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BASIC - PAEDIATRICS Flashcards

1
Q

Name of NSAIDs?

A

Ibuprofen

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2
Q

Indications of NSAIDs?

A
  • PRN for mild-to-moderate pain

- Regular treatment of pain related inflammation

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3
Q

Mechanism of NSAIDs?

What is the selective cox inhibitor?

A
  • Inhibit synthesis of prostaglandins from arachidonic acid by inhibiting cyclooxygenase (COX)
  • COX-1 stimulates prostaglandin synthesis essential to preserve gastric mucosa, maintain renal perfusion (by dilating afferent glomerular arterioles) and inhibit thrombus formation at the vascular endothelium
  • COX-2 expressed in response to inflammatory stimuli stimulates production of prostaglandins that cause inflammation and pain
  • Therapeutic benefits of NSAIDs are principally COX-2 inhibition and adverse effects by COX-1 inhibition
  • Selective COX-2 inhibitors (e.g. etoricoxib) developed to reduce the adverse effects
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4
Q

SE of NSAIDs?

A
  • GI toxicity
  • Renal impairment
  • Increased risk of MI/CVA
  • Fluid retention
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5
Q

Interactions of NSAIDs?

A 
-	GI Ulceration
o	Aspirin, corticosteroid
-	GI bleeding
o	Anticoagulants, SSRIs, venlafaxine
-	Renal Impairments
o	ACEi, diuretics
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6
Q

Contraindications of NSAIDs?

A

o Severe renal impairment
o Heart Failure
o Liver failure

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7
Q

Caution of NSAIDs in prior?

A

o Peptic ulcer disease
o GI bleeds
o CVD

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8
Q

Prescription of NSAIDs?

A
  • Available as tablets, suspensions, gels, suppositories, injectable
  • Acute pain treatment should be stopped when resolved
  • Taken with food to minimise GI upset
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9
Q

What to warm patients on NSAID use?

A
  • Warn patients that the most common side effect is indigestion and advise them to stop treatment and seek medical advice if this occurs
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10
Q

Communication when on NSAIDs?

A
  • For patients with acute pain, explain that long-term use, e.g. beyond 10 days, is not recommended due to the risk of side effects
  • Advise patients requiring long-term treatment (particularly if they have renal impairment) to stop NSAIDs if they become acutely unwell or dehydrated to reduce the risk of damage to the kidneys
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11
Q

What other drug should be considered?

A
  • Can use gastroprotection for patients at increased risk
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12
Q

What is the general dose for NSAIDs in children?

A

3-4 times a day, maximum dose 30mg/kg/day

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13
Q

What is the dose of NSAIDs for children 10-11 years and 12-17 years?

A

o For Child 10–11 years
 300 mg 3 times a day; maximum 30 mg/kg per day; maximum 2.4 g per day.
o For Child 12–17 years
 Initially 300–400 mg 3–4 times a day; increased if necessary up to 600 mg 4 times a day

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14
Q

Indications for paracetamol?

A
  • 1st line analgesic for acute and chronic pain

- Antipyretic

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15
Q

Mechanism of paracetamol?

A
  • Weak cyclooxygenase (COX) inhibitor, involved in prostaglandin metabolism
  • Increase pain threshold and reduce (PGE2) concentrations in thermoregulatory region, controlling fever
  • Specifically, COX-2 isoform (inflammation) rather than COX-1 isoform (protecting gastric mucosa, regulating renal blood flow and clotting)
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16
Q

SE of paracetamol?

Describe mechanism of overdose and treatment?

A
  • Few side effects
    o Metabolised by CYP450 enzymes to toxic N-acetyl-p-benzoquinone imine (NAPQI) which is conjugated with glutathione before elimination
    o NAPQI accumulation causes hepatocellular necrosis
    o Treated with acetylcysteine
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17
Q

Interactions of paracetamol?

