USMLE Step 2 Review 18 13 Drugs of Choice Dog Bites

USMLE Step 2 Review 18 13 Drugs of Choice Dog Bites


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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.

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Begin 18 13 Drugs of Choice Dog Bites Transcription

Dog bites only become infected about 5% of the time, although the rate of infections is far lower in dog bites than in cat bites. Two organisms that might be present in a dog bite are the same as for cat bite.

What are they?

  • Pasteurella multocida and Staph aureus.

What is the drug of choice usually used to cover a wide range of possible organisms in dog bites, including Pasteurella multocida and Staph aureus, but not including rabies?

  • Amoxicillin plus Clavulanate.

And what’s the trade name?

  • Augmentin.

There are a number of other organisms that may be found in dog bites. There is 1 however, that is found most often, usually in dogs, but not usually in cats.

What is it?

  • Viridans streptococcus.

If rabies is a concern in a dog bite or other animal bite, what 2 agents are used?

  • Rabies immunoglobulin plus rabies vaccine.

In the United States, bites from what 5 animals usually require rabies prophylaxis?

  • Bat, raccoon, skunk, fox, wolf.

Again, 5 animal bites usually requiring rabies prophylaxis?

  • Bat, raccoon, skunk, fox, wolf.

Of these 5, which is probably most commonly feared but probably has the lowest risk of actually occurring?

  • Bat bites.

Why is this?

  • Rabid bats usually die quickly, and are too sick to bite unless they are picked up. The other 4 animals, however, remain active with rabies for a significant period of time.

Why is rabies a concern however, with patients who like to explore wild caves?

  • In a cave with a large buildup of bat guano, breathing the bat guano dust has been reported to cause rabies.

What is the probable viral agent of Kaposi’s Sarcoma?

  • HHV8.

There is no drug treatment currently recommended for systemic Kaposi’s Sarcoma.

What agent is currently being tested and via what route?

  • Foscarnet IV.

And the trade name for Foscarnet?

  • Foscavir.

What is the estrogen antagonist which is used for post-menopausal estrogen dependent breast cancer?

  • Tamoxifen.

And what is the non-prescription hormone estrogen receptor competitive inhibitor, which has shown some promise in combination with introleukin-2 in treating advanced cancers, including breast cancer and which may have a preventive role for breast cancer?

  • Melatonin.

What 3 forms of iron are used to treat anemia?

  • Iron fumarate, gluconate, or sulfate.

What is the drug of choice for both treatment and prophylaxis of mania in bipolar illness, which is also called manic depressive illness?

  • Lithium.

And what are 4 trade names for Lithium?

  • Eskalith, Lithobid, Lithonate, LithoTabs.

What class of drug may be used as an alternative?

  • Anti-convulsants.

Two anti-convulsants in particular have proven most effective for bipolar illness. What are they, in order of effectiveness?

  • Carbamazepine and Valproic acid.

And what’s the trade name for Carbamazepine?

  • Tegretol.

And 2 trade names for Valproic acid?

  • Depakote and Depakene.

Which of the 2 preparations of Valproic acid tends to be better tolerated?

  • Depakote.

While Lithium and Carbamazepine/Tegretol are more accepted than Valproic acid for bipolar illness, Valproic acid/Depakote or Depakene has 1 significant advantage. What is it?

  • In overdose, Valproic acid/Depakote or Depakene is much more benign.

Finally, another drug usually used for hypertension has been reported effective in treating bipolar illness but should never be used before Lithium, Carbamazepine, and Valproate have been tried. What is it?

  • Verapamil.

And what class of drug is Verapamil?

  • A calcium channel blocker.

Because calcium channel blockers can slow conduction in the heart, what problem can Verapamil cause in the heart that already has a conduction delay?

  • Heart block.

What are the 2 most likely organisms in post-surgical or post-traumatic brain abscess?

  • Staph aureus or Enterobacter.

What category of bug is Staph aureus?

  • Gram positive.

And what category of bug is Enterobacter?

  • Gram negative.

Now, the drugs of choice include a PRSP and a Cephalosporin in combination. What are they?

  • Either Nafcillin or Oxacillin along with a 3rd generation cephalosporin.

Now, what class of drug are Nafcillin or Oxacillin?

  • They’re PRSPs- Penicillinase Resistant Synthetic Penicillins.

What’s the trade name for Nafcillin?

  • Unipen.

And the trade name for Oxacillin?

  • Prostaphlin.

Which of the 2 bugs is both the 3rd generation cephalosporin and the Nafcillin or Oxacillin for?

  • Staph aureus.

Which of the drugs of choice is for the Enterobacter?

  • The 3rd generation Cephalosporin.

If the Staph aureus is suspected to be MRSA, what drug of choice for MRSA should be substituted for the Nafcillin or Oxacillin?

  • Vancomycin.

And the trade name for Vancomycin?

  • Vancocin.

What class of drug is Vancomycin/Vancocin?

  • A glycopeptide.

If the brain abscess is primary, or continuous, and is not post-op or post-trauma, or due to AIDS, Staph aureus and Enterobacter are still likely, but there are 2 bugs that are much more likely. Give all 4 in order of frequency.

  • Streptococci, Bacteroides, Enterobacter, and Staph aureus.

Which 2 of these bugs are gram positive?

  • Streptococci and Staph aureus.

Which is gram negative?

  • Enterobacter.

And what category is Bacteroides?

  • It’s an anerobe.

What 2 drugs in combination are the drugs of choice for a primary or continuous brain abscess where Strep, Bacteroides, Enterobacter, and Staph are the likely bugs?

  • Cefotaxime or Ceftriaxone, with Metronidazole IV.

What’s the trade name for Cefotaxime?

  • Claforan.

And the trade name for Ceftriaxone?

  • Rocephin.

And the trade name for Metronidazole?

  • Flagyl.



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