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BNF 72/74 > Chapter 5- Infection > Flashcards

Chapter 5- Infection Flashcards

1
Q

What are the safest antibiotics in pregnancy?

A

Penicillins and cephalosporins

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2
Q

If someone has a virus - when are antibacterials indicated?

A

Only to treat secondary bacterial infections e.g bacterial pneumonia secondary to influenza

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3
Q

Two conditions that require prolonged courses of antibiotics

A

TB

Osteomyelitis

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4
Q

Two drugs used to prevent recurrence of rheumatic fever

A

Phenoxymethylpenicillin

Sulfadiazine

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5
Q

Prevention of pneumococcal infection in asplenia or in patients with sickle cell disease

A

Phenoxymethylpenicillin

Pen allergy? - erythromycin

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6
Q

Prevention of early onset neonatal infection

A

Benzylpenicillin (clindamycin if history of allergy to penicillins)

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7
Q

Four sites of action for antimicrobials

A

Cell wall
Protein synthesis
Cell membrane
Nucleus acid synthesis

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8
Q

Name 4 classes of b-lactams

A

Penicillins
Cephalosporin
Carbapenems
Monobactams

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9
Q

Name two glycopeptides

A

Vancomycin

Teicoplanin

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10
Q

True or false: gram positive bacteria have a thicker peptidoglycan layer and NO cell membrane

A

TRUE

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11
Q

Is gentamicin bactericidal

A

YAH

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12
Q

Are tetracyclines bactericidal

A

Nah- bacteristatic

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13
Q

Name four aminoglycosides

A

Gentamicin
Amikacin
Tobramycin
Streptomycin

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14
Q

How do aminoglycosides work??

A

Inhibit protein synthesis

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15
Q

Use and indications for the aminoglycosides

A

IV for serious infections from AEROBIC bacteria e.g septicaemia, complicated UTI, nosocomial RTI

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16
Q

Spectrum of activity for aminoglycosides

A

Active against many G -be including pseudomonas, and some G+ve e.g staphylococci - (streptomycin can be used for TB, mycoplasma)

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17
Q

Are tetracyclines broad spectrum? And name three

A

YES
doxycycline
Minocycline
Oxytetracycline

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18
Q

Oral indications for tetracyclines

A 
Acne 
RTI 
Chlamydia 
SSTI 
Mycoplasma
Periodontal disease
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19
Q

Can you use tetracyclines in under 12s and pregnancy

A

NO - tetracyclines deposit in forming bones/teeth

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20
Q

Name three macrolides

A

Erythromycin
Azithromycin
Clarithromycin

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21
Q

When are macrolides good?

A

Alternative to penicillins for treating strept infections

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22
Q

What type of drug is clindamycin and what’s a side effect

A

Lincosamide

Side effect: Cdiff

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23
Q

What type of drug is linezolid

A

Oxazolidinone - active against G+ve bacteria is a last resort antibiotic for e.g MRSA, vanc resistant enterococci

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24
Q

Tell me about fusidic acid

A

Narrow spectrum for staph infections
Topical: skin & eye
Oral/IV: osteomyelitis &a endocarditis

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25
Q

Name a broad spectrum antipseudomonal penicillin

A

Piperacillin with tazobactam

Ticarcillin with clavulanic acid

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26
Q

Antibiotic for MRSA

A

Vancomycin or teicoplanin

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27
Q

Antibiotics for meningitis

A

Benzylpenicillin
Cefotaxime
Chloramphenicol

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28
Q

First second and third line for C diff

A

Metronidazole
Vancomycin
Fidaxomicin

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29
Q

Name two b-lactamase resistant penicillins

A

Flucloxacillin

Co-amoxiclav

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30
Q

Three common bacteria in meningitis

A

Neisseria meningitidis
Strep pneumoniae
Haemophilus influenza

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31
Q

Glycopeptides vancomycin and teicoplanin are active against what?

A

Gram +ve

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32
Q

Name three aminoglycosides that are active against pseudomonas

A

Gentamicin
Amikacin
Tobramycin

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33
Q

Contraindications to aminoglycosides

A

Myasthenia gravis (aminoglycosides may impair neuromuscular transmission)

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34
Q

Parenteral aminoglycosides should ideally not exceed what duration?

A

7 dayz

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35
Q

Peak level of amikacin

A

30mg/litre

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36
Q

Trough level of amikacin multiple dose regimen

A

<10mg/litre

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37
Q

Trough level of once daily amikacin

A

<5mg/litre

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38
Q

Peak gentamicin

A

5-10mg/litre

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39
Q

Trough gentamicin

A

<2mg/litre

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40
Q

Neomycin is safe for systemic use- true or false?

A

FALSE- too toxic for systemic use

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41
Q

The aminoglycosides streptomycin is used for what?

A

TB

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42
Q

Safety information with streptomycin

A

Side effects increase after cumulative dose of 100g which should only be exceeded in exceptional circumstances

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43
Q

Peak tobramycin

A

10mg/litre

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44
Q

Trough tobramycin

A

<2mg/litre

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45
Q

What can tobramycin dry powder inhalation be used for?

