Antimic Flashcards
4 types of antimicrobials
antibiotics
antivirals
antifungals
antiparasitics
the human microbiome is made up of harmless bacteria that the body needs to function, however what can occur when these bacteria translocate to different parts of the body
infection
what is intrinsic resistance
inherent natural ability of bacteria to be resistant to abx without mutation or getting additional genes
what 4 mechanisms of intrinsic resistance exist
cellular envelope
multi drug efflux pumps
lack of drug targets
enzymes
what type of resistance involves impermeable cellular envelopes that prevent abx from entering
cellular envelope
efflux pumps are on bacterial cell walls and pump abx out, are they associated with gram positive / negative bacteria
gram negative
give one example of lack of drug targets in the context of resistance
penicillins cant be used for mycoplasma because they work on bacterial cells walls and mycoplasma has no cell wall
give an example of enzymes in the context of resistance
some bacteria produce beta lactamase destroys beta lactam rings
define extrinsic bacterial resistance
resistance due to modifications to genome due to environmental factors or gene transfer
what 2 mechanisms of extrinsic resistance exist
horizontal gene transfer and mobile genetic elements
mechanism/ type of extrinsic resistance that is characterised by exchange of genetic info between bacteria
horizontal gene transfer
mechanism/ type of extrinsic resistance that involves jumping plasmids - facilitate transfer of genes between patients
mobile genetic elements
what types of abx are mrsa resistant to
b lactamase abx’s (penicillins)
what type of abx is CRE resistant to
carbapenem based
what superbug is resistant to both penicillins and carbapenem based abx
esbl
what superbug exhibits resistance to vancomycin adn carbapenem based abx and therefore should not be used for a long time
vre
if carbapenem based abx are ineffective is there anything that can be done for those patients yes or no
no
what is meant by antimicrobial stewardship/ ams
organisation approach to promoting and monitoring safe use of antimicrobials
when assessing patients what should you look for evidence of
bacterial infections
some infections are self limiting, if patients present with a fever over 38 degrees is this usually indicative of a viral or bacterial infection
viral
sometimes starting abx can cause more harm to patients, give one example of where this can be the case
risk of c diff
risk of AMR
c diff is gram positive and grows when the gut microbiota is disturbed by abx use causing severe diarrhoea, give one treatment option
faecal transplant
before starting abx treatment a comprehensive risk assessment should be done, what things might you consider
recent abx use or immunocompromised?
would empirical treatment be done with broad or narrow spectrum abx in the short term
broad
what different cultures can be done whilst trying to focus treatment
blood urine faecal cultures
throat and wound swabs
what imaging would you expect when trying to make a diagnosis of pneumonia
CXR
lab investigations may show increased inflamm markers such as
WCC neutrophils lymphocytes CRP
lab investigations look at trends, what might an increase in inflammatory markers indicate about treatment
not working so consider switch
if sepsis is present treatment should be started within what time frame
1h
what are the risks associated with fake pencillin allergies
inc costs
longer hospital stays
trenicillin allergies are mediated by IgE and occur in first 1h of drug
give 3 ways this may manifest
hives
urticaria
anaphylaxis
names of serious life threatening systemic allergic reacs
(drug allergy)
TENS
SJS
DRESS syndrome
pustulosis
difference between allergy (hypersensitivity) and SE
allergy: immunological
SE and intolerance: pharmacological
genetic susceptibilty to ADR = X
idiosyncrasy
various mechanisms mimics allergy = X
pseudo allergy
3 things to consider after checking penA label
allergy hx
risk stratification
specialist/ non allergy specialist de-labelling
what about allergy hx should you find out
reaction description
reaction timing
indication for pen presc
what to consider for pen allergy risk stratification
high/ low risk
isolated symptoms unlikely to be allergic
symptoms suggestive of type 1/ 4 hypersensitivity
what about pen allergy specialist/ non allergy specialist delabelling to check
direct bedside de-labelling?
direct oral pen challenge?
does px need referral to an allergy specialist?
