USMLE - STEP 2 Antibiotics and treatments

Prophylaxis in HIV based on CD4 count (3 big ones)

CD4 < 200 = ppx for PCP w/ bactrim

CD4 < 100 = ppx for toxo w/ double bactrim

CD4 < 50 = ppx for MAC w/ azithromycin

if cant use bactrim, use dapsone

if G6PD deficiency = use atovaquone

post-exposure prophylaxis following HIV exposure?

Tenofovir and Emtricitabine

Tx for disseminated MAC?

clarithromycin and ethambutol (SE is optic neuritis)

prophylaxis vs actual treatment of toxoplasmosis

ppx is double strength bactim

treatment is pyrimethamine and sulfadiazine for 6wks

antibiotics for bacterial meningitis

Vancomycin and Ceftriaxone

if young or old, give ampicillin to cover for listeria

antibiotics used for crypotoccal meningitis

will be in an AIDS pt w/ CD4<200

IV Amphotericin and FLucytosine

tx for lyme disease?

what about lyme meningitis?

lyme disease = doxycycline

if causes meningitis = Ceftriaxone

antibiotic treatment for cellulitis based on presentation

if walk in to office and not super sick: Cephalexin, Clindamycin, or Bactrim

if septic or inpatient = Vancomycin, linezolid

antibiotic treatment for clostridium perfringens (gas gangrene, crepitus, air in soft tissue on xray)

Clindamycin and penicillin

and rapid surgical debridment, especially if signs of NEC fascititis

treatment of bronchitis vs CAP pneumonia vs hospital acquired pneumonia

bronchitis (productive cough, fever, neg CXR): first line is azithromycin. Alt = Doxy or moxiflox

CAP: Azithromycin and Ceftriaxone (FQ is alt)

HAP: Vanc and Zosyn

Aspiration pneumonia or abscess is just like CAP: Ceftriazone and a macrolide

ATYPICAL/WALKING pneumonia is treated like bronchitis = azithromycin only

tx for CAP and Hospital acquired pneumonia

CAP = azithromycin and ceftriaxone

HAP = Vanc and zosyn

Tx of walking/atypical pneumonia

tx like bronchitis: just azithromycin

Doxyclycine or moxifloxacin are alternative

tx for gonorrhea and chlamydia

gonorrhea = ceftriaxone IM 1 time

Chlamydia = 7 days Doxy or 1 IM of Azithro

treatment for asymptomatic bacteriuria in pregnancy?

Amoxicillin

if PCN allergy, use nitrofurantoin

treatment of cystitis

bactrim, nitrofurantoin, or fosfomycin

may be given amoxicillin as the best choice

uncomplicated = 3 days

complicated = 7 days

pyelonephritis tx?

what if its a young healthy girl w/ pyelo who doesnt seem that sick?

IV ceftriaxone 10 days

if ambulatory pyelo = PO cipro

treatment of syphilis

primary (painless chancre and lymphadenopathy) gets IM penicillin once

Secondary gets IM penicillin once

tertiary gets IM penicillin 1-2 weeks

if latent (positive RPR but no symptoms) get IM penicillin once a week for 3 weeks

treatment of H ducreyi

azithromycin or cipro

treatment of LGV

painless chancre with PAINFUL lymphadenopahy (suppurative)

Tx is for chlamydia = Doxycycline

when and what do you give for ppx in mouth surgery? what if it was GI surgery?

if going to have mouth or throat surgery AND

- congenital heart defect w/ residual problem

- bad valve in a transplanted heart

- or prosthetic valve

THEN give AMOXICILLIN

IF asymptomatic valve problem, dont ppx

If GI/GU surgery, Ampicillin

if skin surgery or placement of prosthetic valve surgery, give vanc

treatment for endocarditis in a native valve vs prosthetic valve (based on how long since placement)

native valve = vancomycin

Prosthetic valve = Vanc + Gent

- if w/in 60 days, add cefipime

- if over 1 year, add ceftriaxone

treatment for otitis media?

