Transcript Therapeutics III - 2-20

Therapeutics 3 Tutoring
Exam 4
February 20th, 2016
Lisa Hayes
[email protected]
Outline
•
•
•
•
Infectious Diarrhea
Bone and Joint Infections
Sepsis
STI
Infectious Diarrhea
Which of the following patients could you provide a
recommendation to in the pharmacy? (i.e. who does
not need referral)
• A – pregnant woman for diarrhea for 2 days
• B – 33 year old male otherwise healthy with
diarrhea x 1 week but with no significant
weight loss
• C – 6 year old with diarrhea for 1 day + low
grade fever
• D – elderly female with bloody stools x 3 days
Which of the following agents might be
most beneficial for traveler’s diarrhea?
•
•
•
•
A – Lomotil
B – loperamide
C – Pepto-bismol
D – cipro
Which of the following agents could
interfere with the efficacy of digoxin?
•
•
•
•
A – loperamide
B- ciprofloxacin
C – bismuth
D - polycarbophil
•
•
•
•
Which antibiotic is used to treat the
bloody mucoid diarrhea associated
with Shigella?
A – Septra
B – Ciprofloxacin
C – Doxycycline
D – Augmentin
Yersinia enterocolitica is typically treated
with quinolones and can last up to 3 weeks.
What organism is it associated with?
•
•
•
•
A – chicken/poultry
B – meat
C – eggs
D – seafood
Giardia is associated with infected drinking
water. How would you treat this?
•
•
•
•
A – paramomycin
B – metronidazole
C – tetracycline
D – levaquin
hints
• Know who should be referred and who can be
treated outpt/given advice
• Know the bug to the source + treatment drug
or if just supportive
• Know some common supportive therapies
– Fluid replacement
• Know weight loss numbers – fluid values
Bone and Joint Infections
What is the gold standard test for
diagnosing osteomyelitis?
•
•
•
•
A – CT scan
B – bone biopsy
C – X-ray
D – MRI
WC is a 23 year old patient who has severe pain in his right
leg. He has probably osteomyelitis. He reports routine IVDA
for the past 5 years. What would be an appropriate drug
regimen for his osteomyelitis?
• A – Cefepime 6g/day + Tobramycin
10mg/kg/day
• B – clindamycin 2400mg/day + ceftazidime
6g/day
• C – Nafcillin 12g/day
• D – zosyn 13.5g/day
NV has been diagnosed with PCN-intermediate
S.pneumo osteomyelitis of his right arm. What is
the appropriate definitive treatment?
• A – Ceftriaxone 2g/day
• B – Vancomycin 30mg/kg/day
• C – Nafcillin 12g/day
• D – PCN G 16 MU/day
EB has been diagnosed with osteomyelitis. He wants
to know how long he will need IV antibiotics. What
do you tell him?
•
•
•
•
A – 2 weeks
B – 6 months
C – 6 weeks
D – 3 months
Which of the following is a correct
definition of an osteomyelitis “cure”?
• A – afebrile, normal ESR, completion of 6 week
therapy
• B – afebrile, normal inflammatory markers,
completion of 6 week therapy, no recurrence x 6
mo
• C – afebrile, normal inflammatory markers,
completion of 6 week therapy, no recurrence x 1
year
• D –afebrile, normal ERP, completion of 6 week
therapy, no recurrence x 3 mo
What is the gold standard for
diagnosing septic arthritis?
•
•
•
•
A – xray
B – MRI
C – arthrocentesis
D – elevated inflammatory markers
BN has a large inflammed knee. Arthrocentesis is performed and
gram negative organisms are seen. What do you recommend?
BN is a healthy 30 year old male with no previous health care
admissions and no IVDU
•
•
•
•
A – cefazolin 6g/day
B – vancomycin 40mg/kg/day
C – cefepime 6g/day
D – ceftriaxone 2g/day
BN admits to having an untreated gononorhea
infection. The organism from his knee is confirmed as
N. gonorhea. How long should be treated?
•
•
•
•
A – 14 days
B – 21 days
C – 10 days
D – 3 days
Sepsis/Septic Shock
Key Points to Remember
•
•
•
•
•
•
•
•
•
•
Know difference between SIRS, sepsis, septic shock
Early sepsis versus late sepsis
Review culture predictions
Fluids!
