Antimic Flashcards by X X

4 types of antimicrobials

antibiotics
antivirals
antifungals
antiparasitics

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the human microbiome is made up of harmless bacteria that the body needs to function, however what can occur when these bacteria translocate to different parts of the body

infection

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what is intrinsic resistance

inherent natural ability of bacteria to be resistant to abx without mutation or getting additional genes

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what 4 mechanisms of intrinsic resistance exist

cellular envelope
multi drug efflux pumps
lack of drug targets
enzymes

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what type of resistance involves impermeable cellular envelopes that prevent abx from entering

cellular envelope

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efflux pumps are on bacterial cell walls and pump abx out, are they associated with gram positive / negative bacteria

gram negative

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give one example of lack of drug targets in the context of resistance

penicillins cant be used for mycoplasma because they work on bacterial cells walls and mycoplasma has no cell wall

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give an example of enzymes in the context of resistance

some bacteria produce beta lactamase destroys beta lactam rings

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define extrinsic bacterial resistance

resistance due to modifications to genome due to environmental factors or gene transfer

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what 2 mechanisms of extrinsic resistance exist

horizontal gene transfer and mobile genetic elements

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mechanism/ type of extrinsic resistance that is characterised by exchange of genetic info between bacteria

horizontal gene transfer

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mechanism/ type of extrinsic resistance that involves jumping plasmids - facilitate transfer of genes between patients

mobile genetic elements

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what types of abx are mrsa resistant to

b lactamase abx’s (penicillins)

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what type of abx is CRE resistant to

carbapenem based

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what superbug is resistant to both penicillins and carbapenem based abx

esbl

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what superbug exhibits resistance to vancomycin adn carbapenem based abx and therefore should not be used for a long time

vre

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if carbapenem based abx are ineffective is there anything that can be done for those patients yes or no

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what is meant by antimicrobial stewardship/ ams

organisation approach to promoting and monitoring safe use of antimicrobials

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when assessing patients what should you look for evidence of

bacterial infections

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some infections are self limiting, if patients present with a fever over 38 degrees is this usually indicative of a viral or bacterial infection

viral

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sometimes starting abx can cause more harm to patients, give one example of where this can be the case

risk of c diff
risk of AMR

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c diff is gram positive and grows when the gut microbiota is disturbed by abx use causing severe diarrhoea, give one treatment option

faecal transplant

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before starting abx treatment a comprehensive risk assessment should be done, what things might you consider

recent abx use or immunocompromised?

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would empirical treatment be done with broad or narrow spectrum abx in the short term

broad

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what different cultures can be done whilst trying to focus treatment

blood urine faecal cultures throat and wound swabs

what imaging would you expect when trying to make a diagnosis of pneumonia

CXR

lab investigations may show increased inflamm markers such as

WCC neutrophils lymphocytes CRP

lab investigations look at trends, what might an increase in inflammatory markers indicate about treatment

not working so consider switch

if sepsis is present treatment should be started within what time frame

what are the risks associated with fake pencillin allergies

inc costs longer hospital stays

trenicillin allergies are mediated by IgE and occur in first 1h of drug give 3 ways this may manifest

hives urticaria anaphylaxis

names of serious life threatening systemic allergic reacs (drug allergy)

TENS SJS DRESS syndrome pustulosis

difference between allergy (hypersensitivity) and SE

allergy: immunological SE and intolerance: pharmacological

genetic susceptibilty to ADR = X

idiosyncrasy

various mechanisms mimics allergy = X

pseudo allergy

3 things to consider after checking penA label

allergy hx risk stratification specialist/ non allergy specialist de-labelling

what about allergy hx should you find out

reaction description reaction timing indication for pen presc

what to consider for pen allergy risk stratification

high/ low risk isolated symptoms unlikely to be allergic symptoms suggestive of type 1/ 4 hypersensitivity

what about pen allergy specialist/ non allergy specialist delabelling to check

direct bedside de-labelling? direct oral pen challenge? does px need referral to an allergy specialist?

when documenting what things is it important to note down

differential diagnosis current evidence treatment regimen stop or review date

patients should be reviewed how many hrs after abx initiation 'FOCUS' part of start SMART then FOCUS

