Infections Flashcards
(186 cards)
1
Q
Which clinical bio markers suggest an infection?
A
^ CRP, ^ ESR, decreased BP, increased glucose levels
2
Q
Side effects of antibiotics?
A
GI disturbance
Candidiasis (oral/vaginal)
Colitis
3
Q
PT groups at highest risk of colitis?
A
Elderly
Renal impairment
Liver impairment
4
Q
Antibiotics most associated with colitis?
A
Highest = Clindamycin
Others include: Broad spec antibiotics
E.g. Amoxicillin, 3rd and 4th gen cephalosporins and quinolones
5
Q
Broad spec antibiotics?
A
A2 C3 QT
Amino-glycosides, amoxicillin, carbopenems, cephalosporins, chloramphenicol, Quinolones, tetracyclines
6
Q
What route is avoided in children due to pain?
A
IM
7
Q
What antibiotics are commonly offered in penicillin allergy?
A
Macrolides
e.g. Clarithromycin
8
Q
Why are tetracyclines avoided in <12 and pregnant women?
A
Discolours teeth and growing bones yellow - grey
9
Q
Which tetracyclines can be given to under 12s?
A
Doxycycline
Lymecycline
10
Q
Can quinolones be given in pregnancy or adolescents?
A
No - can cause arthritis in weight bearing joints
11
Q
Which tetracyclines can you use in renal impairment?
A
Doxycycline and minocycline
12
Q
Which antibiotics are safest in pregnancy?
A
Penicillins and cephalosporins
13
Q
Which antibiotics should be avoided in pregnancy?
A
Tetracyclines, Trimethoprim in 1st trimester (teratogenic), Nitrofurantoin at term (can cause haemolysis).
Nitrofurantoin can also cause Nausea so avoid in pts with morning sickness.
14
Q
Examples of tetracyclines
A
Doxycycline
Minocycline
Demeclocycline
Etc.
15
Q
Doxycycline typical dose?
A
200mg OD
16
Q
Tetracycline side effects
A
Benign intracranial hypertension (headaches and visual disturbances),
Tooth and bone discolouration,
Dental hypoplasia
17
Q
Which tetracyclines can you give in hepatic impairment?
A
None
18
Q
Counselling for all tetracyclines?
A
Avoid antacids, zinc or iron 1H before or after
19
Q
Which tetracyclines require counselling on photosensitivity - avoid sunlight
A
“Double - Ds”
Doxycycline and Demeclocycline
20
Q
Which tetracyclines must you counsel the PT to avoid milk?
A
“DOT”
Demeclocycline, Oxtetracycline, Tetracycline
21
Q
Which tetracyclines require the PT to swallow whole with fluently of fluids while sitting/standing?
A
“DMT”
Doxycycline (take with food)
Minocycline
Tetracycline
22
Q
Which bacteria should quinolones never be used for?
A
MRSA due to resistance
23
Q
MHRA alert for quinolones?
A
Long-term serious SEs so not prescribed for non severe infections
24
Q
Examples of quinolones?
A
Ciprofloxacin
Levofloxacin
Moxifloxacin
Etc.
25
How often is ciprofloxacin given daily?
BD
26
Which quinolone causes the most QT prolongation?
Moxifloxacin
27
Which quinolone causes life-threatening hepatotoxicity?
Moxifloxacin
28
Side effects of quinolones?
Tendon damage (within 48H)
CNS disorders - report neuropathy or body weakness
Hallucinations
Aortic aneurysm - report sudden severe chest, back or abdomen pain
QT prolongation
Palpitations
29
Why are quinolones avoided in pregnancy?
Risk or arthropathy
30
Counselling for quinolones?
Avoid indigestion remedies, zinc and iron 1H before or after.
Avoid sunlight - particularly with oxifloxacin.
31
Which quinolone should PTs avoid taking with milk?
Ciprofloxacin
32
Quinolone + warfarin interaction?
