conazole cream
Fluconazole

Front 371

Esophageal candidiasis is tx w/

Back 371

Fluconazole

Front 372

Symptoms of esophageal candidiasis

Back 372

Substernal odynophagia
GE reflux
Nausea

Front 373

Babesiosis is a fungal infex T/F?

Back 373

False. Protozoal

Front 374

Called N American Malaria

Back 374

Babesiosis

Front 375

Most virulent strain of malaria

Back 375

Plasmodium falciparum

Front 376

Malaria is transmitted by th emale Anopheles mosquito T/F?

Back 376

False. Transmitted by female mosquito

Front 377

What disease presents with periodic chills/fever/sweats?

Back 377

Malaria

Front 378

How to dx malaria

Back 378

Thick/thin blood smears

Front 379

Malaria prophylaxis meds

Back 379

Chloroquine
Mefloquine, doxycline, etc

Front 380

Toxoplasmosis is a bacterial infex T/F?

Back 380

False. Protozoal

Front 381

How toxoplasmosis is transmitted

Back 381

Contaminated food, kitty litter

Front 382

Symptoms of primary toxoplasmosis infex

Back 382

Usually none

Front 383

Toxoplasmosis tx

Back 383

Pyrimethamine and sulfadiazine

Front 384

Herpes zoster primary infex is

Back 384

Chickenpox

Front 385

Shingles in pt <40-50 should make you consider what

Back 385

HIV

Front 386

Prodromal symptoms of shingles:

Back 386

burning, tingling in region of sensory nerve distribution (followed by vesicular rash 1-3 dermatomes)

Front 387

Tx of shingles

Back 387

acyclovir po (mild to mod)
acyclovir IV if severe

Front 388

Ebstein Barr Virus (EBV) is also called

Back 388

Infectious Mononucleosis

Front 389

Ebstein Barr symptoms

Back 389

Malaise
Fever
Severe sore throat

Front 390

EBV exam findings may include

Back 390

Waldeyer's Ring exudate
Post cervival lymphadenopathy
Splenomegaly
Maculopap rash

Front 391

Tests for EBV

Back 391

Atypical lymphocytosis
Monospot test

Front 392

Tx for EBV

Back 392

Symptomatic: fluid, analgesics
Possibly steroids

Front 393

Ways CMV transmitted

Back 393

Sexual, congenital, transfusion, transplant, person-to-person (resp secretions)

Front 394

CMV complications w/ AIDS

Back 394

CMV retinitis (blindness)
Esophageal ulcers to anus
Pneumonia

Front 395

CMV tx

Back 395

Gangiclovir

Front 396

HHV-8 causes what type of sarcoma?

Back 396

Kaposi's

Front 397

Rabies is caused by this type of virus

Back 397

rhabdovirus

Front 398

Prominent ways you get rabies

Back 398

Bite of bats, skunks, raccoons and foxes

Front 399

Initial symptoms of rabies

Back 399

Pain at bite wound followed by paresthesias

Front 400

Later manifestations of rabies

Back 400

Extreme behavior
Convulsions
Seizures

Front 401

Rabies tx

Back 401

Passive immunization w/ rabies immune globulin (20 units/kg) w/ at least 50% infused at wound site. Give rest IM at another site
Give vaccine 4 injections 1 ml in deltoid

Front 402

Who is at risk for HIV?

Back 402

Anyone who is sexually active or injects drugs

Front 403

What type of virus is HIV?

Back 403

retrovirus

Front 404

Acute HIV Syndrome:

Back 404

Mono-like (but more severe)
Rash 40-90%
Mucocutaneous ulceration

Front 405

HIV Dx

Back 405

HIV RNA level. Viral load done by PCR

Front 406

Most common HIV clinical presentation

Back 406

Asymptomatic

Front 407

HIV screening test

Back 407

ELISA

Front 408

HIV Confirmatory test

Back 408

WB

Front 409

Sedatives / Sleeping Agents

ADRs

Back 409

- drugged feeling
- daytime fatigue

Front 410

Lithium

drug specifics

Back 410

- need drug level monitoring

Front 411

Lithium


interactions

Back 411

- ACEI, ARBs, NSAIDS, Thiazides

Front 412

Lithium


ADRs

Back 412

- fine, transient hand tremor
- CNS effects (HA, memoryimpairment, confusion, altered motoe skills)
- hypothyroidism
- nephrogenic diabetes insipidus

