Block 31 PPT Flashcards
1
Q
Offer antihypertensive drug Tx to people aged 80 and under with stage 1 hypertension who have one or more of the following:
A
2
Q
Assessment of HTN:
offer
A
3
Q
Drug classes for HTN
A
4
Q
Step approach of anti-hypertensives
A
5
Q
choice of anti-hypertensive
A
6
Q
ACEI side effects?
A
- dry cough
- constipation
- angiodema - can occur years afterwards
7
Q
when would ACEi need to be stopped?
A
- if they’re unwell and they’re not eating or drinking, patient needs to stop ACEi
8
Q
statins mechanism?
A
- inhibition of HMG CoA reductase
- reducing IC cholesterol levels so the liver expresses more LDL receptors and takes up more LDL
9
Q
what do statins interact with?
A
- Statins interact with erythromycin and clarithromycin
- statins and macrolides interact
10
Q
fibrates interact with?
A
- interact w statins
- risk of rhabdomyalysis
11
Q
how do fibrates work?
A
- activation of gene transription factors known as PPARs which regulate genes that control lipoprotein metabolism
- increase lipoprotein lipase activity
- increases hepatic free fatty acid uptake and increases plasma HDL
12
Q
side effects of fibrates?
A
- GI upset
- rash/ pruitus
- dizziness and headache
- myalgia - uncommon
13
Q
which anticoagulants act on factor Xa?
A
- heparin
- fondaparinux
- apixaban, rivaroxaban
14
Q
UFH, LMWH and fondaparinux all bind to…
A
- UFH, LMWH and fondaparinux all bind to antithrombin and accelerate its inhibition of proteases primarly factor Xa
15
Q
LMWH is a once a day?
A
injection that doesn’t require monitoring
16
Q
UFH vs LMWH admin?
A
- IV admin for UFH and subcutaneous for LMWH
17
Q
LMWH side effects?
A
- haemorrhage
- heparin induced thrombocytopenia
- skin reactions
18
Q
prescribing
Warfarin?
A
- vit K antagonist
- takes 3-4 days to work, u have to give min of 5 days of LMWH first
- INR has to be above 2 for 48 hrs before the LMWH can be discontinued
19
Q
warfarin interactions?
A
20
Q
monitoring w warfarin?
A
- INR monitoring required
- usually needs to be between 2-3
- patients need to carry an alert card and a yellow book
21
Q
Vit K dependent coagulation factors are?
A
2 (prothrombin), 7, 9, 10
22
Q
DOACs e.g. dabigatran, apixaban, rivaroxaban?
A
- -abans inhibits factor 10
- dabigatran inhibits thrombin directly
23
Q
reversal of warfarin?
A
- vitamin K
- prothrombin complex concentreate
- (fresh frozen plasma)
24
Q
dabigatran reversal?
A
- idarucizumab - mAb fragment
25
Factor 10 inhibitors reversal?
* andexanet alfa
26
IHD - amlodepine?
* amlodipine = peripheral vasodilation which reduces afterload. Symptomatic but doesn't impact long term survival
27
IHD - beta blocker?
* bisoprolol: reduces work of heart which reduces the angina
28
NSTEMI Tx - avoid which 2 things?
* avoid morphine due to risk of resp depression
* avoid O2 unless patient hypoxic due to free radicals and risk of reflex coronary artery constriction
29
ACS drug therapy?
- aspirin
- clopidogrel/ ticagrelor
- fondaparinux or LMWH
- BB
- statin
30
Antiplatelet drugs - COX inhibitors?
aspirin
31
Antiplatelet drugs - phosphodiesterase inhibitors?
dipyridamole
32
antiplatelet drugs - adenosone disphosphate receptor antagonists?
- clopidogrel
- ticagrelor
33
antiplatelet drugs - glycoprotein 2b/ 3a receptor antagonist?
- abciximab
- tirofiban
34
aspirin - low dose?
* LOW DOSE in heart disease: irreversible inhibition of COX-1
35
aspirin - high/ intermediate dose?
* high dose/ intermediate dose in pain relief and as an anti-inflammatory inhibits COX-2 as well as COX-1
36
clopidogrel vs ticagrelor?
