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Pre Reg 2023 - Ama > 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 (cefalexin (1st gen cefalexin, 2nd gen ceftriaxone, 1st gen cefadroxil)- all but Cefopime a 4th generation cephalosporin

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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 allergic: meropenem

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 - V high anaerobic activity, narrow spectrum

Used for bacteria growing where there isn’t much oxygen: Gut (H pylori, Chron’s), 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 (emergency situation in community)
2) If penicillin allergy- CEFOTAXIME (a cephalosporin)

If hypersensitivity to penicillin & cephalosporins: CHLORAMPHENICOL

4) Can consider addition of Dexamethasone
5) 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

For 14 days consider adding dexamethasone

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7
Q

What is the treatment for meningitis caused by haemophilus influenza?

A

Cefotaxime (OR ceftriaxone) for 10 days

Consider adding dexamethasone

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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

2) staph: flucloxacillin, strep: benzylpenicillin

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

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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 ALL FOR 10-14 DAYS DURATION

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11
Q

Which antibiotics are commonly used for GU infections?

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 AB’s 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 endo)

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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?

A

NEOMYCIN - used for bowel sterilisation before surgery as its so strong it will wipe the bowel clean of bacteria

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17
Q

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

A

The carbapenems. These are beta-lactam antibacterials

NB: 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) (Hint: these are the two we see used in meningitis, a CNS infection!)

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19
Q

Talk me through treatment of UTI’s in pregnancy?

A

Nitrofurantoin: okay to use but avoid at term

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

Cefalexin: a cephalosporin, these are safe in pregnancy

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

All cephalosporins begin with C

(0.5-6.5% cross-sensitiviry)

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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:It IS 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

ONLY use when there is GOOD EVIDENCE to use this COMBO rather than just a single due to resistance!

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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 or rash: stevens johnsons syndrome, photosensitivity

Trimethoprim: Blood disorders: fever, sore throat, ulcers, bruising, bleeds

Penicillamine: not really an anti-bacterial: used as a disease-modifying anti-rheumatic drug Same as above: fever, sore throat, ulcers, bruising

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23
Q

What do you see fusidic acid commonly used for?

A

Staphylococcal infection of the SKIN e.g. impetigo & also EYES comes as 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)
Be careful in liver patients

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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. Can you think of any?

A

LINEZOLID- optic nephropathy

QUINOLONES (Ciprfloxacin, Levofloxacin)- retinal detachment

Ethambutol (used for TB)- ocular toxicity

Rifampicin- colours tears/ contacts red

Rifabutin- Uveitis (eye inflammation)

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29
Q

What two things need to be looked out for with Linezolid treatment?

A

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

Blood disorders: Aneamia, thrombocytopenia

FBC monitored WEEKLY, monitor especially for treatment of 10-14 days or more

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30
Q

What are the TWO very important safety warnings with QUINOLONES (ciprofloxacin, levofloxacin)?

A

May induce 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 (NB: this has also been reported with prednislone!)( also can PROLONG QTc interval- this is a 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

WHAT ANTIOBIOTICS CAN CAUSE QT PROLONGATION??!

A

MACROLIDES especially prone: 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 (mature cheese, soybean, wine, beer)

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

Flushing of upper body= RED MAN SYNDROME

Also:
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

After 3 or 4 doses if renal function is normal (earlier if its impaired!)

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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

Obviously avoid use of vancomycin and gentamicin together!

Ototoxic drugs:Loop diuretics- furosemide!!

Nephrotoxic drugs:CICLOSPORINPlatinum chemotherapy

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37
Q

Treatment with Vancomycin required Full Blood count monitoring. Why is this?

A

Risk or neutropenia- monitor neutrophils and platelets

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38
Q

Which antibiotics could cause CHOLESTATIC JAUNDICE (a liver disorder where bile builds up in the blood stream as it gets blocker from being excreted)?

A

FLUCLOXACILLIN - may even occur up to TWO MONTHS after flucloxacillin stopped, more likely after TWO WEEKS of treatment and older age

Co-fluampicil (contains amoxicillin and flucloxacillin)

Co-amoxiclav

Nitrofurantoin - Use these with caution in those with liver dysfunction!!

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39
Q

Which antibiotics are commonly used to treat acne??

A

Tetracyclines most common: tetracycline, doxycycline, oxytetracycline, lymecycline (trimethoprim for resistant acne)

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)

Tetracyclines - 12+: dental

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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

C

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?

A

BD - 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?? (only trough levels are used with Vancomycin)

A

10 - 15 mg/ L

15-20 for endocarditis

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49
Q

First line antibiotic for Cellulitis?

A

Flucloxacillin (250-500mg QDS)
If penicillin allergic: Clindamycin

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50
Q

CCF

Which antibiotics/ antifungals may cause STEVENS JOHNSON SYNDROME (skin rash)? (3)

A

Co-trimoxazole Clindamycin Fluconazole

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51
Q

What are some of the more common side effects experienced with Metronidazole (its quite an unpleasant antibiotic)?

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)
Fucidin cream Staph eye infections (topical)

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53
Q

N

Which antibiotic is cautioned in problems to do with: Lungs, Liver, and Neurones

A

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

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54
Q

F

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 (no longer available oral)!

