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GPhC Registration Exam Prep 2023 > Infections > Flashcards

Infections Flashcards

1
Q

What are the indications of Quinine?

A

Nocturnal leg cramps
Non-falciparum malaria
Falciparum malaria (in adults and children)

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2
Q

What is the main safety information of quinine?

A

Dose dependant QT Prolongation
Caution in patients with an increased risk of QT Prolongation and Atrioventricular Block

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3
Q

What are the contraindications of Quinine?

A

Remember: TOM Hiddleston

  • Tinnitus
  • Optic Neuritis,
  • Myasthenia Gravis,
  • Haemoglobinemia
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4
Q

What drugs cause a definite risk of haemolysis in G6PD-deficient patients?

A

Mnemonic: MNOPQRS (Alphabetical)

  • Methylthioninium Chloride
  • Nitrofurantoin
  • dapsone and Other sulfones
  • Primaquine
  • Quinolones (ciprofloxacin, moxifloxacin, norfloxacin, ofloxacin)
  • Rasburicase
  • Sulfonamides (including co-trimoxazole)
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5
Q

What’s drugs cause a possible risk of haemolysis in some G6PD-Deficient patients?

A
  • Aspirin
  • Chloroquine
  • Menadione, water soluble derivatives (eg. Menadiol sodium phosphate)
  • Quinine (may be acceptable in acute malaria)
  • sulfonylureas
  • naphthalene in mothballs
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6
Q

What are the drugs which cause C. Diff?

A

The 4 C’s

Cephalosporins
Clindamycin
Ciprofloxacin
Co-amoxiclav

Also
Other broad spec Penicillins
PPIs

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7
Q

What are the main side effects of Nitrofurantoin?

A

Mnemonic: Bob Can Pee Alright

  • Blood Disorders
  • Acute Pulmonary Reactions
  • Peripheral Neuropathy
  • Cholestatic Jaundice
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8
Q

A patient has an eGFR of 38 and the doctor wishes to put them onto nitrofurantoin.

What advice would you give the prescriber with regarding their treatment?

A

Give them a short course only

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9
Q

A patient has an eGFR of 27 and the doctor wishes to start them on nitrofurantoin?

What advice would you give the prescriber regarding their treatment?

A

Nitrofurantoin should be avoid in eGFR <30

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10
Q

What counselling advice would you give patients regarding nitrofurantoin?

A
  • Report any signs of new or worsening respiratory symptoms
  • Report any signs of hepatic dysfunction (abdo pain, swelling legs, jaundice etc)
  • Take with or after food
  • This tablet may discolour the urine, it is of no concern
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11
Q

Can you give chloramphenicol to someone who is pregnant? Yes or no, and if no, why?

A

No - Avoid

Risk of neonatal ‘Grey-Baby syndrome’

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12
Q

What are the antibiotic choices for Lower UTI?

A

Mnemonic: Can Not Avoid the Treatment For Peeing

  • Cefalexin
  • Nitrofurantoin
  • Amoxicillin
  • Trimethoprim
  • Fosfomycin
  • Pivemecillinam
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13
Q

What are the side effects of Amoxicillin?

A
  • Nausea
  • Diarrhoea
  • Antibiotic-Associated Colitis
  • Skin Rash
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14
Q

What are the main interactions of Amoxicillin?

A
  • Methotrexate: Reduced clearance
  • Allopurinol: Increased Risk of Rash
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15
Q

What are the main side effects of Trimethoprim?

A

Remember: ‘HACk SiR’
- Hyperkalaemia
- Agranulocytosis
- Cholestatic Jaundice
- Skin rashes
- Raised serum Creatinine

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16
Q

What are the contra-indications of Trimethoprim?

A
  • Severe Hepatic or Renal Impairment
  • Blood Dyscrasias
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17
Q

What are the side effects of Pivmecillinam?

A
  • Diarrhoea
  • Vulvovaginal Fungal Infection
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18
Q

What are the contra-indications of Pivmecillinam?

A
  • Carnitine Deficiency
  • GI Obstruction
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19
Q

What are the main interactions with Pivmecillinam?

