Therapeutics Id Exam 1- Bone Skin Shit

Front 1

impetigo- what is it
common in what pop

Back 1

superficial infxn of skin
common in peds

Front 2

symptoms of impetigo (2) and where they are located to

Back 2

localized, purulent infection of hte skin
lesions begin as vesicles and become pustules

usually on areas of face and extremities

Front 3

impetigo- caused by what bugs (2)

Back 3

beta hemolytic strep (s. pyogenes and agalactiae)
staph aureus

(skin bugs)

Front 4

how to treat impetigo depends on...(3)

Back 4

number of lesions
location of lesions
likelihood of spreading infection to others

Front 5

topical treatments for impetigo (3 options, and most effective one)

used for what severity of infections

Back 5

mupirocin ointment TID
bacitracin/neomycin (less effective)

more minor infections

Front 6

oral impetigo treatments (5)

note dosing freq
when to give

note on the dosing amount on these drugs

Back 6

dicloxacillin
cephalexin
erythromycin (if pcn allergy)
clindamycin
amox/clav

peds dosing- dosed mg/kg

wider spread systemic

clinda is TID

everything else is QID

augmentin is BID

Front 7

erysipelas vs cellulitis

Back 7

erysipelas is upper dermis only

cellulitis infects full skin thickness

Front 8

erysipelas= presentation (2)

Back 8

lesions that are raised and has a definite demarcation between infected and non infected

butterfly appearance on skin

Front 9

erysipelas microbiology (2)

Back 9

beta hemo strep (group A)
s. aureus

Front 10

erysipelas treatment options (3) general classes

Back 10

PCN, penicillinase-resistant pens
1st gen cephs

these are all good for gram + staph/strep!

Front 11

cellulitis presentation (3)

Back 11

acute painful erythematous infection of entire skin thickness (subQ too)

also get typical fever/cills'

advancing borders

Front 12

cellulitis pathogenesis- portal of entry (4)

Back 12

can start as impetigo
through ulcerations
enter through trauma
or surgical procedures

Front 13

risk factors for cellulitis (6)

Back 13

fat
edema (see a lot in CHF/cirrhosis)
previous surgery
trauma (duh)
hx of cellulitis
current leg ULCER

Front 14

4 ways to dx cellulitis

Back 14

look at clinical apperance
blood cultures (if pt acutely ill)
aspiration of inflamed skin (or if abscess---usually MRSA)

punch biopsies

Front 15

treatment approach to cellulitis

Back 15

usually start with empiric therapy then try dx procedures to ID cultures

Front 16

bugs in cellulitis (2 prominent ones)

5 others...2 of them you would get from environment

Back 16

group A strep (s. pyogens)
Staph aureus including MRSA (abscess usually)

non group A hemolytic strep
bacteroides fragilis
anaerobic strep
aeromonas hydrophilia (fresh water)
vibrio vulnifuicus (sea water)

Front 17

treating mild cellulitis infections with no systemic involvement (fever chills tachycardia hypotension)

ROUTE
main 2 drugs

2 drugs if allergy

Back 17

can use oral meds

dicloxacillin
cephalexin

if PCN allergy
clindamycin
erythromycin

Front 18

treating severe cellulitis (4 options)

Back 18

admit to inpatient and treat with IV

nafcillin
cefazolin (1st gen)
clindamycin
vanco (if pt has risk factors for MRSA, abscess, exposure to pt with MRSA or hx of MRSA)

Front 19

MRSA cellulitis treatment options (6)

Back 19

Bactrim 2 DS?? (higher dose) BID
doxy/minocycline
linezolid
clinda
vanco if IV
daptomycin

Front 20

vanco dosing for MRSA cellulitis

Back 20

30 mg/kg in 2 divided doses

Front 21

dapto dosing for MRSA cellulitis vs. osteomyelitis

Back 21

4 mg/kg IV (lower dose) vs. osteomyelitis where we use higher dose (6 mg/kg)

Front 22

suggested AUC:MIC ratio for vanco needed to kill staph optimally

what trough does this correspond to?

minimum trough necessary

Back 22

AUC:MIC > 400 if the bug has MIC of 1

trough range of 15 mcg/mL (15-20). minimum trough of 10 ug/mL is necessary.

