Infectious Diseases Flashcards

Question

Penicillin VK/Penicillin G coverage?

Answer 1

Very narrow spectrum. Poor coverage of gram-negatives.

Answer 2

Very narrow spectrum. Effective against staph sp.

Answer 3

Narrow-ish spectrum (broader than penicillin and cloxacillin), effective against Strep and Enterococcus, intermediate against Staph.

Answer 4

resistance develops when antimicrobials are used inappropriately. Resistance is caused by beta-lactamases.

Answer 5

Clavulanic acid, tazobactam, sulbactam

Answer 6

Generally gram negative bacteria produce them.

Answer 7

Streptococci, enterococci, non-beta-lactamase producing organisms (e. coli, K. pneumoniae, H. influenzae)

Answer 8

Streptococci, Enterococci, Staphylococcus (not MRSA), anaerobes, some gram-negatives + beta-lactamase producing.

Answer 9

Better gram-positive coverage, weaker gram-negative coverage.

Answer 10

Better gram negative coverage, weaker gram positive coverage.

Answer 11

Good for both gram positive and gram negative.

Answer 12

inside the cell - inhibit RNA and DNA synthesis.

Answer 13

Inhibit DNA topoisomerase.

Answer 14

They are broad-spectrum and are typically reserved for treatment failure or allergy.

Answer 15

Ciprofloxacin, moxifloxacin, levofloxacin.

Answer 16

Ciprofloxacin. Can be used for gram-negative aerobes (E. coli, Klebsiella) and pseudomonas (notable gram-negative bug)

Answer 17

Moxifloxacin, Levofloxacin. Used for enteric gram-negatives, S. pneumoniae (MSSA), pseudomonas (levofloxacin only), anaerobes (moxifloxacin only).

Answer 18

inside the cell.

Answer 19

Doxycycline, Minocycline, Tetracycline.

Answer 20

Bind bacterial ribosome and inhibits proteins synthesis.

Answer 21

- broad spectrum coverage of gram-positive organisms (but increasing resistance) - good coverage of atypicals - moderate coverage of MRSA, S. pneumoniae - NOT FOR Group A Strep (S. pyogenes)

Answer 22

Inside the cell.

Answer 23

Bind bacterial ribosome + inhibits protein synthesis.

Answer 24

Clarithromycin, Azithromycin, erythromycin.

Answer 25

- Broad coverage of respiratory bugs BUT high resistance rates. - Good coverage of atypical and less-common respiratory bugs. - Only moderate coverage of S. pneumoniae (high rates of resistance).

Answer 26

Inside the cell.

Answer 27

Clindamycin

Answer 28

Bind bacterial ribosome and inhibits protein synthesis.

Answer 29

- Good for gram-positive anaerobes, S. pyogenes - useful in penicillin allergic patients - Moderate coverage for S. aureus, including MRSA (increasing resistance)

Answer 30

Drug interactions - ALWAYS check.

Answer 31

High rates of antibiotic-associated diarrhea and C. difficile diarrhea.

Answer 32

Sulfamethoxazole/Trimethoprim

Answer 33

inhibits folate synthesis which is required for DNA synthesis.

Answer 34

- S. aureus, including MRSA - Gram-negative bacilli (E. coli, K. pneumoniae) - UTIs!

Answer 35

Used less often as first line therapy due to unpredictable resistance. Culture is usually required.

Answer 36

Nitrofurantoin

Answer 37

Nitrofurantoin is metabolized to toxic metabolite in bacteria.

Answer 38

It is eliminated rapidly by the kidneys and moves to the bladder quickly.

Answer 39

- Used predominantly for UTIs. Excellent coverage of common UTI bugs (E. coli).

Answer 40

Inhibits bacterial wall synthesis.

Answer 41

One main use: UTIs.

Answer 42

Vancomycin.

Answer 43

Cell-wall inhibitor.