* clopidogrel: irreversible PY12 inhibitor
* ticagrelor: reversible inhibition and more rapid onset of action
37
dipyridamole mechanism?
* inhibits cellular reuptake of adenosine
* increased plasma conc of adenosine which inhibits expression of cell surface GPIIb/IIIa receptors
* inhibits platelet aggregation and causes vasodilation
38
angina - BBs mechanism?
* slows heart and reduces strength of contractility, reduces cardiac ouput
* reduces O2 demand and increases diastole time
* B1 receptors on the heart
39
what can BBs cause as a side effect?
* can cause AV block as a side effect - AV block is CI
40
asthma and COPD with beta blockers?
* asthma is CI but COPD is a caution for beta blockers
41
# Whatis made worse by them?
CCB - negative chronotropic effect?
- diltiazem and verapamil
- non-DPH
- make HF worse as they reduce the HR
42
amlodepine?
- DPH CCB
- * DPH cause peripheral arterial dilation and coronary artery dilatation
43
CCB that reduce cardiac contractility?
- verapamil
44
nitrates in angina?
- vasodilators causing vascular SM relaxation mimicking the impacts of endogenous NO
45
What happens if nitrates are used continiously?
* if used continously the effect rapidly diminishes
* body gets used to having a high NO level
* asymmetric dosing and nitrate free period to reduce this effect
* more of an issue with the longer acting nitrates like isosorbine mononitrate or dinitrate
46
side effects of nitrates?
* headaches - paticularly with the GTN spray
* syncope - nitrate syncope
47
which drug when used alongside a nitrate can cause profound hypotension?
slidenafil
48
HF - pulm oedema tx?
* IV furosemide - loop diuretic
* drops BP
* In very high doses cause ototoxicity
49
bolus =
drug peaks over short time
50
bolus-infusion?
over e.g. half an hour, less risk of toxicity
51
infusion =
given consistently over a long period e.g. adrenaline in ICU
52
how does furosemide help in LVF?
* IV furosemide releases vasodilator prostaglandins into the circ which produces venodilation -> helps in LVF
53
CHF drugs?
- loop diuretics
- ACEi/ ARBs
- aldosterone antagonists
- BBs
54
drugs used in AF?
- BBs
- digoxin
- verapamil
55
VW classification of drugs?
56
what are the 2 shockable rhythms?
VF and pulseless VT
57
reversible causes of cardiac arrest
58
drugs used in ALS?
* adrenaline
* amiodarone after 3 shocks to stabilise myocardium
59
Adenosine?
* adenosine works for SVT
* especially for AVNRT
60
what can adenosine cause?
* Adenosine can cause severe bronchospasms - don't use for asthma
61
bradycardia Tx?
* atropine
* or isoprenaline (B1 stimulant drug)
62
antibiotic stewardship =
* healthcare system wide approach to promotoing and monitoring judicious use of antimicrobials to preserve their future effectiveness
63
points to remember when using ab in hospital
64
what can cause upper lobe pneumonia?
klebsiella and TB
65
Atypical pneumonia?
* patchy inflammatory changes
* mycoplasma pneumoniae
* chlamydophila pneumoniae
* legionalla pneumophilia
66
what can be added for atypical pneumonias?
* macrolides like clarithromycin or tetracyclines like doxycycline can be added
67
what else can cause the clinical picture of atypical pneumonia?
* viral and fungal pathogens can also create the radiological and clinical picture of atypical pneumonia
68
principles of TB drug therapy?
- intensive phase (2 months) + continuation phase (4 -7 months)
69
intensive phase of TB treatment?
- isoniazid
- rifampicin
- pyrazinamide
- ethambutol
70
contination phase of TB treatment?
- isoniazid
- rifampicin
71
Pyrazinamide?
* can never be used alone due to risk of resistance
* crosses BBB and good in TB meningitis
72
ethambutol side effects - main?
* optic neuritis - produces intial red green colour blindness and then reduced visual acuity - vision needs to be monitored
73
other ethambutol side effects?
* peripheral neuritits
* hyperuricaemia, gout
* nephrotoxicity
74
pathophys of endocarditis
75
right vs left sided endocarditis?