Front 413

Antipsychotic agents

specific drugs

Back 413

- 1st generation agents
- haloperidol, chlorpromazine, etc
- 2nd generation
- clozapine (most effective)
- olanzapine
- risperidone
- ziprasidone
- aripiprazole
- quetiapine

Front 414

Migraine Medications
specific drugs ("triptans")

Back 414

- Sumitriptan
-SQ / intranasal formula available
- zolmitriptan
intranasal & ODT formulation available
- Rizatriptan
- ODT available
- Almotriptan
- Eletriptan
- Frovatriptan (long 1/2 life so long lead in time
- Naratriptan

Front 415

Migraine Medications


Interactions

Back 415

- Careful with SSRIs & MAOIs

Front 416

Migraine Medications

ADRs

Back 416

- generally well-toerated
- AMI symtoms (careful with CAD)

Front 417

Sexually Transmitted Infections (STIs)

Trichomonal Vagenitis is caused by?

Back 417

- Trichomonas vaginalis

Front 418

Trichomonal Vaginitis presents with?

Back 418

- vaginal pruritis and a malodorous frothy, yellow-green discharge
- cervical petechiae (strawbeyyy cervix)
- trichomonads are seen on wet prep

Front 419

Trichomonal vaginitis treatment?

Back 419

- treat with metronidazole 2g PO X1
- check for other STIs
- treat partners and educate to refrain from sex until infection is treated

Front 420

Chlamydial Urethritis / Cervicitis (the most common STI) is caused by?

Back 420

- Chlamydia trachomatis

Front 421

Chlamydial Urethritis symptoms?

Back 421

- 75 - 90% of cases are asympotomatic, recommended to screen all women over 25 yrs and other asymptomatic women at increased risk

Front 422

Chlamydial Urethriti presentation?

Back 422

- depends on sex
- men present with urethral discharge of mucopurulent / purulent material, dysuria, or urethral pruritis (accounts fo 35 - 50% of cases of nongonococcal urethritis
- women present with urethritis, bartholinitis, cervicitis characterized by dysuria, abnormal vaginal discharge, or post-coital bleeding. May also present with upper genital tract infections (endometritis, salpingo-oophoritis, or PID characterized by irregular utrine bleeding and adominal / pelvic discomfort
- BOTH SEXES can present with reactive arthritis / tenosynovitis or Reiter's syndrome (urethritis, conjuncitivitis, arthritis, & mucocutaneous lesions)

Front 423

Chlamydial Urethritis / Cervicitis diagnosis

Back 423

- diagnose with Nucleic Acid Amplification testing (NAAT) of discharge or urine
- sensitivity 80-91% (range deoends on type of material collected)
- specifity 95 - 100%
- new home kits on this technology are available

Front 424

Chlamydial Urethritis / cervicitis treatment?

Back 424

- treat with azithromycim 1g PO X1 or doxycyclin 100 mg PO BID X7d
- check for other STIs
- treat partners and educate to refrain from sex until infection is treated

Front 425

Lymphogranuloma venereum
is caused by?

Back 425

- Chlamydia trachomatis serovars Li - L3

Front 426

Lymphogranuloma venereum diagnosis

Back 426

- statrs with painless mucosal lesion leading to lymphatic spread then inguinal bubo then draining sinus tracts

Front 427

Lymphogranuloma venereum treatment?

Back 427

- tread with doxycycline 100mg BID PO X 21d
- check for other STIs
- treat partners and educate to refrain from sex until infection is treated

Front 428

Gonorrhea is caused by?

Back 428

- Nesseria gonorrhoeae (GN diplococci)

Front 429

Gonorrhea infects?

Back 429

- can infect any mucocutaneous surface (oral, urethral, vaginal, anal)

Front 430

Gonorrhea presents with?

Back 430

- presents with yellow, creamy, profuse discharge (may be asymptomatic - women >> men)
- Fitz-Hugh-CUrtis syndrome -> perihepatic gonorrhea (presents with fever & RUQ pain, extension of infectionfrom fallopian tubes -> peritoneum & liver capsule

Front 431

Gonorrhea diagnosis?

