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Which antibiotics work by damaging cell wall synthesis?
Which antibiotics work by damaging bacteria folic acid metabolism?
How do quinolones kill bacteria?
Affectin DNA Gyrase
How does Rifampin work?
Affecting bacterial mRNA synthesis
What antibiotics work by affecting protein synthesis?
- (50S inhibitors)
How do Penicillins act on bacteria?
-Target PENICILLIN BINDING PROTEINS, weakening the cell wall causing bacteria to take up excessive water and rupture.
- - Generally more effective Vs Gram positives
- G pos have 2 layers to envelope and thick cell walll
- G neg have 3 layers - additional envelop prior to cell wall.
What are Penicillinases?
Enzymes AKA (Beta-Lactamases) that cleave the beta lactam ring rendering penicillin and other beta lactam antibiotics inactive.
What are the three penicillinase resistant antibiotics?
What are two broad spectrum Penicillins?
What are the methods of action of Cephalosporins?
Bind to penicillin binding protiens disrupting the cell wall synthesis.
Bactericidal, often resistent to betalactamaces.
Explain the classes of cephalosporins?
- Generally subsequent classes will demonstrate:
- -INC activity Vs gram neg and anarobes
- -INC activity Vs desctruction by beta-lactamases
- -INC abilily to reach CSF
Explain how Macrolides work?
Broad spectrum anibiotics that inhibit bacterial protien synthesis. Called MACROlides because it is a big molecule.
What are the indications for a Macrolide?
Similar antibiotic spectrum of penicillin, active against most gram pos and some gram neg. Often used a substitute for penicillin due to allergy.
Patient education for macrolides?
Take around-the-clock, with a full glass of water (not juice or milk); may take with food to reduce GI upset. Do not chew or crush extended release capsules or tablets. Avoid alcohol (may cause adverse response). May cause nausea, vomiting, or mouth sores. Report immediately any unusual malaise, nausea, vomiting, abdominal colic, or fever; skin rash or itching; easy bruising or bleeding; vaginal itching or discharge; watery or bloody diarrhea; yellowing of skin or eyes, pale stool or dark urine; persistent diarrhea; white plaques, sores, or fuzziness in mouth; or any change in hearing.
How do tetracyclines work?
Tetracyclines inhibit protein synthesis - mostly bacteral static.
What are the indications for Tetracycline?
Gram Neg, Atypicals, MRSA.
What is the method of action of sulfonamindes and trimethoprim?
Supress bacterial growth by inhibiting sythesis of folic acid. Considered mostly bacteriostatic.
What are the indications for use of sulfonomides and Trimethoprim?
Primary indication = urinary tract infections
Adverse rx of sulfonomides:
- Multiple, include:
- hypersensitivity rx
- blood dyscrasias
Trimethoprim (TMP) and Sulfamethoxazole (SMZ) are marketed together as?
How do flouroquinolones work?
Inhibiting bacterial DNA replication, drug is considered RAPIDLY bacterialCIDAL.
Indications for flouroquinolones?
Wide variety of infections, Gr +/-, atypicals, B lactamases, MRSA, Pseudomona; not useful against anarobes.
Interactions of Flouroquinolones?
Increases plasma levels of thophylline and warfarin.
What is the mechanism of action for Nitrofurantoin (Macrobid)?
Broad spectrum anti-biotic, bacterio-static in low concentrations and bacterioCIDAL in high concentrations.
Damages bacterial DNA
Indicaitons for Macrobid?
Gram pos and neg bacteria - ONLY THERAPUTIC in the urine. ONLY used for tx in lower UTI's
Mechanisms of action of Metronidazole (Flagyl) and indications?
Used for protozoal infections and infections caused by anarobic bacteria only.
Drug of choice for C-Diff, destoys bacterial DNA of anarobes.
What is bactroban? (mupirocin)
Topical antibacterial cream - indications
Impetigo: Topical: Ointment:
Describe S/S of hydrocephalus birth to 12 mo?