Terbinafine

Rifampicin Isoniazid Pyrizinamide (R.I.P liver: TB drugs)

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56
Q

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

A

ITRACONAZOLE 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 B

Can also cause electrolyte disturbance: Hypokaleamia and hypomagneseamia

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59
Q

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

A

CHLOROQUINE

MEFLOQUINE

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60
Q

A woman, 4 weeks pregnant, comes and asks you what she can do to avoid malaria when she goes to Bolivia next month. 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

Doxy - last resort and must complete full course before 15 weeks gestati

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61
Q

What does the antimalarial malarone contain?

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

Lonely frail old linda sat in her smelly flat

A 
Lonely linda= Clindamycin (class of its own)
Frail= bones - clindamycin used for osteomyelitis as it concentrates in the bones
Smelly= diarrhoea= discontinue immediately
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64
Q

Daktocort cream (containing Miconazole and Hydrocortisone) needs to be stored where?? Why??Where is the ointment stored?

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- avoid sunlight!

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68
Q

When should a penicillin be discontinued? Describe the affects.

A

Individuals with a history of anaphylaxis, urticaria, or rash immediately after a penicillin should discontinue and not receive penicillins as these are at risk of immediate hypersensitivity.

The rash would come up straight away, be wide spread, all over body, confluent, raised and itchy (urticaria= hives like rash).

Those with history of a minor rash (non-confluent, localised to one area, non-itchy) that occurred more than 72 hours after starting the penicillin are probably not truly allergic, and if a penicillin is absolutely needed they may receive it.

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69
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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70
Q

How is oral thrush managed?

A

Initially TOPICAL treatment with either Miconazole oromucosal gel or

NYSTATIN oral suspension (use pipette provided, hold in mouth, used after food)

If these don’t work or patient has a dry mouth can use Oral fluconazole capsule

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71
Q

Which anti-epileptic does Meropenem reduce the levels of?

A

Sodium Valproate

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72
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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73
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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74
Q

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

A

PPI’s

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75
Q

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

A

bacterial vaginosis= thick, white and fishy discharge- cottage cheese like in appearance

Trichomoniasis Vaginalis= frothy-smell, green/ yellow coloured!

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76
Q

Pink and frothy sputum=?

A

Heart Failure: the pulmonary oedema (fluid on lungs) can result in coughing up blood and requiring more pillows to sleep on to take weight off the chest

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77
Q

What are the most common causative organisms of Community Aquired pneumonia? (2)

A

Streptococcus pneumoniae

Haemophilus influenzae

Atypical (less common): Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella

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78
Q

What antibiotics are suitable in pregnancy?

A

Penicillins and Cephalosporins + erythromycin

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79
Q

What are the indications for aminoglycosides?

A 
Used for serious infections CNS infections e.g meningitis
TB (streptomycin)
Pyelonephritis
pneumonia
endocarditis
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80
Q

What is the therapeutic range for gentamicin?

A

5-10mg/L

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81
Q

Which aminoglycoside is given orally? and why?

A

Neomycin- too toxic for IV use

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82
Q

What are the side effects of aminoglycosides? (3)

A

1) Nephrotoxicity 2) Ototoxicity 3) Peripheral neuropathy

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83
Q

Aminoglycosides shouldn’t be used in…? (2)

A

1) Myasthenia gravis (impairs neuromuscular transmission

2) Pregnancy (ear damage)

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84
Q

Aminoglycosides interact with what drugs?

A

1) Loop diuretics and Vancomycin (ototoxicity)

2) Cisplatin, Ciclosporin and vancomycin (nephrotoxicity)

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85
Q

IV treatment with aminoglycosides should not exceed how many days?

A

7 days

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86
Q

Monitoring requirements for aminoglycosides? (3)

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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87
Q

Common bacteria in meningitis? (3)

A

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

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88
Q

Antibiotics used in meningitis?

A

Benzylpenicillin, cefotaxime, chloramphenicol

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89
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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90
Q

Are cephalosporins broad spectrum?

A

Yes

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91
Q

Indications for cephalosporins?

A

2nd or 3rd line treatment for UTI and RTI

IV for severe resistant organisms Pneumonia, meningitis, gonorrhoea

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92
Q

Side effects of cephalosporins? (2)

A

1) GI effects

2) Penicillin hypersensitivity (avoid in known allergy)

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93
Q

Do IV cephalosporins require approval by a microbiologist?

A

YES and are now mainly restricted to antibiotic associated colitis

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94
Q

Does warfarin interact with cephalosporins? if so, how?

A

YES, 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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95
Q

What is the first line antibiotic group for MRSA?

A

Glycopeptides e.g vancomycin, Teicloplanin etc

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96
Q

What indications are glycopeptides generally used for?

A

MRSA
C.diff
endocarditis
surgical prophylaxis (MRSA risk)

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97
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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98
Q

When would you avoid using glycopeptides?

A

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

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99
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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100
Q

What drugs do glycopeptides interact with?

A

Ciclosporin, cisplatin, aminoglycosides, loop diuretics Suxamethonium- (Increases vancomycin conc)

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101
Q

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

A

1) Staphylococcal joint and bone infections2) Intra abdominal sepsis 3) Cellulitis and skin and soft tissue infections (effective against penicillin resistant streptococci)

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102
Q

Important side effects of clindamycin? (4)

A

1) Antibiotic associated colitis-REPORT diarrhoea 2) Esophageal disorders 3) Jaundice4) SJS, rash

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103
Q

In what patient groups is clindamycin CI?