Back 431

- gram stain / culture of discharge (mostly helpful for men) or NAAT of discharge or urine

Front 432

Gonorrhea treatment

Back 432

- treat with ceftriaxone 250mg IM (or cefixime, cefpodoxime orally) X1 plus azithromycin 1g PO once
- always emperically treat chlamidia also (if NAAT was not perforned)
- check for other STIs
- treat parterners and educate to refrain from sex until infection is treated

Front 433

Human Papillomavirus (HPV) causes?

Back 433

- causes genital warts and cervical / anorectal dysplasia / neoplasia
- HPV 6 and 11 most commonly cause external genital warts -> low risk for neoplasia
- HPV 16, 18, 31, 33, 35 most common for cervical dysplasis -> high risk
- appear as an exophytic growth, often pink or white
- solitary lesions or clustered lesions
- usually no painful, pruritis common
- anorectal warts = condylomata acuminata

Front 434

HPV diagnosis?

Back 434

- diagnose with biopsy

Front 435

HPVtreatment?

Back 435

- treat withablation, imiquimod (Aldara), podofilox, etc.
- check for other STIs

Front 436

Virus (HSV) effects?

Back 436

- HSV predominately causes oral / genital ulcers
- HSV-1 -> oral (can cause genital)
- cold / fever sore
- 85% of US population has serologic evidence of infection
- HSV-2 -> genital (can cause oral)
- 25% of US population has serologic evidence of infections

Front 437

HSV presentation?

Back 437

- presents as grouped, painful vesicles or ulcerations
-fever, adenopathy, and urinary stmptoms possible
- outbreaks often recurrent (remains dormant in sensory ganglion)
- HSV-2 much more likely to have recurrent lesions

Front 438

Other HSV effects?

Back 438

- can also cause:
- ocular disease
- meningoencephalitis
- esophagitis / proctitis
- HSV-1 is associated with Bell's Palsy

Front 439

HSV clinical diagnosis?

Back 439

- clinical diagnosis confirmed with Tzanck smear, DFA, serology, PCR, or culture
- Tzank -> intranuclear inclusions & multinucleated giant cells
- consider viral culture in order to differenciate HSV-1 from HSV-2
- PCR important for CSF studies

Front 440

HSV treatment

Back 440

- treat with acyclovir, valacyclovir, or famciclovir
- 6/yr try supressive therapy
- treatment does not eradicate disease
- check for other STIs

Front 441

Chancroid (caused byHaemophilus ducreyi) presents with?

Back 441

- presents with painful genital ulcer (chancre) with fluctuant inguinal adenitis

Front 442

Chancroid treatment?

Back 442

- treat with ceftriaxone 250mg IM X1 or azithromycin 1g PO X1
- check for other STIs

Front 443

Granuloma inguinale or Donovaliasis (caused by Klebsiella granulomatis) effects?

Back 443

- chronic, relapsing, granulomatous anogenital infection
- painful infiltrated nodules -> ulcer with red friable base of granulation tissue

Front 444

Granuloma inguinale or Donovaniasis diagnosis

Back 444

- Donovans bodies seen on Wright or Giemsa stains

Front 445

Granuloma inguinale or Donovaniasis treatment

Back 445

- treat with doxycycline 100mg PO BID or TMP-SMX DS PO BID C 304 wks
- check for other STIs

Front 446

Syphilis (caused by Treponema pallidium) clinical stages

Back 446

- Primary syphilis
- painless ulcer at site of exposure = chancer
- Secondary syphilis
- generalized maculopapular rash (even palms / soles)
- tertiary syphilis
- infiltrative tumors (gummas), aortitis, neurosyphilis

Front 447

Syphilis diagnosis

Back 447

- screening = VDRL or RPR
- confirmatory = FTA - ABS or MHA - TP
- more sensitive & specific
- stays positive for life

Front 448

Syphilis treatment

Back 448

- treat with penicillin
- type of penicillin and duration of treatment depend on stage of syphilis
- pick benzathine PCN G (Bicillin L-A)

Front 449

selected orthopedic infections

What is osteomyelitis?

