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117 Cards in this Set

  • Front
  • Back
Hematologically, what is meant by a "Shift to the left"?
Increased bands, or immature neutrophils
Describe serum bicarb levels in a patient with metabolic acidosis
LOW!
Describe the respiratory compensation mechanism for metabolic acidosis.
Tachypnea, breath off the CO2 (Acid!)
What hematologic labs could be altered in disseminated intravascular coagulopathy?
Increased PT/PTT and decreased fibrinogen
Describe the effects of glucocorticoids on WBC levels and how this could be distinguished from a true infection.
Increased WBC level, but no shift to the left
What drugs are commonly associated with "Drug Fever"?
Amp B, Phenytoin, various antibiotics
Urinary tract infection, predominant pathogen?
e. coli
Respiratory tract, predominant pathogen?
S. pneumoniae (pneumococcus)
Skin/Soft tissue or IV catheter, predominant pathogen?
Staph
Which type of PCN allergy is the use of beta-lactams CONTRAINDICATED?
IgE mediated (Immediate, Type I)
Sx of IgE mediated Immediate allergic reaction
Anaphylaxis, angioedema, bronchospasm, hypotension...
Patient with IgE mediated PCN allergy, which of the following can be used?
A) PCN
B) Aztreonam
C) Cephalosporins
D) Carbapenems
B
With which type of PCN allergy can beta-lactam use be attempted?
Late, Type 4
Patient with type IV PCN allergy, which agents are the best to recommend?
OC3!!!!
Omnicef (Cefdinir)
Ceftin (Cefuroxime)
Cefpodoxime
Ceftriaxone
#1 Pathogen for community acquired pneumonia?
Pneumococcus
Sx of IgE mediated Immediate allergic reaction
Anaphylaxis, angioedema, bronchospasm, hypotension...
Patient with IgE mediated PCN allergy, which of the following can be used?
A) PCN
B) Aztreonam
C) Cephalosporins
D) Carbapenems
B
With which type of PCN allergy can beta-lactam use be attempted?
Late, Type 4
Patient with type IV PCN allergy, which agents are the best to recommend?
OC3!!!!
Omnicef (Cefdinir)
Ceftin (Cefuroxime)
Cefpodoxime
Ceftriaxone
#1 Pathogen for community acquired pneumonia?
Pneumococcus
Sx of IgE mediated Immediate allergic reaction
Anaphylaxis, angioedema, bronchospasm, hypotension...
Patient with IgE mediated PCN allergy, which of the following can be used?
A) PCN
B) Aztreonam
C) Cephalosporins
D) Carbapenems
B
With which type of PCN allergy can beta-lactam use be attempted?
Late, Type 4
Patient with type IV PCN allergy, which agents are the best to recommend?
OC3!!!!
Omnicef (Cefdinir)
Ceftin (Cefuroxime)
Cefpodoxime
Ceftriaxone
#1 Pathogen for community acquired pneumonia?
Pneumococcus
4 pathogens that normally colonize the URT?
Pneumococcus, Strep, Haemophilus and Neisseria
Most common pathogens that colonize the URT in smokers?
H. flu and M. catarrahlis
Which key pathogen does not typically colonize the URT due to normal host defenses?
GNR... pseudomonas!
Common mechanism of resistance to macrolides?
Efflux
Ciprofloxacin, G+ or G- or BOTH?
G-
Using in G+ will kill the patient...
In the management of pneumococcal CAP, what are considered clnically useful extended spectrum fluoroquinolones?
Levaquin (Levofloxacin), Avelox (Moxifloxacin)... NOT CIPRO!
Guideline treatment of pneumococcal CAP (PCN susceptible)
PCN or....
1) Doxy
2) Macrolide
3) Cephalosporin
4) Ext spectrum FQ
Guideline treatment of pneumococcal CAP (Intermediate PCN Resistance)
PCN or Ceftriaxone OR...

Extended spectrum FQ
Guideline treatment of pneumococcal CAP (High Level PCN Resistance)
Vancomycin
or
Extended Spectrum FQ
Cefditoren, brand name?
Spectracef
Cefditoren, category?
Antibiotic, 3rd generation cephalosporin
Cefditoren, indication?
PCN resistant pneumococcus, beta-lactamase producing H. flu and MSSA
Summary: G+, G-
Cefditoren, dietary considerations
Should take with high fat meal, use with caution in patients with milk protein hypersensitivity
Linezolid, brand?
Zyvox
Linezolid, category?
Antibiotic, Protein synthesis inhibitor
Linezolid, indications?
G+ (inc. res. staph/strep)

