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619 Cards in this Set
- Front
- Back
Tetracycline and sulfonamides are examples of antibiotics that are bacteriocidal. True or false?
|
False
|
|
Tetracycline and sulfonamides are examples of antibiotics that are bacteriocidal. True or false?
|
False
|
|
This class of antibiotics works by disrupting or inhibiting cell wall growth:
1. Cephalosporins 2. Aminogycosides 3. Fluoroquinolones |
Cephalosporins
|
|
This class of antibiotics works by disrupting or inhibiting cell wall growth:
1. Cephalosporins 2. Aminogycosides 3. Fluoroquinolones |
Cephalosporins
|
|
If the patient is immunocompromised (i.e. neutropenic), it is preferable to us a bacteriostatic antibiotic?
|
False
|
|
If the patient is immunocompromised (i.e. neutropenic), it is preferable to us a bacteriostatic antibiotic?
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False
|
|
Tetracycline and sulfonamides are examples of antibiotics that are bacteriocidal. True or false?
|
False
|
|
This class of antibiotics works by disrupting or inhibiting cell wall growth:
1. Cephalosporins 2. Aminogycosides 3. Fluoroquinolones |
Cephalosporins
|
|
If the patient is immunocompromised (i.e. neutropenic), it is preferable to us a bacteriostatic antibiotic?
|
False
|
|
What antibiotic can be associated with permanent hearing loss?
|
Aminoglycosides (gent)
Get drug levels! |
|
What antimicrobial is associated with >80% of patients experiencing nephrotoxicity?
|
Amphotericin-B ("AmphoTerrible")
|
|
This antibiotic can cause Fanconi syndrome (reversible renal)?
|
Tetracycline
|
|
What is Red Lobster Syndrome?
|
Ass w/ rifampin and causes red-orange urine, tears, sweat, contact lens
|
|
What antibiotic can cause kernicterus (jaundice causing brain damage) in newborns?
|
Sulfonamides
|
|
Antibiotic causing darkening of teeth; contraindicated in kids < 8 yrs
|
Tetyracycline
|
|
Red Man/ Red Neck Syndrome?
|
Caused by rapid infusion of vancomycin (histamine release causes flushing)
|
|
Causes loss of red/green color perception
|
High dose ethambutol (optic neuritis)
|
|
Causes disulfiram-like (tachycardia, flusing, HAs, cramps, NVD) reaction when taken with alcohol?
|
Metroidazole (No ETOH for 2 days after therapy)
|
|
Ass w/ hyperkalemia by blocking tubular reabsorption of Na and secretion of K?
|
TMP-SMX
|
|
Antibiotic with highest incidence of Clostridium difficile diarrhea?
|
Clindamycin
|
|
Antibiotic assc w/ hypokalemia
|
Pencillins especially nafcillin and piperacillin
|
|
Antibiotic with highest incidence of Clostridium difficile diarrhea?
|
Clindamycin
|
|
Antibiotic assc w/ rash when used concurrently in Mononucleosis (Epstein Barr Virus)
|
Ampicillin
|
|
Antibiotic assc w/ hypokalemia
|
Pencillins especially nafcillin and piperacillin
|
|
Antibiotics ass w/ CN8 toxicity (hearing loss) in fetus. Category D risk to fetus
|
Aminoglycosides
|
|
Antibiotic assc w/ rash when used concurrently in Mononucleosis (Epstein Barr Virus)
|
Ampicillin
|
|
Antibiotic causing tooth/bone problems for infant and hepatotoxic to mom. Cat D
|
Tetracycline
|
|
Antibiotics ass w/ CN8 toxicity (hearing loss) in fetus. Category D risk to fetus
|
Aminoglycosides
|
|
Antibiotic with highest incidence of Clostridium difficile diarrhea?
|
Clindamycin
|
|
Antibiotic causing tooth/bone problems for infant and hepatotoxic to mom. Cat D
|
Tetracycline
|
|
Antibiotic assc w/ hypokalemia
|
Pencillins especially nafcillin and piperacillin
|
|
Antibiotic assc w/ rash when used concurrently in Mononucleosis (Epstein Barr Virus)
|
Ampicillin
|
|
Antibiotics ass w/ CN8 toxicity (hearing loss) in fetus. Category D risk to fetus
|
Aminoglycosides
|
|
Antibiotic causing tooth/bone problems for infant and hepatotoxic to mom. Cat D
|
Tetracycline
|
|
ADR (Adverse Drug Reactions) for aspirin
|
GI bleeding
|
|
A clinical use for aspirin
|
Analgesia
|
|
Cardiovascular indications for aspirin
|
AMI prophylaxis / AMI / PCI / TIA
|
|
Clopidogrel cardivascular indications
|
Unstable angina / ACS / AMI pts who undergo PCI / TIA / CVA, PAD
|
|
Clopidogrel ADRs
|
GI upset, bruising, bleeding - TTP (uncommom)
|
|
Antibiotic w/ potential for arthropathy in children. Cat C
|
Fluouroquinolones
|
|
Antibiotic w/ teratogenic potential. Cat C
|
Clarithromycin
|
|
Antibiotic potentially hepatotoxic in pregnant women receiving high IV doses
|
Erythromycin
|
|
Gell & Coombs Classification of Hypersensitivity to B-Lactams Type II reaction?
|
Bone Marrow Suppression
|
|
Gell & Coombs Classification of Hypersensitivity to B-Lactams Type IV reaction?
|
Delayed reactions=SJS/TEN
|
|
Clopidogrel interactions cautions
|
caution with drugs that cause bleeding
|
|
Warfarin MOA
|
inhibits vitamin K-dependent Y-carboxylation of coagulation factors II,VII,IX, & X (procoagulants)
|
|
Warfarin drug specifics
|
Measure INR (PT) - value depends on situation
- half-life = 4-hrs ? takes ~ 2d to see effect in PT (INR) |
|
Warfarin reversal
|
Reverse with vitamin K1 (phytonadione) / FFP
|
|
Warfarin prolongation of PT during first few days
|
Caused from depression of factor VII (low and slow)
|
|
Can you use cephalosporins if patient has a maculopapular rash from penicillin?
|
Yes
|
|
Can you use cephalosporin if patient has urticaria and bronchospasm from penicillin?
|
No
|
|
Do agents containing sulfur, sulfites and sulfates cross-react with sulfonamides?
|
No
|
|
Name some effective oral antibiotics for staph
|
Dicloxacillin (gold standard)
Cephalexin (Minocycline/doxyclycline TMP-SMX use if allergic to B-lactams) |
|
MRSA oral antibiotics?
|
Linezolid
M (fairly effective)inocycline/doxycycline>TMP-SMX |
|
Pseudomonal oral ABX?
|
Ciprofloxacin & levofloxacin
|
|
VRE oral ABX?
|
Linezolid (leave alone unless in blood and then refer)
|
|
Anaerobic oral ABX?
|
Metronidazole or amoxicillin/clavulanate (gold std)
Clindamycin (silver std) |
|
Staph IV ABX?
|
Nafcillin (gold std)
Cefazolin (silver std) Vanc (bronze std-use if allergic to B-lactams) |
|
MRSA IV ABX?
|
Vancomycin (gold std)
Others include linezolid, daptomycin, tigecycline, telavancin |
|
Urgent Warfarin anticoagulation method
|
Overlap warfarin / heparin 5-7d if needed
|
|
Warfarin clinical uses
|
Prevention and treatment of thrombosis / embolisim
- atrial fibrillation -may be used with recurrent TIA for pts resistant to ASA & clopidogrel |
|
Warfarin interactions
|
Substrate of mulyiple CYP enzymes
|
|
Warfarin ADRs
|
Bleeding / Purple (blue) toe syndrome / Warfarin-induced skin necrosis
|
|
Heparin MOA
|
Indirect thrombin inhibitor
COmplexes with AT (inactivator of thrombin, factor Xa (lesser extent factors XIIa, XIa, & IXa) |
|
Pseudomonal IV ABX?
|
Piperacillin/Tazobactam
Aztreonam Ceftazidime & cefepime Ciprofloxacin & levofloxacin tobramycin Carbapenems |
|
VRE IV ABX?
|
Linezolid, daptomycin, tigecycline, & telavancin
|
|
What antibiotic is assc w/ Hoignes Syndrome?
|
Penicillin C procaine (single IM dose for GAS pharyngitis)
|
|
An immediate but transient (5-30 min after injection) reax w/ bizarre behavior/neuro reax?
|
Hoignes Syndrome
|
|
What penicillin is used for both GAS pharyngitis and various stages of syphilis?
|
Pencillin G benzathine (IM)
|
|
Heparin drug specifics
|
Check aPTT
Reverse by turning down / stopping heparin - Protamin if urgent reversal required (watch with DM & vasectomy) |
|
Heparin clinical use
|
- DVT prophylaxis
- Sytemic anticoagulation - ACS / AMI |
|
Heparin ADRs
|
Heparin-induced thrombocytopenia (HIT)
|
|
Low Molecular Weight Heprin (LMWH) specific drugs
|
Enoxaparin
|
|
LMWH MOA
|
- inactivates factor Xa
- doesn't prolong aPTT |
|
LMWH drug specifics
|
Don't measure PT / PTT - can measure anti-Xa levels to check anticoagulation (pregnant women)
- reverse with protamine |
|
LMWH clinical use
|
DVT prophylaxis & treatment (surgery & medical pts)
|
|
Fibric Acid Derivatives specific drugs (fibrates)
|
- Gemfibrozil
- Fenofibrate - Fenofibric acid |
|
Fibric Acid Derivatives clinical use
|
use for increased triglycerides
|
|
FIbric Acid Derivatives interactions
|
Careful with stains dur to overlappingtoxicity profiles
|
|
Name anti-staph penicillins still clinically used for SSTI (skin and soft tissue infex)
|
Nafcillin (IV)
Dicloxacillin (po) |
|
Ampicillin may be used to treat listeria monocytogenes.