A
  • Methotrexate: Reduced clearance
  • Valproate - Increased risk of Carnitine Depletion
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20
Q

What are the main interactions with penicillins?

A
  • Methotrexate: may reduce MTX clearance and increase risk of toxicity
  • Allopurinol: Increased risk of rash with Amoxicillin
  • Warfarin: May increase INR Levels
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21
Q

What are the main interactions with Quinolones (-floxacins)?

A
  • Drugs that prolong QT Interval
  • NSAIDs: Increase risk of seizures
  • Theophylline: Plasma levels increased
  • Corticosteroids: Increased risk of tendon damage
  • Ciclosporin: Risk of nephrotoxicity and increased conc.
  • Phenytoin: Increase or decrease levels
  • Methotrexate: may increase plasma levels of MTX
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22
Q

What are the main interactions with Trimethoprim?

A
  • Methotrexate: Increased risk of bone marrow suppression
  • Phenytoin: Reduced risk of Phenytoin toxicity
  • Digoxin: Increased Digoxin levels
  • Azathioprine: Risk of haematological toxicity increased
  • Warfarin: May increase levels
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23
Q

What are the main interactions with Macrolides?

A

Erythromycin and Clarithromycin are enzyme inhibitors.
Mnemonic: Clarithromycin Will Treat Super Tb.

  • Carbamazepine
  • Warfarin
  • Theophylline
  • Simvastatin
  • Ticagrelor
  • Drugs prolonging QT interval
  • Statins (Simvastatin, Atorvastatin)
  • Colchicine
24
Q

What are the side effects of Chloramphenicol?

A
  • Irritation
  • Burning
  • Stinging
25
Q

What is the treatment duration of Lower Urinary Tract Infections for each of the following:

  • Women
  • Men
  • Pregnant Women?

There is one more group you should be remembering, which is it?

A

Women: 3 days
Men: 7 days
Pregnant Women: 7 days

Catheter-associated LUTI: 7 days

26
Q

What antibiotics can be used to treat a Lower Urinary Tract Infection? List 6.

A
  • Trimethoprim
  • Nitrofurantoin
  • Fosfomycin
  • Pivemecillinam
  • Amoxicillin
  • Cefalexin
27
Q

What dose recommended for treating Lower UTIs with nitrofurantoin, and when do you take it?

A

50mg four times a day (Immediate-release)
100mcg twice a day (modified-release)

With or after food

28
Q

What are the main side effects of Nitrofurantoin?

A
  • Acute Pulmonary Reactions
  • Rash
  • Nausea
  • Peripheral Neuropathy
29
Q

The doctor wishes to give a woman who is 12 weeks pregnant nitrofurantoin for a Lower Urinary Tract Infection.

What advice would you give the prescriber?

A

It is not known to be harmful in the first few weeks of pregnancy but avoid when at term.

30
Q

The doctor wishes to give nitrofurantoin to a man with an eGFR=36.

What advice would you give the prescriber?

A

It is fine to use, but keep the course short.

31
Q

What are the main side effects of Penicillins?

A
  • Cholestatic Jaundice (Flucloxicillin)
  • Diarrhoea
  • Skin reactions
  • Clostridium Difficile
  • Black Hairy Tongue (Amoxicillin)
32
Q

What are the side effects of Tetracyclines?

A
  • Photosensitivity
  • Tooth Discolouration
  • Headaches
  • Irreversible Pigmentation (Minocycline)
  • GI Disorders
33
Q

What are the main side effects of Quinolones?

A

Mnemonic: QTC HA

  • QT Prolongation
  • Tendon Damage (Increased risk with those on corticosteroids and over 60 years old)
  • Convulsions (Increased risk with those on NSAIDs)
  • Heart Valve Regurgitation
  • Aortic Aneurysm
34
Q

What are the main side effects of Nitrofurantoin?

A
  • Pulmonary Disorders (report any pulmonary symptoms)
  • Hepatic Disorders (monitor LFTs in long term use)
  • Urine Discolouration
35
Q

What are the main side effects with Trimethoprim?

A
  • Hyperkalaemia
  • Haematological Disorders
  • Skin Rashes
  • Fungal Overgrowth
36
Q

How do you treat a Clostridium Difficile Infection?

