In Flashcards
1
Q
State the antibiotics safe in pregnacy
A
penicillins
cephalosporins (cefalexin)
2
Q
Which antibiotics are contraindicated in children?
A
Quinolones (avoid as can arthropathy, tissue, cartillage damge)
and if under 12: Tetracyclines
3
Q
Which antibiotic has increased risk of clostridium difficile?
A
clindamycin
4
Q
which antibiotics can cause nephrotoxicity?
A
aminoglycosides
vancomycin (glycopeptide)
5
Q
Which antibiotics should be avoided in renal impairment?
A
Nitrofurantoin EGFR less than 45 ml/min/1.73m
Avoid if eGFR less than 45 mL/ minute/1.73 m2; may be used with caution if eGFR 30–44 mL/ minute/1.73 m2 as a short-course only (3 to 7 days), to treat uncomplicated lower urinary-tract infection caused by suspected or proven multidrug resistant bacteria and only if potential benefit outweighs risk.
Trimethoprim In adults:
Manufacturer advises dose reduction to half normal dose after 3 days if eGFR 15–30 mL/minute/1.73 m2.
Manufacturer advises dose reduction to half normal dose if eGFR less than 15 mL/minute/1.73 m2
Tetracyclies (except minocycline/ doxycycline)
6
Q
Which antibotics should be avoided in hepatotoxicity?
A
rifampicin
tetracyclines
7
Q
which antibiotics can cause cholestatic jaundice?
A
Co-amoxiclav
flucloxacillin
Note: report diarrhea to GP as treatment may need changing
8
Q
State the signs of sepsis in babies
A
Blue pale skin lips or tongue that does not fade when you roll a glass over it (same as meningitis)
Difficulty in breathing
Weak high-pitched cry
Sleepier than normal
Not feeding or normal activities
Dry nappy
Dehydrated
9
Q
State the signs of sepsis in adults
A
Blue pale skin lips or tongue
Rash that does not Fade when you roll a glass over it (same as meningitis) non blanching rash
Difficulty in breathing
Slurred speech, confused
10
Q
state treatment of meningococoal septicemia (2)
A
- Benzylpenicillin or cefotaxime/ ceftriaxone
- Chloramphenicol
11
Q
state the treatment of septicemia related to vascular cather
A
Vancomycin or teicoplanin
12
Q
State treatment of septicaemia (community acquired)
A
Piperacillin with tazobactam or cefuroxime
If MRSA suspected, add vancomycin or teicoplanin
If anaerobic suspected, add metronidazole to a broad-spectrum cephalosporin
Meropenem
13
Q
State treatment of septicaemia (hospital acquired)
A
Piperacillin with tazobactam, ticarcillin with clavulanic acid, ceftazidime, imipenem with cilastatin or meropenem
If MRSA suspected, add vancomycin or teicoplanin
If anaerobic suspected, add metronidazole to a broad-spectrum cephalosporin
14
Q
State the common causative agents:
A
Staphylococci
MRSA
Anaerobic
Pseudomonas aeruginosa
Haemflu influenzae
15
Q
how are staphylococci infections treated?
A
flucloxacillin
16
Q
how are MRSA infections treated?
A
vancomycin?
17
Q
how are anaerobic infections treated?
A
metronidazole
18
Q
how are haemflu influenzae infections treated?
A
amoxicillin?
19
Q
State the treatment/ prevention of Rheumatic fever
A
Phenoxymethylpenicillin
OR sulfadiazine
20
Q
State treatment of lower UTI in men
A
Trimethoprim or nitrofurantoin (avoid if egfr less than 45 ml/min)
21
Q
State treatment of lower UTI in children?
A
- Trimethoprim or nitrofurantoin (avoid if egfr less than 45ml/min
- Nitrofurantoin
- Amoxicillin or cefalexin
22
Q
State treatment of lower UTI in non-pregnant women
A
- Nitrofurantoin (avoid if egfr less than 45ml/min) or trimethoprim if low risk of resistance
- Pivmecillinam
- Fosfomcin
23
Q
State treatment of lower UTI in pregnant women
A
- Nitrofurantoin (avoid if egfr less than 45ml/min) but AVOID AT TERM!
