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RACP Written Exam > ID > Flashcards

ID Flashcards

1
Q

What causes neurocysticerosis?

A

Taenia solium
Ingested larvae from undercooked pork

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2
Q

Treatment for cysticercosis

A

Praziquantel

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3
Q

Treatment for neurocysticerosis

A

Albendazole

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4
Q

Cause of hydatid cysts in liver and lungs?
What occurs when they rupture

A

Echinococcus granulosus
If hydatid cysts rupture can cause anaphylaxis
Tx Albendazole

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5
Q

What does clononchis sinesis increase risk of?

A

Cholangiocarcinoma

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6
Q

Schistosomas can cause which type of inflammatory disease?

A

Granulomatous disease

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7
Q

Why in acute schistosomiasis do you have severe fever, uricaria, angiooedema, myalgias and arthralgias 3-8 weeks post infection

A

Period of egg production, increased Antigen production causing hypersensitivity

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8
Q

Chronic schistosomasis leads to increased risk of?

A

SCC of bladder
Pulmonary HTN

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9
Q

Treatment for schistosomaiasis

A

Praziquantel
Corticosteroids

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10
Q

Treatment of scabies

A

Permethrin cream
Oral ivermectin

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11
Q

What is genetic recombination

A

Viruses exchange genetic material

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12
Q

What are the ESCAPPM organisms?

A

Enterobacter
Serratia
Citrobacter
Aeromonas
Proteus
Providencia
Morganella

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13
Q

MoA of penicillin

A

D-ala-D-ala structural analogue that Binds penicillin binding proteins -> blocks cross linking of peptidoglycan wall

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14
Q

MRSA resistance mechanism

A

Altered penicillin binding proteins

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15
Q

What are penicillinase sensitive penicillins and what use do they have?

A

Amoxicillin and ampicillin
Extended spectrum penicillin HHEELPSS
H influenza h pylori e coli enterococci listeria proteus salmonella shigella

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16
Q

Penicillin toxcitities

A

Direct coombs positive haemolytic anaemia
Drug induced interstitial nephritis
C diff pseudomembranous colitis
Hypersensitivity

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17
Q

Moa of vancomycin

A

Inhibition of peptidoglycan formation by binding to d ala d ala

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18
Q

Aminoglycoside moa

A

Irreversible inhibition of ribosome initiation complex Binds 30s subunit, needs o2 so no anaerobic activity

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19
Q

Aminoglycoside mechanism of resistance

A

Bacterial transferase enzymes inactivate the drug via acetylation, phosphorylation or adenylation

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20
Q

Linezolid moa

A

Inhibits ribosome 50s unit and prevents initiation complex

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21
Q

Linezolid resistance

A

Point mutation of ribosome rna

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22
Q

What are the macrolides

A

Azithromycin, erythromycin, clarithromycin

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23
Q

Macrolide moa

A

Inhibit translocation in the ribosome so proteins cannot be produced, bacteriostatic

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24
Q

Macrolide uses

A

Atypical mycoplasma, chlamydia, legionella, Gram +ve cocci

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25
Q

Macrolide resistance

A

Methylation of 23s rRNA binding site, drug can’t bind

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26
Q

Macrolide side effects

A

MACRO
gi motility, arrthymia (qt prolongation) cholestatic hepatitis, rash, eosinophilia

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27
Q

Linezolid also inhibits

A

MAO inhibitor, causes serotonin syndrome

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28
Q

Linezolid ADRs

A

Thrombocytopenia, peripheral neuropathy, serotonin syndrome, lactic acidosis

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29
Q

Tetracyclines and moa

A

Doxycycline
Binds to 30s subunit, prevents trna attachement

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30
Q

Doxycycline resistance

A

Reduced uptake or increased removal from cell by Plasmid encoded transport pump

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31
Q

Type of bacteria doxycycline best against

A

Intracellular
Rickettsia and chlamydia
Use in atypicals

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32
Q

Clindamycin moa

A

Blocks tranlocation of peptides at 50s ribosome subunit

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33
Q

Clindomycin uses

A

Aneorobes above the diaphragm

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34
Q

Clindamycin adrs

A

C diff

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35
Q

Sulfonamides and their moa

A

Sulfamethoxazole
Inhibit DHF synthesis, inhibits foliate synthesis, bacteriostatic

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36
Q

Sulfonamides adr

A

Hypersensitivity
If g6pd def then haemolysis
Tubulointerstitual nephritis
SJS
Displaces other drugs from alb (warfarin)

