Q&A Flashcards
(104 cards)
1
Q
whenever possible treatment with aminoglycosides should not exceed
A
7 days
2
Q
when should once daily bolus regiments of aminoglycosides be avoided (3)
A
- endocarditis due to gram pos/ HACEK organisms
- burns over 20% of body surface area
- creatinine clearance of less than 20
3
Q
should aminoglycosides be used in pregnancy
A
No, risk of auditory and vestibular nerve damage in 2nd and 3rd trimester- worst with streptomycin
4
Q
primary excretion of aminoglycosides
A
renal- monitor closely in impairment
5
Q
what should you monitor with aminoglycosides
A
serum levels
renal function
auditory and vestibular function
6
Q
dosing in extremes of body weight
A
use ideal body weight to calculate dose
7
Q
when are once daily (high dose) dosing of amikacin not appropriate (3)
A
endocarditis
febrile neutropenia
meningitis
8
Q
when do you check gentamicin levels
A
after 3/4 doses, then at least every 3 days and after dose changes (more frequent if renal impairment)
9
Q
Which amino glycoside is too toxic for systemic use
A
Neomycin
10
Q
how often do you check renal function with tobramycin inhaler
A
once a year
11
Q
how late should is a missed dose of tobramycin inhaler
A
6 hours or more- skip dose and take next dose at usual time
12
Q
tobramycin with other inhalers?
A
take all other inhalers before your tobramycin inhaler
13
Q
can you use carbapenems in pregnancy
A
only if benefit outweighs risk…
14
Q
hypersensitivity reaction consideractions for carbapenems
A
avoid if history of immediate hypersensitivity from beta lactam antibacterials
15
Q
renal impairment with ertapenem
A
if eGRF is less than 30 max dose is 500mg/day because of the seizure risk
16
Q
which carbapenem has a risk of hepatotoxicity
A
Meropenem
17
Q
Primary excretion method of cephalosporins
A
renal
18
Q
False positives with cephalosporins
A
Coombs test
urinary glucose
19
Q
can you use cefalexin in pregnancy
A
Yes :)
20
Q
Cefalexin in renal impairment, max doses please
A
if eGFR 40-50= 3g/day
if 10-40= 1.5g/day
if below 10= 750mg/day
21
Q
Cefuroxime in renal impairment, max doses please
A
if eGFR 10-20 =750mg twice a day
if eGFR less than 10= 750mg once a dayw
22
Q
which cephalosporin can precipitate kidney stones
A
Ceftriaxone
23
Q
what should be monitored with ceftriaxone
A
full blood count
24
Q
Is vancomycin or teicoplanin more nephrotoxic
A
Vancomycin
25
teicoplanin and renal impairment
normal regiment days 1-4
if 30-80=normal dose every 2 days
if less than 30= normal dose every 3 days
26
what should we monitor with teicoplanin
serum trough levels after completion of loading dose
blood counts
liver function
kidney function
check for adverse effects if dose > 12mg/kg/day
27
what should we monitor in longer term vancomycin therapy
all acute monitoring +
leukocyte count
28
when should clarithromycin be avoided (impairment)
severe hepatic failure with renal impairment
29
the following 3 increase the risk of rash with amoxicillin
lymphocytic leukaemia
cytomegalovirus
glandular fever
30
IV use of benzylpenicillin sodium, ampicillin, co-amoxiclav and amoxicillin can result in this electrolyte imbalance
accumulation of sodium more common in renal impairment and high doses-> CNS toxicity
31
what should you monitor with long-term use of benzanthine benzylpenicillin
renal
hepatic
haemotopeotic function
32
important cross reactivity with benzathine benzylpenicillin
soy and peanut allergy
33
which electrolyte imbalance is common with piperacillin, flucloxacillin
Hypernatraemia (high sodium content)
34
Metronidazole monitoring parameters
only if treatment exceeds 10 days
35
liver damage with metronidazole
hepatic encephalopathy- give 1/3rd of dose as clearance is reduced
36
Co-amoxiclav with renal impairment
risk of crystalluria and electrolyte accumulation
dose reduction needed if eGRF below 30
37
Quinolones and tetracyclines considerations if going on holiday
avoid excessive exposure to sunlight and UV (for 48 hours after stopping with quinolones)
38
Can you use quinolones in pregnancy
NOPE
39
which conditions can be worsened by use of quinolones
long QT
diabetes (messes with blood sugar levels)
epilepsy
myasthenia gravis
psychiatric disorders
40
when would ciprofloxacin be used in pregnancy
single dose for prevention of secondary meningitis (UL)
41
which quinolone may cause bronchospasm and what do you do about it?