- Amoxicillin
- Cefalexin
Avoid trimethoprim as it is teratogenic in first trimester. Manufacturers advise avoid during pregnancy!
24
Q
State treatment of acute pyelonephritis in
Men and non-pregnant women
A
Cefalexin
or co-amoxiclav
or trimethoprim
Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys and is one of the most common diseases of the kidney. Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems.
25
State treatment of acute pyelonephritis in pregnant women?
cefalexin
26
State treatment of acute cough in adults
Doxycycline or Clarithromycin / erythromycin or amoxicilin
(Amoxicillin or erythromycin preferred in pregnancy)
27
Which antibiotics are preferred in pregnancy for the treatment of acute cough?
Amoxicillin
Erythromycin
28
How is acute cough treated in children?
1. Amoxicillin
2. Clarithromycin/erythromycin
29
State treatment for acute sore throat:
1. Phenoxymethylpenicillin
2. Clarithomycin/erythromycin
30
State the treatment of invasive Group A streptococcal infection, prevention of secondary case:
1. Phenoxymethlypenicilin
2. Erythromycin
31
State the treatment of meningococcal meningitis, prevention of secondary cases:
. Ciprofloxacin
OR rifampicin
OR IM ceftriaxone
## Footnote
Secondary prevention: Systematically detecting the early stages of disease and intervening before full symptoms develop
32
State the treatment of haemophilius influenza type b disease, prevention of secondary cases:
1. Rifampicin
2. IV Ceftriaxone
33
State the treatment of diptheria in non-immune patients, prevention of secondary cases:
Erythromycin
or another macrolide (azithromycin, clarithromycin)
## Footnote
Diphtheria is a highly contagious infection that affects the nose and throat, and sometimes the skin.
Symptoms of diphtheria include:
a thick grey-white coating that may cover the back of your throat, nose and tongue
a high temperature (fever)
sore throat
swollen glands in your neck
difficulty breathing and swallowing
34
State the treatment of pertussis, antibacterial prophylaxis
Clarithromycin (or azithromycin / erythromycin)
## Footnote
Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it's marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop.
35
State the treatment of pneumococcal infection in asplenia or patients with sickle cell disease:
1. Phenoxymethylpenicillin
2. Erythromycin
36
State the treatment of animal cat and dog bites prophylaxis in adults:
1. Co-amoxiclav 3-day course
2. Metronidazole + Doxycycline 3-day course
37
State the treatment of animal cat and dog bites that is infected in adults:
1. Co-amoxiclav for 5 days
2. Metronidazole + Doxycycline 5-day course
38
State the treatment of animal cat and dog bites that is infected in children:
1. Co-amoxiclav
2. Co-trimoxazole if allergic to penicillin under 12 years of age
3. Doxycycline + metronidazole aged 12-17
39
State the treatment of animal scratch from dog/cat:
Flucloxacillin
40
State treatment of meningitis caused by pneumococci:
1. Cefotaxime (or ceftriaxone)
## Footnote
Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, spherical bacteria, alpha-hemolytic member of the genus Streptococcus.
41
State treatment of meningitis caused by haemophilus influenza:
1. Cefotaxime (or ceftriaxone)
42
State treatment of meningitis caused by listeria:
1. Amoxicillin (or ampicillin) + gentamicin
2. Co-trimoxazole
## Footnote
Meningitis is inflammation of the lining around your brain and spinal cord. It can be very serious if not treated quickly.
43
State treatment for otitis externa:
1. Analgesia for pain relief such as paracetamol or ibuprofen
2. Topical antiblotic preparation with or without a topical corticosteroid for 7-14 days
3. Quinolone such as ciprofloxacin may be needed depending on if the person is immunocompromised, severe infection or there is spread beyond the external ear canal
44
Acute otitis media:
1. Amoxicillin
2. Clarithromycin or (erythromycin preferred if pregnant)
3. Co-amoxiclav for 2nd line
## Footnote
Ear infections are infections that affect the inner, middle or outer ear.