A

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

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104
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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105
Q

Important side effects of macrolides? (4)

A

1) Antibiotic associated colitis2) QT prolongation 3) Ototoxicity4) Cholestatic jaundice

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106
Q

Why would you avoid using macrolides in myasthenia gravis?

A

Macrolides cause electrolyte abnormalities which can aggravate myasthenia gravis

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107
Q

Main CI for macrolides?

A

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

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108
Q

What drugs interact with macrolides?

A

1) CYP450 substrates 2) Drugs that prolong QT interval

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109
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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110
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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111
Q

Is metronidazole a CYP450 inhibitor?

A

NO, it is a substrate of CYP450

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112
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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113
Q

How long after stopping metronidazole should you avoid alcohol?

A

2 days

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114
Q

What drugs does metronidazole interact with? (4)

A

1) CYP450 inhibitors 2) CYP450 inducers3) CYP450 substrates4) Lithium (reduces clearance of lithium resulting in toxicity)

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115
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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116
Q

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

A

10 days

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117
Q

Are penicillins broad spectrum?

A

Yes

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118
Q

What are the main indications for penicillins? (7)

A

1) Tonsillitis (streptococcal)2) Otitis media 3) Cellulitis 4) RTI5) Meningitis6) Tetanus (C.diff)7) Skin and soft tissue infections

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119
Q

Main side effects of penicillin’s? (2)

A

1) Penicillin allergy 2) CNS toxicity (convulsions, coma)-do not give intrathecal injection

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120
Q

Main drug interaction of penicillin’s?

A

Methotrexate- reduced renal excretion and increased toxicity

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121
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 penicillin’s + Cholestatic jaundice (no more than 14 days treatment)

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122
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 penicillin’s +Cholestatic jaundice

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123
Q

Name two diaminopyrimidine antibiotics

A

1) Trimethoprim 2) Co-trimoxazole

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124
Q

How do diaminopyrimidines work?

A

Bacteriostatic-inhibit folate synthesis

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125
Q

Main indications of diaminopyrimidines?

A

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

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126
Q

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

A

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

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127
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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128
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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129
Q

Name five Quinolone antibiotics?

A

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

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130
Q

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

A

Rapid resistance developing

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131
Q

Main indications that quinolones are used for? (4)

A

1) UTI 2) severe GI infections including travelers diarrhoea3) LRTI4) Gonorrhoea

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132
Q

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

A

1) C. diff2) Neurological-seizures and hallucinations3) Inflammation and rupture of tendons-STOP4) Prolong QT interval-arrhythmia 5) Photosensitivity

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133
Q

What is an important side effect of monoflaxacin?

A

Life threatening hepatotoxicity

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134
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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135
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 e.g amiodarone, antipsychotics etc

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136
Q

What is the last resort antibiotic for MRSA?

A

Linezolid (vancomycin resistant cocci)

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137
Q

What types of infections is Linezolid used for?

A

Complicated skin and soft tissue infections and pneumonia

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138
Q

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

A

MAOI

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139
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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140
Q

What foods should be avoided while taking linezolid?

A

Tyramine rich foods

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141
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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142
Q

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

A

Check for optic neuropathy

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143
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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144
Q

Which TWO drugs cause peripheral neuropathy?

A

Metronidazole and nitrofurantoin

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145
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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146
Q

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

A

1) Dark yellow/ brown urine2) Pulmonary reactions 3) Peripheral neuropathy 4) Hepatitis

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147
Q

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

A

1) Pregnancy 2) CI in renal impairment

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148
Q

What are the TWO monitoring requirements for LT nitrofurantoin use?

A

Hepatic and pulmonary function

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149
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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150
Q

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

A

Trimethoprim, Nitrofurantoin, Cefalexin, amoxicillin

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151
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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152
Q

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

A

Trimethoprim or nitrofurantoin

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153
Q

Name FIVE tetracyclines?

A

Tetracyline, doxycycline, minocycline, lymecyline, oxytetracyline

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154
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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155
Q

Main side effects associated with tetracylines? (5)

A

1) Photosensitivity 2) Esophageal irritation 3) Hepatotoxicity 4) benign intracranial pressure- headache and visual disturbances-STOP5) Discoloration of tooth enamel

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156
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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157
Q

Name TWO conditions that require prolonged courses of antibiotics?

A

TB and osteomyelitis

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158
Q

Antibiotic used to prevent pneumococcal infection in sickle cell disease?

A

Phenoxymethylpenicillin, if CI then erythromycin

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159
Q

Antibiotic used as prevention for early onset neonatal infection?

A

Benzylpenicillin (IV)

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160
Q

Name FOUR beta lactam antibiotics?

A

1) Penicillins2) Cephalosporins3) Carbapenems4) Monobactams

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161
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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162
Q

What is the first line treatment for C.diff?

A

Metronidazole(or vancomycin or fidoxamicin)

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163
Q

What can a tobramycin dry powder inhaler be used for?

A

Pseudomonas lung infection in CF

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164
Q

Name TWO carbapenems?

A

Imipenem and Meropenem

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165
Q

Name TWO cephalosporins that can be used for CNS infections?

A

1) Cefotaxime 2) Ceftriaxone

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166
Q

Which cephalosporin has good activity against haemophillus influenza?