T/F? |
True
|
|
Amoxicillin is commonly used for URTIs T/F?
|
True
|
|
May be used for dental endocarditis prophylaxis & lyme disease
|
amoxicillin
|
|
Amoxicillin/clavanate is used for:
1. Animal/human bites 2. Amoxicillin failure URTIs 3. Dental Infex 4. All of the above |
4.
|
|
Zosyn is never used for nosocomial infections T/F?
|
False
|
|
Which grp of antibiotics arrests cell wall synthesis by binding to penicillin-binding proteins?
|
Cephalosporins
|
|
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 |
1.
|
|
A rash after cephalosporin usage is expected T/F?
|
False=immediate anaphylaxis
|
|
Which cephalosporin covers enterococci or listeria?
|
None
|
|
Fibric Acid Derivatives ADRs
|
- Reversible hepatoxicity
- Myopathy - May precipitate gallstones |
|
HMG-COA Reductase Inhibitors specific drugs ("stains")
|
- Atorvastatin
- Simvastatin gemeric (more likely to cause ADRs) - Pravastatin |
|
What is the clinical use for HMG-COA Reductase Inhibitors?
|
Use for increased LDL
|
|
What is a common interaction with HMG-COA Reductase Inhibitors?
|
- grapefruit juice & simvastatin
|
|
HMG-COA ADRs
|
- Myalgia - myopathy, rhabdo (very rare)
- reversabile hepatotoxicity |
|
Cephalosporin commonly used for perioperative prophylaxis
|
cefazolin
|
|
ceephalosporin po commonly used for SSTIs
|
Cephalexin
|
|
Bilary sludging (pseudocholelithiasis) is possible with this cephalosporin
|
ceftriaxone
|
|
An example of a 2nd generation cephalosporin & cephamycin
|
cefuroxime
cefaclor cefprozil |
|
A 2nd generation cephalosporin that might be used to treat an amoxicillin failure URTI
|
cefuroxime
cefaclor |
|
What is the chemical form of Niacin (vitamine B3)
|
nicotonic acid & nicotinamide
|
|
What are some available options
|
- immediate release(OTC) - flushing
- sustained release (Slo-Niacin) - hepatoxicity - Extended-release (Niaspan) - least flushing & hepatoxicity |
|
What are Niacin clinical uses
|
Modifies all plasama lipoprotiens & lipids favorablely
|
|
Niacin interactions
|
- Careful with coadministration of "stains" & other fibric acid derivatives
|
|
Niacin ADRs
|
- flushing
-aggravated glucose intolerance / gout |
|
Cephamycin usually used for surgical abdominopelvic prophylaxis
|
cefocitin (IM/IV)
cefotetan (IM/IV) |
|
A 3rd generation cephalosporin with excellent S. Pneumoniae coverage
|
cefpodoxime (IM/IV)
|
|
3rd generation cephalosporin used for single-dose gonorrhea treatment
|
cefpodoxime (IM/IV)
|
|
Cephalosporin (3rd generation) single dose po gonorrhea treatment
|
cefixime
|
|
Rocephin (ceftriaxone) is an example of a 3rd generation cephalosporin T/F?
|
true
|
|
3rd generation cephalosporin used more frequently in pregnant women
|
cefotaxime
|
|
Uses for 3rd generation cephalosporin include
1. refractory AOM 2. meiningitis 3. gonorrhea 4. all of above |
4.
|
|
A momobactam such as aztreonam should not be used w/ pts allergic to penicillin T/F?
|
false
|
|
An example of a glycopeptide antibiotic?
|
vancomycin
|
|
Oral vancomycin use
|
severe or refractory CDAD (C diff assc disease)
|
|
Does vancomycin cover G+ organisms?
|
No
|
|
An example of a lipoglycopeptide?
|
telavancin
|
|
What is telavancin used for?
|
complicated skin & soft tissue infex caused by Gm+, including MRSA
|
|
An example of a cyclic lipopeptide?
|
daptomycin (IV)
|
|
Why is it prudent to hold statins while on daptomycin?
|
Both can cause muscle discomfort/weakness
|
|
Daptomycin is used for MRSA & VRE T/F?
|
True
|
|
Tetracyclines inhibit protein syntheis by binding to 30S ribosomal unit T/F?
|
True
|
|
Take tetracyclines with a full glass of milk
|
False
|
|
What is a special side effect ass w/ minocycline?
|
Vestibular(vertigo)
Purplish/blue hyperpigmentation of skin (esp. scars) drug-induced lupus |
|
Doxycycline is used to teat comminity acquired pneumonia T/F?
|
True
|
|
Class Ia Anti-Arrhythmics
Quindine ADRS |
- sudden death (increased QT & Torsade de Pointes)
- Cinchonism (urinary retention, vascular flushing, blurred vision (mydriasis), delerium, psychosis, anhidrosis) |
|
Class Ia Anti-Arrhythmics
Procainamide ADRs |
revesible Lupus-like syndrome
|
|
Class Ib Anti-Arrhythmics
Lidocaine ADRs |
GI upset, CNS toxicity, cardiac hypotension
|
|
Class Ic Anti-Arrhythmics
specific drugs |
- Flecanide & propafenone
|
|
Class Ic Anti-Arrhythmics
ADRs |
- CNS toxicity (dizziness and blurred vision)
- Cardiac (pro-arrhythmic, (-) inotropic effect |
|
Tetracyclines can not be used to treat Lyme disease T/F?
|
False
|
|
An example of a glycylcine abx
|
tigecycline
|
|
An advantage of tigecycline
|
Extrememly broad coverage
Useful for nosocomial infex |
|
Tigecycline does not cover pseudomonas aeruginosa T/F?
|
True
|
|
Macrolides inhibit bacterial protein synthesis by binding to 50S bacterial ribosomal subunit T/F?
|
True
|
|
An advantage of clarithromycin and erythromycin is that there are few drug interactions with them T/F?
|
False. Both are potent inhibitors of CYP3A4
|
|
An example of a macrolide
|
Erythromycin
Clarithromycin Azithromycin |
|
Azithromycin can be used to trreat non-gonococcal urethritis/cervicitis T/F?
|
True
|
|
An example of a lincosamide
|
clindamycin
|
|
Most common adverse effect of clindamycin
|
diarrhea, including c. diff colitis
|
|
A common use of clindamycin
|
1. substitute for b-lactam allergy for SSTIs & strep pharyngitis
2. anaerobic infex/abscesses (+ b-lactam or fluoroquinolone) |
|
An example of a oxazolidinone
|
linezolid (PO/IV)
|
|
Linezolid uses
|
MRSA & VRE
|
|
Aminoglycosides inhibit bacterial protein synthesis by binding to 50S bacterial subunit T/F
|
False. They bind to 50S not 30S
|
|
Major adverse effects with aminoglycosides
|
Ototoxic
Nephrotoxic Neuromuscular blockade in MG pts |
|
Which aminoglycoside has the best pseudomonal activity?
|
tobramycin
|
|
An example of an aminoglycoside
|
Gentamicin tobramycin amikacin, etc
|
|
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 |
4.
|
|
Non-respiratory Fluoroquinolones uses
|
Upper & lower UTI
Traveler's diarrhea/ enteric infex |
|
Examples of non-respiratory fluoroquinolones
|
ciprofoxacin
ofloxacin lomefloxacin |
|
Example of 3rd generation respiratory fluoroquinolone
|
levofloxacin
moxifloxacin gemifloxacin |
|
A common use of levofloxacin (levaquin)
|
upper & lower UTI
traveler's diarrhea/enteric upper & loer RTI |
|
Sulfa drugs interfere with bacterial folic acid synthesis by inhibiting T/F?