A
  • CYP450 inducers increase the rate of NAPQI production and risk of liver toxicity after paracetamol overdose
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18
Q

Dose reduction of paracetamol?

A
  • Dose reduced in liver toxicity
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19
Q

Caution of paracetamol?

A

o Chronic excessive alcohol use
o Malnutrition
o Low body weight
o Hepatic impairment

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20
Q

Prescription of paracetamol?

A
  • Oral paracetamol can be purchased in retail outlets7
  • Regular administration or PRN
  • Available as tablets, caplets, capsules, soluble tablets or oral suspensions
  • IV is possible
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21
Q

Communication to patient of paracetamol?

A
  • Effects should be felt around half an hour after taking it
  • Warn them not to exceed the recommended maximum daily dose because of the potential risk of liver poisoning
  • Advise them that many medicines purchased from the chemist (e.g. cold and flu preparations) contain paracetamol
  • Warn them to check the label
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22
Q

General dosage of paracetamol in children 10-15 years and 16-17 years?

A

o Child 10-15 years
 480-750mg every 4-6 hours, max 4 doses
o Child 16-17
 0.5-1g every 4-6 hours, max 4 doses

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23
Q

Indication for oxygen?

A
  • Hypoxaemia
  • Accelerate reabsorption in pneumothorax
  • Reduce half-life of carboxyhaemoglobin in carbon monoxide
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24
Q

Mechanism for oxygen?

A
  • Supplemental oxygen therapy increased the PO2 in alveolar gas, driving more rapid diffusion into blood
  • Increases delivery of oxygen to the tissues
  • In pneumothorax, oxygen reduces nitrogen fraction in alveolar gas to accelerate nitrogen diffusion out of body
  • Oxygen competes with CO to bind with haemoglobin and thereby shortens the half-life of carboxyhaemoglobin
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25
Q

SE of oxygen?

A
  • Discomfort of facemask

- Dry throat

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26
Q

Any interactions in oxygen?

A

None

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27
Q

Contraindications of oxygen?

A
  • Caution in Type 2 Respiratory failure (COPD)

- Avoid around naked flames, heat sources or smoking

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28
Q

Prescription of oxygen?
Different deliveries for different indications?
Doses?

A
  • Target oxygen saturation 94-98%
  • Initial delivery device, use reservoir (non-rebreathe) mask in critical illness, use nasal cannula for everyone else
  • Reservoir mask allows highest oxygen concentration and flow rate should be 15L/min
  • Nasal cannula delivers variable oxygen concentrations between 24-50% at flow rates of 2-6L/min
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29
Q

Communication in oxygen?

A
  • Should be kept in place continuously but may briefly be removed for eating and drinking
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30
Q

Monitoring of oxygen?

A

o SpO2 monitoring

o ABG

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31
Q

Names of common beta-2 agonists?

A
  • Short-Acting
    o Salbutamol, Terbutaline
  • Long-Acting
    o Salmeterol, formoterol
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32
Q

Indications of beta-2 agonists?

A
  • Asthma – short acting as step 1, long-acting as step 3 (must be given with inhaled corticosteroids)
  • Hyperkalaemia – nebulised salbutamol (in addition to insulin, glucose, calcium gluconate) in emergency treatment
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33
Q

Mechanism of beta-2 agonists?
What happens in high doses?
Specific long acting SE?

A
  • Beta2-receptors found in smooth muscle of bronchi, GI tract, uterus, blood vessels
  • Stimulation of GPCR leads to smooth muscle relaxation – improves airflow
  • Stimulate Na/K/ATPase pump causing K+ to move into cells – treat hyperkalaemia in addition to insulin
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34
Q

SE of beta-2 agonists?

A
  • ‘Fight-or-flight’ effects
    o Tachycardia, palpitations, anxiety, tremor
  • Gluconeogenesis, may increase serum glucose
  • High doses
    o Serum lactate levels increased
  • Long-acting
    o Muscle cramps
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35
Q

Interactions of beta-2 agonists?

