Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
54 Cards in this Set
- Front
- Back
Fungus
|
cell walls - chitin (cellulose)
contain ergo**sterol ** yeasts (unicellular - budding/fission) hyphae (multicellular, spores, septate/non-septate) High natural immunity (transferrin, langerhans cells) - immune compromised pts at risk |
|
Bugs: Candida
|
4th leading cause of nosocomial infections
Albicans = most common Fungicidal response to Ampohotericin B & Caspofungin Fungistatic response to azoles |
|
Bugs: Tinea
|
tinea corporis (ringworm), t. cruris (jock itch), t. pedis (athlete's foot)
imidazole: econazole = excellent topical antifungal for the tineas |
|
Bugs: Aspergillus
|
opportunistic infection]
Fungicidal response to Amphotericin B, itraconazole and voriconazole NO response to fluconazole Fungistatic response to Caspofungin |
|
Bugs: Cryptococcus
|
fungicidal response to Amphotericin B
fungistatic response to -azoles NO response to caspofungin |
|
Bugs: Histoplasma
|
-
|
|
Drugs: Polyenes
|
Amphotericin B, Nystatin, Natamycin
cell membrane, ergosterol binding & lysis , leakage of K+ cations |
|
Drugs: Azoles
|
cell membrane disruption MOA - inhibit ergosterol production via a CYP-450 dependent enzyme inhibition
Older Azoles = Imidazoles (5 mem ring, 2 nitrogens) - useful drugs: clotrim-, micon-, econ-, and ketocon- Newer Azoles = Triazoles (5mem ring, 3 nitrogens) -useful drugs: itracon-, flucon-, and voricon- -taken over for ampho B for some systemic mycoses -candidemia in non-neutropoenic hosts AE: Liver toxicity w/ long term use (less w/ triazoles), nausea/vomiting **drug interactions - particularly w/ similar hepatic metabolized drugs (cyclosporins, antihistamines, anticoag, antiseizure etc.) |
|
Drugs: Allyamines
|
synthetic antifungals - nail mycoses and ringworm
choice over ketocon or gisofulvin use nail laquer first, then systemic (reduced liver AE) |
|
Drugs: Antimetabolytes (5-FC)
|
inhibit DNA/RNA synthesis
- NOT for fluid sensitive pts (cardiac?) - b/c of amt fluid req. -drug resistance is prob w/ these! - combo w. Ampho B = DRUG OF CHOICE for cryptococcal meningitis |
|
Drugs: Echinocandins
|
Cell wall - inhibit beta-1,3 glucan synthase
-major development in systemic antifungal therapy caution w/ hepatic and renal pts! -renal and hepatic metabolism - but not nephrotoxic -good for bugs resistant to triazoles and ampho B |
|
Amphotericin-B (Polyenes)
|
Ampho-B = concentration dependent (fungicidal and post-antifungal effect), most broad spectrum, "gold standard", in IV form is drug of choice for most systemic mycoses
-little known about excretion - very little by kidneys -AE: fever/chills/phlebitis, nephrotoxic (damage to distal tubules, wasting Na+, K+, Mg++), hypokalemia, hypomagnesemia |
|
Nystatin (polyenes)I
|
skin, mouth, vag & GI infections
extremely toxic - topical use only (po tab, liquid, pastille, cream, vag tablet, powder, ointment) |
|
Natamycin (polyenes)
|
topical OPTHALMIC antifungal
good for yeasts and molds |
|
Clotrimazole (imidazole)
|
synthetic -azole for vag/mouth/skin yeast infections
topical only - cream, po solution, tabs (po or vag) |
|
Miconazole (imidazole)
|
topical or vaginal use only
cream, sprays, powder, suppositories - lots of OTC products available |
|
Ketoconazole (imidazole)
|
began orally administered -azoles, either po or topical
good for: mucosal candidiasis, cutaneous mycoses slow response noted - fungistatic at low concentration, cidal at high concentrations Requires HCl for absorption - achlorydria, H2 antagonists, PPIs, anticholinergics interfere w/ absorption NOT FOR ASPERGILLOSIS OR SYSTEMIC INFECTIONS! |
|
Ciclopirox (imidazole)
|
cream/lotion/gel/nail laqer
for cutaneous candidiasis, the tinea infections, seborrheic dermatitis, NAIL FUNGUS |
|
Ideal Antifungal?
