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PRE- REGISTRATION PHARMACIST > BNF CHAPTER 1 - GASTROINTESTINAL > Flashcards

BNF CHAPTER 1 - GASTROINTESTINAL Flashcards

1
Q

Give examples of aminoglycosides (GN), and what types of bacteria it works on.

A

Gentamicin + Neomycin. They work on mainly gram-negative bacteria. Has a poor effect on anaerobic bacteria

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2
Q

When are aminoglycosides mainly used ?

A

They are given via injection and are used in blind therapy of undiagnosed serious infections. it is usually given in conjunction with metronidazole

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3
Q

what are the dosing instructions for aminoglycosides

A

Loading dose and maintenance dose is based on the patient’s ideal body weight. it is usually given OD and this provides adequate serum concentrations

Higher doses are recommended for immunocompromised, serious infections and neonates

Whenever possible the treatment should not exceed 7 days.

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4
Q

Contraindications for aminoglycosides

A

gentamicin should not be given with furosemide due risk of nephrotoxicity (kidneys) and ototoxicity (ear).
it should be avoided during pregnancy

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5
Q

give examples of carbapenems and what types of bacterias it works on

A

Imipenum and Meropenum work on psuedomonas aeruginosa
it is a broad spectrum antibiotic

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6
Q

when would you use a carbapenems

A

suspected sepsis, severe hospital-acquired infections, hospital-acquired pneumonia, Complicated UTI, abdominal infections, skin + soft tissue infections

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7
Q

what are the two special things about imipenem and ertapenem

A

ertapenem is not active aganist pseumonomas aerugosina
imipenem needs to be co-administered with cilastatin (enzyme inhibitor) because it is partially metabolized by renal enzymes.

the other carbapenems are stable in the kidneys

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8
Q

give examples of cephalosporins and the types of bacteria it works on

A

cefotaxime , cefalexin , ceftriaxone

it is a broad-spectrum antibiotic and it is used to treat complicated UTI and infections of the CNS

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9
Q

give examples of the indications of cephalosporins ?

A

first generation (cefalexin) and second-generation (cefaclor) are useful in complicated UTI or UTI in pregnancy

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10
Q

give examples of the dosing instructions for cephalosporins.

A

ceftriaxone has a long half-life and therefore administered OD
Cefuroxime axetil is poorly absorbed and needs to be administered with food
cefalexin can be taken during pregnancy - dosing QDS

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11
Q

contraindications for cephalosporins

A

interacts with warfarin- increases the anticoagulant effect

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12
Q

Give examples of macrolides and which types of bacterias it works on

A

Claire loves mac - broadly (ACE)
azithromycin, erythromycin, clindamycin

it is a broad-spectrum antibiotic.
it has a similar profile to penicillins but it is technically a different class.

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13
Q

common side effects of macrolides

A

N+V, diarrohea, GI discomfort in some patients.

However this can be avoided by reducing the dose, but if a serious infection is suspected then a higher dose is needed.

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14
Q

Dosing of azithromycin

A

once daily due to tissue concentrations being high and it has a long half life

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15
Q

contraindications with macrolides

A

not recommended during pregnancy
interacts with statins, CCB, warfarin (increasing their concentration)

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16
Q

give examples of penicillin and which bacteria it works on.

A

penicillins are bactericidal and mainly work of gram-positive bacteria.

amoxicillin, phenoxymethylpenicillin , benzylpenicillin

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17
Q

common side effects of penicillins?

A

nausea, diarrhoea - this can cause colitis, GI discomfort, thrush,

encephalopathy (causes changes to the brain)- this happens with very high doses +/- severe renal impairment

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18
Q

pen v - dosing and indications

A

QDS a day on an empty stomach
used for tonsilitis, upper respiratory tract infections.
or for continuing treatment after injections of benzylpenicillin

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19
Q

why is pen v not recommended for serious infections?

A

the absorption of pen v is unpredictable and the plasma concentrations are variable.

