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INFECTION Flashcards

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1
Q

Methotrexate, clari+ery?

A

Safe

BUT AMOXI L!

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2
Q

nitrofurantoin risk?

A

pulmonary fibrosis

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3
Q

METHOTREXATE+AMOXICILLIN?

A

TOXICITY!!!!

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4
Q

RECURRENT VAGINAL THRUSH DOSE?

A

moetronidazole

150MG every third day for 3 doses+150mg ONCE weekly for 6 months

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5
Q

DISULFIRAM, DRINK ALCOHOL?>

A

FULL BODY RASH!

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6
Q

SET INTERACTION?

A

SILDENAFIL
ERYTHROMYCIN
TADALAFIL

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7
Q

isotretinoin+vitamin A, cod liver?

A

avoid in pregnant!

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8
Q

septicaemia?

A

tazobacta+piperacillin

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9
Q

osteomyelitis treatment?

A

fluclo (6 weeks)
w/
fusidic acid/rifampicin (2 weeks)

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10
Q

TRI UTI DOSE?

A

Adult

200 mg twice daily for 3 days (7 days in males).

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11
Q

UPPER UTI?

A

Oral first line (upper UTI symptoms):

Cefalexin, ciprofloxacin, co-amoxiclav (if culture susceptible), or trimethoprim (if

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12
Q

CURB65 SCORE?

A

CONFUSIONt
UREA NITROGEN>7mmol/L
RAISED RESP. RATE>/= 30breaths/min
low bp systolic <90, dyastolic /=65 years

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13
Q

CURB65 SCORE?

A

CONFUSIONt
UREA NITROGEN>7mmol/L
RAISED RESP. RATE>/= 30breaths/min
low bp systolic <90, dyastolic /=65 years

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14
Q

CRB SCORES?

A 
• low severity - CRB65 score 0 or
CURB65 score 0 or 1
• moderate severity - CRB65 score 1
or 2 or CURB65 score 2
• high severity - CRB65 score 3 or 4 or
CURB65 score 3 to 5
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15
Q

ABX WITHOUT FOOD?

A 
FAT PA- 
flucloxacillin,
ampicillin,
tetracycline/oxytetracycline,
phenoxy,
azithromycin capsules - 1 hour before food or two hours after food
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16
Q

ABX WITHOUT FOOD?

A

FAT PA?

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17
Q

d

A
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18
Q

NITROFURANTOIN

Egfr less than?

A

45, don’t use

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19
Q
  1. A 29-year old patient prescribed isoniazid as part of a tuberculosis treatment regimen
A

LIVER TOXICITY!

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20
Q
  1. A 42-year old woman who has been prescribed Yasmin® who smokes two packets of cigarettes a day
A

thrombosis

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21
Q
  1. A 51-year-old patient who has bone metastases and has been prescribed 4 mg zoledronic acid as treatment.
A

HYPOCALCAEMIA, electrolyte disturbacen

but treats
tumour induced hypercalcaemia

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22
Q
  1. A 67-year-old patient who has recently upped her lansoprazole to 30 mg twice daily.
A

hyponatraemia

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23
Q
  1. A 82 year old man who presents to hospital with jaundice. His liver function tests show raised bilirubin and alkaline phosphatase.
A

CO-AMOX, HEPATIC IMPAIRMENT

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24
Q
  1. A 68 year old woman with newly diagnosed pulmonary fibrosis
A

G ( Nitrofurantoin, SPC: Chronic pulmonary reactions (including pulmonary fibrosis and diffuse interstitial pneumonitis) can develop insidiously, and may occur commonly in elderly patients. Close monitoring of the pulmonary conditions of patients receiving long-term therapy is warranted (especially in the elderly).