|
True
|
|
One problem with sulfonamides & trimethoprim is that both can inhibit CYP2C9 T/F?
|
True. watch warfarin
|
|
Major adverse effects of sulfonamides & trimethoprim
|
Severe rash (exfoliative dermatitis)
Reversible myelosuppression Hemolytic anemia in pts w/ G6PD deficiency |
|
Example of sulfonamide/trimethroprim
|
bactrim
septra |
|
Common use of bactrim
|
URTIs
lower UTIs (usually 2nd line) PCP MRSA (not serious) |
|
Can trimethroprim be used when allergic to sulfa?
|
yes
|
|
An example of a nitroimidazole
|
Metronidazole (flagyl)
Tinidazole |
|
Microbial coverage of nitroimidazole (metronidazole & tinidazole)
|
Most strict anaerobes & some protozoa (trich, giardia)
|
|
Uses of metronidazole (flagyl)
|
bacterial vaginosis
C diff infex amebiasis, giardiasis, tric |
|
Long term usage of a nitrofuran will not lead to pulmonary fibrosis
|
False. It may lead to pulmonary fibrosis so don't use long term
|
|
An example of a nitrofuran
|
macrobid
macrodantin |
|
Common use of macrobid or macrodantin
|
lower UTI & prophylaxis of recurrent UTIs
|
|
Non-absorbed oral antibiotic derived from rifampin
|
rifaximin
|
|
Rifaximin is used for:
|
Travelers' diarrhea by non-invasive E coli (not effective if fever & blood)
|
|
TB 1st line drugs
|
R.I.P.E=
Rifampin Isoniazide (INH) Pyrazinamide Ethambutol |
|
TB 2nd line agents
|
streptomycin
kanamycin amikacin capreomycin cycloserine ethionamide levofloxacin moxifloxicin ASA |
|
The drug of choice for latent TB for 9 months=
|
Isoniazide (INH)
|
|
Vitamin B6 helps decrease risk of peripheral neuropathy & drug induced lupus when used with ____TB agent
|
Isoniazide (INH)
|
|
Rifampin is a weak inducer of most CYP enzymes T/F?
|
False--a strong inducer
|
|
Common uses of rifampin
|
1. component of active tb tx
2. latent tb tx (if intolerant of INH) 3. Meningococcal Meningitis prophylaxis |
|
ADRs ass w/ pyrazinamide
|
Non-gouty polyarthralgia (up to 40%0
Asymptomatic hyperuricemia Dose-related hepatitis |
|
Pyrazinamide use
|
component of active tb tx
|
|
Ethambutol use
|
component of active tb tx
|
|
Class III Anti-Arrhythmics
Amiodarone (Cordarone) drug specifics |
- FDA approved for life-threatening arrhythmias and also used for atrial fibrillation
- highly lipid soluble with long elimination 1/2 half life |
|
Amiodarone (Cordarone) interactions
|
- substrate of CYP2C9 & 3A4
- likely inhibits P-glycoprotein (digoxin transport, digoxin excretion blocked) - avoid other QT prolongators (Quinilones) |
|
Class III Anti-Arrhythmics ADRs
|
- Pulmonary toxicity
- Thyroid toxicity (hypothyroidism>>hyperthyroidism - Ocular toxicity - Optic Neuritis - bluish skin discoloration with recurrent sun exposure - Bradycardia |
|
Class III Anti-Arrhythmics
Sotalol (Betapace) ADRs |
- Cardiac (pro-arrhythmic, bradycardia)
- Bronchospasm - Hypoglycemia |
|
Class IV Anti-Arrhythmics
Specific drugs |
- Verapamil
- Diltaizem |
|
Side effect w/ Ethambutol (ETH)?
|
Dose related optic neuritis
|
|
Examples of anti-herpetic antivrals
|
acyclovir
famciclovir valacyclovir |
|
Uses of anti-herpetic anti-virals
|
HSV & VZV infex
|
|
Anti-CMV Antivirals
|
Ganciclovir
valganciclovir |
|
An adverse reax of an anti-CMV antiviral
|
myelosuppression
|
|
Anti-flu antivirals
|
Amantidine/rimantidine
Oseltamivir (tamiflu) Zanamavir (relenza) |
|
Oseltamivir & zanamavir used for
|
Influenza A & B prophylaxis & tx
|
|
An example of a polyene antifungal
|
amphotericin B
nystatin |
|
Nystatin use
|
topical orophayngial candidiasis (Thrush)
|
|
ADR of amphotericin-B
|
F/C, nephrotoxicity
|
|
Uses of amphotericin-b
|
invasive aspergillosis and other deep fungal infex
|
|
Examples of antifungal azoles
|
Clotrimazole
miconazole fluconazole, etc |
|
Topical skin azole antifungals
|
clotrimazole
econazole miconazole |
|
Topical vaginal azole antifungals
|
terconazole
miconazole ticonazole |
|
Systemic azole antifungals
|
ketoconazole
itraconazole fluconazole voriconazole posaconazole |
|
Fluconazole is highly concentrated in the urine
|
True
|
|
Main use of fluconazole (po/iv)
|
Candida infex (thrush, esophagitis, vulvovaginitis)
|
|
Example of echinocandin antifungal
|
casofungin
micafungin anidulofungin |
|
Uses for echinocandin antifungals
|
Nosocomial fungal infex
Immunocompromised pts |
|
Example of an allylamine antifungal
|
lamisil
|
|
CCBs ADRs
|
- Cardiac (hypotension, bradycardia, (-) ionotrope, flushing, peripheral edema)
- CNS (HA, dizziness / lightheadedness) - Note Verapamilcan cause constipation |
|
Digoxin
Interactions |
- many drug interactions based on P-gp
|
|
Digoxin
ADRs |
- Cardiac (arrhythmigenic / AV block)
- oral steroids & diuretics lower K and increase toxicity - Gynecomastia - Yellow vision |
|
Thiazide-type & Loop Diuretics
Specific drugs |
- Thiazide type - HCTZ, chlorthalidone
- Loop - furosemide, bumetanide (closer to kidneys, stronger med) |
|
Thiazide-type & loop diuretics
Interactions |
- Digoxin & Lithium toxicity via electrolyte alterations
- antagonizes diabetes and gout medications |
|
Terbinafine (lamisil) use
|
onychomycosis
cutaneous dermatophyte infex |
|
ADR of terbinafine
|
Hepatotoxicity
|
|
Thiazide-type & Loop Diuretics
ADRs |
- electrolite disturbances (hypokalemia, hypoatremia, hypercalcemia-thiazides)
- SNHL (ringing) - furosemide |
|
Potassium Sparing Diuretics
Specific drugs |
- Spironolactone, amiloride, triamterene (kidney stones - weakest diuretics)
|
|
Potassium Sparing Diuretics
Interactions |
- avoid potassium supplements / salt substitutes
- Digoxin & lithium toxicity |
|
Potassium Sparing Diuretics
ADRs (based on spironolactone) |
- Hyperkalemia
- Hormone-like effects - Estrogenic effects (gynecomastia, menstraul irregularities) - Anti-androgen effects (impotence & reduced libido) |
|
ACE Inhibitors
Spcific Drugs |
- Ex. lisinopril
|
|
ACE Inhibitors
ADRs |
- cough
- hyperkalemia - angioedema - birth defects (contrindicated) |
|
Angiotensin-II Receptor Blockers (ARBs)
Specific drugs |
- "sartan" drugs (losartan)
|
|
ARBs
Interactions |
- other K+ sparing drugs (ACEIs, spironolactone)
|
|
ARBs
ADRs |
- Hyperkalemia
- birth defects (contraindicated) |
|
alpha-Adrenergic Blockers
specific drugs |
- Systemic (nonselective) / Prazosin, terazosin, Doxazosin
- Non-systemic (selective- BPH) / Alfuzosin, Silodasin |
|
alpha-Adrenergic Blockers
ADRs |
- Nonselective agents cause drowsiness / fatigue, nasal congestion, postural hypotension
- Selective agents cause retrograde ejaculation |
|
beta-Blockers
Specific drugs |
- 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) |
|
beta-Blockers
Specific drugs (con't) |
- beta-Blockers with Intrensic Sympathomimetic Activity (ISA) (pindolol, acebutolo-lowers blood pressure with less decrease in hart rate)
|
|
beta-Blockers
Specific drugs (con't) |
- beta-Blockers with alpha-1 b;ocking activity (carvedilol-beta & alpha blockade, more for CHF, than HTN
|
|
beta-Blockers
Interactions |
- Hypotension with other anti-hypertensives
|
|
beta-Blockers
ADRs |
- Bradycardia
- Bronchospasm |
|
Calcium Channel Blockers (CCBs)
Specific drugs |
- ("pines")
- 1st generatio dihydropyridines (nifedipine) 2nd generation dihydropyridines (amlodipine) |
|
CCBs
ADRs |
- Flushing
- peripheral edema - reflex tachycardia Gingival hyperplasia (also phenytoin, dilantine) |
|
Central alpha-Adrenergic Agonists
Specific drugs |
- Clonidine (Catapres)
- Methyldopa (Aldomet) - pregnancy |
|
Central alpha-Adrenergic Agonists
ADRs |
- Sedation
- Dry moth - Depression |
|
Direct Vasodilators
Specific drugs |
- Hydralazine - pregnancy
- Minoxidil |
|
Direct Vasodilators
ADRs |
- Hydralazine (lupus-like reaction)
- Minoxidil (hirsutism & severe fluid retention, refactory BP) |
|
Erectile Dysfunction (ED) Medications
Specific drugs |
- Sildenafil - 4hrs 1/2 life
- Vardenafil - 4 hrs 1/2 life - Tadalafil - 18 hrs 1/2 life |
|