The main symptoms of an ear infection include an earache, difficulty hearing and a feeling of pressure or fullness in your ear.
45
State treatment of scarlet fever:
1. Phenoxymethylpenicillin (if allergic to penicillin then doxycycline but not in under 12s, clarithromycin or erythromycin)
2. Co-amoxiclav
46
State treatment for bacterial conjunctivitis:
1. Self-limiting or give Chloramphenicol
47
State treatment of campylobacter enteritis:
1. Clarithromycin
2. Ciprofloxacin
## Footnote
Campylobacter enteritis is a type of foodborne illness caused by bacteria called Campylobacter. It primarily affects the gastrointestinal tract, causing symptoms such as diarrhea (often bloody), abdominal pain, fever, nausea, and vomiting. It is typically contracted by consuming contaminated food or water, particularly undercooked poultry, unpasteurized milk, or contaminated produce. Though usually not life-threatening, severe cases may require medical treatment, especially in vulnerable populations such as young children, elderly individuals, or those with weakened immune systems.
48
State treatment of typhoid fever:
1. Cefotaxime (or ceftriaxone)
49
State treatment of C.difficile:
1. Vancomycin 125 mg qds for first episode of mild-moderate-severe c.difficile infection
2. Fidaxomicin 200 mg bd for 10 days
50
State treatment of cellulitis:
1. flucloxacillin
2. Clarithromycin/erythromycin
3. Doxycycline (adults only)
51
if the infection is near eyes or nose:
4. Co-amoxiclav
52
State treatment of mild diabetic foot infection:
1. Flucloxacillin
2. Clarithromycin/erythromycin or Doxycycline
53
State treatment of moderate or severe diabetic foot infection:
1. Flucloxacillin with or without IV gentamicin and/or metronidazole or co-amoxiclav with or without IV gentamicin or IX ceftriaxone with metronidazole
2. Co-trimoxazole with or without IV gentamicin and/or metronidazole
54
State treatment of acne vulgaris:
1. Topical adapalene with topical benzoyl peroxide
2. Fixed combination of topical tretinoin with topical clindamycin
3. Fixed combination of topical adapalene with topical benzoyl peroxide and either oral lymecycline or oral doxycycline
55
State treatment of bacterial vaginosis:
1. Single 2g dose of metronidazole or an intravaginal preparation was used previously then prescribe metronidazole 400mg bd for 7 days
56
State treatment of acute vaginal candidiasis (thrush):
1. Oral fluconazole or itraconazole or with an intravaginal imidazole pessary or cream (e.g., clotrimazole or econoazole nitrate)
Note: in pregnancy treatment is intravaginal application of an imidazole such as clotrimazole
57
State treatment if recurrent vulvovaginal candidiasis:
1. Oral fluconazole induction regimen, followed immediately by a maintenance regiment for 6 months
2. Intravaginal imidazole
58
State treatment of genital herpes simplex virus:
1. Acyclovir
2. Famiclovir/valaciclovir
59
State treatment of chlamydia:
| men + non- preg w
1. Doxycycline
2. Azithromycin
3. Erythromycin
4. Ofloxacin
60
State treatment of chlamydia if patient is pregnant
azithromycin/erythromycin/amoxicillin
61
State treatment of gonorrhea:
**Ceftriaxone** if antimicrobial susceptibility is unknown
Micro-organism is sensitive to ciprofloxacin
Alternatives:
- **Gentamicin plus Azithromycin**
62
State treatment of trichomoniasis:
1. Metronidazole 400mg-500mg BD
or metronidazole 2g as single oral dose
## Footnote
a common sexually transmitted infection caused by a parasite.
