08-17-2014, 03:23 PM
finally adeg gets it right, but in real exam u only get 1 chance adeg and u dont have much time and u r under pressure...
A is correct
The patient has most likely developed a drug eruption; cefepime is the probable culprit. Up to 10% of patients develop a "drug rash" with this medication. The best option here is to change the cefepime to aztreonam, which will maintain the gram-negative bacteria coverage, but since it is a monobactam would be less likely to demonstrate crossreactivity with the cephalosporin.
B is not correct. 12% chose this.
Although levofloxacin is used more frequently as a prophylactic medication during episodes of neutropenia, the unpredictable resistance pattern of Pseudomonas aeruginosa makes levofloxacin inadequate for this situation.
C is not correct. 10% chose this.
In empiric therapy for febrile neutropenia, vancomycin is used to combat skin flora that would enter through skin and cause mucosal breakdown. An adjunct to broad-spectrum antibiotics directed at gram-negative organisms, vancomycin is less likely to cause a drug eruption than a β-lactam or a cephalosporin. Substituting a monobactam for the cephalosporin cefepime, and continuing vancomycin, is a more appropriate change. However, should patient demonstrate a persistent drug rash after discontinuation of cefepime it may be appropriate to discontinue it at that time.
D is not correct. 22% chose this.
Vancomycin is an adjunct to cefepime and is also less likely to cause a drug eruption than linezolid, which is generally reserved for vancomycin-resistant organisms. Although this is a consideration in the setting of circumstances that preclude vancomycin therapy, this patient may be not be an ideal candidate for this empiric alteration to linezolid because of the drug's potential for profound myelosuppression, which is already a source of her complaints.
E is not correct. 27% chose this.
The patient has developed an adverse reaction to a medication, so continuing the current therapy regimen would not be appropriate.
A is correct
The patient has most likely developed a drug eruption; cefepime is the probable culprit. Up to 10% of patients develop a "drug rash" with this medication. The best option here is to change the cefepime to aztreonam, which will maintain the gram-negative bacteria coverage, but since it is a monobactam would be less likely to demonstrate crossreactivity with the cephalosporin.
B is not correct. 12% chose this.
Although levofloxacin is used more frequently as a prophylactic medication during episodes of neutropenia, the unpredictable resistance pattern of Pseudomonas aeruginosa makes levofloxacin inadequate for this situation.
C is not correct. 10% chose this.
In empiric therapy for febrile neutropenia, vancomycin is used to combat skin flora that would enter through skin and cause mucosal breakdown. An adjunct to broad-spectrum antibiotics directed at gram-negative organisms, vancomycin is less likely to cause a drug eruption than a β-lactam or a cephalosporin. Substituting a monobactam for the cephalosporin cefepime, and continuing vancomycin, is a more appropriate change. However, should patient demonstrate a persistent drug rash after discontinuation of cefepime it may be appropriate to discontinue it at that time.
D is not correct. 22% chose this.
Vancomycin is an adjunct to cefepime and is also less likely to cause a drug eruption than linezolid, which is generally reserved for vancomycin-resistant organisms. Although this is a consideration in the setting of circumstances that preclude vancomycin therapy, this patient may be not be an ideal candidate for this empiric alteration to linezolid because of the drug's potential for profound myelosuppression, which is already a source of her complaints.
E is not correct. 27% chose this.
The patient has developed an adverse reaction to a medication, so continuing the current therapy regimen would not be appropriate.