ED Medications
Interactions |
- alpha-blockers - postural hypotension & dizziness
- nitrates - hpotension |
|
ED Medications
ADRs |
- HA & flushimg common to all
- Slidenafil associated with bluish vision |
|
Anti-Platelet Agents (weakens platelets)
ADP receptor inhibitors |
- Ticlopidine
- Clopidogrel - Prasugrel |
|
Aspirin
MOA |
- ASA inhibits COX imparing transformation AA -> PGs, prostacycline, & throboxane A2 -> decreased thromboxane A2 -> decreased platelet aggregation
- irreversible plt effect |
|
Diabetic Drugs - Biguanides
Specific drugs |
Metformin
|
|
Biguanides
Interactions |
other "anti-DM" drugs
|
|
Biguanides
ADRs |
- GI upset
- Lactic acidosis (contraindicated in renal insufficiency, liver failure, CHF, major surgery, IV contrast) -will not cause hypoglycomia |
|
Diabetic drugs - Sufonylureas
Specific drugs |
1st generation
-Tolazamide, tolbutamide, chlorpropamide 2nd generation - glimepiride, glipizide, glyburide (longer 1/2 life) |
|
Sulfonylureas
interactions |
- other "anti-DM" agents
|
|
Sulfonylureas
ADRs |
- weight gain
- hypoglycemia - "Disulfiram-like" rxn with possible chlorpropamide |
|
Diabetic drugs - Thiazolidinediones
Specific Drugs ("glitazones") |
- Rosiglitazone
- Pioglitazone |
|
Thiazolidinediones
Interactions |
- Other "anti-DM" agents
|
|
Thiazolidinediones
ADRs |
- weight gain, fluid retention (contraindicated in advanced HF pts
- Troglitazone & rosiglitazone removed or restricted 2 deg. toxicity |
|
Thyroid Medications
Specific drugs |
- Levothyroxine
- Methimazole |
|
Thyroid Medications
Specific drugs |
- Levothyroxine
- Methimazole |
|
Levothyroxine interactions
|
- Interactions include both decreased absoption and drug-drug interactions
|
|
Methimazole interactions
|
- Potentiates anticoagulates
|
|
Levothyroxine ADRs
|
- hyperthyroidism
- decreased bone mineral density - Transient alopecia |
|
Methimazole ADRs
|
- rash
- bone marrow supperssion /aplastic anemia - drug fever - alopecia |
|
Respiratory Therapeutics - Corticosteroid Inhalers
- Ex. fluticasone interactions |
- none
|
|
Corticosteriod Inhalers
ADRs |
- Dysphonia & thrush (rinse and spit)
- Long term risk of growth, cataracts, etc. |
|
Inhaled beta2-Agonists
- specific drugs |
- albuterol (fast onset)
- salmeterol (long acting) |
|
Inhaled beta2-agonists
interactions |
- avoid beta-blockers
|
|
Inhaled beta2-agonists
ADRs |
- tachycardia (palpitations)
- paradoxical bronchospasm - CNS effects (nevvousness, tremor) |
|
Leukotriene Modifiers
Specific drugs |
- Montelukast (Singulair)
- Zafirlukast (Accolate) - Zileuton (Zyflo) |
|
Leukotriene Modifiers
Interactions |
- CYP interactions possible (less with montelukast)
|
|
Leukotriene Modifiers
ADRs |
- Montelukast is predominately used as it is well-tolerated & has QD dosing
- Zileuton has caused hepatotoxicity & agranulocytosis |
|
Theophylline
drug specifics |
- monitor drug levels
|
|
Theophylline
interactions |
- multiple CYP interactions
|
|
Theophylline
ADRs |
- GI upset
- CNS effects (nervousness, tremor, seizure) - Cardiac effects (tachycardia, arrhythmias) |
|
Older Anti-Epileptics
Specific drugs |
- Phenytoin (Dilantin)
- Carbamazepine (Tegretol) - Valproic acid (Depakote) |
|
Older anti-epileptics
interactions |
- multiple CYP interactions
|
|
Older anti-epileptics
ADRs of Phenytoin |
- 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 |
|
Older anti-epileptics
ADRs of Valproic Acid |
- hepatotoxicity / pancreatitis
- CNS effects (primary tremor) - polycystic ovarian syndrome - neural tube drfects (spina bifida) |
|
Leukotriene Modifiers
Specific drugs |
- Montelukast (Singulair)
- Zafirlukast (Accolate) - Zileuton (Zyflo) |
|
Leukotriene Modifiers
Interactions |
- CYP interactions possible (less with montelukast)
|
|
Leukotriene Modifiers
ADRs |
- Montelukast is predominately used as it is well-tolerated & has QD dosing
- Zileuton has caused hepatotoxicity & agranulocytosis |
|
Theophylline
drug specifics |
- monitor drug levels
|
|
Theophylline
interactions |
- multiple CYP interactions
|
|
An example of an h2 blocker
|
famotidine
nizatidine |
|
Example of a Proton Pump Inhibitor
|
Omeprazole
Esomeprazole Lansoprazole Etc. |
|
Interaction of PPI's
|
They alter absorption of pH-dependent drugs (iron, aspirin, etc)
|
|
ADR of a PPI
|
Acid Rebound
|
|
Older anti-emetics such as prochloroperazine and promethazine may potentiate CNS depressants T/F?
|
True
|
|
ADRs of prochloroperazine and promethazine
|
Dizziness
Amenorrhea EPS |
|
Examples of newer anti-emetics
|
Ondanestron
Dolasetron granisetron palonosetron |
|
Indications for newer anti-emetics
|
Chemo induced emesis
post op radiation nausea |
|
Colchicine is a drug commonly used for
|
gout
|
|
ADRs of colchicine
|
diarrhea, myelosuppression, peripheral neuritis, reversible azoospermia
|
|
Gout med that is used for acute gout and may cause severe rash
|
allopurinol
|
|
Examples of bisphosphonates
|
alendronate
risedronate icandronate zoledronate Etc |
|
Serious ADRs of bisphosphonates
|
Esophageal (ulcers, strictures, erosion, etc)
Jaw osteonecrosis Atypical femoral fx |
|
Examples of DMARDS
Idisease modifying anti rheuamatic druds) |
Oral corticosteroids
hydroxychloroquine methotrexate sulfasalazine Tumor necrosis factor=etanercept, infliximab, etc |
|
Examples of oral corticosteroids
|
prednisone
methylprednisolone dexamethasone |
|
Gout med that is used for acute gout and may cause severe rash
|
allopurinol
|
|
Examples of bisphosphonates
|
alendronate
risedronate icandronate zoledronate Etc |
|
Serious ADRs of bisphosphonates
|
Esophageal (ulcers, strictures, erosion, etc)
Jaw osteonecrosis Atypical femoral fx |
|
Examples of DMARDS
Idisease modifying anti rheuamatic druds) |
Oral corticosteroids
hydroxychloroquine methotrexate sulfasalazine Tumor necrosis factor=etanercept, infliximab, etc |
|
Examples of oral corticosteroids
|
prednisone
methylprednisolone dexamethasone |
|
Newer Anti-Epileptics
specific drugs |
- gabapentin
- lamotrigine (lamictal) - leviracetam - oxcarbazepine -tiagabine -topirmate -zonisamide |
|
Newer Anti-Epileptics
interactions |
- all have CYP interactions
- gabapentin & leviracetam are exceptions |
|
Newer Anti-Epileptics
ADRs |
- dizziness
- anorxia - insomnia -cognitive problems - confusion, concentration problems |
|
Monoamine Oxidase Inhibitors (MAOIs)
specific drugs |
- Ex. phenylzine
|
|
MAOIs
interactions |
- sympathomimetics
- high-tyramine foods (cheese-induced crisis) |
|
MAOIs
ADRs |
- orthostatic hypotension
- CNS overstimulation |
|
Tricyclic Antidepressants (TCAs)
specific drugs |
- Ex. amitriptyline
|
|
TCAs
interactions |
- contraindicated with MAOIs
- overlapping toxicities with other CNS depressants |
|
TCAs
ADRs |
- anti-cholinergic effects (fatigue, dry mouth, etc)
|
|
Selective Serotonin Re-Uptake Inhibitors (SSRIs)
specific drugs |
- fluoxetine
- paroxetine -sertraline - citalopram / escitalopram |
|
ADRs oral corticosteroids
|
Cushingoid (fat redistr)
Osteoporosis HPA-axis suppression (growth suppression) Cataracts Avascular necrosis Poor wound healing GI ulcers/bleeding |
|
An ADR of azathioprine (a DMARD)
|
reversible bone marrow suppression
hepatitis/pancreatitis alopecia |
|
An ADR of hydroxychloroquine (a DMARD)
|
Irreversible retinopathy
Hair bleaching/skin pigmentation changes Hemolysis w/ G6PD deficiency |
|
ADR of methotrexate
|
Myelosuppression
Hepatitis/liver fibrosis Hypersensitivity pneumonitis |
|
ADR of sulfasalazine (a DMARD)
|
Rash
Myelosuppression Lupus-like syndrome Hemolysis w/ G6PD deficiency |
|
ADR of TNF inhibitors such as infliimab entercept (DMARD)
|
Increased risk of infection
(check baseline TST & CXR) |
|
Cyclophosphamide is used for
|
chemo
|
|
ADR of cyclophosphamide
|
Hemorrhagic cysititis
alopecia myelosuppression |
|
Chemo drug cisplatin has ADRs similar to gentamicin T/F?
