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infections Flashcards

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1
Q

what are 3 things to consider before choosing an antibiotic?

A

patient
causative organism
risk of resistance with repeated courses

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2
Q

what is blind treatment of infections?

A

using a general antibiotic. not good because if you know the causative agent of the infection then you must prescribe something against it

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3
Q

which is preferred: narrow spec or broad spectrum antibiotic and why?

A

narrow

less side effects

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4
Q

what is a superinfection? what symptoms are they associated with?

A

an infection of an infection. getting treated with an antibiotic can make you susceptible to an infection as they can target both good and bad cells

symptoms include vaginitis and itching anal [pruritus ani]

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5
Q 
aminoglycosides
macrolides
carbapenems
cephalosporins
tetracyclines
amoxicillin 
chloramphenicol
quinolones
ampicillin

are these antibiotics broad spec or narrow spec

A

broad

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6
Q

what antibiotics are narrow spec?

A 
TV and PC
vancomycin
teicoplanin
penicillin G
clindamycin
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7
Q

define sepsis

define septicaemia

A

sepsis: infection of the whole body
septicaemia: infection of the blood

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8
Q

what signs of sepsis must a baby present with in order for them to be referred to A&E

A 
blue tinge to lips/skin
rash that doesnt fade when glass rolled over it
more sleepier than usual
not responding like how they usually do
breathlessness/difficulty breathing
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9
Q

what signs of sepsis must a adult present with that means 999/referral to A&E should be made?

A

acting confused/slurred speech
blue tinge to skin/lips
rash that does not fade when glass rolled over
difficulty breathing

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10
Q

what are the symptoms of sepsis? [6]

A 
shivering/fever/cold
blue tinge
difficulty breathing
fatigue/sleepiness
extreme pain
'i feel like i might die'
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11
Q

what is the early management of sepsis?

what drug should be given in community setting and which should be given in hospital setting?

A

broad spec antibiotic at max recommended dose ideally within an hour

parental benzylpenicillin in community setting

IV ceftriaxone in hospital setting

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12
Q

what are notifiable diseases and give a few examples

A

a disease in which doctors must notify the appropriate government officials as it could be a potential public health risk

examples include covid, food poisoning, measles, meningitis, hepatitis, mumps, plague

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13
Q

which antibiotics must be given before food/on an empty stomach?

A

drop fat

demeclocycline
rifampicin
oxytetracycline
phenoxymethylpenicillin
flucloaxacillin
ampicilin
tetracycline
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14
Q

which antibiotics can be given after/with food? [3]

A

pivmecillinam
metronidazole
nitrofurantoin

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15
Q

which antibiotics can be taken with milk? [3]

A

doxycycline -dox like milk
lymecycline
minocycline

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16
Q

which antibiotics should NOT be taken with milk?

A

C.DOT

ciprofloxacin
demeclocycline
oxytetracyline
tetracycline

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17
Q

which antibiotics can be used in pregnancy?

A

PEC Chest

penicillins
erythromycin [if benefit outweights risk]
clindamycin
cephalosporins

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18
Q

which 2 antibiotics must you wear suncream with to help protect against sunlight?

A

doxycycline

demeclocycline

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19
Q

When should nitrofurantoin be avoided in pregnancy and why?

A

at term as may produce neonatal haemolysis

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20
Q

what other antibiotics should be avoided in pregnant women? [7]

A 
tetracyclines
amino-glycosides
macrolides [except erythromycin]
co-trimoxazole
rifampicin
metronidazole
quinolones
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21
Q

what is the important safety information with flucloxacillin?

A

cholestatic jaundice and hepatitis

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22
Q

what is the safety information for co-amoxiclav?

A

cholestatic jaundice

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23
Q

what is the safety information for linezolid?

A

blood disorder and optic neuropathy

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24
Q

what is the safety information for co-trimoxazole?