Broad spectrum ABX – 1 hour
Vasopressor
When are steroids recc?
Glucose control
DVT Prophylaxis
Stress Ulcer Prophylaxis
Which of the following is not only
indicative of late sepsis?
•
•
•
•
A- DIC
B- azotemia
C- ARDS
D- nausea/vomiting
Which bacteria has the highest
frequency and mortality in sepsis?
•
•
•
•
A- E.coli
B- S. aureus
C- Pseudomonas
D- Enterococcus
Which bacteria would be most likely to
cause sepsis in an immunosuppresed
patient?
•
•
•
•
A- S. aureus
B- Strep viridens
C- B. frag
D- Candida species
Fluid therapy is key in sepsis
treatment. What is the goal urine
output when administering fluids?
•
•
•
•
A- 0.5mL/kg/hr
B-1mL/kg/hr
C- 1.5mL/kg/hr
D- 2mL/kg/hr
Which fluid is not recommended in
sepsis treatment?
•
•
•
•
A- Normal Saline
B- Hetastarch
C- Albumin
D- blood products
A patient’s blood pressure continues to drop despite
proper administration of fluids. Which vasopressor
should be chosen as first line?
•
•
•
•
A- vasopressin
B- epinephrine
C- phenylephrine
D- norepinephrine
What is the goal blood glucose for
patients being treated for sepsis
(critical care level of treatment)?
•
•
•
•
A- under 110
B- under 180
C- under 150
D- under 130
KK is a patient who is refractory to both appropriate fluid and
vasopressor therapy. You wish to initiate corticosteroid therapy.
Which of the following doses would be appropriate.
•
•
•
•
A- 200mg/kg/day dexamethasone
B- 200mg/day dexamethasone
C- 200mg/kg/day hydrocortisone
D- 200mg/day hydrocortisone
Stress ulcer prophylaxis is used in many critical
patients. Which of the following drugs would be
appropriate for SUP?
•
•
•
•
A – Protonix 40mg daily
B – Lovenox 40 mg SQ daily
C – Heparin 5000 SQ TID
D – Zantac 300mg daily
Sexually Transmitted Infections
Which of the following is not an appropriate
treatment for the first episode of genital herpes?
•
•
•
•
A - Acyclovir 400 mg PO TID x 7-10 days
B - Acyclovir 200 mg PO 5 x day x 7-10 days
C- Famciclovir 500 mg PO TID x 7-10 days
D - Valacyclovir 1 g PO BID x 7-10 days
What is the DOC for syphillis prior to
the late latent stage?
• A – PCN VK 500mg BID x 3 weeks
• B – Benzathine PCN G 2.4 MU x 1 dose
• C – Benzathine PCN G 2.4 MU x 3 doses, 1/wk
x 3 weeks
• D – Doxycycline 100mg BID x 4 weeks
How do you treat chlamydia in
pregnancy?
• A – Azithromycin 1g x 1 + Doxycyclin 100mg
BID x 7 day
• B – Z pack + Doxycycline 100mg BID x 7 day
• C – Z pack + amoxicillin 500mg TID x 7day
• D – Azithromycin 1g x 1 + Amoxicillin 500mg
TID x 7 day
Patient X has been diagnosed with gonorrhea. She has a
severe cephalosporin allergy – anaphylaxis to rocephin.
What do you recommend for treatment?
• A – cefixime 400mg x 1 + azithromycin 1 g x 1
• B – azithromycin 1 gm x 1 + test of cure in 1
week
• C – azithromycin 2 g x 1 + test of cure in 1
week
• D – doxycycline 100mg BID x 7 days
What is the emergent treatment for
PID?
• A – Doxycycline 100mg PO BID
• B – Cefotetan 2g IV Q12H + Doxycycline
100mg IV Q12H
• C – Clindamycin 900mg IV Q8H
• D – Cefoxitin 1 g Q12H + Doxycyclin 100mg IV
Q12H
What is not an appropriate treatment
for bacterial vaginosis?
• A – metronidazole 500mg BID x 7 days
• B – clindamycin 300mg BID x 7 days
• C – metrogel 0.75% 1 applicator to the vagina
each night for 5 days
• D – clindamycin 2% cream 1 applicator to the
vagina each night for 14 days
Questions?
• [email protected]