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My Pham Notes > Chapter 5: Infection Part 1 > Flashcards

Chapter 5: Infection Part 1 Flashcards

1
Q

What are the safest classes of antibiotics to use in pregnancy?

A

Penicillins, erythromycin and Cephalosporins (1st gen cefalexin, 2nd gen ceftriaxone)

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2
Q

What antibiotic treatment is indicated for septicaemia (community or hospital acquired)?

A

BROAD SPEC antibiotics: e.g. tazocin (pipericillin and tazobactam)

If MRSA suspected: add Vancomycin

Anaerobic: Metronidazole

Meningococcal: Benzylpenicillin

Pen/Ceph allergy: Chloramphenicol

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3
Q

What antibiotic Is very good against anaerobic bacteria so usually infections of the colon?

A

Metronidazole

Used for bacteria growing where there isn’t much oxygen: Gut, Bacterial vaginosis, Leg ulcers

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4
Q

How is bacterial meningitis empirically treated?

A

1) BENZYPENICILLIN- can be given before transfer to hospital
2) If penicillin allergy- CEFOTAXIME

3) If hypersensitivity to penicillin & cephalosporins: CHLORAMPHENICOL
4) Consider Vancomycin if multiple use of antibiotics in previous 3 months

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5
Q

What is the treatment for meningococcal meningitis?

A

Benzylpenicillin or cefotaxime

2nd line: Chloramphenicol For 7 days

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6
Q

What is the treatment for pneumococcal meningitis?

A

Benzylpenicillin
Cefotaxime (OR ceftriaxone)

If allergic: chloramphenicol
If resistant: vancomycin/rifampicin

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7
Q

What is the treatment for meningitis caused by haemophilus influenza?

A

Cefotaxime or ceftriaxone
For 10 days

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8
Q

What antibiotics are used in endocarditis (infection of the heart)?

A

1) Amoxicillin

If resistant MRSA or pen allergy: Vancomycin

+/- low-dose gentamicin hence the lower target level range for gentamicin in endocarditis (trough<1, peak 3-5)

Staph: flucloxacillin
Strep: Benzylpenicillin

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9
Q

What antibiotic is indicated for gastro-enteritis?

A

This is usually self-limiting and an antibiotic not indicated

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10
Q

What is the antibiotic indicated for C. diff?

A

First episode: oral Metronidazole (high anaerobic activity)

Second episode/2nd line: oral Vancomycin

Use together if combo not worked: oral Fidaxomicin

10-14 day treatment length

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11
Q

Which antibiotics are commonly used for genitourinary infections? Excluding UTI.

A

Azithromycin- used in chlamydia, gonorrhoea

Doxycycline- alternative in chlamydia, pelvic inflammatory disease, syphilis

Metronidazole- used for bacterial vaginosis, pelvic inflammatory disease

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12
Q

What class of antibiotic is Amikacin? When is amikacin usually indicated?

A

An aminoglycoside usually indicated for gentamicin resistant infections as amikacin is more stable than gentamicin to enzyme inactivation.

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13
Q

What is the target one hour peak concentration of gentamicin? (multiple daily dosing)

A

5 - 10 mg/L

(3-5mg/L if endocarditis)

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14
Q

What is the target pre-dose trough concentration of gentamicin? (multiple daily dosing)

A

Under 2 mg/L

(<1mg/L if endocarditis)

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15
Q

What is the target one hour peak conc of gentamicin in treatment of ENDOCARDITIS? And target trough level?

A

Peak: 3 - 5 mg/L

Trough: <1mg/L

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16
Q

Which aminoglycoside is too toxic to be administered parenterally, therefore is taken by mouth?
What is the indication for this?

A

NEOMYCIN

Used for bowel sterilisation before surgery

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17
Q

Etrapenem, Imipenem and Meropenem are all examples of what kind of antibiotics?

A

Carbapenems- beta-lactam antibacterials

Imipenem is administered with cilastatin which is a specific enzyme inhibitor that stops it being renally metabolised

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18
Q

Which two cephalosporins are suitable for infections of the CNS?

A

Cefotaxime + Ceftriaxone (TAX AND TRAX)

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19
Q

What is used in the treatment of UTIs in pregnancy?

A

Nitrofurantoin: okay to use but avoid at term

Cefalexin: a cephalosporin, these are safe in pregnancy

Trimethoprim: Teratogenic risk in first trimester as it is a folate antagonist

Cranberry juice or other cranberry products are not recommended as no evidence to support their use

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20
Q

What classes, other than penicillins, do we have to be wary of with penicillin allergic patients?

A

Cephalosporins- cefalexin, cefadroxil, ceftriaxone, cefixime, cefotaxime

(0.5-6.5% cross-sensitivity)

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21
Q

What is co-trimoxazole? What is it used for?

A

Contains SULFAMETHOXAZOLE and TRIMETHOPRIM!

Resistance to sulphonamides has increased so there are restrictions on the use of co-trimoxazole.

LIMITED USE. Indicated for Pneumonia caused by p.jiroveci/ carinii.

Also for toxoplasmosis + nocardiasis

Should only be used in bronchitis exacerbation/ UTI’s/ otitis media in children when culture and sensitivities evident

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22
Q

What antibiotics require reporting on blood disorders/ rash?

A

Co-trimoxazole (contains trimethoprim and sulfamethoxazole)

Discontinue immediately if signs of a blood disorder such as anaemia, thrombocytopenia, rash (Steven-Johnson syndrome), photosensitivity

Trimethoprim- risk of blood disorders, signs include fever, sore throat, ulcers, bruising, bleeds

Penicillamine: used as a disease-modifying anti-rheumatic drug but same as above, to report fever, sore throat, ulcers, bruising

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23
Q

What do you see fusidic acid commonly used for?
What formulations are available?

A

Staphylococcal infection of the SKIN e.g. impetigo & also EYES

Tablet, cream, eye drops

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24
Q

What happens if a patient on clindamycin develops diarrhoea?

A

Antibiotic associated colitis with clindamycin can be fatal

Discontinue immediately + start vancomycin

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25
Q

Why antibiotic has been associated with myopathy/muscle effects?

A

Daptomycin

Monitor creatinine kinase every 2 days if muscle effects reported

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26
Q

Which antibiotics can cause cholestatic jaundice?

A

Co-amoxiclav
Nitrofurantoin
Flucloxacillin (even upto 2 months after)

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27
Q

What is the important safety information associated with Flucloxacillin?

A

Hepatic disorders: Cholestatic Jaundice and HEPATITIS have been reported in patients even up to 2 months after the drug has been stopped.

Use flucloxacillin with caution in patients with liver impairment!!

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28
Q

A few antibiotics have been associated with visual problems. Name them.

A

Linezolid- optic nephropathy

Quinolones (Ciprofloxacin, Levofloxacin)- retinal detachment

Ethambutol- ocular toxicity

Rifampicin- colours tears/ contacts orange

Rifabutin- uveitis (eye inflammation)

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29
Q

What two adverse events should be monitored during Linezolid treatment?

A

Optic neuropathy (visual problems)- report any visual disturbance IMMEDIATELY

Blood disorders- aneamia, thrombocytopenia

FBC monitored especially in treatment of 10-14 days or more

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30
Q

What are the two safety warnings with QUINOLONES (ciprofloxacin, levofloxacin)?

A

CONVULSIONS
Especially if also taking NSAIDS - even in those that are not epileptic.
Caution in EPILEPSY.
Caution with THEOPHYLLINE as also causes seizures.

TENDON DAMAGE
Tendonitis, tendon rupture
This has also been reported with prednislone.
Can also prolong QTc interval- caution

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31
Q

When should patients discontinue treatment with Quinolones?

A

If any of the following occur:
Psychiatric reactions- hallucinations, anxiety, depression
Neurological reactions- tremor, asthenia (abnormal weakness)

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32
Q

Which antibiotics can cause QT prolongation?

A

MACROLIDES
Erythromycin
Clarithromycin
Azithromycin

QUINOLONES
Ciprofloxacin
Levofloxacin
Especially Moxifloxacin

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33
Q

Linezolid is an antibacterial used in pneumonia. It also had Monoamine oxidase inhibition activity (part of MAOI family).

What should patients be advised to avoid?

A

Avoid consuming large amounts of Tyramine rich foods

Remember: Linezolid will still have interactions/tyramine effects 2 weeks after discontinuation

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34
Q

What can happen if vancomycin is infused too rapidly?

A

RED MAN SYNDROME

Severe Hypotension
Wheezing
Pruritis
Pain
Muscle spasm in back

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35
Q

After how many doses should Vancomycin plasma levels be measured?

A

Pre fourth dose if renal function is normal

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36
Q

What side effects do Vancomycin and Gentamicin both have in common? What drugs should be avoided with these?

A

Ototoxicity
Nephrotoxicity

Ototoxic drugs: Loop diuretics
Nephrotoxic drugs: ciclosporin, platinum chemotherapy

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37
Q

Treatment with Vancomycin requires full blood count monitoring. Why is this?

A

Risk of neutropenia

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38
Q

Which antibiotics could cause CHOLESTATIC JAUNDICE?

A

FLUCLOXACILLIN- may even occur up to 2 months after flucloxacillin stopped, more likely after TWO WEEKS of treatment.
Co-fluampicil (contains amoxicillin and flucloxacillin)
Co-amoxiclav
Nitrofurantoin

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39
Q

Which antibiotics are commonly used to treat acne??

A

Tetracyclines most common: tetracycline, doxycycline, oxytetracycline

Erythromycin (a macrolide) sometimes used

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40
Q

What conditions can Tetracyclines exacerbate?

A

Systemic Lupus Erythematosus
Myasthenia Gravis (increased muscle weakness)

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41
Q

Which antibiotics can cause photosensitivity?

A

Doxcycline
Demeclocycline

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42
Q

Which antibiotics are not recommended in children and adolescences under 18 years old? And why?

