Infection extra Flashcards
(39 cards)
A patient has come in for their check-up at 24 weeks of pregnancy and the nurse prescriber has noticed that they have some cellulitis present on their leg. The nurse would like to prescribe an antibiotic but is aware that they also have a penicillin allergy. Which of the following antibiotics would be most appropriate to prescribe?
Choose only ONE best answer.
A
Flucloxacillin
B
Clarithromycin
C
Erythromycin
D
Doxycycline
E
Metronidazole
C – Due to the penicillin allergy, the first line treatment of flucloxacillin could not be used. The second line treatment would usually be doxycycline, clarithromycin or erythromycin. Doxycycline and clarithromycin should not be used in pregnancy. Metronidazole is not licensed for cellulitis on the legs. This leaves erythromycin as the correct option.
an 83-year-old patient, has been staying in hospital for the last week after a COPD exacerbation and has been diagnosed with a mild pneumonia. Given that the first line treatment is not suitable for this patient, which of the following medications would not be a suitable alternative?
Choose only ONE best answer.
A
Clarithromycin
B
Cefalexin
C
Co-trimoxazole
D
Doxycycline
E
Levofloxacin
A – As the patient has been in the hospital for longer than 48 hours, this pneumonia would be classed as hospital acquired. First line would be co-amoxiclav, with alternatives being cefalexin, co-trimoxazole, doxycycline or levofloxacin.
Clarithromycin is generally avoided in elderly patients, especially those with comorbid conditions such as COPD, due to its potential for drug interactions, particularly with medications that are commonly prescribed to elderly patients. Additionally, clarithromycin has a higher risk of causing QT prolongation, which can be particularly concerning in older adults who may have existing cardiac issues or who are taking other medications that affect the QT interva
A patient has come into the pharmacy with a prescription for an antibiotic due to being bitten by a cat. The patient does not show any signs of infection at the location of the bite but still needs to take some antibiotics. Which medication regimen would be most likely prescribed to the patient?
Choose only ONE best answer.
A
Flucloxacillin 500mg four times a day for three days
B
Flucloxacillin 500mg four times a day for five days
C
Co-amoxiclav 500/125mg three times a day for three days
D
Co-amoxiclav 500/125mg three times a day for five days
E
Metronidazole 400mg three times a day for three days
C – Co-amoxiclav is the first line treatment in animal bites. Though the patient has been bitten, they do not show signs of infection meaning that a prophylactic regimen of three days is needed and not five days.
A patient has come into the general practice with shortness of breath and green sputum. The advanced practitioner pharmacist would like to test them for community acquired pneumonia using the CURB65 test. Which of the following parameters is not measured in the CURB65 score?
Choose only ONE best answer.
A
Blood urea nitrogen
B
Age
C
Blood pressure
D
Weight
E
Respiratory rate
D – The following parameters are measured in the CURB65 score: Confusion, blood urea nitrogen, respiratory rate, blood pressure, and age.
she will go and travel around South America for 6 months. Before setting off, she would like some advice on what to do and avoid in order to prevent herself from getting traveller’s diarrhoea. Which of the following points would be the most appropriate point to tell her?
Choose only ONE best answer.
A
You only need to wash your hands after touching an animal if it is dead
B
If eating seafood, it is best to eat it raw
C
Unpasteurised cheese is safe to eat
D
Tap water should be avoided even for brushing teeth
E
Fruits with no outer skin would be preferrable to eat
D – You would need to wash your hands after touching live animals. Raw fish, seafood and meats should be avoided. Unpasteurised milk and cheese should be avoided. Tap water should be avoided for drinking, preparing food, making ice, cooking and brushing teeth unless it is certain to be safe. Fruits and vegetables which can be peeled by the end-user are more suitable for consumption.
complaining of really bad dyspepsia, even though they were put on a proton pump inhibitor for the last 4 weeks. The pharmacist advises him to go to their doctor and request a test for H. pylori. Which of the following tests can they be expected to undergo?
Choose only ONE best answer.
A
Saliva antigen test
B
13C Urea breath test
C
Mantoux test
D
D-Dimer test
E
TPMT test
B – The tests for H. pylori would typically be a stool antigen test, a 13C urea breath test, or an antibody blood test. A Mantoux test is for tuberculosis, D-Dimer for thromboembolisms and TPMT for the use of thiopurines.