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25
26
ABX WITHOUT FOOD? EMPTY STOMACH?
AMPICILLIN CO-FLUAMPICIL FLUCLOXACILLIN PHENOXYMETHYLPENICILLIN
27
ABX WITH FOOD?
PIVMECILLINAM
28
ALWAYS SENSE CHECK ANSWERS, DOES IT MAKE SENSE? RATIONALISE AND ELIMINATE EACH OPTION, READ THE Q AGAIN
29
TIP: IF A QUESTION HAS AN ANTI-EPILEPTIC, IDENTIFY THE INTERACTION- MACROLIDES/QUINOLONES,NSAIDs, etc
30
31
SEVERE CELLULITIS?
CO-AMOXICLAV CLINDAMYCIN IV CEFUROXIME IV CEFTRIAXONE
32
CELLULITIS MANAGEMENT? penicillin allergy? near eyes or nose? alternative?
FLUCLOXACILLIN penicillin allergy? DOXYCYLINE/CLARITHROMYCIN/ERYTHROMYCIN near eyes or nose? CO-AMOXICLAV alternative? CLARITHROMYCIN W/ METRONIDAZOLE
33
34
Hydrocortisone+quinolones?
Higher risk of tendonitis, okay
35
WHAT TB MEDICATION CAUSES POOR EYE VISION?
ETHAMBUTOL, not isoniazid ISONIAZID is peripheral neropathy- body nerves are damaged
36
MALOFF- ATOVAQUONE w/ PROGUANIL?
Max 12 weeks P med
37
38
SIDE-EFFECTS OF INSULIN?
WEIGHT GAIN OEDEMA LIPODYSTROPHY- body storing fat, SKIN REACTIONS NOT WEIGHT LOSS (hypertrophy- lump of fat tissue under skin, repeated injection)
39
Cellulitis?
Flucloxacillin Doxy/Clari/Ery Co-amoxiclav (children, not pen allergy)
40
HUMAN/ANIMAL BITES- TREATMENT 1st LINE? 2nd LINE? PROPHYLAXIS/TREATMENT?
1st LINE? CO-AMOXICLAV 2nd LINE? DOXYCYCLINE AND METRONIDAZOLE PROPHYLAXIS/TREATMENT DAYS? 3/5 DAYS Treatment when there's presenting symptoms*
41
CELLULITIS- TREATMENT INFECTION NEAR EYES/NOSE 1st LINE? PENICILLIN ALLERGY?
1st LINE? Co-amoxiclav PENICILLIN ALLERGY? Clarithromycin & Metronidazole
42
AMINOGLYCOSIDES DO NOT CAUSE C DIFF
43
SORE THROAT TREATMENT 1st line? 2nd line?
SORE THROAT TREATMENT 1st line? Phenoxymethylpenicillin 2nd line? Clarithromycin or Erythromycin (in pregnancy)
44
``` A Cefalexin B Ciprofloxacin C Clarithromycin D Co-amoxiclav E Vancomycin ```
normal flucloxacillin doxycycline/clarithromycin/erythromycin severe co-amoxiclav/clindamycin | iv cefuroxime/ceftriaxone MRSA- add iv vancomycin/teicoplanin/linezolid SO ANSWER CEFTRIAXONE?
45
TRIMETHOPRIM CAN ALSO CAUSE...?
BLOOD DYSCRASIA, HEAD TOP! | not hepatoxic silly
46
FLUCLOXACILLIN IS CAUTIONED IN..?
HEPATIC IMPAIRMENT!
47
DOXYCYCLINCE CAN BE?
HEPATOTOXIC, don't forget that | can get DYSPHASIA AS WELL
48
WHAT DO WE NOT GIVE IN OTITIS MEDIA?
DOXYCYCLINE, don't be fooled
49
Trimethoprim in pregnancy? Teratogenic, avoid completely!
50
meningitis order?
benzylpenicillin cefotaxime/ceftriaxone (penicillin allergy) chloramphenicol (immediate penicillin allergy)
51
NEPHROTOXIC DRUGS? DAMN-LAG
``` DIURETICS ACE ARB METFORMIN NSAIDS LITHIUM AMINOGLYCOSIDES GENTAMICIN ```
52
Clotrimazole spray?
Large hairy area
53
CANESTEN IN PREGNANCY?
With topical use: Minimal absorption from skin; not known to be harmful. With vaginal use: Pregnant women need a longer duration of treatment, usually about 7 days, to clear the infection. Oral antifungal treatment should be avoided during pregnancy.
54
HYOSCINE BUTYLBROMIDE?
GASTRO, SICKNESS, BUSCOPAN
55
QT PROLONGATION DRUGS?
THE AMAZING SPIDERMAN Q TCA amiodarone SSRIS anti antipsychotics malaria quinine/quinolone
56
INFECTIVE COPD?
For adults aged 18 years and over, the first-choice antibiotic for the management of an infective exacerbation of COPD are amoxicillin, doxycycline or clarithromycin. Doxycycline is prescribed at a dose of 200 mg on first day, then 100 mg once a day for 5‑day course in total. OR CO-AMOXICLAV LEVOFLOXACIN CO-TRIMOXAZOLE
57
MENINGITIS?
BENZYL CEFOTAXIME (calm with minor penicillin alllergy) CHLORAMPHENICOL Signs of meningitis. 1st line is benzylpenicillin but unsuitable due to penicillin allergy. Cefotaxime can be used as no history of immediate anaphylactic reaction to penicillins.
58
SESPSIS?
``` B - bloods cultures U - urinary output F - IV fluids adm A - antibiotics broad spec IV L - lactate levels O - O2 if hypoxia ```
59
YELLOW-GREEN DISHARGE?
TRICHO
60
VAGINAL DISCHARGE GUIDE
61
One week after his hospital admission, the patient develops diarrhoea. A stool sample confirms the presence of Clostridium difficile infection. Doctors decide to stop the lansoprazole and review the antibiotic for his infection. Which ONE of this patient͛s medications listed below is MOST likely to require temporary discontinuation in view of his Clostridium difficile infection?
IBUPROFEN NSAID, he's sick!!
62
CLARI, ATYPICAL PATHOGENS!
63
Penicillin V PHENOXYMETHYLPENICLLIN?
empty stomach | space doses evenly
64
A 4–year-old girl, presents with sore throat, low-grade fever and tender lesions in the mouth and papulovesicular lesions of the distal limbs
HAND FOOT MOUTH DISEASE
65
WAT THIS?
hives | batches of red/skin-coloured welts? itching, painful swelling?
66
A 73-year-old man with a history of allergy to penicillin (anaphylaxis) and azithromycin (anaphylaxis), who is feeling unwell. His respiratory rate is 19 breaths/minute and his blood pressure is 121/82. He has a history of cough for 1 week.. Single choice.