However, it is safe in pregnancy and breast-feeding

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20
Q

what is the indication of flucloxacillin

A

used for penicillin-resistant staph infections and cellulitis
this is because flucloxacillin does not secrete penicillinase.

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21
Q

important side effects of flucloxacillin

A

cholestatic jaundice
hepatitis
use in caution in hepatically-impaired patients

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22
Q

dosing instructions of flucoxacillin

A

QDS a day on an empty stomach
it is safe in pregnancy and breastfeeding women

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23
Q

give examples of broad-spectrum antibiotics

A

ampicillin - used for exacerbations of chronic bronchitis, middle ear infections and UTI’s

co-amoxiclav - used for infections that are likely cause by amoxicillin resistant beta lactamase producing strains

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24
Q

side effects of co-amoxiclav

A

cholestatic jaundice - it can occur during or shortly after use.
most common in ppl aged 65+ , men.
usually self limiting

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25
Q

dosing of broad-spectrum penicillins + is it safe during pregnancy

A

they are safe during pregnancy
TDS ( take with or without food)

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26
Q

give examples of tetracyclines, and what type of bacteria does it work against?

A

it is a broad-spectrum antibiotic, but it is rarely used due to resistance.
examples include tetracycline, doxycycline, and minocycline

remember like this - tdm goes in cycles

27
Q

important MHRA alert with tetracyclines

A

can be deposited in growing bones,
can stain teeth yellow - tetracycline + doxycycline
therefore not recommended in children aged 12 and under
cannot be used in pregnancy or breastfeeding

28
Q

common interactions with tetracyclines

A

absorption of this drug is impaired when taken with milk, calcium, magnesium, iron, zinc and antacids (just remember vitamins and minerals )
maciz - magnesium, antacids, calcium and zinc

29
Q

doxycycline advice

A

can increase photosensitivity - wear SPF 30 +
caution with muscle weakness

can stain the teeth yellow or grey

30
Q

minocycline warnings

A

it is no longer recommended due to its side effects of dizziness and vertigo ( feeling as tho things are spinning around you)

it can cause irreversibe pigmentation
higher risk of lupus erythematosis-like syndrome

31
Q

give an example of quinolones and the type of bacterias it works against

A

works against gram-positive and gram-negative.
it is not effective against anaerobes.

examples; ciprofloxacin, ofloxacin and moxifloxacin

32
Q

MHRA Alerts for quinolones

A

can induce convulsions for patients with or without a history of convulsions.

taking NSAIDS with this medication can increase the chance of convulsions

caution in pts aged 60 and over due to increased risk of tendon damage

caution in pts taking corticosteroids due to increased risk of tendon damage

can cause arthropathy (disease of the joints) of weight-bearing joints and therefore not recommended in children and growing adults

photosensitivity - wear SPF 30 and above

can cause tendon damage - therefore contraindicated in pts with a history of tendon damage

should not be taken during pregnancy

remember it like this - quinolone makes the joints hurt

33
Q

dosing and administration instructions for quinolones

A

ciprofloxacin should not be given with milk, calcium, iron , zinc, or magnesium

ciprofloxacin is given BD

AVOID IN PREGNANCY

34
Q

give examples of glycopeptides and what type of bacteria does it work against.

A

works against aerobic and anaerobic bacteria
it is given by injection
Vancomycin , Teicoplanin - remember it like this glycopeptides watch TV.

35
Q

Glycopeptides indication and dosage

A

vancomycin and teicoplanin can be given orally for the treatment of C.difficile infection (this is the only situation that it can be given orally - due to the poor absorption profile when given orally).

plasma concentration must be monitored throughout therapy.

should be avoided during pregnancy

36
Q

main side effect of glycopeptides

A

ototoxicity and nephrotoxicity

37
Q

tazocin - indication and dosing

A

it consists of tazobactam and piperacillin.
broad-spectrum antibiotic and it works against anaerobes.

used for sepsis, hospital-acquired pneumonia
and other complicated infections.

avoid in pregnancy

given by injection

38
Q

antibiotics cautionary and advisory label

A

Space doses evenly throughout the day and keep taking this medicine until course is finished, unless told to stop.