Answer 44

- gram-positive only - MRSA, Enterococcus, Staphylococcus

Answer 45

ototoxicity, nephrotoxicity, infusion-related reactions

Answer 46

Therapeutic drug monitoring.

Answer 47

- ceftaroline - tetracycline - doxycycline - minocycline - SMX/TMP - clindamycin - vancomycin - daptomycin - linezolid - fosfomycin - rifampin

Answer 48

- Piperacillin-tazobactam - ceftazidime - cefepime - imipenem-cilastatin - meropenem - aztreonam - ciprofloxacin - levofloxacin - gentamicin - tobramycin - amikacin - colistimethate

Answer 49

Gentamicin, Tobramycin, amikacin

Answer 50

bind irreversibly to the 30S subunit of the bacterial ribosome, which results in inhibition of protein synthesis and induction of translational errors (sorry its long).

Answer 51

- gram-negative coverage (Pseudomonas, E. coli, klebsiella)

Answer 52

High urine concentration (70% excreted unchanged)

Answer 53

Antibiotics that work on the cell wall.

Answer 54

Ototoxicity, nephrotoxicity

Answer 55

Therapeutic drug monitoring

Answer 56

HSV - treatment or prophylaxis Varicella-zoster virus (VSV) - treatment

Answer 57

HSV - treatment

Answer 58

Influenza - only in specific cases

Answer 59

Activated by anaerobic bacteria and protozoa into free radicals which cause DNA damage and eventually cell death.

Answer 60

think of it as the "antibiotic scavenger". Covers organisms that other large classes don't. Good coverage of anaerobes, but poor coverage of aerobic.

Answer 61

Azoles and polyenes

Answer 62

Ergosterol because it is an important component of fungal cell membranes.

Answer 63

Inhibit ergosterol production in cell membrane.

Answer 64

Fluconazole, clotrimazole, ketoconazole

Answer 65

MANY drug interactions when taken orally.

Answer 66

bind to ergosterol leading to leakage of cell membrane.

Answer 67

* mycoplasma pneumoniae * chlamydia pneumoniae * legionella pneumoniae

Answer 68

Macrolides.

Answer 69

M. cattarhalis, S. pneumoniae, H. influenzae.

Answer 70

overcome penicillin binding protein resistance of causitive organism.

Answer 71

- acute (< 48H) onset of sxs - middle ear fluid - TM bulging OR acute perforation with purulent discharge

Answer 72

- >6m - mild illness - present within 48H of onset of ear pain - have not had AOM in previous month + not recurrent - no cochlear implants or other hearing impairment - no hx of another condition that could make recovery more difficult

Answer 73

Standard: 45-60 mg/kg/day divided TID High: 80-90 mg/kg/day divided BID or TID

Answer 74

those suspected to have resistant S. pneumoniae or if failed standard dose.

Answer 75

- < 2 yrs old - daycare (or family in daycare) - any abx exposure within 3 months - under-vaccinated or unvaccinated

Answer 76

- used amoxicillin in previous 30 days - hx of AOM unresponsive to amoxicillin (treatment failure) - concurrent purulent conjunctivitis (likely H. influenzae or M. catarhalis) - immunocompromised

Answer 77

H. influenzae and M. catarrhalis

Answer 78

- 2nd gen cephalosporins (cefuroxime, cefprozil) - amoxicillin-clavulanate

Answer 79

no symptomatic improvement in 2-3 days with proper treatment

Answer 80

- wrong drug (need broader spectrum) - dose too low (high dose amox regimen)

Answer 81

clavulanate can cause bad diarrhea (dose dependent)

Answer 82

- uncomplicated infection - greater than or equal to 2 years of age ** most patients**

Answer 83

- child less than 2 years of age - perforated TM - recurrent AOM - failed initial therapy - high risk children

Answer 84

50% of patients will have effusion remaining after treatment and can persist up to weeks ** does not mean treatment failure

Answer 85

- streptococcus pneumoniae - haemophilus influenzae - mycoplasma pneumoniae

Answer 86

< 4 days hospitalization same bugs as CAP (S. pneumoniae, H. influenzae, M. pneumoniae)

