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25 Cards in this Set
- Front
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1. Inhibits viral DNA polymerase
2. Active against Herpes simplex, Herpes zoster, does not treat CMV 3. PO/IV 4. 5-10 mg/kg IV every 8 h 5. Dosage adjustment for renal impairment (Good urine output, can crystallize in the kidney; ensure hydration) |
acyclovir
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valacylcovir dose
1. herpes simplex treatment 2. herpes simplex suppression 3. herpes zoster |
1. herpes simplex treatment = 1 g BID
2. herpes simplex suppression = 500mg -1g QD 3. herpes zoster = 1 g TID |
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1. Inhibits Viral DNA polymerase
2. Available IV/PO 3. Active against Cytomegalovirus (CMV) 4. Dose CMV disease: Induction: 5 mg/kg IV Q12H Maintenance: 5 mg/kg IV QD or 6 mg/kg IV QD five days/week |
ganciclovir
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AE of ganciclovir (7)
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1. bone marrow suppression
2. neutropenia 3. thrombocytopenia 4. nausea 5. vomiting 6. confusion 7. LFT elevation |
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dose of valganciclovir
1. induction 2. maintenance |
1. induction 900 mg q 12 (w/food)
2. maintenance 900 mg QD (w/food) |
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1. Dose: Induction: 60 mg/kg IV Q8H or 90 mg/kg Q12H; Maintenance: 90 mg/kg QD
2. Inhibits viral DNA polymerase. 3. Active against Cytomegalovirus (CMV) and acyclovir resistant herpes symplex virus 4. Dosage adjustment for renal impairment uses modified Cockroft and Gault equation.(MALES mL/min/kg = (140 - age)/(serum creatinine x 72) FEMALES Use above formula and multiply by 0.85) 5. Primary toxicity is nephrotoxicity (~50%). Dose adjustment should be made for renal dysfunction. 6. Other toxicities include: nausea, vomiting, anorexia, seizures, hypocalcemia, and hypomagnesemia. 7. Less well tolerated than ganciclovir/ valganciclovir. 8. Infuse over at least 1 mg/kg/minute following a 2 hour prehydration infusion of 1 liter normal saline. (1 hour of 500 ml before maintenance doses) |
foscarnet
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1. Dose: Induction: 5 mg/kg IV weekly for 2 weeks; Maintenance: 5 mg/kg IV every 2 weeks
2. Second-line agent. (very toxic) 3. Inhibits viral DNA polymerase. Requires intracellular activation. 4. Should be administered with probenecid (2 g three hours before, 1 g two hours after, and 1 g eight hours after dose.) 5. One liter of normal saline should be administered one hour before drug infusion. 6. Primary toxicity is nephrotoxicity. Nausea, fever, alopecia, myalgia, and neutropenia, have also been reported. 7. Urinary protein and serum creatinine levels should be obtained prior to the administration of each dose. |
cidofovir
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clinical presentation of CNS infections (7)
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1. neck stiffness
2. fever 3. headache 4. photophobia 5. N/V 6. seizures 7. altered consciousness. |
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clinical presentation of CNS infections in children (3)
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1. irritability
2. vomiting 3. seizures |
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clinical presentation of CNS infections in elderly (2)
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1. low grade fever
2. altered consciousness |
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treatment for meningitis?
<1 month common bacterial pathogens: Streptococcus agalactiae, Escherichia coli, Listeriamonocytogenes, Klebsiella species (2) |
1. Ampicillin plus cefotaxime
2. ampicillin plus an aminoglycoside |
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treatment for meningitis?
1-23 months common bacterial pathogens: Streptococcus pneumoniae, Neisseria meningitidis,S. agalactiae, Haemophilus influenzae, E. coli |
Vancomycin plus a third-generation cephalosporin
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treatment for meningitis?
2–50 years common bacterial pathogens: N . meningitidis, S. pneumoniae (1) |
Vancomycin plus a third-generation cephalosporin
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treatment for meningitis?
>50 years common bacterial pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram-negative bacilli (1) |
Vancomycin plus ampicillin plus a third-generation
cephalosporin |
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when treating meningitis what are your options for 3rd generation cephalosporins? (2)
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1. cefotaxime
2. ceftriaxone |
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_____ are consistent with meningococcal meningitis, but may also occur
with streptococci or H. influenzae. |
Petechial or purpuric rashes
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_____may occur with pneumococcus meningitis.
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Macular rash
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______ are more common in
pneumococcal meningitis |
Changes in mental status and neurologic
abnormalities |
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prophylaxis for bacterial meningitis: exposed to hemophilis influenzae
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HiB – residing with index case for >4 hrs; (unvaccinated contacts)
daycare – same day care for 5-7 days prior to onset 1. Rifampin 20 mg/kg po (NTE 600 mg) Q24 x 4 doses; Adults 600 mg Q24 x4 doses |
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prophylaxis for bacterial meningitis: exposed to neisseria meningitidis
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close contact for at least 4 hrs during
week before illness; exposure to secretions Cipro 500 mg x1; Ceftriaxone 250 mg IM X1 (adolescent) ceftriaxone 125 mg IM x1 (< 15 yrs) OR Rifampin 600 mg PO Q12 x 4 doses (adult) |
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How would you treat viral meningitis?
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1. enteroviral infections are self-limited
2. supportive: fluids, antipyretics, analgesics 3. acyclovir IV if herpes meningitis is suspected |
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direct infection of the brain parenchyma.
Viruses are by far the most common pathogen associated, although fungi, rickettsiae, and protozoans have also been implicated. |
encephalitis
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viruses associated with encephalitis (8)
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1. arboviruses
2. varicella zoster 3. herpes simplex 4. measles 5. mumps 6. cytomegalovirus 7. HIV 8. rabies |
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clinical presentation for encephalitis prodromal period (5)
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lasts for several days
1. myalgia 2. fever 3. malaise 4. rash 5. mild upper respiratory symptoms |
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clinical presentation for encephalitis for period after prodromal period (4)
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1. headache
2. drowsiness 3. mental status changes 4. meningismus all signify development of enchephalitis |