Levofloxacin
use short acting bronchodilator 15mins-4hours before subsequent doses
42
how late is a missed dose of levofloxacin
4 hours
43
why might levofloxacin be a bad choice for electrolyte disturbances
QT interval prolongation risk
44
Avoid moxifloxacin if
severe hepatic impairment or increased transaminases (5xULN)
45
Max dose of ofloxacin in hepatic impairment
400mg daily
46
what side effects would necessitate immediately stopping co-trimoxazole
blood dyscriasias
rash (SJS)
47
monitoring parameters for co-trimoxazole are
blood counts if prolongued
48
risks of co-trimoxazole with pregnant ladies
1st trimester- teratogenic
3rd timester- neonatal haemolysis and methaemoglobinaemia
49
in which impairments is co-trimoxazole not suitable?
severe liver disease
renal impairment if CrCl less than 15
50
Tetracycline use with a headache may indicate
Raised intracranial pressure- discontinue
51
Doxycycline for malarial prophylaxis can be used in pregnant women provided that...
The full course can be completed before 15 weeks gestation
52
What monitoring is needed with minocycline
if treatment is continued for longer than 6 months, check liver function, pigmentation and signs of lupus every 3 months
53
why should systemic chloramphenicol be reserved for life-threatening indications?
Can cause serious haematological side effects
54
what happens if chloramphenicol is given in pregnancy
3rd trimester= grey baby syndrome
55
what happens if chloramphenicol is given during breast feeding
may cause bone marrow suppression of infant- avoid
56
which patients should you monitor serum levels of chloramphenicol
hepatic impairment
elderly
57
which impairment should you avoid fosfomycin
renal impairment if CrCl <10
58
how long should fucidic acid be used
no longer than 10 days
59
in systemic use, what effect does fucidic acid have on the liver
elevated liver enzymes, hyperbillirubinaemia, jaundice (reversible on discontinuation)- monitor liver function with high doses/ prolonged therapy/ if concurrent use of hepatic drugs
60
which diseases would need close observation & BP monitoring with linezolid
uncontrolled hypertension
phaechromocytoma, carcinoid tumour, thyrotoxicosis, bipolar depression, schizophrenia, acute confusion
61
Linezolid monitoring
weekly FBC
62
monitoring for trimethoprim
if at risk of folate deficiency + long term- blood counts
if at risk of hyperkalaemia- electrolytes
renal function
63
can you take trimethoprim in pregnancy
no way- teratogenic in 1st trimester
64
what is the initial phase of usual treatment for tuberculosis
rifampicin, ethambutol, pyrazinamide, isoniazid for 2 months
65
what is the continuation phase of usual treatment for tuberculosis
rifampicin and isoniazid for a further 4 months (or 10 months if CNS involvement)
66
what is the treatment of latent TB
3 months of isoniazid (+ pyridoxine) and rifampicin
or
6 months of isoniazid (+pyridoxine)
67
define treatment interruption of TB
2 weeks of initial phase or 20% of course
68
what consideration should there be for rifampicin therapy in a 25 year old woman
efficacy of hormonal contraception is reduced
69
monitoring for rifampicin & isoniazid
- renal function before treatment
- hepatic function before treatment and if symptoms pop up later/ alcoholic
- blood counts if prolonged therapy
70
what is the role of pyridoxine hydrochloride in TB treatment
reduces risk of peripheral neuropathy from isoniazid
71
define a recurrent UTI
at least 2 episodes in 6 months / 3+ episodes in 12 months
72
Nitrofurantoin may be withdrawn due to
pulmonary reactions
73
What should be monitored with Amphotericin B
hepatic, renal, blood count, electroltes
74
consideration for IV amphotericin B
test dose 30 mins before with close supervision as anaphylaxis is common
(if absolutely essential in those with previous infusion section can premeditate with antipyretics/ hydrocortisone)
75
Fluconazole + rash
discontinue- SCARS more common with AIDS
76
use initial dose of fluconazole, then half subsequent doses if...