63
State treatment of Pelvic inflammatory disease:
Contact tracing recommended
1. Doxycycline + metronidazole + single dose of IM ceftriaxone or ofloxacin + metronidazole
## Footnote
contact tracing is the process of identifying persons who may have been exposed to an infected person
Pelvic inflammatory disease is an infection of a woman's reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID.
64
State treatment of early syphilis:
1. Benzathine benzylpenicillin
2. Doxycycline or erythromycin
65
State treatment of osteomyelitis:
1. Flucloxacillin (consider adding fusidic acid or rifampicin for initial 2 weeks)
2. Clindamycin If penicillin allergic (consider adding fusidic acid or rifampicin for initial 2 weeks)
3. Vancomycin or teicoplanin If MRSA suspected (consider adding fusidic acid or rifampicin for initial 2 weeks)
## Footnote
inflammation of bone or bone marrow, usually due to infection.
66
State treatment of septic arthritis:
1. Flucloxacilin
2. Clindamycin if penicillin allergic
3. Vancomycin if MRSA suspected
4. Cefotaxime or ceftriaxone if gonococcal arthritis suspected
67
State treatment of localised non-bullous impetigo:
1. Hydrogen peroxide 1%
2. Fusidic acid 2% cream
3. Topical mupirocin if MRSA present
68
what does Myasthenia gravis do?
impair neuromuscular transmission
69
State common side effects of aminoglycosides:
Tinnitus
skin reactions
hypomagnesaemia
OTOTOXCITY
NEPHROTOXICITY
70
If aminoglycosides are used in 2nd and 3rd trimester, what risk does this impose on the infant?
Risk of auditory or vestibular nerve damage
71
Which aminoglycoside has highest risk of auditory/vestibular nerve damage:
Streptomycin
72
What do you measure before and after initial dose of tobramycin:
Lung function
73
State which carbapenem has to be given with cilasatin as a dual treatment:
Imipenem
## Footnote
Imipenem and cilastatin injection is used to treat certain serious infections that are caused by bacteria
Imipenem is in a class of medications called carbapenem antibiotics. It works by killing bacteria. Cilastatin is in a class of medications called dehydropeptidase inhibitors. It works by helping imipenem stay active in your body for a longer period of time.
74
State which carbanem has less seizure-inducing potential:
Meropenem
75
State which cephalosporins are useful for infections of the CNS - meningitis:
cefotaxime / ceftriaxone
76
What class is vancomycin:
Glycopeptide
77
Which antibiotic can cause red man syndrome/thrombophlebitis:
Vancomycin
78
State pre-dose trough for serum vancomycin:
10-20 mg
79
State monitoring requirements for vancomycin:
Monitor auditory function
Monitor full blood count, hepatic and
Monitor vestibular
80
State when to stop taking clindamycin (lincosamide):
Diarrhoea - stop and report to GP
81
Which macrolide is used for toxoplasmosis:
Spiramycin
82
What can macrolides cause:
QT prolongation - avoid with other drugs causing QT prolongation
83
What is the activity of metronidazole- what is active against :
Against anaerobic bacteria and protozoa
84
Which macrolide is safe in pregnancy:
Erythromycin
85
State treatment of tetanus:
Metronidazole or benzylpenicillin
86
State treatment of shigellosis:
Ciprofloxacin or azithromycin
87
State treatment of pneumocytis jiroveci poneumonia:
Co-trimoxazole
88
State treatment of gonorrhea:
IV ceftriaxone
89
State treatment of salmonella (non-typhoid):
Ciprofloxacin
90
State treatment of dental abscess:
Amoxicillin
91
State side effect of tetracyclines:
Intracranial hypertension
92
State treatment of Q fever:
Doxycycline
93
State treatment of cytomegalovirus retinitis:
IV ganciclov
94
State treatment of erysipelas:
Flucloxacillin
95
What can sulphonamides cause:
Steven-Johnson syndrome
96
State some common side effects of macrolides:
QT interval prolongation, diarrhea, taste altered, tinnitus, vertigo, skin reactions
97
State treatment of tetanus:
Metronidazole
98
State treatment of early and late syphilis:
Benzathine benzylpenicillin
99
Which antibiotics are maculopapular rashes common in:
Ampicillin / amoxicillin
100
How do penicillin's work:
Interfere with bacterial cell wall synthesis
101
State side effects of penicillin's:
Diarrhoea
nausea
skin reactions
vomiting
antibiotic associated colitis
102
What is common in men and over aged of 65:
Cholestatic jaundice
103
Which antibiotic has a common side effect of jarisch-herheimer reaction:
Benzylpenicillin
104
what is amoxicillin dose: 1 month to 11 months
125 mg TDS
105
what is the amoxicillin dose: 1 to 4
250 mg TDS
106
what is the amoxicillin dose: 5 to 11
500 mg TDS
107
what is the amoxicillin dose 12+ and adults
500 mg TDS
108
Which antibiotic can increase risk of infection/cholestatic jaundice:
Co-amoxiclav
109
What can quinolones induce:
Convulsions in patients with or without a history of convulsions
taking NSAIDs at the same time as them may also induce convulsions
110
who are quinolones contraindicated in?