A

stevens-johnson syndrome [severe allergic skin reaction and blood disorder]

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25
what is the safety information for quinolones?
tendon damage, arthropathy [joint problems] in children and convulsions with NSAIDs when taken together
26
which 2 antibiotics can colour your urine orange/brown?
nitrofurantoin and rifampicin
27
what are the signs and symptoms of a blood disorder? [7]
``` bruising bleeding sore throat fever malaise rash mouth ulcers ```
28
which antibiotics can cause blood disorders? [5]
``` trimethoprim co-trimoxazole linezolid gentamicin vancomycin ```
29
what is a contraindication of penicillins?
penicillin allergy
30
what is a contra indication of tetracyclines?
children under 12 | pregnant women
31
what is a contra indication of quinolones?
history of tendon disorders related to quinolone use
32
what is a contra indication of aminoglycosides?
myasthenia gravis [muscle weakness]
33
what is the 1st and 2nd line treatment for c.diff infections? what do you give if the 1st/2nd line are ineffective?
1st line - vancomycin 2nd line - fidaxomicin if both ineffective: increase dose of vancomycin and give with or without metronidazole
34
what is cellulitis? | what do you give a patient with cellulitis who is also allergic to penicillins?
infection of the sc fat erythromycin/clarithromycin or doxycyline
35
for the following conditions, match them to their suitable causative organisms: ``` food poisoning MHRSA TB UTI whooping cough gonorrhoea colitis pneumonia ``` ``` e.coli clostridium difficile neisseria gonorrhoea bordetella pertussis methicillin-resistant staphylococcus aureus mycobacterium TB salmonella/shigella/E.coli/norovirus streptococcus pneumoniae/haemophilus influenzae/pneumocystis jirovecii ```
* Food poisoning [GI upset] – salmonella, shigella, Ecoli, norovirus * TB – mycobacterium TB * MHRSA – methicillin-resistant staphylococcus aureus * Colitis – clostridium difficile * Pneumonia – streptococcus pneumoniae [most common cause] but also klebsiella pneumoniae, pseudomonas aeruginosa, haemophilus influenzae, pneumocystis jirovecii [fungal pneumonia] * Gonorrhoea – Neisseria gonorrhoea * Whooping cough – Bordetella pertussis * UIT – e.coli
36
what antibiotic normally treats anaerobic infections?
metronidazole
37
what antibiotics normally treat streptococci infections? what antibiotics normally treat staphylococci infections? what antibiotics normally treat MRSA what antibiotics treat pseudomonas aeruginosa [pneumonia]?
phenoxymethylpenicillin flucloxacillin vancomycin gentamicin
38
what are the 5 antibiotics under the aminoglycoside drug class? which is the chosen aminoglycoside in the UK?
``` gentamicin amikacin tobramycin neomycin streptomycin ``` 'cin' - gentamicin chosen one
39
are aminoglycosides broad spec or narrow spec? | are they bactericidal or bacteriostatic?
broad spec | bactericidal [kills bacteria]
40
which aminoglycosides are used to treat pseudomonas aeruginosa [pneumonia]
TAG tobramycin amikacin gentamicin
41
which aminoglycosides are active against mycobacterium TB [TB]
only one used for TB - streptomycin
42
what formulation/route of admin is aminoglycosides given in and why?
injection route as oral is not good as they are not absorbed in the gut
43
what is the preferred dosage regimen of aminoglycosides? | what is the contra indication of aminoglycosides?
once daily preferred myasthenia gravis [muscle weakness]
44
what is the duration of treatment for parental aminoglycosides?
up to 7 days
45
can aminoglycosides be given in pregnancy and why?
no - may cause auditory nerve damage in infants
46
what are the most common side effects of aminoglycosides? [2]
nephrotoxicity [renally excreted so must monitor renal function] ototoxicity
47
what are the signs of ototoxicity? [4]
ringing in ears/tinnitus incoordination of movements hearing loss dizziness
48
what are the signs of nephrotoxicity? [4]
decreased urine output fluid retention SOB fatigue
49
what are the 2 important interactions of aminoglycosides?
- ototoxicity occurs with loop diuretics [eg furosemide] | - nephrotoxicity occurs with vancomycin, cephalosporins, ciclosporins
50
what is the dose adjustment for a patient taking amino-glycosides with renal impairment? what is the dose adjustment for a patient taking amino-glycosides with severe renal impairment?
- increase dose interval | - reduce dose
51
what are the monitoring requirements of aminoglycosides? [3]
plasma conc renal function vestibular and auditory function
52
serum plasma conc should be monitored in pt taking parental aminoglycosides. which types of patients need this plasma conc monitoring? [5]
``` renal impairement elderly obesity cystic fibrosis ppl on a high dose of aminoglycosides ```
53
when do you need to take blood samples to measure the serum concentration of aminoglycosides?