DOXYCYCLINE
67
daktarin sugar free minimum age?
4 months+
68
A 26-year-old woman has contact dermatitis on her wrist. The maximum number of times per day that hydrocortisone cream should be used is
twice
69
antibiotic-associated colitis
loperamide capsules
70
DD cutanoues lipohyper...
71
Clindamycin also used in cellulitis btw, but severe? Hm
72
WARFARIN-RIVAROXABAN, when INR?
<1.5, no need monitoring, safe
73
DOXYCYCLINE HEADACHE VISUAL BENIGN REPORT
74
H PYLORI
75
MALARIA PROPHYLAXIS
76
vegan deficiency,?
b12?
77
METRO+OMEP H PYLORI?
USE 400MG TDS, OTHERWISE 400MG BD
78
AMOX+OMEP H PYLORI?
USE 500MG BD, otherwise 1000MG BD AS PER
79
IMPORTANCE OF STEWARDSHIP?
Prevents antibiotic resistance Less unnecessary treatment, more caution Higher risk of resistance w/ broad-spectrum antibiotics
80
ANTIMICROBIAL- NICE GUIDANCE DO NOT START WITHOUT CLINICAL EVIDENCE OBTAIN CULTURES-: NARROWING OF BROAD SPECTRUM CHANGE THERAPY TO EFFECTIVELY TREAT RESISTANT PATHOGENS STOP ABs when CULTURES SUGGEST INFECTION IS UNLIKELY AVOID BROAD-SPECTRUM ANTIBIOTICS, e.g. (risk co-amoxiclav quinolones (cipro, levo) cephalosporins (cefaclor, ceftriaxone) AVOID WIDESPREAD USE OF TOPICAL ANTIBIOTICS (e.g. fusidic acid is systemic, use that!)
81
HUMAN/ANIMAL BITES- TREATMENT 1st LINE? 2nd LINE? PROPHYLAXIS/TREATMENT?
1st LINE? CO-AMOXICLAV 2nd LINE? DOXYCYCLINE AND METRONIDAZOLE PROPHYLAXIS/TREATMENT DAYS? 3/5 DAYS Treatment when there's presenting symptoms*
82
TICK BITES (LYME DISEASE)- TREATMENT 1st LINE? 2nd LINE? No. of days?
1st LINE? Doxycycline 100mg BD 2nd LINE? Amoxicillin 1000mg TDS No. of days? 21 days
83
DIABETIC FOOT INFECTION- TREATMENT MILD (<2cm) 1st LINE? If penicillin allergy..?
1st LINE? Flucloxacillin If penicillin allergy..? Clarithromycin/Erythromycin/Doxycycline
84
DIABETIC FOOT INFECTION- TREATMENT MODERATE/SEVERE (abscess, osteomyelitis) 1st LINE? 2nd LINE?
1st LINE? FLUCLOXACILLIN or CO-AMOXICLAV with/without GENTAMICIN 2nd LINE? (Penicillin allergy) CO-TRIMOXAZOLE with/without GENTAMICIN
85
CELLULITIS- TREATMENT FIRST LINE? PENICILLIN ALLERGY?
FIRST LINE? Flucloxacillin PENICILLIN ALLERGY? Clarithromycin OR Erythromycin (in pregnancy) Doxycycline
86
CELLULITIS- TREATMENT INFECTION NEAR EYES/NOSE 1st LINE? PENICILLIN ALLERGY?
1st LINE? Co-amoxiclav PENICILLIN ALLERGY? Clarithromycin & Metronidazole
87
COMMUNITY ACQUIRED PNEUMONIA- THREE TYPES?
LOW SEVERITY MODERATE SEVERITY HIGH SEVERITY
88
COMMUNITY ACQUIRED PNEUMONIA LOW SEVERITY TREATMENT 1st LINE? 2nd LINE?
1st LINE? Amoxicillin 2nd LINE? Doxycycline OR Clarithromycin OR Erythromycin (in pregnancy)
89
COMMUNITY ACQUIRED PNEUMONIA MODERATE SEVERITY TREATMENT 1st LINE? 2nd LINE?
1st LINE? Amoxicillin w/ Clarithromycin OR Erythromycin in pregnancy 2nd LINE? Doxycycline OR Clarithromycin
90
COMMUNITY ACQUIRED PNEUMONIA HIGH SEVERITY TREATMENT 1st LINE? 2nd LINE?
1st LINE? Co-amoxiclav w/ Clarithromycin (OR Erythromycin in pregnancy) 2nd LINE? Levofloxacin
91
DIARRHOEA TREATMENT CLOSTRIDIUM DIFFICILE 1st LINE? 2nd LINE? LIFE-THREATENING? No. of days?
1st LINE? ORAL! Vancomycin 2nd LINE? Fidaxomicin LIFE-THREATENING? Oral Vancomycin+IV metronidazole No. of days? 10 days
92
DIARRHOEA TRAVELLER'S DIARRHOEA STANDBY? PROPHYLAXIS/TREATMENT?
STANDBY? Azithromycin PROPHYLAXIS/TREATMENT? Bismuth Subsalicylate
93
EAR INFECTIONS OTITIS MEDIA (inner, need systemic) 1st LINE? 2nd LINE? (worsened symptoms after 2-3 days treatment) Penicillin allergy?
Can resolve itself if it's not bad! so standard paracetamol, ibu, first initially, 3days-1week 1st LINE? Amoxicillin 2nd LINE? Co-amoxiclav Penicillin allergy? Clarithromycin (Erythromycin in pregnancy)
94
EAR INFECTIONS OTITIS EXTERNA 1st LINE? 2nd LINE? SYSTEMIC TREATMENT NEEDED? Pseudomonas?
1st LINE? Topical Acetic Acid 2% 2nd LINE? Topical Neomycin Sulphate w/ Corticosteroid SYSTEMIC TREATMENT NEEDED? Flucloxacillin (clari/azy/ery back up) Pseudomonas? Cipro/aminogly Note: prolonged use of topical, can affect flora in canal, risk of fungal infection
95
HELICOBACTER PYLORI TRIPLE THERAPY? PPI? + 2 of the following..?
``` PPI? Omeprazole, Lansoprazole, etc (30mg BD) + 2 of the following..? Amoxicillin 1000mg BD OR Metronidazole 400mg BD OR Clarithromycin 500mg BD ``` tetracycline also used, blah blah, 7 days
96
HOSPITAL ACQUIRED PNEUMONIA Non-severe 1st LINE? 2nd LINE? (adults) DC^2L 2nd LINE? (children)
1st LINE? Co-amoxiclav ``` 2nd LINE? (adults) Doxycycline OR Cefalexin OR Co-trimoxazole OR Levofloxacin ``` 2nd LINE? (children) Clarithromycin
97
Why do we avoid doxycycline in children<12?
Deposition in growing bone & teeth Binding to calcium Causes staining Dental hypoplasia
98
IMPETIGO TREATMENT LOCALISED NON-BULLOUS 1st LINE? 2nd LINE?
1st LINE? Hydrogen Peroxide 1% 2nd LINE? Fusidic Acid (Mupirocin 2% if fusidic acid resistance suspected)