in patients with tendon damage
Patients over 60+
## Footnote
Risk of tendon damage is increased by concomitant use of corticosteroids
111
what should be done if tendinitis suspected in pt taking quinolone?
quinolone should be discontinued immediately
112
State MHRA side effects for quinolones and when to stop treatment:
Tendinitis
113
What are symptoms of tendinitis?
Tendon damage
Muscle pain and weakness
Joint pain
peripheral neuropathy
CNS effects
114
Why are quinolones contraindicated in children:
Joint inflammation - arthropathy
115
State some cautions of quinolones:
Diabetes
Prolong QT interval prolongation
Exposure to excessive sunlight should be avoided
116
What is co-trimoxazole:
Sulfamethoxazole and trimethoprim
117
State treatment of pneumocystis jrovecii:
Co-trimoxazole
118
Which tetracycline has an increased risk of lupus-erythematosus like syndrome and causes irreversible pigmentation:
Minocycline
119
State one caution for tetracyclines:
Myasthenia gravis / systemic lupus erythematosus
120
State common side effects of tetracyclines:
Diarrhea
angioedema
tooth discolouration
photosensitivity reactions
skin reactions
headaches and visual disturbances (may indicate benign intracranial hypertension- discontinue)
## Footnote
angiodema= where a part of the body suddenly becomes swollen
Intracranial hypertension (IH) is a build-up of pressure around the brain.
121
State treatment dose of doxycycline for prophylaxis of malaria:
100 mg once daily, to be started 1-2 days before entering endemic area
and continues for 4 weeks after leaving
122
Which tetracycline can cause tongue discolouration:
Minocycline
123
State a side effect of chloramphenicol if used in 3rd trimester:
Gray baby syndrome
124
State a side effect of vancomycin:
Red-man syndrome
125
How long should topical fusidic acid cream be used for:
No longer than 10 days
126
State a CHM important safety information for the drug linezolid (oxazolidinone):
Severe optic neuropathy if used longer than 28 days
(Report symptoms of visual impairment, blurred vision, visual field defect, acuity)
127
State which conditions linezolid should be avoided in:
Uncontrolled hypertension
Carcinoid tumour
Bipolar depression
Schizophrenia
Thyrotoxicosis
128
State monitoring requirements for linezolid:
FBC including platelet count weekly
129
State contraception advice for patient taking tedizolid:
Effective contraception in women recommended
Additional method of contraception advised in women taking hormonal contraceptives - effectiveness reduced
130
State pregnancy advice for patient wanting to take trimethoprim:
Teratogenic in first trimester
Manufacturer advised to avoid in pregnancy
131
State a patient/ carer advice for patient taking trimethoprim:
Blood disorder
so recognise symptoms of sore throat, fever, rash, ulcer, bleeding, bruising, purpura develop
132
State contraception advice for patients taking rifabutin:
Rifabutin induces hepatic enzymes and effectiveness of hormonal contraceptives is reduced
133
State the treatment of multibacillary leprosy:
Combination of rifampicin, dapsone and clofazimine for at-least 2 years
134
State treatment of paucibacillary leprosy:
Rifampicin and dapsone for 6 months
135
What are rhe side effects of clofazimine?
