Therapeutics - CNS

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  1. CNS infections occurs with a wide variety of clinical conditions, what are the major examples?
    • meningitis
    • meningoencephalitis
    • encephalitis
    • brain and meningeal abcesses
    • shunt infections
    • wide variety of bacteria, fungi, viruses, and parasites
  2. What are the top four organisms causing meningitis morality?
    • 1) S. pneumonia (PCN-R)
    • 2) S. pneumonia (PCN-S)
    • 3) N. meningitides
    • 4) H. flu
  3. What can cause aseptic meningitis?
    • Chemical irritants (INCLUDING DRUGS), viral, fungal, parasitic, tubercular, sarcoid, neoplastic, and syphilitic processes in the CNS
    • NSAIDs are a common drug etiology
  4. What is a normal CSF Glucose result?
    50-66% of plasma
  5. What is an abnormal CSF Glucose result?
    < 50 mg/dl
  6. What is a normal CSF Protein result?
    < 50 mg/dl
  7. What is an abnormal CSF Protein result?
    > 150 mg/dl
  8. What is a normal CSF WBC result?
    < 10/mm3 (monos
  9. What is an abnormal CSF WBC result?
    > 10/mm3
  10. What is a normal CSF Lactic Acid result?
    < 14 mg/dl
  11. What is an abnormal CSF Lactic Acid result?
    > 35 mg/dl
  12. What is a normal CSF pH?
  13. What is an Abnormal CSF pH?
  14. Bacteria which cause meningitis possess a ___________________which resists neutrophil phagocytosis.
    Polysaccharide capsule
  15. Bacteria which lack ______________________ are incapable of producing meningitis
    Polysaccharide capsule
  16. How does meningitis present?
    • Fever, stiff neck or back
    • Nuchal rigidity (don’t want to move head)
    • + Brudzinski sign
    • + Kernig sign
    • All lead to seizures and or hydrocephalus
  17. What is a + Kernig sign?
    MD flexes hip 90 degrees to the trunk and attempts to extend the knees. This will produce contracture or extensor spasm at the knee
  18. What is a + Brudzinski sign?
    Flexion of the neck by the MD will produce hip and knee flexion
  19. What characteristics of a drug allow it to transfer into the CNS?
    • Small molecular weight
    • Antibiotics which are un-ionized
    • Highly lipid soluble
    • Low protein binding
    • Relationship between MBC and concentration in the CSF
  20. What groups of patients are most likely to get N. meningitides (Meningococcus)?
    Children and young adults
  21. What specific symptom/sign indicates N. meningitides (Meningococcus)?
  22. What is the treatment for N. meningitides (Meningococcus)?
    • Pen G Q4H
    • Cefotaxime 2 grams IV Q4H
    • Ceftriaxone 2 grams IV Q12H
  23. How do you prophylax for N. meningitides (Meningococcus)?
    • Rifampin
    • Ceftriaxone when Rifampin is CI (like pregnant adults)
  24. What patients are more likely to get Streptococcus pneumonia (Pneumococcus)?
    • Very young (1-4 months)
    • Very old
    • Patients with a primary infection of the ear, paranasal or sinuses
  25. What are the risk factors for Streptococcus pneumonia (Pneumonococcus)?
    • pneumonia
    • endocarditis
    • CSF leak secondary to head trauma
    • Splenectomy
    • alcoholism
    • sickle cell disease
    • bone marrow transplantation
  26. How do you treat Streptococcus pneumonia (Pneumonococcus)?
    • Pen G, Cefotaxime or Ceftriaxone
    • Relatively resistant = Ceftriaxone
    • Highly resistant = Vancomycin
  27. What patients are most likely to get H. flu meningitis?
    • Previously 6 months to 3 years
    • Primary infection of middle ear, paranasal sinuses or lungs
  28. H. flu is often resistant to what drug?
  29. What are the drugs used to treat H. flu meningitides?
    3rd gen cephalosporins (Cefotaxime or Ceftriaxone)
  30. Why are cefotaxime or ceftriaxone preferred for H. flu meningitis?
    DOC for Beta-lactamase producers
  31. How do you prophylax for H. flu meningitis?
  32. What concomitant drug should be given along with antibiotics for bacterial meningitis?
    Dexamethasone before or at the time of the initiation of antibiotics
  33. What benefits does Dexamethasone given before or at the time of antibiotic initiation have for meningitis?
    Lower fatality, lower rates of severe hearing loss, neurological sequelae
  34. What is the TREATMENT OF CHOICE for N. meningitides meningitis?
    PCN G 200-300,000 U/kg/d
  35. What is the TREATMENT OF CHOICE for S. pneumonia?
    • Ceftriaxone 2 Gm IV Q12H + Vancomycin 15 mg/kg/dose
    • (children 100mg/kg/day IV Q 12hrs)
  36. What is the TREATMENT OF CHOICE for H. influenza?
    Ceftriaxone 2 Gm IV Q12 H (children 50-100mg/kg IM/IV Q 12 hrs)
  37. What groups are most susceptible to Listeria monocytogenes?
    • Neonates (genital or subclinical infection in mother)
    • Aged
    • Immunosuppressed
  38. What is the treatment of choice for Listeria monocytogenes?
    • Ampicillin (DOC) +/- aminoglycoside
    • 100 mg/kg IV q 8 hrs in neonates
    • 200 mg/kg IV Q 4 hours in adults
    • Trimethoprim-sulfamethoxazole has been used with success
    • Length of therapy - 3 weeks or longer
  39. What is the most common etiology of viral meningitis?
    • Enteroviruses including polio, Coxsackie, and echoviruses
    • (RNA viruses present in the GI tract)
    • Fecal oral
  40. What group usually gets viral meningitis?
    • Children < 14 years (children and young adults)
    • Summer and early fall
  41. What are the Symptoms of Meningitis?
    Headache, low grade fever, nuchal rigidity, malaise, drowsiness, nausea, vomiting, and photophobia
  42. How long does it take to recover from Viral meningitis?
    24-72 hours
  43. Are you more likely to see PMNs or Lymphocytes with Aseptic meningitis?
  44. Are you more likely to see PMNs or Lymphocytes with Septic meningitis?
  45. What is the treatment for Aseptic meningitis?
    Supportive only
  46. What group of patients is most likely to get Herpes?
    Neonates and sexually active adults
  47. How does Herpes Meningitis present?
    • Suddenly after a brief influenza like prodrome
    • Fever, HA, behavioral disorders, speech difficulties, focal seizures
  48. What is the treatment for Herpes meningitis?
    • Acyclovir
    • Acyclovir resistant viruses = Vidarabine or Foscarnet
  49. What is the primary cuase of shunt infections?
    • S. epidermidis for VA and VP shunts
    • S. aureus (2nd leading cause)
    • Usually G+
  50. How do you treat shunt meningitis where MRSA or MRSE is suspected?
    • Vancomycin and Gentimicin or rifampin
    • Remove shunt
  51. S. aureus shunt infection with PCN-resistant MSSA is:
    Nafcillin 2 Gm IV Q4H
  52. S. aureus shunt infection with MCN-resistant MRSA?
    Vancomycin 30-40 mg/kg/d
  53. PCN-resistant S. epidermidis shunt infection should be treated with what?
    Vancomycin 30-40 mg/kg/d
  54. MCN-resistant epidermidis shunt infection should be treated with what?
    Vancomycin 30-40 mg/kg/d
Card Set:
Therapeutics - CNS
2014-11-14 02:46:07
Therapeutics CNS
Therapeutics - CNS
Therapeutics - CNS
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