99
IMPETIGO TREATMENT WIDESPREAD NON-BULLOUS 1st LINE?
1st LINE? Fusidic Acid (Mupirocin 2% if fusidic acid resistance suspected)
100
IMPETIGO TREATMENT BULLOUS/SYSTEMICALLY UNWELL 1st LINE? 2nd LINE?
1st LINE? Flucloxacillin 2nd LINE? Clarithromycin (OR Erythromycin in pregnancy)
101
LOWER UTI TREATMENT MEN 1st LINE?
Nitrofurantoin (eGFR>45) OR Trimethoprim
102
LOWER UTI TREATMENT NON-PREGNANT WOMEN 1st LINE? 2nd LINE?
1st LINE? Nitrofurantoin OR Trimethoprim (low risk of resistance) 2nd LINE? Pivmecillinam OR Fosfomycin
103
LOWER UTI TREATMENT PREGNANT WOMEN 1st LINE? 2nd LINE?
1st LINE? Nitrofurantoin (avoid at term) 2nd LINE? Cefalexin OR Amoxicillin
104
Nitrofurantoin should only be used if eGFR is...?
>/= 45mL/min
105
LOWER UTI TREATMENT- No. of days MEN? PREGNANCY? UNCOMPLICATED? CATHETER-ASSOCIATED?
MEN? 7 days treatment PREGNANCY? 7 days treatment UNCOMPLICATED? 3 days treatment CATHETER-ASSOCIATED? 7 days treatment
106
STREP THROAT/SCARLETT FEVER BACTERIA?
Streptococcus
107
STREP THROAT/SCARLETT FEVER 1st LINE? 2nd LINE?
1st LINE? Phenoxymethylpenicillin 2nd LINE? Clarithromycin OR Erythromycin (in pregnancy)
108
SCARLETT FEVER 1st LINE? 2nd LINE?
1st LINE? Phenoxymethylpenicillin--> Amoxicillin 2nd LINE? Azithromycin--> true penicillin allergy
109
SYMPTOMS OF SCARLETT FEVER?
Flu-like- high temp, swollen neck glands Red rash w/ small, raised bumps, rough feeling like sandpaper White coating on tongue- strawberry like
110
TREATMENT ACNE VULGARIS?
ADAPALENE/CLINDAMYCIN/BENZOYL PEROXIDE/LYMECYCLINE
111
TREATMENT BACTERIAL VAGINOSIS/TRICHOMONIASIS? (anaerobic)
METRONIDAZOLE
112
TREATMENT CHLAMYDIA?
1g STAT azithromycin- uncomplicated chlamydia DOXYCLCINE
113
TREATMENT CONJUNCTIVITIS/BLEPHARITIS?
CHLORAMPHENICOL
114
Chloramphenicol OTC sale?
0.5% eye drops (10mL) OR 1% eye ointment (4g) 2 years+ Max. treatment 5 days
115
TREATMENT DENTAL ABSCESS?
AMOXICILLIN OR METRONIDAZOLE
116
TREATMENT GONORRHOEA
CEFTRIAXONE/CIPROFLOXACIN IM gent+azi if allergy
117
TREATMENT MENINGITIS?
BENZYLPENICILLIN
118
TREATMENT SCABIES?
PREMETHRIN- | apply over whole body including face, neck, scalp & ears
119
TREATMENT SINUSITIS?
PHENOXYMETHYLPENICILLIN Very unwell? Co-amoxiclav (pen allergy? Doxycycline/Clarithromycin/Ery in pregnancy
120
TREATMENT THREADWORM? OTC sale?
MEBENDAZOLE 2 YEARS+ MAX. SINGLE DOSE 100mg MAX. PACK SIZE 800mg
121
PATHOGENS CAP/MENINGITIS? UTI? THRUSH? CELLULITIS?
CAP/MENINGITIS? Streptococcus Pneumoniae UTI? Eschericia Coli THRUSH? Candida Albicans CELLULITIS? Staphylococcus Aureus
122
ANTIBIOTICS AMINOGLYOSIDES- EXAMPLES?
``` Amikacin Gentamicin Neomycin Streptomycin Tobramycin ```
123
AMINLOGLCYCOSIDES Concs measured in all patients receiving parenteral aminoglycosides. Must be determined in...?
Obesity High doses Cystic fibrosis Elderly
124
AMINOGLYCOSIDES When do you measure serum-gent conc?
After 3/4 doses Every 3 days After a dose change (common in renally impaired)
125
Aminoglycosides Peak? Trough?
Peak? 1hr after dose | Trough? Just before next dose
126
AMINOGLYCOSIDES- MULTIPLE DAILY DOSE REGIMEN TARGETS PEAK? ENDOCARDITIS? TROUGH
MULTIPLE DAILY DOSE REGIMEN PEAK? 5-10mg/L ENDOCARDITIS? 3-5mg/L (co-prescribed w/ other ABxs) TROUGH <2 <1 endo
127
AMINOGLYCOSIDES- DOSE ADJUSTMENTS TROUGH TOO HIGH? PEAK TOO HIGH?
TROUGH TOO HIGH? Increase dose interval PEAK TOO HIGH? Decrease dose
128
AMINOGLYCOSIDES- DOSE ADJUSTMENT RENAL IMPAIRMENT? SEVERE RENAL IMPAIRMENT?
RENAL IMPAIRMENT? Increase dose interval SEVERE RENAL IMPAIRMENT? Reduce dose
129
Aminoglycosides, avoid concomitant use of...?
Nephrotoxic drugs
130
AMINOGLYCOSIDES- MHRA WARNING Drugs that cause ototoxicity? CLVV
``` Interactions w/ Ototoxicity? Cisplatin Loop Diuretics Vancomycin Vinca Alkaloids (vinblastine, vincristine, vindesine, vinflunine) ```
131
AMINOGLYCOSIDES- MHRWA WARNING Drugs that cause renal impairment? NEPHROTOXIC RISK?
NSAIDs ACEi ARBs Metformin NEPHROTOXIC RISK? Loop/NSAIDs/
132
AMINOGLYCOSIDES CONTRAINDICATED IN..? PREGNANCY? OBESITY?
CONTRAINDICATED IN..? Myasthenia Gravis (chronic, autoimmune disease of muscles) PREGNANCY? AVOID: risk of auditory/vestibular nerve damage (Vertigo) Have to use? Just monitor OBESITY? Use IBW to calculate dose
133
CEPHALOSPORINS 1ST GENERATION? Fad, Fal, Frad
CeFadroxil CeFalexin CeFradine
134
CEPHALOSPORINS 2ND GENERATION? Furry Fox Face
CeFuroxime CeFoxitin CeFaclor
135
CEPHALOSPORINS 3rd & 5th GENERATION?
All parenteral except from oral Cefixime (3rd)
136
Patients with hypersensitivity to penicillin should not receive a cephlaosporin due to...?
Cross-sensitivity
137
CHLORAMPHENICOL USE? AVOID IN? OTC AGE?
USE? Eye infections AVOID IN? Pregnancy- grey-baby syndrome, if used in third trimester OTC AGE? 2years+
138
CLINDAMYCIN Associated with...?
Antibiotic-associated colitis (inflammation of lining of colon- FATAL? Common in elderly Discontinue+contact a doctor ASAP if severe/prolonged/bloody diarrhoea develops