A

Cefaclor

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167
Q

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

A

Ceftriaxone

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168
Q

What is the maximum duration of treatment for fusidic acid?

A

10 days

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169
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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170
Q

Name TWO antimycobacterials?

A

Clofazimine and Dapsone (both used for leprosy)

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171
Q

Name the three antibiotics that can be used in lyme disease?

A

1) doxycycline
2) amoxicillin
3) azithromycin

Should be used in this order unless <9 years (avoid doxycycline)

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172
Q

Name SEVEN bacteria that can cause UTI?

A

1) E coli2) Staph saprophyticus3) Proteus4) Klebsiella5) Pseudomonas aeruginosa 6) Staph epidermidus 7) Enterococcus Faecalis

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173
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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174
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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175
Q

How long is the initial phase of TB treatment?

A

2 months

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176
Q

How long is the second phase of TB treatment?

A

4 months

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177
Q

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

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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178
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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179
Q

Which TB drugs cause liver toxicity?

A

IsonazidRifampacinPyrazinamide

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180
Q

Which TB drugs cause peripheral neuropathy?

A

Isonazid

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181
Q

Which TB drugs cause occular toxicity?

A

Ethambutol

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182
Q

What are the monitoring requirements for TB treatment?

A

Plasma levels e.g ethambutolUrinalysisVisual acuity testingBlood countsLiver and hepatic functionAuditory function in the elderly

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183
Q

What is the duration of treatment for extrapulmonary TB?

A

10 months

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184
Q

What is a specific CI of pyrazinamide?

A

Acute attack of gout

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185
Q

Name the antibiotics in the aminoglycoside class

A

AmikacinGentamicinNeomycinStreptomycinTobramycin

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186
Q

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

A

Gentamicin - treatment of choice AmikacinTobramycin - usually via inhalation in CF

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187
Q

What aminoglycoside is active against TB?

A

Streptomycin(mainly reserved for this indication)

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188
Q

Can aminoglycosides be given orally?

A

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

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189
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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190
Q

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

A

Gentamicin plus another antibioticStreptomycin is an alternative if resistant to gentamicin

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191
Q

Are aminoglycosides more active against gram positive or gram negative?

A

Gram negative but are broad

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192
Q

Can neomycin be given IV?

A

No too toxic Can only be used for skin/mucous membrane infections… However BNF states the cream is less suitable for prescribing(Can also be used to reduce the bacterial population of the colon prior to bowel surgery or in hepatic impairment)

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193
Q

What is the problem with using aminoglycosides in myasthenia gravis?

A

ContraindicatedMay impair neuromuscular transmission

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194
Q

What antibiotics can be used for prophylaxis in rheumatic fever?

A

Pen V or sulfadiazine

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195
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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196
Q

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

A

Pen V

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197
Q

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

A

Rifampicin

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198
Q

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

A

Erythromycin

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199
Q

What is pertussis?

A

Whooping cough

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200
Q

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

A

Clarithromycin

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201
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)

202
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-amoxIf penicillin allergic: Doxycycline and metronidazoleUp to 5 days and give tetanus jab

203
Q

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

A

Single dose IV cefuroxime/flucloxacillinAdd in gent

204
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

205
Q

What antibacterial prophylaxis do you use in caesarean section?

A

Single dose cefuroxime

206
Q

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

A

VoriconazoleLiposomal amphotericin

207
Q

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

A

CaspofunginItraconazole

208
Q

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

A

FluconazoleItraconazole as an alternative

209
Q

What is micafungin licensed for?

A

Invasive candidiasisOesophageal candidiasisProphylaxis of candidiasis in patients undergoing haematopoietic stem cell transplantation

210
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

211
Q

What is tinea capitis?

A

Fungal infection (ringworm) of scalp

212
Q

What is tinea pedis?

A

Athlete’s foot

213
Q

How do you treat tinea captis?

A

SystemicallyGriseofulvin Can also used an additional topical application

214
Q

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

A

FalseSystemic is more effective

215
Q

Is fluconazole active against Aspergillus?

A

No

216
Q

Is caspofungin effective against CNS fungal infections?

A

No

217
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 inadequateHowever, more expensive

218
Q

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

A

Aspergillus and CandidaNot active against CNS fungal infections

219
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

220
Q

Are carbapenems useful against MRSA?

A

No

221
Q

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

A

Yes apart from ertapenem

222
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

223
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 benpenCefotaxime if penicillin allergic / chloramphenicol if history of immediate hypersensitivity to penicillin and cephalosporins

224
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 startingAvoid using dex in septic shock, meningococcal septicaemia, immunocompromised, or meningitis following surgery

225
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 ceftriaxoneConsider adding vancomycin10 days

226
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 ampicillinConsider adding vanc10 days

227
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/ceftriaxoneChloramphenicol is an alternative if history of immediate hypersensitivity to penicillins or cephalosporins 7 days

228
Q

What bacteria can be the cause of meningitis?

A

Meningococcal (neisseria)PneumococcalHaemophilus influenzaeListeria

229
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

230
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

231
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 daysAlternative- co-trimoxazole for 21 days

232
Q

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

A

Paracetamol, ibuprofen, nasal salineAntibiotics not usually required

233
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.