Answer 87

> 4 days hospitalization Klebsiella, E. coli, Enterobacter

Answer 88

<3 months pseudomonas aeruginosa, acinetobacter, S. aureus/MRSA

Answer 89

duration of hospital stay impacts the potential bugs involved

Answer 90

- heart, lung disease (COPD), diabetes - recent antibiotics within the last 3 months - aspiration pneumonia, cystic fibrosis

Answer 91

- up to 50% of patients report URTI - abrupt onset of: fever, chills, dyspnea, cough (prod or non prod), rust colored sputum or hemoptysis, pleuritic chest pain

Answer 92

- tachypnea (quick shallow breathing) - tachycardia - dullness to percussion (could indicate consolidation) - diminished breath sounds over affected area - inspiratory crackles - low oxygen saturation

Answer 93

disrupts the beta-lactam portion (destroys the beta-lactam ring) results in an inactivated drug that cannot kill the bacteria

Answer 94

chest x-ray will see pulmonary infiltrates or consolidation

Answer 95

- CBC, lytes, liver function, renal function - arterial blood glass - sputum sample (may reveal PMNs and causative organism) - blood culture

Answer 96

- infiltrate on CXR - at least one respiratory symptom (new or increased cough, new or increased sputum, dyspnea, pleuritic chest pain) - at least one other sign/symptom (fever >38C, leukocytosis, hypoxia (O2 SAT <90%)

Answer 97

- pneumonia severity index (PSI) - CRB-65 (simpler to use)

Answer 98

WHERE a patient should receive treatment (outpatient, inpatient, etc) - not if they should receive treatment

Answer 99

- age>65 years - cardiac, pulmonary, renal or hepatic failure, - smoking, alcoholism - diabetes, malignancy - malnutrition/acute weight loss - immunosuppressive treatment

Answer 100

High dose amoxicillin (1000mg TID) - no atypical coverage (need to add a second drug (macrolide) if you think your patient needs this)

Answer 101

healthy patients with no recent antibiotic use

Answer 102

Mycoplasma pneumoniae Chlamydia pneumoniae

Answer 103

- young healthy patients - resolves without antibiotics - "walking pneumonia"

Answer 104

affects patients in long-term care, immunocompromised or have multiple comorbidities

Answer 105

- used in combination with beta-lactam for atypical coverage - s. pneumoniae coverage, but high resistance so monotherapy is not recommended

Answer 106

- may be used in patients with a beta-lactam allergy or other comorbidities/risk factors for resistant S.pneumoniae - or if someone couldn't adhere to two medications - doxy has atypical and gram negative coverage and is not associated with S. pneumoniae resistance

Answer 107

- patients with comorbidities (heart, lung disease, DM) are at increased risk of having gram negative, atypical infections along with S. pneumoniae so a broader spectrum antibiotic is needed for additional organism coverage (beta-lactamase inhibitor has increased spectrum of activity for gram negatives) - this has no atypical coverage

Answer 108

levofloxacin and moxifloxacin reserved for: - treatment failure - comorbidities with recent antibiotic use - allergies - documented highly drug-resistant bacteria

Answer 109

- traditionally thought to be 7-10 days but recent RCTs have shown similar cure rates with shorter duration - patients require a minimum of 3 days (typical durations 3-5 days) - longer durations are seen with complex pneumonia (like abscess)

Answer 110

- bladder infection (cystitis) - urethral infection (urethritis)

Answer 111

- kidney infection (pyelonephritis) - ureter infection (ureteritis)

Answer 112

- no structural or functional abnormalities - immunocompetent host - female - no recent instrumentation/catheterization

Answer 113

- E.coli (gram neg) - 80-90% infections but also... - K. pneumoniae (gram-neg) - K. ocytoca (gram neg) - Proteus spp. (gram neg) - Enterococcus (gram pos)