* right sided: usually IV drug user
* left side: usually a native or prosthetic heart valve
76
ab used in endocarditis?
* penicillin G and gentamicin
77
non-pharmacological Tx of asthma and COPD?
* lifestyle advice
* weight loss
* smoking cessation
* avoiding triggers
* breathing exercise programs
78
SABA?
* salbutamol, terbutaline
* activates B2 receptors which relaxes the SM in the lung, dilating and opening the airways
79
Side effects of SABA?
arryhtmias, headache, palpiptations, fine tremor
80
ICS?
* beclometasone
* fluticasone
* by-passes first pass metabolism
* potent inhibitors of inflammatory process
81
Reliever vs preventer therapy in asthma?
* SABA = reliever therapy, only taken to relieve symptoms
* ICS = preventer, tackles underlying problem
82
LABAs - formoterol vs salmeterol?
* formoterol: fast onset, but long duration of action
* salmeterol: delayed onset, long duration of action
83
never give LABA without ? in asthma
ICS - risk of excess cardiovascular events
84
never give ? alone in COPD
ICS
85
short acting muscarinic antagonists?
* SAMA: ipatropium binds to muscarnic receptors
86
LAMA?
* tiotropium - long acting anti-muscarinic that is selective for M3
87
MRA are mainly beneficial in?
COPD but ipatropium can be added to a B2 agonist in severe asthma exacerbations
88
theophylline?
* inhibits phosphodiesterase and blocks adenosine receptors
* used for status asthmaticus
89
Monteleukast?
leukotriene receptor antagonist
90
steroids?
* oral: prednisolone
* IV: hydrocortisone
91
oxygen alert card for?
hypercapnic respiratory failure
92
COPD pathway
93
HTN flowchart
* offer HTN drug in addition to lifestyle advice to adults of any age with stage 2 hypertension
94
HTN lifestyle interventions?
* encourage exercise and reduction in alcohol intake
* encourage low dietary sodium intake
* inform people abt local initiatives e.g. patient organisations that provide support and promote healthy lifestyle change
95
ACEi side effects?
dry cough, headaches, dizziness, rash
96
ARBs side effects?
dizziness, headaches, cold/ flu like symptoms
97
CCBS side effects?
headaches, swollen ankles and constipation. Drinking grapefruit juice can inc risk of side effects
98
diuretics side effects?
postural hypotension, increased thirst
99
BBs side effects?
cold hands and feet, dizziness and headaches
100
primary prevention =
* Primary prevention refers to the steps taken by an individual to prevent the onset of the disease.
This is achieved by maintaining a healthy lifestyle choice such as diet and exercise.
101
secondary prevention =
* Secondary prevention focuses on reducing the impact of the disease by early diagnosis prior to any critical and permanent damage.
* This facilitates avoiding life threatening situations and long term impairments from a disease
102
secondary prevention of CVD involves...
* The secondary prevention of CVD includes diagnosis and prevention.
* Most critical step of secondary prevention is early diagnosis
* requires identifying risk factors, criticality of risk factors, and how the variation of these factors relates to CVD.
103
Tx of hypercholesteroleamia/ hypertriglyceridaemia?
* first line: statins
* if not well controlled with a statin, use ezetimibe
* fenofibrate can be added to statin therapy if triglycerides remain high even after LDL-choleserol levels have been reduced
104
HTN lifestyle advice?
* dietary advice - reduced saturated fats, intake of sugar and refined sugar
* physical activity: at least 150 minutes of moderate-intensity aerobic activity per week or 75 mins of vigorous intensity activity
* weight management
* alcohol reduction
* smoking cessation
105
stroke prevention in AF patients?
* Apixaban
* dabigatran
* edoxaban
* ribaroxaban
* CHADS-VASC score of >2
106
anticoagulation in AF - if DOACs don't work use?
* if DOACs not tolerated/ suitabled use a vitamin K antagonist
107
rate control in AF?
* beta blocker (not sotalol) or a rate limiting CCB like diltiazem or verapamil
* digoxin monotherapy if other drugs ruled out due to comorbities/ patient preferences
108
AF - if monotherapy doesn't control symptoms and if symptoms thought to be due to poor ventricular rate control, consider combination therapy with 2 of;
- beta blocker
* diltiazem
* digoxin
109
rhythm control in AF?