139
CLINDAMYCIN Clostridium difficile suspected?
STOP! | Can't stop ABx/severe diarrhoea? Seek specialist advice
140
GLYCOPEPTIDES- EXAMPLES? VDT^2
VANCOMYCIN DALBAVANCIN TEICOPLANIN (can be used in COMMUNITY ACQUIRED PNEUMONIA! TELAVANCIN
141
GLYCOPEPTIDES WHICH DRUG MUST BE GIVEN PARENTERALLY FOR SYSTEMIC INFECTIONS DUE TO REDUCED ABSORPTION W/ ORAL INTAKE..? AVOID IN..? TROUGH CONC.?
WHICH DRUG MUST BE GIVEN PARENTERALLY FOR SYSTEMIC INFECTIONS DUE TO REDUCED ABSORPTION W/ ORAL INTAKE..? Vancomycin AVOID IN..? Pregnancy TROUGH CONC.? 15-20mg/L (for endo/worse?) 10-20 usually?
142
GLYCOPEPTIDES Vancomycin oral, monitor?
Conc. in inflammatory intestinal disorders
143
GLYCOPEPTIDES- SIDE-EFFECTS? NO CRABS
NEPHROTOXICITY OTOTOXICITY CARDIOGENIC SHOCK ON RAPID IV RED MAN SYNDROME ANAPHYLACTOID REACTIONS- avoid rapid infusion+rotate site BLOOD DYSCRASIAS: agranulocytosis/eosinophilia/neutropenia SEVERE CUTANEOUS ADVERSE REACTIONS- SJS syndrome?
144
LINEZOLID- SAFETY INFORMATION RISK OF SEVERE OPTIC NEUROPATHY?
Report visual impairment (blurry/altered vision) | Monitor regularly if treatment >28 days
145
LINEZOLID- SAFETY INFORMATION RISK OF BLOOD DISORDERS?
Monitor full blood counts weekly Close monitoring if treatment>10-14 days/renal impairment A REVERSIBLE MAOI BTW, FUN FACT!
146
LINEZOLID- INTERACTIONS TYRAMINE-RICH FOODS? SEROTONIN SYNDROME?
``` TYRAMINE-RICH FOODS? mature cheese marmite salami yeast extract fermented soya bean extract some beers/wines ``` ``` SEROTONIN SYNDROME? (altered cognitive state) SSRIs Dopaminergics 5-HT1 agonists TCAs Lithium Other MAOIs ```
147
MACROLIDES- EXAMPLES? A C E
AZITHROMYCIN (OD) CLARITHROMYCIN (BD) ERYTHROMYCIN (QDS)
148
MACROLIDES AZITHROMYCIN TDS 1/52 for..?
Prophylaxis in COPD patients
149
MACROLIDES CAUTIONED IN..?
Patients w/ myasthenia gravis Pregnancy? Erythromycin>Clarithromycin Avoid Clarithromycin in 1st trimester of pregnancy (teratogenicity)
150
MACROLIDES- SIDE-EFFECTS? HOG-QT
HEPATOXICITY OTOTOXICITY GI DISTURBANCES QT PROLONGATION
151
MACROLIDES- INTERACTIONS Macrolides are CYB ENZYME INHIBITORS (so will increase levels of CYP enzyme substrates) STATINS? WARFARINS?
Macrolides are CYB ENZYME INHIBITORS (so will increase levels of CYP enzyme substrates) STATINS? Increased risk of myopathy WARFARINS? Increased risk of bleeding
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MACROLIDES- INTERACTIONS HYPOKALAEMIA?
LOOP/THIAZIDE DIURETICS STEROIDS SALBUTAMOL THEOPHYLLINE abcde i
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MACROLIDES- INTERACTIONS QT PROLONGATION?
``` AMIODARONE DOMPERIDONE FLUCONAZOLE LITHIUM METHADONE ONDANSETRON QUININE QUINOLONES SOTALOL SSRIs ```
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METRONIDZOLE- SIDE-EFFECTS TNVDA
TASTE DISTURBANCE- metallic taste, furred tongue N&V- take w/ OR after food MUST NOT DRINK ALCOHOL- disulfiram like side-effect (N&V, flushing) -AVOID ALCOHOL during & >/=48hrs after treatment
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NITROFURANTOIN PREGNANCY? RENAL IMPAIRMENT? URINE DISCOLOURED? TAKE?
PREGNANCY? avoid at term? RENAL IMPAIRMENT? Avoid if eGFR<45mL/min/1.73m^2 URINE DISCOLOURED? Yellow/Brown TAKE? W/ OR after food
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PENICILLINS NARROW-SPECTRUM (beta-lactamase sensitive, broken down by beta-lactamases, useless in these infections causing): PENICILLIN G? Benzylpenicillin Gastric acid stable? PENICILLIN V? Phenoxymethylpenicillin Gastric acid stable?
PENICILLIN G? Benzylpenicillin Gastric acid stable? Parenteral use only PENICILLIN V? Phenoxymethylpenicillin Gastric acid stable? Suitable for oral administration
157
PENICILLINS- BROAD-SPECTRUM (beta-lactamase sensitive): EXAMPLES?
Ampicillin | Amoxicillin
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PENICILLINS- BROAD-SPECTRUM Beta-lactamase resistant combo?
Amoxicillin+Clavulanic Acid (Co-amoxiclav)
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BROAD-SPECTRUM PENICILLINS SIDE-EFFECTS?
DIARRHOEA- antibiotic-associated colitis MACULOPAPULAR rash- most common in patients w/ glandular fever; DO NOT USE BROAD-SPEC BLINDLY FOR 'SORE THROAT' Do you DD
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PENICILLINASE-RESISTANT PENICILLIN EXAMPLE?
Flucloxacillin
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PENICILLINASE-RESISTANT PENICILLIN FLUCLOXACILLIN Take on empty stomach..? Safety information? Cautioned in?
Take on empty stomach..? 1hr before food/2hrs after Safety information? Cholestatic jaundice+hepatitis can occur, up to 2 months after treatment has ben stopped. Risk factors: >2 weeks use+elderly Cautioned in? Hepatic impairment
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ANTIPSEUDOMONAL PENICILLINS?
Piperacillin- only available in combo w/ beta-lactamase inhibitor Tazobactam Ticarcillin- only available in combo w/ beta-lactamase Clavulanic Acid