- Birth- 12 months
- -Large HC
- – Sluggish, vomiting, piercing cry, irritability
- – Bulging anterior fontanel, bossing, separation of thesuture line, slow pupil response to light.
- - Must measure HC until 2 y/o
Descibe hydrocephalus 12 mo or older?
- 12 months-Children
- – ↑ ICP
- – HA after sleeping
- – Lethargy / Irritability / Confusion
- – Personality
Management of acute mastoiditis...
Urgent ENT referral is imperitive.
Complications include, structural damage, senorineural loss, and intracranial infection.
Review tympanic membrane, Right EAR
Treatment for AOM:
< 2 treat if dx certain HIGH dose Amoxicillin 80-90 mg/kg/day BID 10 days
>= 2, 1st choice is defer ABX for 48-72 hrs. 2nd choice HIGH dose Amoxicillin 80-90 mg/kg/day BID 5-10 days
- TX for 10 days if
- < than 2
- ABX use past 3 mo
- Attends day care
- Complicated AOM or perforated TM
USE Cephalosporin or Macrolide if True PCN Allergy.
- Starts with some injury:noise trauma, blow to head, dz induced injury
- • Dorsal cochlear nucleus(brain) tries to adaptand creates a phantomsound
- • Refer, some tx available
Describe Meniere Disease/ Syndrome
Disease: IdopathicSyndrome: trauma, endocrine, medications, electrolyte imbalance.
Clinical Findings History: vertigo, low tone roaring tinnitus, increase earpressure
NV Episodes lasting minutes to hours
Exhausted Triggers: food, drinks, stress, menstrual cycle
- Diagnosis: by exclusion
- • Treatment– Minimize or prevent symptoms– Antihistamines– Antiemetic (N/V)– Benzodiazepines (anxiety)– Diuretics (decrease fluid load)
Describe S/S of Ambloypia
- Amblyopia, or "lazy eye," is the loss of one eye's ability to see details.
It is the most common cause of vision problems in children.
Causes, incidence, and risk factorsAmblyopia occurs when the nerve pathway from one eye to the brain does not develop during childhood.
This occurs because the abnormal eye sends a blurred image or the wrong image to the brain.This confuses the brain, and the brain may learn to ignore the image from the weaker eye.
Strabismus is the most common cause of amblyopia. There is often a family history of this condition.The term "lazy eye" refers to amblyopia, which often occurs along with strabismus.
However, amblyopia can occur without strabismus and people can have strabismus without amblyopia.Other causes include:Childhood cataractsFarsightedness, nearsightedness, or astigmatism, especially if it is greater in one eye.
Symptoms Eyes that turn in or out. Eyes that do not appear to work together. Inability to judge depth correctly. Poor vision in one eye.
- Signs and tests
- Amblyopia is usually easily diagnosed with a complete examination of the eyes. Special tests are usually not needed.
- First, any eye condition that is causing poor vision in the amblyopic eye (such as cataracts) needs to be corrected.
Children with a refractive error (nearsightedness, farsightedness, or astigmatism) will need glasses.
Next, a patch is placed on the normal eye. This forces the brain to recognize the image from the eye with amblyopia. Sometimes, drops are used to blur the vision of the normal eye instead of putting a patch on it.
Expectations (prognosis)Children who get treated before age 5 will usually recover almost completely normal vision, although they may continue to have problems with depth percention.
Delaying treatment can result in permanent vision problems. After age 10, only a partial recovery of vision can be expected.ComplicationsEye muscle problems that may require several surgeries, which can have complications
Define below inrelation to eye position:
Eso = in ward
Exo = Out ward
Hyper = Superior
Hypo = Inferior
Tropia and Phoria
Tropia = Always deviated
Phoria = Sometimes deviated
Describe S/S allergic conjunctivitis
Stringy mucoid discharge, itchy, burning, mild, diffuse, usually bilateral involvment, normal visual acuity and intraoccular pressure. Red sclera.