48-72 hrs

what actions can be taken after abx have been reviewed (CARES)

cease amend refer extend switch

who can you refer patients to or involve in your decision making process in the context of antimicrobial therapy

complex outpatient antimicrobial team

why does it take time for abx to penetrate and treat prostate

it is made of dense material thus course lengths diff for prostatis and sinusitis

what are the advantages of IVOS IV oral switch

shorter hospital stay reduced risk of first line and associated hospital reactions eg catheter assoc infecs

why should inappropriate abx regimens like 5/7 or 7/7 be challenged

no longer appropriate

why should co amox not be switched ivos too early

poor iv to oral ba so wont get above mic

daptomycin is used for staph aureus but has no oral option true or false

true

why are quinonlones good abx in the context of ivos

good iv to oral ba so can start oral

why can vancomycin when given po not be used for serious infections

only has local effect in gi tract oral option not systemically effective

what can the target toolkit for abx prescribing help pharmacists do

check abx appropriateness patient understanding aid prescribing

// Common infections in secondary care what are 3 common pathogens that cause cellulitis

s pyogenes staph aureus pseudamonas

name 3 drugs that when IVOS switch they have good IV -> PO BA

ciprofloxacin levofloxacin co-trimoxazole

simple cases of cellulitis can be treated within what time frame

5-7 days

if cellulitis is around the face or eyes why would patients be given co amoxiclav

more gram negative bacteria

true or false, diabetics with cellulitis are treated with co amoxiclav because they usually present with more severe gram negative bacteria

true

3 types of pneumonia

cap hap aspiration

what type of pneumonia is caused by inhalation of non air substances

aspiration

which type of pneumonia is commonly caused by the following streptococcus pneumoniae haemophyllus moraxella

cap

which type of pneumonia is commonly caused by oral flora and streptococcal species

aspiration

which type of pneumonia is commonly caused by staph aureus, gram negative bacteria, legionella, and rarely pseudamonas

hap

hap is pneumonia >Xhrs after hospital admission

what investigations can help confirm a diagnosis of pneumonia

cxr sputum cultures bronchoscopy viral throat swabs

the curb 65 score is used for patient mortality and looks at new confusion, high urea, hypotension, rr above 30 and age above 65. Why might it be misleading for younger patients

can maintain sats so score low but be clinically unwell

whats higher curb 65 score assoc with

greater risk fo death

what drug is traditionally used to treat hap in anyone that has a curb 65 score of 3 or 4 (high risk)

levofloxacin

what 7 common infections are under pharmacy first scheme

uti shingles impetigo insect bite sore throat sinusitis acute otitis media

what drug used to treat uti

nitrofurantoin

what drug used to treat shingles

aciclovir valaciclovir

what drug used to treat impetigo

hydrogen peroxide cream fusidic acid cream flucloxacllin clarithromycin erythromycin

what drug used to treat insect bite

fluclox clarithro erythro

what drug used to treat sore throat

pen v clarithro erythro

what drug used to treat sinusitis

mometasone/ fluticasone nasal spray pen v clarithro erythro doxycycline

what drug used to treat acute otitis media

phenazone + lidocaine ear drops amoxicillin clarithro erythro

the pharmacy first scheme only allows you to treat simple utis in young women from 16 to

give 3 diagnostic symptoms of uti, 2 of which patients must have before recieving abx

burning pain passing more at night cloudy urine

what is the treatment regimen of nitrofurantoin for simple uti

100mg mr 3/7

for uti px must be referred if systemically unwell, have kidney pain or tenderness or show signs of upper uti or pyelonephritis. List some different signs of upper uti/pyelonephritis

shaking fever chills

trimethoprim 200mg bd 3/7 can be used for utis but why is it not first line anymore

e coli is resistant to drug

list some causative organisms for uncomplicated uti

e coli klebsiella staph

list some causative organisms of complicated uti

esbl pseudomonas

if patients present with sore throats you should perform a feverpain score, what score would indicate they require abx treatment

3-4

what abx may be used to treat sore throats

phenoxymethyl clarithro erythro

there are many red flag symptoms for sore throats that would indicate referral, but what different conditions might prompt referral

quinsy scarlet fever glandular fever

patients with sore throats that are immuncompromised should referred as well as those with persistent mouth ulcers unable to swallow mass unilateral swelling present why is this

could be malignancy

urgent referral for what groups of px showing acute otitis media (earache)

px very unwell w systemic features or px at high risk of complications due to comorbidities eg children w significant heart lung kidney disease severe immunosuppression CF

infected insect bites should only be treated with abx if they show signs of infection, what kind of things would you be looking out for

redness swelling pus hot to touch

referral criteria for insect bites

human/animal/etc bite from outside UK severe pain out of proportions to wound significant comorbidities and systemically unwell

sinusitis is usually self limiting over 10 days however if certain symptoms are present patients may benefit from abx therapy, what are these symptoms

teeth hurt nasal discharge facial pain

name 3 common fungal infections that are seen in practice

candidiasis aspergillosis mucormycosis

why should question patients that are started on ampho b very early

very broad spec and used last line

why is it important to consider drug interactions and toxicity particularly when giving antifungals

many are cyp450 enzyme inhibitors