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PENICILLINS- SIDE-EFFECTS INTRAHETCAL? CROSS-SENSITIVITY? PENICILLIN ALLERGY?
INTRAHETCAL? Do not give INTRATHECALLY- can cause encephalopathy (same with Vincristine sulfate/vinca alkaloids!) VINCRISTINES- NEUROTOXICITY! CROSS-SENSITIVITY? Cross-sensitivity: DO NOT GIVE CEPHALOSPORINS in history of immediate penicillin hypersensitivity PENICILLIN ALLERGY? True allergy-> immediate rash, anaphylaxis Maybe not? minor rash, small, not itchy/confluent >72hrs after
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QUINOLONES- EXAMPLES?
``` CIPROFLOXACIN DELAFLOXACIN LEVOFLOXACIN MOXIFLOXACIN OFLOXACIN ```
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QUINOLONES- SIDE-EFFECTS MAY CAUSE? Advice?
MAY CAUSE? LOWERS SEIZURE THRESHOLD- avoid in epilepsy (+tramadol, sertraline, ibuprofen) PSYCHIATRIC DISORDERS TENDON DISORDERS PHOTOSENSITIVITY HYPERSENSITIVITY DISORDERS Advice? Reduce sunlight+UV radiation exposure+can impair driving ability
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QUINOLONES- IMPORTANT SAFETY INFORMATION?
TENDINITIS- common in >60years, STOP! AORTIC ANEURYSM+DISSECTION- seek help asap if sudden-onset severe abdominal/chest/back pain HEART VALVE REGURGITATION- seek help asap if SOB/peripheral neuropathy/new heart palpitations FLUOROQUINOLONES ARE VERY VERY BAD
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QUINOLONES- CAUTIONS? MAP-QT
MYASTHENIA GRAVIS ARTROPATHY (arthritis joint disease, yutes/adults) PERFORATED TYMPANIC MEMBRANCE (when used by ear) QT INTERVAL PROLONGATION
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QUINOLONES- INTERACTIONS FOOD & DRINKS? DRUGS THAT CAUSE..?
FOOD & DRINKS? AVOID dairy/mineral-foritifed drinks- reduces absorption DRUGS THAT CAUSE..? QT prolongation (amiodarone, SSRIs, haloperidol, chlorpromazine) Reduce seizure threshold (quinolones+NSAIDs)
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TETRACYCLINES- EXAMPLES?
DOXYCYCLINE TETRACYCLINE MINOCYCLINE
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TETRACYCLINES LABEL? LABEL exception? DLM
LABEL? Do not take w/ milk, indigestion remedies, or medicines containing iron/zinc, 2hrs before/after you take this medicine LABEL exception? DLM- DOES LIKE MILK Doxycycline Lymecycline Minocycline
171
TETRACYCLINES- SIDE-EFFECTS?
TEETH DISCOLOURATION/BONE DEPOSIT- avoid in >12 years/pregnant women BENIGN INTRACRANIAL HYPERTENSION- stop & report headache/visual disturbances LUPUS-ERYTHMEATOSUS-LIKE SYNDROM+IRREVERISBLE PIGMENTATION- highest risk w/ minocycline
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TETRACYCLINES- COUNSELLING POINTS
HEPATOXIC- avoid in liver failure PHOTOSENSITIVITY- avoid exposure to sunlight/lamps DYSPHAGIA- swallow whole with plenty of fluid, sitting/standing CAUTION IN MYASTHENIA GRAVIS
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TRIMETHOPRIM- SIDE-EFFECTS?
BLOOD DYSCRASIA- long-term; look out for signs of blood disorders fever, sore throat, rash, mouth ulcers, bruising or bleeding ANTIFOLATE- teratogenic risk in first trimester, avoid interactions w/ other antifolates:: methotrexate/phenytoin HYPERKALAEMIA- ACEi, ARB, digoxin, K+ sparing/aldosterone CAUTION IN RENAL IMPAIRMENT!
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ANTIBIOTICS- NARROW vs BROAD SPECTRUM NARROW? PvPGG TLC
``` PG TLC PENICILLIN (Pen V+Pen G) GLYCOPEPTIDES TRIMETHOPRIM LINEZOLID CLINDAMYCIN ``` Anaerobic- METRONIDAZOLE
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ANTIBIOTICS- NARROW vs BROAD SPECTRUM BROAD? CAPTN MCQ
``` CAPTN MCQ CHLORAMPHENICOL AMINOGLYCOSIDES PENICILLINS (amoxicillin+ampicillin) TETRACYCLINES NITROFURANTOIN MACORLIDES CEPHALOSPORINS QUINOLONES ```
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ANTIBIOTICS- BACTERIOSTATIC vs BACTERICIDAL BACTERIOSTATIC (prevents growth)? CLTMC
``` CHLORAMPHENICOL LINEZOLID TETRACYCLINE MACROLIDES CLINDAMYCIN ```
177
ANTIBIOTICS- BACTERIOSTATIC vs BACTERICIDAL BACTERICIDAL (kills)?
``` CEPHALOSPORIN AMINOGLYCOSIDES NITROFURANTOIN TRIMETHOPRIM QUINOLONES METRONIDAZOLE GLYCOPEPTIDES PENICILLINS ```
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ANTIBIOTIC DIRECTIONS WITH/AFTER FOOD? MNCP
``` WITH/AFTER FOOD? Metronidazole Nitrofurantoin Clarithromycin MR Pivmecillinam ```
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ANTIBIOTIC DIRECTIONS TAKE ON EMPTY STOMACH? (30-60mins before meal/snack OR at least 2hours after)
FLUCLOXACILLIN PHENOXYMETHYLPENICILLIN AZITHROMYCIN CAPS (not tabs/liquid) TETRACYCLINE/OXYTETRACYCLINE
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ANTIBIOTICS CAUTION IN MYASTHENIA GRAVIS?
QUINOLONES- Ciprofloxacin AMINOGLYCOSIDES- Gentamicin, Metronidazole... MACROLIDES- Clarithromycin... TETRACYCLINES- Doxycycline...
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ANTIBIOTICS NEPHROTOXIC/CAUTIONIN KIDNEY FAILURE?
