1. Therapeutics 3 Tutoring Exam 4 February 20 th, 2016 Lisa Hayes lhayes3@uthsc.edu

2. Outline Infectious Diarrhea Bone and Joint Infections Sepsis STI

3. Infectious Diarrhea

4. 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

5. Which of the following agents might be most beneficial for traveler’s diarrhea? A – Lomotil B – loperamide C – Pepto-bismol D – cipro

6. Which of the following agents could interfere with the efficacy of digoxin? A – loperamide B- ciprofloxacin C – bismuth D - polycarbophil

7. Which antibiotic is used to treat the bloody mucoid diarrhea associated with Shigella? A – Septra B – Ciprofloxacin C – Doxycycline D – Augmentin

8. 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

9. Giardia is associated with infected drinking water. How would you treat this? A – paramomycin B – metronidazole C – tetracycline D – levaquin

10. 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

11. Bone and Joint Infections

12. What is the gold standard test for diagnosing osteomyelitis? A – CT scan B – bone biopsy C – X-ray D – MRI

13. 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

14. 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

15. 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

16. 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

17. What is the gold standard for diagnosing septic arthritis? A – xray B – MRI C – arthrocentesis D – elevated inflammatory markers

18. 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

19. 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

20. Sepsis/Septic Shock

21. 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

22. Which of the following is not only indicative of late sepsis? A- DIC B- azotemia C- ARDS D- nausea/vomiting

23. Which bacteria has the highest frequency and mortality in sepsis? A- E.coli B- S. aureus C- Pseudomonas D- Enterococcus

24. 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

25. 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

26. Which fluid is not recommended in sepsis treatment? A- Normal Saline B- Hetastarch C- Albumin D- blood products

27. 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

28. 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

29. 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

30. 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

31. Sexually Transmitted Infections

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. Questions? lhayes3@uthsc.edu