Infections Flashcards
(129 cards)
1
Q
Are narrow or broad spec antibiotics preferred?
A
Narrow are preferred, except for serious infections where broad-spec is needed
2
Q
What are examples of tetracyclines?
A
Doxycycline
Lymecycline
3
Q
What age are tetracyclines contraindicated in?
A
<12 years old
4
Q
Which macrolide has the highest risk of c.difficile?
A
Clindamycin
5
Q
What is a patient at risk of if they are hepatically impaired and take co-amoxiclav?
A
Cholestatic jaundice
6
Q
What are examples of aminoglycosides?
A
Gentamicin
Streptomycin
Neomycin
7
Q
What class of drug is vancomycin?
A
Glycopeptide
8
Q
What eGFR should you avoid giving nitrofurantoin to?
A
If <45ml/min
9
Q
Which specific antibiotics should you avoid during pregnancy?
A
Remember MCAT
Metronidazole
Chloramphenicol
Aminoglycosides
Tetracyclines
10
Q
Which class of organisms generally requires metronidazole to treat?
A
Anaerobic infections
11
Q
Is clindamycin bacteriostatic or bacteriocidal?
A
Bacteriostatic
12
Q
How often during the day is clindamycin usually given?
A
Four times a day
13
Q
What should you monitor with clindamycin if patient is taking it for >10 days?
A
Renal/liver function
14
Q
Which specific side effects should you report if a patient is taking linezolid?
A
Blood disorders
Visual issues (optic neuropathy)
15
Q
What class of drug is linezolid?
A
A reversible MAOI
16
Q
What foods should you avoid with linezolid?
A
Tyramine rich foods, e.g. cheese, salami, wine, soy sauce
17
Q
Is trimethoprim bactericidal or bacteriostatic?
A
Bactericidal
18
Q
What are the side effects of trimethoprim which patients should report?
A
Blood disorders
Hyperkalaemia
19
Q
What can trimethoprim cause in pregnancy?
A
Teratogenicity because it is an anti-folate
20
Q
When is chloramphenicol used?
A
Only for severe life-threatening infections
21
Q
What can chloramphenicol cause if used during pregnancy?
A
Grey baby syndrome
22
Q
What are some side effects of metronidazole?
A
GI disturbances
Taste disturbances
Oral mucositis
Furred tongue
23
Q
Why should patients taking metronidazole avoid alcohol? How long should they avoid alcohol for?
A
Because it can cause disulfiram-like effects.
Must stop alcohol during and 2 days after stopping treatment
24
Q
What colour can nitrofurantoin cause urine to change into?
A
Yellow/brown
25
How do aminoglycosides work?
They irreversibly bind to ribosomes and hence inhibit protein synthesis
26
How are aminoglycosides usually given? What is their frequency?
They are usually given once a day by injection as they are not absorbed by the gut
27
What 2 specific side effects could occur with aminoglycosides and glycopeptides?
Oto and nephrotoxity - must monitor renal and auditory function
28
How is the loading and maintenance dose of aminoglycosides calculated?
Based on weight and renal function
29
When should you perform more frequent and earlier monitoring if a patient is receiving an aminoglycoside?
If they are renally impaired
30
What are the signs of nephrotoxicity?
Low urine output/creatinine clearance
High creatinine/urea
31
What drugs can increase the risk of ototoxicity if given alongside an aminoglycoside?
Loop diuretics
Macrolides
Antimalarials
32
What electrolyte disturbances can be caused from aminoglycosides?
Hypokalaemia
Hypocalcaemia
Hypomagnasaemia
33
How do glycopeptides work?
They inhibit cell wall synthesis
34
Which glycopeptide is active against MRSA?
Vancomycin
35
How is vancomycin given?
Slow infusion to avoid anaphylactic reactions
36
How often should vancomycin plasma conc. be monitored?
After 3-4 doses
After dose changes
37
What can happen is a vancomycin infusion is given too slowly?
Red man syndrome
38
What other side effects are involved with vancomycin?
Blood disorders
Skin disorders - steven-johnson syndrome
Thrombophlebitis
39
What are signs of headaches/visual disturbances a sign of if taking a tetracycline?
Benign intracranial hypertension
40
What are the contra-indications of taking a tetracycline?
If <12years old
Pregnant/breastfeeding
If severe hepatic impairment present
41
What are some common side effects of tetracyclines?
Photosensitivity
Skin reactions
Discolouration of teeth (in children)
Poor skeletal development
42
When should a patient take antacids/iron if they are also taking a tetracycline?
2h before/after
43
What is the dose of doxycycline for malarial prophylaxis?
100mg OD 1-2 days before, during travel, and 4 weeks after coming back
44
What are examples of quinolones?
Ciprofloxacin
Levofloxacin
Ofloxacin
45
Why should you avoid quinolones in MRSA infections?
Because there is resistance present
46
What are some side effects of quinolones?