Back 449

- inflammation of the bone / bone marrow
1) hematogenous seeding common in children
- most commonly metaphysis of long bones
2) contiguous spread common in adults
- often from a soft tissue infection (i.e. DM ulcer)

Front 450

Osteomyelitis etiology

Back 450

- S. aureus is most common overall cause (esp. hematogenous)
- contiguous-focus is often polymicrobial
- Salmonella spp. more common in sickle cell patients

Front 451

Osteomyelitis presentation

Back 451

- variable depending on site of infection

Front 452

Osteomyelitis diagnose

Back 452

- diagnose with labs, imaging, (xray, bone +/- WBC scans, CT or MRI), and bone biopsy with histopathology and cultures
- always r/o tumor (especiallyin children)
- treat with ABX and surgery

Front 453

WHat is Infectious Arthritis

Back 453

- inflamation of a joint from a pyogenic organism usually from a transient bacteremia

Front 454

Infectious Arthritis most common cause?

Back 454

- S. aureus is the most common cause
- N. gonorrhoea most common cause in young, sexually active people
-represents disseminated gonoccal disease (DGI) ->presents with fever, migratory polyarthralgias, tenosynovitis, and dermatitis
- ceftriaxone

Front 455

Infectious Arthritis presentation?

Back 455

- present with single, hot, swollen joint
- r /o rheumatic disease

Front 456

Infectious Arthritis diagnoses

Back 456

- diagnose with joint aspiration
- anti-staphylococcal ABX

Front 457

Cardiac Infections:
spontaneous bacterial endocarditis (SBE) or infective endocarditis

Back 457

- microbial infection of the lining of the hart -> characteristic lesion is a vegetation, which is most commonly found on valvular structures

Front 458

SBE microbial etiology

Back 458

- Native valve
- viridans streptococci, S. aureus, and Enterococci
- Prosthetic Valve
- Early infections (<2 months after valve placed)
- coagulase (-) staphylococci
- S. aureus
- Late infection
- viridans streptococci, S. aureus, and Enterococci

Front 459

SBE or Infective Endocarditis
microbial etiology (con't)

Back 459

- other organisims HACEK organisms)
- Haemophilus parainfluenzae / aphrophilus
- Actinobacillus actinobacillus actinomycetemitians
- Cardiobacterium hominis
- Eikenella corredens
- Kingella kingae

Front 460

SBE or Infective Endocarditis
classification

Back 460

- Left-sided IE
- microbial etiology depends on native vs. prosthetic valve -> vintral
- right-sided IE
- usually S. aureus in IVDU -> tricuspid

Front 461

SBE or Infective Endocarditis classification
presentation pattern

Back 461

1) Acute presentation -> often appear septic - think S. aureus
2) Subacute presentation
- present with febrile illness lasts for days to weeks ("FUO)
- nonspecific symptoms (caugh, dyspnea, arthralgias, diarrhea, abnominal / flank pain) common
- think "strep" and Enterococci

Front 462

SBE or Infective Endocarditis
common clinical manifestations (for both patterns)

Back 462

- 90% have murmurs -> CHF most common complication / cause of death
- 40% have systemic emboli (spleen & renal most common)
- 25% have characteristic peripheral lesions
- petchiae of palate, conjunctiva, beneath fingernails
- subungal (splinter hemorrhages)
- Olser nodes (painful, violaceous raised lesions of fingers / toes)
- Janeway lesions (painless erythematous lesions of palms / toes)
- Roth's spots (retinal exudative lesions)

Front 463

SBE or Infective Endocarditis diagnostic evaluation & treatment options

Back 463

- labs (CBC, ESR, UA)
- blood cultures X 2-3
- EKG (evaluate conduction abnormalities) & CXR 9 evaluate for septic emboli & evidence of CHF)
- echo (TEE more sensitive than TTE)
Duke Criteria is used for diagnostic criteria
treatment options - empiric therapy
1) nafcillin + ampicillin + gentimicin OR
2) vancomycin + gentimicin

Front 464

Meningitis w/ highest mortality

Back 464

S pneumoniae

Front 465

How meningitis is spread

Back 465

Resp droplets or mucosa-to-mucosa (most common)

Front 466

Most common classification of meningitis

Back 466

Acute (bacterial or aseptic)

Front 467

Meningitis vs meningoencephalitis

Back 467

`encepalitis involves both meninges & brain parenchyma

Front 468

What is a parameningeal infex?

