Chapter 5: Infection part 2 Flashcards
What is the CURB score and what does each marker mean?
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
What is the dose of nitrofurantoin for a UTI?
50mg QDS
When would you add flucloxacillin to pneumonia treatment?
If staphylococcus is suspected
How would you manage someone with mild facial cellulitis?What if the patient was penicillin allergic?
Co-amoxiclav Clarithromycin for people with a penicillin allergy
How do you treat Scarlet fever?
Pen V
How long should you abstain from alcohol after a metronidazole course?
48 hours
Within what time should you notify PHE of a patient with a notifiable disease?What about if it is urgent?
Send the form to the proper officer within 3 days, or notify them verbally within 24 hours if the case is urgent by phone, letter, encrypted email or secure fax machine.
What are the treatment options for recurrent thrush?
Initially:3 doses of 150mg fluconazole ( 3 days apart)or intravaginal antifungal for 10-14 daysAfter:Maintenance of 6 months or oral fluconazole 150mg weekly or intravaginal clotrimazole 500mg weekly
What are the treatment options for recurrent UTIs if trigger is not known and if trigger is known?
Manage acute UTI firstThen, i) If trigger is known, 1st choice is trimethoprim 200mg single dose after trigger exposureNitrofurantoin 100mg single dose after trigger exposureAlternatives- amoxicillin 500mg or cefalexin 500mgii) If trigger is NOT known, 1st choice trimethoprim 100mg ONNitrofurantoin 50-100mg ONAlternatives: Amoxicillin 250mg ON or cefalexin 125mg ON
Is Fluconazole or Itraconazole more readily absorbed?
Fluconazole
What is amphotericin B used for?
Aspergillosis, blastomycosis, candidiasis, cryptococcosis
Does amphotericin B need to be prescribed by brand?
Yes
Name 7 antifungal drugs?
FluconazoleKetoconazoleItraconazoleAmphotericin BNystatin VoriconazoleMiconazole
What is the mechanism of action of antifungal drugs?
Fungal cells contain ergosterol (not found in human/animal cells), antifungals bind to ergosterol creating pores as well as inhibiting ergosterol synthesis.
What are the main side effects of fluconazole? (3)
1) Prolonged QT interval2) Hepatotoxicity3) Renal impairment
What patient groups should avoid fluconazole? (2)
1) liver disease2) pregnancy (teratogenic)
Which antifungal’s are CYP450 inhibitors?
FluconazoleKetoconazoleItraconazole
What drugs do antifungals interact with?
1) CYP450 substrates2) QT prolonging drugs e.g amiodarone, antipsychotics, quinolones etc
What are the main side effects of Voriconazole?
HepatotoxicityPhotosensitivity (check for malignancy and seek medical attention if sunburnt)
What must you carry if you are taking voriconazole?
An alert card
What is nystatin normally used for? what are the typical dosage instructions?
Oral thrush-100,000 units QD for 7 days
What age group can fluconazole 150mg be sold to the public OTC?
16-60 for candidiasis
What must you monitor in patients taking LT treatment of fluconazole?
Liver enzymes before and during treatment
What must you monitor when taking LT treatment of voriconazole?
Renal and hepatic function before starting and then at least weekly for one month and then monthly. Check for malignancy and avoid sunlight.
Hepatotoxicity is also associated with another antifungal, please name it?
Ketoconazole
What are the general monitoring requirements for antifungals?
1) ECG2) Adrenal function (can cause adrenal insufficiency)3) Hepatic function
What is the most common cause of fungal meningitis?
Cryptococcal meningitis
Can you use Itraconazole in heart failure or history of heart failure?
AVOID
How would you treat fungal meningitis?
IV amphotericin followed by oral fluconazole
What are the 1st and 2nd line treatments for aspergillosis?
1) Voriconazole2) Liposomal amphotericin (alternatives are itraconazole or caspofungin)
What antifungal can you use to treat tinea capitis?
Griseofulvin
Is topical or systemic therapy more effective for fungal nail infections?
Systemic