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HIV & Infections > advanced infections > Flashcards

advanced infections Flashcards

1
Q

what is the key principle when developing antimicrobial agent

A

selective toxicity: need to kill/inhibit growth of pathogenic cells but have no effect on host cells (human)

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2
Q

give examples of commonly prescribe antibiotics that require monitoring

A

-Gentamicin
-Vancomycin
-Teicoplanin
-Amikacin
-Tobramycin
-Chloramphenicol (I/v use)

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3
Q

what bacteria does gentamicin mainly target

A

-gram negative which is usually responsible for urosepsis (sepsis caused by UTIs)

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4
Q

what are the side effects of gentamicin associated with ears

A
  • cochlear and vestibular apparatus damage = loss balance, tinnitus (ringing in ears), hearing loss
    -concurrent use with ototoxic diuretics e.g. furosemide = increased risk of ototoxicity
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5
Q

what are the side effects of gentamicin associated with kidneys

A

-renal damage as nephrotoxicity risk increased with prolonged treatment
-not to use with other nephrotoxic drugs
-use with ototoxic diuretics = nephrotoxicity risk increased

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6
Q

can gentamicin cause allergic reaction and what is associated with this

A

yes and nausea, vomiting and rashes

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7
Q

what is gentamicin contraindicated in?

A

severe renal impairment and pregnancy

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8
Q

how to prevent ototoxicity and nephrotoxicity with gentamicin

A

dose according to ideal body weight (if they are obese) and monitor plasma conc to avoid accumulation

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9
Q

what are the 2 ways to administer and monitor gentamicin therapy

A
  1. multiple dosing regimen = monitoring peak levels approx 30 mins after admin & trough level (prior to admin). ( mainly used in heart infections e.g. endocarditis)
  2. Hartford nomogram = consistent dose of 7mg/kg calc from lower value of ideal weight or actual weight…. plasma con mesaured 6-14hrs post 1st dose = dosage interval …. this used to determine if dosing should be every 24 or 36 or 48 hrs
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10
Q

what bacteria causes TB

A

mycobacterium tuberculosis & occasionally M. bovis or M. africanum

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11
Q

what is mycobacterium

A

slow growing aerobic rod shaped bacteria which increases with poor social conditions, inadequate nutrition, and overcrowding
-has lipid rich cell wall = retains dyes & resists decolourisation with acid (acid fast bacilli)

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12
Q

how is TB spread

A

inhalation of droplets, meaning lungs first infected, but has to be prolonged close contact

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13
Q

what is the host initial response to TB

A

-cell mediated immune system response .
-disease may reactivate if immunity falls at later stage = 10% estimated lifetime risk

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14
Q

what happens if TB spreads from primary focus to the rest of the body

A

resolve spontaneously or develop into localised infection (limited to specific area / organ) e.g. meningitis

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15
Q

name some risk factors associated with TB

A
  • Social deprivation – overcrowding e.g. prisons, poverty, homelessness
  • HIV
  • Diabetes
  • Malignancy
  • TNF antagonist therapy
  • Immigration e.g. cities, from high incidence area
  • Close contacts of TB cases
  • Living in high incidence area
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16
Q

what symptoms are associated with TB

A

-mimics inflammatory & malignant diseases
- early stages symptomless
-presents with : chronic cough, haemoptysis(coughing up blood), shortness of breath,
fever & weight loss

17
Q

presenting symptoms of TB meningitis (when its spreading)

A

fever, headache, neck stiffness and slowly deteriorating level of consciousness

18
Q

what is miliary TB

A

-minute tubercles form in different organs due to spread of bacilli through body in blood
-more common in infants/ young children

19
Q

what is common in advanced TB and what does this affect

A

-extra-pulmonary TB
which affects liver, spleen, pancreas,
bone marrow

20
Q

how is TB diagnosed

A

clinical signs and symptoms, radiographic appearances and
laboratory investigations

21
Q

what investigation required in TB

A
  • 3 sputum samples for microscopy and culture = test for presences of acid fast bacilli
  • chest x ray
22
Q

what treatment regimen is used for TB and why

A

-Combination treatment = prevent drug resistance
- Prolonged treatment as bacteria grows slow…. 6 months treatment recommended

23
Q

what are the 2 phases for TB treatment

A
  • Initial phase for 2 months – rifampicin, isoniazid, pyrazinamide & ethambutol
    = eradicate actively growing & semi-dormant bacilli.
  • Continuation phase for 4 months – rifampicin & isoniazid= eliminate residual bacilli & reduce the risk of treatment failure or relapse
24
Q

how does treatment in CNS TB differ

A
  • for 12 months and a glucocorticoid added in beginning of treatement e.g. prednisolone, dexamethasone
25
Q

at what point is pulmonary tb usually not infectious

A

after 2 weeks with appropriate treatment

26
Q

what are the risk factors for MDR- TB in uk

A

-prior tb treatment + failure
-male gender
-HIV positive

27
Q

what is offered for patients who cannot comply to treatment for TB

A

directly observed therapy offered
-mainly offered to homeless or drug or alcohol misusers

28
Q

name side effects of TB treatment

A

-GI symptoms
- Non-gouty polyarthritis - pyrazinamide
- Rash – rifampicin
- Urine and bodily fluid discolouration - rifampicin
- Drug fever – temperature > 39°C & patient well
- Hepatotoxicity
- Peripheral neuropathy - isoniazid
- Flu-like symptoms - rifampicin
- Optic neuritis – ethambutol

29
Q

when is pyridoxine prophylactically given in TB and what does this do

A
  • patients with diabetes, alcohol
    dependence, chronic kidney disease, pregnancy, malnutrition, and HIV infection.
  • reduces the risk of peripheral neuropathy with isoniazid
30
Q

how is adherence to TB medication promoted

A

-Urine drug assays
- Examination of urine colour
- Tablet counts
- Controlled dosage systems
- Tablet diaries
- Signed care contracts
- Incentive schemes
- Reminder letters
- Education & Information
- Liquid formulation as appropriate
- DOT (directly observed therapy)

31
Q

what vaccine is available for TB

A

BCG

HIV & Infections (4 decks)

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