Answer 114

- E.coli (50% infections) - Enterobacter spp. (gram neg) - Pseuomonas aeruginosa (gram neg) - Staph aureus (gram pos)

Answer 115

- age (older age) - gender (female) - recent sexual intercourse - diabetes - pregnancy - renal disease - structural or functional urologic abnormalities (indwelling catheter, neurologic dysfunction, vesicoureteral reflux, incomplete bladder emptying) - urinary tract obstruction (including drugs like anticholinergics) - diaphragms/spermicides

Answer 116

- dysuria (painful or difficult urination) - frequency (urinating often) - nocturia (nighttime urination) - urgency (the feeling of needing to urinate) - suprapubic pain (pain or discomfort in the lower abdomen) - gross hematuria (blood in the urine) - absence of vaginal discharge (presence could indicate vaginitis) NO systemic illness (fevers, chills, vomiting)

Answer 117

- flank pain (pain in the lower back) - fever/chills - nausea/vomiting - malaise

Answer 118

- altered mental status/confusion - change in eating habits - GI symptoms - but can still exhibit other classic symptoms too

Answer 119

- leukocyte esterase test (enzyme in neutrophils) - nitrate reductase test (common urinary tract pathogens will convert nitrate to nitrite -- E.coli will produce nitrites)

Answer 120

- microscopic examination of urine (color, clarity, specific gravity) - presence of protein, glucose, RBCs, WBCs, bacteria and epithelial cells - increased suspicion of infection if pyuria (>10 WBC/mm3, bacteriuria 10^8 CFU/L) ** without pyuria unlikely to have UTI

Answer 121

- takes 24-48 hours for results - tells us gram stain, quantity of bacteria, identification of organism, suceptibility

Answer 122

10^5 - 10^8 CFU/L

Answer 123

when patients have a positive urine culture but NO symptoms

Answer 124

- elderly patients, like long term care - chronic catheter

Answer 125

- pregnant women - children - patients who will undergo urologic procedures

Answer 126

Efficacy: 97% susceptible to E.coli - ineffective if CrCl < 30 mL/min Safety: well tolerated, pregnancy considerations Convenience: cheap, BID dosing with MacroBID

Answer 127

Efficacy: ~20% E.coli resistance Safety: well tolerated, renal dose adjustment Convenience: BID

Answer 128

Efficacy: good susceptibility but want to reserve for more resistant bugs, broad spectrum Safety: CI in renal dysfunction Convenience: single dose

Answer 129

- need to consider if the medication will penetrate the kidney - nitrofurantoin and fosfomycin - do not use for pyelonephritis as does not provide adequate renal tissue concentrations

Answer 130

10-14 days

Answer 131

- Ceftriaxone - Ampicillin - Amoxi-Clav - Ciprofloxacin - Aminoglycosides

Answer 132

- Amoxi-Clav - Cefixime - Ciprofloxacin

Answer 133

beta lactams (need culture and sensitivity to confirm susceptibility)

Answer 134

SMX/TMP Cephalexin

Answer 135

because body changes predispose to infection: - dilation of renal pelvis and ureters - decreased ureteral peristalsis - reduced bladder tone

Answer 136

prematurity, low birth weight, and still birth - routine screening is part of pre-natal care

Answer 137

treat for 3-7 days and follow up culture to document eradication

Answer 138

- cephalexin (7 days) - amoxicillin (7 days) - nitrofurantoin (5 days) (avoid >36-38 weeks GA)

Answer 139

- TMP/SMX or TMP (avoid in first trimester and in last 6 weeks of pregnancy)

Answer 140

- traditionally considered complicated infections - may need to consider prostatitis (prostate infection) - same antibiotics, as long as no prostate involvement - longer duration of therapy (7 days)

Answer 141

- Mycoplasma pneumoniae (walking pneumonia) - Chlamydia pneumoniae - Legionella pneumoniae