Discolour soft contact lenses
Hair colour changes (reversible)
May alter colour of breast milk
Skin discolouration of infant
## Footnote
Clofazimine is a medication that treats leprosy.
136
State patient carer advice with dapsone:
bruising, bleeding
Rash with fever + eosinophilia = discontinue immediately
137
State treatment of Lyme disease (tick bite):
1. Doxycycline
2. Amoxicillin
3. Azithromycin
Note: above treatment is in patients presenting with erythema migrans rash with our without non-focal symptoms
Note: in patients presenting with focal symptoms of cranial nerve or peripheral nervous involvement, doxycycline should be used
Note: in patients presenting with symptoms of central nervous system involvement, IV ceftriaxone is recommended
138
State treatment of TB - tuberculosis:
***Initial treatment for 2 months:***
**Rifampicin** (hepatically excreted)
**Isoniazid** (with pyridoxine hcl) (hepatically excreted)
**Pyrazinamide** (hepatically excreted)
**Ethambutol** (renally excreted)
**AND**:
Continuation treatment for ***four*** months:
**Rifampicin**
**Isoniazid**
139
what should isoniazid be given wiith in the treatment of TB?
with pyridoxine hcl
(to prevent the development of peripheral neuropathy)
140
How long should unsupervised treatment of TB be taken for:
6 months i.e. in pregnancy and breastfeeding
## Footnote
The unsupervised treatment regimen is for individuals who are likely to take antituberculosis drugs reliably and willingly without supervision
141
State which conditions rifampicin is contraindicated in:
Acute porphyria's and jaundice
142
State common side effects of rifampicin:
Nausea
vomiting
sweat discolouration
tears discolouration
urine red
sputum discolouration
AKI
143
State monitoring requirements for patients taking rifampicin:
Renal
Hepatic
FBCs
144
State patient carer advice for those taking rifampicin:
Rifampicin discolours soft contact lenses
Recognise signs of liver disorder: vomiting, nausea, malaise, jaundice
145
State side effect of bedaquiline:
QT interval prolongation
146
State side effects of cycloserine:
CNS toxicity = severe = discontinue
Rashes or allergic dermatitis = severe = discontinue
147
State patient carer advice for ethambutol:
Discontinue if visual impairment occurs
Not to be used in patients under 5 years old - caution
148
Which bacteria is common in UTI:
E.coli
149
Which bacteria is common in sexually active young women:
Staph saprophyticus
150
State a MHRA alert on nitrofurantoin:
Reminder of risks of pulmonary and hepatic adverse drug reactions:
* Increase vigilance for acute pulmonary reactions in first week of treatment
* Closely monitor patients on long term therapy or worsening respiratory symptoms, especially if elderly
* Be vigilant for signs and symptoms of hepatic dysfunction
151
State treatment of acute prostatitis:
1. Ciprofloxacin or ofloxacin or trimethoprim
2. Levofloxacin or co-trimoxazole
152
Which antifungal prescribes puts patients at an increased risk of heart failure:
Itraconazole
Also
Patients advises on liver disorder: dark urine, abdominal pain, nausea, vomiting, fatigue
153
What is the patient carer advice for the antifungal: voriconazole
patients should avoid intense or prolonged exposure to direct sunlight, and to avoid use of sunbeds.
