bacterial infection

Question 1

If patient is allergic to penicillins, which other classes of abx should they avoid?

Answer 1

cephalosporins and carbapenems (as they are also b lactams) esp if pt has immediate hypersensitivity

Question 2

trimethoprim = which electrolyte disturbances?

Answer 2

hyperkalaemia

hyponatraemia

Question 3

gentamicin peak and trough levels for norm and for endocarditis:

Answer 3

norm: peak 5-10mg/L trough <2
endocarditis: 3-5mg/L trough <1

Question 4

electrolyte disturbances with aminoglycosides?

Answer 4

hypomagnesaemia

hypokalaemia

Question 5

which classes of abx are nephrotoxic?

Answer 5

aminoglycosides

glycopeptides

Question 6

examples of each gen of cephalosporins:

Answer 6

1st: cefalexin
2nd: cefuroxime
3rd: ceftriaxone

Question 7

which abx classes can cause ototoxicity?

Answer 7

aminoglycosides
glyopeptides
macrolides

Question 8

glycopeptide trough level pre dose? norm and for endocarditis

Answer 8

norm: 10-15mg/L
endocarditis: 15-20mg/L

Question 9

if you adminster vancomycin IV too rapidly, what can happen?

Answer 9

thrombophlebitis presented as red man syndrome (flushing)

Question 10

macrolides are enzyme inhibitors therefore avoid use of? (give examples)

Answer 10

inducers e.g. carbamazepine, theophylline, warfarin, statins

Question 11

macrolides and pregnancy?

Answer 11

CCP, EE! (clarithromycin contraindicated pregnancy, erythromycin embroyos! (so is ok))

Question 12

metronidazole (for anaerobic targets) side effects?

Answer 12

GI (take with/after food)
taste disturbance
furry tongue
sore mouth
- avoid alcohol

Question 13

administration difference between benzylpen and phenoxymethylpen

Answer 13

benzylpen IV or IM only (not PO)

phenoxymethylpen can be given orally

Question 14

broad vs narrow spec penicillin examples?

Answer 14

broad: amoxicillin, tazocin
narrow: benzylpen, phenoxymethylpen

Question 15

quinolone interactions?

Answer 15

theophylline/NSAIDs are CI as reduces seizure threshold

caution with warfarin as increases INR

Question 16

3 main points for quinolones?

Answer 16

• report muscle pain (tendonitis MHRA alert)
• reduces seizure threshold so CI in epileptics
• causes QT prolongation

Question 17

which abx class is only suitable for those above 12 years?

Answer 17

tetracyclines

Question 18

which tetracyclines do you need to avoid milk with and which can you take milk with?

Answer 18

milk allowed? Does Like Milk (doxy, lyme, minocycline)
milk not allowed? DOT (demeclocycline, oxytetracycline, tetracyline)

• ALL tetracyclines though, you need to avoid indigestion remedies 2hrs before or after

Question 19

tetracycline interactions?

Answer 19

isotretinoin, lithium, warfarin and statins

Question 20

which class of abx can cause intracranial hypertension?

Answer 20

tetracyclines

Question 21

what class of abx is co-trimoxazole in?

Answer 21

sulphonamides (the only one)

Question 22

interaction with Na valproate and which abx?

Answer 22

meropenum

Question 23

SE of co-trimox?

Answer 23

SJS/skin rashes

Question 24

rifampicin 2 key points?

Answer 24

• enzyme inducer. CI contraceptives, use IUD

- hepatotoxic so patient to report signs

Question 25

which abx should you avoid tyramine foods with?

Answer 25

linezolid and isoniazid

Question 26

patient to report what when on linezolid?

Answer 26

visual symptoms as can cause optic neuropathy

Question 27

patient to report what when on trimethoprim?

Answer 27

fever/sore throat/rash as blood dyscrasias is a side effect

Question 28

which abx colours urine yellow/brown?

Answer 28

nitrofurantoin

Question 29

best abx for pregnancy?

Answer 29

penicllins, cephalosporins, clindamycin, meropenum

Question 30

trimeth and nitro when to avoid in pregnancy?

Answer 30

trimeth avoid in 1st trimester | nitro avoid at term

Question 31

most likely abx to cause c.diff?

Answer 31

Clindamycin, Cephalosporins, Broad spec pens, Fluoroquinolones, PPIs (crazy chimps buy fluorescent poo)

Question 32

c.diff tx?

Answer 32

1st ep: PO metronidazole 10-14 days | subsequent: vanc or last line fidoxamicin

Question 33

endocarditis tx?

Answer 33

amoxicillin +/- low dose gent

Question 34

UTI tx?

Answer 34

nitro 100mg BD MR or trimeth 200mg BD - 3 days for women, 7 days for everyone else inc pregnant women

Question 35

CAP tx:

Answer 35

mild: amox mod: amox + clarith OR doxy alone severe: benzylpen + clarith/doxy

Question 36

HAP tx:

Answer 36

early onset? co-amox | late onset? BS ceph

Question 37

meningitis tx:

Answer 37

benzylpen or cefotaxime if pen allergy (chloramphenicol is immediate pen allergy)

Question 38

osteomyelitis tx:

Answer 38

flucloxacillin long term usually

Question 39

imetigo tx?

Answer 39

local? fusidic acid 7 days | spread? flucloxacillin 7 days

Question 40

cellulitis tx:

Answer 40

fluclox

Question 41

animal/human bites tx:

Answer 41

co-amox OR doxy + met

Question 42

MRSA tx?

Answer 42

tetracycline or if severe, vanc

Question 43

oral/dental infection tx:

Answer 43

metronidazole 200mg TDS for 3/7 | OR amox/doxy

Question 44

sore throat tx (caused by strep):

Answer 44

phenoxymethylpen or benzylpen if severe, remember benzylpen only IV or IM

Question 45

sinusitis tx?

Answer 45

amox/clarith/doxy

Question 46

otitis externa tx:

Answer 46

flucloxacillin

Question 47

otitis media tx:

Answer 47

amoxicillin

Question 48

TB tx:

Answer 48

1. RIPE (rifampicin, isonazid, pyrazinamide, ethambutol) for 2 months - isonazid causes peripheral neuroathy so always given with pyroxidine - ethambutol; patient to report visual changes 2. then continue rifampicin and isonazid for 4 further months

Question 49

which abx causes urine/tears/contacts red/orange/yellow?

Answer 49

rifampicin

Question 50

h.pylori tx:

Answer 50

triple therapy for 7 days: 1. PPI 2. amoxicillin 3. clarithromycin or metro (both used if pen allergy so cant use amox)

Question 51

abx with food?

Answer 51

``` metro pivemecillinam itraconazole nitrofurnatoin cefuroxime ```

Question 52

abx on empty stomach?

Answer 52

``` azithromycin phenoxymethylpen fluclox oxytetracycline rifampicin ```

Question 53

abx with full glass of water?

Answer 53

clindamycin doxycycline metronidazole