what if allergic?

amoxicillin

if allergic, not anaphylactic = ceph

anaphylactic gets azithromycin

treatment for sinusitis?

amoxicillin-clavulanate (for all URIs)

DONT use azithromycin

treatment for bacterial pharyngitis

amoxicillin-clavulanate

treatment for a brain abscess?

ceftriaxone, metronidazole (+/- vanc) for 6 weeks

tx for histoplasmosis

if mild, supportive

if chronic cavitary lesions = itraconazole for >1 year

Severe acute pulm disease gets amphotericin B for 14days and itraconazole for 1 year

treatment and prophylaxis for malaria

Tx is chloroquine, as well as primaquine for resistance

Severe disease = IV quinidine

ppx = Atovaquone-proguanil and mefloquine

treatment for a neutropenic fever

fever >101 (or 100.4 for 24hrs) and absolute neutrophil count <500

- prophylaxis with cefepime or Zosyn

if no resolution in 72hrs, give antifungals

RMSF treatment

doxycycline or chloramphenicol if preg

otitis externa

cipro

tx for anthrax

cipro or doxycycline

tx for osteomyelitis

clindamycin plus one of the following:

- Cipro

- ampicillin

- naficillin

if MRSA = vancomycin

IF diabetic, tx for gram neg orgs with ceftriaxone/cipro

treatment for lichen sclerosis

topical steroids

tx for chronic bacterial prostatitis

6weeks of fluoroquinolones

male with recurrent UTIs and pain w/ ejaculation

prophylaxis in sickle cell disease

if under 5yo, give kids prophylactic penicillin BID due to splenic autoinfarction

treatment for bacterial conjunctivitis?

what if they wear contacts?

Erythromycin ointment, bactrim drops, or azithro drops

IF WEAR CONTACTS: FQ

tx for pertussis

azithromycin

also give azithromycin to close contacts

tx for PVCs?

B blocker or inc in B blocker dosage but only if frquent and symptomatic (palpitations)

treatment for dermatitis herpetiformis?

dapsone

and gluten free diet

tx for acute dystonia due to EPS SE?

Benztropine

OR diphenhydramine

tx for EPS SE from antipsychotic drugs

Can give benzotropine (anti-chol) for any of them, OR:

- Acute dystonia: diphenhydramine

- Akasthesia: B blocker or Benzo

- Parkinsonism: amantidine

- TD: valbenazine, deutrabenazine

COPD exacerbation management

B agonist and ipratropium inhalers/nebs

Glucocorticoids

Antibiotics if infection present

NPPV if ventilatory failure

treatment of DKA

- IV normal saline. Dextrose once glucose < 200

- IV insulin. SQ once below 200/able to eat (overlap by 1-2 hours)

- IV potassium if K <5.2

NOTE: if K < 3.3 HOLD INSULIN until give K

- give bicarb IF pH < 6.9

- phosphate if P < 1 or card/resp problems

management of suspected aortic injury due to trauma?

If hemodynamically stable, get CT angio

if unstable: TEE and emergent surgery

treatment for kawasaki disease

Aspirin and IVIG (w/in 10 days of fever onset)

first line tocolytics and when they are used (at what gestational age)

Indomethacin: <32weeks (SE include gastritis, plt dysfunction, oligohydramnios, and PDA closure)

Nifedipine (CCB): FIRST LINE BETWEEN 32-34 weeks (SE of tachycardia, palpitations, nausea, flushing, HA)

best cholesterol medication to treat hypertriglyceridemia (like when have yellow streaks on skin or palmar xanthomas)

fenofibrate

first treatment for TCA overdose

manage ABCs and then give Sodium bicarb

treatment for acne based on severity

if just noninflammatory black and white heads, first try topical retinoids, salicylic

if inflammatory:add benzoyl peroxide

if inflammatory and moderate severity add topical eryhtromycin

if inflam and severe, add oral antibiotics

if >5mm and appear cystic AND unresponsive to all of the above, then add oral isoretinoin

management of pheochromocytoma

alpha blockers first, then B blockers

what anti-hypertensive should be used in cocaine-induced chest pain

verapamil/diltiazem

which blood thinners do you use for acute STEMI vs NSTEMI vs undergoing stent placement or PCI