Back 468

Space occupying lesions that mimic menigitis ((brain abscess, etc)

Front 469

Classic symptoms of meningitis

Back 469

Fever, severe HA, stiff neck

Front 470

Which meningitis presents w/ characteristic rash?

Back 470

meningococcemia

Front 471

How do you check for nuchal rigidity?

Back 471

Turn head side-to-side, then flex and observe for discomfort

Front 472

What is gold standard for meningitis dx?

Back 472

CSF examination (opening PSI, cell ct, diff, glu, protein, gram st & cx)

Front 473

When should you order CT w/ suspected meningitis?

Back 473

Significant papilledema, dilated NR pupil, ocular motion abnormalities, stupor, brady, HTN

Front 474

Would you have an increased or normal PSI on LP w/ bacterial meningitis?

Back 474

Increased

Front 475

Would you have an elevated PSI with aseptic meningitis?

Back 475

Normal or minimally elevated

Front 476

What organisms cause aseptic meningitis?

Back 476

Enteroviruses (coxsackie & echo mostly)

Front 477

Besides S pneumoniae, what is another organism often causing bacterial meningitis?

Back 477

Listeria

Front 478

Tx for community acq acute meningitis?

Back 478

Vanc + ceftriaxone +/- Ampicillin (Amp for listeria)
May give dexamethasone too

Front 479

Tx for aseptic meningitis

Back 479

Supportive: analgesia, anti-emetics, anti-pyretics

Front 480

What causes meningoencephalitis?

Back 480

HSV
Arboviruses (W Nile, St Louis, etc)

Front 481

What are some different symtoms aseptic vs septic meningitis might have?

Back 481

Aseptic=more neuro findings and seizures (W Nile=muscle weakness & flaccid paralysis)

Front 482

What imaging for meningoencephalitis shows temporal lobe abnormalities?

Back 482

MRI

Front 483

How to tx meningoencephalitis?

Back 483

Supportive + empiric acyclovir

Front 484

What is erysipelas?

Back 484

Infex of epidermis/dermis usually caused by S pyogenes

Front 485

What does erysipelas look like?

Back 485

Red, glistening, demarcated

Front 486

Erysipelas tx?

Back 486

Anti-staph antibiotics

Front 487

This infection involves the epidermis, dermis and connective tissue?

Back 487

cellulitis

Front 488

Symptoms of cellulitis?

Back 488

Fever/chills, erythema, induration (lymphatic streaking).

Front 489

Is erythema more or less intense with cellulitis or erysipelas?

Back 489

Erysipelas

Front 490

How to tx cellulitis?

Back 490

Anti-staph antibiotics

Front 491

Cellulitis is usually caused by what organisms?

Back 491

S pyrogens or S aureus

Front 492

What do you call infex of hair follicle and apocrine glands?

Back 492

Folliculitis

Front 493

Common areas of body folliculitis presents

Back 493

face, buttocks, extensor surfaces

Front 494

Tx of folliculitis

Back 494

Warm compresses and mucipiricin

Front 495

Wnat organism causes Hot Tub Folliculitis?

Back 495

P Aeruginosa (contaminated hot tubs, pools)

Front 496

How does Hot Tub Folliculitis present?

Back 496

Pruritic, sometimes tender papule to pustule

Front 497

Tx of Hot Tub Folliculitis

Back 497

Warm compresses and anti=pruritic meds
NO ABX

Front 498

Presentation of folliculitis

Back 498

small, tender erythematous papules; often topped by central papule

Front 499

What is a faruncle (boil)?

Back 499

Firm, tender, erythematous nodule becomes fluctuant

Front 500

Common areas where faruncles (boils) found

Back 500

neck, axillae, buttocks

Front 501

Organisims causing faruncles

Back 501

S aureus orCA MRSA

Front 502

Tx of faruncles

Back 502

I&D, anti-staph abx

Front 503

What is a carbuncle?

Back 503

mult abscesses separated by connective tissue, extending into subQ fat in areas of thick, inelastic skin

Front 504

Whar part of body are carbuncles usually found?

Back 504

Neck, back, thighs

Front 505

What other symptoms are common w/ carbuncles?

Back 505

Fever and constitutional

Front 506

Organism usually causing carbuncles

Back 506

S aureus

Front 507

Tx of carbuncles

Back 507

I&D, anti-staph abx

Front 508

What is necritizing fascitis?