Seizures
Tendon damage
QT prolongation
Arthropathy
47
When can tendon damage occur if a patient is taking a quinolone?
Within 48h of taking the quinolone
48
How can heart valve regurgitation present if a patient is taking a quinolone?
Swollen ankles/feet
New onset palpitations
SOB
49
Why should patients avoid NSAIDs with quinolones?
Because they can induce seizures/convulsions
50
Which part of the ribosome do macrolides bind to and inhibit protein synthesis from?
50s subunit of ribosome
51
Why is azithromycin usually given OD?
Because it has a half life of 2-4 days
52
Which macrolide can be given four times a day?
Erythromycin
53
Which macrolide can cause taste disturbances?
Clarithromycin
54
Which macrolide has the highest risk of QT prolongation and GI side effects?
Erythromycin
55
Are macrolides taken with food or empty stomach?
With or just after food
56
Why should rivaroxiban and erythromycin be avoided together?
Because erythromycin is a strong enzyme inhibitor which can increase the patients bleeding risk if given with rivaroxiban
57
Why is Pen G (benzylpenicillin) only given by injection?
Because it is inactived by the GI system
58
Which specific patient group is at risk of having a penicillin allergy?
Those with atopic conditions, e.g. eczema, hay fever, asthma
59
What symptoms can present during a penicillin allergy?
Immediate rash
Anaphylaxis (swelling)
Hives
60
What is a maculopapular rash a sign of if a patient is given a penicillin for a sore throat?
Glandular fever
61
What should you do to the dose of amoxicillin if a patient has an eGFR of <30ml/min?
Reduce dose due to risk of convulsions
62
What is the dose of benzylpenicillin if a patient has suspected meningitis before transferring to hospital?
1.2g for 1 dose
63
Which penicillin is used for penicillinase-resistant infections?
Flucloxacillin
64
When can cholestatic jaundice/hepatitis occur if a patient is taking flucloxacillin?
Up to 2 months after treatment
65
Which electrolyte imbalance is a patient at risk of if they take high doses of piperacillin + tazobactam?
Hypernatraemia
66
Can you give a cephalosporin to a patient who is also penicillin allergic?
No - risk of cross-sensitivity
67
What is an example of a 1st generation cephelasporin?
Cephalexin
68
What are some examples of 2nd generation cepahlosporins?
Cefuroxime
Cefaclor
69
What are some examples of 3rd generation cepahlosporins (given only parentally0?
Cefixime
Ceftriaxone
Cefotaxime
Ceftazidime
70
Why is cefadroxil given BD?
Because it has a long duration of action
71
What are some examples of carbapenems?
Meropenem
Imipenem
72
Can you given carbapenems to patients with a penicillin allergy?
No - risk of cross-sensitivity
73
What can increase the risk of a patient developing C.difficile?
Long-term PPIs
>65yrs old
Prolonged hospitalisation
Hx of C.difficile
74
What is the 1st and 2nd line treatment for first episode mild/moderate/severe C.difficile?
1st: Oral vancomycin
2nd: oral fidaxomicin
75
What is given for relapsing or life-threatening C.difficile?
Oral Vancomycin (+ metronidazole IV if life-threatening)
76
What are the symptoms of endocarditis?
Chest pain
Flu like symptoms
Heart murmur
SOB
Swollen feet/ankles
77
What is the treatment for endocarditis?
IV Amoxicillin +/- gentamicin
78
What is classified as hospital acquired pneumonia?
If patient develops it >48h after hospital admission
79
Which tool measures the severity of a patients pneumonia? What does each letter stand for?
CURB-65
Confusion
Urea
Respiratory depression
Blood pressure
>65yrs old
80
What antibiotics are given if a patient has a low CURB-65 score (0-1)?
Amoxicillin
If penicillin allergic: doxycyline, or clarithromycin
If pregnant: erythromycin
81
What antibiotics are given if a patient has a moderate CURB-65 score (1 or 2)?
As low severity, PLUS clarithromycin or erythromycin if atypical pathogens present
82
What antibiotics are given if a patient has a high CURB-65 score (>3)?
Co-amoxiclav WITH clarithromycin (or erythromycin if pregnant)
If penicillin allergic: levofloxacin
83
What is the treatment for severe HAP?
IV piperacillin + tazobactam or ceftriaxone
84
What are the symptoms of meningitis?
Stiff neck
Non-blanching rash
Photophobia
Back rigidity
Unusual skin colour
85
What is the 1st and 2nd line treatment for meningitis?
1st: benzylpenicillin (Pen G) 2.4g IV every 4h
2nd: chloramphenicol or cefotaxime
86
What is osteomyelitis?
Inflammation or swelling of the bone tissue resulting in infection
87
What is the 1st and 2nd line treatment for osteomyelitis?
1st: Flucloxacillin 8g daily
2nd: clindamycin
88
How often is chloramphenicol eye ointment used for bacterial conjunctivitis?