Increased bleeding
33
Ciprofloxacin + NSAID/theophylline interaction?
Increased risk of seizures
34
Causative agent of skin/cellulitis infections and treatment?
Staphylococci
Give flucloxacillin
35
MRSA infection treatment?
Vancomycin ( OR Teicoplanin OR Linezolid )
36
Causative agent of throat infections and treatment?
Streptococcal
Pen G or Pen V
37
Causative agent of dental infections and treatment?
Anaerobic bacteria
Metronidazole
38
Pseudomonas auruginosa treatment?
Gentamicin
Or anti-pseudomonal penicillin
39
Linezolid drug class?
Reversible and non-selective MAOI
40
Linezolid side effects and subsequent monitoring?
Blood dyscrasias - monitor FBC especially if treatment > 10-14days
Optic neuropathy - monitor visual function if treatment > 28 days
41
Linezolid + Tyramine rich foods/ other meds which raise BP interaction and how long do you have to wait?
Hypertensive crisis - wait 2 weeks before taking Linezolid
42
Can chloramphenicol be used in pregnancy?
No - can cause grey-baby syndrome
43
Metronidazole dose?
400/500mg TDS 3 days
44
Metronidazole counselling?
With or after food
Avoid alcohol
45
Metronidazole side effects?
GI disturbances
Metallic taste
Oral mucositis
Furry tongue
46
Nitrofurantoin counselling?
Take with food
47
Nitrofurantoin side effects?
Yellow - brown urine
Nausea
Peripheral neuropathy - avoid if eGFR < 45
Lung reactions (pneumocystis) - Stop
48
Can nitrofurantoin be used in renal impairment?
Only if eGFR > 45
49
Can nitrofurantoin be given in pregnancy?
Yes but avoid at term
50
At what age can nitrofurantoin not be given?
Infants < 3 months
51
Is trimethoprim a folate?
No it is an anti folate
52
Trimethoprim dose?
200mg BD
OR 100mg ON for prophylaxis
53
Trimethoprim side effects?
Blood disorders
Hyperkalaemia
Mouth ulcers
54
Can trimethoprim be used in pregnancy?
No it is teratogenic
55
Examples of aminoglycosides?
Genamycin (1st choice)
Neomycin
Amikacin
56
Can neomycin be given parentally?
No - toxic
57
Gentamicin route?
Parenteral only
58
Normal Gentamicin therapeutic drug range?
Peak = 5 - 10mg/L
Trough = < 2
59
When is gentamicin TDR reduced and what are the new targets?
Endocarditis
Peak = 3-5mg/L
Trough = <1
60
When giving gentamicin, when is dose reduction preferred over interval increase in renal impairment?
When eGFR < 30
61
Gentamicin dose when given OD?
7mg/kg OD
62
When should once daily doses of Gentamicin be avoided?
When eGFR < 20ml/min
63
Monitoring requirements when giving multiple daily doses of gentamicin with normal renal function?
Monitor after 3-4 doses, then every 3 days, then after dose changes.
More frequent in renal impairment.
64
Can gentamicin be given in pregnancy?
Avoid due to ototoxicity in the baby during the 2nd and 3rd trimester
65
Side effects of gentamicin?
Ototoxicity
Nephrotoxicity
Peripheral neuropathy
66
Gentamicin MHRA alert?
Some batches contain histamine so monitor for anaphylaxis reactions
67
Examples of glycopeptides?
Vancomycin
Dalbeavancin
Teicoplanin
68
How often is Teicoplanin given daily?
OD
69
Vancomycin route of administration?
Parenteral
70
Vancomycin TDR?
10-20mg/L
71
Side effects of vancomycin?
Ototoxicity
Nephrotoxicity
Blood dyscrasias
Red-man syndrome (when given too rapidly)
Tinnitus - Stop if this occurs
72
What medication causes red-mans syndrome when given too rapidly and what are the symptoms?
