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gphc exam > Infection > Flashcards

Infection Flashcards

1
Q

Name tetracyclines

A

doxycycline, demeclocycline, lymecycline, minocycline, oxytetracycline, tetracycline, tigecycline

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2
Q

what is on the label of tetracyclines

A

do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

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3
Q

which tetracyclines are okay with metal ions

A
  • Doxycycline
  • Lymecycline
  • Minocycline
    Does Like Milk
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4
Q

Side effects of tetracyclines

A
  • benign intracranial hypertension - stop & report headache/visual disturbance
  • lupus-erythematous like syndrome and irreversible pigmentation in sunlight
  • teeth discolouration and bone deposits
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5
Q

which tetracycline has biggest risk of pigmentation in the sun

A

minocycline

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6
Q

who should you avoid tetracycline in

A
  • under 12 years old
  • pregnant
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7
Q

tetracyclines counselling points

A
  • hepatotoxicity - avoid in liver failure
  • photosensitivity = avoid sunlight/sunlamps
  • dysphagia = swallow whole, plenty fluid, while sitting/standing
  • caution in myasthenia gravis
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8
Q

Metronidazole side effects

A
  • taste disturbance (metallic taste/furred tongue)
  • NV (take with/after food)
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9
Q

What to avoid with metronidazole

A
  • alcohol during and 48 hours after treatment
  • causes disulfiram reactions (NV, flushing)
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10
Q

When to avoid nitrofurantoin

A
  • pregnant = avoid at term
  • eGFR < 45
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11
Q

Nitrofurantoin administration directions

A

with/after food

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12
Q

Nitrofurantoin urine colour

A

yellow/brown

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13
Q

Trimethoprim cautions

A
  • blood dyscrasias - fever, sore throat, rash, mouth ulcers, bruising, bleeding
  • antifolate so interaction with MTX, phenytoin, folic acid
  • hyperkalaemia
  • caution in renal impairment
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14
Q

Name quinolones

A

ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin

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15
Q

Quinolones cause

A
  • reduce seizure threshold (avoid in epilepsy) - also with NSAIDs
  • psychiatric and tendon disorders
  • allergies
  • reduce sunlight and UV exposure
  • may impair driving ability
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16
Q

Quinolones MHRA warnings

A
  • tendonitis
  • risk of aortic aneurysm and dissection - sever abdo, chest, back pain
  • risk of heart valve regurgitation - SOB, peripheral oedema, new heart palpitations
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17
Q

Quinolones cautions

A
  • QT prolongation
  • myasthenia gravis
  • arthropathy in children/adolescents
  • perforated tympanic membrane when used by ear
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18
Q

Quinolones interactions

A
  • dairy/mineral - fortified milk (reduces absorption)
  • drugs causing QT prolongation
  • drugs reducing seizure threshold (NSAIDs)
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19
Q

Chloramphenicol common indication

A

eye infection

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20
Q

Chloramphenicol OTC age

A

2 years and over

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21
Q

Chloramphenicol contraindication

A

pregnancy - ‘grey baby syndrome’ if used in 3rd trimester

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22
Q

Clindamycin side effects

A
  • abx-associated colitis (fatal) - more common in elderly, discontinue & contact dr ASAP if severe, prolonged, or bloody diarrhoea
  • suspected C. diff - stop, specialist advice if cant stop
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23
Q

Linezolid side effects

A
  • severe optic neuropathy - monitor eyes regularly if tx > 28 days
  • blood disorders - FBC weekly if tx > 10-14 days
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24
Q

Linezolid interactions

A
  • tyramine - mature cheese, marmite, yeast extract, fermented soya bean extract, some beers and wines
  • serotonin syndrome - SSRIs, dopaminergic, 5-HT1 agonists, TCAs, Lithium, MAOIs - altered cognitive state = coma
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25
Q

Name narrow spec penicillins

A
  • Pen G (benzylpenicillin) - parenteral use only (not gastric acid stable)
  • pen V (phenoxymethylpenicillin)
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26
Q

Name broad spec penicillins

A
  • ampicillin
  • amoxicillin
  • co-amoxiclav (b-lactamase resistant)
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27
Q