234
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 illnessOr if bacterial sinusitis is suspected

235
Q

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

A

1st line- Pen V2nd line- Co-amox (especially if more serious illness)

236
Q

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

A

Doxycycline or clarithyromycin

237
Q

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

A

Erythromycin

238
Q

What antibiotic can be used in a pregnant UTI patient?

A

Cefalexin

239
Q

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

A

FlucloxacillinClarithromycin

240
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

241
Q

Otitis media is most common in which age group?

A

Children

242
Q

What antibiotics are likely to cause C.Diff?

A

ClindamycinPenicillinsCephalosporinsFluoroquinolones

243
Q

What 3 antibiotics can be used in C.Diff?

A

VancomycinMetronidazoleFidaxomicin

244
Q

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

A

Oral metronidazole for 10-14 days

245
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 infection10-14 days

246
Q

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

A

Metronidazole 5-7 days

247
Q

What antibiotics cover chlamydia?

A

Azithromycin (single dose)DoxycyclineErythromycin

248
Q

What is the recommended length of treatment for osteomyelitis?

A

6 weeks

249
Q

Osteomyelitis and septic arthritis antibiotic choice:
1. First line
2. If penicillin allergic
3. If MRSA suspected

A
  1. Flucloxacillin
  2. Clindamycin
  3. Vancomycin or teicoplanin
250
Q

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

A

Pen VAmoxicillinHowever these are not effective against bacteria that produces beta lactamasesCo-amox can be used in severe cases

251
Q

What is the drug of choice for acute ulcerative gingivitis?

A

Metronidazole

252
Q

Is haemophilus influenzae a bacteria or a virus?

A

Bacteria

253
Q

What is the recommended therapy for Haemophilus influenzae?

A

Cefotaxime or ceftriaxone

254
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

255
Q

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

A

AmoxicillinAlternatives= doxycycline, clarithromycin7 days (if infection caused by staph, it would be 14-21 days)

256
Q

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

A

Amoxicillin AND clarithromycinOr doxycycline alone 7 days

257
Q

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

A

Benpen AND clarithromycin/doxycycline7-10 daysIf MRSA suspected, add teic/vanc

258
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 + clarithromycin7-10 daysAlternative to co-amox would be cefuroxime or ceftriaxone

259
Q

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

A

If staphylococci suspected

260
Q

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

A

Teic/vanc

261
Q

What are the main organisms that cause pneumonia?

A

Streptococcus pneumoniaeHaemophilus influenzaeChlamydia pneumoniaeMycoplasma pneumoniaeLegionella pneumophila

262
Q

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

A

Doxycycline

263
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 hospitalLate onset = more than 5 days after admission to hospital

264
Q

How do you treat early onset HAP?

A

Co-amox or cefuroxime

265
Q

How do you treat late onset HAP?

A

Antipseudomonal penicillin e.g. Pip TazORBroad spectrum cephalosporin e.g. ceftazidimeORQuinolone e.g. ciprofloxacinMRSA- add vanc

266
Q

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

A

Fusidic acid

267
Q

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

A

Oral flucloxacillin Clarithromycin

268
Q

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

A

High dose flucloxacillin Clindamycin/clarithromycin

269
Q

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

A

FlucloxacillinErythromycin10-14 days

270
Q

What are the side effects of aminoglycosides?

A

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

271
Q

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

A

Risk of auditory or vestibular nerve damage

272
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

273
Q

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

A

No

274
Q

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

A

TRUE

275
Q

What are some common side effects of cephalosporins?

A

Abdo painEosoniphiliaThrombocytopenia

276
Q

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

A

Used in cautionBut should not be given if there is immediate hypersensitivity

277
Q

What are the glycopeptide antibiotics?

A

DalbavancinTeicoplaninTelavancinVancomycin

278
Q

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

A

Teicoplanin

279
Q

What drugs are associated with red man syndrome?

A

GlycopeptidesTeicoplaninVancomycin

280
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

281
Q

What are the cautions in macrolides?

A

QT prolongationand electrolyte disturbances

282
Q

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

A

Acute lymphocytic leukaemiaChronic lymphocytic leukaemiaCMVGlandular fever

283
Q

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

A

Risk of crystalluria Especially in renal impairment

284
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)

285
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)

286
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)

287
Q

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

A

500mg TDSIncreased up to 1g TDS if needed

288
Q

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

A

500mg TDS

289
Q

What is the MHRA warning surrounding flucloxacillin?

A

Cholestatic jaundice and hepatitis

290
Q

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

A

Black hairy tongue

291
Q

Ciprofloxacin is a type of what antibiotic?

A

Quinolone

292
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

293
Q

Should quinolones be used in MRSA?

A

No

294
Q

What quinolone is active against pseudomonas?

A

Ciprofloxacin

295
Q

What are some common side effects of quinolones?

A

QT prolongationHearing impairmentDecreased appetiteRhabdomylosisDrug should be discontinued if psychiatric, neurological reactions occurCautioned in young adults and children- risk of arthropathy

296
Q

What antibiotic would you use for PCP prophylaxis and treatment?

A

Co-trimoxazole

297
Q

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

A

Blood disorders Rash - steven johnson’s syndrome

298
Q

What age group are tetracyclines contraindicated in?

A

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

299
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

300
Q

Is there any special patient advice with doxycycline?

A

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

301
Q

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

A

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

302
Q

What muscle side effect can daptomycin cause?