Vancomycin
Symptoms = rash on face, torso and neck
73
Examples of macrolides?
Azithromycin
Clarithromycin
Erythromycin
74
Which macrolide is available OTC to over 16s for chlamydia?
Azithromycin
75
Which macrolide is safest in pregnancy?
Erythromycin
76
How often is azithromycin given daily?
OD
77
How often is clarithromycin given daily?
BD
78
How often is Erythromycin given daily?
BD or QDS
79
Side effects of macrolides?
GI disturbance
Taste disturbance
Tongue discolouration
QT prolongation
80
Which macrolide has the most GI effects and most likely to prolong QT?
Erythromycin
81
Should azithromycin and Clarithromycin be taken with or without food?
Azithromycin = before food
Clarithromycin = after food
82
Which two macrolides require a 2H gap when using indigestion remedies?
Azithromycin and clarithromycin
83
Example of an antispseudomonal penicillin?
Piperacillin and Ticarcillin
84
What route can you give antispseudomonal penicillins?
Parenteral
85
Which penicillins can cause cholestatic jaundice?
Flucloxacillin
Co-amoxiclav
86
Why should amoxicillin not be used for sore throats?
Could be glandular fever which presents as a maculopapular rash which could be mistaken for a pen allergy.
87
What is the purpose of clavulanic acid in co-amoxiclav?
Protects amoxicillin against beta-lactamases
88
Dose of amoxicillin for each age bracket?
1 - 11months = 125mg TDS
1 - 4years = 250mg TDS
Adults = 500 - 1000mg TDS
89
What route must amoxicillin never be given due to risk of brain damage?
Intrathecally
90
Which penicillins are hepatotoxic
Flucloxacillin and co-amoxiclav
91
Interaction between amoxicillin and warfarin?
Increased bleeding
92
Interaction between amoxicillin and methotrexate?
Increased toxicity
93
How many generations of cephalosporins are there?
5
94
Example of 1st gen cephalosporins?
“Cefa”
Cefalexin, Cefadroxil (BD), Cefradine
95
Example of 2nd gen cephalosporins?
“2 foxes for tea”
Cefaroxime, Cefoxitin, Cefaclor
96
Example of 3rd generation cephalosporins?
“Me/one”
Cefixime, Cefotaxime, Ceftazidime, Ceftriaxone
97
Example of 4th generation cephalosporins?
“Pi”
Cefepime
98
Example of 5th generation cephalosporins?
“Ol”
Ceftaroline, ceftobiprole
99
Which cephalosporins are most associated with colitis?
3rd and 4th gen
100
Can you use cephalosporins in penicillin allergy?
Avoid
Use 3rd gen or cefuroxime if necessary
101
Which antibiotics do you take before food?
“DROP FAT”
Demeclocycline
Rifampicin
Oxtetracycline
Pen V
Flucloxacillin
Ampicillin/azithromycin
Tetracycline
102
Side effects of co-trimoxazole?
Steven-Johnson’s syndrome
103
Which penicillin can cause hypernatraemia in high doses?
Pen G
104
Penicillin interactions?
“WAM”
Warfarin, allopurinol, methotrexate
105
What is gastroenteritis and what are the common causes?
Food poisoning
Causes include = shigella, salmonella, E. Coli, rotavirus and noravirus
106
How is gastroenteritis treated?
Typically self limiting but if antibiotics needed give ciprofloxacin
107
C. Diff infection cause?
Elderly, PPI use, antibiotics
108
Treatment of 1st episode C. Diff infections?
For 1st episode:
1st line = Vancomycin 125mg QDS
2nd line = Fidaxomycin 200mg BD
109
Treatment of 2nd episode C. Diff infections?
If within 12weeks of 1st ep = fidaxomycin
If over 12weeks since first ep = fidaxomycin / vancomycin
110
Causative agents for endocarditis?
