Septrin is co-trimoxazole - Sulfamethoxazole - Trimethoprim

ICP Flashcards by Nathan Kelly

What type of antibiotics work on the cell wall?

Any examples?

Penicillins - pen V, amoxicillin, flucloxacillin
Cephalosporins - ceftriaxone, cefuroxime
Carbapenems - meropenem, ertapenem
Aztreonam (a monobactam)
Glycopeptides - vancomycin, teicoplanin

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Give examples of 1st, 2nd and 3rd generation cephalosporins

1st generation - cephalexin
2nd generation - cefuroxime
3rd generation - ceftriaxone, cefotaxime

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Give examples of antibiotics that work on protein synthesis

Aminoglycosides - gentamicin, streptomycin

Macrolides - erythromycin, clarithromycin

Clindamycin (a lyncosamide)

Tetracyclines - doxycycline
Chloramphenicol

Fusidic acid

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Antibiotics working on DNA

Fluroquinolones - ciprofloxacin

Metronidazole

Nitrofurantoin

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Antibiotics working on RNA

Rifampicin

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Antibiotics working on folate

Trimethoprim

Sulphonamides - sulfamethoxazole

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Possible adverse events with antibiotics

Allergy
Side effects of antibiotics
Interaction with medications
Effect on normal flora - leading to diarrhoea, candidiasis (oral/vaginal), resistance
Venflon / central line infection
Increased antibiotic resistance

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Which drug classes are beta lactams

Penicillins
Cephalosporins
Carbapenems
Monobactams (Aztreonam)

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Give some examples of mechanisms of antibiotic resistance

Enzymatic inactivation - penicillinase e.g. MRSA
Altered target site
Decreased permeability
Efflux pumps
Utilising alternative metabolic pathway

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What is the CURB-65 score for pneumonia?

Confusion - AMT <=8
Urea - >7mmol/L
Respiratory rate - >=30/min
Blood pressure - SBP <90, DBP <60
65 - or older age
1 point for each

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Treatment for MRSA

Vancomycin
Clindamycin
--
Teicoplanin
Linezolid
Daptomycin
Gentamicin
Rifampicin/Fusidic acid (not alone)

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Treatment for C. difficile

Metronidazole PO/IV

Vancomycin PO

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Which antibiotics should not be used in any trimester of pregnancy?

Tetracyclines - can cause discolouration of the developing teeth

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Which trimester should trimethoprim be avoided in?

First trimester - as it is an anti-folate

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Which trimester should nitrofurantoin be avoided in?

3rd trimester

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Structure + function of antibodies

IgM - pentamer, first antibody produced but it is short acting
IgG - monomer, crosses placenta, involved in long-term immunity
IgA - dimer, secreted into mucous, saliva, tears, colostrum (breast milk)
IgE - monomer, involved in allergy and antiparasitic
IgD - monomer, not much known about function

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Why might eczema improve during pregnancy?

Immune system is dampened down during pregnancy

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What types of bacteria are asplenic patients at risk of?

Encapsulated bacteria

Neisseria meningidis
Streptococcus pneumoniae
Haemophilus influenzae
E coli (some strains)

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Risks of vaccinations?

Injection site pain and inflammation
Bleeding (can’t take aspirin before vaccination)
Fever
Flu-like symptoms

Major - anaphylaxis and guillian-barré syndrome

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Contraindications for vaccination

Previous problems with vaccination
Allergy
Egg allergy
Pregnancy - no live vaccinations allowed
Immunocompromised - no live vaccinations

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Which vaccinations are live?

Live flu vaccine
Rotavirus
Shingles
BCG
Oral typhoid
Varicella
Yellow fever
MMR

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Examples of quinolones

Ciprofloxacin

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Contents of septrin?

Septrin is co-trimoxazole

Sulfamethoxazole
Trimethoprim

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Side effects of gentamicin?

Ototoxic, nephrotoxic

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UTI in pregnancy?

Cephalosporins e.g. cefalexin 1st line

Risk factors for pneumonia?