1 hour after administration [peak conc] | just before giving the next dose [trough conc]
54
what must you do if the trough conc of aminoglycosides is high?
increase the dosage interval
55
what must you do if the peak conc of an aminoglycoside is high?
decrease the dose
56
what must you do if the serum plasma concentrations of aminoglycosides are within range? what must you do if the serum plasma concentrations of aminoglycosides are below range?
- maintain the dose | - increase the dose
57
what should the peak concentration range be for gentamicin IV/IM multiple daily regimen? what should the trough concentration range be for gentamicin IV/IM multiple daily regimen?
peak: 5-10mg/L trough: under 2mg/L
58
what should the peak and trough conc ranges be for multiple daily dose regimen of gentamicin in endocarditis?
peak: 3-5mg/L trough: below 1mg/L
59
when is amikacin normally used?
when infection is resistant to gentamicin as it is more stable to enzyme inactivation
60
can neomycin be used for parental administration?
no, too toxic
61
what is the formulation that tobramycin is administered by?
nebuliser/inhalation
62
what are the side effects of gentamicin? [9]
``` tinnitus [hearing loss] nephrotoxicity neurotoxicity N&V skin reactions depression blood disorder vestibular damage antibiotic associated colitis ```
63
what are the 2 MHRA warnings associated with aminoglycosides?
- can increase risk of deafness [ototoxicity] in pt with mitochondrial mutations - can cause histamine related adverse reactions so caution in pt on drugs that cause histamine release
64
are carbapenems broad spec or narrow spec antibiotics? | what kind of antibiotic are they?
broad spec beta lactam antibiotics
65
which carbapenems are used for severe hospital acquired infections eg septicaemia, complicated UTI, hospital acquired pneumonia?
imipenem and meropenem
66
what do you give when imipenem is partially inactivated by kidney enzmyes?
cilastatin [2 i's]
67
which carbapenems are stable with renal enzymes and do not need to be given with cilastatin?
meropenem, doripenem, ertapenem
68
what are the side effects of carbapenems? [4]
nausea vomiting headache diarrhoea
69
what is the caution of carbapenems?
caution in those with allergy to beta lactam antibiotics such as penicillins or cephalosporins because they are structurally similar [cross sensitivity may occur]
70
give some examples of cephalosporins
``` CEFACLOR CEFADROXIL CEFALEXIN CEFIDEROCOL CEFIXIME CEFOTAXIME CEFRADINE CEFTAROLINE FOSAMIL CEFTAZIDIME CEFTRIAXONE CEFUROXIME ``` begin with cef
71
are cephalosporins narrow spec or broad spec antibiotics? what is their drug action?
broad spec bind to penicillin binding proteins and interrupt cell wall synthesis leading to bacterial cell death
72
list some common indications of cephalosporins
UTI septicaemia pnemonia meningitis
73
which 2 cephalosporins are suitable for CNS infections [eg meningitis]?
cefotaxime and ceftriaxone
74
which of these cephalosporins are 1st gen, 2nd generation and 3rd generation: ``` cefalexin cefradine cefadroxil cefotaxime cefixime ceftazidime cefuroxime cefaclor ceftriaxone ```
1st gen: cefalexin, cefradine, cefadroxil 2nd gen: cefuroxime, cefaclor 3rd gen: [the 3 T's] ceftazidime, ceftriaxone, cefotaxime, cefixime
75
which generations of cephalosporins are antibiotic associated colitis more common in?
2nd and 3rd gen
76
what is the drug action of vancomycin? give an example of an indication of vancomycin
has bactericidal activity against aerobic and anaerobic gram positive bacteria c.diff/antibiotic associated colitis
77
what route of administration is preferred in vancomycin and why?
iv route bc not absorbed well orally
78
list some side effects of vancomycin? [8]
``` red man syndrome neutropenia dizziness agranulocytosis hyerpsensitivity drug fever skin reactions ```
79
A patient on vancomycin must develop which side effect for it to be discontinued?
tinnitus
80
which out of these two antibiotics have a higher risk of nephrotoxicity? vancomycin or teicoplanin
vancomycin
81
what should the trough concentration range be for vancomycin?
10-20mg/L
82
what should the initial and subsequent doses of vancomycin be based upon?
initial - body weight | subsequent - serum vancomycin concentrations
83
what should you monitor with vancomycin? [4]
full blood count renal hepatic auditory and vestibular function
84
what is the drug action of clindamycin?
active against gram positive bacteria
85
what are the common indications of clindamycin? to which patients is clindamycin normally offered to?
- bone and joint infections [osteomyelitis] | - patients with penicillin allergy [alternative drug to macrolides]
86
what is the contraindication of clindamycin?
diarrhoea states
87
what is the side effect of clindamycin?
antibiotic associated colitis.
88
which symptom must a patient present with for clindamycin to be stopped?
