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Meningitis Tx
Pharm-II
| Question | Answer |
|---|---|
| Inflammation/infx of the membranes surrounding the brain and spinal cord | meningitis |
| Acute inflammation/inx of brain parenchyma | encephalitis |
| 5 of the usual bacteria causing meningitis and their morphology | Strep pneumo: Gm+ cocci , H. flu: Gm- Coccobacilli, N. meninggtidis: Gm - cocci, Gram – bacteria: Gm – Bacilli , listeria monocytogenes: gm + bacilli |
| Why is knowing the morphology important | must know if want to start empiric tx |
| What are RF’s for meningitis | Sickle cell, asplenic status, any head trauma, infx, or foreign body, cigarette smoke, alcoholism |
| Most common bacteria w/ exposure to cigarette smoke, head infx? | N. meningitis, strep pneumo |
| What are the three types of vaccines | Hib, pneumococcal conjugate (prevar), meningoccal polysaccharide (menomune) |
| What are some complications of meningitis | SNHL, hydrocephalus, focal sensory motor deficits, sz d/o, death |
| Layers of the meninges | Dura, Arachnoid, Pia, subarachnoid b/w arachnoid and pia: CSF |
| Where is CSF made | choroid plexus in the lateral and 4th ventricle, flows unidirectionally down the spinal cord |
| ~ amounts of CSF in Infants, kids, adults | I: 40-60ml, K: 60-100ml, A: 110-160ml |
| Diagnostic tests for meningitis | LP: CSF cell count, chemistries, gm stain, culture, Blood Culture, |
| Abnl levels/nl levels for WBC, Neut, Pro, Gluc, Gm stain | WBC: <5, 1,000-5,000 Neut: 0-15, >80, Pro: <50, 100-500, Glu: 50-66%SBG, <40 (<60%SBG), Gm stain: 75-90 |
| Likely pathogents for meningtitis <1m | Gropu B strep, E.coli, L. monocytogenes, Klebsiella species |
| Likely pathogens for meningitis 1-23m | S. pneumo, N. meningitides, Group B strep, H.flu, E.coli |
| LIkeley pathogens for meningitis 2yo-50yo | N. meningitides, s. pneumo |
| Likely pathogens >50yo | S. pneumo, N. meningitids,L. monocytogens, gm – bacilli |
| Tx goals for meningitis tx | Eradicate infx, improve signs and sxs, prevent neuro sequelae |
| What are supportive care methods for meningitis | antipyretics, fluids, antieemtics, rest |
| What is papilledema and what does it mean | swelling of the optic disc in the eye, signifies increased ICP |
| Signs and sxs for bacterial meningitis | new onset sz, papilledma, altered consciousness, focal neuro deficits, |
| Tx if suspicion for bacterial meningitis w/ - Gm stain | Dexamethasone + empiraical abx |
| If < 1m tx therapy w/ - Gm stain | Ampicillin + cefotaxime or ampicillin + AG |
| Tx 1-23 m therapy w/-gm stain | Vanco + 3rd generation Ceph |
| 2-50years tx therapy for meningitis w/ - gm stain | Vanco + 3rd gen ceph |
| Tx >50yo for meningitis w/-gm stain | Vanco + ampicillin + 3rd gen ceph |
| Why do we use dexamethasone | subarachnoid space is inflamed, killing the bacteria ↑debris ↑ inflammation ↑ICP dexamethasone ↓ inflammation prior to abx dose |
| What are the guidelines to give dexamethasone | Infants/kids w/ H. flu tybe b, Infants/kids/adults w/ S. pneumo, and give 15mins prior to 1st dose |
| Who should we prophylaxis for meningitis | H. flu or N. meningitides people who were around these pt’s |
| How to tell the difference between encephalitis and meningitis | gradual onset of sxs w/ encephalitis |
| What is the typical viral encephalitis course | 1-2 weeks w/ ↑morbidity w/ HSV and West Nile |
| Tx of viral encephalitis | fluids, antipyretics/analgesics WNV: anti-sz, tx for ↑ICP, HSV: anti-sz, acyclovir |
| Which type of viral encephalitis do we tx w/ antivirals | Herpes Simplex Virus encephalitis w/ acyclovir |
Created by:
streetsmarts
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