(BIG 3) NITROFURANTOIN AMINOGLYCOSIDES GLYCOPEPTIDES- vancomycin, teicoplanin... tetracyclines trimethoprim
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ANTIBIOTICS HEPATOXIC/CAUTION IN LIVER FAILURE?
``` MACROLIDES FLUCLOXACILLIN CO-AMOXICLAV chloramphenicol nitrofurantoin tetracyclines ``` 3/4 TB meds- rifampicin, isoniazid & pryazinamide (RIPE) What's the 4th? ethambutol
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TUBERCULOSIS TREATMENT INITIAL PHASE? MONTHS? RIPE
``` RIPE- 2 MONTHS RIFAMPICIN ISONIAZID PYRAZINAMIDE EHTAMBUTOL ```
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TUBERCULOSIS TREATMENT CONTINUATION PHASE? MONTHS? RI.
RI- 4 MONTHS | RIFAMPICIN ISONIAZID
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TUBERCULOSIS TREATMENT Isoniazid sometimes with..?
Pyridoxine (vitamin b6)
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TUBERCULOSIS TREATMENT LATENT TUBERCULOSIS?
3 MONTHS OF RIFAMIPICIN+ISONIAZID OR 6 MONTHS OF ISONIAZID
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TUBERCULOSIS MEDICATIONS Patients w/ latent TB 35-65 years should be cleared of...?
Hepatooxicity
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TUBERCULOSIS MEDICATIONS RIFAMPICIN?
Discolours contact lenses Orangey-red body fluids Enzyme inducer- CYP450 interactions
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TUBERCULOSIS MEDICATIONS ISONIAZID?
PERIPHERAL NUEROPATHY- give prophylactic pyridoxine (vitamin b6) pain/numbness/tingling/weakness in hands/feet Enzyme inhibitor- CYP450 interaction
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TUBERCULOSIS MEDICATIONS PYRAZNIAMIDE?
HEPATOTOXIC
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TUBERCULOSIS MEDICATIONS ETHAMBUTOL?
VISUAL IMPAIRMENT | OCULAR TOXICITY
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FUNGAL INFECTIONS- TREATMENT ASPERGILLOSIS?
VORICONAZOLE
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FUNGAL INFECTIONS- TREATMENT CRYPTOCOCCOSIS?
AMPHOTERICIN B
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FUNGAL INFECTIONS- TREATMENT VAGINAL THRUSH?
CLOTRIMAZOLE/FLUCONAZOLE. RESISTANT? ITRACONAZOLE
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FUNGAL INFECTIONS- TREATMENT ORAL THRUSH?
NYSTATIN/MICONAZOLE/FLUCONAZOLE. RESISTANT? ITRACONAZOLE
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FUNGAL INFECTIONS- TREATMENT SKIN/NAIL INFECTIONS?
TOPICAL->SYSTEMIC THERAPY | TERBINAFINE/ITRACONAZOLE
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FUNGAL INFECTIONS- TREATMENT TERBINAFINE KEY POINTS?
Apply thinly Report liver dysfunction- dark urine/ stools, jaundice, N&V, abdominal pain Continue use-> monitor liver function
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TERBINAFINE OTC Age? TREATMENT PACK SIZE Tinea pedis OR Tinea pedis+cruris? Tinea pedis+cruris+corporis?
Age? 16+ TREATMENT PACK SIZE Tinea pedis OR Tinea pedis+cruris? 15g Tinea pedis+cruris+corporis? 30mL spray/30g gel
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FUNGAL INFECTIONS TINEA (ringworm) ``` Capitis? Corporis? Cruris? Pedis? Unguim/Oncyhomycosis? ```
``` Capitis? Head Corporis? Body Cruris? Groin Pedis? Feet Unguim/Oncyhomycosis? Nails ```
200
FUNGAL INFECTIONS TINEA TREATMENT?
Topical antifungal cream OR Terbinafine
201
FUNGAL INFECTIONS Amorolfine nail lacquer, initial terbinafine AMOROLFINE OTC Age? How often? Max. strength+pack size?
AMOROLFINE OTC Age? 18+ How often? Once weekly Max. strength+pack size? 5%, 3mL
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ANTIFUNGAL MEDICATIONS- SIDE-EFFECTS QT PROLONGATION/HEPATOXICITY? highest to lowest risk... KVIF
KETOCONAZOLE VORICONAZOLE ITRACONAZOLE FLUCONAZOLE
203
ANTIFUNGAL MEDICATIONS CARBONDATED DRINKS CAN IMPROVE BIOAVAILABILITY OF..?
ITRACONAZOLE
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ANTIFUNGAL MEDICATIONS LIFE-THREATENING HEPATOTOXICITY?
KETOCONAZOLE- oral treatment suspended, *Oral ketoconazole for Cushing's syndrome and topical products containing ketoconazole are not affected by this advice
205
ANTIFUNGAL MEDICATIONS PHOTOTOXICITY?
VORICONAZOLE- avoid sunlight exposure
206
ANTIFUNGAL MEDICATIONS AMPHOTERICIN B Cautioned in? Anaphylactic risk test for IV amphotericin B? Why maintain same formulation? Terbinafine risk?
AMPHOTERICIN B Cautioned in? renal failure Anaphylactic risk test for IV amphotericin B? Test dose with 30mins obs Why maintain same formulation? Serious harm/fatal OD, all. Terbinafine risk? Hepatotoxicity
207
AMOROLFINE WHEN SHOULD YOU REFER TO GP/DO NOT SELL? x2-DPB
``` <18 years >2 nails affected diabetic pregnant breastfeeding ```
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VIRAL INFECTIONS CHICKEN POX (varicella zoster)/ SHINGLES (herpes zoster) TREATMENT?
ACICLOVIR OR VALACICLOVIR (pro-drug)
209
VIRAL INFECTIONS CHICKEN POX (varicella zoster)/ SHINGLES (herpes zoster) TREATMENT?