A

Quinolones: Ciprofloxacin, levofloxacin, moxifloxacin

This is because of the risk of TENDON DAMAGE/ JOINT DISEASE (Aropathy)

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43
Q

What is an important monitoring parameter with Linezolid?

A

WEEKLY Full Blood Counts due to risk of blood disorder/ anaemia

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44
Q

Which antibiotics may cause a false positive result on urinary glucose tests- i.e. be careful when testing for diabetes?

A

CEPHALOSPORINS
Cefalexin, Ceftriaxone etc

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45
Q

Which antibiotic is a FOLATE SYNTHESIS INHIBITORS and is therefore teratogenic?

A

Trimethoprim
Co-trimoxazole (contains sulfamethoxazole and trimethoprim)

Therefore AVOID in pregnancy- especially first trimester when folate is needed

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46
Q

What frequency of administration is Vancomycin given?
What about Teicoplanin?

A

12 hourly due to long half life

Teicoplanin: even longer acting OD dosing after loading dose

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47
Q

Name 2 Glycopeptide antibiotics?

A

Vancomycin
Teicoplanin (less nephrotoxic than vancomycin)

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48
Q

What are the target pre-dose TROUGH levels for vancomycin?

A

10 - 15 mg/ L

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49
Q

First line antibiotic for Cellulitis?
And in penicillin allergy?

A

Flucloxacillin (250-500mg QDS)

If penicillin allergic: Clindamycin

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50
Q

Which antibiotics/ antifungals may cause STEVEN-JOHNSON SYNDROME?

A

Co-trimoxazole
Clindamycin
Fluconazole

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51
Q

What are some of the more common side effects experienced with Metronidazole?

A

Lots of GI disturbance- sick, stomach pain

Mouth effects: Taste disturbance, oral mucositis (mouth ulcers), furry tongue

Alcohol- disulfiram like reaction

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52
Q

What is fusidic acid used for?

A

Narrow spectrum antibiotic used for STAPHYLOCOCCAL SKIN infections
Used for impetigo (topical)
Staph eye infections (topical)

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53
Q

Which antibiotic is cautioned in problems to do with the following?
Lungs
Liver
Neurones

A

Nitrofurantoin:
Pulmonary Fibrosis
Cholestatic Jaundice
Peripheral
Neuropathy
Can cause Vit B/ Folate deficiency

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54
Q

Which antifungal medication can cause QT prolongation?

A

FLUCONAZOLE

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55
Q

What antibiotics/antifungals should be stopped if signs of dark urine, vomiting, fatigue, anorexia occur?

A

This indicated LIVER FAILURE

Discontinue drugs that are hepatotoxic: Itraconazole
Fluconazole
Ketoconazole
Terbinafine
Rifampicin
Isoniazid
Pyrizinamide

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56
Q

Which antifungal is cautioned in patients at a high risk of heart failure?

A

ITRACONAZOLE
As can worsen this
More at risk if on negatively ionotropic drug e.g. CCB

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57
Q

What skin condition may Terbinafine (antifungal) exacerbate?

A

Psoriasis

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58
Q

Which antifungal can cause renal toxicity?

A

AMPHOTERICIN
Can also cause electrolyte disturbance- Hypokaleamia and hypomagneseamia

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59
Q

Which antimalarials are unsuitable in patients with epilepsy/history of epilepsy?

A

CHLOROQUINE
MEFLOQUINE

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60
Q

Which antimalarials are ok to use in pregnancy?

A

Chloroquine and Proguanil can both be used at normal doses in pregnancy as benefit of malaria prophylaxis outweighs any risk

BUT recommend FOLIC ACID 5mg to be taken with proguanil

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61
Q

What does the antimalarial Malarone contain?
What condition is this recommended in?

A

Proguanil & Atovaquone
This is fine to use in epilepsy- does not contain chloroquine or mefloquine

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62
Q

What is the most common causative bacteria of a UTI?

A

E. coli

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63
Q

What is the main indication for clindamycin?
Why?

A

Osteomyelitis
Good bone penetration

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64
Q

Daktacort cream (containing Miconazole and Hydrocortisone) needs to be stored where?
What about Daktacort ointment?

A

Daktocort CREAM stored in fridge- creams are more water based so more liable to bacterial growth

Ointment on shelf- more stable, less water less bacteria

Similar to chloramphenicol eye drops/ ointment- DROPS in FRIDGE as more water based, ointment on shelf

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65
Q

What drugs are used to treat Bacterial Vaginosis?

A

Metronidazole vaginal gel
Clindamycin cream

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66
Q

Which antifungal requires an Alert card as it is so Hepato-toxic?

A

Voriconazole

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67
Q

What two toxicities may Voriconazole cause?

A

Hepatotoxicity
Phototoxcity

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68
Q

What antibiotics are commonly seen prescribed for chest infections?

A

Penicillins- Amoxicillin or Ampicillin

Or if not: A Macrolide - Azithromycin, Clarithromycin or Erythromycin

Co-amoxiclav used for more serious chest infections as it has broader action over the typical bacteria (e.g. H. influenzae)

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69
Q

How is oral thrush managed?

A

Initially topical treatment with either Miconazole oromucosal gel or NYSTATIN oral suspension
If these don’t work or patient has a dry mouth can use Oral fluconazole capsule

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70
Q

What is the key drug interaction with meropenem?

A

Sodium Valproate level significantly reduced

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71
Q

What is the usual organism (Not atypical) causing Lower respiratory tract infections?

A

Streptococcus pneumoniae - major cause of pneumonia

S. pneumoniae is also one of the major causes of meningitis (pneumonococcal) along with Neisseria meningitidis (meningococcal)

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72
Q

What antibiotic should be used for resistant strains of pneumonia?

A

Co-amoxiclav

This contains amoxicillin plus clavulanic acid which is a beta lactamase inhibitor- this makes this antibiotic very effective against more resistant strains.

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73
Q

Aside from antibiotics like clindamycin etc, what can cause C.diff?

A

PPI

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74
Q

What is the difference between the discharge in bacterial vaginosis and Trichomoniasis Vaginalis?

A

Bacterial vaginosis- thick, white and fishy discharge-
Trichomoniasis Vaginalis- frothy-smell, green/ yellow coloured

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75
Q

What are the most common causative organisms of Community Aquired pneumonia?

A

Streptococcus pneumoniae
Haemophilus influenzae

Atypical (less common):
Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella

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76
Q

What antibiotics are suitable in pregnancy?

A

Penicillins and Cephalosporins

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77
Q

What are the indications for aminoglycosides?

A

Used for serious infections
CNS infections e.g meningitis, TB
Pyelonephritis, pneumonia, endocarditis

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78
Q

What is the therapeutic range for gentamicin?

A

5-10mg/L

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79
Q

Which aminoglycoside is given orally? And why?

A

Neomycin
Too toxic for IV use

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80
Q

What are the side effects of aminoglycosides?

A

1) Nephrotoxicity
2) Ototoxicity
3) Peripheral neuropathy

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81
Q

Aminoglycosides shouldn’t be used in what conditions? Why?

A

1) Myasthenia gravis (impairs neuromuscular transmission)
2) Pregnancy (ear damage)

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82
Q

Aminoglycosides interact with what drugs?

A

1) Loop diuretics and Vancomycin (ototoxicity)
2) Cisplatin, Ciclosporin and vancomycin (nephrotoxicity)

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83
Q

IV treatment with aminoglycosides should not exceed how many days?

A

7 days

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84
Q

Monitoring requirements for aminoglycosides?

A

1) Plasma concentration (18-24 hours after dose)
2) Renal function (especially during periods of dehydration)
3) Auditory and vestibular function

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85
Q

Common bacteria in meningitis? (3)

A

1) Neisseria meningitidis
2) Streptococcus pneumoniae
3) Haemophilius influenza

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86
Q

Antibiotics used in meningitis?

A

Benzylpenicillin, cefotaxime, chloramphenicol

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87
Q

Name 8 cephalosporins?

A

1) Cefalexin 2) Cetrotide 3) Cefaclor 4) Cefuroxime 5) Cefixime 6) Ceftriaxone 7) Ceftaroline 8) Fosamil

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88
Q

Are cephalosporins broad spectrum?

A

Yes

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89
Q

Indications for cephalosporins?

A

2nd or 3rd line treatment for UTI and RTIIV for severe resistant organisms Pneumonia, meningitis, gonorrhoea

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90
Q

Side effects of cephalosporins? (2)

A

1) GI effects
2) Penicillin hypersensitivity (avoid in known allergy)

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91
Q

Do IV cephalosporins require approval by a microbiologist?

A

YES and are now mainly restricted to antibiotic associated colitis

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92
Q

What is the interaction between cephalosporins and warfarin?

A

Cephalosporins kill the gut flora responsible for synthesizing vitamin K this results in a reduction in the production of vitamin K dependent blood clotting factors-results in increased anticoagulant effect of warfarin.

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93
Q

What is the first line antibiotic group for MRSA?

A

Glycopeptides e.g vancomycin, Teicloplanin etc

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94
Q

What indications are glycopeptides generally used for?

A

MRSAC.diff endocarditissurgical prophylaxis (MRSA risk)

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95
Q

What are the main side effects of glycopeptides? (5)

A

1) Nephrotoxicity
2) Blood disorders
3) Ototoxicity
4) Red man syndrome
5) Thrombophlebitis (IV)

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96
Q

When would you avoid using glycopeptides?

A

Elderly, history of deafness, renal impairment, pregnancy (ear damage)

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97
Q

What are the monitoring requirements for glycopeptides? (5)

A

1) FBC
2) WCC
3) Hepatic and renal function
4) Urinalysis
5) Auditory function in elderly

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98
Q

What drugs do glycopeptides interact with?

A

Ciclosporin, cisplatin, aminoglycosides, loop diuretics, suxamethonium (Increase vancomycin conc)

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99
Q

What are the indications for clindamycin (lincosamide)? (3)

A

1) Staphylococcal joint and bone infections
2) Intra abdominal sepsis
3) Cellulitis and skin and soft tissue infections (effective against penicillin resistant streptococci)

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100
Q

Important side effects of clindamycin? (4)

A

1) Antibiotic associated colitis-REPORT diarrhoea
2) Esophageal disorders
3) Jaundice
4) SJS, rash

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101
Q

In what patient groups is clindamycin CI?