Staphylococcus, streptococcus, enterococcus, HACEK
111
Endocarditis treatment with native valve? Blind therapy
Amoxicillin +/- low dose gentamicin
112
Endocarditis treatment with native valve and penicillin allergy or MRSA suspected? Blind therapy
Vancomycin +/- low dose gentamicin
113
Endocarditis treatment with prosthetic valve? Blind therapy
Vancomycin + Rifampicin + low-dose gentamicin
114
Endocarditis treatment once cultures come back?
Vancomycin if MRSA
Flucloxacillin if staphylococcal
Pen G if streptococcal
115
Treatment of low-severity CAP?
Amoxicillin
116
Treatment of low-severity CAP with penicillin allergy?
Clarithromycin + Doxycycline
117
Treatment of low-mild severity CAP with penicillin allergy and pregnant?
Erythromycin + Doxycycline
118
Treatment of mild severity CAP if atypical pathogens are the cause?
Amoxicillin + clarithromycin
119
Treatment of high-severity CAP?
PO/IV Co-amoxiciav + clarithromycin (Erythromycin in pregnancy)
120
Treatment of high-severity CAP with a penicillin allergy?
Levofloxacin
121
Treatment of non-severe and low resistance risk HAP?
Co-amoxiclav
122
Treatment of non-severe and low resistance risk HAP with a penicillin allergy?
Doxycycline or cefalexin
123
Treatment of severe HAP?
Pippericillin tazobactam
124
Treatment of meningitis in blind therapy?
Pen G
125
Treatment of meningitis with penicillin allergy or pneumococcal cause?
Cefotaxime or chloramphenicol if immediate sensitivity
126
Treatment for osteomyelitis?
Flucloxacillin
127
Treatment for osteomyelitis in penicillin allergy?
Clindamycin
128
What are the two types of impetigo?
Bullous and non-bullous
129
What is the causative agent of impetigo?
Staphylococcus
130
1st line treatment for local non-bullous impetigo not near the eyes?
Hydrogen peroxide 1% cream
131
Treatment for local non-bullous impetigo if 1% hydrogen peroxide not suitable?
Fusidic acid
Or Mupirocin in resistance
132
1st line treatment for wide-spread non-bullous impetigo but PT is not systemically unwell?
Fusidic acid
133
1st line treatment for wide-spread non-bullous impetigo and PT is systemically unwell?
Flucloxacillin
134
1st line treatment for wide-spread non-bullous impetigo and PT is systemically unwell and has a penicillin allergy?
Clarithromycin or erythromycin
135
Interaction between fusidic acid and statins?
Rhabdomylosis - hold statin for up to 7 days post treatment with fusidic acid
136
Cellulitis treatment?
PO/IV flucloxacillin
137
Cellulitis treatment with penicillin allergy?
Clarithromycin or doxycycline or erythromycin
138
Cellulitis treatment if near the eyes or nose?
PO/IV Co-amoxiclav
139
Cellulitis treatment if near the eyes or nose if PT has a penicillin allergy?
Clarithromycin + Metronidazole
140
Animal or human bite treatment?
PO/IV Co-amoxiciav
141
Animal or human bite treatment in penicillin allergy?
Doxycycline + Metronidazole
142
Treatment of pericoronitis/gingivitis?
Metronidazole or Amoxicillin
143
Treatment of periapical periodontal abscesses?
Pen V or amoxicillin for up to 5days
144
Otitis externa causative agents?
Staphylococcus or pseudomonas auruginosa
145
Otitis externa treatment?
Flucloxacillin
146
Otitis externa treatment in penicillin allergy?
Clarithromycin or Erythromycin or Azithromycin
147
Otitis media treatment?
Amoxicillin or co-amoxiclav if worse after 2-3 days
148
Otitis media treatment in penicillin allergy?
Clarithromycin or erythromycin
149
Sinusitis treatment?
Pen V or co-amoxiciav if worse after 2-3 days
150
Sore throat treatment?