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37
Q

Sulfonamides resistance

A

Altered enzyme leads to decreased uptake or increases PABA synthesis

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38
Q

Dapsone moa

A

Inhibit DHF synthesis, inhibits foliate synthesis, bacteriostatic

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39
Q

Dapsone adrs

A

Methhaemoglobulinaemia, agranulocytosis, hameolysis if g6pd def

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40
Q

Trimethoprim moa

A

Inhibits bacterial dihydrofolate reductase, bacteriostatic

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41
Q

Trimethoprim adrs

A

HyperK, megaloblastic anaemia, leukopenia, granulocytopenia

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42
Q

Daptomycin moa

A

Creates transmembrane channels in Gram +ve cocci

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43
Q

What is dapsone used in

A

S aureus skin infections
Can’t use in lungs, inactivated by surfactant

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44
Q

Dapsone adrs

A

Myopathy, rhabdo

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45
Q

Metronidazole moa

A

Forms toxic free radical metabolites in bacteria which kills it
Also kills protozoa

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46
Q

Metronidazole adrs

A

Red Man syndrome (disulfram like reaction, severe flushing, tachy, low bp) with alcohol, headache, metallic taste

47
Q

Metronidazole used for

A

Get gap on the metro
Giardia
Entamoeba
Trichmonas
Garderella vaginalis
Anaerobes

48
Q

Fluroquinolones and moa

A

Ciprofloxacin, moxifloxacin
Inhibits prokaryotic enzymes topoisomerase 2 and 4 (DNA gyrase inhibition)

49
Q

Fluroquinolones adrs

A

GI, superinfections, rash, headache, dizziness, rarely myalgias, cramping, tendon rupture

50
Q

Fluroquinolones resistance

A

Mutation in DNA gyrase
Plasmid medicated resistance
Efflux pumps

51
Q

Rifampin moa

A

Inhibit bacterial rna polymerase -> reduced mrna synthesis

52
Q

Rifampin adrs

A

Hepatotoxicity, cypP450 inducer
Red-orange body fluids

53
Q

Isoniazid moa

A

Inhibits mycolic acts synthesis and reduces cell wall synthesis
Needs bacterial catalase peroxidase in order to convert to active form (encoded by KatG)

54
Q

Isoniazid resistance

A

Needs bacterial catalase peroxidase in order to convert to active form (encoded by KatG)
Mutations in katG

55
Q

Insoniazid causes what deficiency

A

Vit B6 (pyridoxine)

56
Q

Isoniazid adrs

A

B6 def, hepatotoxicity, cypP450 inhibition, drug induced lupus, overdose causes seizures

57
Q

Pyrazinamide adrs

A

Hepatotoxicity, hyperuricaemia

58
Q

Ethambutol moa

A

Inhibits arabinosyltransferase, reduces arabinogalactan synthesis and reduces cell wall synthesis

59
Q

Ethambutol adrs

A

Optic neuropathy (red-green colour blindness and decreased visual acuity)
Usually reversible

60
Q

Treatment of TB leprosy

A

Dapsone and rifampin
Add clofazimime for lepromatous form

61
Q

Amphotericin B and nystatin MoA

A

Binds ergosterol and forms membrane pores which leak electrolytes

62
Q

Treatment considerations when using amphotericin B

A

supplement K and Mg due to altered renal tubule permeability

63
Q

Amphotericin B ADRs

A

nephrotoxicity, arrthymias, anaemia, phelbeitis, fever/chills, hypotension

64
Q

MoA of Flucytosine

A

Antifungal
Inhibts DNA and RNA synthesis by converting to 5FU through cytosine deaminase

65
Q

ADR of Flucytosine

A

Myelosuppression

66
Q

What are the azoles

A

clotrimazole, fluconazole, voriconazole, ketoconazole

67
Q

MoA of Azoles

A

Inhibits fungal ergosterol synthesis by inhibiting CYP450 (usually converts lanosterol to ergosterol)

68
Q

Azole ADRs

A

Testosterone synthesis inhibition (gynocomastia), liver dysfunction, QT prolongation

69
Q

Terbinafine MoA

A

Inhibits fungal enzyme squaline epoxidase, stops lanosterol synthesis

70
Q

What are the Echinocandins

A

Anidulafungin, caspofungin, micafungin

71
Q

MoA echinocandins

A

inhibits Beta-glucan synthesis which inhibits cell wall synthesis

72
Q

Griseofulvan MoA

A

interferes with microtubule function, accumulates in nails

73
Q

Griseofulvin ADRs

A

teratogenic, carcinogenic, confusion, headaches, disulfram-like reaction, increased CYP450 and warfarin metabolism

74
Q

What is a disulfiram-like reaction

A

adverse reaction to alcohol (N+V, headache, dizziness, hangover) caused by accumulation of acetaldehyde
Cephalosporins, macrolides, sulfonureas

75
Q

Oseltamivir MoA

A

Inhibits influenza neuramindase, reduces viral progeny release

76
Q

Remdesivir MoA

A

prodrug of ATP analogue
inihibts viral RNA-dependent RNA polymerase and evades viral proof-reading, reducing viral RNA production