diarrhoea | discontinue if c.diff infection occurs eg watery stools
89
what should be monitored if a patient is being treated with clindamycin for longer than 10 days?
renal and liver function
90
list some examples of macrolides? | when are these normally prescribed?
erythromycin, azithromycin, clarithromycin | when a patient has an allergy to penicillin
91
is clarithromycin broad spec or narrow spec? what is the mechanism of action?
broad spec bacteriostatic - stops bacteria cell growth
92
list some common indications of macrolides
respiratory infections skin/soft tissue infections eradication of hpylori severe pneumonia
93
what are the important interactions of macrolides?
clarithromycin and erythromycin are enzyme inhibitors so interact with drugs such as warfarin and simvastatin by increasing the plasma conc of them
94
list some indications of erythromycin
``` skin and oral infections early syphilis chlamydial infections respiratory tract infections legionella campylobacter enteritis [intestinal infection] ```
95
what are the side effects of erythromycin
nausea vomiting diarrhoea
96
what is included in the warning label of erythromycin? gastro resistant only
keep taking course until finished unless told otherwise space doses evenly do not take indigestion remedies 2 hours before or after taking this med swallow whole
97
can erythromycin be used in pregnancy and breastfeeding?
only if benefits outweigh risks
98
what is the drug action of azithromycin
has action against some gram positive but more stronger action against gram negative
99
how many times a day is it recommended to take azithromycin and why? can you use azithromycin in pregnant or breastfeeding women?
once a day because has long half life yes but only if there are no other options available
100
what are the warning labels for azithromycin?
finish course unless told otherwise space doses evenly do not take indigestion remedies 2 hours before or after take on an empty stomach which is 1 hour before food or 2 hours after food
101
when and to who can azithromycin be sold to the public?
in pt over 16 with confirmed asymptomatic chlamydia
102
what is the daily regimen of clarithromycin?
twice daily
103
when must you avoid clarithromycin in pregnant or breastfeeding woman? is clarithromycin suitable in renal or liver impairment?
avoid in pregnancy esp in 1st trimester avoid
104
what are the warning labels for clarithromycin?
``` space doses evenly finish course unless told otherwise take with or just after food swallow whole dissolve or mix with water before taking ```
105
what are the 5 different classes of penicillin and give an example of each of them?
beta lactamase sensitive [benzylpenicillin[penG], phenoyxymethylpenicillin] penicillinase resistant penicillin [flucloaxcillin] broad spectrum penicillin [ampicillin, amoxicillin, co-amoxiclav] antipseudomonal penicillin [piperacillin, ticarcillin] mecillinamtype [pivmecillinam]
106
what is the drug action of penicillins and the caution of penicillins?
bactericidal - destroys cell wall synthesis caution in those with allergy
107
what are the common side effects of penicillins?
allergy diarrhoea with oral route leads to antibiotic associated collitis
108
which route of administration must you AVOID with penicillins and why
intrathecal [spinal] injection leads to encephalopathy
109
what is the percentage of people that develop an allergy to penicillin? what is the percentage of people that develop an anaphylactic reaction to penicillin?
1-10% 0.05%
110
what should you do if a patient on penicillin presents with an allergic reaction?
stop penicillin and change to macrolide
111
what is benzylpenicillin inactivated by? what route of administration should they be given in and why?
inactivated by beta lactamases injection because absorption from gut is low because can get inactivated by gastric acid
112
list some indications of benzylpenicillin
meningitis throat infections pneumonia cellulitis
113
what is the caution of benzylpenicillin? can pregnant/breastfeeding woman have it? is it ok in renal impairment?
high amounts of sodium can accumulate with high doses yes not known to be harmful in high doses it can cause neurotoxicity
114
list some indications of phenoxymethylpenicillin is it ok for pregnant/breastfeeding women?
oral infections, respiratory infections in CHILDREN, tonsilitis, cellulitis yes
115
list the side effects of phenoxymethylpenicillin [4]
neurotoxicity increased risk of infection coagulation disorder oral disorders
116
what is the warning label of phenoxymethylpenicillin?
space doses evenly finish taking course unless told otherwise take on an empty stomach [1hr before food and 2 hours after]
117
what are some indications of ampicillin? what class of penicillins are they in? when during the day should they be taken and why?