3-4 times a day
89
What is the treatment for viral conjunctivitis?
Artificial tears
Cold-compress
Antihistamines
Alternatively nothing as it can go away on its own
90
What is the difference between bullous and non-bullous impetigo?
Bullous: fluid-filled blisters, yellow crust forming (more severe)
Non-bullous: water-filled pustules that burst and form a yellow/gold crust usually around mouth
91
What is the treatment for non-bullous impetigo/systemically well?
1st line: Hydrogen peroxide 1% cream 5/7
2nd: fucidic acid cream 5/7, or mupirocin 2% 5/7
92
What is the treatment for bullous impetigo/systemically unwell/widespread?
1st: flucloxacillin 500mg QDS 5/7
2nd of prenicillin allergic: clarithromycin 250mg BD 5/7
93
What is the 1st and 2nd line treatment for cellulitis/erysipelas?
1st: flucloxacillin 500mg QDS
2nd: clarithromycin, or erythomycin if pregnant, or oral doxycyline
94
What is given as 1st line for a animal/human bite?
Co-amoxiclav 500/125mg TDS 5/7
95
What are the treatment options for dental infections?
Co-amoxiclav
Metronidazole
Amoxicillin
Macrolides (but not clindamycin)
96
What is the 1st line treatment for a strep. sore throat infection?
Pen V 500mg QDS 5/7
97
What age is clarinase (mometasone nasal spray) licensed for?
>18 years old
98
What is the organism that causes tuberculosis?
Mycobacterium tuberculosis
99
What is the vaccine given for TB?
BCG
100
What are the drugs, and for how long, which are used for the initial phase of TB?
Initial phase: 4 drugs for 2 months; remember RIPE
Rifampicin
Isoniazid (+pyridoxine/vit. B6)
Pyrazinamide
Ethambutol
101
What are the drugs, and for how long, which are used for the continuation phase for TB?
Continuation phase: 2 drugs for 4 months
Rifampicin
Isoniazid (+pyridoxine)
102
What colour can rifampicin stain contact lenses/bodily fluids?
Red/orange
103
What should be monitored whilst a patient is on rifampicin?
LFTs - risk of hepatotoxicity
FBC
104
What should patients taking ethambutol report?
Optic nerve damage/visual problems
Renal symptoms
105
Why is vitamin B6 (pyridoxine) given alongside isoniazid?
To reduce the risk of peripheral neuropathy
106
Which specific parameter should you monitor if a patient is taking itraconazole for >1 month?
LFTs
107
Which patients are at risk of HF if they take itraconazole?
High doses
Longer courses
Patients already with CVD
Patients taking CCBs
108
Why should you refer back prescriptions of oral ketoconazole?
Because there is a big risk of hepatotoxicity - risk outweighs benefits
109
Why are brands of amphotericin B not interchangeable?
Because there is a risk of harm and fatal overdoses
110
Which antifungal has a liposomal formulation?
Ambisome
111
What is the treatment for oral thrush (POM and P)?
POM: nystatin oral drops QDS 7/7
P: miconazole oral gel (Daktarin oral gel)
112
What is the usual oral dose of aciclovir?
200mg x5 times a day 5/7
113
Which antiviral is used as prophylaxis of influenza for high risk groups?
Olseltamivir
114
What does the acronym ABCD for malaria stand for?
Awareness of risk
Bite prevention
Chemoprophylaxis
Diagnosis
115
How can a traveller prevent malarial bites?
Impregnated permethrin nets
DEET 20-50% spray/lotion
Protecting skin after dusk
116
Can DEET spray/lotion be used in pregnant/breast feeding women?
Yes
117
Which specific patients should you avoid giving mefloquine to?
Those with depression
Epilepsy
<3months of age
118
Which specific side effect should patients taking mefloquine report?
Psychosis
Suicidal ideation
Other neuropsychiatric reactions
119
How is mefloquine taken as malarial prophylaxis?
Weekly 2-3 weeks before, during, and 4 weeks after travel
120
How is maloff/malarone taken as malarial prophylaxis?
1-2 days before, during, and 1 week after travel
121
Which 2 antimalarials should you avoid in epileptic patients?
Chloroquine
Mefloquine
They can both reduce seizure threshold levels
122
Which antimalarials can you give in renally impaired patients?
Doxycycline
Mefloquine
123
Which anti-malarials can you give in pregnancy?
Maloff Protect
5mg folic acid also to be taken
124
Why is mefloquine given weekly?
Because it has a very long half life
125
Can you take maloff protect/malarone with food?
Yes, preferably with food or milky drink
126
What is the brand of mefloquine?
Lariam
127
When do symptoms of malaria generally occur after travel?
First 3 months after returning
128
Which drug can be used to treat malaria?
Quinine 600mg TDS 5/7
Alternatively Malarone
129