Patients should cover sun-exposes areas of skin and use sunscreen with high protection:
154
State important contraception advice for patients taking griseofulvin:
Effective contraception during treatment and 1 month after treatment for women
Men should avoid fathering a child during treatment and for at least 6 months after administration
155
What is pneumonia caused by
Pneumocystis jirovecci
156
State treatment of threadworms OTC
Under 6 months and pregnant/BF women = hygiene measures alone for 6 months
Over 2 and adults - sell mebendazole and can take 2nd dose after 2 weeks
157
State treatment of acute uncomplicated .falciparum malaria:
1. Arterieter with lumenfantrine
2. Artenimol with piperaquine phosphate
## Footnote
Uncomplicated malaria is where the person has symptomatic infection with malaria parasites, but no signs of vital organ disturbance.
Uncomplicated malaria can progress to severe malaria, become chronic, or resolve, depending on host immunity and prompt access to appropriate treatment.
Plasmodium falciparum is a unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that causes malaria in humans.
158
State treatment of severe or complicated falciparum malaria:
IV artesunate
## Footnote
Plasmodium falciparum is a unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that causes malaria in humans.
159
What is chloroquine used for:
Chloroquine + proguanil = prophylaxis of malaria in areas where there is little
resistance
160
what is chloroquine and proguanil used to treat?
prophylaxis of malaria in areas where there is little
resistance
161
State use of doxycycline in adults and children over 12:
Prophylaxis of malaria and used in areas of widespread mefloquine or chloroquine resistance
162
What drug is used to eliminate the liver stages of p. vivax or p.ovale following chloroquine treatment:
Primaquine
163
State doxycycline use and specific counselling for prophylaxis of malaria:
For malaria:
Take 1-2 days before entering the endemic area and continue for 4 weeks after leaving
General counselling advice:
Protect skin from sunlight - even on a bright but cloudy day
Do not take indigestion remedies, or medicines containing iron, zinc 2 hours before or after you take this medicine
Capsules should be swallowed whole with plenty of fluid during meals while sitting or standing
164
how should we counsel patients taking doxycyline?
Protect skin from sunlight - even on a bright but cloudy day
Do not take indigestion remedies, or medicines containing iron, zinc 2 hours before or after you take this medicine
Capsules should be swallowed whole with plenty of fluid during meals while sitting or standing
165
How can patients protect themselves against malaria bites (apart from meds)?
Mosquito nets impregnated with permethrin (most effective)
Mats and vapourised insecticides
DEET solution 20-50% in adults and children over 2 months
166
Can DEET be used by pregnant and breastfeeding ?
Yes
but breastfeeding moms should wash hands and breast tissue after
167
Should suncreen be applied before DEET solution (malaria)?
Yes
168
What sunscreen SPF should be used if pt using DEET (malaria)?
Sunscreen SPF 30-50
169
In the prophylaxis of malaria how should the following antimalarial be given: Atovaquone with proguanil(Malarone)
1-2 days before entering endemic and 1 week after
170
In the prophylaxis of malaria how should the following antimalarial be given:Chloroquine / proguanil
1 week before
171
In the prophylaxis of malaria how should the following antimalarial be given: Mefloquine
2-3 weeks before
172
What is the longest time the following antimalarial can be given for malaria prophylaxis: doxycyline
up to 2 years
173
What is the longest time the following antimalarial can be given for malaria prophylaxis: chloroquine+ proguanil
up to 5 years
174
What is the longest time the following antimalarial can be given for malaria prophylaxis :Mefloquine / malarone
up to 1 year
175
What do you check for when patient is mefloquine or chloroquine:
Contra-indicated in patients with history of seizures
Both chloroquine and mefloquine are unsuitable for malaria prophylaxis in individuals with a history of epilepsy.
In these patients, doxycycline or atovaquone with proguanil hydrochloride may be used.
176
Which antimalarial safe in pregnancy:
Chloroquine / proguanil ( Folic acid 5 mg given with proguanil)
Mefloquine can be used in first trimester if benefit outweighs the risk
177
Why is folic acid given with proguanil in pregnant women?
Proguanil works by blocking folic acid production in the malaria parasite.
There is therefore a theoretical concern that proguanil could reduce a woman's folic acid levels.
In pregnancy, folic acid is needed for the normal formation of a baby's spine and skull.