A

Existing diarrhoea
Caution in middle aged/ elderly women after an operation

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102
Q

What are the indications for macrolides?

A

Respiratory infections (in addition to penicillin), Lyme disease, severe pneumonia (added to penicillin), skin and soft tissue infections (alternative to penicillin)

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103
Q

Important side effects of macrolides? (4)

A

1) Antibiotic associated colitis
2) QT prolongation
3) Ototoxicity
4) Cholestatic jaundice

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104
Q

Why would you avoid using macrolides in myasthenia gravis?

A

Macrolides cause electrolyte abnormalities which can aggravate myasthenia gravis

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105
Q

Main CI for macrolides?

A

1) Hepatic impairment (cholestatic jaundice)
2) Arrhythmia (QT prolongation)

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106
Q

What drugs interact with macrolides?

A

1) CYP450 substrates
2) Drugs that prolong QT interval

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107
Q

What are the main indications of metronidazole? and appropriate doses? (3)

A

1) Antibiotic associated colitis (400mg TD 5 days)
2) Oral infections (200mg TD 3 days for gingivitis)
3) Gynecological infections e.g trichomonas vaginal infection

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108
Q

Main side effects associated with metronidazole? (3)

A

1) Neurological effects e.g peripheral and optic neuropathy
2) Mouth-Taste disturbance, furred tongue and mucositis
3) Hearing loss

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109
Q

Is metronidazole a CYP450 inhibitor?

A

NO, it is a substrate of CYP450

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110
Q

What happens if you drink alcohol while taking metronidazole?

A

Di-sulfram like reaction will occur. Metronidazole inhibits the clearing of acetylaldehyde (intermediary metabolite)- this causes flushing, headache, tachycardia

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111
Q

How long after stopping metronidazole should you avoid alcohol?

A

2 days

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112
Q

What drugs does metronidazole interact with? (4)

A

1) CYP450 inhibitors
2) CYP450 inducers
3) CYP450 substrates
4) Lithium (reduces clearance of lithium resulting in toxicity)

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113
Q

What effect will ketoconazole have on metronidazole?

A

Ketoconazole is a CYP450 inhibitor, metronidazole is a substrate of CYP450 therefore ketoconazole will reduce the metabolism of metronidazole. Metronidazole is a pro-drug so this will reduce the efficacy of metronidazole.

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114
Q

What duration of treatment with metronidazole requires FBC and hepatic monitoring?

A

10 days

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115
Q

Are penicillins broad spectrum?

A

Yes

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116
Q

What are the main indications for penicillins? (7)

A

1) Tonsillitis (streptococcal)
2) Otitis media
3) Cellulitis
4) RTI5) Meningitis
6) Tetanus (C.diff)
7) Skin and soft tissue infections

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117
Q

Main side effects of penicillins? (2)

A

1) Penicillin allergy
2) CNS toxicity (convulsions, coma)

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118
Q

Main drug interaction of penicillins?

A

Methotrexate- reduced renal excretion and increased toxicity

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119
Q

What are the main indications for co-amoxiclav? (3)
Main side effect of co-amoxiclav?

A

1) Pneumonia
2) UTI (250-500mg 8hrly)
3) H.pylori (combo therapy)

Same as penicillins- Cholestatic jaundice (no more than 14 days treatment)

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120
Q

What are the main indications for flucloxacillin? (3)

Main side effect of flucloxacillin?

A

1) Skin and soft tissue infections e.g cellulitis 2) Osteomyelitis/septic arthritis
3) Endocarditis

Same as penicillins +Cholestatic jaundice

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121
Q

Name two diaminopyrimidine antibiotics.

A

1) Trimethoprim
2) Co-trimoxazole

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122
Q

How do diaminopyrimidines work?

A

Bacteriostatic-inhibit folate synthesis

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123
Q

Main indications of diaminopyrimidines?

A

Uncomplicated UTI (200mg 12 hourly), RTI, pneumocystis pneumonia (co-trimoxazole)

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124
Q

What are the main side effects associated with diaminopyrimidines? (2)

A

1) Blood disorders (look out for bruising, bleeding, ulcers etc)
2) SJS

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125
Q

What are the main CI for diaminopyrimidines? (2)

A

1) Pregnancy (Teratogenic-especially in first trimester)
2) Caution in folate deficiency

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126
Q

Drugs that interact with diaminopyrimidines?

A

K+ elevating drugs e.g ACE inhibitors, ARB’sFolate antagonists e.g methotrexate Phenytoin, warfarin (reduced clearance)

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127
Q

Name five Quinolone antibiotics?

A

1) Ciproflaxacin
2) Monoflaxacin
3) Levofloxacin
4) Ofloxacin
5) Norfloxacin

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128
Q

Why are quinolones typically 2nd and 3rd line drugs?

A

Rapid resistance developing

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129
Q

Main indications that quinolones are used for? (4)

A

1) UTI
2) severe GI infections including travelers diarrhoea
3) LRTI
4) Gonorrhoea

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130
Q

What are the main side effects associated with quinolones? (5)

A

1) C. diff
2) Neurological-seizures and hallucinations
3) Inflammation and rupture of tendons-STOP
4) Prolong QT interval-arrhythmia
5) Photosensitivity

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131
Q

What is an important side effect of monoflaxacin?

A

Life threatening hepatotoxicity

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132
Q

In what conditions should quinolones be use with caution?

A

1) Epilepsy
2) GPD6 deficiency
3) Joint disorders e.g myasthenia gravis
4) Children and adolescents (disease of joints)

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133
Q

What drugs do quinolones interact with?

A

1) Calcium and antacids (reduce absorption)
2) Theophylline (quinolones inhibit CYP450)
3) NSAIDS
4) Prednisolone (tendon rupture)
5) QT prolonging drugs

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134
Q

What is the last resort antibiotic for MRSA?

A

Linezolid (vancomycin resistant cocci)

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135
Q

What types of infections is Linezolid used for?

A

Complicated skin and soft tissue infections and pneumonia

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136
Q

What type of drug is linezolid? (HINT-psychiatric effects)

A

MAOI

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137
Q

What are the main side effects associated with Linezolid?

A

1) Bipolar and confusional states 2) History of seizures 3) Uncontrolled hypertension 4) Elderly (increased risk of eosinophilia)

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138
Q

What foods should be avoided while taking linezolid?

A

Tyramine rich foods

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139
Q

What monitoring is required for Linezolid if the treatment exceeds 14 days?

A

FBC monitoring unless patient has existing myelosuppression, taking blood drugs and renal impairment (check for eosinophilia)

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140
Q

What monitoring is required for Linezolid if treatment exceeds 28 days?

A

Check for optic neuropathy

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141
Q

What drugs does Linezolid interact with and why?

A

SSRIs, triptans, tricylic antidepressants, sympathomimetics, buspirone, opioids, pethidine, antipsychotics (MAOI inhibitor)

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142
Q

Which TWO drugs cause peripheral neuropathy?

A

Metronidazole and nitrofurantoin

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143
Q

What type of infection is nitrofurantoin used for and what are the typical doses?

A

1st line for UTI (100mcg m/r BD for 3 days) and as prophylaxis for UTI (50-100mg nightly for max 6 months)

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144
Q

What are the main side effects associated with nitrofurantoin? (4)

A

1) Dark yellow/ brown urine
2) Pulmonary reactions
3) Peripheral neuropathy
4) Hepatitis

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145
Q

In what patient groups would nitrofurantoin be an inappropriate choice? (2)

A

1) Pregnancy
2) CI in renal impairment

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146
Q

What are the TWO monitoring requirements for LT nitrofurantoin use?

A

Hepatic and pulmonary function

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147
Q

In what patient groups would a specimen and culture be collected before treatment for UTI?

A

Men, pregnant women, children <3, Upper UTI, resistant organism suspected e.g Klebsiella suspected

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148
Q

What are the treatment options for an uncomplicated UTI in a child >3mo?

A

Trimethoprim, Nitrofurantoin, Cefalexin, amoxicillin

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149
Q

What are the treatment options for an uncomplicated UTI in a child <3mo?

A

IV ampicillin with gentamicin or cefotaxime in hospital, then oral treatment

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150
Q

What are the antibiotic treatment options for recurrent UTI’s in children?

A

Trimethoprim or nitrofurantoin

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151
Q

Name FIVE tetracyclines?

A

Tetracyline, doxycycline, minocycline, lymecyline, oxytetracyline

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152
Q

What are the main indications for tetracylines? (4)

A

1) Chlamydia and PID
2) Acne
3) LRTI (including COPD)
4) Malaria, lyme disease, rickettsia

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153
Q

Main side effects associated with tetracylines? (5)

A

1) Photosensitivity
2) Esophageal irritation
3) Hepatotoxicity
4) benign intracranial pressure- headache and visual disturbances-STOP
5) Discoloration of tooth enamel

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154
Q

In what patient groups would you want to avoid tetracylines?

A

1) Children <12 (binds to teeth)
2) Pregnancy and breastfeeding

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155
Q

Name TWO conditions that require prolonged courses of antibiotics?

A

TB and osteomyelitis

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156
Q

Antibiotic used to prevent pneumococcal infection in sickle cell disease?

A

Phenoxymethylpenicillin, if CI then erythromycin

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157
Q

Antibiotic used as prevention for early onset neonatal infection?

A

Benzylpenicillin (IV)

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158
Q

Name FOUR beta lactam antibiotics?

A

1) Penicillins
2) Cephalosporins
3) Carbapenems
4) Monobactams

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159
Q

What is the main use for fusidic acid?

A

Narrow spectrum for staph infections, topically on the skin or eye or IV/oral for osteomyelitis and endocarditis

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160
Q

What is the first line treatment for C.diff?