|
-Fungicidal
-Has novel MOA -Broad spectrum - including restistant orgs -well tolerated |
|
fluconazole (Triazoles)
|
concentration dependent - fungicidal
concentration independent - fungistatic well tollerated, topical OR systemic, great bioavailability renally excreted = great for fungal bladder infections! |
|
itraconazole (Triazoles)
|
time & conc dependent, fungicidal for aspergillis
-negligible CSF - *metabolized hepatically* liver failure! (excreted fecally) |
|
voriconazole (Triazoles)
|
time-dependent fungicidal for Aspergillus! first line for invasive systemic!
rapid PO absorption (+tastes good!) 50% CSF penetration - consider for fungal meningitis 96% po availability *reversible visual disturbances x 1 hr* |
|
griseofulvin
|
po agent for nail mycoses, + skin and hair
(keratinized tissues or precursors) take w. high fat diet to increase blood levels |
|
caspofungin
|
cidal for candida, NOT for cryptococcus
-salvage therapy for invasive aspergillosis and candida -Interactions: RUDUCES AUC for multiple drugs!!! |
|
micofungin
|
drug of choice for immunosuppressed pts - candida
|
|
Antifungal Resistance
|
primary vs secondary
increasing w/ repeated long term use (HIV pts) |
|
Vaccines
|
smallpox - 1790
not eradicated until 1980 Short term goal: prevention for individual Long term goal: eradication Foege's method - surveillance & containment strategy, more effective than mass vaccination programs alone National Childhood Vaccine Injury Prevention Act 1986 - responsible for documentation requirements & informed consent |
|
Education - Vaccines & Thimerosal
|
EDUCATE ON VACCINATION
-measles rate in 2012 highest since 2006, more ppl not getting their kids vaccinated -Florida w/ highest rate vaccine preventable deaths -exemptions LOW in Mississippi & W. Virginia, HIGH in Oregon... >45000 deaths annually in US Thimerosal - pulled in 2001, cleared in 2012 - not the damaging ethyl-mercury, and was never even in MMR anyhow - banning could sig. effect accessibility to vaccines |
|
VAERS
VFC ACIP |
VAERS - Vaccine Adverse Event Reporting System - how providers report rxns to DHHS
VFC - Vaccines for Children - for groups who can't afford (Wake County Health Department Clinic) ACIP - Advisory Comittee on immunixation practices - revise/review schedule annually for peds & adults, work w/ CDC -Yellow Book - CDC annually published recommendations for travellers, what to get and when, and what need to get back into the US. |
|
Vaccine - define & describe types
|
-suspension of weakened or death pathogenic celles injected to stim antibodies
2 types: 1) Live or attenuated and 2) Killed mostly use killed b/c inactive, OK for immunocompromised pts BUT live vaccine has faster response |
|
Conjugate vs. Non-Conjugate
|
Non-conjugate = No memory cells (so Thymus independent) - Requires Boosters!