A

1st Line: Vancomycin 125-500mg four times a day for 10 days

2nd Line: Fidaxomycin 200mcg twice a day for 10 days

37
Q

What are the cautions with Quinolones?

A
  • History of Epilepsy
  • Risk factors for QT Prolongation
  • Children or adolescents (Arthropathy risk)
38
Q

A doctor wishes to give ciprofloxacin to a 28 year old female who is 24 weeks pregnant.

What advice would you give the prescriber?

A

Avoid

39
Q

What are the indications of Quinolones?

A

Mnemonic: DEAR P

  • Diverticulitis
  • Eye Infections
  • Acute Otitis Media
  • Respiratory Tract Infection
  • Prostatitis
40
Q

What counselling advice would you give to a patient starting a quinolone?

A

Treatment with quinolones should be stopped at the first sign of serious adverse reactions, such as tendon pain or inflammation, CNS effects and peripheral neuropathy.

41
Q

What are the indications for Trimethoprim?

A
  • UTI
  • Acute Pyelonephritis
  • Acute Prostatitis
  • Acute Diverticulitis
42
Q

What are the main side effects of Fluconazole?

A

4HQ

  • Headaches
  • Hyperlipidaemia
  • Hair loss
  • Hepatic Disorders
  • QT Prolongation
43
Q

What are the main drugs which cause C. Diff?

A

The 4 C’s

  • Clindamycin
  • Cephalosporins
  • Co-amoxiclav
  • Ciprofloxacin

Also
- Broad spec Penicillins
- Other Fluoroquinolones (Moxifloxacin, Ofloxacin, Levofloxacin)

44
Q

What are the main side effects of Nitrofurantoin?

A
  • Blood Disorders
  • Cholestatic Jaundice
  • Acute Pulmonary Reactions
  • Peripheral Neuropathy
45
Q

What are the main counselling points with Nitrofurantoin?

A
  • Take with or after food
  • Report any new or worsening respiratory symptoms
  • Report any signs of hepatic dysfunction (vomiting, jaundice etc)
  • Nitrofurantoin may discolour the urine, this is harmless
46
Q

What monitoring is required for Trimethoprim and when?

A

In long term treatment: monitor FBC and U+Es

47
Q

A doctor wishes to start a patient with an eGFR of 12 on Trimethoprim.

What is the advice you give to the prescriber?

A

Half the normal dose

48
Q

A doctor wishes to start a patient with an eGFR of 28 on Trimethoprim.

What is the advice you give to the prescriber?

A

Half the dose after 3 days.

49
Q

A doctor wishes to start a 24 year old woman on trimethoprim. She is 12 weeks pregnant.

What advice do you give the prescriber?

A

Avoid in the first trimester

Risk of teratogenicity.

50
Q

What are the main counselling points with Tetracyclines?

A
  • Wear suncream and avoid direct sunlight while on treatment
  • avoid indigestion remedies, containing iron or zinc for 2 hours before and after dose (doxycycline, lymecycline, minocycline)
51
Q

What are the main side effects of Tetracyclines?

A

Mnemonic: POST

  • Photosensitivity
  • Oesophageal Irritation
  • Severe headaches and/or visual disturbances
  • Tooth Discolouration

Also:
- Irreversible Pigmentation
- GI Disorders

52
Q

What are the indications for tetracyclines?

A

Mnemonic: PR CAR

  • Respiratory Infection
  • Periodontal Infections
  • Chlamydia
  • Acne
  • Rosacea
53
Q

What are the main interactions with Tetracyclines?

A
  • CYP3A Inducers
  • Lithium
  • Methotrexate
  • Retinoids
54
Q

A doctor wishes to prescribe a 22 year old woman with doxycycline. She is 23 weeks pregnant.

What advice do you give to the prescriber?

A

Avoid

May cause discolouration of child teeth and affect skeletal development (affects calcium)

55
Q

What is the main warning with minocycline?

A

Causes irreversible pigmentation (greater risk of lupus erythematosus like symptoms)

GPhC Registration Exam Prep 2023 (13 decks)

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