* if symptoms continue after HR controlled or if rate control strategy not been successful
* first line: BB
* dronedarone as a second line after successful cardioversion
110
# and the drug used w
AF - cardioversion?
* electrical cardioversion if AF >48 hrs
* amiodarone therapy 4 weeks before and up to 12 months after
111
AF - left atrial ablation?
* drug Tx unsuccessful, unsuitable or not tolerated
* radiofrequency point by point ablation
* cryoballoon ablation
* laser balloon ablation
112
which patients need a CHADS-VASC score calculating?
* symptomatic or asymptomatic paroxysmal, persistent or permanent atrial fibrillation
* atrial flutter
* a continuing risk of arrhythmia recurrence after cardioversion back to sinus rhythm or catheter ablation
113
anticoagulation is initiated in patients with a CHADS-VASC score of?
* all patients >2
* men with a score of 1
114
DVT - anticoagulation?
* apixaban or rivaroxaban
* LMWH followed by at least five days dabigatran or edoxaban
* or LMWH with Vit K antagonist
* for a minimum period of 3 months
115
identify patients who should be considered for prophylaxis of deep vein thrombosis
116
factors temporarily increasing risk of DVT
117
prevention of DVTs?
* Graduated compression stockings
* DOACs
118
PE management - before confirmation?
LMWH
119
PE management?
* Fondaparinux.
* Low molecular weight heparin (LMWH).
* LMWH followed by an oral anticoagulant (dabigatran or edoxaban).
* Oral anticoagulant treatment (warfarin, apixaban, or rivaroxaban).
* Unfractionated heparin.
120
mechanical interventions of PE?
* IVC filters - these are designed to trap fragmented thromboemboli from the deep leg veins en route to the pulmonary circulation (whilst preserving blood flow in the IVC filter)
- thrombolysis
121
Warfarin reversal?
Vitamin K1 (phytomenadione)
122
apixaban reversal?
Andexanet alfa reverses bleeding in those treated with apixaban or rivaroxaban (direct factor 10 inhibitor)
123
dabigatran reversal?
Idarucizumab reverses bleeding caused by dabigatran
124
heparin reversal?
* protamine sulfate is a specific antidote (but only partially reverses the effects of low molecular weight heparins).
125
ALI initial management?
* analgesia and heparin
126
ALI - endovascular interventions?
* Percutaneous catheter-directed thrombolytic therapy.
* Percutaneous mechanical thrombus extraction.
127
ALI - surgical interventions?
* Surgical thromboembolectomy.
* Endarterectomy.
* Bypass surgery.
* Amputation if the limb is unsalvageable.
128
chronic limb ischemia management?
* Urgent referral to vascular MDT
* pain management: paracetamol and opioids
* refer to pain management service if pain isn't managed well or persists after revascularisation or amputation
129
CLI - advice on?
* foot care - for example daily foot inspection, keeping ischaemic feet clean to avoid infection, being careful to avoid injury when cutting the toenails, avoiding walking barefoot, and wearing well-fitting shoes.
130
conservative management of CLI?
* secondary prevention to improve long term outcomes
* addressing modifiable RFs - smoking cessation
* supervised exercise program - Excercise typically involves walking until the onset of symptoms, and where possible until the maximal pain is reached.
131
which therapies should be offered to CLI patients?
* Lipid therapy: statins should typically be offered to patients with peripheral vascular disease.
* Anti-platelet therapy: all patients with peripheral arterial disease should be offered Aspirin or Clopidogrel as secondary prevention.
132
Naftidrofuryl oxalate?
this is a peripheral vasodilator that may be considered in patients with CLI in whom conservative measures have failed and decline surgical options.
133
Revascularisation in CLI?
* angioplasty +/- stent
* remote endarterctomy
134
Surgical management of CLI?
* bypass - vessel used to bypass diseased segment of artery
135
When should oxygen be given?
<94% O2 sats
136
oxygen delivery in a patient w COPD?