middle ear infection, UTI, bronchitis broad spec penicillins on an empty stomach BEFORE food as absorption badly affected by food in gut
118
what are the warning labels of ampicillin? is it ok in pregnant/breastfeeding women? what is the side effect?
space doses, finish course, take on an empty stomach yes maculopapular rash [like with amox]
119
what are some indications of amoxicillin? what is a side effect of amoxicillin? is it ok in pregnant/breastfeeding? what are the warning labels for amoxicillin?
h.pylori, uncomplicated pneumonia, oral infections, UTI, otitis media maculopapular rash yes space doses, finish unless told otherwise [absorption not affected by food]
120
what is co-amoxiclav a mixture of? what class of penicillins is it? what kinds of infections are they reserved for?
amoxicillin and clavulanic acid [beta lactamase inhibitor] broad spec penicillin amoxicillin resistant bacteria that are also beta lactamase producing
121
is co-amoxiclav safe for pregnant and breastfeeding women? what is a caution of co-amoxiclav?
yes cholestatic jaundice [do not exceed 14 days treatment]
122
what class of penicillins is flucloxacillin? list some indications of flucloxacillin
penicillinase resistant penicillins cellulitis , otitis externa, pneumonia, impetigo [normally for skin infections]
123
what is the important safety information regarding flucloaxcillin and the advice associated with it?
risk of cholestatic jaundice/hepatic impairment occurring 2 months after flucloxacillin been stopped treatment exceeding 14 days and in ppl who are older is a risk factor. caution in those with hepatic impairment related to flucloxacillin and those with hepatic impairment
124
give some examples of antibiotics in the class quinolones list some indications of quinolones which disease must you AVOID them in?
ofloxacin, ciprofloxacin, norfloxacin, nalidixic acid uncomplicated UTI, resp infections, bone and joint infections, GI infections, gonorrhoea MRSA
125
in which class of patients are quinolones not recommended in and why? which symptoms must present for quinolones to be discontinued? is it safe in pregnancy?
children and young adults bc of risk of arthropathy [joint disease] psychiatric, neurological, hypersensitivity reactions no risk of arthropathy - avoid
126
what are the warning labels of quinolones?
space doses, finish course do not take with milk, indigestion remedies or anything containing zinc or iron 2 hours before or after taking this medicine.
127
what are the important interactions of quinolones? [3]
NSAIDs - increased risk of convulsions prednisolone - increased risk of tendon damage drugs that cause QT prolongation/arrhythmia's eg amiodarone, SSRIs, macrolides and antipsychotics
128
what is a contra indication of quinolone
history of tendon damage associated with quinolones
129
what are the cautions of quinolones [3]
can cause QT prolongation [arrythmias] avoid exposure to excessive sunlight - discontinue if photosensitivity occurs pt with history of epilepsy/seizures
130
what is the important safety information related to quinolones [2]
- can increase risk of convulsions [esp with NSAIDs together] - can cause tendon damage 48 hours after treatment [esp with corticosteroids]. higher risk in over 60 year olds
131
give some examples of tetracylines are they broad spec or narrow spec? what is their drug action?
doxycyline, minocycle, lymecycline, oxytetracyline broad bacteriostatic
132
what are the side effects of minocycline?
more risk of lupus like syndrome - photosensitive rash, fever, swelling irreversible pigmentation sometimes
133
what are the cautions of tetracyclines? [3]
antacids, Aluminium, calcium, zinc, iron, magnesium can decrease absorption can increase risk of muscle weakness in those that have myasthenia gravis taking it with milk can also cause reduction in absorption
134
what are the warning labels of tetracylines?
finish course, space doses, avoid indigestion remedies or zinc/iron 2 hours before and 2 hours after taking this medicine, take with a full glass of water, dissolve or mix with water, avoid excessive exposure to the sun/protect skin from sun
135
list the side effects of tetracylines
nausea and vomitting and diarrhoea discontinue if intracranial hypertension occurs dysphagia and oseophageal reactions [advice pt to stay sat upright for 30 mins after taking] excessive sun burns skin reaction headache tooth discolouration in children
136
what are the contraindications of tetracyclines?
avoid in pt under 12 years old avoid in pregnant/breastfeeding - tooth discolouration of child in 2nd/3rd trimester avoid in hepatic impairment
137
what are the main indications of trimethoprim? what is the mode of action of trimethoprim?
UTI, respiratory tract infections bacteriostatic. also an folate antagonist which makes it teratogenic
138
what is the contraindication of trimethoprim? is it safe in pregnancy?