A patient has been rushed to hospital after they were diagnosed with severe osteomyelitis in the doctor’s practice. The patient needs to be initiated on antibiotics immediately, but has a penicillin allergy. Which of the following treatment plans could you expect to see?
Choose only ONE best answer.
A
Co-amoxiclav + metronidazole
B
Co-trimoxazole + gentamicin
C
Clarithromycin + metronidazole
D
Doxycycline + metronidazole
E
Co-amoxiclav + gentamicin
B – Treatment in severe osteomyelitis in patients with penicillin allergy would be co-trimoxazole +/- gentamicin and/or metronidazole
A patient has been to their doctor after a recurring outer ear infection which hurts too much to even apply creams onto to help it settle down. After doing a swab test of the infection, results showed that it is a staphylococcus aureus variant of otitis externa. Which of the following antibiotics should be prescribed?
Choose only ONE best answer.
A
Ciprofloxacin
B
Vancomycin
C
Flucloxacillin
D
Amoxicillin
E
Clarithromycin
C – otitis externa is usually caused by Pseudomonas aeruginosa or Staphylococcus aureus. If pseudomonas is suspected, we would use an aminoglycoside or ciprofloxacin, but as this is a staphylococcus infection, flucloxacillin should be used. If the patient had a penicillin allergy, we would then use a macrolide.
A patient has been admitted to an out-patient clinic in a hospital after having a CURB65 assessment which gave them a score of 2. The patient does not have any atypical pathogens suspected. Which of the following treatments would be recommended?
Choose only ONE best answer.
A
Amoxicillin 500mg three times a day
B
Amoxicillin 500mg three times a day + clarithromycin 500mg twice a day
C
Doxycycline 200mg two times a day
D
Co-amoxiclav 500/125mg three times a day
E
Levofloxacin 500mg twice a day
A – The patient has not shown any atypical pathogens, so would not need the addition of clarithromycin or erythromycin. The patient can be treated with amoxicillin on its own.
A patient has come into the pharmacy thinking that they had a stye underneath their right eye. The pharmacist, after taking a look thought that it might be cellulitis instead and would need a prescription to help treat it. Which of the following medications would most likely be prescribed?
Choose only ONE best answer.
A
Chloramphenicol
B
Co-amoxiclav
C
Clarithromycin + metronidazole
D
Doxycycline
E
Flucloxacillin
B – When the cellulitis is near the eyes or nose, a course of co-amoxiclav would be used as first line therapy. Clarithromycin and metronidazole would be used if there is a penicillin allergy.
A patient has been admitted to hospital for an infection and has been prescribed parenteral gentamicin. The patient has a BMI of 31. Which of the following statements regarding their dose would be most appropriate?
Choose only ONE best answer.
A
Use their ideal body weight to calculate their dose
B
Use their ideal body weight plus 20% to calculate a final dose
C
Their actual body weight can be used as they are not considered obese
D
All patients receiving gentamicin parenterally should be receiving the same dose
E
Patients with a BMI over 25 should not be treated with gentamicin
A – Parenteral gentamicin is dependent on the patient’s weight and the patients ideal body weight should be used if they are obese (BMI over 30) to avoid toxicity.
A patient has been prescribed an antibiotic which after taking a few doses, has given them horrible gastrointestinal side-effects. The pharmacist explains that they should be taking their medication with or after food. Which of the following antibiotics should be taken with or after food?
Choose only ONE best answer.
A
Amoxicillin
B
Flucloxacillin
C
Metronidazole
D
Phenoxymethylpenicillin
E
Tetracycline
C – Metronidazole should be taken with or after food where flucloxacillin, phenoxymethylpenicillin, and tetracycline should be taken on an empty stomach. Amoxicillin can be taken with or without food. Nitrofurantoin is also a notable medication to take with or after food.
A patient has been prescribed flucloxacillin for the treatment of cellulitis. The doctor would like to offer some counselling points to the patient. Which of the following counselling points would be most appropriate?
Choose only ONE best answer.
A
Flucloxacillin should not be used in penicillinase-resistant infections
B
Flucloxacillin can be given in penicillin allergies
C
Flucloxacillin should not be given in Staphylococcus infections
D
Gastrointestinal side-effects are rare with flucloxacillin
E
Patients taking flucloxacillin may develop cholestatic jaundice even up to two months after treatment
E – Flucloxacillin is a penicillinase-resistant antibiotic which should not be given in penicillin allergies as it is a penicillin. It is commonly used in Staphylococcus infections and it is common to experience gastrointestinal side-effects such as nausea and vomiting. Patients taking flucloxacillin may develop cholestatic jaundice and hepatitis even up to two months after treatment, however this is very rare
Mx Cad Bury has been prescribed ciprofloxacin 250mg tablets to be taken twice daily for a urinary tract infection. The pharmacist has advised them to be careful around certain foods. Which of the following statements would be most appropriate?