A

Metronidazole(or vancomycin or fidoxamicin)

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161
Q

What can a tobramycin dry powder inhaler be used for?

A

Pseudomonas lung infection in CF

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162
Q

Name TWO carbapenems?

A

Imipenem and Meropenem

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163
Q

Name TWO cephalosporins that can be used for CNS infections?

A

1) Cefotaxime
2) Ceftriaxone

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164
Q

Which cephalosporin has good activity against haemophillus influenza?

A

Cefaclor

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165
Q

Which cephalosporin should be used in history of hypercalciuria (history of renal stones)?

A

Ceftriaxone

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166
Q

What is the maximum duration of treatment for fusidic acid?

A

10 days

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167
Q

What are the specific monitoring requirements for minocycline if the treatment is longer than 6 months?

A

Monitor every 3 months for hepatotoxicity, pigmentation of the skin and systemic lupus erythromtosus

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168
Q

Name TWO antimycobacterials?

A

Clofazimine and Dapsone (both used for leprosy)

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169
Q

Name the FOUR antibiotic groups that can be used in lyme disease?

A

1) Macrolides
2) Amoxicillin
3) Macrolides

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170
Q

Name SEVEN bacteria that can cause UTI?

A

1) E coli
2) Staph saprophyticus
3) Proteus
4) Klebsiella
5) Pseudomonas aeruginosa
6) Staph epidermidus
7) Enterococcus Faecalis

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171
Q

What is the antibacterial prophylaxis and treatment of choice for animal bites?

A

Co-amoxiclav (if penicillin allergic- doxycyline + metronidazole for up to 5 days) and give the tetanus jab

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172
Q

What is the treatment for a >50 year old with meningitis?

A

Cefotaxime or ceftriaxone AND Amoxicillin or Ampicillin Consider adding vancomycin (10 days)

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173
Q

How long is the initial phase of TB treatment?

A

2 months

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174
Q

How long is the second phase of TB treatment?

A

4 months

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175
Q

What drugs are used in the initial phase of treatment for TB?
At what doses?

A

Isonazid (300mg OD)
Rifampicin (<50kg=450mg OD, >50kg=600mg OD)
Pyrazinamide (<50kg=1.5g, >50kg=2g OD)
Ethambutol (15mg/kg OD)

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176
Q

What drugs are used in the second phase of treatment for TB?

A

Isonazid (300mg OD)
Rifampicin (same as initial)

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177
Q

Which TB drugs cause liver toxicity?

A

Isonazid
Rifampacin
Pyrazinamide

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178
Q

Which TB drugs cause peripheral neuropathy?

A

Isonazid

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179
Q

Which TB drugs cause occular toxicity?

A

Ethambutol

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180
Q

What are the monitoring requirements for TB treatment?

A

Plasma levels e.g ethambutol
Urinalysis
Visual acuity testing
Blood counts
Liver and hepatic function
Auditory function in the elderly

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181
Q

What is the duration of treatment for extrapulmonary TB?

A

10 months

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182
Q

What is a specific CI of pyrazinamide?

A

Acute attack of gout

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183
Q

Name the antibiotics in the aminoglycoside class

A

Amikacin
Gentamicin
Neomycin
Streptomycin
Tobramycin

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184
Q

What aminoglycosides are active against Pseudomonas and what one is the treatment of choice?

A

Gentamicin - treatment of choice
Amikacin
Tobramycin - usually via inhalation in CF

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185
Q

What aminoglycoside is active against TB?

A

Streptomycin (mainly reserved for this indication)

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186
Q

Can aminoglycosides be given orally?

A

No- destroyed by the gut so must be given via injection

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187
Q

Is gentamicin a broad or narrow antibiotic?What strains does it have poor activity against?

A

Broad but it is inactive against anaerobes and poor activity against haemolytic streptococci and pneumococciVery good for gram negative organisms

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188
Q

Which aminoglycoside is used for encocarditis?If it is resistant to this, what is an alternative aminoglycoside?

A

Gentamicin plus another antibiotic
Streptomycin is an alternative if resistant to gentamicin

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189
Q

Are aminoglycosides more active against gram positive or gram negative?

A

Gram negative but are broad

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190
Q

What is the problem with using aminoglycosides in myasthenia gravis?

A

Contraindicated
May impair neuromuscular transmission

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191
Q

What antibiotics can be used for prophylaxis in rheumatic fever?

A

Pen V or sulfadiazine

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192
Q

What anitbiotics can be used for prevention of secondary case of menincoccal meningitis?

A

Ciprofloxacin or rifampicin Or IM ceftriaxone (unlicensed)

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193
Q

What antibiotic can be used for prevention of secondary infection for Group A strep?

A

Pen V

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194
Q

What antibiotic can be used for prevention of secondary infection in Influenza Type B?

A

Rifampicin

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195
Q

What antibiotic can be used for prevention of secondary cases of diphtheria in non-immune patients?

A

Erythromycin

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196
Q

What is pertussis?

A

Whooping cough

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197
Q

What antibiotic is used for prophylaxis of pertussis (whooping cough)?

A

Clarithromycin

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198
Q

What antibiotic is used post splenectomy or in patients with sickle cell disease for prevention of pneumococcal infection?

A

Pen V (Erythromycin if penicillin allergic)

199
Q

What antibacterial prophylaxis/treatment is used in animal and human bites?If the patient is penicillin allergic, what should be used instead?

A

Co-amox
If penicillin allergic: Doxycycline and metronidazole
Up to 5 days and give tetanus jab

200
Q

What antibacterial prophylaxis do you use in hip and knee replacement?

A

Single dose IV cefuroxime/flucloxacillin
Add in gent

201
Q

What antibacterial prophylaxis do you use in high lower limb amputation?

A

Use i/v co-amoxiclav alone or i/v cefuroxime + i/v metronidazole

202
Q

What antibacterial prophylaxis do you use in caesarean section?

A

Single dose cefuroxime

203
Q

What is 1st line for aspergillosis?What is 2nd line if this cannot be used?

A

Voriconazole
Liposomal amphotericin

204
Q

If a patient with aspergillosis is intolerant/refractory to voriconazole and liposomal amphotericin, what other antifungals can be used?

A

Caspofungin
Itraconazole

205
Q

What systemic antifungal is used in vaginal candidiasis?For resistant organisms, what can be used?

A

Fluconazole
Itraconazole as an alternative

206
Q

What is micafungin licensed for?

A

Invasive candidiasis
Oesophageal candidiasis
Prophylaxis of candidiasis in patients undergoing haematopoietic stem cell transplantation

207
Q

Cryptococcal meningitis, a fungal infection, is especially common in which group of immunocompromised patients?How is this treated?

A

HIV positive IV amphotericin followed by PO fluconazole

208
Q

What is tinea capitis?

A

Fungal infection (ringworm) of scalp

209
Q

What is tinea pedis?

A

Athlete’s foot

210
Q

How do you treat tinea captis?

A

Systemically
Griseofulvin
Can also used an additional topical application

211
Q

True or false:In fungal nail infections, topical therapy is more effective than systemic

A

False
Systemic is more effective

212
Q

Is fluconazole active against Aspergillus?

A

No

213
Q

Is caspofungin effective against CNS fungal infections?

A

No

214
Q

What is the advantage of lipid amphotericin formulations over conventional amphotericin?

A

Significantly less toxic and are recommended when the conventional formulation of amphotericin is contra-indicated because of toxicity, especially nephrotoxicity or when response to conventional amphotericin is inadequate
However, more expensive

215
Q

What are echinocandin antifungals active against? (Caspofungin, micafungin)

A

Aspergillus and Candida
Not active against CNS fungal infections

216
Q

What can be used for MRSA?

A

Glycopeptides mainly:
Teicoplanin
Vancomycin
Alternatives:
Tigecyline
Daptomycin
Linezolid (if glycopeptide unsuitable)
Tetracyclines can be used for skin or soft tissue infections or UTI caused by MRSA
Clindamycin can be used for bone and joint MRSA infections

217
Q

Are carbapenems useful against MRSA?

A

No

218
Q

Do carbapenems have good activity against pseudomonas? What is the exception to this?

A

Yes apart from ertapenem

219
Q

Why does imipenem have to be administered with cilastatin?

A

Imipenem is partially inactivated in the kidney by enzymatic activity and is therefore administered in combination with cilastatin, a specific enzyme inhibitor, which blocks its renal metabolism

220
Q

If meningitis is suspected, what antibiotic should be given before being transferred to hospital (as long as this doesn’t delay treatment)?What would be an alternative?

A

IV benpen
Cefotaxime if penicillin allergic / chloramphenicol if history of immediate hypersensitivity to penicillin and cephalosporins

221
Q

When would you use dexamethasone in meningitis?
In what situations would you avoid this?

A

Particularly in pneumococcal meningitis in adults, either before starting antibacterial therapy or within 12 hours of starting
Avoid using dex in septic shock, meningococcal septicaemia, immunocompromised, or meningitis following surgery

222
Q

What is the recommended antibiotic therapy for children 3 months - adults 50 years in meningitis if the cause is unknown?What is the suggested duration of treatment?

A

Cefotaxime or ceftriaxone
Consider adding vancomycin
10 days

223
Q

What is the recommended antibiotic therapy for adults over 50 years in meningitis if the cause is unknown?What is the suggested duration of treatment?

A

Cefotaxime or ceftriaxone AND amoxicillin or ampicillin
Consider adding vanc10 days

224
Q

What is the recommended antibacterial therapy for meningitis caused by meningococci (neisseria)?What would be an alternative if not suitable?What is the suggested duration of treatment?

A

Benpen Or cefotaxime/ceftriaxone
Chloramphenicol is an alternative if history of immediate hypersensitivity to penicillins or cephalosporins 7 days

225
Q

What bacteria can be the cause of meningitis?