Back 508

Infex that progressively destroys subQ fascia/fat (muscle sparing)

Front 509

What orgainism is responsible for necrotizing fascitis?

Back 509

Most infex are polymicrobial, but classically (10%) caused by S pyrogenes

Front 510

How does necrotizing fascitis present?

Back 510

Like cellulitis but systemic toxicity and pain worse

Front 511

Tx of necrotizing fascitis

Back 511

Debridement is KEY
Broad spectrum ABX secondary

Front 512

What is Fournier's gangrene?

Back 512

Polymicrobial necrotizing fascitis of scrotum +/- perineum, penis or abd wall

Front 513

What pts are you most likely to see Fournier's gangrene in?

Back 513

Diabetics

Front 514

Tx of Fournier's gangrene

Back 514

Debridement is key;
Broad spectrum abx secondary

Front 515

What is clostridial myonecrosis (gas gangrene)?

Back 515

infex that progressively destroys subQ fascia, fat and muscle

Front 516

What orgainism causes gas gangrene?

Back 516

C perfringens

Front 517

Who is at risk for gas gangrene?

Back 517

Traumatic wounds; enteric surgery

Front 518

Presentation of gas gangrene ( clostridial myonecrosis)

Back 518

Severe pain, systemic toxicity, +/- crepitus

Front 519

Tx of gas gangrene (clostridial myonecrosis)

Back 519

Extensive debridement
Broad pectrum abx (secondary)

Front 520

Unique organism often found in dog/cat wound

Back 520

Pasturella multocida

Front 521

Unique organism often found in human bite

Back 521

Eikenella corrodens

Front 522

What are some abx choices for bites?

Back 522

amoxicillin/calvulanate po or amp/sulbactum IV
cefuroxime or doxycycline or
TMP-SMX or FQ
Plus clindamycin or metronidazole

Front 523

How does non-inflammatory diarrhea present?

Back 523

large, watery stool
no blood/PMNs
nausea/flu-like symptoms common

Front 524

What organisms can cause non-inflammatory diarrhea?

Back 524

Viral, protozoal (giargia), bacterial (S aureus, B cereus, V cholera)

Front 525

Can you use anti-peristaltic agents w/ non-inflammatory diarrhea?

Back 525

Yes

Front 526

How does inflammatory diarrhea present?

Back 526

small volume, frequent, bloody/mucosy stools
many PMNs
fever/chills, cramping

Front 527

Organism w/ Inflammatory diarrhea

Back 527

Protozoal ( E histolytica)
Bacterial (E coli 0157, C diff, Shigella, Salmonella, Campybact, Salmonella)

Front 528

Can you use anti-peristaltic agents with inflammatory diarrhea?

Back 528

No

Front 529

What virus causes Winter Vomiting Disease and is ass w/ cruise ship diarrhea?

Back 529

Norovirus

Front 530

How is norovirus diarrhea acquired?

Back 530

Contaminated food/water or person-to-person

Front 531

What is most common cause of gatroenteritis is US?

Back 531

Norovirus

Front 532

How does norovirus present?

Back 532

diarrhea (+/- N/V) and abd pain that lasts 1-3 d

Front 533

How to tx norovirus

Back 533

Supportively w/ ORT (oral rehydration therapy)

Front 534

What is the most common parisitic etiology of infex diarrhea in US?

Back 534

Giardia lamblia

Front 535

What activity is giardiasis assc w/?

Back 535

Camping/hiking

Front 536

How to dx giardiasis

Back 536

EIA (serology)

Front 537

Gow to tx giargiasis

Back 537

metronidazole (or tinidazole or nitrazoxanide)

Front 538

How does Cryptosporidiosis present?

Back 538

Cholera-like diarrhea

Front 539

In what pts is cryptosporidiosis severe?

Back 539

AIDS

Front 540

What to tx AIDS pts w/ cryptosporidiosis?

Back 540

Refer them

Front 541

How does cholera present?

Back 541

rice water stool

Front 542

How to dx cholera

Back 542

Stool cx (looking for vibrio)

Front 543

How to tx cholera

Back 543

ORT or IV
Azithromycin decreases duration

Front 544

Inflammatory diarrhea amebiasis is caused by

Back 544

Enttamoeba histolytica

Front 545

Where is amebiasis mainly found?