- Lung damage e.g. bronchiectasis - Alcoholism - Diabetes - klebsiella risk - Smoking - Travel - ITU / VAP - Occupational e.g. brucellosis in abertoirs - COPD - haemophilus/moraxella - Immunosuppresion - Nursing home - Age >65 or <5 - Air conditioning - Legionella - Recent viral illness

Pneumonia organism more common in diabetics / alcohol dependent

Klebsiella

Most common organisms of pneumonia

S. pneumoniae - causes classic whiting out of lobe on CXR H. influenzae Klebsiella pneumoniae

Most common cause of pneumonia in COPD

Haemophilus influenzae

Treatment for pseudomonas pneumonia

Ciprofloxacin

Causes of atypical pneumonia

Mycoplasma pneumoniae Legionella pneumophilia Coxiella burnetii Chlamydia pneumoniae (RF birds)

Viral causes of pneumonia

Influenzae RSV Adenovirus

Pathophysiology of aspiration pneumonia

Acid from stomach entering lungs causing a pneumonitis

Protozoal causes of pneumonia

Pneumocystis jirovecii | Toxoplasmosis

Classic feature of pneumocystis jirovecii pneumonia?

Put sats probe on, ask patient to walk and sats will rapidly drop

DECAF score

``` Dyspnoea - MRCD 1-4=0, 5a=1, 5b=2 Eosinophils <0.05 = 1 Consolidation = 1 Acidosis pH <7.3 = 1 Fibrillation (AF) =1 ```

Antibiotic therapy for pneumonia with CURB score <=2 or CRB <=1

Amoxicillin or clarithromycin

Antibiotic therapy for pneumonia with CURB score >=3 or CRB >=2

Under 65: Coamoxiclav IV plus clarithromycin Over 65: Piperacillin-tazobactam IV + clarithromycin PO

Why must a CXR be done 6 weeks post-pneumonia?

- Ensures clearance | Rules out other cause of shadowing e.g. malignancy

Complications of pneumonia

Parapneumonic effusion EMpyema Abscess

Appearance of neisseria gonorrhoea on microscopy?

Gram negative intracellular diplococci

Where to swab to test for gonorrhoea and chlamydia in men and women?

Women - vulvovaginal swab best | Men - first pass urine better

Treatment of gonorrhoea

Ceftriaxone IM once or Ciprofloxacin 500mg PO

Complications of gonorrhoea

- PID - Infertility - Neonatal conjunctivitis (ophthalmia neonatorum) - Epididymo-orchitis - Disseminated gonoccocal infection - rash like meningococcal septicaemia

Treatment for chlamydia

Doxycycline 100mg BD 1 week or Azithromycin for 2 days

Types of HSV sti

Type 1 - stomatitis | Type 2 - genitals

How to diagnose HSV ulcers?

Clinical diagnosis

Treatment for HSV STI infection

Aciclovir if diagnosed within 5 days, otherwise supportive

Stages of syphilis

Primary - up to 90 days, get chancre formation (painless ulcer) Secondary - 4-10 weeks after chancre, get maculopapular rash on palms and soles, condylomata lata (raised plaques), fever headache myalgia Tertiary - neurosyphilis. Argyll Robertson pupil - pupil constricted, not reactive to light but accomodates Tabes dorsalis - infection of dorsal column so loss of proprioception

What is an argyll-roberton pupil

Complication of tertiary syphilis | Pupil constricted, not reacting to light but still accommodates

Treatment of syphilis

Benzylpenicilin injectio or doxycycline 100mgBD duration dep on stage

How long is syphilis infectious for?

It is infectious for up to 2yrs, usually until after the secondary phase

Treatment for genital warts

- Do nothing - Immune modulation - imiquimod - Cryotherapy

Characteristics of molloscum contagiosum

Round Same colour as skin Nodular No inflammatory changes to skin

Causative agent of molloscum contagiousm

Molloscipoxvirus

Treatment for scabies

Permethrin 5% cream

Pathophysiology of bacterial vaginosis

Loss of usual lactobacilli, leading to proliferation of gram negative anaerobes e.g. garnerella vaginalis

Symptoms of bacterial vaginosis

Malodorous, grey/white discharge

Treatment for bacterial vaginosis

Metronidazole

Candidiasis clinical features

Itchy, dry, smelly discharge, white

Risk factors for candidiasis

Pregnancy Anaemia Diabetes Recent antibiotics

Treatment for candidiasis

Fluconazole

Management of recurrent candidiasis

Investigate for immunosuppresion / underlying factors e.g. diabetes Genital hygiene advice Confirm diagnosis with swabs and find out type of candida

Trichomoniasis clinical features

Yellow, frothy, smelly discharge | Asymptomatic in men

Treatment for trichomoniasis

Metronidazole