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Infection Flashcards

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1
Q

Virus causing chicken pox/ shingles

A

Varicella-zoster

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2
Q

Tx for shingles

A

Aciclovir, valaciclovir or famciclovir

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3
Q

Tx for chickenpox

A

Fever: Paracetamol
- AVOID NSAIDs

Itchiness: calamine lotion and chlorphenamine

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4
Q

when are antivirals used in the treatment of chicken pox?

A

Patients aged 14+
- treated within 24 hours of onset

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5
Q

What are the signs of shingles?

A

Tingling, itching and burning rash of FLUID FILLED blisters
- rash follows a nerve on sides of body that do not cross the midline

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6
Q

Hand, foot and mouth disease
- viral/ bacterial?
- treatment

A

VIRAL
Tx: Paracetamol and ibuprofen + hydration

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7
Q

Glandular fever
- viral/ bacterial?
- treatment

A

VIRAL
Tx: Paracetamol and ibuprofen + hydration

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8
Q

Slapped cheek syndrome
- viral/ bacterial?
- treatment

A

VIRAL
Tx: Paracetamol and ibuprofen + hydration

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9
Q

Scarlett fever
- viral/ bacterial?
- treatment

A

BACTERIAL
- refer to GP for ABx (COME BACK TO THIS WHEN WATCHED VIDEO)
+ paracetamol/ ibuprofen

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10
Q

Treatment of severe COVID-19

A

Oxygen
Corticosteroids- dexamethasone
Antivirals- remdesivir
Monoclonal antibodies- tocilizumab
Small molecule inhibitors
LMWH- VTE prophylaxis

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11
Q

when should someone NOT go for their COVID vaccine?

A

If you are feeling acutely unwell or have symptoms of COVID-19

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12
Q

Examples of NRTIs in Tx of HIV

A

Abacavir
emtricitabine
Tenofovir

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13
Q

Examples of NNRTIs used in treatment of HIV

A

Efavirenz
Etravirine

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14
Q

Examples of protease inhibitors used in treatment of HIV

A

Retonavir
Darunavir

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15
Q

examples of integrase inhibitors used in treatment of HIV

A

Dolutegravir
Raltegravir

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16
Q

examples of entry inhibitors used in the treatment of HIV

A

Enfuvirtide

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17
Q

What is the goal of HIV treatment?

A

To reduce the viral load to a level that in UNDETECTABLE with blood tests

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18
Q

What is post-exposure prophylaxis?
When should it be initiated and how long is it given for?

A

Medication given after possible exposure of HIV, such as
- sexual exposure
- needle-stick injury
- human bite

Initiated within 72 hours for 28 days

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19
Q

What is angular cheilitis

A

causing pain, redness, and cracking

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20
Q

Treatment of vaginal thrust

A

Clotrimazole- 2% two or three times daily for 7 days
Fluconazole- 150mg one dose
Resistant -> itraconazole

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21
Q

treatment for oral thrush

A

Miconazole- oral gel
Nystatin
Fluconazole- systemic 7-21 days

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22
Q

Ring worm treatment

A

Topical

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23
Q

Fungal toenail treatment (onchomycosis)
- when to refer to GP

A

Terbinafine
Amorolfine nail lacquer
- once WEEKLY for up to one year

Refer to GP if under 18, >2 nails affected, diabetic, pregnant or breastfeeding

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24
Q

What is the main caution of all ‘-azole’ antifungals?