|
True
(renal, ears) |
|
5-FU (Chemo) ADRs
|
Oral mucositis/GI ulcers
Nausea Myelosuppression |
|
Chemo bleomycin ADRs delayed toxicity ADRs
|
Pulmonary fibrosis
Alopecia |
|
Doxorubicin chemo drugs has delayed ADRs:
|
Cardiotoxic
Delayed emesis Alopecia Mylelosuppression Stomatitis |
|
Paclitaxel (taxol) chemo delayed ADRs
|
Neuropathy (esp palmar/plantar)
Myelosuppression |
|
Leukocyte Stimulating Med (help w/ chemo causing decreased WBC)
|
Filgastrim
|
|
ADR of filgastrim (used to stimulate WBCs)
|
Bone pain
Fever |
|
SSRIs
interactions |
- CYP interactions
- potent inhibitor of CYP2D6 - paroxetine & fluoxetine most likely for interaction |
|
SSRIs
ADRs |
- Note FDA requires warning about antidepressants & sucide
- sexual side effects - ED/delayed ejaculation (men) - anorgasmia (women) - decreased libido in both - anorexia - bruxism |
|
SSRIs
ADRs |
- 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 |
|
ADHD Medications
specific drugs |
- Methylphenidate
- short-acting, intermediate-acting, long acting - dexmethylphenidate - dextroamphetamine - short-acting, long-acting - amphetamine mixture |
|
ADHD Medications
ADRs |
- motor/vocal tics
- anorxia/weight loss - insomnia - tachycardia |
|
Erythropoietin or darbepoetin is used to
|
Stimulate erythrocytes (RBCs)
|
|
Possible ADR of erythropoetin
|
AMI/CVA (with elevated Hct)
|
|
An example of a transplant med
|
cyclosporine
tacrolimus |
|
If allergic to sulfonamide (rash), will pt be allergic to sulfur, sulfate or sulfite
|
No, not necessarily
|
|
Meds to avoid w/ sulfa allergy
|
Furosemide
HCTZ Sulfonykureas (glyburide) |
|
Why drug interactions w/ grapefruit juice?
|
Grapefruit juice (small amts) inhibits intestinal CYP3A4
|
|
Can the grapefruit juice interaction be lessened by separting meds and juice?
|
No
|
|
Oral drugs w/ narrow therapeutic windows are especially problematic w/ grapefruit juice T/F?
|
True
|
|
Other citrus that can cause drug interactions
|
Seville (sour) oranges
Pomelos |
|
Drugs to watch w/ grapefruit juice
|
Amiodarone
Benzodiazepines CCBs Statins Cyclosporine |
|
Drugs causing esophageal irrittaion
|
Tetracyclines
Bisphosphonates NSAIDS Potassium chloride |
|
Dugs causing alopecia
|
Chemo: bleomycin, cyclophosphamide, fluorouracil
Interferons |
|
2 drugs that are common offenders for drug-induced lupus
|
Procainamide
Hydralazine |
|
Drugs ass w/ drug fever
|
Anticonvulsants (phenytoin, carbamezepine)
Antimicrobial Allopurinol H2 blockers |
|
Drugs ass w/ QT issues
|
Anti-arrhythmics
Cisapride Macrolides Droperidol Haloperidol |
|
Benzodiazepines
specific drugs |
- Ex. lorazepam, alprazolam, midazolam
|
|
Benzodiazepines
interactions |
- potentiation of CNS depression with ETOH / other CNS depressants
|
|
Benzodiazepines
ADRs |
- sedation, dizziness, withdrawl symptoms
|
|
Sedatives / Sleeping Agents
specific drugs |
- zolpidem
- zaleplon |
|
Sedatives / Sleeping Agents
interactions |
- potentiations of CNS depression with ETOH / other CNS depressants
|
|
What are 1st semester warfarin effects on fetus?
|
Hypoplastic nasal bridge, chonfrodysplasia
|
|
Fetal Hydantoin Syndrome (phenytoin)
|
Growth deficiency
Craniofacial anomalies Mental retardation Nail/digital hypoplasia |
|
Valproic acid can cause what teratogenic effect?
|
neural tube defects
|
|
DES (diethylstilbestrol) can cause what teratogenic effect?
|
vaginal adenocarcinoma
|
|
ACEI can cause what teratogenic effects?
|
CV & CNS malformations
|
|
A drug to avoid with G6PD deficiency
|
Sulfa abx
Nitrofurantoin Dapsone Sulfasalazine Antimalarials |
|
Thalidomide was ass w/ what fetal effect?
|
Phocomelia (shortened limbs)
|
|
Histoplasmosis is linked to
|
bird or bat poop
|
|
Histoplasmosis is a bacterial infex T/F
|
False. Fungal
|
|
Histoplasmosis is treated w/
|
Itraconazole (mild) or amphotericin-b (severe)
|
|
Blastomycosis is linked to
|
Ohio River Valley soil/dust exposure
|
|
Blastomycosis causes:
|
Asymptomatic pulm infex
Derm issues w/ clavicles and above |
|
Blastomycosis is treated w/
|
Itraconazole or amphotericin-b (severe)
|
|
Coccidiodomycosis (San Joaquin Fever) linked to
|
southern CA to Texas
|
|
Coccidiodomycosis causes:
|
Influenza-like illness
erythema nodosum |
|
Coccidiodomycosis tx
|
Often no tx needed
|
|
Pneumocystosis (PCP) is often seen in these pts
|
AIDS
|
|
PCP presents w/ these symtoms
|
Fever, dyspnea, non-productive cough
|
|
Diagnose PCP w/
|
CXR
Sputum/bronch DFA |
|
Treat PCP w/
|
TMP-SMX & use prednisone if PaO2<70
|
|
Cryptococcus is the most common cause of fungal meningitis T/F?
|
True
|
|
Cryptococcus is seen more in these pts
|
AIDS
Immunocompromised |
|
Cryptococcus may present w/ what symptoms?
|
Altered mental state, HA, meningismus
|
|
Treat cryptococcus w/
|
Amphotericin-B or floconazole
|
|
Dx cryptococcus w/
|
CSF & serum crypto antigen
India ink may be + |
|
Sedatives / Sleeping Agents
ADRs |
- drugged feeling
- daytime fatigue |
|
Lithium
drug specifics |
- need drug level monitoring
|
|
Lithium
interactions |
- ACEI, ARBs, NSAIDS, Thiazides
|
|
Lithium
ADRs |
- fine, transient hand tremor
- CNS effects (HA, memoryimpairment, confusion, altered motoe skills) - hypothyroidism - nephrogenic diabetes insipidus |
|
Antipsychotic agents
specific drugs |
- 1st generation agents
- haloperidol, chlorpromazine, etc - 2nd generation - clozapine (most effective) - olanzapine - risperidone - ziprasidone - aripiprazole - quetiapine |
|
Disease entities caused by Aspergillosis
|
Allergic bronchopulmonary aspirgillosis
Aspergilloma (fungus ball looks like lung ca) Invasive (most common in pts w/ prolonged neutropenia) |
|
Vag Candidiasis is tx w/
|
Conazole cream
Fluconazole |
|
Esophageal candidiasis is tx w/
|
Fluconazole
|
|
Symptoms of esophageal candidiasis
|
Substernal odynophagia
GE reflux Nausea |
|
Babesiosis is a fungal infex T/F?