Conjugate = memory cells (Thymus dependent) - good first response, better second response |
|
Toxoid
|
Bacterial toxin itself broken down/weakened
still produces antibodies ex: Tetanus |
|
Active vs Passive immunization
|
ACTIVE - antigen given in some form - can be live attenuated (live polio), or inactivated/killed org (IPV), or natural exposure (getting chicken pox as a kid) - note - memory cells better if you had the illness than if just got the vaccine
PASSIVE - antibody given - holds you over... -direct antibodies, gen. given due to exposure or near exposure (ex: immunoglobulins for RSV) **pts who have immune globulin, whole blood or antibody-containing products should NOT have a vaccine for 6wks, preferably 3mo. EXCEPTION: Hep B mom, or unknown status - vaccinate and give baby immune globulin |
|
Herd immunity
|
when community is fully immunized (above threshold), spread is limited, individuals NOT immunized are protected
-significant for immunocompromised pts when they can't get the vaccine |
|
Diptheria, Tetanus & Pertussis
|
-DTaP over DTP as DTP has whole cells
-Repeat Tdap not recommended except preg adolescents w/ each pregnancy Contraindications - absolute - anaphylaxis, encephalopathy w/in 7 days of administration -precautionary - T>105 of unknown cause, collapse/shock, persistent inconsolable crying >3hrs, seizure w/ or w/o fever w/in 3 days of admin SE - mainly from whole cell pertussis component - local rxns decrease w/ repeated admin. |
|
Pediarix
|
combo DTP, polio and HepB
-can decrease injections in infants by 6 -contraindications - allergy to Neomycin and yeast (don't use Neosporin on kids! the neomycin exposure can lead to s/sx allergic rxn when vaccines given) |
|
Pentacel
|
Combo DTaP, polio and HiB
|
|
DAT
|
equine diptheria antitoxin
-CDC provides to US physicians under IND protocol -diptheria presents & manifests insidiously as a membranous nasopharyngitis or obstructive laryngotracheitis, accompanied by a low grade fever |
|
Adult Tetanus & Diptheria
|
given Q10 years
give tetanus toxoid if 5-7 years since vaccine and pt w/ puncture wound, or if 7-8 years just give vaccine |
|
Polio
|
spread by oral-fecal contamination
OPV - oral, live attenuated poliovirus - aka Sabin - IgA production in gut and oropharynx -NOT for immunocompromised pts/families -PO = lifelong immunity IPV - inactivated poliovirus vaccine (aka Salk) - minimal IgA production - for immunocompromised/hospitalized pts - given SQ |
|
Hep A
|
-no long term neg effects like other Hep vaccines
- given to pts w/ clotting factor disorder, liver disease, travelers, men who have sex w/ men, illicit drug users, or ppl who work w/ Hep A positive primates |
|
Hep B
|
- vaccine provides long term protection - recommended for pre and post exposure prophylaxis
- Immune globulin provides temporary protection - recommended for some post-exposure situations Recombivax & Energix-B - 3 doses within a year Heplisav - 2 doses one month apart ALL NEWBORNS receive first HepB vaccine b/f hospital discharge, if mom HepB+, infant gets an extra dose, first one doesn't count towards the series (4 injections instead of 3) -if mom's status unknown or unable to determine, give infant vaccine + HBIG |
|
MMR - viral illnesses
|
Mumps - droplet spread viral infection
- fever, swelling/tenderness salivary glands, -can affect testes, ovaries, pancreas, meninges, brain -most cases ages 5y-14y, rare in <1y Measles - highly infectious, acute viral -NOT endemic to US d/t vaccine coverage but still common elsewhere -infants have antibodies approx. 1mo from mom if mom was vaccinated, or approx. 4mo if mom had the disease Rubella - mild, highly contagious viral illness HIGLY TERATOGENIC!!! -RASH, lymphadenopathy, joint pain (esp. adults). *Congenital Rubella Syndrome* -cataracts/congenital glaucoma, CHD (PDA, periph pulmonary arterial stenosis), hearing loss, pigmentary retinopathy -purpura, spenomegaly, jaundice, microcephaly, mental retardation, meningoencephalitis, radiolucent bone disease |