G.I side effects= N&V, Superinfection (Clindamycin and broad spectrum kill normal flora and allow selective organisms to thrive so can cause C.diff or Thrush (Candida)

39
Q

amoebic infection - definition

A

it is a gastrointestinal illness caused by a parasite, which is spread through human poop
(anaerobic infection)

40
Q

what are the drugs of choice in an amoebic infection? (giardiasis)

A

mepacrine hydrochloride 100mg TDS for 7 days
or metronidazole 1g TDS for 3 days, 1g BD for 4 days (total is 7 days treatment )

41
Q

antibacterial considerations before supplying

A
  1. viral infections should not be treated with antibiotics
  2. avoid blind prescribing, always take a culture sample
  3. generally narrow spectrum antibiotics are preferred.
  4. the dose of the antibiotic should be based on factors such as age, weight, hepatic function, renal function and severity of the infection, allergy, pregnancy, current medication regimie,
  5. avoid prolonged therapy and always complete the antibiotic course
  6. follow national and local guidelines.
  7. review antibiotic if sensitivity occurs.
42
Q

give examples of notifiable diseases

A

anthrax
botulism
mumps and rubella
cholera
COVID-19
diarrhoea (if bloody and infectious)
plague
paratyphoid fever
SARS
Scarlet fever
smallpox
tetanus
tuberculosis
typhus
whooping cough
yellow fever
BNF page 541

43
Q

what is the management of early sepsis or high risk of sepsis

A

give broadspectrum antibiotic at the highest dose (immediately - within 1 hour).

samples and blood cultures should be taken to the lab to be tested.

once the causative microbe has been identified treat as per local and national guidelines.

the need for vasodilators, inotropes, intravenous fluids and oxygen should be assessed and given without delay - taking into consideration of their systolic BP and lactate concentration.

pts should be monitored no later than every 30 minutes

44
Q

which antibiotic is given as a prevention of reoccurrence of rheumatic fever

A

phenoxymethyl penicillin or sulfadiazine

45
Q

what antibiotic do you give for the PREVENTION invasive group A streptococcal infection

A

Pen V
if the patient is allergic than give erythromycin or azithroymycin

46
Q

What antibiotic do you give for the PREVENTION of secondary cases of meningococcal meningitis?

A

ciprofloxacin or rifampicin

47
Q

what antibiotics do you give for the PREVENTION of secondary cases of haemophillus type b infection

A

close contacts of the index case such as - ppl in the household, pre-school or primary school setting should recieve treatment.

First choice - rifampicin
alternative includes ceftriaxone

treatment lasts up to 4 weeks

47
Q

what antibiotics do you give for the PREVENTION of secondary cases of haemophillus type b infection

A

close contacts of the index case such as - ppl in the household, pre-school or primary school setting should recieve treatment.

First choice - rifampicin
alternative includes ceftriaxone

treatment lasts up to 4 weeks

48
Q

which antibiotic is prescribed for the prevention of whooping cough

A

clarithromycin , azithroymcyin or erythromycin
needs to be given within 3 weeks of onset of cough

49
Q

what is the antibiotic of choice given for the prevention of pneumococcal infections in sickle-cell patients

A

pen v
if allergic erythromycin

50
Q

what is the treatment for COMMUNITY-acquired septicaemia

A

a broad spectrum antipseudomonal penicillin -
TAZOCIN (piperacillin and tazobactam) with TIMETIN (ticarcillin with clavulanic acid)

or
broad spectrum antibiotic - cephlasporins - cefuroxime

if an anaerobic infection is suspected add metronidazole

if meticillin resistant stap.aureus infection suspected add vancomycin

51
Q

what is the treatment for HOSPITAL -acquired septicemia

A

a broad spectrum antipseudomonal penicillin -
TAZOCIN (piperacillin and tazobactam) with TIMETIN (ticarcillin with clavulanic acid) with ceftazidme , imipenem with cistatin or meropenem.