Answer 142

Neither gram positive or negative

Answer 143

macrolides

Answer 144

An antifungal

Answer 145

very poorly absorbed - so limited systemic adverse effects or drug interactions

Answer 146

azole antifungals

Answer 147

contact time with the area

Answer 148

swish and swallow or swish and spit - depends on site of infection (oral vs esophageal involvement)

Answer 149

long acting parenteral lipoglycopeptide (think long acting vancomycin)

Answer 150

acute skin and soft-tissue infections

Answer 151

- physical barrier (skin) - chemical barriers (stomach acid) - mucus and cilia protect our respiratory tract - urine flushes out bacteria from our urinary tract - enzyme are present in our tears and saliva

Answer 152

specific response in the body is evoked but person is not ill

Answer 153

presence of organism at a body site without production of disease

Answer 154

- Corynebacterium - Enterobacteriaceae - Lactobacillus - Mycoplasma - Staphylococci - Streptococci

Answer 155

- drainage of abscess - removal of dead tissue (needs blood flow to work) - removal of foreign bodies or prosthetic device - decrease in immune suppression

Answer 156

- malnutrition - extremes of age - immune globulin deficiencies - deficiencies in cellular immunity - alcoholism - diabetes - immunosuppressive therapy - invasive procedures

Answer 157

- malaise - listlessness (no energy) - loss of appetite - headache - myalgias (muscle aches and pains) - arthralgias (joint stiffness)

Answer 158

late afternoon

Answer 159

normal range is 5-10 x 10^9/L so anything above 10 x10^9/L may be an infection

Answer 160

broken into groups based on the shape of the nucleus - segmented neutrophil, band

Answer 161

a mature neutrophil

Answer 162

an immature neutrophil

Answer 163

the presence of non-segmented neutrophils in the blood inflammation is the most common cause of a left shift, but some other conditions such as hemolytic anemia and primary diseases of marrow, can also cause release of immature neutrophils from marrow

Answer 164

inflammation (increase with inflammation)

Answer 165

increased heart rate, anxiety, confusion

Answer 166

- decreased BP then decreased CO - decrease in renal function - hepatic dysfunction (increased bilirubin) - decreased oxygenation - disseminated intravascular coagulation - eventually multiple organ failure

Answer 167

steptococcus pyogenes

Answer 168

streptococcus agalactiae

Answer 169

determines which antibiotics the organism is susceptible to

Answer 170

minimum inhibitory concentration - the lowest antimicrobial concentration that prevents growth after 24hrs of incubation

Answer 171

the zone size correlates with the sensitivity of the organism -- the larger the zone the more sensitive the organism is to the specific antibiotic

Answer 172

Empiric: treatment given based on experience, without precise knowledge of the cause or nature of a disorder Specific: targeted therapy given once the pathogen and antibiotic susceptibility have been identified

Answer 173

a report that summarizes the antimicrobial susceptibility of bacteria, showing how likely they are to be killed or inhibited by various antibiotics

Answer 174

Bactericidal - kill the bacteria Bacteriostatic - inhibit bacterial growth

Answer 175

bactericidal

Answer 176

bactericidal

Answer 177

6-aminopenicillanic acid (thiazolidine ring attached to a beta lactam ring)

Answer 178

acid labile (easily destroyed in an acidic environment)

Answer 179

Penicillin V is a more acid stable formulation but NEEDS to be taken on an empty stomach

Answer 180

highly active against gram positive bacteria and spirochetes

Answer 181

spirochetes

Answer 182

methicillin, cloxacillin, flucloxacillin, dicloxacillin

Answer 183

Staph Aureus (NOT MRSA) have relative resistance to beta-lactamases less gram positive activity otherwise (not as good for streptococci or meningococci compared to the natural penicillins)

Answer 184

Cloxacillin (DOC for MSSA) Flucloxacillin and dicloxacillin are alterations of cloxacillin with more side effects and are not widely used and methicillin is just the reference drug for this category

Answer 185

Ampicillin and Amoxicillin active against both gram positive and gram negative bacteria destroyed by beta-lactamases