STEMI = PCI or tPA

NSTEMI = use heparin and early PCI (or used following thrombolytic use in STEMI)

technically, BEST for NSTEMI and those undergoing PCI/stenting= G2a/3b inhibitors (abciximab, tirofiban, eptifibide)

treatment for Right ventricular MI

shows up as new inferior wall MI and CLEAR LUNGS (ST change in 2, 3, aVF)

high volume fluid replacement

AVOID nitro (nitrates in general, b/c worsen cardiac filling/preload)

best initial test for constrictive pericarditis?

xray is best initial test

confirmarion or best test overall is CT

medication treatment for aortic dissection

B blockers and nitroprusside

treatment for acute migraine

ppx?

triptans or ergots

prophylaxis is B blockers if get them >3 times a month

can also use CCB, TCA, etc..)

acute tx an ppx for cluster headache

acute tx is 100% O2 and steroids (and lithium)

ppx is verapamil

treatment for pseudotumor cerebri

serial LPs

weight loss

acetazolamide

tx for postherpetic neuralgia

TCAs, gabapentin, carbamazepine, or phenytoin

topical capsaicin

tx of status epilepticus

benzo first

then phenytoin/fosphenytoin if not working

then can try phenobarbitol

last line is an anesthetic (succinylcholine)

when can you stop seizure prophylaxis?

no seizures for 2 years

empiric therapy given while waiting on results of brain biopsy for cancer vs abscess?

penicillin

metronidazole

ceftriaxone

treatment for parkinsons

Mild disease

- anticholinergic meds: Benztropine for the rigidity/tremor

- Amantidine (increases the dopamine)

Severe Disease:

- dopamine agonists (ropinerole/pramipexole) are the best INITIAL treatment

- levadopa/carbidopa are the MOST EFFECTIVE (helps w/ bradykinesia and dyskinesia)

- COMT inhibitors (capones): only if on leva/carbidopa, block metab of dopamine

- MAOI also block reuptake of dopamine

ONLY MAOI drugs are associated with slowing the progression of the disease (rasagiline)

tx for restless leg syndrome

pramipexole

treatment for huntington's disease

no cure

treat dyskinesia w/ tetrabenzine

treat psychosis w/ haloperidol/quietiapine

tx for tic disorders

fluphenazine (antipsychotic 1st gen) (dopamine antagonist)

tx for acute MS

what about drugs to help prevent exacerbations

acute MS = steroids

help prevent relapse:

- glatirimer

- B IFN

- fingolimod

- Azithioprine

- Cyclophosphamide

treatment (and quick overview) of each of the following:

- conjunctivitis

- Uveitis

- Glaucoma

- Abrasion

conjunctivitis is viral (bilat, watery, itchy, normal vision, preauricular nodes) or bacterial (unilat, purulent, no nodes, normal vision): viral is cold compresses, bacterial is topical Abx

- Uveitis is autoimmune, photophobia, Slit lamp exam, Steroids

- Glaucoma = pain, fixed midpoint pupil, tonometry, azetazolamide/mannitol/pilocarpine

- abrasion = trauma, sand in eye feeling, fluorescein stain, no therapy and patch not clearly beneficial

drug treatment options for chronic glaucoma

usually asymptomatic, found on tonometry

- acetazolamide

- pilocarpine

- prostaglandin analogs (end in prost)

- topical B blockers

- A2 agonists (apraclonidine)

tx of acute angle-closure glaucoma

due to dilation from darkness sometimes

sudden onset severe painful red eye, hard to palpation

tonometry

wont react to light

- IV acetazolamide

- IV mannitol

- topical B blocker/pilocarpine

- laser iridotomy

tx for herpes keratitis

swollen, red, painful but dont use steroids (will worsen it)

fluorescein stain = dendritic pattern

ORAL acyclovir

tx for invasive aspergillosis

voriconazole or caspofungin

amphotericin is a DISTRACTOR, not good for this

what do you need to test for before using primaquine?