Back 545

Tropics

Front 546

How to dx amebiasis

Back 546

Stool-antigen detection & PCR better than O&P
Also, serology (antigen) & abd CT

Front 547

Tx of amebiasis

Back 547

metronidazole or tinidazole for colonic dz followed by paromycin (for cysts)
Drain abscess if applicable

Front 548

What foods is E coli 0157 assc w/?

Back 548

Undercooked hamburger, unpasteurized milk/juice, raw fruits & veggies

Front 549

How does E coli 0157 present?

Back 549

afebrile + bloody diarrhea

Front 550

Tx of E coli

Back 550

Supportive

Front 551

C diff is usually assc w/

Back 551

antibiotic usage (esp clindamycin)

Front 552

Symptoms of C diff

Back 552

diarrhea that can lead to PMC, toxic megacolon and fulminant colitis

Front 553

Tx of C diff

Back 553

d/c other abx if possible
metronidazole
contact isolation

Front 554

Specific drugs for Parcinson's

Back 554

Carbidopa / levodopa

Front 555

Parkinson's medications ADRs

Back 555

Perheral effects like anorxia and orthostatic hypertension

CNS effects like confusion and delusions

Front 556

Specific Alzheimer's medications

Back 556

cholinesterase inhibitors like Donezpezil and Tacrine

non-cholinesterase inhibitors leke Memantine for moderate cases

Front 557

Alzheimer's medications ADRs

Back 557

Cholinesterase inchibitors
- N/V/D, insomnia

Non-cholinesterase
- dizziness, confusion

Front 558

Dermotologic therapeutics

Accutane interactions

Back 558

Avoid concomitant tetracycline and ETOH

Front 559

How to dx C diff

Back 559

stool toxin assay/PCR

Front 560

Shigellosis is assc w/ what institution?

Back 560

Day-care

Front 561

How does shigellosis present?

Back 561

bloody diarrhea, abd pain, tenesmus and systemic toxicity

Front 562

Tx of shigellosis

Back 562

fluouquinolone
(kids TMP-SMX or azithromycin)

Front 563

What is the most common bacterial cause of infectious diarhhea in the US?

Back 563

Campylobacteriosis

Front 564

What is campylobacteriosis assc w?

Back 564

Raw/ poorly cooked chicken

Front 565

How does campylobacteriosis present?

Back 565

fever, bloody diarrhea, abd pain
Post-campy Guillain-Barre & reactive arthritis possible

Front 566

Tx of campylobacteriosis

Back 566

Azithromycin (erythromycin)

Front 567

How do you ususally get Salmonellosis?

Back 567

Contaminated food/drink or reptiles (turtles)

Front 568

What Salmonella organisim usually causes enteric fever?

Back 568

S typhi

Front 569

Accutane (Isotretinoin) ADRs

Back 569

Pesudotumor cerebri
teratogenic
psychosis / suicidal ideation (?)

Front 570

Specific antihistamines

Back 570

1st gen
- hydroxyzine
- diphenhydramine
2nd gen
- fexofenadine
- loratadine

Front 571

antihistamines ADRs

Back 571

drowsiness, dry mouth, tremor

Front 572

Morphine derivitives specific medications

Back 572

codeine, morphine, hydrocodone, oxycodone

Front 573

Morphine derivities ADRs

Back 573

urinary retention, constipation, respiratory suppression

Front 574

What is enteric fever?

Back 574

Syndrome characterized by constitutional symptoms, GI symptoms & HA

Front 575

GI symtoms in Samonella typhi

Back 575

Marked constipation or pea soup diarrhea

Front 576

Enteric fever is often assc w/ rose spots T/F?