blood disorders [bc it is an antifolate] no! avoid! esp in 1st trimester - causes fetal abnormalities
139
list the side effects of trimethoprim [8]
``` skin reactions blood disorders nausea diarrhoea electrolyte imbalance fungal overgrowth headache ```
140
what are the monitoring requirements of trimethoprim?
full blood counts when pt using for long term
141
what is the warning labels for trimethoprim?
finish course unless told otherwise | space doses
142
what is the important patient and safety advice associated with trimethoprim?
- pt must seek medical attention if any signs of blood disorders appear - seek medical attention if symptoms such as fever, sore throat, mouth ulcers, skin rashes, bruising/bleeding develop!
143
what are the 2 MHRA warnings of linezolid and what advice must be given to patients for each?
1 - optic neuropathy: report any signs of blurred vision etc 2 - blood disorders. monitor full blood count weekly. pt should avoid eating tyramine rich foods [processed meats]
144
how long does a patient have to be on linezolid for a risk of optic neuropathy to develop?
more than 28 days
145
what is an indication for nitrofurantoin?
UTI
146
``` what is the duration of treatment of nitrofurantoin for UTI in women men pregnant women patients using a catheter ```
women 3 days | everyone else 7 days
147
what are the contraindications of nitrofurantoin?
G6PD deficiency, infants under 3 months
148
what are the cautions of nitrofurantoin?
diabetes, electrolyte imbalance, anaemia, folate deficiency
149
what must be monitored on long term treatment of nitrofurantoin?
liver | pulmonary [lung] esp in elderly
150
can nitrofurantoin be used in renal impairment? | which egfr levels must it be avoided or used in caution with?
can be used but risk of peripheral neuropathy avoid if egfr less than 45 but can be used in caution if egfr between 30-44 only as a short course to treat uncomplicated lower UTI and only if benefits outweigh risks
151
how is TB treated?
in 2 phases initial phase - 2 months using 4 drugs continuous phase - 4 months using 2 drugs
152
what drugs are used in the continuous and initial phases of TB?
initial - RIPE: rifampicin, isoniazid, pyrazinamide, ethambutol continous - isoniazid , rifampicin
153
which TB antibiotic does NOT cause hepatotoxicity?
ethambutol
154
what should be monitored in a patient on TB antibiotics?
hepatic function | renal function
155
which types of patients should get continuous hepatic and renal function monitoring whilst on TB antibiotics?
alcohol dependant pt | pt with pre existing liver disease
156
which TB drug colours soft contact lenses?
rifampicin
157
what is the pt and carer advice for rifampicin?
discolours soft contact lenses | discontinue if any signs of liver damage appear [nausea, jaundice, vomitting]
158
what are the pt and carer advice for ethambutol?
may cause visual side effects discontinue if deterioration in vision occurs
159
what is the pt and carer advice for isoniazid? what can a pt take to prevent this from occuring? which types of patients is this generally for?
risk of peripheral neuropathy vitamin B6 [pyridoxine] can be taken from start of treatment as precaution alcohol dependance, renal failure, diabetes
160
what drugs can be given for UTI?
``` amoxicillin ampicillin nitrofurantoin trimethoprim oral cephalosporins ``` 7 day or 3 day course for non pregnant women
161
what is the 1st line and 2nd line treatment of a UTI of pregnant women
1st line: nitrofurantoin 2nd line: amoxicillin or cefalexin [trimethoprim teratogenic!]
162
what is the 1st line and 2nd line for UTI in non pregnant women?
1st line: trimethoprim or nitrofurantoin 2nd line: nitrofurantoin [if they did not have it already], amoxicillin, fosfomycin, pivmecillinam
163
what is the 1st and 2nd line for UTI in men?
1st line: nitrofurantoin or trimethoprim | 2nd line: investigate other causes eg pyelonephritis or prostatitis
164
what antibiotics can be used to treat pyelonephritis?
cefalexin , co-amoxiclav, ciprofloxacin, trimethoprim
165
what antibiotics can be used to treat prostatitis?
trimethoprim , quinolones
166
which drug is the first choice drug to treat gingivitis? | which drug is the best alternative to amoxicillin to treat oral infections?
metronidazole for both
167
what is the caution with metronidazole?
avoid alcohol during treatment and 2 days after - get hangover like symptoms eg nausea, vomitting, headache etc
168
``` what class of antifungals is the following: fluconazole, itraconazole, posaconazole, voriconazole ```
triazole antifungals
169
``` what class of antifungal is the following: miconazole ```
imidazole antifungals
170
``` what class of anti-fungal is the following: nystatin and amphotericin ```
polyene antifungals
171
what is amphotericin IV normally used for?
systemic fungal infections
172
name antifungals in the 'other' class and what they are used for
griseofulvin and terbinafine | athletes foot