A

MyopathyReport any muscle weakness and monitor creatine kinase if necessaryNeed to monitor CK twice a week whilst on it

303
Q

What monitoring requirements are needed for systemic fusidic acid?

A

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

304
Q

What is the important safety information regarding linezolid?

A

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

305
Q

What food does linezolid interact with and why?

A

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

306
Q

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

A

Gram +ve

307
Q

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

A

200mg BD

308
Q

Can you use trimethoprim in renal impairment?

A

Yes- monitorMay need to half normal dose

309
Q

What is the patient advice surrounding rifampicin?

A

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

310
Q

How does rifampicin interact with hormonal contraceptives?

A

Effectiveness of hormonal contraceptives are reduced - alternative method needed

311
Q

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

A

Rifampicin IsoniazidPyrazinamideEthambutolStreptomycin- hardly used but may be useful if resistant to isoniazid

312
Q

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

A

42 months

313
Q

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

A

24 months

314
Q

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

A

Pyridoxine (vitamin B6)Prophylaxis of isoniazid-induced neuropathy

315
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)

316
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 monthsShould NOT be given streptomycin

317
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.

318
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

319
Q

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

A

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

320
Q

What is the general TB treatment regimen?

A

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

321
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

322
Q

What would be the treatment regimen for latent TB?

A

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

323
Q

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

A

2 weeks

324
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

325
Q

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

A

Voractiv

326
Q

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

A

Rifinah

327
Q

Why is ethambutol cautioned in young children?

A

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

328
Q

What kind of toxcity can ethambutol cause?

A

Ocular - report any visual disturbancesNephrotoxicityOther side effects include red-green colour blindness, hepatotoxicity

329
Q

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

A

Peripheral neuropathyHepatic disordersOtotoxicity

330
Q

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

A

HepatoxicityAggravates gout

331
Q

What antibiotics respond to a lower UTI?

A

TrimethoprimNitrofurantoinAmoxicillinAmpicillinCefalexin

332
Q

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

A

3 days

333
Q

What antibiotics for a UTI should be used in pregnancy?

A

Penicillins and cephalosporins are the best choices

334
Q

At what EGFR should you avoid prescribing nitrofurantoin in?

A

<45

335
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)

336
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

337
Q

What are some side effects of amphotericin?

A

NAME?

338
Q

Are different preparations of amphotericin interchangeable?

A

No Vary in PD, PKShould preferably prescribe by brand to avoid confusion

339
Q

What are some side effects of fluconazole?

A

NAME?

340
Q

What is a specific side effect with IV isavuconazole?

A

Infusion related reactions:Hypotension, SOB, paraesthesiaNausea, headacheDiscontinue if these occur

341
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 diseaseShould 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

342
Q

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

A

Hepatotoxicity- patients should be aware of liver disorder signsPhototoxicity- 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 hallucinationsKeep an alert card on them

343
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 methodMen: Avoid fathering a child during and for at least 6 months after administration

344
Q

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

A

For moderate to severe infections, prednisolone for 21 days

345
Q

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

A

TRUE

346
Q

What is the drug of choice for threadworm?

A

Mebendazole

347
Q

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

A

Permethrin (insecticide)

348
Q

Can DEET spray be used during pregnancy and breastfeeding?

A

Yes

349
Q

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

A

Suncream Then DEET

350
Q

How does DEET spray affect the SPF of suncream?

A

Lowers it so a factor 30-50 should be used

351
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 beforeMalarone and doxycycline is 1-2 days beforeIn warfarin patients- 2-3 weeks before

352
Q

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

A

1-2 days before

353
Q

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

A

1-2 days before

354
Q

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

A

2-3 weeks before

355
Q

How long can Malarone be used for in malaria prophylaxis?

A

Up to 1 year

356
Q

How long can doxycycline be used for in malaria prophylaxis?

A

Up to 2 years

357
Q

How long can mefloquine be used for in malaria prophylaxis?

A

Up to 1 year

358
Q

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

A

ChloroquineMefloquineProguanil is recommended in areas with chloroquine resistanceDoxycyline or Malarone is recommended in areas without chloroquine resistance

359
Q

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

A

Those without a spleen

360
Q

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

A

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

361
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

362
Q

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

A

Continue for 4 weeks afterExcept for Malarone which is 1 week

363
Q

In warfarin patients, when should malaria prophylaxis begin?

A

2-3 weeks before travellingINR should be stable before departure

364
Q

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

A

Before starting the course7 days after starting the course After completing the courseFor prolonged stays, INR needs to be checked at regular intervals

365
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.

366
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

367
Q

What combination of antimalarials is in Malarone/Maloff?

A

Atovaquone and proguanil

368
Q

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

A

MalaroneRiametQuinine

369
Q

What is P. Falciparum resistant to?

A

Chloroquine

370
Q

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

A

Quinine (with doxycycline or clindamycin)MalaroneRiamet

371
Q

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

A

Quinine followed by clindamycin(cannot use doxycycline)

372
Q

What are the treatment options for non-falciparum malaria?

A

ChloroquineHowever, if resistant- Malarone or Riamet

373
Q

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

A

Chloroquine

374
Q

What antimalarials does Riamet contain?

A

Artemether and lumefantrine

375
Q

What is the important safety information with chloroquine?

A

Occular toxicity Very toxic in overdose

376
Q

What are some side effects of chloroquine?