A

Meningococcal (neisseria)
Pneumococcal
Haemophilus influenzae
Listeria

226
Q

What is the recommended antibacterial therapy for meningitis caused by pneumococcal?
If the organism if penicillin and cephalosporin resistant, what can be added?
What is the suggested duration of treatment?

A

Cefotaxime or ceftriaxone
Consider adding dex before first dose or within 12 hours of starting antibacterial therapy If penicillin sensitive, change to benpenIf penicillin and cephalosporin resistant, vancomycin and rifampicin can be added14 days

227
Q

What is the recommended antibacterial therapy for meningitis caused by Haemophilus influenzae?
What is the suggested duration of treatment?

A

Cefotaxime or ceftriaxone
Consider adding dex before first dose or within 12 hours of starting antibacterial therapy 10 days

228
Q

What is the recommended antibacterial therapy for meningitis caused by Listeria?What is the suggested duration of treatment?
If history of immediate penicillin hypersensitivity, what could be an alternative?

A

Amoxicillin/ampicillin AND gentamicin 21 days - can consider stopping gentamicin after 7 days
Alternative- co-trimoxazole for 21 days

229
Q

How should the following be managed:
Patients presenting with sinusitis symptoms of 10 days or less

A

Paracetamol, ibuprofen, nasal saline
Antibiotics not usually required

230
Q

How should the following be managed:Patients presenting with sinusitis symptoms of 10 days or more

A

Could be considered for treatment with a high-dose nasal corticosteroid, such as mometasone furoate [unlicensed use] or fluticasone [unlicensed use] for 14 days. Supply of a back-up antibiotic prescription could be considered and used if symptoms do not improve within 7 days, or if they worsen rapidly or significantly.

231
Q

In what situations would you offer antibiotics for sinusitis?

A

Should only be offered to patients with acute sinusitis who are systemically very unwell, have signs and symptoms of a more serious illness
Or if bacterial sinusitis is suspected

232
Q

What is 1st and 2nd line in a non-penicillin allergic sinusitis patient if antibiotics are indicated?

A

1st line- Pen V
2nd line- Co-amox (especially if more serious illness)

233
Q

What is 1st line in a penicillin allergic sinusitis patient if antibiotics are indicated?

A

Doxycycline or clarithyromycin

234
Q

What is 1st line in a penicillin allergic sinusitis PREGNANT patient if antibiotics are indicated?

A

Erythromycin

235
Q

What antibiotic can be used in a pregnant UTI patient?

A

Cefalexin

236
Q

If antibiotics are clinically appropriate, what would be used for otitis externa?What if the patient is penicillin allergic?

A

Flucloxacillin
Clarithromycin

237
Q

If antibiotics are clinically appropriate, what would be used for otitis media?What if the patient is penicillin allergic?

A

Amoxicillin (or co-amox as second line)
Clarithromycin

238
Q

Otitis media is most common in which age group?

A

Children

239
Q

What antibiotics are likely to cause C.Diff?

A

Clindamycin
Penicillins
Cephalosporins
Fluoroquinolones

240
Q

What 3 antibiotics can be used in C.Diff?

A

Vancomycin
Metronidazole
Fidaxomicin

241
Q

For first episode of mild-moderate C.Diff, what should be used and for how long?

A

Oral metronidazole for 10-14 days

242
Q

For second/subsequent C.Diff infection not responding to metronidazole, what can be used and for how long?

A

Oral vancomycin
Fidaxomicin can be used for severe infection

10-14 days

243
Q

What antibiotic is used for bacterial vaginosis and how long for?

A

Metronidazole 5-7 days

244
Q

What antibiotics cover chlamydia?

A

Azithromycin (single dose)
Doxycycline
Erythromycin

245
Q

What is the recommended length of treatment for osteomyelitis?

A

6 weeks

246
Q

Osteomyelitis and septic arthritis antibiotic choice:1. First line2. If penicillin allergic3. If MRSA suspected

A
  1. Flucloxacillin
  2. Clindamycin
  3. Vancomycin or teicoplanin
247
Q

What penicillins can you use for oral infections e.g. dental?

A

Pen V
Amoxicillin

However these are not effective against bacteria that produces beta lactamases
Co-amox can be used in severe cases

248
Q

What is the drug of choice for acute ulcerative gingivitis?

A

Metronidazole

249
Q

Is haemophilus influenzae a bacteria or a virus?

A

Bacteria

250
Q

What is the recommended therapy for Haemophilus influenzae?

A

Cefotaxime or ceftriaxone

251
Q

What antibiotics do you use to treat an acute exacerbation of chronic bronchitis and how long for?

A

Amoxicillin or a tetracycline for 5 days

252
Q

What antibiotic therapy is recommended in low severity CAP and how long for? What would be alternatives?

A

Amoxicillin
Alternatives= doxycycline, clarithromycin

7 days (if infection caused by staph, it would be 14-21 days)

253
Q

What antibiotic therapy is recommended in moderate severity CAP and how long for?

A

Amoxicillin AND clarithromycin
Or doxycycline alone 7 days

254
Q

What antibiotic therapy is recommended in high severity CAP and how long for?

A

Benpen AND clarithromycin/doxycycline
7-10 days
If MRSA suspected, add teic/vanc

255
Q

For life-threatening CAP, what would be the recommended treatment and how long for?If the patient was penicillin allergic, what would be the alternative?

A

Co-amox + clarithromycin
7-10 days
Alternative to co-amox would be cefuroxime or ceftriaxone

256
Q

In CAP, the usual treatment duration is 7-10 days. When would you extend this to 14-21 days?

A

If staphylococci suspected

257
Q

If MSRA was suspected in CAP, what would you add on to the treatment?

A

Teic/vanc

258
Q

What are the main organisms that cause pneumonia?

A

Streptococcus pneumoniae
Haemophilus influenzae
Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella pneumophila

259
Q

What would you use to treat pneumonia caused by chlamydial/mycoplasma?

A

Doxycycline

260
Q

What is the difference between early onset vs late onset HAP (in terms of days in hospital)?

A

Early onset = less than 5 days admission to hospital
Late onset = more than 5 days after admission to hospital

261
Q

How do you treat early onset HAP?

A

Co-amox or cefuroxime

262
Q

How do you treat late onset HAP?

A

Antipseudomonal penicillin e.g. Pip Taz OR
Broad spectrum cephalosporin e.g. ceftazidime OR
Quinolone e.g. ciprofloxacin
MRSA- add vanc

263
Q

What would you use to treat a small area of impetigo?

A

Fusidic acid

264
Q

What would you use to treat a widespread infection of impetigo?If penicillin allergic, what would be an alternative?

A

Oral flucloxacillin
Clarithromycin

265
Q

What would you use to treat cellulitis?If penicillin allergic, what can be used?

A

High dose flucloxacillin Clindamycin/clarithromycin

266
Q

What antibiotic would you use for mastitis during breastfeeding?What if penicillin allergic?

A

Flucloxacillin
Erythromycin
10-14 days

267
Q

What are the side effects of aminoglycosides?

A

Hearing impairment (ototoxicity - patients should report tinnitus, hearing loss, vertigo)
Nephrotoxicity
May impair muscle transmission-c/i in myasthenia gravis

268
Q

What is the risk of aminoglycosides to the infant in pregnancy?

A

Risk of auditory or vestibular nerve damage

269
Q

What is a possible problem with carbapenems that means it is cautioned in CNS disorders?

A

Seizure inducing potential
Also increased risk of seizures if renal impairment is present

270
Q

Should you give carbapenems if there is a history of immediate hypersensitivity to penicillins?

A

No

271
Q

True or false:
Cephalosporins penetrate the meninges poorly unless they are inflamed

A

TRUE

272
Q

What are some common side effects of cephalosporins?

A

Abdo pain
Eosoniphilia
Thrombocytopenia

273
Q

Should you give cephalosporins if there is a history of penicillin allergy?

A

Used in caution
But should not be given if there is immediate hypersensitivity

274
Q

What are the glycopeptide antibiotics?

A

Dalbavancin
Teicoplanin
Telavancin
Vancomycin

275
Q

Which of the following antibiotics has a lower incidence of nephrotoxicity:TeicoplaninVancomycin

A

Teicoplanin

276
Q

What drugs are associated with red man syndrome?

A

Glycopeptides
Teicoplanin
Vancomycin

277
Q

What is the main advice to give to patients on clindamycin and should stop taking if this happens?

A

Diarrhoea
Stop and contact doctor

278
Q

What are the cautions in macrolides?

A

QT prolongationand electrolyte disturbances

279
Q

Amoxicillin can cause an increased risk of erythematous rash in what conditions?

A

Acute lymphocytic leukaemia
Chronic lymphocytic leukaemia
CMV
Glandular fever

280
Q

Why should you maintain adequate hydration with high doses of IV amoxicillin?

A

Risk of crystalluria
Especially in renal impairment

281
Q

What is the dose of amoxicillin in susceptible infection for a child 1-11 months?

A

125mg TDS (increased up to 30mg/kg TDS if needed)

282
Q

What is the dose of amoxicillin in susceptible infection for a child 1-4 years?

A

250mg TDS (increased up to 30mg/kg TDS if needed)

283
Q

What is the dose of amoxicillin in susceptible infection for a child 5-11 years?

A

500mg TDS (increased up to 30mg/kg TDS if needed)

284
Q

What is the dose of amoxicillin in susceptible infection for a child 12-17 years?

A

500mg TDS
Increased up to 1g TDS if needed

285
Q

What is the dose of amoxicillin in susceptible infection for an adult?

A

500mg TDS

286
Q

What is the MHRA warning surrounding flucloxacillin?

A

Cholestatic jaundice and hepatitis

287
Q

What is a side effect of oral amoxicillin and co-amox in terms of colouring the patient’s tongue?

A

Black hairy tongue

288
Q

Ciprofloxacin is a type of what antibiotic?

A

Quinolone

289
Q

What is the important safety information regarding fluoroquinolones?

A

May induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.
Tendon damage (including rupture) has been reported rarely in patients receiving quinolones.
Tendon rupture may occur within 48 hours of starting treatmentSmall increased risk of aortic aneurysm and dissection

290
Q

Should quinolones be used in MRSA?