178
Which antimalarials do you avoid in renal impairment:
Avoid proguanil
Avoid malarone (proguanil with atovoquanone) and chloroquine if egfr is less than 30
179
A patient has EGFR less than 30, what antimalarials should they avoid?
malarone
chloroquine
180
What two drugs make up malarone?
proguanil with atovoquanone
181
what are normal egfr values?
A normal eGFR is greater than 90, but values as low as 60 are considered normal if there is no other evidence of kidney disease
## Footnote
e. eGFR is often shown as a percentage of normal because people find it useful to think of kidney function as a percentage, going from 100% (fully functioning) to 0% (no function).
182
what egfr shows kidneys not working properly?
What is a concerning eGFR level?
eGFR of 60 -89 may mean early-stage kidney disease.
eGFR of 15 -59 may mean kidney disease
eGFR below 15 may mean kidney failure.
183
What advice do you give to patients on warfarin + taking antimalarials:
Begin prophylaxis 2-3 weeks before
AND INR should be stable before departure
Monitor INR before, 7 days after starting and after treatment
184
Which group of patients are at a severe risk of contracting malaria:
Asplenia / severe splenic dysfunction
## Footnote
Asplenia means the absence of a spleen
the spleen plays a crucial role in clearing infected red blood cells, producing antibodies, and activating the immune response against the malaria parasite. Without a spleen, individuals have a weakened immune system and reduced ability to fight off the infection, making them more susceptible to severe malaria.
185
What is falciparum malaria caused by:
the protozoa: Plasmodium falciparum
(most deadly kind of malaria)
186
What are contraindications for chloroqiuine?
Diabetes (may cause hypo)
May lower seizure threshold
Myasthenia gravis
## Footnote
due to its potential to cause hypoglycemia (low blood sugar levels)
187
State some side effect of chloroquine:
Ocular toxicity
OT interval prolongation
Chloroquine very toxic in overdose as can cause arrythmias and convulsions
188
What can chloroquine overdose cause?
chloroquine is very toxic in overdose
can cause arrhythmias and convulsions
189
State contraindications for mefloquine:
History of psychiatric disorders
depression
convulsions
190
State important patient carer advice for patients taking mefloquine:
Stop and seek immediate help, if neuropsychiatric symptoms occur such as
depression / suicidal thoughts, insomnia, nightmares, abnormal dreams, anxiety, suicide, confusion
191
Why can the symptoms of mefloquine stay for several months?
because it has a very long half- life
192
state some MHRA warnings with quinine?
Dose-dependent QT interval prolongation
193
Which 2 drugs are licensed for post-exposure prophylaxis of influenza:
Oseltamivir and zanamivir
(Oseltamivir should be given within 48 hours Zanamivir should be given within 36 hours)
Zamanivir should be reserved for patients who are severely immunocompromised
194
for post-exposure prophylaxis of influenza: how soon should olseltavmavir be given?
within 48 hours
195
for post-exposure prophylaxis of influenza: how soon should zamanavir be given?
within 36 hours
Zamanivir should be reserved for patients who are severely immunocompromised
196
State treatment of Covid-19:
Dexamethasone should be offered to patients with Covid-19 who need supplemental oxygen
Hydrocortisone or prednisolone
197
State treatment of Covid-19 for patients hospitalised or for symptomatic patients who are at a high risk of progression to severe disease:
* Remdesivir, molnupiravir or nirmatrelvir with ritonavir
* Sotrovimab
* Tocilizumab
* Baricitinib
198
In the prophylaxis of malaria how should the following antimalarial be given:Doxycycline
1-2 days before entering endemic and 4 weeks after
199
State which of the following is most characteristically associated with amphotericin B
Flu-like symptoms
hypomagnesaemia
hypokalaemia
200
State treatment of late latent syphilis:
1. Benzathine benzylpenicillin
2. doxycycline
## Footnote
a period when there are no visible signs or symptoms of syphilis
a type of sexually transmitted infection.
201
how are pseudmonas aeruginosa infections treated?
gentamicin