A

QT prolongation
Hepatotoxicty

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25
Which ‘-Azole’ antifungal has the highest risk of hepatotoxicity?
Ketoconazole- close monitoring is needed
26
What is the 2 cautions for itraconazole? - think heart and babies
- caution in reduced left ventricular ejection fraction - women should use contraception until period following the end of therapy
27
What is the main side effects of voriconazole?
Serious dermatological reactions - phytotoxicity - squamous cell carcinoma
28
What is the risk of IV amphotericin B? - how do you avoid this
Risk of anaphylaxis - give a test dose with 30 mins of obs after - helped with a SLOW INFUSION RATE (2+ hours) with diphenhydramine, paracetamol and hydrocortisone
29
Main adverse effects of terbinafine - skin and organs
- Hypersensitivity and skin reactions - liver and renal impairment
30
medicines used for TB - RIPE
Rifampicin Isoniazid Pyrazinamide (Vitamine B6) Ethambutol
31
which TB medications can cause hepatotoxicity? - RIP
Rifampicin Isoniazid Pyrazinamide - do not give with other drugs that can cause hepatotoxicity
32
What is the main counselling point for Rifampicin?
Can discolour bodily fluids RED - urine, sweat and tears - including contact lenses
33
What can isoniazid cause - how is this prevented?
Peripheral neuropathy - given with pyridoxine (vitamin B6) to help prevent this
34
What can ethambutol cause?
Visual impairment due to optic neuritis
35
Is Rifampicin a CYP inhibitor or inducer?
Inducer - speeds up metabolism of other drugs, so decrease levels in body
36
is isoniazid an enzyme inducer or inhibitor
Inhibitor - decrease metabolism of other drugs, causing toxic levels/ side effects
37
Trimethoprim - MOA - pregnancy? - interactions - electrolyte imbalances - main cautions
MOA: Anti-folate Teratogenic- avoid in pregnancy (first trimester) Interacts with other anti-folates- methotrexate and phenytoin Can cause HYPERkalameia and HYPOnatraemia -> renal impairment Can cause BLOOD DYSCRASIA - measure FBC - look out for signs of: fever, sore throat, rash, mouth ulcers, bruising and bleeding
38
What is the main counselling advice for tetracyclines? - e.g. what is on the labels
Do not take with indigestion remedies, or medicines containing iron or zinc, TWO hours before/ after you take this medication
39
Which tetracyclines DO NOT interact with milk
DOES LIKE MILK D-Doxycycline L- Lymecycline M- Minocycline
40
Which tetracyclines DO interact with milk?
DOT D- Democycline O- Oxytetracycline T- Tetracycline
41
Who should tetracyclines be avoided in?
Children under 12 Pregnancy/ breastfeeding - affects teeth and skeletal development
42
What signs should watch for when taking tetracyclines that would indicate to STOP taking them? - what could this be caused by?
Headache and visual disturbances - begin intracranial hypertension
43
Main side effects of tetracyclines
Photosensitive- avoid sun exposure Oesophagitis Hepatic impairment
44
Examples of quinolones
Ciprofloxacin Levofloxacin Ofloxacin
45
What is the MHRA warning with quinolones? - 2!!
1. They should only be prescribed when other common antibiotics are inappropriate 2. Risk of suicidal thoughts of behaviour
46
What are the main side effects of quinolones?
Tendon rupture/ tendinitis
47
When to avoid using Nitrofurantoin
If eGFR less than 45 in pregnancy at TERM
48
What is MHRA warning for Nitrofurantoin?
Risk of pulmonary and hepatic events
49
Do you take Nitrofurantoin with food or on an empty stomach?
With or after food
50
what colour can Nitrofurantoin make your urine?
Yellow or brown
51
Which type of bacteria does metronidazole fight again?
Anaerobic
52
side effects of metronidazole
Nausea and vomiting Diarrhoea Taste disturbances- metallic taste
53
Should you take metronidazole on an empty stomach or with/ after food?
With/ after food
54
What is the main interaction of metronidazole - what is it called - how to avoid
Alcohol - causes a disulfiram like reaction -> vomiting, hot flushes, stomach pain - avoid alcohol for 48 hours AFTER LAST dose
55
Which macrolide is preferred in pregnancy?
Erythromycin
56
Cautions of macrolides
- QT prolongation - HYPOkalaemia - severe hepatic or renal impairment
57
Side effects of macrolides
Ototoxicity- reversible hearing loss on large doses QT prolongation Hepatotoxicity
58