A

QT prolongation
Agranulocytosis

Side-effects which occur at doses used in the prophylaxis or treatment of malaria are generally not serious

Arrhythmias and convulsions in overdose

377
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 depressionHas a long half life so can persist up to several months after discontinuation

378
Q

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

A

G6PD as if deficient, can cause haemolysis

379
Q

What is the difference between quinine sulphate and quinine bisulphate?

A

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

380
Q

What is the important safety information regarding quinine?

A

QT prolongation

381
Q

What are the initial treatment options for chronic Hep B?

A

Peginterferon alphaInterferon alphaTreatment with the above should be stopped if no improvement after 4 monthsEntecavirTenofovirTreatment should be changed to other antivirals if no improvement after 6-9 months

382
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.

383
Q

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

A

Combination of ribavirin and peginterferon alphaRibavirin monotherapy=ineffective

384
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 closelyRisk of Hep B reactivation (if patient has both B and C)Need to be screened for Hep B before starting treatment

385
Q

What is herpes labialis?

A

Cold sore

386
Q

What is herpes zoster?

A

Shingles

387
Q

What is varicella?

A

Chicken pox

388
Q

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

A

Within 72 hoursContinued for 7-10 days

389
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

390
Q

What kind of drug is foscarnet?

A

Antiviral

391
Q

What antivirals are used for CMV?

A

Ganciclovir IVValganciclovir POFoscaret - toxic and causes renal impairment

392
Q

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

A

Myelosuppression

393
Q

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

A

Triple therapy2 nucleoside reverse transcriptase inhibitors and ONE of the following;- Boosted protease inhibitor- Non-nucleoside reverse transcriptase inhibitor- Integrase inhibitor

394
Q

What is used for HIV pre-exposure prophylaxis?

A

Emtricitabine with tenofovir

395
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.

396
Q

Name the nucleoside reverse transciptase inhibitors for HIV

A

ZidovudineAbacavirDidanosineEmtricitabineLamivudineStavudineTenofovir disoproxil.

397
Q

Name the protease inhibitors used for HIV

A

AtazanavirDarunavirFosamprenavirRitonavirSaquinavirTipranavirMetabolised by cytochrome P450 enzyme systems

398
Q

Name the integrase inhibitors used for HIV

A

Dolutegravir, elvitegravir and raltegravir

399
Q

Name the non-nucleoside reverse transcriptase inhibitors used for HIV

A

Efavirenz, etravirine, nevirapine, and rilpivirine

400
Q

What is Maraviroc?

A

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

401
Q

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

A

Osteonecrosis

402
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

403
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

404
Q

What reaction can occur with HIV medicines?

A

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

405
Q

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

A

Nevirapine

406
Q

What is the important information that requires patient counselling for patients on nevirapine for HIV?

A

NAME?

407
Q

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

A

Cholesterol

408
Q

What are the long term effects of HIV treatment?

A

1.Immune reconstitution syndrome: as the immune system stands up on its feet again due to antiretroviral treatment, marked inflammatory reactions happen against opportunistic organisms2. Lipodystrophy syndrome: this is made up of insulin resistance, fat redistribution and dyslipidaemiaBlood lipids and sugars should be measured before, 3-6 months after and yearly after HIV treatment.3. Osteonecrosis: following long-term exposure to treatment.

409
Q

Protease inhibitors are mainly associated with what side effects?

A

Lipodystrophy and metabolic effects.

410
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

411
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

412
Q

How long should influenza treatment be for?

A

Twice daily dosing for 5 days

413
Q

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

A

Once daily dosing for 10 days

414
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.

415
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.

416
Q

What penicillin based antibiotics must you take on an empty stomach (1 hour before food or 2 hours after food)?

A

FlucloxacillinAmpicillinPenicillin V

417
Q

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

A

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

418
Q

Which tetracycyline antibiotics should be taken on an empty stomach?

A

Oxytetracycline and tetracycyline

419
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.

420
Q

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

A

TRUE

421
Q

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

A

FalseTake with or just after food

422
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.

423
Q

What specific monitoring should you do with daptomycin?

A

Creatine kinase twice a week

424
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 infectionPeople with a prescription for oral ketoconazole should be referred back to their doctors

425
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

426
Q

What CD4 count is classed as AIDs?

A

<200

427
Q

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

A

Piperacillin (Pip taz)

428
Q

Which antibacterial drug increases the risk of serotonin syndrome?LinezolidVancomycinTelvancinSeptrin

A

Linezolid as it is a weak MAOI Serotonin syndrome risk increases with:SSRIsTCAsMacrolidesAmiodaroneFluoroquinolonesAntipsychoticsQuinineRisk of hypertensive crisis

429
Q

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

A

Antiretroviral drugs can cause redistribution of fat around the body

430
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).

431
Q

What are adverse effects of quinine?

A

TinnitusDeafnessBlindnessQT prolongationHypoglycaemiaGI upsetHypersensitivity reactions

432
Q

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

A

May darken urine (brown)

433
Q

Which of these is used to boost the effects of protease inhibitors?ElvitegravirMaravirocRitonavirEtravirine

A

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

434
Q

What are the side effects of trimethoprim?

A

Megaloblastic anaemiaGI effectsTaste disturbanceElevated creatinine levelsSkin rashHyperkalaemia

435
Q

Trimethoprim can cause high levels of what electrolyte?

A

Potassium

436
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.