A
  • Beta-blockers reduce effectiveness
  • Hypokalaemia
    o Concomitant use with theophylline, corticosteroids
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36
Q

Contraindications of beta-2 agonists?

A
  • Long-acting only prescribed in asthma with inhaled corticosteroid
    o As associated with increased asthma deaths
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37
Q

Caution of beta-2 agonists?

A

o CVD – tachycardia promote angina, arrhythmias
o Hypokalaemia
o Diabetes

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38
Q

Prescription of beta-2 agonists?

A
  • PRN prescription
    o Use 2 puffs every 4 hours, up to 10 if needed
    o If more, then hospital
  • Can be administered aerosol (MDI), dry powder, nebulised, in combination with steroid (Symbicort, Seretide)
  • Spacer provided to improve airway deposition and treatment efficacy
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39
Q

Communication of beta-2 agonists?

A
  • Medicine will make their airways relax and therefore improve their breathing
  • Treats the symptoms, not the disease
  • Clear on how and when to take the inhaler (e.g. for acute symptoms, pre-emptively before exercise or regularly for long-acting medication)
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40
Q

Monitoring of beta-2 agonists?

A
  • Monitored via peak expiratory flow rate (PEFR)
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41
Q

Name of antimuscarinics?

A

Ipratropium, tiotropium, glycopyrronium

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42
Q

Indications of antimuscarinics?

A
  • Acute exacerbation (short-acting)

- Added in step 4 of chronic asthma (long-acting)

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43
Q

Mechanism of antimuscarinics?

A
  • Bind to muscarinic receptor, competitive inhibitor of acetylcholine
  • Stimulation of muscarinic receptor causes ‘rest and digest’ effects
  • Blockage has opposite effects:
    o Reduced smooth muscle tone
    o Reduced secretions
    o Relaxation of pupillary constrictor and ciliary muscles – pupil dilatation and preventing accommodation – blurred vision
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44
Q

SE of antimuscarinics?

A
  • Little systemic absorption

- Blurred vision, urinary retention, constipation, dry mouth

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45
Q

Interactions of antimuscarinics?

A
  • None
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46
Q

Cautions of antimuscarinics?

A

o Angle-closure glaucoma

o Arrhythmias

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47
Q

Contraindications of antimuscarinics?

A

o Hypersensitivity to atropine or derivatives

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48
Q

Prescription of antimuscarinics?

A
  • Short-acting used QDS or PRN
  • In acute asthma
    o 0.25mg in 4mL saline
    o Every 20-30 mins for 1st 2 hours then every 8 hours if needed
  • Can be inhaled or nebulised liquid
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49
Q

Communication of antimuscarinics?

A
  • Treatment to make their airways relax, which should therefore improve their breathing
  • Treats the symptoms, not the disease
  • Ensure they are clear on how and when to take the inhaler (e.g. for acute symptoms, pre-emptively before exercise or regularly for long-acting medication)
  • Discuss possible side effects, such as dry mouth, and advise them to chew gum or suck sweets or bottle of water
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50
Q

Monitoring of antimuscarinics?

A
  • Monitor PEFR
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51
Q

Names of inhaled corticosteroids?

A

Beclomethasone (Clenil Modulite 50mcg lower-potency, Clenil 200mcg)

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52
Q

Indications of inhaled corticosteroids?

A

Step 2 of therapy in chronic asthma – not controlled by short-acting B2 agonists

53
Q

Mechanism of inhaled corticosteroids?

A
  • Pass through plasma membrane and activate receptor which:
    o Upregulation of anti-inflammatory proteins
    o Downregulates pro-inflammatory interleukins, cytokines, chemokines
  • Effects
    o Reduces mucosal inflammation
    o Widens the airways
    o Reduces mucus secretion
54
Q

SE of inhaled corticosteroids?

