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Management of Infection > Lecture 11 - Management of Infection > Flashcards

Lecture 11 - Management of Infection Flashcards

1
Q

What is pharmaceutical care?

A

a philosophy of practive in which the patient is the beneficiary of the pharmacists actions

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2
Q

What does pharmaceutical care focus?

A

the attitudes, behaviours, commitments, concerns, ethics, functions, knowledge, responsibilities and skills of the pharmacist on the provision of drug therapy with the goal of achieving definite therapeutic outcomes toward patient health and quality of life

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3
Q

What patients are at risk of infection?

A

immunocompromised patients

patients in ICU or post operation

malnourished

patients with cancer and diabetes

elderly or infirm

infants and neonates

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4
Q

Appropriate use of antibiotics?

A

correct diagnosis (known or presumed site of infection)

antibiotic culture and sensitivity

patient factors

site and severity

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5
Q

What patient factors need to be checked before treatment?

A

contraindications

interactions (medicines, foods)

allergies

renal and hepatic function

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6
Q

What is the preferred route of administration?

A

oral with adequate doses

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7
Q

What should be avoided when oral alternatives are available?

A

topical antibacterial agents

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8
Q

What is intravenous therapy needed for?

A

clinical symptoms of infection

CNS infection, joint infection, staph aureus bacteraemia, sepsis, oral route compromised

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9
Q

When should IV be used until?

A

there is clinical control of infection

indicators are returning to their reference range

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10
Q

What type of injection is more reliable?

A

IV more than IM

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11
Q

When should IV be switched to oral therapy?

A

in patients who have been on IV for 24-48 hours who have

settling temperature

falling indicators of infection

able to take oral therapy

oral therapy available

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12
Q

What is the BNF vs prescribed dose of penicillin?

A

BNF = 250-500mg four times a day

dose used = 500mg-1g four times a day

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13
Q

What is the BNF vs prescribed dose of gentamicin?

A

BNF = 80mg three times a day

dose used = 5-7mg/kg

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14
Q

What should patients therapy be modified based on?

A

patient factors
results of culture and sensitivity
patient response to therapy
therapeutic drug monitoring

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15
Q

Pharyngitis?

A

majority are viral, no antibiotic required

<20% bacterial

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16
Q

How to treat streptococcus pyogenes (pharyngitis)?

A

narrow spectrum penicillin

macrolide

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17
Q

Patient factors to consider with pharyngitis?

A

age - adult or child

penicillin allergy

oral administration (which formulation)

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18
Q

Otitis media?

A

usually viral or self limiting

symptoms for 2-3 days the they disappear

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19
Q

What causes otitis media and how to treat it?

A

haemophilus influenzae

penicillin e.g. amoxicillin
macrolide

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20
Q

Patient factors for otitis media?

A

normally a childhood condition

formulation

delayed prescribing - self limiting

surgical intervention (grommets)

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21
Q

What formulation is usually used for otitis media?

A

in a child so rarely use ear drops, liquid most likely

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22
Q

What causes sinusitis and how to treat it?

A

strep pneumoniae
haemophilus influenzae

penicillin e.g. amoxicillin
tetracycline

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23
Q

What is sinusitis?

A

sinuses are congested and infection grows

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24
Q

Patient factors of sinusitis?

A

nasal decongestants (potential rebound for congestion)
age
non drug treatments e.g. steam inhalation