|
False. Protozoal
|
|
Called N American Malaria
|
Babesiosis
|
|
Most virulent strain of malaria
|
Plasmodium falciparum
|
|
Malaria is transmitted by th emale Anopheles mosquito T/F?
|
False. Transmitted by female mosquito
|
|
What disease presents with periodic chills/fever/sweats?
|
Malaria
|
|
How to dx malaria
|
Thick/thin blood smears
|
|
Malaria prophylaxis meds
|
Chloroquine
Mefloquine, doxycline, etc |
|
Toxoplasmosis is a bacterial infex T/F?
|
False. Protozoal
|
|
How toxoplasmosis is transmitted
|
Contaminated food, kitty litter
|
|
Symptoms of primary toxoplasmosis infex
|
Usually none
|
|
Toxoplasmosis tx
|
Pyrimethamine and sulfadiazine
|
|
Herpes zoster primary infex is
|
Chickenpox
|
|
Shingles in pt <40-50 should make you consider what
|
HIV
|
|
Prodromal symptoms of shingles:
|
burning, tingling in region of sensory nerve distribution (followed by vesicular rash 1-3 dermatomes)
|
|
Tx of shingles
|
acyclovir po (mild to mod)
acyclovir IV if severe |
|
Ebstein Barr Virus (EBV) is also called
|
Infectious Mononucleosis
|
|
Ebstein Barr symptoms
|
Malaise
Fever Severe sore throat |
|
EBV exam findings may include
|
Waldeyer's Ring exudate
Post cervival lymphadenopathy Splenomegaly Maculopap rash |
|
Tests for EBV
|
Atypical lymphocytosis
Monospot test |
|
Tx for EBV
|
Symptomatic: fluid, analgesics
Possibly steroids |
|
Ways CMV transmitted
|
Sexual, congenital, transfusion, transplant, person-to-person (resp secretions)
|
|
CMV complications w/ AIDS
|
CMV retinitis (blindness)
Esophageal ulcers to anus Pneumonia |
|
CMV tx
|
Gangiclovir
|
|
HHV-8 causes what type of sarcoma?
|
Kaposi's
|
|
Rabies is caused by this type of virus
|
rhabdovirus
|
|
Prominent ways you get rabies
|
Bite of bats, skunks, raccoons and foxes
|
|
Initial symptoms of rabies
|
Pain at bite wound followed by paresthesias
|
|
Later manifestations of rabies
|
Extreme behavior
Convulsions Seizures |
|
Rabies tx
|
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 |
|
Who is at risk for HIV?
|
Anyone who is sexually active or injects drugs
|
|
What type of virus is HIV?
|
retrovirus
|
|
Acute HIV Syndrome:
|
Mono-like (but more severe)
Rash 40-90% Mucocutaneous ulceration |
|
HIV Dx
|
HIV RNA level. Viral load done by PCR
|
|
Most common HIV clinical presentation
|
Asymptomatic
|
|
HIV screening test
|
ELISA
|
|
HIV Confirmatory test
|
WB
|
|
Sedatives / Sleeping Agents
ADRs |
- drugged feeling
- daytime fatigue |
|
Lithium
drug specifics |
- need drug level monitoring
|
|
Lithium
interactions |
- ACEI, ARBs, NSAIDS, Thiazides
|
|
Lithium
ADRs |
- fine, transient hand tremor
- CNS effects (HA, memoryimpairment, confusion, altered motoe skills) - hypothyroidism - nephrogenic diabetes insipidus |
|
Antipsychotic agents
specific drugs |
- 1st generation agents
- haloperidol, chlorpromazine, etc - 2nd generation - clozapine (most effective) - olanzapine - risperidone - ziprasidone - aripiprazole - quetiapine |
|
Migraine Medications
specific drugs ("triptans") |
- 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 |
|
Migraine Medications
Interactions |
- Careful with SSRIs & MAOIs
|
|
Migraine Medications
ADRs |
- generally well-toerated
- AMI symtoms (careful with CAD) |
|
Sexually Transmitted Infections (STIs)
Trichomonal Vagenitis is caused by? |
- Trichomonas vaginalis
|
|
Trichomonal Vaginitis presents with?
|
- vaginal pruritis and a malodorous frothy, yellow-green discharge
- cervical petechiae (strawbeyyy cervix) - trichomonads are seen on wet prep |
|
Trichomonal vaginitis treatment?
|
- treat with metronidazole 2g PO X1
- check for other STIs - treat partners and educate to refrain from sex until infection is treated |
|
Chlamydial Urethritis / Cervicitis (the most common STI) is caused by?
|
- Chlamydia trachomatis
|
|
Chlamydial Urethritis symptoms?
|
- 75 - 90% of cases are asympotomatic, recommended to screen all women over 25 yrs and other asymptomatic women at increased risk
|
|
Chlamydial Urethriti presentation?
|
- 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) |
|
Chlamydial Urethritis / Cervicitis diagnosis
|
- 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 |
|
Chlamydial Urethritis / cervicitis treatment?
|
- 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 |
|
Lymphogranuloma venereum
is caused by? |
- Chlamydia trachomatis serovars Li - L3
|
|
Lymphogranuloma venereum diagnosis
|
- statrs with painless mucosal lesion leading to lymphatic spread then inguinal bubo then draining sinus tracts
|
|
Lymphogranuloma venereum treatment?
|
- tread with doxycycline 100mg BID PO X 21d
- check for other STIs - treat partners and educate to refrain from sex until infection is treated |
|
Gonorrhea is caused by?
|
- Nesseria gonorrhoeae (GN diplococci)
|
|
Gonorrhea infects?
|
- can infect any mucocutaneous surface (oral, urethral, vaginal, anal)
|
|
Gonorrhea presents with?
|
- 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 |
|
Gonorrhea diagnosis?
|
- gram stain / culture of discharge (mostly helpful for men) or NAAT of discharge or urine
|
|
Gonorrhea treatment
|
- 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 |
|
Human Papillomavirus (HPV) causes?
|
- 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 |
|
HPV diagnosis?
|
- diagnose with biopsy
|
|
HPVtreatment?
|
- treat withablation, imiquimod (Aldara), podofilox, etc.
- check for other STIs |
|
Virus (HSV) effects?
|
- 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 |
|
HSV presentation?
|
- 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 |
|
Other HSV effects?
|
- can also cause:
- ocular disease - meningoencephalitis - esophagitis / proctitis - HSV-1 is associated with Bell's Palsy |
|
HSV clinical diagnosis?
|
- 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 |
|
HSV treatment
|
- treat with acyclovir, valacyclovir, or famciclovir
- 6/yr try supressive therapy - treatment does not eradicate disease - check for other STIs |
|
Chancroid (caused byHaemophilus ducreyi) presents with?
|
- presents with painful genital ulcer (chancre) with fluctuant inguinal adenitis
|
|
Chancroid treatment?
|
- treat with ceftriaxone 250mg IM X1 or azithromycin 1g PO X1
- check for other STIs |
|
Granuloma inguinale or Donovaliasis (caused by Klebsiella granulomatis) effects?
|
- chronic, relapsing, granulomatous anogenital infection
- painful infiltrated nodules -> ulcer with red friable base of granulation tissue |
|
Granuloma inguinale or Donovaniasis diagnosis
|
- Donovans bodies seen on Wright or Giemsa stains
|
|
Granuloma inguinale or Donovaniasis treatment
|
- treat with doxycycline 100mg PO BID or TMP-SMX DS PO BID C 304 wks
- check for other STIs |
|
Syphilis (caused by Treponema pallidium) clinical stages
|
- Primary syphilis
- painless ulcer at site of exposure = chancer - Secondary syphilis - generalized maculopapular rash (even palms / soles) - tertiary syphilis - infiltrative tumors (gummas), aortitis, neurosyphilis |
|
Syphilis diagnosis
|
- screening = VDRL or RPR
- confirmatory = FTA - ABS or MHA - TP - more sensitive & specific - stays positive for life |
|
Syphilis treatment
|
- treat with penicillin
- type of penicillin and duration of treatment depend on stage of syphilis - pick benzathine PCN G (Bicillin L-A) |
|
selected orthopedic infections
What is osteomyelitis? |
- 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) |
|
Osteomyelitis etiology
|
- S. aureus is most common overall cause (esp. hematogenous)
- contiguous-focus is often polymicrobial - Salmonella spp. more common in sickle cell patients |
|
Osteomyelitis presentation
|
- variable depending on site of infection
|
|
Osteomyelitis diagnose
|
- 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 |
|
WHat is Infectious Arthritis
|
- inflamation of a joint from a pyogenic organism usually from a transient bacteremia
|
|
Infectious Arthritis most common cause?