A
  • Occur locally in the airway
    o Oral candidiasis
    o Hoarse Voice
  • Few systemic effects unless at very high dose which may cause adrenal suppression, growth retardation and osteoporosis
55
Q

Interactions of inhaled corticosteroids?

A
  • None
56
Q

Contraindications of inhaled corticosteroids?

A
  • Caution of long-term high-dose corticosteroids as potential for growth suppression
57
Q

Prescription of inhaled corticosteroids?

A 
-	Inhalation of powder (circle one)
o	Child 5-11 years
	100-200mcg BDS
o	Child 12-17 years
	200-400mcg BDS, can be increased 
-	Inhalation of aerosol (normal puffer)
o	Child 12-17 years
	50-200mcg BDS, can be increased to 400mcg
-	Prescribe brand name
-	May need steroid card
-	Drugs are delivered in aerosol (metered dose inhaler [MDI]) or dry powder form
58
Q

What should be prescribed with inhaler?

A
  • Spacer with metered dose inhalers improves airway deposition and treatment efficacy and reduce oral adverse effects
  • Inhaler and technique should be checked and corrected at every consultation
59
Q

Communication of inhaled corticosteroids?

A
  • Explain that you are offering a steroid inhaler to ‘dampen down’ inflammation in the lung
  • Reassure them that hardly any of the steroid is absorbed into the body so, except in very high-dose treatment, there are unlikely to be any serious side effects (or weight gain)
  • Advise them to rinse their mouth and gargle after taking the inhaler to prevent development of a sore mouth or hoarse voice
  • Show your patient how to use the device
60
Q

Monitoring of inhaled corticosteroids?

A
  • Review after 3–6 months
61
Q

Name of osmotic laxatives?

A

Lactulose, Macrogol (Movicol), phosphate enema

62
Q

Indications of osmotic laxatives?

A

Constipation and faecal impaction – 1st line Movicol in paediatrics
Bowel preparation prior to surgery or endoscopy
Hepatic encephalopathy

63
Q

Mechanism of osmotic laxatives?

A
  • Osmotically active substances (sugars/alcohol) that remain in gut lumen
  • Hold water in stool
  • Maintain volume and stimulate peristalsis
  • Lactulose
    o Reduces ammonia absorption by increasing gut transit rate and acidifying stool
    o Inhibits proliferation of ammonia-producing bacteria
    o Useful in hepatic encephalopathy
64
Q

SE of osmotic laxatives?

A
  • Flatulence
  • Abdominal cramps
  • Nausea
  • Diarrhoea
  • Phosphate enema
    o Local irritation, electrolyte disturbances
65
Q

Interactions of osmotic laxatives?

A
  • Effects of warfarin may be slightly increased
66
Q

Contraindications of osmotic laxatives?

A

o Intestinal obstruction (risk of perforation)

67
Q

When would you use phosphate enema in caution?

A

o Heart failure, ascites, electrolyte disturbances

68
Q

Prescription of osmotic laxatives?

A
  • Orally used prescribed regularly
  • May take a few days for an effect to be seen, as need to pass through GI tract
  • Phosphate enema PRN or once only
  • Taken with or without food
  • Can have solutions which can be diluted in another liquid (squash) to improve compliance
  • Enemas administered with patient lying on side and stay in position for a few minutes
69
Q

Communication of osmotic laxatives?

A

o Explain treatment with a laxative
o Will hopefully make their stool softer and easier to pass
o To work, it requires them to drink plenty of water: they should aim to have at least 6–8 glasses of liquid per day
o Mention that side effects can occur, but these may get better over time
o Advise that the dose should be adjusted to maintain comfort
o If regularly passing >2/3 soft stools per day, dose should be reduced, or stopped

70
Q

Name of stimulant laxatives?

A

Senna, Bisacodyl, glycerol suppositories

71
Q

Indications of stimulant laxatives?

A

Constipation – 2nd line in paediatrics

As suppositories for faecal impaction

72
Q

Mechanism of stimulant laxatives?