Answer 186

has poor bioavailability (is more acid stable than natural penicillins though)

Answer 187

better oral absorption than ampicillin and also available in combo with clavulanic acid (beta-lactamase inhibitor)

Answer 188

Extended Spectrum Beta Lactamases (ESBL) - found in E.Coli and Klebsiella pneumoniae AND New Delhi Metaloo-Beta Lactamase (NDM-like) - Acinetobacter baumannii

Answer 189

Piperacillin increased activity against gram negative rods and active against pseudomonas aeruginosa parenteral administration only available combined with tazobactam

Answer 190

- wide tissue distribution including CNS - most excreted by kidneys - generally short half lives (frequent dosing): mostly 3 times a day, cloxacillin is 4 times - concentration independent pharmacodynamics - considered safe in pregnancy - distributed to breast milk - ?drug interaction: oral contraceptives - could reduce the efficacy of OC (I think this is debated a lot though if clinically relevant)

Answer 191

BLACKLEGGED ticks. Ixodes scapularis, ixodes pacificus.

Answer 192

*B. burgdorferi* a spirochete.

Answer 193

early (days to weeks): rash (bullseye) appears w/in 7-10 days,low grade fever, fatigue. early, disseminated (< 3m): vague - muscle aches, fatigue, encephalitis/meningitis, cardiac conduction issues. late/persistent (> 3m): confusion, fatigue, encephalopathy, multiple joint arthritis. IF giving prophylaxis need to be within 24 h of attachment and < 72 h from removal.

Answer 194

* bulls-eye rash/EM rash * flu-like sxs * stinging sensation * cardiac or neurological signs * MSK complaints * rash spreading along extremities

Answer 195

* tick attached for > 24 h (engorged tick) * < 72 h since tick removal * tick bite from high risk area w/ blacklegged ticks where local rate of ticks infected w/ *B. burgdoferi* > 20% * No CIs to doxycyline (pregnancy, < 8 y/o)

Answer 196

* light-coloured clothing * closed toe shoes, long sleeve shirts and pants * use insect repellent (DEET)

Answer 197

* inspect clothing, pets, and body for ticks * remove ticks and clean the affected area * shower or bathe w/in 2 hours after returning from outdoors * put clothes in dryer on high heat to kill ticks on clothing

Answer 198

use fine tipped tweezers, grab as close to the skin as possible, pull straight up, if head gets detached try to remove, if cannot remove easily then leave it and let skin heal, after removing clean area with soap and water. DO NOT CRUSH tick, put it in alcohol, place in a sealed bag (wrap tightly in tape). Try to hold onto it to bring to determine if it is blacklegged type.

Answer 199

doxycyline adults: 200 mg po x 1 dose children: < 45 kg: 4 mg/kg po x 1 dose

Answer 200

Listed in order of preference. Adults: * doxycycline x 10 days * cefuroxime x 14 days * amoxicillin x 14 days children (< 8 y/o): * amoxicillin x 14 days * cefuroxime x 14 days * doxycyline x 10 days (case by case) * azithromycin x 7 days (2nd line when other therapies CI/not tolerated

Answer 201

children: all may receive single dose doxycyline. pregnancy/breastfeeding: doxycyline single dose safe.

Answer 202

Children: * < 6 m: soybean oil (lasts 3.5h) * > 6 m: DEET or icaridin P/L: * avoid chemical repellents, if possible. if needed use low-strenght sparingly, wash off after protection no longer needed. Non-pharm = long clothing, avoid insect habitats.

Answer 203

* Nervous system involvement = doxy or ceftriaxone x 14-21 days * carditis = doxy, amoxi, cefurox, ceftriax x 14-21 days * arthritis = doxy, amoxi, cefurox x 28 days * arthrtis, recurrent (IV) = ceftriax x 14 days * acrodermatitis chronica atrophicans = doxy, amoxi, cefurox x 21-28 days * borrelial lymphocytoma = doxy, amoxi, cefurox x 14 days

Answer 204

* releif of myalgias and h/a = NSAIDs, acet. * supportive care for chronic lyme = OT, psych

Answer 205

caused by *R. rickettsii*, vector is *D. andersoni*. Early tx w/ doxycyline.