Back 576

True

Front 577

Tx of Salmonellosis

Back 577

Ceftriaxone (if severe)
Vaccine is available

Front 578

Pain medications NSAIDS specific drugs

Back 578

Ibuprofen, naproxen, ketorolac

Front 579

NSAIDS interactions

Back 579

increased risk of GI bleed with aspirin & ETOH

Front 580

NSAIDS ADRs

Back 580

GI effects
- dyspepsia / gastritis
Nephrototoxicity
- renal prostoglandin inhibition

Front 581

Pain medications NSAIDS specific drugs

Back 581

Ibuprofen, naproxen, ketorolac

Front 582

Minimizing NSAIDs GI effects

Back 582

- Misoprostol (prosagladin analog that can prevent gastric ulcers
- PPIs may be helpful

Front 583

NSAIDS interactions

Back 583

increased risk of GI bleed with aspirin & ETOH

Front 584

NSAIDS ADRs

Back 584

GI effects
- dyspepsia / gastritis
Nephrototoxicity
- renal prostoglandin inhibition

Front 585

Minimizing NSAIDs GI effects

Back 585

- Misoprostol (prosagladin analog that can prevent gastric ulcers
- PPIs may be helpful

Front 586

What orgainism causes Rocky Mountain Spotted Fever?

Back 586

Rickettsia rickettsi

Front 587

How is Rocky Mt Spotted Fever transmitted?

Back 587

tick bite

Front 588

Symptoms of Rocky Mt Spotted Fever?

Back 588

"influenza" prodromal, followed by chills/fever, HA, myalgias
Red macular rash appears 2nd-6th day of fever

Front 589

Where does Rocky Mt Spotted Fever rash appear?

Back 589

Wrists, ankles, then central

Front 590

Tx Rocky Mt Spotted Fever

Back 590

Doxycycline

Front 591

What causes Ehrlichiosis/Anaplasmosis?

Back 591

tick bite

Front 592

How do symtoms of Ehrlichiosis/Anaplasmosis differ from RMSF?

Back 592

Same as RMSF but rash less common or rash spares hands/feet

Front 593

How to tx Ehrlichiosis/Anaplasmosis

Back 593

doxycycline

Front 594

Tetanus is caused by

Back 594

Clostridium tetani

Front 595

What type of wound is tetanus most often assc w?

Back 595

Puncture, but any wound can be prone

Front 596

How does tetanus first present?

Back 596

jaw or neck stiffness
Dysphagia

Front 597

How does tetanus later present?

Back 597

jaw muscle spasm=trismus

Front 598

How to prevent tetanus

Back 598

Vaccine

Front 599

Tetanus tx

Back 599

vaccine + TIG + penicillin G

Front 600

What organism causes botulism?

Back 600

Clostridium botulinum

Front 601

How do most get botulism?

Back 601

Home canned products
Honey (infants)

Front 602

How does botulism present?

Back 602

Sudden diplopia, dry mouth, dysphagia, dysphonia, muscle weakness that leads to paralysis

Front 603

Botulism tx

Back 603

Botulism IG (infants)
Trivalent equine antitoxin (adults)

Front 604

What organism causes Lyme?

Back 604

Borrelia burgdorferi (spirochete)

Front 605

Where is Lyme most common?

Back 605

NE and Upper Midwest

Front 606

How is Lyme transmitted?

Back 606

tick bite

Front 607

What are the early Stage 1 dermatologic symptoms of Lyme?

Back 607

Erythema migrans=sm red papule to centrifygal spread with central clearing (75%)

Front 608

What are some possible Stage 2 (disseminated) symptoms of Lyme

Back 608

AV block, myopericarditis
Cranial nerve palsy
Peripheral neuritis

Front 609

What are late Stage 3 symtoms of Lyme?

Back 609

Chronic arthritis=monoarticular or asymmetric oligoarticular involving lg joints

Front 610

Lyme Dx

Back 610

Clinical if rash
Serology: ELISA w/ WB

Front 611

Lyme tx

Back 611

doxycycline > 8 yrs or amoxicillin < 8 yrs
(ceftriaxone if more severe)

Front 612

Anthrax is caused by

Back 612

Bacillus anthracis

Front 613

Anthrax tx

Back 613

FQ + clindamycin +/- rifampin

Front 614

What is natural exposure anthrax caused from?

Back 614

infected animals, exposure to wool=cutaneous

Front 615

Inhalation anthrax is caused from

Back 615

bioweapons

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What are symtoms of inhalational anthrax?

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mediastinitis, hemorrhagic lymphadenitis, widened mediastinum on CXR, no pneumonia

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Smallpox is caused by

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Variola major

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Smallpox was eradicated in

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1980

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Smallpox tx

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cidofovir + vaccine