Front 23

vanco dosing based on..not MRSA cellulitis (30 mg/kg dose)- what does and what it's based on (which weight)

interval range

Back 23

15-20 mg/kg
based on ABW (actual)

8-12h intervals with normal renal function

Front 24

how to determine proper intervals for vanco dosing (age/Scr) (3)

Back 24

age < 40 and SCr < 1.4 = q8h

age 40-65 SCr < 1.4 interval = 12 h

age > 65 OR Scr > 1.4 (regardless of age) interval = 24 h

Front 25

renal dysfunciton guidelines for vanco

Back 25

if est. CrCl < 20 ml/min dose by levels (trough/PK/PD method)

Front 26

cap on vanco dose if really obese pt

Back 26

cap at 2 gm

Front 27

patients on CVVHD usually require what dosing for vanco

Back 27

10-15 mg/kg q24h and verified with serum level monitoring

Front 28

monitoring for vanco

when to start

Back 28

trough only, if they are on vanco for extended periods

patient has to be at steady state (usually 30 min before the 4th dose)

Front 29

post dose level

Back 29

level drawn and how many hours after completion of infusion it was drawn

(e.g. 6 hour post dose)

Front 30

review vanco dosing equations

Back 30

--

Front 31

peripheral vein conc. vs central vein conc. of vanco and what this implies for administration

Back 31

they are different (different blood volumes?) so you can give a more conc. solution centrally (PICC)

Front 32

how long before you see improvement in cellulitis

Back 32

within 24 hours

Front 33

cellulitis clinical course (atypical)

Back 33

sometimes you see inflammation worsen after initiating treatment- if this happen can give coritcosteroids in addition to abx

Front 34

duration of treatment for cellulitis

Back 34

7-14 days

Front 35

local/non pharm care for cellulitis

Back 35

elevate and immobilize the involved area

Front 36

how to prevent cellulitis (3)

does abx ppx help?

Back 36

keep skin hydrated
reduce edema
treat any open areas in the skin

abx ppx is questionable

Front 37

leading cause of hospitalization in pt with diabetes

Back 37

foot ulcers

Front 38

complications from diabetic foot infections (6)

Back 38

ischemia
infection
neuropathy
poor wound healing
trauma/ulceration
gangrene

Front 39

prevention of foot ulcers (6)

Back 39

optimize glycemic control
detect early by inspecting foot
clean with mild soap
moisturize
well fitting shoes
stop smoking

Front 40

avoid what if you have foot ulcers predisposition (3)

Back 40

hot soaks
heating pads
harsh topical agents

(all of these cause dmg to skin)

Front 41

risk factors for amputation (4) and why

Back 41

PAD (seen in smoking, htn, hyperlipidemia)
structural foot deformity (can have weird high pressure areas)
ulceration (allows for entry of infection)

peripheral neuropathy (decreased sweating leads to dry skin which complicates infections)

Front 42

how to treat foot ulcers (general) (2)

Back 42

debridement- remove dead and necrotic skin

then abx (empiric to cover likely pathogens)

Front 43

foot ulcer pathogens (5

Back 43

anaerobes
group a strep
staph
enterococci (gram +) and enterobacteriaceae (gram -)

Front 44

duration of therapy for foot ulcers

Back 44

until infection has resolved

Front 45

mild infection of foot ulcer- abx choices (6)

Back 45

oral

dicloxacillin
clindamycin
cephalexin
bactrim
amox/clav (pretty good choice)

Front 46

moderate cellulitis infection

Back 46

oral or IV

bactrim/augmentin

then ceftriaxone/cefoxitin

levo
linezolid/dapto
ertapenem
cefuroxime
....IDK LOOK AT CHART THERE HAS TO BE SOME COMMON VEIN

Front 47

severe cellulitis infection (4) tx

Back 47

very broad coverage

pipercillin/tazobactam (zosyn)
levo or cipro + clinda
imipenem-cilastatin
vanco + ceftazidime (+/- metronidazole)

Front 48

becaplermin (regranex) used for what?