A

Pseudomonas lung infection in cystic fibrosis

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46
Q

Name two carbapenems active against pseudomonas aeruginosa

A

Imipenem and meropenem

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47
Q

What is cilastatin

A

Specific enzyme inhibitor given with imipenem to prevent its renal metabolism

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48
Q

Which carbapenem has less seizure inducing potential?

A

Meropenem

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49
Q

Name two cephalosporins used for infections of the CNS (meningitis as an example)

A

Cefotaxime

Ceftriaxone

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50
Q

What percentage of people whom are allergic to penicillin will be allergic to cephalosporins

A

0.5-6.5%

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51
Q

If cephalosporins essential in a penicillin allergic patient as there’s no alternative which ones should be avoided

A 
Cefaclor
Cefadroxil
Cefalexin
Cefradine
Ceftaroline
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52
Q

Name the cephalosporin that has good activity against H.influenzae

A

Cefaclor

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53
Q

Name the cephalosporin that needs to be given with food to increase absorption

A

Cefuroxime

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54
Q

Caution with ceftriaxone

A

History of hypercalciuria history of kidney stones

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55
Q

What is tazobactam

A

Beta lactamase inhibitor

56
Q

Spectrum of activity for the glycopeptides teicoplanin and vancomycin and telavancin

A

Active against aerobic and anaerobic gram positive bacteria including MRSA

57
Q

Which has a longer half life teicoplanin or vancomycin

A

Teicoplanin

58
Q

The lincosamide clindamycin is active against what

A

Gram positive cocci including streptococci and penicillin resistant staphylococci and many anaerobes especially bacteria fragilis

59
Q

Which has more activity against Haemophilus influenzae erythromycin or azithromycin

A

Azithromycin! Erythromycin has poor activity against it

60
Q

Cautions with macrolides?

A 
Electrolyte disturbance (predisposition to QT prolongation) 
May aggravate M gravis
61
Q

Caution for erythromycin

A

Avoid in acute porhyrias

62
Q

Name a monobactam and what’s it’s spectrum of activity

A

Aztreonam: gram -ve only including p.aeruginosa, neisseria meningitidis, h.influenzae

63
Q

Activity of metronidazole

A

Anaerobic bacteria and Protozoa

64
Q

Which has a longer duration of action - metronidazole or tinidazole?

A

Tinidazole

65
Q

Are penicillins bactericidal or bacteristatic

A

Bactericidal

66
Q

What is the penicillin pivmecillinam hydrolysed to

A

Mecillinam

67
Q

Caution with puperacillin/tazobactam and ticarcillin/clavulanic acid

A

High doses may lead to hypernatraemia owing to sodium content of preparations

68
Q

Caution with preparations containing clavulanic acid

A

Cholestatic jaundice

69
Q

What is in co-fluampicil

A

Ampicillin + flucloxacillin

70
Q

Important safety information with flucloxacillin

A

Cholestatic jaundice and hepatitis

71
Q

Penicillins can cause cholestatic jaundice - its more common in what age and gender?

A

Male over 65

72
Q

Is temocillin penicillinase resistant?

A

Yes

73
Q

Contra indications to colistin

A

Myasthenia gravis

74
Q

Can colistin be used for pseudomonal lung infection in cystic fibrosis

A

Yes

75
Q

Moxifloxacin has been associated with what adverse effects

A

QT interval prolongation and life threatening hepatotoxicity

76
Q

CSM safety information with quinolones

A

Convulsions may be induced - taking NSAIDs at the same time may induce them

Tendon damage

Can prolong QT

77
Q

Common/very common side effect of ciprofloxacin

A

Flatulence

78
Q

Side effect of tetracyclines related to the brain

A

Benign intracranial hypertension- headache and visual disturbances discontinue treatment!

79
Q

Directions for administration of doxycycline

A

Plenty of fluid while sitting or standing and taken during meals

80
Q

Monitoring requirements for minocycline

A

If treatment continued for longer than 6 months, monitor every 3 months for hepatotoxicity l, pigmentation and for systemic lupus erythromatosus

81
Q

Max duration for topical fusidic acid

A

10 days to avoid resistance developing

82
Q

Spectrum of action for linezolid

A

Gram positive including MRSA

83
Q

Important safety information with linezolid

A

Severe optic neuropathy if used longer than 28 days

Blood disorders

84
Q

Trimethoprim is a folate antagonist therefore shouldn’t be given when

A

Preganancy - teratogenic risk in first trimester

85
Q

What should patients be told to look out for if on long term treatment with trimethoprim

A

Blood disorders (fever, sore throat, rash, mouth ulcers, purpura, bruising, bleeding

86
Q

Treatment duration of anthrax

A

60days

87
Q

What’s the three drug regimen recommended for multibacillary leprosy

A

Rifampicin
Dapsone
Clofazimine

88
Q

Two drug regimen for paucibacillary leprosy

A

Rifampicin

Dapsone

89
Q

Name two antimycobacterials

A

Clofazimine

Dapsone

90
Q

Antibiotics used in Lyme disease

A

Doxycycline
Amoxicillin
Cefuroxime
Macrolides

91
Q

How many drug and treatment phases in TB treatment

A

Initial phase- 4 drugs

Continuation phase- 2 drugs

92
Q

Name the four drugs in the initial phase of TB treatment

A

Rifampicin
Ethambutol
Pyrazinamide
Isoniazid (with pyridoxine)

93
Q

How long is the initial phase of TB treatment

A

2months

94
Q

When do you use streptomycin in TB

A

During initial phase if resistance to isoniazid is established prior to treatment

95
Q

Drugs in continuation phase of TB and for how long

A

Rifampicin
Isoniazid (+pyridoxine)
4months

96
Q

In TB - supervised consumption is how often a week?

