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Pradeepa's notes > Infection > Flashcards

Infection Flashcards

1
Q

What is the first line tx for human and animal bites?

A

co-amoxiclav
tx - 5dy
prophylaxis - 3dy

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2
Q

What is the second line tx for human and animal bites?

A

doxycyclinr + metronidazole
tx - 5dy
prophylaxis - 3dy

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3
Q

what do you use to tx human and animal scratches?

A

flucloxacillin

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4
Q

what is 1st line for tick bites (lyme disease)

A

doxycycline 100mg BD 21dy

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5
Q

what is 2nd line for tick bites (lyme disease)

A

amoxicillin 1g TDS 21dy

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6
Q

1st line for diabetic foot infection less than 2cm

A

flucloxacillin

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7
Q

2nd line or penicilin allergy for diabetic foot infection less than 2cm

A

clarithyromycin, erythromycin or doxycycline

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8
Q

1st line for diabetic foot infection - severe abscess or oestomyelitis

A

flucloxacillin or co-amox +/- gentamicin

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9
Q

2nd line or pen allergy for diabetic foot infection - severe abscess or oestomyelitis

A

co-trimoxazole +/- gentamicin

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10
Q

1st line for cellulitis

A

flucloxacillin

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11
Q

tx for cellulitis if pen allergy or if flucloxacillin unsuitable

A

clarithyromycin, erythromycin
doxycycline
co-amox

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12
Q

tx if infection near nose/eyes

A

co-amox

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13
Q

tx if infection near nose/eyes + pen allergy

A

clarithromycin + metronidazole

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14
Q

tx for low severity community acquired pneumonia

A

1st - amox
2nd doxy / clarithy / erytho

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15
Q

tx for moderate severity community acquired pneumonia

A

1st amox + clarith
2nd doxy or clarith

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16
Q

tx for high severity community acquired pneumonia

A

1st co-amox + clarith
2nd levofloxacin

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17
Q

c.diff tx

A

1st vancomycin
2nd fidaxomicin
life threat - vanco + iv metronidazole

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18
Q

travellers diarrhoea tx

A

Aithromycin
prophylaxis/tx - bismuth subsalicylate

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19
Q

otitis media

A

1st amox
2nd co-amox
or clarith/erytho if allergy

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20
Q

otitis externa

A

1st acetic acid 2%
2nd topical neomycin + corticosteriod
if systemic = fluclox

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21
Q

h.plyori tx

A

-triple therapy
-PPI (x omeprazole if clopidogrel) with amox 1g BD or metronidazole 400mg BD or clarithromycin 500mg BD

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22
Q

how do you diagnose h.pylori

A

urea 13C breath test x 2WK after PPI or 4WK after antibiotics

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23
Q

non-severe hospital acquired pneumonia tx

A

-1st co-amox
-2nd (adults) doxycl or cefalexin or co-trimox or levofloxacin
-2nd (child) clarithromycin

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24
Q

impetigo localised non-bullous

A

1st hydrogen peroxide
2nd fusidic acid or mupirocin 2%

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25
Q

impetigo wide spread non-bullous

A

fusidic acid or mupirocin

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26
Q

impetigo bullous or systemically unwell

A

1st flucloxacillin
2nd clarithy

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27
Q

lower uti men

A

1st nitrofurantoin or trimethoprim for 7DY

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28
Q

lower uti non preg

A

1st nitrofurantoin or trimethoprim
2nd pivmecillinam or fosfomycin
if uncomplicated 3DY

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29
Q

lower uti pregn

A

1st nitrofurantoin (if egfr >45)
2nd cefalexin or amox
7DY tx

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30
Q

what causes strep throat and scarlet fever and what is the tx?

A

-streptococcus
-1st phenoxymethylpenicillin
-2nd clarithromycin

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31
Q

scarlet fever symptoms

A
  • flu like symp - high temp, swollen neck glands
    -red rash small raised bumps rough feeling = sandpaper
    -white coating on tongue
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32
Q

tx of acne vulgaris

A

adapalene, clindamycin, benzoyl peroxide, lymecycline

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33
Q

tx of bacterial vaginosis _ trichomoniasis

A

metronidazole

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34
Q

tx of chlamydia

A

doxy

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35
Q

tx of conjunctivitis b+ blepharitis

A

choramphenicol x under 2 (POM) or pregn

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36
Q

tx of dental absess

A

amox or metronidazole

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37
Q

tx of gonorrhoea

A

ceftriaxone or ciprofloxacin

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38
Q

tx of meningtisis

A

benzylpenicillin

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39
Q

tx of scabies

A

permethrin ( whole body)