173
why must you avoid rapid infusion of amphotericin B [an anti-fungal]
risk of arrythmia
174
what monitoring is required with amphotericin B? | is it safe in pregnancy?
renal, hepatic, full blood count, plasma electrolyte no harm seen but advised against
175
what is the caution of fluconazole?
QT interval prolongation
176
what are some side effects of fluconazole?
N&V, GI, skin reactions
177
what symptoms prompt discontinuation of fluconazole?
discontinue if signs of hepatic disease or rash appear
178
when can fluconazole be sold to the public?
in pt aged 16-60 with vaginal thrush [vaginal candidiasis] | max dose 150mg and label must note that
179
what is the important safety information of itraconazole?
can cause heart failure so caution in those at risk
180
what signs must appear for discontinuation of itraconazole to occur?
signs of hepatic disorder [nausea, vomitting, dark urine etc]
181
why has the MHRA suspended the use of ORAL ketoconazole? which indication is still allowed to be treated with oral ketoconazole?
risk of hepatotoxicity greater than benefit cushings syndrome
182
what is the patient and carer advice associated with ORAL ketonazole?
report if signs of liver failure occur | dizziness may affect performance of skilled tasks
183
what are the two risks with vericonazole?
phototoxic: warn pt of excessive sunburn and skin reactions and to avoid direct sunlight hepatotoxicity
184
how often must you monitor hepatotoxicity with vericonazole?
before treatment, then weekly for 1 month then monthly during treatment
185
what should patients on vericonazole keep on them at all times?
alert cards
186
what do dermatophyte infections usually affect on body? [3]
skin hair nails
187
who is most at risk of dermatophyte infections? [4]
diabetics immunocompromised peripheral arterial disease poor circulation
188
what is the proper name for athletes foot?
tinea pedis
189
what is the proper name for ring worm?
tinea corporis
190
what is the proper name for ringworm of the scalp?
tinea capitis
191
what is the proper name for fungal toe nail infection?
tinea uguium
192
what is molluscum contagiousum and describe it
small firm raised spots on skin viral infection not harmful often found in armpit/behind knees/groin
193
for skin and nail infections: when are topical therapy anti-fungals used?
for mild localised skin infections eg tinea corporis and tinea pedis
194
when should systemic anti-fungals be considered [for fungal infections] over topical ones?
- if site infected too hard to reach eg scalp - if larger areas on body affected - if topical treatment ineffective
195
what drug is used to treat helminth infections [threadworms]? how often can you advise patients to take this medication?
mebendazole for pt over 6 months take one 100mg single dose. second dose may be taken in 2 weeks to prevent reinfection. treat all family members
196
what are the 2 types of herpes virus?
herpes simplex complex [1 and 2] varicella-zoster virus
197
what area of the body does herpes simplex 1 and herpes simplex 2 affect?
1 mouth - herpes simplex 1. 2 genitals = herpes simplex 2 herpes simplex 1: lips, eyes and mouth herpes simplex 2: genitals
198
when should anti-viral treatment for herpes simplex complex occur?
within 5 days of infection
199
what viral skin infection can varicella zoster cause? when should treatment be ideally started? what can those at risk take?
chicken pox within 24 hours to reduce symptoms etc varicella zoster immunoglobin prophylaxis [vaccine]
200
what viral skin infection can herpes zoster cause? when and for how long should treatment be commenced? what should be offered to pt at high risk and immunocompromised pt?
shingles within 72 hours of rash and for 7-10 days parental administration of antiviral drug
201
what are the 3 antivirals used for herpes viruses and which is the treatment of choice?
aciclovir - treatment of choice valciclovir famciclovir
202
what herpes infections does aciclovir treat? what herpes infections does famciclovir treat? what herpes infections does valciclovir treat?
- herpes simplex - herpes zoster and genital herpes - herpes zoster and herpes simplex and cytomegalovirus disease after organ transplant
203
what are the 2 types of malaria? | which is fatal and which is not?
falciparum [fatal] and non-falciparum [non fatal]
204
what is falciparum malaria caused by? | what is non-falciparum malaria caused by?
plasmodium falciparum | plasmodium vivax
205
which anti-malarials are recommended for the treatment and prevention of non-falciparum malaria?
chloroquine [avlovlor] Pmed
206
what can you add if a pt is experiencing resistance to chloroquine whilst being treated for non-falciparum malaria?
ADD proguanil
207
which anti-malarial used to be given as a malaria prophylaxis but now has resistance against it and so is rarely used?
mefloquine [POM]
208
what are the cautions with Mefloquine?