if an anaerobic infection is suspected add metronidazole

if meticillin resistant stap.aureus infection suspected add vancomycin

52
Q

Cardiovascular infections - endocarditis (native valve) caused by staphylococci

A

give flucoxacillin for 4 weeks,
(if you suspect a lung abscess give for at least 6 weeks)

GENERAL RULE OF THUMB

Staphylococci infection - flucoxacillin
streptococci - benzylpenicillin or pen v
MRSA - vancomycin
Anaerobic infections - metronidazole
pseudonomas - gentamicin

53
Q

meningitis initial empirical therapy

A

benzylpenicillin should be given before going to hospital as long as this does not delay the trip to the hospital.

3 months - 50 years old - if the causing agent has not been identified whilst in hospital - give cefotaxime or ceftriaxone.

54
Q

Diabetic foot infection - course of action

A

first choice - oral flucloxacillin 500mg to 1g QDS for 7 days for a mild infection
penicillin allergy - clarithromycin (500mg BD) or erythromycin (500mg QDS)

for moderate to severe - based on clinical assessment. IV flucloxacillin with or without gentamicin and or metronidazole / co-amoxiclav

55
Q

what is the treatment therapy for otitis media?

A

amoxicillin for 5- 7 days
penicillin allergy - clarithromycin
pregnancy - erythromycin
give paracetamol or ibuprofen for the pain

this is caused by inflammation (infection) of the middle ear

56
Q

what is the treatment of otitis externa

A

first line - give paracetamol for pain relief, and use a warm flannel

second line - topical acetic acid 2% (1 spray TDS) for 7 days or topical antibiotic (neomycin ) 3 drops TDS

if you suspect cellulitis - flucoxacillin 250mg QDS

57
Q

What treatment do you give for conjunctivitis?

A

first-line - clean eyelids with cotton wool dipped in warm water. use a warm compress on the affected eye

it is usually self-limiting

second line - chloramphenicol eye drops - instill one drop into the eye every 2 hours for the first 48 hours, then frequency to 3-4 times daily

chloramphenicol ointment - apply 3-4 times daily .

58
Q

what treatment do you give for typhoid fever

A

cefotaxime

59
Q

what treatment is given for an acute sore throat

A

first line - paracetamol or ibuprofen for pain.
FEVERPAIN score above 2 - treat with antibiotics

2nd line - phenoxymethylpenicillin 500mg QDS or 1g BD ( for 5-10 days)

give clarithromycin 250mg to 500mg QDS for 5 days

60
Q

what treatment do you give for influenza?

A

annual vaccination is essential for those deemed high-risk.

at-risk patients receive anti-viral medication oseltamivir 75mg BD for 5 days.

at-risk patients
- pregnant
- COPD
- CVD disease
- Renal disease
- Liver disease

61
Q

what treatment do you give for sinusitis?

A
  1. paracetamol and ibuprofen for pain relief
  2. if symptoms last less than 10 days - no antibiotics
  3. symptoms last for more than 10 days - consider high-dose nasal corticosteroids if they are aged 12 and over.
  4. if systemically unwell or at high risk of complications then give antibiotics.

phenoxymethylpenicillin 500g QDS - 5 days
penicillin allergy - clarithromycin 500mg BD - 5 days OR erythromycin 250-500mg QDS - 5 days

62
Q

treatment of acute exacerbation of COPD

A

amoxicillin 500mg TDS or doxycycline 200mg on day 1 then 100mg - total duration is 5 days.

penicillin allergy - clarithromycin 500mg BD for 5 days

63
Q

scarlet fever - treatment

A

1st choice - phenoxymethylpenicillin 500mg QDS for 10 days
penicillin allergy - clarithromycin 250-500mg BD for 5 days

PRE- REGISTRATION PHARMACIST (1 decks)

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