May present with Rhinorrhea, sneezing, watery eyes occuring in fall an spring.
Readily apparent with flourecein stain and a cobalt blue light.
Glaucoma general information
- Disease of the optic nerve
- Open angle more comman 90-95% of all cases
- Symptom free until loss of periferal vision
- Leads to blindness
- 2nd leading cause of blindness for whites
- 1st leading cause of blindness for blacks
- Excellent prognosis if caught early
Glaucoma risk factors:
- Risk Factors
- – Age
- – Elevated eye pressure
- – Family Hx– African Americans
- – Far or Nearsightedness– Hx of eye injuries
- – Diabetes, migraine HA; poor circulations
Chronic Open Angle Glaucoma
- No S/S
- Normal Vision
- SS blank spots become larger
- Blindness of optic nerve fibers die without tx
Emergent closed angle
Iris block drainage angel and completely blockd the flow of fluid rapidly.
- SS sudden
- -Blurred vision
- -severe eye pain
- -rainbow collored halos around lights
Anterior Uveitis (IRIS) Causes:
- – Juvenile rheumatoidarthritis
- – TB
- – Herpes Simplex
- – Trauma
- – Kawasaki Disease
Causes of posterior (Choroids) Uveitis
- – Toxoplasmosis
- – Cytomegalovirus
- – TB
- – AIDS
Antterior Uveitis: IRITIS S/S
- • Decrease vision
- • Pain
- • Photophobia
- • Pupil size decreased
- • No discharge ortearing
- -refer to opthamologist
Herpes Zoster S/S
- -Eye pain
- -Mucoid discharge
- -Cornea maybe cloudy or clear
- -Unilateral presentation
- -IMMEDIATE REFERRAL to an opthalmologist
Red Eye Infections Caused by:
- C. Trachomatis and N. Gonorrhoeae
- -use gloves when examining, test visual acuity;
- corneal involvement will have pain, dec visual acuity and photophobia.
- - Tx
- depends on cz but use artificial tears in all pts to keep eyes wet; educate about avoidance of spreading; highly contagious and remains contagious after 48hrs of TX; no contacts during TX
- Sty - painful, tender, red infection around a hair follicle.
- erythematous tender lump in eyelid; results of infected meibomian gland (internal) or infected hair follicle of eyelash (external), and may develop into a chalazion;
- common to be staph infection; sx itching, redness, irritation, swelling; obj- maybe drainage from stye; check visual acuity; tx- warm compress, no tears
- shampoo, eye hygiene; DON’T squeeze it; if infected- erythromycin or cipro ointment; if resistant use PO ATB as well
- Granulomatous infection of the meibomian gland; painless swelling on the eyelid; sx- slow developing, hard, painless mass; obj- turn eyelid out to see; check visual acuity; tx- warm compress, no tears shampoo, eye hygiene; if persists
- >4wks refer to optho for I&D, biopsy or steroid injection.
- POINTS INSIDE LID VS. STY ON LID MARGIN
Infection of tear ducts, need ATB therapy
Detached Retina - RISK FACTORS:
- Risk Factors
- – Nearsightedness
- – Previous cataract surgery
- – Glaucoma
- – Injury
- – Family Hx
- – Previous detachment
Detached Retina - EARLY SYMPTOMS
- Early symptoms
- – Flashing lights
- – New floaters
- – Shadow in the peripheryof the vision field
- – Gray curtain across your field of vision
- TX for tear - can do laser or cryo which seals retina to back wall of eye; detachment-surgery
Macular degeneration -
- Main task is to determine if acute prob.
- -If sudden loss in vision refer to opthamologist.
- - Using PIN HOLE test -
- If vision is less than 20/20 without corrective lenses but corrects it implies an uncorrected refractive error.