Pen V for 5-10 days
151
Sore throat treatment if penicillin allergy?
Clarithromycin or erythromycin for 5 days
152
Chlamydia treatment?
Doxycycline or Azithromycin 1g for one day then 500mg for 2 days
153
Bacterial vaginosis treatment?
Metronidazole 2g for one dose OR 400-500mg BD for 5-7days
Or topical clindamycin for 7 days
Or topical metronidazole for 5 days
154
Causative agent for lower UTI?
E. Coli
155
Treatment of lower UTI?
Nitrofurantoin or Trimethoprim
3 days for women 5 days for men
156
Treatment of lower UTI in pregnancy?
Nitrofurantoin for 7 days
Or amoxicillin or cefalexin
157
How many times is classed as recurrent UTI?
2 in 6 months
Or 3+ in 12months
158
Signs of sepsis?
“SEPSIS”
Slurred speech
Extreme shivering/muscle pain
Passing no urine all day
Severe breathlessness
It feels like you are about to die
Skin mottled or discoloured
159
Treatment of community acquired sepsis?
Antispseudomonal penicillin or cephalosporins
160
Tuberculosis treatment?
“RIPE”
Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for 2 months
THEN
Rifampicin + Isoniazid for 4 months
161
Tuberculosis symptoms?
Cough lasting 3+ weeks
Neck swelling
Night sweats or fever
162
What colour does rifampicin turn urine?
Orange - red
163
Which anti-tuberculosis medication can cause peripheral neuropathy and what can be done to prevent/treat this?
Isoniazid
Give with pyridoxine (vit. B6)
164
Which anti-tuberculosis medication does the patient have to avoid tyramine or histamine rich foods?
Isoniazid
165
Which anti-tuberculosis medication can cause visual disturbances?
Ethambutol
166
Which anti-tuberculosis medication is NOT hepatotoxic?
Ethambutol
167
Treatment of oral candidiasis?
Nystatin (POM) or Miconazole
168
Vulval or vaginal thrush (candidiasis) treatment?
Flucloxacillin as a single oral dose
Or clotrimazole topically
169
Malaria symptoms?
> 38degrees
Chills
Headache
Muscle aches
Diarrhoea and vomiting
170
Are anti malarials 100% effective?
No
171
Which antimalarials must you avoid in epilepsy?
Chloroquine and mefloquine
172
Which antimalarials must you avoid in renal impairment?
Proguanil and Malarone if eGFR< 30
173
Which antimalarials can you give in pregnancy?
Chloroquine and proguanil
Along with 5mg folic acid
174
Which antimalarials must you avoid in pregnancy?
Doxycycline
175
What must be done if a patient requires anti malarial prophylaxis but takes warfarin?
Start 2-3 weeks before travel as requires a stable INR before leaving.
Measure INR before starting, after 7 days and on completion.
176
Which antimalarials can cause psychiatric reactions?
“Quines”
Chloroquine and mefloquine
177
Typically how long before and after travel should antimalarials be taken?
1 week before and 4 weeks after
178
Which antimalarials can be take 1-2 days before travel?
Doxycycline and Malorone
179
Which antimalarials should be started 2-3 weeks before travel?
Mefloquine
180
Which antimalarial should only be taken for 1 week after travel?
Malorone
181
Which antimalarials should only be taken OD?
Malarone, doxycycline and proguanil
182
Which antimalarials should only be taken once weekly?
“Quines”
Mefloquine and chloroquine
183
When can quinine be given as stand by treatment for malaria?
If access to medical care is >24H away
184
What written instructions must be given with quinine when given as stand by treatment for malaria?
Seek medical help if they have a fever >38degrees for over 7 days
185
Which antibiotics are least likely to cause c. Diff infection?
Aminoglycosides
186
Clarithromycin and Ciclosporin interaction?
Clarithromycin increases the concentration of Ciclosporin