Broad spec penicillins side effects

A
  • diarrhoea common - abx-associated colitis
  • maculopapular rashes common in patients with glandulofever - dont use broad spec blindly for sore throat
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28
Q

Name Penicillinase - resistant penicillins and give details

A
  • flucloxacillin
  • take on empty stomach 1 hour before or 2 hours after food (after hard as QDS)
  • cholestatic jaundice/hepatitis risk unto 2 months after stopping. Risk = administration > 2 wks, increased age - same for co-amox
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29
Q

Name antipseudomonal penicillins

A
  • piperacillin only available with tazobactam
  • ticarcillin only available with clavulanic acid
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30
Q

Penicillins side effects

A
  • DONT give intrathecally - encephalopathy = FATAL
  • true pen allergy = immediate rash, anaphylaxis
  • may not be allergy = minor rash, small, not itchy, non-confluent, rash after 72 hours
  • cross-sensitivity = cephalosporins
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31
Q

Name 1st gen cephalosporins

A
  • Cefadroxil
  • Cefalexin
  • Cefradine
    Fad, Fal, Frad
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32
Q

Name 2nd gen cephalosporins

A
  • Cefuroxime
  • Cefoxitin
  • Cefaclor
    Furry Fox Face
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33
Q

3rd and 5th gen cephalosporins

A

all parenteral except oral cefixime

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34
Q

Cephalosporins contraindications

A

penicillins and other b-lactams due to cross sensitivity

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35
Q

Name glycopeptides

A

dalbavanacin, teicoplanin, telavancin, vancomycin

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36
Q

Vancomycin details

A
  • parenterally for systemic infections (reduced absorption orally)
  • avoid in preg unless benefits > risk
  • initial dose by body weight then adjust based on levels
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37
Q

Vancomycin levels

A
  • trough = 15-20mg/L
  • measure before next dose
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38
Q

Vancomycin interactions

A
  • ototoxicity - cisplatin, vinka alkaloids, aminoglycosides, loop diuretics
  • nephrotoxicity - NSAIDs, ACEi, ARBs, Metformin, diuretics
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39
Q

Vancomycin side effects

A
  • red man syndroms
  • steven johnson syndrome
  • blood dyscrasias
  • cardiogenic shock on rapid IV injection
  • anaphylactoid reactions at infusion sites - avoid rapid infusion, rotations sites
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40
Q

Name macrolides

A
  • azithromycin - OD (COPD prophylaxis = 3x week)
  • clarithromycin - BD
  • erythromycin - QDS
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41
Q

Macrolides cautions

A
  • myasthenia gravis
  • erythro > clarithro in pregnancy
  • avoid clarithro in 1st trimester
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42
Q

Macrolides side effects

A
  • hepatotoxicity
  • ototoxicity in large doses
  • increased GI disturbances
  • QT prolongation
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43
Q

Macrolides interactions

A
  • macrolides = CYP inhibitors so increase levels of statins and warfarin (myopathy/bleeding)
  • hypokalaemia - diuretics, steroids, salbutamol, theophylline
  • increased QT prolongation - amiodarone, domperidone, fluconazole, lithium, SSRIs, methadone, ondansetron, quinine, quinolones, sotalol
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44
Q

Name aminoglycosides

A
  • amikacin, gentamicin, neomycin, streptomycin, tobramycin
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45
Q

Who should serum concentrations of aminoglycosides be taken for

A
  • all patients receiving parenteral aminoglycosides
  • must be determined in obesity, high doses, cystic fibrosis, elderly
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46
Q

Gentamicin levels

A
  • after 3 or 4 doses, then every 3 days or after a dose change, more frequent if renal impairment
  • measure 1 hour after dose and just before next dose
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47
Q

Gentamicin multiple daily dose regimen level targets

A
  • peak = 5-10mg/L
  • peak in endocarditis = 3-5mg/L bcos co-prescribed with other abx
  • trough = <2 mg/L
  • trough in endocarditis = < 1 mg/L as co-prescribed with other abx
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48
Q

Gentamicin dose adjustments based on levels

A
  • trough too high = increase dose interval
  • peak too high = decrease dose
  • renal impairment = increase interval, decrease dose if severe - avoid concomitant use of nephrotoxics
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49
Q