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40
Q

tx of sinusitis

A

phenoxymethylpencillin or doxycl

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41
Q

tx of threatworm

A

mebendazole x under 2 or pregn

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42
Q

what pathogen causes community acquired pnuem

A

streptococcus pneumoniae

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43
Q

what pathogen causes uti

A

e.coli

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44
Q

what pathogen causes thrush

A

candida albicans

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45
Q

what pathogen causes cellulitis

A

staphylococcus aures

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46
Q

what pathogen causes meningitis

A

steptococcus pneumoniae

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47
Q

what are aminoglycosides

A

amikacin, gentamicin, neomycin, streptomycin, tobramycin

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48
Q

when does serum aminoglycosides conc need to be measured

A

all pt with parental
obesity, high doses, cystic fibrosis and elderly
measure after 3-4 doses then every 3DY and after dose change

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49
Q

what is peak concentration

A

level after 1hr after dose - if high lower dose.
for aminoglycosides conc = 5-10mg/l endocarditis - 3-5mg/l

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50
Q

what is trough concentration

A

level before next dose - if high increase interval
for aminoglycosides conc = <2 mg/l endocarditis -<1mg/l

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51
Q

renal impairment and aminoglycosides

A

increase dose interval if severe decrease dose
avoid co-comitant use of nephrotoxic drugs

52
Q

what is the MHRA warning with aminoglycosides

A

use of aminoglycosides assoc with ototoxicity
- interactions with cisplatin, loop diuretics (furosemide, bumentide, torsemide), vancomycin, vinca alkaloids (vinblastine, vinasitine, vindesine, vinflusline)

53
Q

CI with aminoglycosides

A

myarthesria gravis
pregn - risk of auditory or vestibular nerve damage
obesity - ideal body weight for parental dose

54
Q

1st gen of cephalosporins

A

cefadroxil, cefalexin, cefradine

55
Q

2nd gen of cephalosporins

A

cefuroxime, cefoxitin, cefaclor

56
Q

3rd + 5th gen of cephalosporins

A

all parental apart from oral cefixime

57
Q

is cephalosporins okay in penicillin allergy?

A

if hypersensitivity to penicillin or other beta-lactams there is cross sensitivity so NO

58
Q

s/e of clindamycin

A

-antibiotic assoc-colitis can be fatal high risk in elderly contact doc if severe, prolonged or bloody diarrhoea
-in c.diff if suspected discontinue

59
Q

what are glycopeptides

A

dalbavancin, teicoplanin, tstevancin + vancomycin

60
Q

caution with glycopeptides

A

-for systemic infections use parental route with vancomycin due to low absorption with oral route
-avoid in pregn (benefit vs risk)
-initial dose based on weight then adjust based on vanco conc = trough = 15-20
-can cause ototoxicity and nephrotoxicity

61
Q

glycopeptides s/e

A

-red man syndrome
-severe cutaneous adverse steven-johnson syndrome
-blood dyserasis - agranulocytosis, eosinophilia + neutropenia
-cardiogenic shock on rapid IV inj
-risk of anphylactoid reactions at infusion site avoid rapid infusion and rotate site

62
Q

linezolid caution

A

-risk of severe optic neuropathy - report visual impairment + monitor reg if tx more than 28DY
-risk of blood disorders - weekly monitor FBC regular if tx more than 10-14DY

63
Q

linezolid interactions

A

-tyramine rich foods - mature cheese, marmite, yeast extract, fermented soya bean extract, beers and wine

64
Q

linezolid + serotonin syndrome

A
  • SSRI, dipaminergics, 5-HT1 agonists, TCAs, lithium + MOAIs
65
Q

what are macrolides

A

azithromycin (OD), clarithromycin (BD), erythromycin (QDS)

66
Q

macrolides caution

A

-myasthenia gravis
-pregn only erytho

67
Q

macrolides s/e

A

-hepatoxity
-ototoxicity (hearing loss in high dose)
- high GI s.e N+V+D
-QT prolongation

68
Q

macrolides interactions

A
  • cyp450 inhibitors - statins inc myopathy, warfarin inc bleeding
    -hypokalaemia - loop diureitcs/thiazides, steroids, salbutamol, theophylline,
    -QT prolongation - amiadrone, domperidone, fluconazole, lithium, methadone, ondansetron, quinine, quinolones, SSRIs, sotalol
69
Q

metronidazole s/e

A

-taste disturbance, metallic taste, furred tongue
-n+v
- x alcohol (48hr after)

70
Q

nitrofurantoin caution

A

-x pregn
-renal impairment avoid if egfr <45
-may discolour urine yellow/brown
-with/after food

71
Q

narrow spectrum penicillin (beta lactamase sensitive)

A

-penicilin G benzylpenicillin
–>x gastric acid safe so only parental
-penicillin V phenoxymethylpenicillin
–> gastric safe