Choose only ONE best answer.
A
Avoid dairy products as this will increase absorption leading to drug toxicity
B
Avoid dairy products as this will decrease absorption leading to subtherapeutic effects
C
Avoid mineral fortified drinks as this will increase absorption leading to drug toxicity
D
Avoid a high salt diet as this will increase absorption leading to drug toxicity
E
Avoid a high salt diet as this will decrease absorption leading to subtherapeutic affects
B – Patients taking quinolones should be advised to avoid having dairy products and mineral fortified drinks as this can lead to reduced absorption of the medication leading to subtherapeutic effects.
Ms Tilly Domide is due to go travelling through South America after their wedding and is looking at getting some anti-malarial medications. They also expect that they will be trying to conceive whilst abroad, and would like to know if they should take any medication to help with that. Which of the following medications would be most appropriate.
Choose only ONE best answer.
A
Take folic acid 400 mcg once daily to be taken before conception
B
Take folic acid 400 mcg once daily to be taken before conception and until week 12 of pregnancy
C
Take folic acid 400 mcg once daily to be taken before conception and throughout the whole pregnancy
D
Take folic acid 5mg once daily to be taken before conception and until week 12 of pregnancy
E
Take folic acid 5mg once daily to be taken before conception and throughout the whole pregnancy
D – Patients taking anti-malarial medications would be at a higher risk of having neural tube defects when conceiving. Therefore, a prescription dose of 5mg folic acid should be taken daily before conception and then until week 12 of pregnancy.
A patient has been prescribed itraconazole 200mg twice daily for the treatment of aspergillosis. The patient would like to know more about the medication. Which of the following points about itraconazole would be most appropriate?
Choose only ONE best answer.
A
Avoid carbonated drinks as this can decrease the absorption of itraconazole
B
Itraconazole is safe to use in patients with liver failure
C
Itraconazole is safe to use in patients with cardiac failure
D
Itraconazole is associated with high risk of blood dyscrasia
E
Women of childbearing potential should use contraceptive precautions until the menstrual period following the end of Itraconazole therapy
E – Carbonated drinks can enhance the bioavailability of itraconazole. Itraconazole is also associated with hepatotoxicity and cardiac failure, but blood disorders are uncommon. Women of childbearing potential should use contraceptive precautions until the menstrual period following the end of Itraconazole therapy.
A patient has been prescribed benzylpenicillin for the treatment of endocarditis. The medication is to be administered by slow intravenous injection but the patient would like to have it orally. The pharmacist advises that this would not be possible as such formulations do not exist. Why can benzylpenicillin not be given orally?
Choose only ONE best answer.
A
Bacteria in the mouth would degrade the medication, making it less effective
B
Stomach acid would degrade the medication, making it less effective
C
Oral formulations are more likely to produce adverse reactions
D
Oral formulations are much more expensive
E
Oral formulations are not bioequivalent
B – Benzylpenicillin is not gastric acid stable and therefore must only be used parentally, either through intravenous infusion or intramuscular injection.
has been admitted to hospital with osteomyelitis which has developed a resistance to penicillin. They have been started on sodium fusidate, and the patient’s medication list currently consists of metformin, gliclazide, aspirin, ramipril and atorvastatin. Which medical interaction, should be brought to the attention of the patient?
Choose only ONE best answer.
A
Stop ramipril during treatment with sodium fusidate, and restart ramipril 2 days after the last dose
B
Stop ramipril during treatment with sodium fusidate, and restart ramipril 7 days after the last dose
C
Stop atorvastatin during treatment with sodium fusidate, and restart atorvastatin 2 days after the last dose
D
Stop atorvastatin during treatment with sodium fusidate, and restart atorvastatin 7 days after the last dose
E
Stop ramipril and atorvastatin during treatment with sodium fusidate, and restart ramipril 2 days after the last dose
D– In systemic use of fusidic acid, statin treatment should be discontinued throughout the duration of treatment and should be re-introduced seven days after the last dose of systemic fusidic acid. The patient should be advised to seek medical advice immediately if they experience any symptoms of muscle weakness, pain or tenderness.