|
- 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 |
|
Infectious Arthritis presentation?
|
- present with single, hot, swollen joint
- r /o rheumatic disease |
|
Infectious Arthritis diagnoses
|
- diagnose with joint aspiration
- anti-staphylococcal ABX |
|
Cardiac Infections:
spontaneous bacterial endocarditis (SBE) or infective endocarditis |
- microbial infection of the lining of the hart -> characteristic lesion is a vegetation, which is most commonly found on valvular structures
|
|
SBE microbial etiology
|
- 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 |
|
SBE or Infective Endocarditis
microbial etiology (con't) |
- other organisims HACEK organisms)
- Haemophilus parainfluenzae / aphrophilus - Actinobacillus actinobacillus actinomycetemitians - Cardiobacterium hominis - Eikenella corredens - Kingella kingae |
|
SBE or Infective Endocarditis
classification |
- Left-sided IE
- microbial etiology depends on native vs. prosthetic valve -> vintral - right-sided IE - usually S. aureus in IVDU -> tricuspid |
|
SBE or Infective Endocarditis classification
presentation pattern |
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 |
|
SBE or Infective Endocarditis
common clinical manifestations (for both patterns) |
- 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) |
|
SBE or Infective Endocarditis diagnostic evaluation & treatment options
|
- 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 |
|
Meningitis w/ highest mortality
|
S pneumoniae
|
|
How meningitis is spread
|
Resp droplets or mucosa-to-mucosa (most common)
|
|
Most common classification of meningitis
|
Acute (bacterial or aseptic)
|
|
Meningitis vs meningoencephalitis
|
`encepalitis involves both meninges & brain parenchyma
|
|
What is a parameningeal infex?
|
Space occupying lesions that mimic menigitis ((brain abscess, etc)
|
|
Classic symptoms of meningitis
|
Fever, severe HA, stiff neck
|
|
Which meningitis presents w/ characteristic rash?
|
meningococcemia
|
|
How do you check for nuchal rigidity?
|
Turn head side-to-side, then flex and observe for discomfort
|
|
What is gold standard for meningitis dx?
|
CSF examination (opening PSI, cell ct, diff, glu, protein, gram st & cx)
|
|
When should you order CT w/ suspected meningitis?
|
Significant papilledema, dilated NR pupil, ocular motion abnormalities, stupor, brady, HTN
|
|
Would you have an increased or normal PSI on LP w/ bacterial meningitis?
|
Increased
|
|
Would you have an elevated PSI with aseptic meningitis?
|
Normal or minimally elevated
|
|
What organisms cause aseptic meningitis?
|
Enteroviruses (coxsackie & echo mostly)
|
|
Besides S pneumoniae, what is another organism often causing bacterial meningitis?
|
Listeria
|
|
Tx for community acq acute meningitis?
|
Vanc + ceftriaxone +/- Ampicillin (Amp for listeria)
May give dexamethasone too |
|
Tx for aseptic meningitis
|
Supportive: analgesia, anti-emetics, anti-pyretics
|
|
What causes meningoencephalitis?
|
HSV
Arboviruses (W Nile, St Louis, etc) |
|
What are some different symtoms aseptic vs septic meningitis might have?
|
Aseptic=more neuro findings and seizures (W Nile=muscle weakness & flaccid paralysis)
|
|
What imaging for meningoencephalitis shows temporal lobe abnormalities?
|
MRI
|
|
How to tx meningoencephalitis?
|
Supportive + empiric acyclovir
|
|
What is erysipelas?
|
Infex of epidermis/dermis usually caused by S pyogenes
|
|
What does erysipelas look like?
|
Red, glistening, demarcated
|
|
Erysipelas tx?
|
Anti-staph antibiotics
|
|
This infection involves the epidermis, dermis and connective tissue?
|
cellulitis
|
|
Symptoms of cellulitis?
|
Fever/chills, erythema, induration (lymphatic streaking).
|
|
Is erythema more or less intense with cellulitis or erysipelas?
|
Erysipelas
|
|
How to tx cellulitis?
|
Anti-staph antibiotics
|
|
Cellulitis is usually caused by what organisms?
|
S pyrogens or S aureus
|
|
What do you call infex of hair follicle and apocrine glands?
|
Folliculitis
|
|
Common areas of body folliculitis presents
|
face, buttocks, extensor surfaces
|
|
Tx of folliculitis
|
Warm compresses and mucipiricin
|
|
Wnat organism causes Hot Tub Folliculitis?
|
P Aeruginosa (contaminated hot tubs, pools)
|
|
How does Hot Tub Folliculitis present?
|
Pruritic, sometimes tender papule to pustule
|
|
Tx of Hot Tub Folliculitis
|
Warm compresses and anti=pruritic meds
NO ABX |
|
Presentation of folliculitis
|
small, tender erythematous papules; often topped by central papule
|
|
What is a faruncle (boil)?
|
Firm, tender, erythematous nodule becomes fluctuant
|
|
Common areas where faruncles (boils) found
|
neck, axillae, buttocks
|
|
Organisims causing faruncles
|
S aureus orCA MRSA
|
|
Tx of faruncles
|
I&D, anti-staph abx
|
|
What is a carbuncle?
|
mult abscesses separated by connective tissue, extending into subQ fat in areas of thick, inelastic skin
|
|
Whar part of body are carbuncles usually found?
|
Neck, back, thighs
|
|
What other symptoms are common w/ carbuncles?
|
Fever and constitutional
|
|
Organism usually causing carbuncles
|
S aureus
|
|
Tx of carbuncles
|
I&D, anti-staph abx
|
|
What is necritizing fascitis?
|
Infex that progressively destroys subQ fascia/fat (muscle sparing)
|
|
What orgainism is responsible for necrotizing fascitis?
|
Most infex are polymicrobial, but classically (10%) caused by S pyrogenes
|
|
How does necrotizing fascitis present?
|
Like cellulitis but systemic toxicity and pain worse
|
|
Tx of necrotizing fascitis
|
Debridement is KEY
Broad spectrum ABX secondary |
|
What is Fournier's gangrene?
|
Polymicrobial necrotizing fascitis of scrotum +/- perineum, penis or abd wall
|
|
What pts are you most likely to see Fournier's gangrene in?
|
Diabetics
|
|
Tx of Fournier's gangrene
|
Debridement is key;
Broad spectrum abx secondary |
|
What is clostridial myonecrosis (gas gangrene)?
|
infex that progressively destroys subQ fascia, fat and muscle
|
|
What orgainism causes gas gangrene?
|
C perfringens
|
|
Who is at risk for gas gangrene?
|
Traumatic wounds; enteric surgery
|
|
Presentation of gas gangrene ( clostridial myonecrosis)
|
Severe pain, systemic toxicity, +/- crepitus
|
|
Tx of gas gangrene (clostridial myonecrosis)
|
Extensive debridement
Broad pectrum abx (secondary) |
|
Unique organism often found in dog/cat wound
|
Pasturella multocida
|
|
Unique organism often found in human bite
|
Eikenella corrodens
|
|
What are some abx choices for bites?
|
amoxicillin/calvulanate po or amp/sulbactum IV
cefuroxime or doxycycline or TMP-SMX or FQ Plus clindamycin or metronidazole |
|
How does non-inflammatory diarrhea present?
|
large, watery stool
no blood/PMNs nausea/flu-like symptoms common |
|
What organisms can cause non-inflammatory diarrhea?
|
Viral, protozoal (giargia), bacterial (S aureus, B cereus, V cholera)
|
|
Can you use anti-peristaltic agents w/ non-inflammatory diarrhea?
|
Yes
|
|
How does inflammatory diarrhea present?
|
small volume, frequent, bloody/mucosy stools
many PMNs fever/chills, cramping |
|
Organism w/ Inflammatory diarrhea
|
Protozoal ( E histolytica)
Bacterial (E coli 0157, C diff, Shigella, Salmonella, Campybact, Salmonella) |
|
Can you use anti-peristaltic agents with inflammatory diarrhea?
|
No
|
|
What virus causes Winter Vomiting Disease and is ass w/ cruise ship diarrhea?
|
Norovirus
|
|
How is norovirus diarrhea acquired?