72
Q

broad spectrum penicillin (beta lactamase sensitive)

A

-amox
-amox + clavulanic acid (co-amox) –> beta lactamase resistant

73
Q

broad spectrum penicillin side effects

A

-diarrhoea
-maculopapular rashes commonly occur in pt = glandular fever x use broad spec in sore throats blindly

74
Q

penicillinase resistant penicillin

A
  • fluclox
    -empty acid 1hr before food / 2hr after food
  • cholestastic jaundice + hepatitis = v rare but up to 2 MT POST TX
    -if more than 2wk inc s.e with age
75
Q

antipseudomonal penicillin

A

-piperacillin + tazobactam
- ticarcillin + clavulanic acid

76
Q

s/e of penicillin

A
  • x intrathecathy - encephalopathy = fatal
  • true penc allergy ; rashes or anaphylactic
  • x allergy ; minor rashes, small, hot, itchy + con-confluent or rash after 72hr
    -cross sens - x give cephlasporins
77
Q

quinolones

A

ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin

78
Q

quinolones caution + s/e

A

-lower seizure threshold avoid in epilepsy
- psychotic disorders
- tendon disorders
-hypersen reactions
- sunlight + uv radiation lower exposure
- impair driving

79
Q

quinolones MHRA

A

-tendinitis - higher in 60+, stop and seek advice if suspected
- small risk of aneurysm + dissection (sudden onset, severe abdominal chest back pain)
-small heart valve regurgitation (SoB, peripheral, new heart palpations, odema)

80
Q

quinolones caution

A

-qt prolongation
-myasthenia gravis
-arthropathy in children and teens
-perforated tympanic membrane (ear)

81
Q

quinolones interaction

A

food, water - avoid dairy products, mineral fortified drinks, lower absorption of drugs - qt prolongation
-seizure threshold + NSAIDs (ibuprofen)

82
Q

tetracyclines

A

doxycycline, demeclocycline, lymecycline, minocycline, oxytetracycline, tetracycline + tigecycline
-x milk, indigestion remedies (iron, zinc) 2hr before or after

83
Q

tetracyclines + milk

A

DOES LIKE MILK
doxy, lymcy, minocycl

84
Q

tetracyclines s/e

A

-benign intracranial hypertension - stop if headache + visual impairment
-lupus -erythematosus like syndrome + irreversible pigmentation - more in minocyc
-teeth discolouration + bone deposits x under 12 or preg

85
Q

tetracyclines counselling points

A

-hepatotoxic - avoid liver failure
-photosensitivity - avoid exposure to sunlight or sunlamps
- dysphagia - swallowed whole while standing
-caution myasthenia gravis

86
Q

trimethoprim interactions

A

-may cause blood dyscrasis - long tx look for blood disorder signs (fever, sore throat, rash, mouth ulcers, bruising, or bleeding)
-antifolate x pregn interaction with methotrexate + phenytoin
-renal impairment
-hyperkalaemia

87
Q

narrow spectrum antibiotics

A

-less stomach s/e
- penicillin V + G
-glycopeptides
-trimethoprim
-linezolid
-clindamycin

88
Q

broad spectrum antibiotics

A

-chloramphenicol
-aminoglycosides
-penicillin (amox _ ampicillin)
-tetracycline
-nitrofurantoin
-macrolides
-cephalosporins
-quinolones

89
Q

anaerobic antibiotic

A

metronidazole

90
Q

bacteriostatic antibiotics

A

prevents bacterial growth
-chloramphenicol
-linezolid
-tetracycline
-macrolides
-clindamycin

91
Q

bactericidal antibiotics

A

kills bacteria
-cephalosporins
-aminoglycosides
-nitrofurantoin
-trimethoprim
-quinolones
-metronidazole
-glycopeptides
-penicillin

92
Q

antibiotics with/after food

A

-metronidazole
-nitrofu
-clarith MR
- pivermecilinam

93
Q

antibiotics empty stomach 30-60mins before/2hr after

A

-fluclox
-phenoxymeth
-azithro caps
-tetracy + oxytetracycline

94
Q

caution in myasthenia gravis

A

-quinolones
-aminoglycosides
-macrolides
-tetracyc

95
Q

nephrotoxic antibiotics

A

-nitrofur
-aminoglycosides
-gylcopepides
-tetracycl
-trimetho

96
Q

heptotoxic antibiotics

A

-macrolides
-flucloxacillin
-co-amox
-chloramphenicol
-nitrofur
-tetracycli
-rifampicin + isoniazid + pyrazinamide

