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British National Formulary > 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 & 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

Radars and Arrows.

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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

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56
Q

Spectrum of activity for the glycopeptides teicoplanin and vancomycin and telavancin

A

Active against aerobic and anaerobic gram positive bacteria including MRSA

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57
Q

Which has a longer half life teicoplanin or vancomycin

A

Teicoplanin

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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

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59
Q

Which has more activity against Haemophilus influenzae erythromycin or azithromycin

A

Azithromycin! Erythromycin has poor activity against it

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60
Q

Cautions with macrolides?

A

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

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61
Q

Caution for erythromycin

A

Avoid in acute porhyrias (its a genetic blood disorder) Features are tachycardia and unlocalised pain.

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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

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63
Q

Activity of metronidazole

A

Anaerobic bacteria and Protozoa

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64
Q

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

A

Tinidazole

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65
Q

Are penicillins bactericidal or bacteristatic

A

Bactericidal

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66
Q

What is the penicillin pivmecillinam hydrolysed to

A

Mecillinam

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67
Q

Caution with Piperacillin/tazobactam and ticarcillin/clavulanic acid

A

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

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68
Q

Caution with preparations containing clavulanic acid

A

Cholestatic jaundice

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69
Q

What is in co-fluampicil

A

Ampicillin + flucloxacillin

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70
Q

Important safety information with flucloxacillin

A

Cholestatic jaundice and hepatitis

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71
Q

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

A

Male over 65

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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 with Ciprofloxacin if under 12. Doxycycline if over 12…

87
Q

What’s the three drug regimen recommended for multibacillary leprosy

A

Dapsone Rifampicin Clofazimine

DR.C

88
Q

Two drug regimen for paucibacillary leprosy

A

Dapsone Rifampicin

DR

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 Isoniazid Pyrazinamide Ethambutol (with pyridoxine to prevent peripheral neuropathy caused by isoniazid)

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

138
Q

Signs of an infection and Clinical Markers?

A
139
Q

Identify the varying needs of Children, Elderly and Penicillin allergic patients, stating the drugs to avoid and where applicable what can be used instead

A
140
Q

Highlight the Antibiotic drugs to avoid or be aware of in Hepatic/ Renal and Pregnancy

A
141
Q

Whats the side effect issue with broad spectrum Abx

A

They can precipitate diarrhoea and they kill off Good bacteria flora.

142
Q

As a General Rule of Thumb, how do we treat:

Staphlococci:

MRSA:

Streptococci:

Anaerobic Bacteria

Pseudomonas Aeruginosa

A
143
Q

Treatment of Meningococcal Meningitis?

A

Ciprofloxacin or Rifampixin or IM Ceftriaxone

144
Q

Treatment of Haemophilus Influenzae

A

Rifampicin or Ceftriaxone.

145
Q

What is this and what is it’s treatment?

A

Diptheria, Treat with Erythromycin or another macrolide

146
Q

What is this most likely to be and what is the treatment?

A

Dog Bite. Treat animal bites with Co-Amoxiclav alone or Doxycycline + Metronidazole if penicillin allergic.

consider rabies prophylaxis

147
Q

What ABx do we give when inserting a pacemaker, and when in terms of timing?

A

Single dose of IV Cefuroxime alone or Flucloxacillin + Gentamicin 30 minutes before the procedure.

148
Q

What is this and generally what is the causative organism? and how do we treat

A

Endocarditis: Staph Aureus or Meticillin-Resistant Staph Aureus

Penicillin or Vancomycin if penicillin allergic… Low Dose Gentamicin features here also

149
Q

Name the causative oganisms of this condition and tx

A

Meningococci (give Benzylpenicillin or cefotaxime)

Pneumococci (ceftriaxone)

Haemophilus Influenzae (cefotaxime or ceftriaxone)

Listeria (amoxicillin or ampicillin)

150
Q

Treatment for CAP Low-severity

A

Amoxicillin or Ampicillin for 7 days (can be up to 14-21 if caused by staphlococci)

Alternatives: Doxycycline or Clarithromycin…

151
Q

Difference between otitis externa and otitis media? and treatment?

A

Otitis media is an infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum. Initial treatment is with Amoxicillin. or Co-Amoxiclav.

Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and eardrum.

Initial treatment is with flucloxacillin or Clarithromycin

The difference is location.

152
Q

What are the symptoms of Bacterial Vaginosis? What is the treatment? and whats the appearance between BV and Thrush

A

Oral Metronidazole OR Metronidazole topical gel 5 days/ Clindamycin topical gel

Thrush also has a thick white discharge like cottage cheese

153
Q

Causative bacterial organisms for pneumonia in community and hospital?

A

Staphlycoccus Aureaus, and Pseudomonas Aeruginosa and Legionella

154
Q

CAP treatment in modeate severity?

A

Amoxicillin (or Ampicillin) + Clarithromycin/Erythro/Azithro or doxycycline alone

If MSRA is suspected then give Vanco or Teicoplanin.

155
Q

Treatment of High severity CAP?

A

Benzylpenicillin + Clarithromycin or Azithromycin/ Erythromycin

If MRSA suspected: Vancomycin.

Treatment is typically 7-10 days, but can be up to 14-21 days if severe.

If life threatening or in nursing home, Co-Amoxiclav + Clarithromycin. alternative: Cefuroxime + Clalrithro.