A

Three times a week

97
Q

True or false: streptomycin can be used in pregnancy

A

False

98
Q

How long is the continuation phase for extrapulmonary CNS TB

A

10months

99
Q

Treat patients for latent TB if close relative has TB if they are under what age

A

65

100
Q

When can ethambutol be omitted from says treatment

A

If resistance from isoniazid is not suspected

101
Q

Why is pyridoxine given with isoniazid

A

To prevent peripheral neuropathy

102
Q

What’s a key side effect of ethambutol and when is it most likely to occur

A

Ocular toxicity - impaired renal function

103
Q

Contraindication to pyrazinamide

A

Acute attack of gout

104
Q

Bacteria that’s most common cause of UTI

A

Escherichia coli

105
Q

Other bacteria causing UTIs

A 
Staph saprophyticus 
Proteus
Klebsiella 
Pseudomonas aeruginosa 
Staph epidermidis
Enterococcus faecalis
106
Q

Name the fungal infection that commonly affects the respiratory tract

A

Aspergillosis

107
Q

Name the most common cause of fungal meningitis

A

Cryptococcal meningitis

108
Q

Why is itraconazole and terbinafine used more than griseofulvin

A

Broader spectrum and used for shorted duration

109
Q

Which is active against aspergillus: itraconazole or fluconazole

A

Itraconazole

110
Q

Which is more reliably absorbed: itraconazole or fluconazole

A

Fluconazole

111
Q

For optimal absorption itraconazole requires what

A

Acid environment

112
Q

Which triazole antifungal should be avoided or used with caution in liver disease

A

Itraconazole

113
Q

What formulations of amphotericin are available and why

A

Lipid formulations e.g ambisome - makes then Mmm significantly less toxic

114
Q

What’s used with amphotericin for its synergistic effect

A

Flucytosine

115
Q

True or false: amphotericin should be prescribed by brand

A

True

116
Q

Fluconazole can be sold to public for vaginal candidiasis if what?

A

Aged 16-60 and not more than 150mg

117
Q

Important safety information with itraconazole

A

Following reports of heart failure caution is advised when prescribing itraconazole for those at high risk of heart failure

118
Q

Itraconazole should be avoided when?

A

Patients with ventricular dysfunction or a history of heart failure unless the infection is serious

119
Q

Common cause of pneumonia in aids

A

Pneumocystis jirovecii

120
Q

Treatment options for pneumocystis pneumonia mild to moderate disease

A

Co-trimoxazole
Atovaquone
Dapsone + trimethoprim
Clindamycin + primaquine

121
Q

Treatment options for severe pneumocystis pneumonia

A

Co-trimoxazole
Pentamidine
Corticosteroid

122
Q

Treatment of choice for threadworms in those over 6 months

A

Mebendazole as a STAT dose - can give 2nd dose 2 weeks after

123
Q

Mebendazole licensing?

A

Can be sold OTC for those over 2 years if package is clearly labelled 100mg as single dose and not more than 800mg is in a container

124
Q

Side effects of mebendazole

A

Abdominal pain
Diarrhoea
Flatulence
Stevens J syndrome (rare)

125
Q

Treatment of acute non complicated falciparum malaria

A

Artemether with lumefantime

126
Q

What is primaquine used for in malaria

A

Used to eliminate the liver stages of P. Vivax or P. Ovale following chloroquine treatment

127
Q

Name the two most important herpes virus pathogens

A

Herpes simplex virus

Varicella zoster virus

128
Q

True or false- valaciclovir is a prodrug of aciclovir

A

True

129
Q

Name a HIV fusion inhibitor

A

Enfuvirtide

130
Q

Name three HIV integrase inhibitors

A

Dolutegravir
Elvitegravir
Raltegravir

131
Q

Name 4 non-nucleoside reverse transcriptase inhibitors

A

Efavirenz
Etravirine
Nevirapine
Rilpivirine

132
Q

Name two drug used in influenza

A

Oseltamivir

Zanamivir

133
Q

Oseltamivir should be given within how many hours of symptoms onset

A

48 hrs

134
Q

Zanamivir should be given within how many hours of symptoms onset

A

36hrs

135
Q

First line options for aspergillosis fungal infection

A

Voriconazole

Liposomal amphotericin

136
Q

Second line options for aspergillosis

A

Caspofungin
Itraconazole
Posaconazole

137
Q

What’s the fungus that most commonly causes fungal meningitis

A

Cryptococcosis

BNF 72/74 (17 decks)

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