437
Q

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

A

i) 75mg BD for 5 days for treatmentii) 75mg OD for 10 days for prophylaxis

438
Q

Is vancomycin good for treating gram negative or positive organisms?

A

Gram positive

439
Q

Is teicoplanin good for treating gram negative or positive organisms?

A

Gram positive

440
Q

Allopurinol and what antibiotic can result in a skin rash?

A

Amoxicillin

441
Q

True or false:NSAIDs and fluoroquinolones together increase seizure risk

A

TRUE

442
Q

Can macrolides cause QT prolongation?

A

Yes

443
Q

What tetracyclines can you take with milk?

A

Does Like Milk acronymDoxyclineLymecyclineMinocycline

444
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 daysAlternatives:Azithromycin 1 g orally for one day, then 500mg orally once daily for two daysErythromycin 500 mg BD for 10–14 days

445
Q

How you manage a pregnant lady with chlamydia?

A

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

446
Q

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

A

GUM clinic

447
Q

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

A

1 week after completing treatment

448
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

449
Q

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

A

Yes

450
Q

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

A

5 weeks

451
Q

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

A

<25 years

452
Q

What can a high ESR indicate?

A

Inflammation, infection

453
Q

Is ESR usually low or raised in infection?

A

Raised

454
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.

455
Q

What is the cut off eGFR for nitrofurantoin?

A

45

456
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)

457
Q

Can tetracyclines cause hepatotoxicity?

A

Yes

458
Q

True or false:Tetracyclines can be used during pregnancy

A

FALSE

459
Q

True or false:Trimethoprim can be used during pregnancy

A

False - teratogenic in first trimester

460
Q

True or false:Nitrofurantoin can be used during pregnancy

A

True But avoid at term

461
Q

Can metronidazole be used during pregnancy?

A

No Only use if benefit outweighs risk

462
Q

Is Ben Pen active against streptococci?

A

Yes

463
Q

Is linezolid active against MRSA?

A

Yes

464
Q

Can chloramphenicol be used in pregnancy?

A

No

465
Q

Should metronidazole be taken with or without food?

A

With or just after food

466
Q

What electrolyte disturbances can be caused by aminoglycosides?

A

HypokalaemiaHypo MgHypo Ca

467
Q

What is the MHRA warning about gentamicin?

A

Potential for histamine-related adverse drug reactions with some batches

468
Q

Is gentamicin used for MRSA?

A

No

469
Q

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

A

HypotensionBronchospasms Caused by rapid infusion

470
Q

Which is associated with a higher incidence of nephrotoxicity?TeicoplaninVancomycin

A

Vancomycin

471
Q

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

A

Stop Side effect of tetracyclines- benign intracranial hypertension

472
Q

What tetracyclines should you avoid milk in? (DOT)

A

DemeclocyclineOxytetracyclineTetracycline

473
Q

What tetracyclines can you have milk with? (DLM)

A

Doxycycline LymecyclineMinocycline

474
Q

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

A

DoxycyclineMinocyclineTetracycline

475
Q

Can ciprofloxacin cause QT prolongation?

A

Yes

476
Q

Are quinolones active against MRSA?

A

No

477
Q

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

A

They should stop the drug

478
Q

What is the interaction between ciprofloxacin and theophylline?

A

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

479
Q

Which quinolone should you protect yourself from sunlight if on it?

A

Ofloxacin

480
Q

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

A

14 days

481
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 afterTake with food/milky drink

482
Q

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

A

Take with food/milky drink to maximise absorption

483
Q

What is the renal cut off for Malarone?

A

<30 mL/min

484
Q

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

A

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

485
Q

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

A

4 weeks after

486
Q

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

A

2 tablets once a weekStart 1 week before, during and 4 weeks afterTake just after food

487
Q

Should chloroquine be taken on an empty stomach?

A

No Take just after food

488
Q

Should proguanil be taken on an empty stomach?

A

No Take just after food

489
Q

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

A

2 tablets ODStarted 1 week beforeContinue for 4 weeks after Take just after food

490
Q

Should mefloquine be taken on an empty stomach?

A

No Take just after food

491
Q

What are the side effects associated with glycopeptides?

A

NAME?

492
Q

What is the dose of trimethoprim for a UTI?

A

200mg BD

493
Q

What is the safest macrolide to use in pregnancy?

A

Erythromycin

494
Q

What is penicillin G?

A

Benzylpenicillin

495
Q

What is first line for acute infective exacerbation of COPD and how long for?

A

Amoxicilin, clarithromycin or doxycycline for 5 days

496
Q

What is first line for acute exacerbation of bronchietasis and how long for?

A

Amoxicilin, clarithromycin or doxycycline for 7-14 days

497
Q

What is low severity CAP in terms of CURB score?

A

0-1

498
Q

What is moderate severity CAP in terms of CURB score?

A

2

499
Q

What is high severity CAP in terms of CURB score?

A

03-May

500
Q

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

A

Confusion - mental test 8 or less Urea > 7 mmol/LResp rate 30 breaths/min or moreBlood pressure systolic < 90 or diastolic 60 or less65 years and older1 point for eachLow risk 0-1Moderate 2High risk 3-5

501
Q

What monitoring is required for clindamycin?

A

Renal and liver function if more than 10 days of treatment

Pre Reg 2023 - Ama (24 decks)

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