Gentamicin interactions

A
  • ototoxicity - cisplatin, loop diuretics, vancomycin, vinka alkaloids
  • nephrotoxicity - NSAIDs, ACEi, ARBs, Metformin, diuretics
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50
Q

Gentamicin contraindications

A
  • myasthenia gravis
  • pregnancy - risk of auditory or vestibular nerve damage - monitor serum concs
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51
Q

Gentamicin dose in obesity

A

use ideal body weight based on height to calculate parenteral dose

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52
Q

Aims of antimicrobial stewardship

A
  • prevents resistance
  • less unnecessary treatment, more caution
  • higher risk of resistance with broad spec abx
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53
Q

Antimicrobial stewardship NICE guidance

A
  • only start abx if clinical evidence of bacteria
  • follow local guidelines
  • futures to narrow spectrum
  • avoid broad spec if possible
  • avoid widespread use of topical abx especially if systemic available
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54
Q

Which abx come with risk of C. diff, MRSA, abx resistant UTIs

A
  • co-amox
  • quinolones (ciprofloxacin)
  • cephalosporins
  • clindamycin
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55
Q

Most common pathogen of CAP

A

streptococcus pneumoniae

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56
Q

Most common pathogen of UTIs

A

escherichia coli

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57
Q

Most common pathogen of thrush

A

candida albicans

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58
Q

Most common pathogen of cellulitis

A

staphylococcus aureus

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59
Q

Most common pathogen of meningitis

A

streptococcus pneumoniae

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60
Q

Most common pathogen of sore throat

A

streptococci

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61
Q

Treatment of human/animal bites

A
  1. co-amox
  2. doxy + metro
    - prophylaxis = 3 days, Tx = 5 days
    - scratches = fluclox
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62
Q

Treatment of tick bites (Lyme disease)

A
  1. doxy (100mg BD)
  2. amoxicillin (1g TDS)
    - Tx = 21 days
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63
Q

Cellulitis treatment

A
  1. fluclox
    - alt: clarithro (erythro-preg), or doxy, or co-amox
  2. near eyes/nose = co-amox
    - alt: clarithro and metro
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64
Q

mild CAP treatment

A
  1. amox
  2. doxy or clarithro (erythro-preg)
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65
Q

mod CAP treatment

A
  1. amoxicillin and clarithro (erythro-preg)
  2. doxy or clarithro (erythro-preg)
66
Q

severe CAP treatment

A
  1. co-amox and clarithro (erythro-preg)
  2. levofloxacin
67
Q

mild (<2cm) diabetic foot infection treatment

A
  1. fluclox
    - alt: clarithro (erythro-preg)
68
Q

mod/severe diabetic foot infection (abscess, osteomyelitis)

A
  1. fluclox or co-amox +/- gent
    - alt: co-trimox +/- gent
69
Q

C. diff treatment

A
  1. vancomycin
  2. fidoxamicin
    - life threatening = vancomycin and IV metro
    - 10 days tx
70
Q

travellers diarrhoea treatment

A
  • standby: azithromycin
  • prophylaxis/tx = bismuth subsalicylate
71
Q

Otitis media treatment

A
  1. amoxicillin
  2. co-amox (if worsening after 2-3 days
    - alt: clarithro (erythro-preg)
72
Q

Otitis externa treatment

A
  1. topical acetic acid 2%
  2. topical neomycin + hydrocortisone
    - if systemic tx required - fluclox
73
Q

H. pylori treatment

A
  • Urea 13c breath test not within 2 wks PPI or 4 wks abx
    1. PPI + amoxicillin + clarithro
  • pen allergy = metro
74
Q

mild HAP treatment

A
  1. co-amox
  2. adults = doxy or cefalexin or co-trimox or levofloxacin
  3. children = clarithro
    (doxy in children = teeth/bone deposits, discolouration of teeth, avoid in < 12 yrs)
75
Q