which macrolides effect CYP enzymes? - inducer or inibitor?
Clarithromycin and erythromycin are INHIBITORS Therefore INCREASE concentration (and side effects) of drugs like - Rivaroxaban - warfarin - CCBs - Statins - Theophylline
59
If a patient is prescribed a course of clarithromycin and talking a statin, what is the advice?
STOP statin while taking macrolide
60
Macrolides can cause HYPOkalaemia, so avoid giving with other drugs that cause hypokalaemia such as…
- loop/ thiazide diuretics - steroids - salbutamol - theophylline
61
Macrolides increase the risk of QT prolongation, so avoid giving them with other drugs that cause QT prolongation such as…
Amiodarone Domperidone Fluconazole Lithium Methadone Ondansetron Quinolones
62
What can linezoild cause? - 3
1. Peripheral and optic neuropathy Report signs of - tingling or numbness - visual impairment Monitor if treatment is more than 28 DAYS 2. Myelosuppression - FBC at baseline then weekly 3. Serotonin syndrome - avoid other drugs that also cause this e.g. SSRIS, TCAs, Tramadol and lithium
63
What is the food reaction with linezolid?
EInteracts with tyramine-rich foods
64
Example of glycopeptide
Vancomycin
65
How is vancomycin usually administered? - what condition is the acception?
IV - unless it is being used for C.DIFF
66
What should the trough concentration be in vancomycin? - when is it measured?
15-20mg/L - measured on second day of treatment immediately before the next dose
66
How is vancomycin dosed?
Initial dosed based on BODY WEIGHT - Doses are then adjusted according to serum-concentration levels
67
Severe HAP
In severe HAP: add vancomycin OR teicoplanin if MRSA suspected (not both)
68
Example of aminoglycosides
Gentamicin Neomycin
69
Serum Aminoglycoside concentrations must be determined in which patients?
- all receiving parental - Obesity - CF - elderly - renal impairment
70
When should serum-gentamicin levels be checked?
After 3-4 doses, then 3 days AND after a dose change - measured 1 hour AFTER dose and BEFORE next dose (peak and trough)
71
Gentamicin serum conc levels - multiple daily dose regime - endocarditis
MDD - PEAK: 5-10 mg/L - TROUGH: <2 mg/L Endocarditis: 3-4 mg/L - PEAK: 3-5 mg/L - TROUGH: <1mg/L
72
Dose adjustments for gentamicin - trough too high - peak too high - severe renal impairment
Trough too high: increase dose INTERVAL Peak too high: DECREASE dose Severe renal impairment: Increase dose INTERVAL
73
MHRA warning with aminogylcosides
OTOTOXICITY - avoid in drugs that also cause (such as cisplain, loop diuretics, vancomycin and vinca alkaloids)
74
Two cautions of aminoglycosides
Ototoxicity Renal impairment - avoid with drugs causing these
75
What weight in obese patients is used for dosing of gentamicin?
CORRECTED body weight, based on IDEAL body weight to calculate parenteral dose
76
Which skin reaction can be caused due to aminoglycosides?
Steven-Johnstone sydrome Red mans syndrome- if infused too rapidly
77
If someone has a penicillin allergy, which antibiotic may they also be allergic to?
Cephalosporins
78
Can chloramphenicol be used in pregnancy or breastfeeding?
NO- can cause grey baby syndrome
79
Who is OTC chloramphenicol NOT licensed in?
Pregnancy, breastfeeding and children under 2
80
Two side effects of chloramphenicol?
Hypersensitivity Bone marrow depression
81
What is the severe skin reaction associated with Clindamycin?
Steven- Johnson syndrome - discontinue
82
What GI reaction may be associated with Clindamycin?
C.DIFF - discontinue if suspected/ confirmed
83
What is a true penicillin allergy? - what is not a true allergy?
SEVERE IMMEDIATE REACTION - Anaphylaxis, wide spread rash, breathing difficulties etc NOT a true allergy: minor rash developing after 72 hours, or any diarrhoea or vomiting
84
Which two penicillins can cause hepatitis or cholestatic jaundice? - after how long can this happen?
Flucloxacillin or Co-amoxiclav - up to 2 MONTHS after treatment
85
Interaction of penicillin and - methotrexate - warfarin - allopurinol
Methotrexate: reduce clearance of MXT = increase toxicity Warfarin: alters INR = needs monitoring Allopurinol: increase risk of skin reactions
86
Risks of quinolones - 3
1. Heart valvular regurgitation 2. Long-lasting side effects (MSK and nervous system) 3. Aortic aneurysm

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