|
Contaminated food/water or person-to-person
|
|
What is most common cause of gatroenteritis is US?
|
Norovirus
|
|
How does norovirus present?
|
diarrhea (+/- N/V) and abd pain that lasts 1-3 d
|
|
How to tx norovirus
|
Supportively w/ ORT (oral rehydration therapy)
|
|
What is the most common parisitic etiology of infex diarrhea in US?
|
Giardia lamblia
|
|
What activity is giardiasis assc w/?
|
Camping/hiking
|
|
How to dx giardiasis
|
EIA (serology)
|
|
Gow to tx giargiasis
|
metronidazole (or tinidazole or nitrazoxanide)
|
|
How does Cryptosporidiosis present?
|
Cholera-like diarrhea
|
|
In what pts is cryptosporidiosis severe?
|
AIDS
|
|
What to tx AIDS pts w/ cryptosporidiosis?
|
Refer them
|
|
How does cholera present?
|
rice water stool
|
|
How to dx cholera
|
Stool cx (looking for vibrio)
|
|
How to tx cholera
|
ORT or IV
Azithromycin decreases duration |
|
Inflammatory diarrhea amebiasis is caused by
|
Enttamoeba histolytica
|
|
Where is amebiasis mainly found?
|
Tropics
|
|
How to dx amebiasis
|
Stool-antigen detection & PCR better than O&P
Also, serology (antigen) & abd CT |
|
Tx of amebiasis
|
metronidazole or tinidazole for colonic dz followed by paromycin (for cysts)
Drain abscess if applicable |
|
What foods is E coli 0157 assc w/?
|
Undercooked hamburger, unpasteurized milk/juice, raw fruits & veggies
|
|
How does E coli 0157 present?
|
afebrile + bloody diarrhea
|
|
Tx of E coli
|
Supportive
|
|
C diff is usually assc w/
|
antibiotic usage (esp clindamycin)
|
|
Symptoms of C diff
|
diarrhea that can lead to PMC, toxic megacolon and fulminant colitis
|
|
Tx of C diff
|
d/c other abx if possible
metronidazole contact isolation |
|
Specific drugs for Parcinson's
|
Carbidopa / levodopa
|
|
Parkinson's medications ADRs
|
Perheral effects like anorxia and orthostatic hypertension
CNS effects like confusion and delusions |
|
Specific Alzheimer's medications
|
cholinesterase inhibitors like Donezpezil and Tacrine
non-cholinesterase inhibitors leke Memantine for moderate cases |
|
Alzheimer's medications ADRs
|
Cholinesterase inchibitors
- N/V/D, insomnia Non-cholinesterase - dizziness, confusion |
|
Dermotologic therapeutics
Accutane interactions |
Avoid concomitant tetracycline and ETOH
|
|
How to dx C diff
|
stool toxin assay/PCR
|
|
Shigellosis is assc w/ what institution?
|
Day-care
|
|
How does shigellosis present?
|
bloody diarrhea, abd pain, tenesmus and systemic toxicity
|
|
Tx of shigellosis
|
fluouquinolone
(kids TMP-SMX or azithromycin) |
|
What is the most common bacterial cause of infectious diarhhea in the US?
|
Campylobacteriosis
|
|
What is campylobacteriosis assc w?
|
Raw/ poorly cooked chicken
|
|
How does campylobacteriosis present?
|
fever, bloody diarrhea, abd pain
Post-campy Guillain-Barre & reactive arthritis possible |
|
Tx of campylobacteriosis
|
Azithromycin (erythromycin)
|
|
How do you ususally get Salmonellosis?
|
Contaminated food/drink or reptiles (turtles)
|
|
What Salmonella organisim usually causes enteric fever?
|
S typhi
|
|
Accutane (Isotretinoin) ADRs
|
Pesudotumor cerebri
teratogenic psychosis / suicidal ideation (?) |
|
Specific antihistamines
|
1st gen
- hydroxyzine - diphenhydramine 2nd gen - fexofenadine - loratadine |
|
antihistamines ADRs
|
drowsiness, dry mouth, tremor
|
|
Morphine derivitives specific medications
|
codeine, morphine, hydrocodone, oxycodone
|
|
Morphine derivities ADRs
|
urinary retention, constipation, respiratory suppression
|
|
What is enteric fever?
|
Syndrome characterized by constitutional symptoms, GI symptoms & HA
|
|
GI symtoms in Samonella typhi
|
Marked constipation or pea soup diarrhea
|
|
Enteric fever is often assc w/ rose spots T/F?
|
True
|
|
Tx of Salmonellosis
|
Ceftriaxone (if severe)
Vaccine is available |
|
Pain medications NSAIDS specific drugs
|
Ibuprofen, naproxen, ketorolac
|
|
NSAIDS interactions
|
increased risk of GI bleed with aspirin & ETOH
|
|
NSAIDS ADRs
|
GI effects
- dyspepsia / gastritis Nephrototoxicity - renal prostoglandin inhibition |
|
Pain medications NSAIDS specific drugs
|
Ibuprofen, naproxen, ketorolac
|
|
Minimizing NSAIDs GI effects
|
- Misoprostol (prosagladin analog that can prevent gastric ulcers
- PPIs may be helpful |
|
NSAIDS interactions
|
increased risk of GI bleed with aspirin & ETOH
|
|
NSAIDS ADRs
|
GI effects
- dyspepsia / gastritis Nephrototoxicity - renal prostoglandin inhibition |
|
Minimizing NSAIDs GI effects
|
- Misoprostol (prosagladin analog that can prevent gastric ulcers
- PPIs may be helpful |
|
What orgainism causes Rocky Mountain Spotted Fever?
|
Rickettsia rickettsi
|
|
How is Rocky Mt Spotted Fever transmitted?
|
tick bite
|
|
Symptoms of Rocky Mt Spotted Fever?
|
"influenza" prodromal, followed by chills/fever, HA, myalgias
Red macular rash appears 2nd-6th day of fever |
|
Where does Rocky Mt Spotted Fever rash appear?
|
Wrists, ankles, then central
|
|
Tx Rocky Mt Spotted Fever
|
Doxycycline
|
|
What causes Ehrlichiosis/Anaplasmosis?
|
tick bite
|
|
How do symtoms of Ehrlichiosis/Anaplasmosis differ from RMSF?
|
Same as RMSF but rash less common or rash spares hands/feet
|
|
How to tx Ehrlichiosis/Anaplasmosis
|
doxycycline
|
|
Tetanus is caused by
|
Clostridium tetani
|
|
What type of wound is tetanus most often assc w?
|
Puncture, but any wound can be prone
|
|
How does tetanus first present?
|
jaw or neck stiffness
Dysphagia |
|
How does tetanus later present?
|
jaw muscle spasm=trismus
|
|
How to prevent tetanus
|
Vaccine
|
|
Tetanus tx
|
vaccine + TIG + penicillin G
|
|
What organism causes botulism?
|
Clostridium botulinum
|
|
How do most get botulism?
|
Home canned products
Honey (infants) |
|
How does botulism present?
|
Sudden diplopia, dry mouth, dysphagia, dysphonia, muscle weakness that leads to paralysis
|
|
Botulism tx
|
Botulism IG (infants)
Trivalent equine antitoxin (adults) |
|
What organism causes Lyme?
|
Borrelia burgdorferi (spirochete)
|
|
Where is Lyme most common?
|
NE and Upper Midwest
|
|
How is Lyme transmitted?
|
tick bite
|
|
What are the early Stage 1 dermatologic symptoms of Lyme?
|
Erythema migrans=sm red papule to centrifygal spread with central clearing (75%)
|
|
What are some possible Stage 2 (disseminated) symptoms of Lyme
|
AV block, myopericarditis
Cranial nerve palsy Peripheral neuritis |
|
What are late Stage 3 symtoms of Lyme?
|
Chronic arthritis=monoarticular or asymmetric oligoarticular involving lg joints
|
|
Lyme Dx
|
Clinical if rash
Serology: ELISA w/ WB |
|
Lyme tx
|
doxycycline > 8 yrs or amoxicillin < 8 yrs
(ceftriaxone if more severe) |
|
Anthrax is caused by
|
Bacillus anthracis
|
|
Anthrax tx
|
FQ + clindamycin +/- rifampin
|
|
What is natural exposure anthrax caused from?
|
infected animals, exposure to wool=cutaneous
|
|
Inhalation anthrax is caused from
|
bioweapons
|
|
What are symtoms of inhalational anthrax?
|
mediastinitis, hemorrhagic lymphadenitis, widened mediastinum on CXR, no pneumonia
|
|
Smallpox is caused by
|
Variola major
|
|
Smallpox was eradicated in
|
1980
|
|
Smallpox tx
|
cidofovir + vaccine
|