Back 48

aids in healing of a non-healing ulcer but not intended if current infection (should be under control)

Front 49

becaplermin (regranex) MoA

Back 49

platelet derived GF that stimulates cell migration to site of application to promote healing

Front 50

what is necrotizing fascitis

Back 50

rare severe infection involving the subQ tissues taht results in progressive destrution of fascia and fat but may spare the skin

Front 51

clinical presentation of NF- initial phase

Back 51

beings like cellulitis (red, warm, swollen without distinct margins)

Front 52

NF- systemic sx (2)
local sx (3)

Back 52

mental status changes
lethargy


unexplained pain (cuz under skin)
woodn hard feeling of subQ tissue
discoloration of skin

Front 53

bugs in NF (2 usual, 4 others)

Back 53

usually group A strep
or staph

can also be klebsiella
enterobacter
anaerobes
CA-MRSA has been reported

Front 54

NF can result from...(3)

Back 54

can result from bowel surgeries or penetrating abdominal trauma
decubitus ulcer or perianal abscess
injection sites in IVDU

Front 55

risk factors of NF (5)

Back 55

diabetes
immunosuppression
alcoholism
PVD
trauma/surg

Front 56

NF clinical features (5)

Back 56

failure to respond to abx
wooden hard feeling
systemic tox
bullous lesions
skin necrosis derp

Front 57

how to dx

Back 57

surgical exploration

Front 58

lab findings of NF (2) (properties)

Back 58

usually non specific
blood cultures are positive 60% of the time

Front 59

treatment of NF- first step

then abx choices (if strep, s. aureus)

Back 59

debridement (q 24-36 h)
pen + clinda (if strep- clinda is there to inhibit protein synthesis so strep can't make toxin proteins)
nafcilin, cefazolin, clinda if staph

Front 60

NF abx if mixed infection (3 drugs)

Back 60

pip/tazo or amp/sulb (combos) PLUS clinda plus cipro if mixed

Front 61

NF abx if clostridium (2)

Back 61

clinda OR pen

Front 62

gas gangrene- what is it

Back 62

necrotizing infxn of skeletal muscle

Front 63

gas gangrene presentation

how does it progress?
toxicity?
similar to what?
(6)

Back 63

similar to cellulitis
increasing pain beginning at injury site
RAPIDly progressive
gas production on xray (bugs make CO2)
systemic tox
foul smell

Front 64

gas gangrene bugs (4)

Back 64

anaerobes (that's why it's stinky)

clostridium perfingens (suaully this)

c. septicum
c. novyi
c. histolyticum

Front 65

treatment of gas gangrene: nonpharm

pharm (2)

supportive (2)

Back 65

surgical (amputation/debride)
pen + clinda
clinda + cefoxitin (?? why)

ICU support
hyperbaric O2 tx

Front 66

pressure sores- occurs why?

Back 66

due to maceration of skin esp at areas where bone is covered by little fat

Front 67

predisposing factors to pressure sores (4)

Back 67

pressure
shearing
friction
moisture

Front 68

pt at risk for pressure sores (4)

Back 68

IMMOBILE
sensory impairment
incontinence of bladder/bowel (moisture)
poor nutrition

Front 69

stages of sores and what they mean (4) when you need surgery

Back 69

stage I: abrasion, limited to epidermis (like a red mark on your head from sleeping on desk)

stage II: extends to subQ fat

stage III: further extension...need surg

stage IV: penetrates into deep fascia, involving msucle and bone. need surg

Front 70

complicatoins of pressure sores (2)

Back 70

infections (not every sore is infected)
osteomyelitis

Front 71

bugs in pressure sores (2 categories)

Back 71

gram neg aerobes
gram neg anaerobes

WHY ALL GRAM NEG??
(mostly because these are people who are hospitalized, so more exposure to gram -)
often polymicrobic

Front 72

how to culture pressure sores (and how not to) (2)

Back 72

surface cultures (swab) are useless- you're just sampling the environment

deep wound cultures can help guide therapy though

Front 73

how to prevent pressure scores (2)