localised non-bullous impetigo treatment

A
  1. hydrogen peroxide 1%
  2. fusidic acid (resistant = mupirocin 2%)
76
Q

Chloramphenicol eye drops dosage

A
  • 1 drop every 2 hours during waking hours for the first 48 hours then 1 drop 4 hourly for the next 72 hours during waking hours
  • 5 day course total
77
Q

widespread non-bullous impetigo treatment

A
  1. fusidic acid (resistant = mupirocin 2%)
78
Q

bullous or systemically unwell impetigo treatment

A
  1. fluclox
  2. clarithro (erythro-preg)
79
Q

lower UTI men tx

A

nitro or trimeth

80
Q

lower UTI non-preg tx

A
  1. nitro or trimethoprim
  2. pivmecillinam or fosfomycin
81
Q

lower UTI preg tx

A
  1. nitro
  2. cefalexin or amoxicillin
82
Q

lower UTI tx cautions

A
  • trimethoprim = teratogenic, interacts with folic acid, MTX, phenytoin
  • nitro not in eGFR < 45
  • men, preg, catheter = 7 days tx
  • uncomplicated = 3 days tx
83
Q

strep throat and scarlett fever tx

A
  • both part of streptococcus bacteria family
    1. phenoxymethylpenicillin
    2. clarithro (erythro-preg)
84
Q

What is scarlett fever

A
  • flu-like symptoms
  • swollen neck glands
  • red rash with small raised bumps
  • rough feeling like sandpaper
  • white coating on tongue
85
Q

acne vulgaris treatment

A

adapalene, clindamycin, benzoyl peroxide, lymecycline

86
Q

BV and trichomoniasis treatment

A

metronidazole

87
Q

chlamydia treatment

A

doxycycline

88
Q

conjunctivitis and blepharitis tx

A

chloramphenicol (not OTC < 2 yrs)

89
Q

dental abscess tx

A

amoxicillin or metro

90
Q

gonorrhoea tx

A

ceftraxone or ciprofloxacin

91
Q

meningitis tx

A

benzylpenicillin

92
Q

scabies tx

A

permethrin - whole body neck down - tx whole house

93
Q

sinusitis tx

A

phenoxymethylpenicllin (allergy = doxy)

94
Q

threadworm tx

A

mebendazole - not <2 yrs, preg - tx whole house

95
Q

Name narrow spec antibiotics

A
  • Pen V and G
  • Glycopeptides
  • Trimethoprim
  • Linezolid
  • Clindamycin
    PG TLC
96
Q

Name broad spec antibiotics

A
  • Chloramphenicol
  • Aminoglycosides
  • Penicillins (amoxicillin, ampicillin)
  • Tetracycline
  • Nitrofurantoin
  • Macrolides
  • Cephalosporins
  • Quinolones
    CAPTN MCQ
97
Q

Name anaerobic antibiotics

A

metronidazole

98
Q

Name bacteriostatic antibiotics

A
  • prevents bacterial growth
  • Chloramphenicol
  • Linezolid
  • Tetracyclines
  • Macrolides
  • Clindamycin
99
Q

Name bactericidal antibiotics

A
  • kills bacteria
  • Cephalosporins
  • Aminoglycosides
  • Nitrofurantoin
  • Trimethoprim
  • Quinolones
  • Metronidazole
  • Glycopeptides
  • Penicillins
100
Q

Which antibiotics should be taken with/after food

A
  • metronidazole
  • clarithromycin MR
  • nitrofurantoin
  • pivmecillinam
101
Q

Which antibiotics should be taken on an empty stomach (30-60 mins pre/2 hours after food)

A
  • flucloxacillin
  • phenoxymethylpenicillin
  • azithromycin capsules (not tabs or liquid)
  • tetracycline
  • oxytetracycline
102
Q

What is myasthenia gravis

A

muscle weakness especially in face (droopy eyes, slurred speech)

103
Q

Which antibiotics should be taken in caution with myasthenia gravis

A
  • Quinolones
  • Aminoglycosides (gent)
  • Macrolides
  • Tetracyclines
104
Q

Which antibiotics are nephrotoxic

A
  • nitrofurantoin (<45 - avoid)
  • aminoglycosides (gent)
  • glycopeptides (vancomycin, teic)
  • tetracyclines and trimethoprim - lower risk
105
Q