A

No

291
Q

What quinolone is active against pseudomonas?

A

Ciprofloxacin

292
Q

What are some common side effects of quinolones?

A

QT prolongation
Hearing impairment
Decreased appetite
Rhabdomylosis
Drug should be discontinued if psychiatric, neurological reactions occur
Cautioned in young adults and children- risk of arthropathy

293
Q

What antibiotic would you use for PCP prophylaxis and treatment?

A

Co-trimoxazole

294
Q

What is a rare but serious side effect of co-trimoxazole?

A

Blood disorders
Rash - steven johnson’s syndrome

295
Q

What age group are tetracyclines contraindicated in?

A

Children < 12 due to deposition in growing bones and teeth Staining of teeth can occur

296
Q

What are the common side effects of tetracyclines?

A

Angiodema
Henoch Schonlein purpura (spotty rash)
Photosensitivity reaction
Headaches and visual disturbances- may indicate benign intercranial hypertension - discontinue if intercranial pressure increases

297
Q

Is there any special patient advice with doxycycline?

A

Should be taken with meals
Avoid exposure to sunlight and sun lamps
Do not take zinc, indigestion remedies 2 hours before or after

298
Q

What is a serious side effect of chloramphenicol when given systemically?

A

Haemotological side effects (agranulocytosos, bone marrow disorder)
Aplastic anaemia- reports of leukaemia
Should only be reserved for life-threatening conditions e.g. typhoid fever

299
Q

What muscle side effect can daptomycin cause?

A

Myopathy
Report any muscle weakness and monitor creatine kinase if necessary
Need to monitor CK twice a week whilst on it

300
Q

What monitoring requirements are needed for systemic fusidic acid?

A

Elevated liver enzymes, hyperbilirubinaemia and jaundice can occur with systemic use
Manufacturer advises monitor liver function with high doses or on prolonged therapy

301
Q

What is the important safety information regarding linezolid?

A

Severe optic neuropathy- patients should report visual impairment
Blood disorders - thrombocytopenia, anaemia

302
Q

What food does linezolid interact with and why?

A

Tyramine-rich foods (such as mature cheese, salami)
Avoid consuming large amounts
Also is a reversible MAOI

303
Q

Is linezolid active against gram-ve, gram+ve or both?

A

Gram +ve

304
Q

What would be the dose of trimethoprim in an adult for UTI?

A

200mg BD

305
Q

Can you use trimethoprim in renal impairment?

A

Yes- monitor
May need to half normal dose

306
Q

What is the patient advice surrounding rifampicin?

A

May stain contact lenses red
Report signs of liver disorder
May colour urine red - harmless

307
Q

How does rifampicin interact with hormonal contraceptives?

A

Effectiveness of hormonal contraceptives are reduced - alternative method needed

308
Q

What antibiotics are used in the initial phase of TB treatment?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin- hardly used but may be useful if resistant to isoniazid

309
Q

How many antibacterials are used in the initial phase of TB treatment and how long for?

A

42 months

310
Q

How many antibacterials are used in the continuous phase of TB treatment and how long for?

A

24 months

311
Q

If someone is isoniazid, what else must be prescribed and why?

A

Pyridoxine (vitamin B6)
Prophylaxis of isoniazid-induced neuropathy

312
Q

Generally speaking, after 2 months of RIPE treatment for TB, what antibiotics are continued for a further 4 months?

A

Rifampicin and isoniazid (needs to be on pyridoxine for prevention of neuropathy)

313
Q

What treatment for TB should be given in pregnancy and breastfeeding?

A

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 4 months
Should NOT be given streptomycin

314
Q

DOT TB therapy should be offered to which groups of people?

A

Directly observed therapy should be offered to patients who:
Have a history of non-adherence
Have previously been treated for tuberculosis
Are in denial of the tuberculosis diagnosis- have multidrug-resistant tuberculosis, have a major psychiatric or cognitive disorder
Have a history of homelessness, drug or alcohol misuse
Are in prison, or have been in the past 5 years
Are too ill to self-administer treatment
Request directly observed therapy

315
Q

In a patient with HIV and TB, starting antiretrovirals in the first 2 months of TB treatment can increase the risk of what?

A

Immune reconstitution syndrome

316
Q

In patients with HIV and TB, how long should the TB treatment be for?What is the exception to this?

A

6 months
However if the TB has CNS involvement, 12 months max

317
Q

What is the general TB treatment regimen?

A

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 4 months

318
Q

What is the general CNS TB treatment?

A

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 10 monthsInitial high dose of dexamethasone or prednisolone should be started at the same time and slowly withdrawn over 4-8 weeks

319
Q

What would be the treatment regimen for latent TB?

A

Isoniazid for 6 months - recommended if interactions with rifampicin a concern
OR rifampicin and isoniazid for 3 months - recommended if hepatotoxicity a concern

320
Q

A break in TB treatment of how many weeks is classed as a treatment interruption?

A

2 weeks

321
Q

What are the 6 toxicity syndromes associated with intermittent TB treatment?

A

Influenza-like, abdominal, and respiratory symptoms, shock, renal failure, and thrombocytopenic purpura

322
Q

What is the brand name of the medicine that contains RIPE for TB?

A

Voractiv

323
Q

What is the brand name of medicine that contains RI (rifampicin and isoniazid) for TB?

A

Rifinah

324
Q

Why is ethambutol cautioned in young children?

A

Can cause visual impairment
Ethambutol should be used with caution in children until they are at least 5 years old and capable of reporting symptomatic visual changes accurately.

325
Q

What kind of toxcity can ethambutol cause?

A

Ocular - report any visual disturbances
Nephrotoxicity
Other side effects include red-green colour blindness, hepatotoxicity

326
Q

What are the main side effects to look out for in a patient on isoniazid?

A

Peripheral neuropathy
Hepatic disorders
Ototoxicity

327
Q

What are the main side effects to look out for in a patient on pyrazinamide?

A

Hepatoxicity
Aggravates gout

328
Q

What antibiotics respond to a lower UTI?

A

Trimethoprim
Nitrofurantoin
Amoxicillin
Ampicillin
Cefalexin

329
Q

What is the recommended duration of treatment for uncomplicated UTI in women?

A

3 days

330
Q

What antibiotics for a UTI should be used in pregnancy?

A

Penicillins and cephalosporins are the best choices

331
Q

At what EGFR should you avoid prescribing nitrofurantoin in?

A

<45

332
Q

Does does caspofungin interact with and what should be done about the dose?

A

Some enzyme inducers e.g. rifampicin, carbamazepine, phenytoin increase dose to 70mg daily (if not already on it)

333
Q

What is the risk of giving an infusion of amphotericin?

A

Risk of arrhythmias if given too rapidly
Anaphylaxis- test dose is needed and close observation is needed for first 30 mins after this test dose

334
Q

Are different preparations of amphotericin interchangeable?

A

No
Should preferably prescribe by brand to avoid confusion

335
Q

What is a specific side effect with IV isavuconazole?

A

Hypotension, SOB, paraesthesia
Nausea, headache

Discontinue if these occur

336
Q

What is the important safety information regarding itraconazole?

A

Reports of heart failure, especially in high risk patients:-
High dose and long courses
Patients on negative ionotropic drugs
CCBs
Elderly
Chronic heart disease
Should be avoided in those with a history of heart failure unless the infection is serious
Also, hepatotoxicity that can be life-threatening can occur.
Patient should be aware of liver disorder signs

337
Q

What are the specific side effects for voriconazole that requires patient counselling?

A

Hepatotoxicity- patients should be aware of liver disorder signs
Phototoxicity- patients should avoid intense or prolonged exposure to direct sunlight, avoid sunbeds If they get sunburnt, seek medical attention
It is the antifungal that is most associated with hallucinations
Keep an alert card on them

338
Q

What is the contraception and conception advice for both men and women who are on griseofulvin (antifungal for dermatophyte infections of the skin)?

A

Women: Should continue effective contraception at least 1 month after administration. The effectiveness of the pill may reduce so use an additional barrier method

Men: Avoid fathering a child during and for at least 6 months after administration

339
Q

What adjunctive therapy is recommended in PCP treatment in patients with HIV?

A

For moderate to severe infections, prednisolone for 21 days

340
Q

True or false:All members in a household must be treated if one person in the house has threadworm

A

TRUE

341
Q

What is the drug of choice for threadworm?

A

Mebendazole

342
Q

For malaria prophylaxis, what are mosquito nets usually impregnated with?

A

Permethrin (insecticide)

343
Q

Can DEET spray be used during pregnancy and breastfeeding?

A

Yes

344
Q

When applying DEET and suncream, what should be applied first?

A

Suncream then DEET

345
Q

How does DEET spray affect the SPF of suncream?

A

Lowers it so a factor 30-50 should be used

346
Q

Generally speaking, how much time before travelling should malaria prophylaxis be started? What are the exceptions to this?

A

1-2 weeks before
Mefloquine is 2-3 weeks before
Malarone and doxycycline is 1-2 days before
In warfarin patients 2-3 weeks before

347
Q

How much time before travelling should malaria prophylaxis with Malarone be started?

A

1-2 days before

348
Q

How much time before travelling should malaria prophylaxis with doxycycline be started?

A

1-2 days before

349
Q

How much time before travelling should malaria prophylaxis with mefloquine be started?

A

2-3 weeks before

350
Q

How long can Malarone be used for in malaria prophylaxis?

A

Up to 1 year

351
Q

How long can doxycycline be used for in malaria prophylaxis?

A

Up to 2 years

352
Q

How long can mefloquine be used for in malaria prophylaxis?

A

Up to 1 year

353
Q

What antimalarials are unsuitable for those with epilsepy?What would be alternatives?

A

Chloroquine
Mefloquine
Proguanil is recommended in areas with chloroquine resistance
Doxycyline or Malarone is recommended in areas without chloroquine resistance

354
Q

Which group of patients are at a particularly high risk of severe malaria?

