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Finals > Antimic > Flashcards

Antimic Flashcards

1
Q

4 types of antimicrobials

A

antibiotics
antivirals
antifungals
antiparasitics

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2
Q

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

A

infection

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3
Q

what is intrinsic resistance

A

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

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4
Q

what 4 mechanisms of intrinsic resistance exist

A

cellular envelope
multi drug efflux pumps
lack of drug targets
enzymes

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5
Q

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

A

cellular envelope

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6
Q

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

A

gram negative

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7
Q

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

A

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

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8
Q

give an example of enzymes in the context of resistance

A

some bacteria produce beta lactamase destroys beta lactam rings

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9
Q

define extrinsic bacterial resistance

A

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

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10
Q

what 2 mechanisms of extrinsic resistance exist

A

horizontal gene transfer and mobile genetic elements

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11
Q

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

A

horizontal gene transfer

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12
Q

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

A

mobile genetic elements

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13
Q

what types of abx are mrsa resistant to

A

b lactamase abx’s (penicillins)

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14
Q

what type of abx is CRE resistant to

A

carbapenem based

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15
Q

what superbug is resistant to both penicillins and carbapenem based abx

A

esbl

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16
Q

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

A

vre

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17
Q

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

A

no

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18
Q

what is meant by antimicrobial stewardship/ ams

A

organisation approach to promoting and monitoring safe use of antimicrobials

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19
Q

when assessing patients what should you look for evidence of

A

bacterial infections

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20
Q

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

A

viral

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21
Q

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

A

risk of c diff
risk of AMR

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22
Q

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

A

faecal transplant

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23
Q

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

A

recent abx use or immunocompromised?

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24
Q

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

A

broad

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25
Q

what different cultures can be done whilst trying to focus treatment

A

blood urine faecal cultures
throat and wound swabs

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26
Q

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

A

CXR

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27
Q

lab investigations may show increased inflamm markers such as

A

WCC neutrophils lymphocytes CRP

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28
Q

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

A

not working so consider switch

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29
Q

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

A

1h

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30
Q

what are the risks associated with fake pencillin allergies

A

inc costs
longer hospital stays

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31
Q

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

A

hives
urticaria
anaphylaxis

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32
Q

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

A

TENS
SJS
DRESS syndrome
pustulosis

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33
Q

difference between allergy (hypersensitivity) and SE

A

allergy: immunological
SE and intolerance: pharmacological

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34
Q

genetic susceptibilty to ADR = X

A

idiosyncrasy

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35
Q

various mechanisms mimics allergy = X

A

pseudo allergy

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36
Q

3 things to consider after checking penA label

A

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

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37
Q

what about allergy hx should you find out

A

reaction description
reaction timing
indication for pen presc

38
Q

what to consider for pen allergy risk stratification

A

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

39
Q

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

A

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

40
Q

when documenting what things is it important to note down

A

differential diagnosis
current evidence
treatment regimen
stop or review date

41
Q

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

A

48-72 hrs

42
Q

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

A

cease
amend
refer
extend
switch

43
Q

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

A

complex outpatient antimicrobial team

44
Q

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

A

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

45
Q

what are the advantages of IVOS IV oral switch

A

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

46
Q

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

A

no longer appropriate

47
Q

why should co amox not be switched ivos too early

A

poor iv to oral ba so wont get above mic

48
Q

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

A

true

49
Q

why are quinonlones good abx in the context of ivos

A

good iv to oral ba so can start oral

50
Q

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

A

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

51
Q

what can the target toolkit for abx prescribing help pharmacists do

A

check abx appropriateness
patient understanding
aid prescribing

52
Q

// Common infections in secondary care

what are 3 common pathogens that cause cellulitis

A

s pyogenes
staph aureus
pseudamonas

53
Q

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

A

ciprofloxacin
levofloxacin
co-trimoxazole

54
Q

simple cases of cellulitis can be treated within what time frame

A

5-7 days

55
Q

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

A

more gram negative bacteria

56
Q

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

A

true

57
Q

3 types of pneumonia

A

cap
hap
aspiration

58
Q

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

A

aspiration

59
Q

which type of pneumonia is commonly caused by the following

streptococcus pneumoniae
haemophyllus
moraxella

A

cap

60
Q

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

A

aspiration

61
Q

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

A

hap

62
Q

hap is pneumonia >Xhrs after hospital admission

A

48

63
Q

what investigations can help confirm a diagnosis of pneumonia

A

cxr
sputum cultures
bronchoscopy
viral throat swabs

64
Q

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

A

can maintain sats so score low but be clinically unwell

65
Q

whats higher curb 65 score assoc with

A

greater risk fo death

66
Q

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

A

levofloxacin

67
Q

what 7 common infections are under pharmacy first scheme

A

uti
shingles
impetigo
insect bite
sore throat
sinusitis
acute otitis media

68
Q

what drug used to treat uti

A

nitrofurantoin

69
Q

what drug used to treat shingles

A

aciclovir
valaciclovir

70
Q

what drug used to treat impetigo

A

hydrogen peroxide cream
fusidic acid cream
flucloxacllin
clarithromycin
erythromycin

71
Q

what drug used to treat insect bite

A

fluclox clarithro erythro

72
Q

what drug used to treat sore throat

A

pen v
clarithro
erythro

73
Q

what drug used to treat sinusitis

A

mometasone/ fluticasone nasal spray
pen v
clarithro
erythro
doxycycline

74
Q

what drug used to treat acute otitis media

A

phenazone + lidocaine ear drops
amoxicillin
clarithro
erythro

75
Q

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

A

64

76
Q

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

A

burning pain
passing more at night
cloudy urine

77
Q

what is the treatment regimen of nitrofurantoin for simple uti

A

100mg mr 3/7

78
Q

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

A

shaking
fever
chills

79
Q

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

A

e coli is resistant to drug

80
Q

list some causative organisms for uncomplicated uti

A

e coli
klebsiella
staph

81
Q

list some causative organisms of complicated uti

A

esbl
pseudomonas

82
Q

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

A

3-4

83
Q

what abx may be used to treat sore throats

A

phenoxymethyl
clarithro
erythro

84
Q

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

A

quinsy
scarlet fever
glandular fever

85
Q

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

A

could be malignancy

86
Q

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

A

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

87
Q

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

A

redness
swelling
pus
hot to touch

88
Q

referral criteria for insect bites

A

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

89
Q

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

A

teeth hurt
nasal discharge
facial pain

90
Q

name 3 common fungal infections that are seen in practice

A

candidiasis
aspergillosis
mucormycosis

91
Q

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

A

very broad spec and used last line

92
Q

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

A

many are cyp450 enzyme inhibitors

Finals (30 decks)

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