A
  • Stimulant laxatives increase water and electrolyte secretion from the colonic mucosa
  • Increasing volume of colonic content and stimulating peristalsis
  • Direct pro-peristaltic action, although the exact mechanism differs between agents
    o Bacterial metabolism of Senna in intestine produces metabolites that have a direct action on the enteric nervous system, stimulating peristalsis
    o Rectal administration of glycerol suppositories, provokes a similar but more localised effect and can be useful to treat faecal impaction
    o Docusate sodium has both stimulant and faecal softening actions
73
Q

SE of stimulant laxatives?

A
  • Abdominal pain/cramps
  • Diarrhoea
  • Prolonged use
    o Melanosis coli (reversible pigmentation of intestinal wall)
74
Q

Interactions of stimulant laxatives?

A
  • None
75
Q

Contraindications of stimulant laxatives?

A

o Intestinal Obstruction
o Haemorrhoids
o Anal Fissures

76
Q

Prescription of stimulant laxatives?

A
  • Regular oral administration, usually BDS

- When rectal, PRN or once only

77
Q

Communication of stimulant laxatives?

A
  • Explain offering treatment with a laxative that will help stool to pass
  • As with other laxatives, ensuring good oral fluid intake will also help, 6–8 glasses of liquid per day
  • Stimulant laxatives do not work immediately and may need a few doses before a sustained effect is noticed
  • Dose can be adjusted if necessary to maintain comfort
  • If they are regularly passing >2/3 soft stools per day, dose should be reduced or stopped
  • Mention side effects but these may get better over time
78
Q

Name of emollients?

A

Aqueous cream, liquid paraffin

Examples - E45, Aveeno (colloidal oatmeal)

79
Q

Indications of emollients?

A
  • Topical treatment for all dry or scaling skin disorders

- Used alone or in combination with topical corticosteroids in the treatment of eczema

80
Q

Mechanism of emollients?

A
  • Emollients replace water content in dry skin
  • Contain oils or paraffin-based products that soften skin and reduce water loss by protecting against evaporation
  • Many preparations used as soap substitute (as soap is drying to the skin) and also bath or shower emollients
81
Q

SE of emollients?

A
  • Greasy on skin but this is part of therapeutic effect

- Exacerbate acne and folliculitis by blocking pores and hair follicles

82
Q

Interactions of emollients?

A
  • Space out topical emollients – usually apply emollient 15 minutes before application of steroid cream
83
Q

Contraindications of emollients?

A
  • Fire hazard when oil content high
84
Q

Properties of different types of emollients?

A 
-	Properties
o	Emulsions of oil and water to make creams, lotions and ointments
o	Lotions (less oil, more water) and creams (50% oil and water) spread further
o	Ointments (80% oil, 20% water) are more occlusive and potent
-	If find greasy and unpleasant, consider a cream or lotion instead of ointment and apply more often
85
Q

Directions for emollients?

A
  • Directions
    o Applied BDS/TDS in active disease
    o Give sufficient supply for frequent use
    o Continue after improvement to prevent recurrence
    o Apply emollients in the direction of hair growth
86
Q

Communication of emollients?

A
  • Encourage use as often as possible
87
Q

Names of topical corticosteroids?

Potency of each example?

A

Mild – Hydrocortisone 0.5-2.5%
Moderate – Eumovate (Clobetasone butyrate 0.05%)
Potent – Betnovate (betamethasone valerate 0.1%)
Very Potent – Dermovate (Clobetasol propionate 0.05%)

88
Q

Indications of topical corticosteroids?

A
  • Inflammatory skin conditions, e.g. eczema, psoriasis where emollients are ineffective
89
Q

Mechanism of topical corticosteroids?