|
MMR - vaccine
|
Either a trivalent preparation (MMR) or single antigen of each
-ALL contain live, attenuated antigens -given SQ -contraindications: -anaphylaxis to eggs or hypersensitivity to neomycin, immunocompromised, or PREGNANCY - b/c of teratogenic effects of rubella -SE - arthralgia, may be migratory - inform family |
|
Varicella
|
-Benign, highly contagious - part of herpes family
-vaccine contains live attenuated virus -any disease after vaccination is gen. mild -latent form: Shingles! -Contraindications - neomycin allergy, pregnancy, immunocompromised |
|
Varicella Zoster Immune Globulin
|
postexposure prophylaxis of varicells
- for pts w/ high risk for severe disease who lack evidence of immunity or if varicella vaccine contraindicated |
|
Shingles
|
virus lays dormant in neurons & reactivates as shingles - primary infection virus latent in dorsal root ganglia - provocation may be decades later, reactivates and travels centrifugally in peripheral nerves, causing shingles
-VERY painful - "on fire" -single dose for adults >60, reduces occurrence and pain by 50% -contraindications: immunocompromised, or w/ TB, allergic to gelatin or neomycin, pregnant women |
|
Synagis
|
Immunoglobulin for RSV
-most infections mild but can cause severe illness in preemies or w/ CLD. also for infants w/ heart defects as prevention -given Q30 days during RSV season -SE: mild tenderness & erythema @ site |
|
Haemophilius Influenza
|
CONJUGATE H influenza type B (98% effective)
-causes invasive or non-invasive disease - meningitis, septicemia, arthritis, pneumonia, eppiglottitis, otitis media, cellulitis, osteomyelitis, pericarditis -common SE: minor tenderness @ site, possible low grade fever |
|
Neisseria Meningitidis
|
CONJUGATE meningococcal vaccine for A, B, C & W-135 (99% effective)
Recommendation: 11-18yrs High risk pop: 6wks to 55yrs + -close quarters - military, college dorm etc. -travelling to area where common (W. Africa) -damaged spleen, including sickle cell -immunocompromised - complement deficiency Contraindicated - previous severe rxn to vaccine or moderate/severe illness warrants postponement of vaccine OK for Pregnant women!!! SE: - mild tenderness & erythema at site, transient fever, HA, malaise |
|
Streptococcus Pneumoniae
|
pneumococcal vac prevents bacteremia, sepsis, pneumonia, sinusitis, otitis (notorious), meningitis from invasive bacteria
Recommendations: sickle cell asplenia or functional asplenia, HIV, immunocompromised states, cochlear implant, CSF leak, smokers Contraindications: moderate/severe febrile illness, previous allergic rxn to vaccine, pregnant women Common SE: mild tenderness & erythema at site, fever |
|
Influenza
|
Trivalent (inactivated) - for 6mo to 18yrs
FluMist: >2y to 49yrs (if healthy and nonpregnant) -live attenuated, burns when given -must remain on mucous membranes to be absorbed FluMist Quadravalent: 2-49yrs FluBlock trivalent recombinant hemagglutinin -18-49yr -NO USE OF eggs/virus -highly purified, no preservatices, antibiotics, etc. Fluzone High Dose: >/= 65yrs -contains 4x more hemagglutinin per dose than standard vaccines - >60yrs only produce 1/3 response to antibodies For pts 19-40 or 50-death who are diabetics, chronic heart, lung, renal disease or immunocompromised -recommend inactivated vaccine H1N1 - can be given same day as regular flu, same requirements - live attenuated to each nare |
|
Rotavirus
|
Rotashield - causes intussusceptions, increased peristalsis
Rotateq - oral pentavalent live virus vaccine Rotarix - contraindicated if allergy to vaccines or for immunocompromised infants |
|
HPV
|
-precursor for cervical, vulvar, anal & penile cancers
-cervical CA 2nd leading cause of cancer deaths among women world wide. -Most common newly aquired STI Gardasil = broader coverage - vaccine of choice -approved males and females 9-26yrs -coverage min. 5 yrs, still monitoring for need for boosters etc. Ceravix - 100% effective but less types than gardasil -ages 10-25yrs |