A

Those without a spleen

355
Q

What antimalarials can be given at their usual dose during pregnancy?

A

Chloroquine
Proguanil
However, resistance exists so may have to look at other options, only if benefit outweighs risk and travel is unavoidable

356
Q

If a pregnant lady is on proguanil during malaria prophylaxis, what else must she be on?

A

Folic acid at high dose (5mg) for at least the first trimester

357
Q

How long should malaria prophylaxis continue after leaving the at risk country?What is the exception to this?

A

Continue for 4 weeks after
Except for Malarone which is 1 week

358
Q

In warfarin patients, when should malaria prophylaxis begin?

A

2-3 weeks before travelling
INR should be stable before departure

359
Q

When should INR be checked in warfarin patients on malaria prophylaxis?

A

Before starting the course
7 days after starting the course
After completing the course
For prolonged stays, INR needs to be checked at regular intervals

360
Q

What is standby malaria treatment?

A

Travellers visiting remote, malarious areas for prolonged periods should carry standby treatment if they are likely to be more than 24 hours away from medical care. Self-medication should be avoided if medical help is accessible.
In order to avoid excessive self-medication, the traveller should be provided with written instructions that urgent medical attention should be sought if fever (38°C or more) develops 7 days (or more) after arriving in a malarious area and that self-treatment is indicated if medical help is not available within 24 hours of fever onset.

361
Q

When travelling to different places that require 2 different malaria prophylaxis regimens, what do you do?

A

The regimen for the higher risk area should be used for the whole journey

362
Q

What combination of antimalarials is in Malarone/Maloff?

A

Atovaquone and proguanil

363
Q

For the treatment of malaria, is the infective species is unknown/mixed, what are the options?

A

Malarone
Riamet
Quinine

364
Q

What is P. Falciparum resistant to?

A

Chloroquine

365
Q

What are the treatment options for malaria caused by P.Falciparum?

A

Quinine (with doxycycline or clindamycin)
Malarone
Riamet

366
Q

What are the treatment options for malaria caused by P.Falciparum in pregnancy?

A

Quinine followed by clindamycin
(cannot use doxycycline)

367
Q

What are the treatment options for non-falciparum malaria?

A

Chloroquine
However, if resistant- Malarone or Riamet

368
Q

What are the treatment options for non-falciparum malaria in pregnancy?

A

Chloroquine

369
Q

What antimalarials does Riamet contain?

A

Artemether and lumefantrine

370
Q

What is the important safety information with chloroquine?

A

Occular toxicity
Very toxic in overdose

371
Q

What is a main neurological side effect of mefloquine?

A

Mefloquine is associated with potentially serious neuropsychiatric reactions.
Abnormal dreams, insomnia, anxiety, and depression occur commonly.
Therefore, contraindicated in those with history of psychiatric disorders including depression
Has a long half life so can persist up to several months after discontinuation

372
Q

What screening should be done before a patient starts taking primaquine and why?

A

G6PD as if deficient, can cause haemolysis

373
Q

What is the difference between quinine sulphate and quinine bisulphate?

A

Bisulphate has less quinine in
Should not be used for malaria, only quinine sulphate

374
Q

What is the important safety information regarding quinine?

A

QT prolongation

375
Q

What are the initial treatment options for chronic Hep B?

A

Peginterferon alphaInterferon alpha
Treatment with the above should be stopped if no improvement after 4 months
Entecavir
Tenofovir
Treatment should be changed to other antivirals if no improvement after 6-9 months

376
Q

What determines treatment route for chronic Hep C?

A

Before starting treatment, the genotype of the infecting hepatitis C virus should be determined and the viral load measured as this may affect the choice and duration of treatment.

377
Q

What is used for the initial treatment of chronic Hep C?

A

Combination of ribavirin and peginterferon alpha
Ribavirin monotherapy=ineffective

378
Q

What is the MRHA warning regarding direct-acting antivirals to treat chronic Hep C?

A

Risk of interaction with Vitamin K antagonists and changes in INR.
INR needs to be monitored closely
Risk of Hep B reactivation (if patient has both B and C)
Need to be screened for Hep B before starting treatment

379
Q

What is herpes labialis?

A

Cold sore

380
Q

What is herpes zoster?

A

Shingles

381
Q

What is varicella?

A

Chicken pox

382
Q

In shingles, within how many hours of rash onset should antivirals be started?
How long is it continued for?

A

Within 72 hours
Continued for 7-10 days

383
Q

In adults with chickenpox, within how many hours of rash onset should antivirals be started to reduce duration and severity of symptoms?

A

Within 24 hours

384
Q

What kind of drug is foscarnet?

A

Antiviral

385
Q

What antivirals are used for CMV?

A

Ganciclovir IV
Valganciclovir PO
Foscaret - toxic and causes renal impairment

386
Q

During CMV treatment, what does ganciclovir cause if given with zidovudine (for HIV)?

A

Myelosuppression

387
Q

Initial treatment of HIV-1 includes what combination types of antiretroviral drugs?

A

Triple therapy
2 nucleoside reverse transcriptase inhibitors and ONE of the following
Boosted protease inhibitor
Non-nucleoside reverse transcriptase inhibitor
Integrase inhibitor

388
Q

What is used for HIV pre-exposure prophylaxis?

A

Emtricitabine with tenofovir

389
Q

Why are some HIV medicines used in combination with cobicistat?

A

It is a pharmacokinetic enhancer that boosts the concentrations of other antiretrovirals, but it has no antiretroviral activity itself.

390
Q

Name the nucleoside reverse transciptase inhibitors for HIV

A

Zidovudine
Abacavir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Tenofovir disoproxil.

391
Q

Name the protease inhibitors used for HIV.

A

Atazanavir
Darunavir
Fosamprenavir
Ritonavir
Saquinavir
Tipranavir*

Metabolised by cytochrome P450 enzyme systems*

392
Q

Name the integrase inhibitors used for HIV

A

Dolutegravir, elvitegravir and raltegravir

393
Q

Name the non-nucleoside reverse transcriptase inhibitors used for HIV

A

Efavirenz, etravirine, nevirapine, and rilpivirine

394
Q

What is Maraviroc?

A

Antagonist of the CCR5 chemokine receptor. It is licensed for patients exclusively infected with CCR5-tropic HIV.

395
Q

What has been reported in patients with advanced HIV disease or following long-term exposure to antiretroviral treatment?

A

Osteonecrosis

396
Q

What is the MHRA advice regarding preparations containing dolutegravir (integrase inhibitor used for HIV)?

A

Increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception

397
Q

What CNS effects can efavirenz cause and how can this be reduced?

A

Depression, psychosis, confusion, hallucination, abnormal behaviour, suicidal ideations
Take the dose at bedtime, especially during the first 2-4 weeks of treatment

398
Q

What reaction can occur with HIV medicines?

A

Hypersensitivity e.g. Rash, lesions, oedema, SOB

399
Q

Which HIV medicine is associated with a high incidence of rash including Stevens-Johnson syndrome?

A

Nevirapine

400
Q

Efavirenz for HIV is associated with an increase in plasma concentration of what substance?

A

Cholesterol

401
Q

What are the long term effects of HIV treatment?

A

Immune reconstitution syndrome: as the immune system stands up on its feet again due to antiretroviral treatment, marked inflammatory reactions happen against opportunistic organisms
Lipodystrophy syndrome: this is made up of insulin resistance, fat redistribution and dyslipidaemia
Blood lipids and sugars should be measured before, 3-6 months after and yearly after HIV treatment.
Osteonecrosis: following long-term exposure to treatment.

402
Q

Protease inhibitors are mainly associated with what side effects?

A

Lipodystrophy and metabolic effects.

403
Q

What can be used for the treatment of influenza and within how many hours of symptom onset should it be started?

A

Oseltamivir (Tamiflu) first line and zanamivir is reserved for those who are immunocompromised or when oseltamivir cannot be usedWithin 48 hours

404
Q

What can be used for post-exposure prophylaxis of influenza and within how many hours of exposure?

A

Oseltamivir (Tamiflu) within 48 hours of exposure and zanamivir within 36 hours of exposure

405
Q

How long should influenza treatment be for?

A

Twice daily dosing for 5 days

406
Q

How long should post-exposure prophylaxis for influenza be for?

A

Once daily dosing for 10 days

407
Q

What is a particular caution with co-amoxiclav in in terms of side effects?

A

Cholestatic jaundice can occur either during or shortly after the use of co-amoxiclav

408
Q

What is a rare but potentially fatal side effect of ketoconazole?

A

Associated with fatal hepatotoxicity. The CSM advise that prescribers shouldweigh the potential benefits of ketoconazole treatment against the risk of liver damage and shouldcarefully monitor patients both clinically and biochemically.

409
Q

What penicillin based antibiotics must you take on an empty stomach?

A

Flucloxacillin
Ampicillin
Penicillin V

410
Q

What shouldn’t a patient take at the same time as tetracycline antibiotics?

A

Do not take milk, indigestion remedies, or medicines containing iron or zinc at the same time of day as this medicine (prevents absorption of the antibiotic and should be taken 2-3 hours apart)
Oxytetracycline and tetracycline should be taken on an empty stomach

411
Q

Which tetracycyline antibiotics should be taken on an empty stomach?

A

Oxytetracycline and tetracycyline

412
Q

What is the patient advice surrounding trimethoprim?

A

On long-term treatment, patients and their carers should be told how to recognise signs of blood disorders and advised to seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop.

413
Q

True or false:
Rifampicin should be taken on an empty stomach

A

TRUE

414
Q

True or false:
Metronidazole should be taken on an empty stomach

A

False
Take with or just after food

415
Q

What shouldn’t a patient take at the same time as ciprofloxacin?

A

Do not take milk, indigestion remedies, or medicines containing iron orzinc at the same time of day as this medicine.

416
Q

What specific monitoring should you do with daptomycin?