Dry Macular Degeneration:
- – Most common type
- – Waste products build upin the macula
- – Wavy lines & blank spotsin your centeral vision
- – Colors dim– Progressive; no tx
Wet Macular Degeneration:
- – Less common, More serious
- – New blood vessels formaround macula, fluidleaks from the vessels,the macula bulges anddistorts vision.
- – Dark spots and blankspots
- – Caught early, laser Txslow vision loss
Macular Degeneration S/S:
- Leading cause of blindness > 60 y/o
- - hallmark is inability to see in low light; teach pt to check themselves using amsler grid to detect changes in vision (graph paper looks wavy instead of like graph paper)
NOSE - Epitaxis
Hemorrage of the nasal mucosa resulting from the traumatic or spontaneous rupture of superficial veins and arteries.
- 90% of the time Anterior / Kiesselbach's plexus AKA Little's area. Area of convergence of 3 arteries.
-Posterior: Refer to ENT
– 90% Local irritation: dryness (heat) ,infection, allergytrauma, foreign body, cocaine.
- – Management:
- • Apply pressure
- • Cotton with with vasoconstriction nasal solution Neo-synephrine10-15 min ,Venous bleed this usually works.
- • Silver nitrate stick apply to bleeding site
- • Petrolatum-based ointment
- • Increase humidity
- • Saline drops
Foreign Nasal Body -
- • Always check bilateral nares for patency andvisualize .
- • Do not remove foreign body unless you aresure you can remove object.
- • Refer as needed
- • Usually bilateral from the middle turbinate into thenasal lumen; hard to breathe,
- • nose drips constantly
- • sense of smell just isn't what it used to be
- • dull headaches
- • snoring—
Rhinitis (AKA CORYZA)-ALLERGIC
- • Triad SS
- – Nasal congestion
- – Sneezing
- – Clear drainage
- • Assessment– Pale, boggy
- – Clear thin secretions
- – Allergic shiners
- – Nasal salute
- – Enlarged tonsils & adenoid
- TX- Decrease exposure to allergen
- - Oral antihistamines first line tx for allergic rhinitis - short term.
- -Intranasal corticosteroids have traditionally been considered the best means of controlling the longer term sx of allergic rhinitis.
Rhinitis (NON) Alergic
- • Nonallergic
- – Vasomotor = changes in blood flow tonares; temperature change, pollutants, tobacco
- – Medicamentosa = Medication overuse usually from vasoconstrictor nosedrops
- – Atrophic (geriatric)
- – Pregnancy
Rhinitis - ACUTE VIRAL
- • Sudden onset
- • Low or no fever
- • Mild pharyngitis
- • Exposure
- • Erythemic TM
- • Erythemic nasal mucosa
- • Thin discharge initiallythen mucopurulentafter 2-3 days
- TX - treated symptomatically
- -Fever and HA - acetominophen 325 to 650 PO q4h prn
- -Rhinorrhea - oral decongest- sudafed - 30-60 mg PO q3-4h prn
- -Neo-synephrine spray
- -Persistent cough with Dextromethorphan 15 to 30mg q4h prn
- • Common Pathogens:
- – Streptococcus pneumoniae
- – Haemophilus influenzae
- – Moraxella catarrhalis
- • Sinus Location: Most common
- – Maxillary pain over teeth
- – ethmoid pain over or behind eyes
- • Manifestations:
- – Subacute: clinical ss for 4-12 weeks
- – Chronic: clinical ss 12 weeks
- – Recurrent: 4+ incidents / yr; with clearing between each episode
- – Mild / moderate: 10 + days with increase SS
Sx-pain over sinuses, over time worsens w/throbbing, pain when bent over, fatigue, periorbital swelling; congestion, pressure, sore throat, HA worse in AM