The doctor is currently treating a patient for an infection who also has myasthenia gravis. The doctor would like to know an appropriate antibiotic they can prescribe this patient considering their co-morbidities. Which of the following medications would be appropriate to use in patients with myasthenia gravis?
Choose only ONE best answer.
A
Ciprofloxacin
B
Flucloxacillin
C
Tobramycin
D
Clarithromycin
E
Doxycycline
Flucox
A patient has come into the pharmacy presenting with a headache, stiff neck, fever as well as a rash which did not disappear when pressure was applied. The pharmacist recommended they go to A&E immediately where they were treated with antibiotics. Given that the patient has an intolerance to penicillin, but no other drug classes, which of the following antibiotics would be most suitable to give to the patient?
Choose only ONE best answer.
A
Benzylpenicillin
B
Ceftriaxone
C
Ciprofloxacin
D
Teicoplanin
E
Vancomycin
presenting with meningitis, which the two possible treatments are benzylpenicillin or ceftriaxone. Given that the patient has an intolerance to penicillin, benzylpenicillin would not be appropriate, leaving ceftriaxone as the only appropriate option.
Mr Robbo has come into the pharmacy with a prescription for some antibiotics for the treatment of chlamydia. Which of the following treatment programmes would be most appropriate for him, given that he has no allergies or intolerances to medications.
Choose only ONE best answer.
A
Azithromycin 250mg – Take one 1g dose on the first day, followed by 500mg once daily for 2 days
B
Azithromycin 250mg – Take one 1g dose on the first day, followed by 500mg once daily for 6 days
C
Doxycycline 100mg – Take one on the first day, then one daily for another 6 days
D
Doxycycline 100mg – Take one, twice daily for 7 days
E
Erythromycin 500 mg – Take one, twice daily for 10–14 days
D – Chlamydia’s first line treatment would be doxycycline 100mg, taking one twice a day for 7 days. If this is not appropriate them azithromycin can be used, taking one 1g dose on the first day, followed by 500mg once daily for 2 days.
A patient who is currently 38 weeks pregnant has come into the hospital out-patient clinic presenting with pain on urination, where the urine is cloudy. The doctor would like to prescribe them something for a urinary tract infection. Which of the following treatment plans would be most appropriate?
Choose only ONE best answer.
A
Cefalexin 500mg three times a day for 3 days
B
Cefalexin 500mg three times a day for 7 days
C
Nitrofurantoin 100mg MR two times a day for 3 days
D
Nitrofurantoin 100mg MR two times a day for 7 days
E
Trimethoprim 200mg two times a day for 3 days
B – Nitrofurantoin should be avoided at term in pregnant patients. Trimethoprim is generally avoided in pregnancy due to its anti-folate aspects which may lead to teratogenicity. Cefalexin and amoxicillin may be appropriate, but this would be for a period of 7 days due to the patient being pregnant.
A patient has been receiving gentamicin in a multiple daily dose regimen. In their latest blood tests, it showed that their blood-gentamicin levels were too high when it was measured a few minutes before their next dose. Which of the following changes, if needed would be most appropriate to the patient’s dose?
Choose only ONE best answer.
A
Reduce the dose amount of the gentamicin
B
Increase the time interval between the doses of gentamicin
C
Reduce the dose amount and increase the time interval between doses of gentamicin
D
Stop the gentamicin completely
E
Make no changes to the dose of gentamicin
B – As the trough level of gentamicin is too high, the appropriate dose adjustment would be to increase the time interval between the doses of gentamicin to bring down the trough levels.
Mr kooks has come into the general practice with a urinary tract infection asking to see the independent pharmacist prescriber. The pharmacist has seen that the patient is also taking ibuprofen, methotrexate and omeprazole. Which of the following treatments would be most suitable?
Choose only ONE best answer.
A
Nitrofurantoin – 3 days treatment
B
Nitrofurantoin – 7 days treatment
C
Trimethoprim – 3 days treatment
D
Trimethoprim – 7 days treatment
E
Cefalexin – 7 days treatment
B – First line treatment would be either nitrofurantoin or trimethoprim. However, given that the patient is already on methotrexate, trimethoprim should not be used as this would increase the risk of antifolate interactions. Treatment for men should be 7 days.