97
Q

TB initial phase tx

A

TWO MONTHS
-rifampicin
-isoniazid
-pyrazinamide
-ethambutol

98
Q

TB continuous phase tx

A

FOUR MONTHS
-rifampicin
-isoniazid

99
Q

latent TB tx

A

3 MONTHS of rifampicin + isoniazid or 6 MONTHS of isoniazid

100
Q

TB medication

A

-clear hepatotoxicity 35-65
-rifampicin - discolour soft contact lesnes + bodily fluids orangey red. enzyme inducer
-isoniazid - neuropathy - prophylactic pyridoxine HCL (vit b6) given - cyp450 inhibitor
-pyrazinamide = heptatotoxic
-ethambutol = visual impairment + ocular toxicity

101
Q

tx of aspergillons

A

voriconazole

102
Q

tx of cryptococlosis

A

amphotericin B

103
Q

tx of thrush

A

-vaginal - clotrimazole / fluconazole or itraconazole
- oral - nystatin/miconazole/fluconazole/ itraconazole

104
Q

tx of skin + nail infections

A

topical therapy -> systemic therapy itraconazole, terbinafine

105
Q

tinea (ringworm)

A

tinea capitis - head
tinea corporis - body
tinea crusis - groin
tinea pedis - feet
tinea uriguium/longchontosis - nails

106
Q

tinea (ringworm) tx

A

topical antifungal cream or terbinafine

107
Q

duration of nail region terbinafine or amorofine nail laquer

A

OW for 1 yr
refer to gp if l<18, 2+ nails, diabetic, pregnant/BF

108
Q

antifungal medications

A

fluconazole, itraconazole, ketoconazole, voriconazole

qt prolongation + heptatotoxicity (less in flucon,ketocon,voricom,itracon)

109
Q

amphotericin B

A

-caution in renal failure,
-anaphylaxiss risk in IV - 30 min observation
-maintain same formulation between conventional, liposomal, lipid-complex formulation

110
Q

Itraconazole

A

carbonated drinks inc bioavailability

111
Q

ketoconazole

A

life threatening hepatotoxicity - oral tx suspended

112
Q

voriconazole

A

photosensitivity occurs uncommonly - avoid sunlight exposure

113
Q

terbinafine

A

hepatotoxicity

114
Q

tx of varicella zoster, chickenox, herpes zoster, shingles

A

Aciclovir, valaclovir (prodrug)

115
Q

chickenpox

A

-pt 14+ = antiviral 24hr onset

116
Q

herpes/shingles

A

-tingling sensation, burning, fluid filled blisters,
-shingles follow pattern of individual nerve on one side of body looks like blet/half belt around ribcage/torso

117
Q

malaria bite protection

A

-not absolute
-mosquito net impregnated permethrin
-diethyltoluamide (DEET) 20-50% (50% longer protection)
–>suitable for 2+ MT
–>avoid ingestion - wash hands
–>suitable pregn + BF
–>apply SPF then DEET

118
Q

malaria prophylaxis tx

A

malarone, chloroquine, proguanil, mefloquine, doxycycline

IF ILLNESS OCCURS IN 1 YR ESP 3MT AFTER RETURN = MALARIA

119
Q

malarone + atorvaquone + proguanil

A

-before travel - 1-2DY
-dosage - 1OD
-after travel - 1WK
-max use - 1YR

120
Q

chloroquine

A

-before travel -1WK
-dosage - OW
-after travel -4WK
-max use -LONG TERM

121
Q

progunanil

A

-before travel -1WK
-dosage -1OD
-after travel -4WK
-max use -LONG TERM

122
Q

mefloquine

A

-before travel -2-3WK
-dosage -OW
-after travel -4WK
-max use -1YR

123
Q

doxycycline

A

-before travel -1-2DY
-dosage -1OD
-after travel -4WK
-max use -2YR

124
Q

malaria pt groups

A

-asplenia - high risk of malaria
-pregn - avoid travelling to regions with malaria. can give chloroquine + proguanil + 5mg folic acid (neural tube defect risk)

125
Q

malaria medication groups

A

-epilepsy avoid chloroquine + mefoloquine
- warfarin - start tx 2-3wk before travel
–> INR stable before travel
–>INR measured before antimalarials, 7DY after starting + after completing
–>prolonged stay check INR regularly

126
Q

antimalarial caution

A

-mefloquine - psychiatric disorders develops stop. convulsions
-chloroquine - convulsions, retinotoxic
-proguanil - renal impairment lower dose
- doxyc avoid sunlight exposure

127
Q

malaria standby tx

A

-travelling = emergency standby tx if 24+HR away from medical care
-avoid self medication if access available
-written instructions provided - seek urgent if fever (38+) develops 7DY after arriving
-self tx if no help available within 24hr of fever onset

Pradeepa's notes (12 decks)

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