psychiatric reactions do not give to epileptic pts or those with psychiatric problems [ME=mental]
209
is proguanil alone suitable for treatment of malaria? | what can it be combined with to make it suitable for treatment of acute uncomplicated malaria?
no | malarone
210
which anti-malarial is used for treatment of uncomplicated falciparum, treatment of non-falciparum malaria and prophylaxis of falciparum malaria? what kinds of trips is it suitable for and why?
malarone short trips bc you only need to take it 7 days after leaving high risk area
211
which drug is used in treatment of both falciparum and non falciparum malaria and has a QT interval prolongation risk?
quinine
212
which drug is used for prophylaxis in malaria for patients over 12 years old who show resistance to chloroquine and mefloquine?
doxycyline
213
what is the most effective barrier against insects that you may need to advice ppl to do when going to high risk countries?
mosquito nets impregnated with permethrin [insecticide]
214
what can be used on the skin of children and adults over 2 months as malaria prophylaxis?
diethyltoluamide DEET
215
how long can chloroquine & proguanil be used for long term malaria prophylaxis?
up to 5 years
216
how long can doxycycline be used for long term malarial prophylaxis? how long can malarone and mefloquine be used for long term malarial prophylaxis?
up to 2 years | up to 1 year
217
how long should each of the following anti-malarials be taken before and after travel: mefloquine once weekly doxycycline once daily malarone once weekly other antimalarials
- 2/3 weeks before travel and 4 weeks after travel - 1/2 days before travel and 4 weeks after travel - 1-2 days before travel and 1 week after travel [preferred] - 1 week before travel and 4 weeks after travel
218
which anti-malarials should be avoided in epilepsy?
chloroquine and mefloquine
219
what is the prophylactic dose and duration of proguanil for malaria prophylaxis?
1 tablet [200mg tablet] daily for 1 week before travel and 4 weeks coming back
220
what is the dose and duration of treatment of chloroquine for malaria prophylaxis?
take one weekly for 1 week before travel and for 4 weeks after coming back
221
what should you advice travellers returning back from malarial regions?
report any illness commencing 1 year [esp 3 months] after returning from high risk area
222
which anti-malarias can be recommended to epileptic patients in areas WITHOUT chloroquine resistance?
proguanil
223
which anti-malaria drugs can be given to epileptic patients in areas WITH chloroquine resistance?
doxycyline or malarone
224
which anti-malarial drugs can you use in pregnant/breastfeeding women?
proguanil and chloroquine
225
which antimalarials must be avoided in the 1st trimester of pregnancy and should only be used if there is no other alternative?
doxycyline malarone mefloquine
226
what must pregnant women take alongside proguanil?
folic acid for 1st trimester
227
which antimalarials must be avoided in renal impairment? which ones can you give in renal impairment?
proguanil malarone and chloroquine doxycyline, mefloquine
228
when should a patient on anticoagulant medication start their malaria prophylactic medications?
2-3 weeks before travel
229
how often should INR be measured in patients [that are taking anticoagulants] starting malaria prophylaxis medication
before starting treatment then 7 days after starting treatment and completing the course
230
what is the 1st line treatment of non-falciparum malaria? | what is the 2nd line treatment for non-falciparum malaria?
chloroquine quinine, riamet or malarone
231
what is the 1st line treatment for falciparum malaria?
quinine [followed by doxycyline or clindamycin], malarone, riamet
232
what is the 1st line treatment for falciparum malaria in pregnant women?
quinine [high doses teratogenic but benefit outweighs risk]
233
what symptom must occur in a patient taking mefloquine that would result in discontinuing the medication?
mefloquine
234
what is the important safety information for chloroquine?
ocular toxicity occurs when dose exceeds 4mg/kg daily
235
what is the treatment of influenza virus? [2]
oseltamivir [tamiflu] zanamivir [relenza]
236
when should oseltamivir be given after pt gets exposed to influenza virus? when should zanamivir be given after pt gets exposed to influenza virus?
- within 48 hours of exposure | - within 36 hours of exposure
237
who is eligible for free nhs flu vaccination? [7]
pregnant women elderly over 50 years people with chronic illness eg diabetes, liver disease, heart failure people who live in residential homes people who live with someone at risk of infection [immunocompromised] people with carers allowance who are carers for disabled/vulnerable people frontline health or social care workers

infections (2 decks)

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