Gram positive big guns
Linezolid, hallmark ADRs
*Thrombocytopenia
*Leucopenia
Diarrhea, abd pain...
Telithromycin, brand?
Ketek
Telithromycin, cateogry?
Antibiotic, similar to macrolides
Macrolides, predominant coverage?
G+
Telithromycin, coverage
S. pneumoniae (G+)
Minimal GNR/Anaerobes
Specific spectrum:
1) S. pneumoniae
2) H. flu
3) M. cat
4) Strep pyogenes
5) C. pneumoniae
6) L. pneumophila
7) M. pneumoniae
Telithromycin, indications
Mild to moderate community acquired pneumoniae (ONLY)
Major ADR of telithromycin?
Hepatotoxicity - limited indications
Telithromycin, common dose
800mg (2 x 400mg tablets) BID w/ or w/o food
Telithromycin, INx
STRONG 3A4 inhibitor:
Affects dig, theophylline, sotalol, rifampin
Telithromycin, contraindications
*Hepatitis or jaundice history associated with Ketek or any macrolide.
*MG
Telithromycin, warnings
*Acute hepatic failure / severe livery injury reported
Telithromycin, hallmark ADRs
1) QTC prolongation
2) MG exacerbation (thus C/I)
3) Hepatotoxicity
4) Visual disturbances
5) Loss of consciousness
Major off-label use of FQ in peds?
CF due to pseudomonas
Extended spectrum respiratory FQ, Hallmark ADRs
*QTc prolongation
*Avoid with Class 1A or III
*Photosensitivities
What is Factive?
Gemifloxacin
Gemifloxacin, Brand?
Factive
Gemifloxacin, Category
Extended spectrum FQ
Gemifloxacin, spectrum
Staph, strep, ATYPICALS
Gemifloxacin, elimination
Renal/Hep
Major ADR of gemifloxacin (Factive)?
Photosensitivity
Empiric outpatient Tx of CAP, drug of choice?
Doxycycline 100mg BID x 7 - 14 days
Guideline treatment of pneumococcal CAP OUTPATIENT w/ suspected aspiration, preferred agent?
Augmentin
Guideline treatment of pneumococcal CAP OUTPATIENT, possible agents?
1) Doxycycline (DOC)
2) Macrolide (Ery/Azi/Cla)
3) FQ (Not Cipro)
4) Levaquin
5) Augmentin if suspected aspiration
CAP Empiric Inpatient Therapy (NON-ICU)
Ceft or Cefotax + Macrolide
OR
B-lactam/Clav + Macrolide
OR
ESFQ
Empiric Inpatient CAP treatment (ICU)
Ceft or Cefotax or B-lact/clav (Zosyn)
AND
Macrolide or ESFQ
[Summary: Zosyn + Mac/FQ]
B-lact allergy? FQ + Clind
CAP Duration of therapy?
7 - 10 days unless chlamydia or legionella
Quinidine, Antiarrhythmic Classification
1A
Procainamide, Antiarrhythmic Classification
1A
Disopyramide, Antiarrhythmic Classification
1A
Lidocaine, Antiarrhythmic Classification
1B
Mexiletine, Antiarrhythmic Classification
1B
Flecainide, Antiarrhythmic Classification
1C
Propafenone, Antiarrhythmic Classification
1C
Beta-blockers, Antiarrhythmic Classification
2
Amiodarone, Antiarrhythmic Classification
3
Sotalol, Antiarrhythmic Classification
3
Dofetilide, Antiarrhythmic Classification
3
Ibutilide, Antiarrhythmic Classification
3
Calcium channel blockers, Antiarrhythmic Classification
4
Class 1A arrythmias, indications?
Ventricular and Atrial
Class 1B arrythmias, indications?
Ventricular
Class 1C antiarrythmic indications
Vent, Atrial.... Flecainide particularly high risk in ventricular
Quinidine ADRs
GI upset!!!
Cinchonism
Thrombocytopenia
Hepatitis
Drug fever
Quinidine Interactions
Digoxin, warfarin increased

Amiodarone increases quinidine levels
Quinidine elimination
Liver
Quinidine Therapeutic Level
2-6
Which agent has an active metabolite known as NAPA?
Procainamide
What class agent does NAPA act like?
3
Procainamide ADRs
1) Positive ANA
2) SLE
3) GI
4) CNS
5) Fever
6) Rash
7) Neutropenia
Symptoms of procainamide induced SLE?
Pleural or pericardial pain
Procainamide Elimination
50% hepatic, 50% renal
Normal NAPA levels
<20mg/L
Major complaint reported by patients for disopyramide?
Anticholinergic ADRs
Inotropic classification of disopyramide
Negative
Disopyramide drug interactions
Phenytoin increases disopyramide metabolism
Disopyramide elimination
50%/50%
Lidocaine is useful in the treatment of ______________.
Ventricular arrythmias
Lidocaine ADRs
CNS related
Lidocaine drug interactions
Metabolism decreased by beta blockers and cimetidine
Lidocaine elimination
90% liver
Mexiletine major ADRs
GI IRRITATION
CNS

**Take with food
Mexiletine drug interactions
Phenytoin increases metabolism
Mexiletine elimination
90% liver
Flecainide ADRs
** GI and CNS***
Proarrythmic
Flecainide Drug Interactions
Flecainide levels may be increased by amiodarone
Flecainide elimination
70% liver, 30% renal
Propafenone ADRs
GI/CNS
Metallic taste
Caution: Agent is similar to betablocker
What is the most effective antiarrythmic agent for ventricular arrythmias?
Amiodarone
SEVERE ADRs of Amiodarone
Pulmonary fibrosis
ADRs of Amiodarone
SEVERE: Pulmonary fibrosis
CNS, thyroid, GI, blue-gray skin, photosensitivity, corneal deposits, optic neuritis, hepatotoxicity, bradycardia
Brain explosions, spontaneous combustion, i hate the naplex, i hate studying
V. Tach, Tx?
Lidocaine, then procainamide or amiodarone
V. fib, Tx?
Defibrillate
EPI or Vasopressin
Amiodarone then Lidocaine
Consider magnesium and procainamide if above fails
PSVT, Tx?
Vagal maneuvers
Rx: Adenosine preferred
Secondary: Vera, dilt, BB, digoxin
A. Fib, Tx?
Anticoagulate
Block AV node w/ BB, CCB or Dig
Torsade De Pointes, Tx?
Stop cause and correct Electrolyte abnormality
Give Mg 2g bolus
Increase HR until cause is removed
Digoxin elimination?
Renal