Superficial Fungal Infections Pharm
What is the recommended treatment for uncomplicated vulvovaginal candidiasis?
Singe dose oral fluconazole (Diflucan)
What is the most common route of infection for endemic mycoses? What would you expect to see on imaging?
respiratory; CXR will show diffuse, nodular infiltrates with enlarged hilar/mediastinal lymph nodes
When the patient is in the lateral recumbent position, the bevel should be facing towards the _______ and needle pointed slightly ________
ceiling; cephalad
What are the two most common microbes for skin abscesses?
Staph and strep
Explain the difference between meningitis and encephalitis.
Meningitis- inflammation of leptomeninges
encephalitis- abnormalities in brain function such as altered mental status, motor or sensory deficits
What OTC topical medications are available for treatment of vaginal candidiasis? When are they recommended over oral?
Clotrimazole and miconazole; pregnancy
For blastomycosis, ________ can be used to treat mild-moderate disease while _________ should be used for severe disease
Itraconazole; Amphotericin
How many tubes are collected for a CSF sample? How much CSF per tube?
4 tubes; 10 drops per tube
What does fluctuance vs induration mean? Which one is conducive for drainage?
Fluctuance means it feels fluid-filled, indurated means it is hard to the touch. Fluctuance indicates readiness for drainage
What two physical exam signs evaluate for meningeal irritation?
Kernig and Brudzinski's
Which two types of mycotic infections (tinea) must be treated with oral rather than topical antifungals?
scalp (tinea capitis) and nails (tinea unguium)
What are the black box warnings for itraconazole?
congestive heart failure, potent CP450 interactions, QT prolongation
Which patient position is considered more accurate when measuring opening pressure?
lateral recumbent position
What shape should your incision be for an I&D?
Which organism is most likely responsible for meningitis which appears with a rash and eventually requires a limb amputation?
Neisseria meningitidis
What is the mechanism of action of fluconazole? What are the side effects?
inhibition of ergosterol synthesis; minor GI upset and rare cases of serious hepatic toxicity
What medication class should be used for invasive candidiasis? What are the meds included in this class?
echinocandin- caspofungin (Cancidas), micafungin (Mycamine), anidulafungin (Eraxis)
What are four techniques that help with prevention of post-dural puncture headache?
1. pass needle bevel parallel to dural fibers
2. replace stylet before moving needle
3. use small diameter needle
4. use atraumatic needle
What are curved hemostats used for in I&D?
explore cavity and break up loculations
What are some early complications of meningitis? Name three for credit
Seizures, subdural effusion and empyema, stroke, cerebral edema, hydrocephalus, venous sinus thrombosis, brain abscess
What is the MoA of nystatin? What is a side effect of long-term use? What type of infection should nystatin not be used for?
Inhibitor of fungal membrane stability. Long-term can cause dental caries due to containing sucrose. Should not be used for dermatophyte infections
What is the primary treatment for invasive Aspergillosis and what are the side effects?
Voriconazole- prolonged QT interval, herpatotoxicity, visual changes, renal toxicity
what is xanthochromia and what does its presence in centrifuged CSF indicate?
A yellow color from the breakdown of RBCs; Evidence of preexistent blood in subarachnoid space
What is the use of needle aspiration for skin abscesses? Why does I&D still need to be performed?
Useful for diagnosis to see if there is really a pocket of fluid. Still must incise and drain because it will just close back up and re-fill with pus
Which organism is most likely causative in an asplenic patient? A patient with a complement deficiency?
Asplenic- s. pneumoniae (encapsulated organism)
Complement deficiency- neisseria meningitidis
What are the two first line treatments for tinea capitis in children? What are side effects of each?
Griseofulvin and terbinafine (Lamisil)
Griseofulvin- induction of p450, teratogenicity
Terbinafine- hepatotoxicity
Describe the side effects of Amphotericin. How can these be lessened (two ways)?
Infusion reaction (chills, fever, nausea, hypotension, flushing, respiratory distress, arrhythmias), thrombophlebitis due to vein irritation, nephrotoxicity
Lessen reactions by using liposomal formulation and pretreating with Tylenol, Benadryl, and hydrocortisone
What three ligaments will the needle cross before it accesses the spinal canal? Which one will result in a "pop"?
Supraspinous, interspinous, ligamentum flavum. Ligamentum flavus will result in a pop sensation
What are absolute contraindications to incision and drainage? Why?
Multiple abscesses- requires too much lidocaine
Facial abscess- concern form cavernous sinus thrombosis
On cell differential in lumbar puncture, bacterial meningitis shows mostly _________ while viral, fungal, and TB show mostly _________
PMNs (neutrophils); lymphocytes