A

Creatine kinase twice a week

417
Q

What is the CHMP advice regarding the use of oral ketoconazole to treat fungal infections?

A

Marketing authorisation for oral ketoconazole to treat fungal infections should be suspended.
The CHMP concluded that the risk of hepatotoxicity associated with oral ketoconazole is greater than the benefit in treating fungal infection
People with a prescription for oral ketoconazole should be referred back to their doctors

418
Q

How does calcium carbonate interact with doxycycline? What do you recommend the patient does if the patient is normally on calcium carbonate e.g. Adcal and is prescribed doxycycline?

A

Calcium carbonate is predicted to decrease the absorption of doxycycline
Separate administration by 2-3 hours

419
Q

What CD4 count is classed as AIDs?

A

<200

420
Q

Which of the following is active against pseudomonas:- Benpen- Flucloxacillin- Ampicillin- Piperacillin

A

Piperacillin (Pip taz)

421
Q

Which antibacterial drug increases the risk of serotonin syndrome?
Linezolid
Vancomycin
Telvancin
Septrin

A

Linezolid as it is a weak MAOI Serotonin syndrome risk increases with:
SSRIs
TCAs
Macrolides
Amiodarone
Fluoroquinolones
Antipsychotics
Quinine
Risk of hypertensive crisis

422
Q

Which drug class is most associated with lipodystrophy?Antiretroviral drugsAlkylating agentsTCAsARBs

A

Antiretroviral drugs can cause redistribution of fat around the body

423
Q

Quinine can be very toxic - what are the signs of toxicity?

A

Life-threatening features include arrhythmias (which can have a very rapid onset) and convulsions (which can be intractable).

424
Q

What are adverse effects of quinine?

A

Tinnitus
Deafness
Blindness
QT prolongation
Hypoglycaemia
GI upset
Hypersensitivity reactions

425
Q

What advice should you give to a patient on metronidazole regarding their urine?

A

May darken urine (brown)

426
Q

Which of these is used to boost the effects of protease inhibitors?
Elvitegravir
Maraviroc
Ritonavir
Etravirine

A

Ritonavir - it is a protease inhibitor itself but it inhibits CYP enzymes that would otherwise metabolise other protease inhibitors

427
Q

What are the side effects of trimethoprim?

A

Megaloblastic anaemia
GI effects
Taste disturbance
Elevated creatinine levels
Skin rash
Hyperkalaemia

428
Q

Trimethoprim can cause high levels of what electrolyte?

A

Potassium

429
Q

What is the advice surrounding ribavirin and contraception?

A

Effective contraception essential during treatment and for 4 months after treatment in females and for 7 months after treatment in males of childbearing age.

430
Q

What is the standard dose of oseltamivir in:i) Treatment of fluii) Prevention of flu

A

i) 75mg BD for 5 days for treatment
ii) 75mg OD for 10 days for prophylaxis

431
Q

Is vancomycin good for treating gram negative or positive organisms?

A

Gram positive

432
Q

Is teicoplanin good for treating gram negative or positive organisms?

A

Gram positive

433
Q

Allopurinol and what antibiotic can result in a skin rash?

A

Amoxicillin

434
Q

True or false:NSAIDs and fluoroquinolones together increase seizure risk

A

TRUE

435
Q

Can macrolides cause QT prolongation?

A

Yes

436
Q

What tetracyclines can you take with milk?

A

Does Like Milk acronym
Doxycline
Lymecycline
Minocycline

437
Q

What is 1st line treatment for chlamydia (both the patient and partner)?
If this is not suitable, what regimes can be used instead?

A

Doxycycline 100 mg BD for 7 days

Alternatives:
Azithromycin 1 g orally for one day, then 500mg orally once daily for two days
Erythromycin 500 mg BD for 10–14 days

438
Q

How do you manage a pregnant lady with chlamydia?

A

Azithromycin 1 g orally for one day, then 500mg orally once daily for two days
Erythromycin 500 mg BD for 10–14 days

439
Q

If a patient is thought to have chlamydia and presents in a primary care setting, where should you refer to?

A

GUM clinic

440
Q

When should you do an STI screen in a patient with chlamydia?

A

1 week after completing treatment

441
Q

If a patient and their partner are being treated for chlamydia, how long should they abstain from sexual intercourse? With what antibiotic is this different?

A

Until they have both finished treatmentWith azithromycin, you need to wait 7 days after

442
Q

Does a partner of someone of chlamydia need to be treated if their screen result is negative?

A

Yes

443
Q

How many weeks after the start of treatment do you do a test of cure treatment for chlamydia?

A

5 weeks

444
Q

What age should you offer repeat testing of chlamydia in 3-6 months after treatment?

A

<25 years

445
Q

What can a high ESR indicate?

A

Inflammation, infection

446
Q

Is ESR usually low or raised in infection?

A

Raised

447
Q

Why aren’t quinolones e.g. ciprofloxacin, ofloxacin generally used in children?

A

Quinolones cause arthropathy and therefore are not recommended in children and growing adolescents.

448
Q

What is the cut off eGFR for nitrofurantoin?

A

45

449
Q

Can you use tetracyclines in renal impairment?

A

No - should not be given at all in renal impairment
Apart from doxycycline and minocycline (but these should be used with caution)

450
Q

Can tetracyclines cause hepatotoxicity?

A

Yes

451
Q

True or false:
Tetracyclines can be used during pregnancy

A

FALSE

452
Q

True or false:Trimethoprim can be used during pregnancy

A

False - teratogenic in first trimester

453
Q

True or false:Nitrofurantoin can be used during pregnancy

A

True
But avoid at term

454
Q

Can metronidazole be used during pregnancy?

A

No
Only use if benefit outweighs risk

455
Q

Is Ben Pen active against streptococci?

A

Yes

456
Q

Is linezolid active against MRSA?

A

Yes

457
Q

Can chloramphenicol be used in pregnancy?

A

No

458
Q

Should metronidazole be taken with or without food?

A

With or just after food

459
Q

What electrolyte disturbances can be caused by aminoglycosides?

A

Hypokalaemia
Hypo Mg
Hypo Ca

460
Q

What is the MHRA warning about gentamicin?

A

Potential for histamine-related adverse drug reactions with some batches

461
Q

Is gentamicin used for MRSA?

A

No

462
Q

Red man syndrome caused by vancomycin causes is associated with what other clinical features?

A

Hypotension
Bronchospasms
Caused by rapid infusion

463
Q

Which is associated with a higher incidence of nephrotoxicity?TeicoplaninVancomycin

A

Vancomycin

464
Q

If a patient on a tetracycline develops a headache, what should they do?

A

Stop
Side effect of tetracyclines- benign intracranial hypertension

465
Q

What tetracyclines should you avoid milk in? (DOT)

A

Demeclocycline
Oxytetracycline
Tetracycline

466
Q

What tetracyclines can you have milk with? (DLM)

A

Doxycycline
Lymecycline
Minocycline

467
Q

What tetracyclines cause oesophageal irritation and is recommended to take with plenty of fluid?

A

Doxycycline
Minocycline
Tetracycline

468
Q

Can ciprofloxacin cause QT prolongation?

A

Yes

469
Q

Are quinolones active against MRSA?

A

No

470
Q

If a patient on a quinolone develops psychiatric disturbances, what should you recommend?

A

They should stop the drug

471
Q

What is the interaction between ciprofloxacin and theophylline?

A

Ciprofloxacin is an enzyme inhibitor and causes theophylline toxicity - convulsions risk

472
Q

With which quinolone should you protect yourself from sunlight?

A

Ofloxacin

473
Q

Cholestatic jaundice risk is increased with amoxicillin/flucloxacillin if on it for more than how many days?

A

14 days

474
Q

What is the dosing regimen for Malarone for the prophylaxis of malaria?

A

1 tablet OD
Started 1-2 days before, during, and 7 days after

475
Q

Should Malarone be taken on an empty stomach or with food?

A

Take with food/milky drink to maximise absorption

476
Q

What is the renal cut off for Malarone?

A

<30 mL/min

477
Q

What is the dosing regimen for doxycycline for the prophylaxis of malaria?

A

1 tablet OD
Start 1-2 days before, during and 4 weeks after

478
Q

How long do you continue malaria prophylaxis with doxycycline after leaving the area of risk?

A

4 weeks after

479
Q

What is the dosing regimen for chloroquine in the prophylaxis of malaria?

A

2 tablets once a week
Start 1 week before, during and 4 weeks after

480
Q

Should chloroquine be taken on an empty stomach?

A

No Take just after food

481
Q

Should proguanil be taken on an empty stomach?

A

No Take just after food

482
Q

What is the dosing regimen for proguanil in the prophylaxis of malaria?

A

2 tablets OD
Started 1 week before
Continue for 4 weeks after

483
Q

Should mefloquine be taken on an empty stomach?

A

No, take just after food

484
Q

What are the side effects associated with glycopeptides?

A

Infusion reactions, headache, nausea, diarrhea, skin rash and pruritus
C. diff

485
Q

What is the dose of trimethoprim for a UTI?

A

200mg BD

486
Q

What is the safest macrolide to use in pregnancy?

A

Erythromycin

487
Q

What is penicillin G?

A

Benzylpenicillin

488
Q

What is first line for acute infective exacerbation of COPD? Treatment duration?

A

Amoxicilin, clarithromycin or doxycycline for 5 days

489
Q

What is first line for acute exacerbation of bronchietasis? Treatment duration?

A

Amoxicilin, clarithromycin or doxycycline for 7-14 days

490
Q

What is low severity CAP in terms of CURB score?

A

0-1

491
Q

What is moderate severity CAP in terms of CURB score?

A

2

492
Q

What is high severity CAP in terms of CURB score?

A

3-5

493
Q

What is the CURB score and what does each marker mean?

A

Confusion - mental test 8 or less
Urea > 7 mmol/L
Resp rate 30 breaths/min or more
Blood pressure systolic < 90 or diastolic 60 or less
65 years and older

My Pham Notes (22 decks)

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