ACICLOVIR OR VALACICLOVIR (pro-drug)
210
VIRAL INFECTIONS Chickenpox 14+ years?
Can consider antiviral treatment within 24hrs of onset of rash *NEVER GIVE IBUPROFEN/ASPIRIN U16s-> can mask symptoms of infection
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VIRAL INFECTIONS HERPES/SHINGLES SYMPTOMS?
Tingling sensation/burning/fluid-filled blisters Shingles will follow pattern of individual nerves on 1 side of body Can look like a belt/half belt around rib cage/torso
212
MALARIA BITE PROTECTION ADVICE (not absolute)?
MOSQUITO NETS IMPREGNATED W/ PERMETHRIN DEET 20-50% protection (50 best) - >2months old - Avoid ingestion-> wash hands before eating, foul smell - Pregnancy & breastfeeding fine (wash breast pre-feeding) - Apply DEET AFTER sunscreen Note: DEET reduces SPF of sunscreen-> use high SPF lotion
213
MALARIA PROPHYLAXIS TREATMENT MALORONE (atovaquone w/ proguanil) BEFORE TRAVEL? DOSE? AFTER TRAVEL? MAX. USE?
MALORONE (atovaquone w/ proguanil) BEFORE TRAVEL? 1-2 days DOSE? 1 OD AFTER TRAVEL? 1 WEEKLY MAX. USE? 1 YEAR
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MALARIA PROPHYLAXIS TREATMENT CHLOROQUINE BEFORE TRAVEL? DOSE? AFTER TRAVEL? MAX. USE?
CHLOROQUINE BEFORE TRAVEL? 1 WEEK DOSE? 1 WEEKLY AFTER TRAVEL? 4 WEEKLY MAX. USE? LONG-TERM
215
MALARIA PROPHYLAXIS TREATMENT PROGUANIL BEFORE TRAVEL? DOSE? AFTER TRAVEL? MAX. USE?
PROGUANIL BEFORE TRAVEL? 1 WEEK DOSE? 1 OD AFTER TRAVEL? 4 WEEKS MAX. USE? LONG-TERM
216
MALARIA PROPHYLAXIS TREATMENT MEFLOQUINE BEFORE TRAVEL? DOSE? AFTER TRAVEL? MAX. USE?
MEFLOQUINE BEFORE TRAVEL? 2-3 WEEKS DOSE? 1 WEEKLY AFTER TRAVEL? 4 WEEKS MAX. USE? 1 YEAR
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MALARIA PROPHYLAXIS TREATMENT DOXYCYCLINE BEFORE TRAVEL? DOSE? AFTER TRAVEL? MAX. USE?
DOXYCYCLINE BEFORE TRAVEL? 1-2 DAYS DOSE? 1 OD AFTER TRAVEL? 4 WEEKS MAX. USE? 2 YEARS
218
MALARIA PROPHYLAXIS TREATMENT Which one is long-term?
Officer PC Long Proguanil Chloroquine
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Return from malarial region Any illness that occurs within 1 year and especially within 3 months of return might be malaria--> see doctor asap!
220
MALARAIA- PATIENT GROUPS ASPLENIA?
Risk of severe malaria. OK.
221
MALARIA- PATIENT GROUPS PREGNANCY? REFER!!!
AVOID TRAVELLING TO MALAROUS REGIONS. Obvs. CHLOROQUINE+PROGUANIL can be given; avoid other meds--> Take 5mg folic acid- neural tubule defect risk 400mcg folic acid OTC btw
222
MALARIA- MEDICATION GROUPS EPILEPTIC PATIENTS SHOULD AVOID..?
CHOLORQUINE/MEFLOQUINE- reduces seizure threshold
223
MALARIA- MEDICATION GROUPS WARFARIN Treatment? INR? WHEN TO MEASURE?
WARFARIN Treatment? 2-3 weeks before departure INR? Stable before fly ``` WHEN TO MEASURE? Measure INR: Before anti-malaria & 7 days after starting course & After completing course ``` Prolonged stays? check INR on the regs
224
MALARIA- MEDICATION CAUTIONS MEFLOQUINE?
MEFLOQUINE? History of psychiatric disorders. develop? STOP+advice History of convulsions
225
MALARIA- MEDICATION CAUTIONS CHLOROQUINE?
CHLOROQUINE? History of convulsions Can be retinotoxic
226
MALARIA- MEDICATION CAUTIONS PROGUANIL?
PROGUANIL? RENAIL IMPAIRMENT-> reduce dose
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MALARIA- MEDICATION CAUTIONS DOXYCYCLINE?
DOXYCYCLINE? Avoid exposure to sunlight
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MALARIA- EMERGENCY STANDBY TREATMENT When to carry standby treatment? what even is this? WRITTEN INSTRUCTIONS?
When to carry standby treatment? what even is this? >24hrs away from medical care WRITTEN INSTRUCTIONS? - Seek urgent medical attention if fever (38°C or more) develops 7 days (or more) after arriving in a malarious area - Self-treatment is indicated if medical help is not available within 24 hours of fever onset
229
DOXYCYCLINE SIDE-EFFECTS?
PHOTOSENSITIVITY TEETH DISCOLOURATION HEADACHE DIARRHOEA NOT CONSTIPATION!
230
splenectomy/sickle-cell disease, Abx?
Phenoxymethylpenicillin
231
MICONAZOLE--NUMBER OF DAYS MOUTH? SKIN? THRUSH?
MOUTH? 2.5ML QDS+7 DAYS AFTER...HALF IN <2 SKIN? BD+10 DAYS AFTER THRUSH? 7 days?
232
NYSTATIN?
7 DAYS+48 HOURS AFTER HEALING
233
Allopurinol labelling?
FULL GLASS OF WATER TAKE WITH FOOD/MEAL DO NOT STOP TAKING
234
Bacterial meningitis under 3?
Give cefotaxime
235
SESPSIS treamtent?
piperacillin w/ tazo key MRSA? Add vanc/tteico
236
WHAT IS ST JOHN'S WORT?
INDUCER!
237
Omeprazole?
hyponataraemie, increase dose Hypomagnesaemia (more common after 1 year of treatment, but sometimes after 3 months of treatment)
238
PD/ASTHMA exacerbations + ABX Amoxicillin 500mg TDS for 5 days 200mg stat doxy and then 100mg OD for 7 days 200mg BD clarithromycin for 7 days Prednisolone: 40mg OD for asthma for 5 days 30 OD for COPD for 7-14 days If prophylaxis then Azithromycin Three times per week

GPhC BNF (48 decks)

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