A
  • Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes (e.g. cytokines, tumour necrosis factor alpha)
  • Suppression of circulating monocytes and eosinophils
  • Increased gluconeogenesis from increased circulating amino and fatty acids, released by catabolism of muscle and fat
  • Mineralocorticoid effects, stimulating Na+ and water retention and K+ excretion in the renal tubule
  • Because topical, effects limited to site – need prolonged use of potent topical steroids for systemic effects
90
Q

SE of topical corticosteroids?

A
  • Skin thinning
  • Telangiectasia
  • Contact dermatitis
  • When used on face:
    o Perioral dermatitis
    o Exacerbate acne
  • Rarely, systemic effects:
    o Adrenal suppression
    o Immunosuppression
    o Diabetes
    o Osteoporosis
91
Q

Interactions of topical corticosteroids?

A
  • None when topical
92
Q

Contraindications of topical corticosteroids?

A
  • Contra-indications
    o Infection present
  • Avoid potent on face and course should be short
93
Q

Prescription of topical corticosteroids?

A
  • Use as mild as possible for as short a time
  • < 2 weeks (1 week for facial lesions)
  • Prescription
    o Name, strength, formulation, amount
  • BDS applied thinly on affected area
  • Wash hands after application
94
Q

Communication of topical corticosteroids?

A
  • Warn them of the risk of skin damage if the treatment is applied to the wrong areas or for too long
  • BNF advise finger-tip of cream or ointment should cover two palms worth
95
Q

Indications of benzylpenicillin?

A
  • Meningitis - 1st line community

- CAP – Secondary Care Neonates

96
Q

Indications of amoxicillin?

A
  • CAP – Primary Care 1st line
  • CAP – Secondary care Children
  • HAP – IV amoxicillin
  • UTI - < 3months IV
  • UTI - > 3months oral
  • Otitis Media
97
Q

Indications of co-amoxiclav?

A
  • Alternatives in CAP and HAP
  • > 3 months UTI and pyelonephritis
  • Otitis Media
98
Q

Indications of tazocin?

A
  • HAP >5 days in hospital
99
Q

Indications of ampicillin?

A
  • < 3 months UTI
100
Q

Indications of phenoxymethylpenicillin?

A
  • Tonsillitis
101
Q

Indications of flucloxacillin?

A
  • Otitis Externa, etc
102
Q

General mechanism of penicillins?

A
  • Contain B-lactam ring responsible for antimicrobial activity
  • Inhibit enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
  • Preventing osmotic gradient being maintained and leads to cell swelling, lysis and death
103
Q

SE of penicillins?

A
  • GI upset
  • Allergy (1-10%)
    o Skin rash 7-10 days after 1st exposure or 1-2 days after repeat
    o Anaphylaxis
  • CNS toxicity
  • Antibiotic-Associated colitis
    o Tazocin, clindamycin, cephalosporins, fluoroquinolones, co-amoxiclav, ampicillin and amoxillin
  • Cholestatic Jaundice
    o Co-amoxiclav
104
Q

Interactions of penicillins?

A
  • Reduce renal excretion of methotrexate

- Broad-spectrum antibiotics enhance anticoagulant effect of warfarin by killing normal vitamin K flora

105
Q

Warnings in penicillin use?

A

o Dose reduction in renal impairment

o Avoid amoxicillin in sore throat as can give rash if EBV

106
Q

Names of cephalosporins?

A

Ceftriaxone

Cefotaxime

107
Q

Indications of cephalosporins?

A 
Ceftriaxone
-	1st line hospital meningitis
-	Sepsis
-	UTI < 3 months IV with amoxicillin
-	UTI > 3months oral
-	Upper UTI >3 months
Cefotaxime
-	Add on meningitis
-	Severe CAP
108
Q

Prescription of cephalosporins?

A
  • Usually given 6-12 hourly given orally, IV or IM
109
Q

Names of macrolides?

A

Clarithromycin
Erythromycin
Azithromycin

110
Q

Indications of macrolides?