Back 73

assess risk with braden scale

change positions q2-3 hrs

Front 74

local wound care of pressure sores (2)

Back 74

clean/debride
surgery (if stage 3-4)

Front 75

topical tx for pressure sores- which are not recommended

what should be used instead for topicals (not abx)? (2)

Back 75

the harsh ones that are basically disinfectants

normal saline to irrigate
wet/dry dressing alteration

Front 76

topical abx for pressure sores- when to use, for how long, what to use (3, what to use for MRSA)

Back 76

may be tried for ulcers that are not healing.

usually tried for 2 wks

silver sulfadiazine
triple abx cream/ointment
mupirocin cream if MRSA

Front 77

Systemic abx in pressure sores- when to use

Back 77

ONLY use if pt has systemic signs of infection (fever, wbc, hypotension, ams)

Front 78

systemic abx choice for pressure sores (3 choices, some are combos)

duration if cellulitis or abscess-

if wound is moderate/near bone/crush injury

Back 78

treat as if they have cellulitis, sepsis, osteomyelitis depending on what they have


wide spectrum- beta-lactam/b-lactamase inhibitor, carbepenem, quinolone + clinda

Front 79

bugs for dog/cat bites (3 aerobic, 2 anaerobic)

Back 79

aerobes: pasturella, staph, strep

anaerobic: bacteroides, fusobacterium

Front 80

avg bite wound has how much bacteria

Back 80

5 types at least

Front 81

complications of infected animal bites (5)

Back 81

septic arthritis (hand wounds/extremities)
osteomyelitis
subQ abscess
tendonitis
bactermia

Front 82

animal bites- tx of choice

Back 82

augmentin 875 mg BID

Front 83

alternatives to animal bites (1 adult, 1 peds, a bunch of gay ones she didn't tlak about)

Back 83

adults: clinda + quinolones

peds: clinda + bactrim (cuz no quinolones in kids

others: dicloxacillin + PCN VK
amp/sul
pip/tazo
cefoxitin
carbapenems

Front 84

adjunctive tx for animal bites (4)

Back 84

clean wound with NS
superficial debridement
elevation
rabies/tetanus ppx

Front 85

bugs in human bites: aerobic (4)

Back 85

vridans strep (just htink strep)
beta hemolytic strep
staph
eikenella corrodens

Front 86

bugs in human bites: anaerobic (3)

Back 86

fusobacteria
peptostrep
prevotella spp

Front 87

viral transmission in human bites (4)

Back 87

HIV
herpes
hep A
hep B

Front 88

complications from human bite infections (4)

Back 88

septic arthritis
osteomyelitis
nerve dmg
fractures

Front 89

5 steps to treating human bites

Back 89

aggressive irrigation
surg debridement
immobilization
tetanus ppx
abx ppx ASAP

Front 90

human bites: if no sign of infection but broken skin what ppx to use
duration

Back 90

augmentin 875 for 5 days

Front 91

if signs of infection in human bites use what 3 options?

Back 91

amp/sul
cefoxitin
ertapenem

all IV

Front 92

osteomyelitis- what is it and how do you get it (2)

Back 92

inflammation of bone caused by pyogenic organism through blood or open injury

Front 93

acute osteomyelitis
often in whom

Back 93

a new infection of the bone
often in kids

Front 94

chronic osteomyelitis

Back 94

infection that develops secondary to open injury to bone or surrounding tissue

Front 95

hamatogenous osteomyelitis- cause

Back 95

transient bacteremia causes infection in susceptible bone

Front 96

hematogenous osteomyelitis- risk factors (4)

Back 96

iVDU
IV catheters/urinary caths
underlying diseases
trauma

Front 97

bugs in heme osteo - most common

and 6 others

Back 97

staph***
e. coli (e.g. if you get bacteremia from UTI and you have fucked up bone- get in that way)
kleb
salmonella
proteus
pseudomonas
TB- vetebral osteomyleitis

Front 98

contiguous focus osteomyelitis- definition

Back 98

infxn of bone from nearby infected area

Front 99

risk factors of CF osteo (2)

Back 99

surgery (orthopedic)
soft tissue infections (foot, etc)