* Use a 24% Venturi mask at 2-3 L/min (or a 28% Venturi mask at 4 L/min, or nasal cannulae at 1-2 L/min if a 24% mask is not available) for people with suspected chronic obstructive pulmonary disease (COPD), morbid obesity, a chest wall deformity, or a neuromuscular disorder
* if sats remain <88% afteruse of a 28% venturi mask, change to either a nasal cannulae at 2-6 L/min or a simple face mask at 5 L/min
137
Oxygen delivery in hypoxaemic patients?
* use a nasal cannulae at 2-6 L/min, or a simple face mask at 5-10 L/min.
138
acute asthma exacerbation management?
- oxygen
- SABA: nebulized salbutamol for life-threatening/ severe asthma or ipatropium bromide with poor initial response
* oral predinosolone or IV hydrocortisone
139
moderate severity asthma exacerbation management?
pressurized metered-dose inhaler with a large volume spacer
140
stepwise management of asthma?
* ICS: Fluticasone and Beclomethasone.
* LABA: salmeterol
* LTRA: monteleukast
141
# Four
COPD exacerbations?
* Increase SABA use - nebuliser - salbutamol or ipatropium
* oral corticosteroids - prednisolone
* antibiotics - amoxicillin, doxycycline, or clarithomycin
- oxygen
142
NIV may be needed in a COPD exacerbaton if?
high levels of oxygen needed but there's a risk of T2RF
143
chronic COPD management?
* 1) SABA or SAMA for use on PRN basis
* 2) LABA plus LAMA or LABA plus ICS if features of steroid responsiveness/ asthmatic features
* 3) triple therapy: LABA + LAMA + ICS
144
oral therapies in COPD?
* corticosteroids - especially in acute exacerbations
* theophylline
* mucolytics e.g. carbocysteine
* ab - in exacerbations - or prophylactically (azithromycin)
145
non-pharm management of COPD?
* healthy diet and physical activity
* smoking cessation
* pulmonary rehabilitation
* pneumococcal and influenza vaccinations
146
First lines for stable angina?
* first line: BB or a CCB
* If the person cannot tolerate the beta-blocker or calcium-channel blocker, consider switching
147
stable angina - if BB and CCB are CI/ not toleraed consider:
* A long-acting nitrate (such as isosorbide mononitrate).
* Nicorandil.
* Ivabradine.
* Ranolazine.
148
symptomatic relief of angina?
* sublinguial GTN for reliief of pain
149
anginal chest pain - advise the patient to?
* Stop what they are doing and rest.
* Use their glyceryl trinitrate spray or tablets
* Take a second dose after 5 minutes if the pain has not eased.
* Call 999 for an ambulance if the pain has not eased 5 minutes after the second dose, or earlier if the pain is intensifying or the person is unwell.
150
secondary prevention for angina?
* antiplatelet treatment - aspirin
* clopidogrel should be continued if the person is alr on it for stroke or PAD
* ACEi for ppl w stable angina and diabetes
* statin
* antihypertensive treatment
151
initial management of ACS?
* GTN
* IV morphine - paticularly if acute MI suspected
* loading dose of aspirin
* oxygen shouldn't routinely be given
* monitoring for hyperglycaemia - insulin should be given
152
STEMI - intervention?
* coronary reperfusion therapy - either primary PCI or fibrinolysis ASAP
* Primary PCI (if within 12 hours of symptom onset and within 120 minutes of the time when fibrinolysis could have been given) is the preferred strategy for most patients.
153
drug therapy in STEMI?
* aspirin + second antiplatelet: prasugrel, ticagrelor, or clopidogrel
* Aspirin alone may be appropriate for some patients with a high bleeding risk not undergoing a PCI.
154
unstable angina and NSTEMI tX?
* ASPIRIN plus prasugrel, ticagrelor or clopidogrel
* antithrombin therapy with fondaparinux sodium should also be offered
155
UA/ NSTEMI with renal impairment offer?
UFH
156
Following ACS patients should be offered?
* following ACS, should be offered cardiac rehabilitation programme - including advice for lifestyle changes, stress management and health education.
157
drugs offered after an ACS?
-ACEi
- BB
- dual antiplatelet therapy
- statin
158
acute HF management?