Which antibiotics are hepatotoxic

A
  • macrolides
  • fluclox
  • co-amox
  • rifampicin, isoniazid, pyrazinamide
  • chloramphenicol, nitrofurantoin, tetracyclines - lower risk
106
Q

Malaria - bite protection

A
  • mosquito nets covered in permethrin
  • DEET 20-50% - okay for > 2 months old - avoid ingestion
  • DEET suitable if pregnant/breastfeeding - was breast before feeding
  • DEET after sunscreen - reduces SPF so use high SPF lotion
107
Q

Malaria - patient groups

A
  • asplenia - risk of severe malaria
  • preg = avoid malaria areas, only chloroquine or proguanil suitable but risk of NTD so take folic acid 5mg
108
Q

Malaria - medication groups

A
  • epilepsy - avoid chloroquine and mefloquine - reduces seizure threshold
  • warfarin = start 2-3 wks before, measure INR before tx, 7 days after and after completing course. prolonged stays = check regularly
109
Q

Mefloquine cautions

A
  • psychiatric disorder - stop and medical attention
  • convulsions
110
Q

Chloroquine cautions

A
  • convulsions
  • retinotoxic
111
Q

Proguanil cautions

A
  • renal impairment - reduce dose
112
Q

Malaria - Doxycycline cautions

A

avoid exposure to sunlight

113
Q

Malaria - standby treatment

A
  • carry emergency tx if likely to be more than 24 hrs away from medical care
  • avoid self-medication if possible
  • provide written instructions: seek attention if fever develops 7 days after arriving in malarious area, self treat if help not available within 24 hours of fever onset
114
Q

Atovaquone/proguanil details

A
  • malarone (POM) or Maloff protect (P) - OTC > > 18 yrs, > > 40kg (6st 4lbs)
  • start 1-2 days before until 1 week after
  • 1OD
  • max use = 1 year
115
Q

Chloroquine details

A
  • OTC alone or with proguanil
  • start 1 week before until 4 weeks after
  • 1 a week
  • max use = long-term (PC Long)
116
Q

Proguanil details

A
  • OTC alone or with chloroquine
  • start 1 week before until 4 weeks after
  • 1OD
  • max use = long term (PC Long)
117
Q

Mefloquine details

A
  • POM
  • start 2-3 weeks before until 4 weeks after
  • 1 weekly
  • max use = 1 year
118
Q

Doxycycline details

A
  • POM
  • start 1-2 days before until 4 weeks after
  • 1OD
  • max use = 2 years
119
Q

Malaria advice

A

illness within 1 year, especially 3 months of return, might still be malaria - see dr early mention malaria

120
Q

Tuberculosis treatment

A
  • initial 2 months = RIPE
  • continue for further 4 months = RI
  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
  • total 6 months treatment
121
Q

Latent TB treatment

A
  • 3 months rifampicin and isoniazid or 6 months isoniazid
  • if 35 - 65 years old, should be cleared of hepatotoxicity
122
Q

Rifampicin details

A
  • discolours soft contact lenses and bodily fluids red/orange
  • CYP 450 inducer
123
Q

Isoniazid details

A
  • peripheral neuropathy - give B6 (pyridoxine)
  • CYP 450 inhibitor
124
Q

Pyrazinamide details

A
  • hepatotoxic
125
Q

Ethambutol details

A
  • visual impairment and ocular toxicity
126
Q

Varicella zoster (chicken pox, herpes zoster, shingles) treatment

A
  • aciclovir/valaciclovir (pro drug)
  • chicken pox = never NSAIDs - age 14 yrs + = antiviral within 24 hours of onset
  • herpes/shingles = tingling sensation, burning, fluid filled blisters - follows nerves on one side of body - belt/half-belt around rib cage/torso
127
Q

Aspergillosis treatment

A

voriconazole

128
Q

cryptococcosis treatment

A

amphotericin B

129
Q

vaginal thrush treatment

A
  • clotrimazole/fluconazole
  • resistant = itraconazole
130
Q

oral thrush treatment

A
  • nystatin/miconazole/fluconazole
  • resistant = itraconazole
131
Q

fungal skin and nail infections treatment

A
  • topical therapy
  • systemic therapy (itraconazole, terbinafine)
132
Q

Name all the places of Tinea (ringworm)