Answer 206

at least 30 days

Answer 207

* early localized sxs (erythema migrans) x 7-10 days * early disseminated sxs (myalgias, fever, stiff neck, heart palpitations, chest pain) x weeks to months (< 3 m). * late/persistent sxs (confusion, impaired memory, arthritis) x months (> 3 m)

Answer 208

* improvement of early localized sxs, ongoing * improvement of cardiac s/sxs, ongoing * improvement of arthritis, ongoing * improvement of neurological manifestations, ongoing

Answer 209

Yeasts: *Candida sp. and crytococcus sp.* Moulds: *Aspergillus sp.* and zygomycetes Dimorphic: *histoplasma sp. and blastomyces sp.*

Answer 210

vulvovaginal candidiasis, oral candidiasis, tinea infections, and onychomycosis.

Answer 211

esophageal candidiasis, invasive aspergillosis, cadidemia, hepatosplenic candidiasis, pulmonary histoplasmosis/blastomycosis, cryptococcal meningitis

Answer 212

Tinea barbae: face Tinea capitis: scalp Tinea corporis: body Tinea cruris: groin Tinea pedis: athletes foot Tinea manuum: hands

Answer 213

keep skin clean and dry loose-fitting clothing non-medicated powders (NO cornstarch)

Answer 214

topical antifungals (clotrimazole 1%, ketoconazole 2%, miconazole 2%, terbinafine 1%, ciclopirox 1%, tolnaftate 1%) azole antifungals x 2-4 weeks terbinafine x 1-2 weeks tx 1-2 weeks after clearing **NO topicals for sclap since does not penetrate**

Answer 215

white, patchy areas overlying areas of erythema which can be removed w/ rubbing but leave red/bleeding. sxs: cotton mouth, loss of taste, may have pain on eating/swallowing, burning sensation on tongue, metallic taste, dysphagia. signs: erythema, white patches/plaques (on buccal mucosa, throat, tongue, gum)

Answer 216

extension of oral or just esophagus. sxs: dysphagia, odynophagia, retrosternal chest pain, epigastric pain signs: fever, plaque, advanced cases present with narrowing of lumen **Must tx systemically**

Answer 217

Seroids + abx, dentures, anticholinergic AEs, chemo, radiation of head/neck, immunocompromised, organ transplants, HIV/AIDS

Answer 218

cytotoxic agents, corticosterois, immunosuppressants, drugs that decrease gastric acid (PPIs), environmental chemicals, drugs that induce neutropenia

Answer 219

neonates + advanced age. HIV/AIDS, DM, malignancies, intensive radiotherapy, chemotherapy, nutritional deficiencies

Answer 220

Thrush, oropharyngeal candidiasis, esophageal candidiasis, GI candidiasis, GERD, viral esophagitis, radiation esophagitis

Answer 221

Topical therapies (nystatin) - need to be administered frequently. May be irritating. suspensions - may be better for patients with dry mouth, but contact time is short Clotrimazole (troches)

Answer 222

Imidazole and Triazole antifungal agents (fluconazole, itraconazole, voriconazole, posaconazole)

Answer 223

Fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole, ketoconazole. MOA: inhibit CYP450 needed in the biosynthetic pathway of ergosterol, an essential molecule in fungal cell membranes. B/c of MOA - lots of DDIs. DDIs: due to inhibition of CYP - major 3A4 and some 2C9/19. AEs: N/V, LFTs, gynecomastia.

Answer 224

IV only: caspofungin, micafungin, anidulafungin. MOA: inhibit synthesis of an essential cell wall component of candida, non-candida, and aspergillus.

Answer 225

Nystatin, amphotericin B. MOA: interact with fungal membrane to produce channels through membrane, causing leakage of essential cell contents.