* IV diuretic therapy
* If a person has cardiogenic pulmonary oedema with severe dyspnoea and acidaemia consider starting non‑invasive ventilation without delay
159
Chronic HF - patients should be told to ? everyday
* weighing themselves at a set time of day and to report any weight gain of more than 1.5–2.0 kg in 2 days
160
which drugs should be avoided in ppts w reduced ejection fraction HF?
- Rate-limiting calcium-channel blockers (verapamil and diltiazem)
- short-acting dihydropyridines e.g. nifedipine, or nicardipine
- reduce cardiac contractility
161
which calcium channel blocker can be used in those with HF and angina?
amlodepine
162
CHF w reduced ejection fraction Tx?
1) ACE and BB such as (bisoprolol, carvediolol or nebivolol
2) ARB instead of ACEI
3) MRA
163
ARBs used in HF?
- Candesartan
- losartan
- valsartan
164
HF - MRAs such as
spironolactone or eplerenone should be added
165
which drugs can be used if the HF persists despite the BB, ACEi/ ARB and MRA?
* For patients in sinus rhythm, digoxin is recommended as add-on therapy in worsening or severe heart failure despite optimal treatment
* Ivavradine, SGLT-2 inhibitors like dapagflozin, hydralazine and nitrate if symptoms persist
166
All people w CHF need monitoring:
* clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status
* a review of medication, including need for changes and possible side effects
* an assessment of renal function.
* at least 6-monthly for people with stable heart failure
167
atrial flutter - ventricular rate control?
* BB, diltiazem, verpamil
* digoxin can be added if rate not well controlled, paticularly useful in HF
168
other methods of rate control in flutter?
* electric cardioversion by cardiac pacing or direct current), pharmacological cardioversion, or catheter ablation.
169
supraventicular tachycardias?
* Adenosine is usually the treatment of choice for terminating paroxysmal supraventricular tachycardia
* verapamil (INTERACTS with BB) can be used if this doesn't work
170
other options in SVT?
* IV Amiodarone hydrocholride
* flecainide acetete or a BB like esmolol hydrochloride)
171
unsustained VT Tx?
* ppts with unstable unsustained VT should receive direct current cardioversion to restore sinus rhythm
* if it fails, IV amiodarnone
172
sustained VT who are haemodynamically stable:
* IV amiodarone preferred
* flecainide, propafenone, lidocaine
* non sustained VT can be treated with a BB
173
Torsades de pointes?
- polymorphic VT
* (usually drug-induced, but other factors including hypokalaemia, severe bradycardia, and genetic predisposition are also implicated)
174
Torsades Tx?
* iV infusion of magnesium sulfate
* beta-blocker (but not sotalol hydrochloride) and atrial (or ventricular) pacing can be considered
175
bradycardia Tx?
- atropine
- adrenaline
176
pharmacological management of AV block?
* atropine: antimuscarinic: blocks action of the vagus nerve at the SAN/ AVN increasing SAN activity and conduction through AVN
* isoprenaline (non-selective BA)
177
when is pacing needed for AV block?
* acute bradyarrhythmia
* following MI
* long term option in patients w bradyarrythmias
178
ALS pathway for VT/ VF?
* Defibrillation
* CPR with 30:2 ratio of compressions to rescue breaths
* continue CPR for 2 minutes and then check to see of VT/ VF persists
* CPR for 2 minutes then check
* resume CPR then give adrenaline and amiodraone IV
179
ALS pathway - if VT/ VF persists then give?
* Give further adrenaline 1 mg IV after alternate shocks (approximately every 3–5 minutes).
* Give amiodarone after 5 defibrillations, lidocaine can be used instead
180
ALS pathway for non-shockable dysrhythmias (asystole, PEA)?
* CPR - with a 30:2 ratio of compressions to rescue breaths for people with pulseless electrical activity (PEA) or asystole.
* Give adrenaline 1 mg intravenously (IV) as soon as venous access is achieved.
* continue CPR until airways secured
* once the airway is secured, ventilate the lungs at a rate of about 10 breaths per minute and continue chest compressions without pausing during ventilation.