A
  • Tinea capitis = head
  • Tinea corporis = body
  • Tinea cruris = groin
  • Tinea pedis = feet
  • Tinea unguium/onchomyosis
133
Q

Tinea (ringworm) treatment

A

topical anti fungal cream or terbinafine

134
Q

OTC antifungals

A
  • terbinafine or amorolfine nail laquer
  • OTC for 18 yrs +, refer to GP if <18yrs, 2 + nails affected, diabetic, preg, breastfeeding
  • once weekly for upto 1 year, have to wait for whole nail to grow out
135
Q

Name antifungal medications

A

fluconazole, itraconazole, ketoconazole, voriconazole

136
Q

antifungal meds cautions

A
  • QT prolongation
  • hepatotoxicity
  • less risk in fluconazole, more risk in itraconazole, ketoconazole, voriconazole
137
Q

Itraconazole details

A

carbonated drinks improve bioavailability

138
Q

Ketoconazole side effect

A

life threatening hepatotoxicity - oral tx suspended

139
Q

Voriconazole side effect

A

phototoxicity uncommonly - avoid sunlight

140
Q

Terbinafine side effect

A

hepatotoxicity

141
Q

Amphotericin B cautions

A
  • renal failure
  • anaphylaxis risk with IV - test with 30 min observations
  • prophylactic antipyretics or hydrocortisone if previous reaction
  • maintain same formulation between conventional, liposomal, and lipid complex formulations - serious harm/fatal
142
Q

Phenoxymethylpenicillin administration instructions

A

take on empty stomach, 1 hour before or 2 hours after food

143
Q

Pyridoxine dose

A

for prevention of isoniazid associated peripheral neuropathy: 10 - 20mg daily

144
Q

Gentamicin max length of treatment for multiple daily dose regimen

A

7 days

145
Q

Mefloquine contra indications

A
  • psychiatric disorders
  • depression
  • anxiety
  • abnormal dreams
146
Q

Which antibiotics are appropriate for UTI

A
  • nitrofurantoin
  • timethoprim
  • pivmecillinam
  • oral cephalosporins
147
Q

Quinolones - increased risk of tendon damage with:

A
  • concomitant use of corticosteroids
  • > 60 years old
  • history of tendon disorders
148
Q

Miconazole cream length of treatment

A

continued for 10 days after lesions cleared

149
Q

Gentamicin once daily levels how many hours after dose

A

20 hours

150
Q

Antibiotics appropriate in chest infection

A
  • amoxicillin
  • doxycycline
  • azithromycin
151
Q

Exacerbation of chronic bronchitis treatment

A
  • amoxicillin/ampicillin
  • tetracycline
152
Q

Which antibiotic can be used for pseudomonas infections

A

tobramycin

153
Q

Which antibiotic can be used for staphylococcus infections

A

flucloxacillin

154
Q

Endogenous Cushing’s Syndrome treatment

A

ketoconazole 400-600mg in 2-3 doses, increased to 800mg to 1200mg. Maintenance = 400 to 800mg daily in 2-3 doses

155
Q

Chlamydia treatment

A
  • azithromycin 1g stat
  • doxycycline 7 days
156
Q

Phenoxymethylpenicillin dose for 6-11 year old

A

250mg QDS

157
Q

Recurrent vaginal thrush treatment

A

fluconazole 150mg every third day for a total of 3 doses followed by 150mg once weekly for 6 months

158
Q

threadworm treatment for children 6 months and under

A

hygiene measures alone

159
Q

no interaction between metronidazole and

A

carbamazepine

160
Q

severe renal impairment eGFR

A

<30

161
Q

TB drugs and hepatotoxicity

A
  • Rifampicin, Isoniazid, Pyrazinamide, Pyridoxine cause hepatotoxicity
  • Ethambutol is the ONLY one that does not cause hepatotoxicity
162
Q

Oseltamivir for influenza prophylaxis eligibility

A

can have if ‘at-risk’, includes > 65 years, one or more chronic conditions including diabetes

gphc exam (22 decks)

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