Answer 226

increase drug concentrations of: cyclosporine, tacrolimus, sirolimus, CCBs, BZDs, statins, steroids, warfarin, rifampin decrease azole concentrations with: carbamazepine, phenobarbital, phenytoin, rifampin, and rifabutin.

Answer 227

fungal invasion of nail matrix that changes the nails appearance. Chronic condition that rarely spontaneously resolves.

Answer 228

* Distal lateral subungal onychomycosis (DLSO): thickening, discoloration of distal/lateral edge. Crumbling yellow debris under nail edge. * Endonyx onychomycosis: rare. involves only the interior of the nail plate. Milky white patches and splitting of distal nail plate. * Proximal subungual onychomycosis (PSO): uncommon. crumbling and whitening of proximal area beneath nail bed. * Total dystrophic onychomycosis (TDO): end stage DLSO or PSO. Complete destruction of the nail plate. Nail appears ridged ad opaque with a yellow-brown colour. * Superficial white onychomycosis (SWO): common in children. nail plate infected, no involvement of nail bed. nail plate has white and powdery patches.

Answer 229

* bacterial paronychia: fast onset of painful swollen nail fold or cuticle. * eczema: transverse ridges with affected nail folds. * lichen planus: longitudinal ridges with nail atrophy. * medications (e.g., chemotherapy): onycholysis. * melanoma: dark verticle bands. * nail psoriasis: symmetrical nail pitting with yellow-gray or silvery white nails. * onychogryphosis: thick, claw like nails * yellow-nail syndrome: slow nail growth with yellow-green curved appearance.

Answer 230

*prevention*: wear proper footwear and socks that minimize humidity, dry feet thoroughly after washing, keep nails clean and cut short straight across, do not share nail clippers or footwear, wear rubber gloves if hands often immersed, control chronic comorbidities, avoid being barefoot in shared public places, give feet a break from shoes, examine nails regularly. *treatment*: apply emollients on cracked skin to reduce further spread of infection. Educate pts on nail trimming and debridement.

Answer 231

* > 60% nail involvement: oral terbinafine. * 20-60% nail imvolvement: topical efinaconazole +/- oral terbinafine (> 3 nails). * < 20% nail involvement: topical efinaconazole.

Answer 232

* apply once daily until nail clearance or up to 48 weeks. * used in SWO or mild/moderate DLSO, clean nails weekly with isopropyl alcohol, flammable. * cure rates: mycotic (33%), clinical (7%)

Answer 233

* apply 1 drop (2 drops for big toe) nightly for 48 weeks * used in mild/moderate DLSO. Flammable. * cure rates: mycotic (54-61%), clinical (14-47%)

Answer 234

* apply once daily to the tip and under the nail for 24 weeks * used in mild DLSO, keratolytic and hydrating effects improve appearance, wash from unaffected skin thoroughly. * cure rates: mycotic (27.2%)

Answer 235

* adults 250 mg daily x 6-12 weeks (finger) or 12-24 weeks (toe) * effective for dermatophyte OM, monitor LFTs, CYP2D6 inhibitor. * cure rates: mycotic (70%), clinical (38%)

Answer 236

* pulsed regimen 200 mg BID for 1 week/month for 2 months (finger) or 3 months (toe) * continuous regimen 200 mg daily x 6 weeks (finger) or 12 weeks (toe) * preferred tx for non-dermatophyte OM, monitor LFTs, less AEs with pulsed therapy, CYP3A4 inhibitor. * cure rates: mycotic (54%), clinical (14%)

Answer 237

* adults: 150-300 mg weekly x 12-16 weeks (finger) or 18-26 weeks (toe) * least cost effective, many DDIs, QTc prolongation, CYP2C19, 2C9, and 3A4 inhibitor. * cure rate: mycotic (55-59%), clinical (20%)

Answer 238

* infection eradicated and nail appearance improved in 6-48 weeks.

Infectious Diseases Flashcards

(269 cards)