181
ALS - non shockable: recheck after 2 minutes then?
* continue CPR if no pulse/ signs of life
* give adrenaline after every alternate sequence of CPR/rhythm check (approximately every 3–5 minutes).
182
CAP - low severity?
* CURB-65 score 0
* amoxicillin
* alternatives: doxycycline or clarithrymoycin if atypical pathogens suspected or amoxicillin unsuitable
183
moderate severity CAP?
* Score of 1 or 2
* amoxicillin and (if atypical pathogens suspected) clarithromycin/ erythryomycin
* alternatively doxycyline or clarithromycin
184
High severity CAP?
* 3-5
* co-amoxiclav plus clarithromycin
185
Atypical CAP pathogens?
* The addition of a macrolide to amoxicillin if an atypical pathogen is suspected gives a broader spectrum of activity with which to target atypical pathogen
* doxycycline and clarithromycin have good activity aginst strep pneumoniae and atypical infections
186
HAP - first choice ab if non-severe symptoms?
co-amoxiclav
187
HAP - Alternative oral antibiotics if non‑severe symptoms or signs, and not at higher risk of resistance, for penicillin allergy or if co‑amoxiclav unsuitable:
* doxycycline
* cefalexin
* co-trimoxazole
* levofloxacin
188
HAP - First-choice intravenous antibiotics if severe symptoms or signs (for example, symptoms or signs of sepsis) or at higher risk of resistance:
* Piperacillin with tazobactam
* Ceftazidime
* Ceftriaxone
* Cefuroxime
* Levofloxacin
* Meropenem
189
HAP - Antibiotics to be added if suspected or confirmed meticillin-resistant Staphylococcus aureus infection (dual therapy with a first-choice intravenous antibiotic)
* Vancomycin
* Teicoplanin
* Linezolid
190
latent TB Tx?
* 6 months of isoniazid with pyridoxine (6H) or
* 3 months of isoniazid (with pyridoxine) and rifampicin (3HR)
191
active TB w/o CNS involvement?
* isoniazid (with pyridoxine), rifampicin, pyrazinamide and ethambutol for 2 months
* followed by rifampicin and isoniazid for 4 months.
192
TB w CNS involvement?
* RIPE plus pyroxidine for first 2 months
* then stop pyrazinamide and ethambutol for the last 8 months
* Patients with CNS involvement are offered dexamethasone or prednisolone at the start of treatment which is then weaned over 4-8 weeks
193
MSSA bacterial endocarditis Tx?
flucloxacillin
194
MRSA or penicillin allergy bac endo?
vancomycin
195
prosthetic valve bacterial endocardiits?
in the presence of a prosthetic valve, rifampicin and gentamicin should be added to both regimens and the duration should be ≥6 weeks
196
streptococcal endocarditis Tx?
* Standard four-week regimen: penicillin G, OR amoxicillin, OR ceftriaxone
197
penicillin allergic strep endo?
vancomycin for four weeks
198
Native valve endocarditis or late prothetic valve endocarditis:
Ampicillin, flucloxacillin and gentamicin, OR vancomycin and gentamicin.
199
Early prosthetic valve endocarditis:
vancomycin, gentamicin and rifampicin.
200
Rational prescribing - aims to (4)
* maximise clinical effectiveness
* minimise harms
* avoid wasting scarce healthcare resources
* respect patient choice.
201
what is rational prescribing?
* Rational use of medicines requires that "patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.
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WHO interventions to promote rational use?
* use of clinical guidelines
* Continuing in-service medical education as a licensure requirement
* Public education about medicines
* Use of appropriate and enforced regulation
* Establishment of a multidisciplinary national body to coordinate policies on medicine use
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concept of antibiotic resistance?
* if ab are not used in the correct dose or are overused, will cause antibiotic resistance
* bacteria that survive an treatment will survive and be able to multiply and pass on characteristics to the next generation
* leading to an increasing number of antibiotic resistant strains of bacteria
* Consequences are more severe disease, frequent recurrence, long recovery time, high treatment methods and costs.
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reducing risk of antibiotic resistance?
* only using antibiotics for bacterial diseases
* finishing the course of antibiotics
* selecting the correct ab and dosage
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