CrC< 50
77
Itraconazole should be avoided, unless the infection is severe if
ventricular dysfunction- can precipitate heart failure (esp with concurrent renal impairment)
hepatic impairment - hepatotoxic
78
which conditions can reduce absorption of itraconazole
AIDS
neutropenia
79
itraconazole with WOCBP
ensure effective contraception until period after end of treatment
80
Grisefulvin and contraception?
women need effective contraception for at least 1 month after treatment, men need for 6 months after treatment
Oral contraceptives efficacy is reduced
81
Malaria prophylaxis if epileptic
doxycycline (may interact with anti epileptics) or atorvaquone with proguanil
82
Malaria prophylaxis in pregnancy
chloroquine
proguanil hydrochloride (with folic acid
mefloquine if 2nd/ 3rd trimester
doxycycline if can complete before 15 weeks gestation
83
Malaria prophylaxis with warfarin
start prophylaxis 2-3 weeks before trip so INR can stabilise
84
Malarone should be avoided if
CrCl<30
85
How to take malarone
1 tab once a day
start 1-2 days before entering endemic region and continue for 1 week after leaving
if vom/ diarrhoea this may reduce absorption
86
How to take Avloclor
once a week
start one week before
continue for 4 weeks after
87
Overdose features of avloclor
arrhythmia and convulsions- very difficult to treat
88
how to take lariam
once a week
2-3 weeks before entering, 4 weeks after leaving
89
lariam and WOCBP
continue adequate contraception for 3 months after stopping (long half life)
90
define long covid
symptoms are longer than 4 weeks
91
WOCBP with molnupiravir
use effective contraception during treatment and for 4 days after
also avoid breast feeding for 4 days after last dose
92
Patient with HIV and COVID-19 should avoid
nirmatrelvir- can cause resistance to HIV drugs
93
Nirmatrelvir with WOCBP
reduced efficacy of OHC
use effective contraception until completion fo one menstrual cycles after stopping
avoid breast feeding for 1 week
94
when does HIV turn to AIDS
when CD4 drops to below 200 cells/ microlitre
95
which drug is preferred in pregnant women with influenza
oseltamivir
96
consideration for zanamivir in children and teens
neurological and psychiatric disorders more common
97
zanamivir with asthma or COPD
bronchospasm- SABA should be available,
avoid in severe unless can monitor very closely
98
which drugs increase risk of C. diff infection?
clindamycin, cephalosporins (esp 3rd and 4th gen), fluroquinolones, broad spec penicillins, PPIs
99
how late can you present for treatment of gonorrhoea
14 days since exposure
100
how long til you worry about a cough
3-4 weeks
101
deadline for hospital to give antibiotics for pneumonia
4 hours since diagnosis
102
deadline for hospital to give antibiotics for sepsis
1 hour since diagnosis
103
CURB65 used in pneumonia stands for
confusion, uremia, respiratory rate, BP, age ≥ 65 years
admit if >2
104
H. pylori irradiation
PPI + 2x antibacterials (usually amoxicillin + clarithromycin/ metronidazole)