G6PD

treatment for mild vs severe sunburn

mild = cool compres, aloe, NSAIDs

severe (blisters) = admission, IVF, wound care

treatment for acute gout attack/flare

when do you use 2nd line

NSAIDs first line

dont use NSAIDs when on a blood thinner (including aspirin) and can worsen HF so would use COLCHICINE

dont use colchicine in elderly pts or severe renal failure (main SE to know is diarrhea, abdominal pain)

which SSRI is NOT ok in pregnancy?

paroxetine (slight inc risk of cardiac malformations)

tx for entamoeba histolytica

metronidazole and cipro

bloody diarrhea after travel, not improved by normal antibiotics (cipro alone), do stool ova/parasite test

tx for legionella pneumonia?

fluorquinilone (or azithromycin specifically, not one of the other macrolides)

contaminated water

fever, bradycardia, GI (vomiting, diarrhea, cramps), and pneumonia

gram stain shows just neutrophils

urine legionella antigen is best test

treatment of genital warts

podophyllin resin or trichloroacetic acid

imiquimod

cryo or laser therapy

TCA is first line in pregnancy

treatment for hypertriglyceridemia based on how high the level is

if >150 (up to 500): wt loss, dec alcohol, inc exercise

- add statin if any heart risk

if >1000 = fibrates, fish oil, abstinence from alcohol

super elevated can cause pancreatitis

management of a patient who has intermittent tachycardia/SVT and bradycardia

Sick sinus syndrome

most common indication for a pacemaker

antibiotic used for dog/cat/human bites

amoxicillin/clavulanate

antibitoics for epididymitis

tetracycline or FQ

tx for metastatic prostate cancer

androgen ablation (GnRH agonists, orchiectomy, flutamide) and chemo

how to treat pneumonia based on presentation

- if young and no chronic diseases = outpt azithromycin

- if over 65 or any chronic disease = azithro and amoxicillin (or a FQ)

- if hospitalized for it = FQ or azithro/amox

- if hospital ACQUIRED = vanc and zosyn

antibiotics for strep pharyngitis

amoxicillin for 10 days

azithromycin if anaphylaxis, cephalosporin if just allergic to penicillin

empiric coverage for meningitis based on age

everyone gets vanc and ceftriaxone

if under 1month or over 60, get ampicillin

ppx for close contacts if meningococcal meningitis (cipro, rifampin, or ceftriaxone)

empiric antibiotics for brain abscess

vancomycin

ceftriaxone

metronidazole

Abx treatment for:

coccidioides

cryptococcus

histoplasmosis

blastomycosis

MAC

toxo

- coccidio = fluconazole/itra, ampho if bad

- crypto = IV amphotericin and flucytosine, continue fluconazole for 8wks

- Histo: mild/acute = symptomatic/itraconazole

- chronic/cavitary = 1 year of itraconazole

- severe pulm or disseminated = LIPOSOMAL amphotericin B or ampho for 2 weeks + 1yr itraconazole

- Blasto: itraconazole or ampho if bad

- MAC = clarithromycin or ethambutol+rifabutin (ppx is azithromycin)

- Toxo: PO pyramethamine + sulfadiazine + lecovorin

treatment of fever of unknown origin with neutropenia

neutrophil count under 500 and fever gets Zosyn

if no improvement in 3 days, suspect fungal and give antifungals

routine use of Granulocyte colony stim factors not recommended

empiric antibiotics for infective endocarditis

Vancomycin and gent

prophylaxis if needed is amoxicillin