when documenting what things is it important to note down
differential diagnosis
current evidence
treatment regimen
stop or review date
patients should be reviewed how many hrs after abx initiation
‘FOCUS’ part of start SMART then FOCUS
48-72 hrs
what actions can be taken after abx have been reviewed (CARES)
cease
amend
refer
extend
switch
who can you refer patients to or involve in your decision making process in the context of antimicrobial therapy
complex outpatient antimicrobial team
why does it take time for abx to penetrate and treat prostate
it is made of dense material
thus course lengths diff for prostatis and sinusitis
what are the advantages of IVOS IV oral switch
shorter hospital stay
reduced risk of first line and associated hospital reactions eg catheter assoc infecs
why should inappropriate abx regimens like 5/7 or 7/7 be challenged
no longer appropriate
why should co amox not be switched ivos too early
poor iv to oral ba so wont get above mic
daptomycin is used for staph aureus but has no oral option true or false
true
why are quinonlones good abx in the context of ivos
good iv to oral ba so can start oral
why can vancomycin when given po not be used for serious infections
only has local effect in gi tract
oral option not systemically effective
what can the target toolkit for abx prescribing help pharmacists do
check abx appropriateness
patient understanding
aid prescribing
// Common infections in secondary care
what are 3 common pathogens that cause cellulitis
s pyogenes
staph aureus
pseudamonas
name 3 drugs that when IVOS switch they have good IV -> PO BA
ciprofloxacin
levofloxacin
co-trimoxazole
simple cases of cellulitis can be treated within what time frame
5-7 days
if cellulitis is around the face or eyes why would patients be given co amoxiclav
more gram negative bacteria
true or false, diabetics with cellulitis are treated with co amoxiclav because they usually present with more severe gram negative bacteria
true
3 types of pneumonia
cap
hap
aspiration
what type of pneumonia is caused by inhalation of non air substances
aspiration
which type of pneumonia is commonly caused by the following
streptococcus pneumoniae
haemophyllus
moraxella
cap
which type of pneumonia is commonly caused by oral flora and streptococcal species
aspiration
which type of pneumonia is commonly caused by staph aureus, gram negative bacteria, legionella, and rarely pseudamonas
hap
hap is pneumonia >Xhrs after hospital admission
48
what investigations can help confirm a diagnosis of pneumonia
cxr
sputum cultures
bronchoscopy
viral throat swabs
the curb 65 score is used for patient mortality and looks at new confusion, high urea, hypotension, rr above 30 and age above 65. Why might it be misleading for younger patients
can maintain sats so score low but be clinically unwell
whats higher curb 65 score assoc with
greater risk fo death
what drug is traditionally used to treat hap in anyone that has a curb 65 score of 3 or 4 (high risk)
levofloxacin
what 7 common infections are under pharmacy first scheme
uti
shingles
impetigo
insect bite
sore throat
sinusitis
acute otitis media
what drug used to treat uti
nitrofurantoin
what drug used to treat shingles
aciclovir
valaciclovir
what drug used to treat impetigo
hydrogen peroxide cream
fusidic acid cream
flucloxacllin
clarithromycin
erythromycin
what drug used to treat insect bite
fluclox clarithro erythro
what drug used to treat sore throat
pen v
clarithro
erythro
what drug used to treat sinusitis
mometasone/ fluticasone nasal spray
pen v
clarithro
erythro
doxycycline
what drug used to treat acute otitis media
phenazone + lidocaine ear drops
amoxicillin
clarithro
erythro
the pharmacy first scheme only allows you to treat simple utis in young women from 16 to
64
give 3 diagnostic symptoms of uti, 2 of which patients must have before recieving abx
burning pain
passing more at night
cloudy urine
what is the treatment regimen of nitrofurantoin for simple uti
100mg mr 3/7
for uti px must be referred if systemically unwell, have kidney pain or tenderness or show signs of upper uti or pyelonephritis. List some different signs of upper uti/pyelonephritis
shaking
fever
chills
trimethoprim 200mg bd 3/7 can be used for utis but why is it not first line anymore
e coli is resistant to drug
list some causative organisms for uncomplicated uti
e coli
klebsiella
staph
list some causative organisms of complicated uti
esbl
pseudomonas
if patients present with sore throats you should perform a feverpain score, what score would indicate they require abx treatment
3-4
what abx may be used to treat sore throats
phenoxymethyl
clarithro
erythro
there are many red flag symptoms for sore throats that would indicate referral, but what different conditions might prompt referral
quinsy
scarlet fever
glandular fever
patients with sore throats that are immuncompromised should referred as well as those with
persistent mouth ulcers
unable to swallow mass
unilateral swelling present
why is this
could be malignancy
urgent referral for what groups of px showing acute otitis media (earache)
px very unwell w systemic features
or px at high risk of complications due to comorbidities eg children w significant heart lung kidney disease severe immunosuppression CF
infected insect bites should only be treated with abx if they show signs of infection, what kind of things would you be looking out for
redness
swelling
pus
hot to touch
referral criteria for insect bites
human/animal/etc bite from outside UK
severe pain out of proportions to wound
significant comorbidities and systemically unwell
sinusitis is usually self limiting over 10 days however if certain symptoms are present patients may benefit from abx therapy, what are these symptoms
teeth hurt
nasal discharge
facial pain
name 3 common fungal infections that are seen in practice
candidiasis
aspergillosis
mucormycosis
why should question patients that are started on ampho b very early
very broad spec and used last line
why is it important to consider drug interactions and toxicity particularly when giving antifungals
many are cyp450 enzyme inhibitors