156
Q

When Pneumonia is caused by Atypical Pathongens such as legionella, how do we treat CAP?

A

Give Clarithromycin and add Rifampicin for the first few days if its a high severity rifampicin for the first few days. Alternatives to Rifampicin is Quinolone.

157
Q

How to treat HAP?

A

Early onset (less than 5 days) after administration to hospital – Co-Amoxiclav or Cefuroxime 7 days

Late onset infection (more than more than 5 days on admission) Piptaz or broad spectrum cephalosoprin or a quinolone e.g Ciprofloxacin.

If MRSA suspected: Vancomycin

If severe caused by an P.Aeruginosa consider adding IV Aminoglycoside.

158
Q

What is this a typical example of, and what are signs and symptoms?

A

Impetigo. it looks like:

  • look a bit like cornflakes stuck to your skin
  • get bigger
  • spread to other parts of your body
  • be itchy
  • sometimes be painful

If it is local

  1. Topical Fusidic Acid
  2. Mupirocin (if MRSA)

If it is all over the body:

  1. Oral Flucloxicillin
  2. Phenoxymethylpenicillin (if severe infection detected)
  3. Clarithromycin if penicllin allergic.
159
Q

what is this and whats the underlying signs? for treatment? what’s

A

Erysipelas

You may feel unwell and feverish with a high temperature and shivers. This may start a few hours or a day before the skin changes become visible. The affected skin will become sore, swollen, firm, warm, and red, and blisters may form. The nearest lymph glands may become swollen and tender. The area of affected skin may gradually get larger. These features can develop quite quickly, over hours to a few days.

Usually the face and the legs.

Treatment:

  • Phenoxymethylpenicillin
  • Benzylpenicillin
  • High dose Flucloxicillin if severe.. or Clarithro in allergy.
160
Q

What is this condition and how do we treat it?

A

Cellulitis – can be caused by insect bites/ cuts/ surgical incisions…

Treatment:

Flucloxacillin high dose.

Streptococcal infection confirmed replace phenoxymethylpenicillin or benzyl with fluclox.

If gram-negative bacteria or anaerobes susppected, use broad-spectrum abx. if penicillin allergic , clindamycin or clarithromycin.

161
Q

what is this condition, what causes it and how to treat it? how can it be prevented

A

Mastitis occurs in breastfeeding women

Milk stasis can occur for a number of reasons, including:

  1. a baby not properly attaching to the breast during feeding
  2. a baby having problems sucking
  3. infrequent feeds or missing feeds
  4. In some cases, this build-up of milk can also become infected with bacteria. This is known as infective mastitis

Treatment:

  • Flucloxicillin 10-14 days.
  • Erythromycin in allergy 10-14 days.

Steps to prevent mastisis?

  • let baby finish feeds before removing
  • encourage baby to drink more, esp when breasts feel full
  • avoid pressure on breasts.
162
Q

How do we treat animal bites

A

cleans wound thoroughly – for tetanus-prone wound, give human tetanus immmunoglobin + vaccine if necessary.

consider rabies prophylaxis

Assess risk of blood-bourne viruses (and HIV + Hep B + C)

Give prophylaxis to prevent viral spread.

Co-Amoxiclav treatment. Doxy + Metro if allergy.

163
Q

What drug Abx does entamycin have poor activity against?

A

Haemolytic streptococci and pneumococci.

164
Q

When used for the blind therapy of undiagosed serious infections, what is gentamycin accompanied with?

A

Gentamycin is accompanied with metronidazole and penicillin

165
Q

in gentamycin-resistant enterococcal endocarditis, what can we give?

A

streptomycin in this case

166
Q

What is the standard duration of treatment for gentamycin?

A

7 days long ideally for gentamycin

167
Q

A once daily high dosage regimen of an aminoglycoside should be avoided in adults with createnine clearance below..

A

Less than 20ml/minute

168
Q

A once daily high dosage regimen of an aminoglycoside should be avoided in children with createnine clearance below..

A

20ml/minute

169
Q

What trimester bears the greatest risk to mothers on aminoglycoside and what is the nature of the teratogenicity?

A

second and third trimester – greatest risk to pregnant women. There’s a risk of auditory or vestibular damage

170
Q

What is the most key thing to monitor for patients on aminoglycosides?

A

Renal functioning. If there is impairment in renal functioning, the dose must be increased.

171
Q

In patients with normal renal functioning, how often do we measure aminoglycoside serum conc? Does this apply to children too

A

measured after 3 or 4 doses and after a dose change.

Also applies to childen with normal renal functioning. Includng auditory and vestibular

172
Q
A
173
Q

whats this and how does it differ from a similar cough

A

Croup

Symptoms: cough in baby – worse at night. Pertussis is coughing that is whooping followed by vomiting.

174
Q

whats this?

A

measles red blotchy rash across body – inflamed eyes / fever / dry cough and runny nose

175
Q

what is this

A

mumps

176
Q

whats this

A

rubella: symptoms are red or pink rash that begins on face and spreads downwards to neck and body. Muscle pain also and mild fever

177
Q

what is this?

A

scarlett fever: Symptoms are pink, red rash often preceded by sore throat on headache and whiteness on tongue. Rash feels like sand paper.

178
Q

whats this

A

chicken box – blistering/ itchy and can be fever…

British National Formulary (18 decks)

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