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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.
Play USMLE Audio MP3 18 09 Drugs of Choice Syphilis Below
Begin 18 09 Drugs of Choice Syphilis Transcription
What is the drug of choice for syphilis?
- Benzathine Penicillin G.
What is the trade name of the preparation that includes both Benzathine Penicillin G and Procaine Penicillin G?
In what tissue is gas gangrene mostly found?
The organism for gas gangrene is usually assumed from the clinical diagnosis. What is it?
- Clostridium perfringens.
And the drug of choice?
- Clindamycin plus Penicillin G.
What’s the trade name for Clindamycin?
What treatment is indicated in addition to the Clindamycin plus Penicillin G for gas gangrene?
- Debridement of necrotic tissue.
What is another treatment modality sometimes needed in addition to antibiotics and debridement?
- Hyperbaric oxygen.
What is the condition that can be acquired for a cat scratch or a cat licking the skin usually in children or teenagers?
- Cat-Scratch Disease.
And the organism?
- Afipia felis.
And the treatment?
- There is no drug of choice.
In immunocompromised patients, IV antibiotic is often employed. What are the 3 antibiotics most often tried in immunocompromised patients with cat-scratch disease?
- Rifampin, Ciprofloxacin, or Trimethoprim Sulfa.
There are 2 main signs or symptoms. What is the palpatory sign of cat-scratch disease, and how long does it last in immunocompetent patients?
- The patient will have very swollen lymph nodes that can present anywhere. They are tender at first, and can persist for 2 years.
What is the symptom usually present at the beginning and how does it progress?
- They usually have fever at the beginning but it goes away, and then the patient doesn’t seem very sick.
What is the name for the mite that causes scabies?
- Sarcoptes scabiei.
The treatment of scabies depends upon severity and location. Topical treatment is usually tried before resorting to systemic. What is the topical drug of choice that can be used anywhere on the body, including the head and the scalp?
- Permethrin cream.
And the trade name for Permethrin cream?
What are 2 topical drugs of choice that may only be used from the neck down?
- Crotamiton or Lindane.
And the trade name for Crotamiton cream?
And the trade name for Lindane cream?
What is the systemic drug of choice for scabies which does not respond to topical treatment?
And the trade name for Ivermectin?
What is the topical drug of choice for persistent burning and itching after you have successfully eradicated the live mites?
- Topical corticosteroid.
What is the drug of choice for arsenic, antimony, and gold poisoning?
Trade name for Dimercaprol?
- BAL in oil.
What other type of metal poisoning is Dimercaprol the drug of choice for?
What does MRSA stand for?
- Methicillin-Resistant Staph Aureus.
What is the drug of choice and drug of choice against MRSA?
- Vancomycin IV.
And the trade name for Vancomycin?
What class of antibiotics is Vancomycin/Vancocin?
- A glycopeptide.
What general class of bacteria is Vancomycin/Vancocin completely active against?
- All of the gram-positives.
What is the preferred second choice against MRSA, including route of administration?
- Trimethoprim Sulfa IV.
And 2 trade names for Trimethoprim Sulfa?
- Bactrim, Septra.
Where is it normal for about 20% of adults to carry Staph aureus, including MRSA?
- In the anterior nares.
What class of antibiotic is Methicillin?
- It’s a PRSP- Penicillinase-Resistant Synthetic Penicillin.
What is penicillinase?
- An enzyme that attacks Penicillin.
And what is another name for penicillinase, the enzyme carried by most Staph and by other Penicillin resistant bugs?
So, Staph aureus starts out resistant to Penicillins due to it’s ability to produce what (Give both names)?
- Penicillinase, beta-lactamase.
Then, MRSA is even more resistant because it has also developed resistance to these synthetic antibiotics developed to overcome penicilliase or beta lactamase. What is MRSA additionally resistant to (Give the name and the category)?
- Methicillin, a PRSP.
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