77
Q

Aciclovir, Famiciclovir, valaciclovir MoA

A

guanosine analogues
phosphorylated by HSV/VZV viral thymidine kinase (not activated in uninfected cells and in CMV), inihibits viral RNA polymerase
Valacyclovir is aciclovir prodrug, has beeter oral biovailability

78
Q

Aciclovir, Famiciclovir, valaciclovir ADR

A

obstructive crystalline nephropathy and AKI if not hydrated enough

79
Q

Aciclovir, Famiciclovir, valaciclovir resistance

A

mutated viral thymidine kinase

80
Q

Ganciclovir MoA

A

Guanosine analoug
phosphorylated by CMV viral kinase, inhibits DNA polymerase
Valganciclovir is prodrug, has better bioavailability

81
Q

Foscarnet MoA

A

Viral DNA/RNA prolymerase inhibitor and HIV reverse transcriptase inhibitor

82
Q

Foscarnet ADRs

A

Nephrotoxicity
Electrolyte disturbance

83
Q

Cidofovir MoA and ADR

A

Inhibits viral DNA polymerase
ADR: nephrotoxicity (use with probenicid and saline to reduce toxicity)

84
Q

Common combo of HIV therapy

A

2 NRTIs and an integrase inhibitor

85
Q

Therapy used for HIV PrEP

A

Tenofovir and emtricitabine

86
Q

NRTIs MoA

A

abacavir, tenofovir
inhibit nuceloside binding to reverse transcriptase to terminate DNA chain

87
Q

NRTI ADRs

A

myelosuppression, nephrotoxicity

88
Q

When is abacavir contraindicated?

A

HLAB5701 mutations, increases hypersensitivity

89
Q

NNRTIs ADRs

A

rash, hepatoxocitity

90
Q

Integrase inhibitor MoA

A

inhibiting integrase prevents HIV genome integration into host cell chromosome

91
Q

Integrase inhibitors ADRs

A

raised CK, weight gain

92
Q

Protease inhibitors all need to be prescribed with

A

ritonavir or cobicistat

93
Q

Protease inhibitors MoA

A

protease usually cleaves RNA into functional parts, if inhibited prevents maturation of new virions

94
Q

Protease inhibitor ADRs

A

hyperglycaemia, nausea and diarrhoea

95
Q

MoA of enfuvirtide

A

binds gp41, inhibiting entry
Fusion inhibitor

96
Q

Maraviroc MoA

A

binds CCR5 and inhibits interaction with gp120

97
Q

NS5A inhibitors MoA (hep C therapy)

A

end in pasvir
is a viral phosphorylase which plays key role in RNA replication

98
Q

NS5B inhibitors MoA

A

end in buvir
RNA-dependent RNA polyermerase, prevents viral replication

99
Q

NS3/4A inhibitors MoA

A

end in previr
inhibit viral protease, prevents replication

100
Q

Ribavirin MoA

A

inhibits guanine synthesis

101
Q

Treatment for acyclovir resistant HSV

A

Foscarnet or Cidofovir

102
Q

Extrahepatic manifestations of Hep C

A

DM
Autoimmune hypothyroidism
Membronous/membranoproliferative GN
Lichen planus

103
Q

Empiric treatment for sepsis in splenectomy

A

Ceftriaxone and vanc

104
Q

mortality in sepsis and splenectomy

A

50%

105
Q

Most common organisms causing sepsis in splenectomy pt

A

strep pneumoniae
H influenza
Neisseria meningiditis

106
Q

empiric sepsis tx pre hospital

A

ceftriaxone

107
Q

empiric tx community acquired

A

Gent and fluclox
add vanc is MRSA
add ceftriaxone if meningitis
(cefazolin if allergic)

108
Q

empiric tx of hospital sepsis

A

PipTaz

109
Q

What is ecthyma gangrenosum and what caused by

A

rash with haemorrhagic vesicles, rim of erythema and central necrosis
Caused by pseudomonas

110
Q

What causes sepsis after ingesting raw shellfish (US) -> sudden malaise, fever, hypotension
bullous haemorrhagic lesions
occurs in liver disease, DM, renal insuff, cancer

A

vibrio vulnificus

111
Q

Most common causitive organisms of nec fasc

A

group a strep
clostridium perfringins

112
Q

empriric treatment for nec fasc

A

meropenam or pip/taz plus vancomycin plus clindamycin
if water associated wound add ciprofloxacin

113
Q

Pneumovax dosing for adults

A

1 dose when non indigenous 70yo
aborginal >50yo 3 doses
pneumovax 23 better at preventing adult infections

RACP Written Exam (14 decks)

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