A

Clarithromycin
- Secondary care child CAP alternative
- Tonsillitis, Otitis media and externa if penicillin allergic
Erythromycin
- Primary care CAP alternative to amoxicillin
Azithromycin
- Primary care CAP alternative to amoxicillin

111
Q

Mechanism of macrolides?

A
  • Inhibit bacterial protein synthesis
  • Bind to 50s subunit of ribosome and block translocation
  • Bacteriostatic which assists immune system in killing and removing bacteria from body
  • Synthetic macrolides (clarithromycin and azithromycin) have increased activity against Gram-negative
112
Q

Prescription of macrolides?

A
  • Can be given orally as tablets, suspensions with or without food
  • IV must be diluted
113
Q

Indications of trimethoprim?

A

1st line in UTI for >3 months

114
Q

Mechanism of trimethoprim?

A

nhibit bacterial folate synthesis, slowing bacterial growth (bacteriostatic)

  • Effective against Gram-positive and Gram-negative bacteria
  • Widespread bacterial resistance
  • Excreted unchanged into urine so used for UTIs
115
Q

SE of trimethoprim?

A
  • GI upset (nausea, vomiting and sore mouth)
  • Skin rash (3-7%)
  • Haematological disorders – megaloblastic anaemia, leukopenia and thrombocytopenia
  • Hyperkalaemia
  • Competitively inhibits creatinine secretion by the renal tubules which commonly leads to a small reversible rise in serum creatinine concentration during trimethoprim treatment
116
Q

Contraindications of trimethoprim?

A
  • 1st trimester of pregnancy
117
Q

Cautions of trimethoprim?

A

o Folate deficiency

o Dose reduction in renal impairment

118
Q

Prescription of trimethoprim?

A
  • Oral use only usually 12 hourly for 3 days

- Communicate as with other antibiotics

119
Q

Indications of nitrofurantoin?

A

Lower UTI in > 3 months

120
Q

Mechanism of nitrofurantoin?

A
  • Metabolised (reduced) in bacterial cells by nitrofuran reductase
  • Active metabolite damages bacterial DNA and causes cell death (bactericidal)
  • Active against relevant bacteria, reaches therapeutic concentrations in urine through renal excretion and most bactericidal in acidic environments such as urine
  • Bacteria with reduced nitrofuran reductase activity are resistant to nitrofurantoin
121
Q

SE of nitrofurantoin?

A
  • GI upset (nausea and diarrhoea)
  • Turn urine dark yellow or brown
  • Chronic treatment
    o Chronic pulmonary reactions
    o Hepatitis
    o Peripheral neuropathy
  • Neonates cause haemolytic anaemia
122
Q

Interactions of nitrofurantoin?

A
  • None
123
Q

Contraindications of nitrofurantoin?

A

o Pregnant women towards term
o Babies <3 months
o Renal impairment

124
Q

Cautions of nitrofurantoin?

A

o Long-term use associated with adverse effects

125
Q

Prescription of nitrofurantoin?

A
  • Oral use only usually 3-days
  • It should be taken with food or milk to minimise gastrointestinal effects
  • Explain as with previous antibiotics
126
Q

Fluids resuscitation dose for children?

A

 0.9% saline – 20mls/kg

127
Q

Oral rehydration fluids in children?

A

o 50mls/kg over 4 hours orally

128
Q

How to work out fluid deficit in children?

A

Mild (5%)
o Dry mucous membranes, skin turgor, decreased urine output
Moderate (10%)
o Decreased skin turgor, oliguric, high pulse, >CRT, lethargy
Severe (15%)
o Shock, anuric, hypotension

 Calculation
• % dehydration x weight(kg) x 10
• Give as 0.45% saline over 48h
• Add K+ (20mmol/500ml) once child passed urine

129
Q

How to work out maintenance fluids for children?

A

o Maintenance Fluids (0.9% saline with 5% dextrose with 10mmol KCL)
 1st 10kg 100mls/kg/day
 2nd 10kg 50mls/kg/day
 3rd & subsequent kg 20mls/kg/day

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