Obj-purulent nasal secretions (PMN’s on giemsa stain); opacification w/transillumination; turbinates=red, bacterial; gray, allergic; sinuses tender to palpation
Sinusitis DX and TX
- • Dx Tests:
- – CT Scan: gold standard, of paranasal sinuses forcomplicated cases
- – X--Ray: not helpful– CBC: if il
l• Treatment– Acute: Amoxicillin 10-14 days; failure: Augmentin,– if allergic Biaxin or Zithromax– Chronic: treat for four weeks.– Improve within 48 hours
Sinusitis Patient Education
- • Education
- – Humidify air
- – Increase fluid intake
- – Warm compresses
- – Neti Pot / NS Nasal Irrigation
- – Elevate head to sleep
- – Avoid swimming /diving
- – No smoking
• Follow-up– 10-14 days
- • Refer
- – Recurrent
- – Cellulitis/periorbital swelling
- – Uncontrolled asthma
- • Viral
- – Rhinovirus
- – Adenovirus
- – Coxsackievirus
- – Epstein-Barr ( virus causing mono)
- • Bacterial
- – Group A Beta-Hemolytic Strept (GABHS)
- – Neisseria gonorrhoeae
- – Corynebacterium diphtheriae
- – Streptococci serogroups C & G
• Fungal– Candida albicans
GABHS pharyngitis symptoms
- • Fever >101
- • Headache
- • Sore throat; dysphagia
- • Nasal congestion
- • Erytherma tonsils & pharynx; white /yellow exudate
- • “strawberry tongue”: white coating/red papillae
- • Anterior cervical adenopathy /tender enlarged
- strep infections have pastia’s sign
- (sandpaper-like, scarletiniform rash in axillary and AC area)
- • Abdominal Pain, vomiting, headache
- • Pastia’s Sign -“Sandpaper” rash: appear 24-48h after infection & last 4-10 d
GABHS pharyngitis TX
- • Gold Standard: Penicillin V 10 Days
- • Reoccurrences : Same drug, Augmentin, orcephalexin
- • Penicillin Allergy Options
- – Erythromycin
- – Clarithomycin
- – Azithromycin
Once pts have been treated for GABHS for 24hrs they are no longer contagious.
- • Post-Strept Glomerulonephritis: (PSGN)
- – 1-3 weeks post- infection
- – Treatment does not prevent
- – Edema, oliguria, hypertension, gross hematuria
- – Supportive Tx; hospitalize
- • Rheumatic Fever
- – Fever, rash, joint arthralgia ,carditis, small nodules,Chorea
- – Treat with Penicillin
- • Physical Exam Findings
- – Tonsillitis/pharyngitis possibly exudative
- – Palatative petechiae
- – Adenopathy : large mildly tender
- -mono- general fatigue, gradual onset low grade
- fever, severe sore throat.
- • Ant/post cervical
- • Epitrochlear (highly indicative)
Mono- pts may have general lymphadenopathy and monospot may not be + for 1-2wks; if you give Amoxi w/mono-pt will get red rash all over; don’t let them play contact sports (for risk of splenic rupture)
LFT’s for all mono cases to check for hepatitis
- – Splenomegaly
- • 2-3 cm’s below costal margin
- • 2-4 week duration
• Pharyngitis: fever,cervical nodes,ulcerations or vesicleson soft palate andtonsillar pillars.
- Herpangina- shows little viral ulcers in back of
- throat, viral, use salt water gargles
- • Pharyngitis, malaise,diarrhea, lesions,cervical nodes
- • Eroding vesicles andoral mucosa
- • Vesicles on palms and soles of feet
Pharyngitis PT Education
Pt. Ed-replace toothbrushes; don’t share food or washcloths; no oral sex; warm compresses to enlarged tonsils; don’t use aspirin in kids- risk of Reye’s syndrome; finish entire course of ATB
- • Inflammation of theepiglottis (cartilage thatcovers the trachea)
- • Young children, fever
- • Drooling
- • Tripod sitting and sniffing position
- • Cyanosis
- • Stridor
- • H-flu