Front 100

bugs in CF osteo (3)

Back 100

staph
gm negative aerobes
anaerobic

Front 101

acute osteo- timing of s/sx

duration of therapy

Back 101

s/sx less than month
parenteral abx for 4-6 wks

Front 102

how to tx acute osteo (4 options)

when to change

Back 102

empirical so...

cefazolin
nafcillin
vanco
cipro

change if you get back culture/sensitivity

Front 103

chronic osteo- definition of timing of s/sx

duraiton of therapy

Back 103

s/sx >1 month often with underlying disease

give IV abx 4-6 weeks often followed by oral abx 1-2 months (or years) DEPENDS on clinical course

Front 104

how to select abx in chronic osteo

surgery?

Back 104

empieric tx NOT rec'd

base selection on culture results

usually need surgical debridement (as opposed to acute which may or may not need)

Front 105

oral abx in osteomyelitis- works?

Back 105

good response in kids with ACUTE osteo

but not in adults

Front 106

home IV therapy for osteomyelitis: choices (3)

Back 106

vanco
dapto
cefazolin

Front 107

pathogenesis of infectious arthirtis

Back 107

hematogenous inoculation of pathogen leading to infection

Front 108

precipitating factors of IA (5)

Back 108

intra articular injections
corticosteroids especially
preexisting arthritis
IVDA
trauma

Front 109

IA clinical prsentation (4)

Back 109

similar to cellulitis but limited to joint

pain
swelling
infalmmatory signs
fever

Front 110

how to dx IA

Back 110

recover organisms from joint by aspirating synovial fluid

Front 111

site of infection of IA_ most common

(4)

Back 111

knee (most common)

also hip
ankle
elbow

Front 112

IA bugs (5)

Back 112

staph or strep

also neisseria gonorrhea (STD untreated- can cause it)

e. coli

p aeruginosa

Front 113

non-gonococcal IA tx (2 combos)

duration

Back 113

cover MRSA and gram -

vanco + ceftriaxone or cefotaxime (MRSA + gram -)

vanco + cipro or levo


treat 2-3 weeks

Front 114

IA gonococal infxn options (3)

duration

Back 114

ceftriaxone** all of these are 1 gm, difference is recephin is QD and others are q8h
cefotaxime
ceftizoxime

duration 7 days

Front 115

how is joint infection categorized and explain each (3)

Back 115

early onset- acquired during procedure

delayed onset- acquired during procedure but caused by less virulent organisms

late onset: usually from hematogenous seeding.

Front 116

prosthetic joint infection bugs- early (2), delayed (1), late onset (3)

Back 116

early- staph aureus and gram negative bacilli

delayed- less virulent- coagulase neg staph (CONS)

late onset- staph aureus and CONS (or e coli if following UTI)

Front 117

prosthetic joint replacement- generally requires what type of treatments (2)

Back 117

med and surg (need to take joint out and put in spacer...then new joint)

Front 118

why does the joint have to be removed?

Back 118

because organisms often make biofilms on the shit making medical mgmt alone inadequate- need to clean off the joint

Front 119

early onset joint infection tx regimen (3 steps...and durations)

Back 119

surgical debridement followed by long term IV abx (6 weeks)

then several months of oral abx

Front 120

IV abx used for early onset joint infxn (MSSA vs MRSA 2 each)

Back 120

MSSA: nafcillin
cefazolin

MRSA: vanco 30 mg/kg/d in 2 div doses (like cellulitis) or dapto

can add rifampin (BUT NEVER USE THIS ALONE TOO MUCH RESISTANCE)

Front 121

linezolid long term therapy AE (3)

Back 121

thrombocytopenia
anemia
peripheral neuropathy

Front 122

delayed/late onset tx for joint infection (2 choices)

Back 122

debride and abx (same as early...)

OR

replace joint

Front 123

when to use long term oral suppressive therapy and what to use (for joint infection)

Back 123

cipro + rifampin

only used if you can't replace joint anymore because there's not enough bone left

Front 124

routine abx ppx for joint replacement? yay or nay

Back 124

NOBODY KNOWS- but recent pub does not support this practice