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25
Why is tetracycline contraindicated in children?
it can affect growing bones and teeth (can discolour teeth)
26
What are symptoms of COPD?
increased wheeze, increased shortness of breath, increased sputum volume and purulence need 2/3 of these to have infective exacerbation of COPD
27
What is COPD?
chronic obstructive pulmonary disease
28
What causes exacerbation of COPD?
strep pneumoniae haemophilus influenzae moraxella catarrhalis
29
How to treat exacerbation of COPD?
penicillin tetracycline macrolide
30
What might be needed if exacerbation of COPD is severe?
IV therapy
31
Patient factors for lower respiratory tract infection?
``` possibility of recurrent infection previous therapy likely to be effective route of therapy (normally oral) patient age (likely to be older) other diseases (drug interactions) ```
32
What causes community acquired pneumonia?
strep pneumoniae haemophilus influenzae
33
Treatment of non severe CAP?
penicillin e.g. amoxicillin tetracycline macrolide (clarithromycin)
34
Treatment of moderate CAP?
ask about foreign travel possibility of legionella (esp if patient is confused) penicillin e.g. amoxicillin and either tetracycline or macrolide
35
Severe CAP treatment?
consider legionella if patient is confused macrolide (IV or oral as appropriate) and either penicillin (or penicillin with beta lactamase inhibitor) quinolone may be used in a patient with true penicillin allergy
36
How to treat early HAP?
within 4 days of hospital admission - treat as CAP
37
How to treat HAP within 7 days of discharge or 5 days after admission?
CURB <2 penicillin with beta lactamase inhibitor tetracycline
38
Within 7 days of discharge or 5 days after hospital admission (CURB<3)?
penicillin and extended spectrum penicillin
39
Pneumonia patient factors?
patient age - adult or child severity of infection (need for IV) severe infection may affect absorption comorbidities
40
What might need to be done if patient has sepsis?
may need to withhold other meds e.g. antihypertensives
41
Treatment of UTI?
male, female and pregnant woman all need to be treated differently
42
Uncomplicated UTI in men ad non-pregnant women cause?
E. coli proteus spp enterococci
43
Uncomplicated UTI in men ad non-pregnant women treatment?
trimethoprim nitrofurantoin
44
UTI in pregnant woman treatment?
nitrofurantoin penicillin
45
Women with upper UTI without sepsis?
trimethoprim nitrofurantoin
46
Men with upper UTI without sepsis?
trimethoprim penicillin with beta lactamase inhibitor
47
Upper UTI with sepsis treatment?
Women, men and pregnant women penicillin with beta lactamase inhibitor and aminoglycoside
48
UTI in pregnancy?
possibility of teratogenicity (much higher risk in 1st and 2nd trimester) which trimester?
49
Catheter with a UTI?
makes it hard to eradicate the infection without removing the catheter
50
Length of treatment for a UTI?
3 days may be enough
51
Additional counselling for a patient with a UTI?
avoid perfumed wipes, hygiene, post coital infections, increase fluids, avoid coffee
52
What causes cellulitis?
staph aureus, strep pyogenes
53
Treatment of mild cellulitis/erysipelas?
narrow spectrum penicillin tetracycline macrolide
54
Treatment of moderate cellulitis?
narrow spectrum penicillin | glycopeptide IV
55
Treatment of human or animal bite?
penicillin with beta lactamase inhibitor tetracycline and metronidazole
56
Patient factors for skin and soft tissue infections?
site of infection comorbidities age of the patient is the infection bacterial only (possibility of viral or fungal infection at the same time) is topical treatment possible
57
What is necrotising fasciitis?
a rapidly spreading infection caused by strep pyogenes
58
How to treat necrotising fascittis?
benzylpenicillin 2.4mg every 6 hours and flucloaxillin 2g every 4-6 hours gentamicin IV and clindamycin IV every 6 hours and metronidazole IV 500mg every 8 hours
59
What might be needed in necrotising fasctiitis?
surgical treatment to cut the infection away to stop it extending
60
Pyrexia of unknown origin?
sepsis or severe sepsis
61
Treatment of pyrexia of unknown origin?
penicillin and aminoglycoside IV glycopeptide IV and aminoglycoside iV
62
What might be difficult if a patient is hypertensive?
IV access
63
Clostridium difficile infection?
antibiotic associated diarrhoea related to broad spectrum antibacterial therapy
64
Treatment of non severe C diff?
metronidazole 400mg every 8 hours vancomycin 125mg every 6 hours
65
Treatment of severe C diff?
vancomycin 125mg every 6 hours
66
Treatment of complicated C diff?
vancomycin 125mg every 6 hours +/- metronidazole 400mg every 8 hours
67
Treatment of relapsing C diff?
consider faecal transplant, re-establishing the microbiome
68
Why is vancomycin given orally in C diff?
we want local treatment in the GI tract
69
Treatment of herpes simplex?
cold sores aciclovir topically
70
Treatment of herpes zoster?
chickenpox, shingle aciclovir 800mg five times a day valaciclovir 1g every 8 hours
71
Patient factors for viral infections?
age onset of symptoms formulation of treatment
72
When is antiviral treatment not appropriate for chicken pox?
when the patient has had it for more than 72 hours
73
How to treat tinea causing athletes foot?
antifungal powders/ointment
74
How to treat ringworm?
topical antifungal
75
What does candida cause?
oral and vaginal infections
76
How to treat vaginal infections caused by candida?
azole antifungals - usually oral e.g. fluconazole
77
Patient factors for candida infections?
age, other treatments e.g. inhaled or oral steroids
78
Prescribing factors?
allergies sensitivities under/over dosing resistance local differences side effects

Management of Infection (36 decks)

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