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1
Q

State the antibiotics safe in pregnacy

A

penicillins
cephalosporins (cefalexin)

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2
Q

Which antibiotics are contraindicated in children?

A

Quinolones (avoid as can arthropathy, tissue, cartillage damge)
and if under 12: Tetracyclines

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3
Q

Which antibiotic has increased risk of clostridium difficile?

A

clindamycin

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4
Q

which antibiotics can cause nephrotoxicity?

A

aminoglycosides
vancomycin (glycopeptide)

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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)

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6
Q

Which antibotics should be avoided in hepatotoxicity?

A

rifampicin
tetracyclines

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7
Q

which antibiotics can cause cholestatic jaundice?

A

Co-amoxiclav
flucloxacillin

Note: report diarrhea to GP as treatment may need changing

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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

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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

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10
Q

state treatment of meningococoal septicemia (2)

A
  1. Benzylpenicillin or cefotaxime/ ceftriaxone
  2. Chloramphenicol
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11
Q

state the treatment of septicemia related to vascular cather

A

Vancomycin or teicoplanin

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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

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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

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14
Q

State the common causative agents:

A

Staphylococci
MRSA
Anaerobic
Pseudomonas aeruginosa
Haemflu influenzae

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15
Q

how are staphylococci infections treated?

A

flucloxacillin

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16
Q

how are MRSA infections treated?

A

vancomycin?

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17
Q

how are anaerobic infections treated?

A

metronidazole

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18
Q

how are haemflu influenzae infections treated?

A

amoxicillin?

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19
Q

State the treatment/ prevention of Rheumatic fever

A

Phenoxymethylpenicillin

OR sulfadiazine

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20
Q

State treatment of lower UTI in men

A

Trimethoprim or nitrofurantoin (avoid if egfr less than 45 ml/min)

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21
Q

State treatment of lower UTI in children?

A
  1. Trimethoprim or nitrofurantoin (avoid if egfr less than 45ml/min
  2. Nitrofurantoin
  3. Amoxicillin or cefalexin
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22
Q

State treatment of lower UTI in non-pregnant women

A
  1. Nitrofurantoin (avoid if egfr less than 45ml/min) or trimethoprim if low risk of resistance
  2. Pivmecillinam
  3. Fosfomcin
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23
Q

State treatment of lower UTI in pregnant women

A
  1. Nitrofurantoin (avoid if egfr less than 45ml/min) but AVOID AT TERM!
  2. Amoxicillin
  3. Cefalexin

Avoid trimethoprim as it is teratogenic in first trimester. Manufacturers advise avoid during pregnancy!

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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.

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25
Q

State treatment of acute pyelonephritis in pregnant women?

A

cefalexin

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26
Q

State treatment of acute cough in adults

A

Doxycycline or Clarithromycin / erythromycin or amoxicilin

(Amoxicillin or erythromycin preferred in pregnancy)

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27
Q

Which antibiotics are preferred in pregnancy for the treatment of acute cough?

A

Amoxicillin
Erythromycin

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28
Q

How is acute cough treated in children?

A
  1. Amoxicillin
  2. Clarithromycin/erythromycin
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29
Q

State treatment for acute sore throat:

A
  1. Phenoxymethylpenicillin
  2. Clarithomycin/erythromycin
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30
Q

State the treatment of invasive Group A streptococcal infection, prevention of secondary case:

A
  1. Phenoxymethlypenicilin
  2. Erythromycin
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31
Q

State the treatment of meningococcal meningitis, prevention of secondary cases:

A

. Ciprofloxacin
OR rifampicin
OR IM ceftriaxone

Secondary prevention: Systematically detecting the early stages of disease and intervening before full symptoms develop

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32
Q

State the treatment of haemophilius influenza type b disease, prevention of secondary cases:

A
  1. Rifampicin
  2. IV Ceftriaxone
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33
Q

State the treatment of diptheria in non-immune patients, prevention of secondary cases:

A

Erythromycin

or another macrolide (azithromycin, clarithromycin)

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

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34
Q

State the treatment of pertussis, antibacterial prophylaxis

A

Clarithromycin (or azithromycin / erythromycin)

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.

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35
Q

State the treatment of pneumococcal infection in asplenia or patients with sickle cell disease:

A
  1. Phenoxymethylpenicillin
  2. Erythromycin
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36
Q

State the treatment of animal cat and dog bites prophylaxis in adults:

A
  1. Co-amoxiclav 3-day course
  2. Metronidazole + Doxycycline 3-day course
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37
Q

State the treatment of animal cat and dog bites that is infected in adults:

A
  1. Co-amoxiclav for 5 days
  2. Metronidazole + Doxycycline 5-day course
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38
Q

State the treatment of animal cat and dog bites that is infected in children:

A
  1. Co-amoxiclav
  2. Co-trimoxazole if allergic to penicillin under 12 years of age
  3. Doxycycline + metronidazole aged 12-17
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39
Q

State the treatment of animal scratch from dog/cat:

A

Flucloxacillin

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40
Q

State treatment of meningitis caused by pneumococci:

A
  1. Cefotaxime (or ceftriaxone)

Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, spherical bacteria, alpha-hemolytic member of the genus Streptococcus.

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41
Q

State treatment of meningitis caused by haemophilus influenza:

A
  1. Cefotaxime (or ceftriaxone)
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42
Q

State treatment of meningitis caused by listeria:

A
  1. Amoxicillin (or ampicillin) + gentamicin
  2. Co-trimoxazole

Meningitis is inflammation of the lining around your brain and spinal cord. It can be very serious if not treated quickly.

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43
Q

State treatment for otitis externa:

A
  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
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44
Q

Acute otitis media:

A
  1. Amoxicillin
  2. Clarithromycin or (erythromycin preferred if pregnant)
  3. Co-amoxiclav for 2nd line

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.

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45
Q

State treatment of scarlet fever:

A
  1. Phenoxymethylpenicillin (if allergic to penicillin then doxycycline but not in under 12s, clarithromycin or erythromycin)
  2. Co-amoxiclav
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46
Q

State treatment for bacterial conjunctivitis:

A
  1. Self-limiting or give Chloramphenicol
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47
Q

State treatment of campylobacter enteritis:

A
  1. Clarithromycin
  2. Ciprofloxacin

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.

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48
Q

State treatment of typhoid fever:

A
  1. Cefotaxime (or ceftriaxone)
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49
Q

State treatment of C.difficile:

A
  1. Vancomycin 125 mg qds for first episode of mild-moderate-severe c.difficile infection
  2. Fidaxomicin 200 mg bd for 10 days
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50
Q

State treatment of cellulitis:

A
  1. flucloxacillin
  2. Clarithromycin/erythromycin
  3. Doxycycline (adults only)
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51
Q

if the infection is near eyes or nose:

A
  1. Co-amoxiclav
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52
Q

State treatment of mild diabetic foot infection:

A
  1. Flucloxacillin
  2. Clarithromycin/erythromycin or Doxycycline
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53
Q

State treatment of moderate or severe diabetic foot infection:

A
  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
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54
Q

State treatment of acne vulgaris:

A
  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
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55
Q

State treatment of bacterial vaginosis:

A
  1. Single 2g dose of metronidazole or an intravaginal preparation was used previously then prescribe metronidazole 400mg bd for 7 days
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56
Q

State treatment of acute vaginal candidiasis (thrush):

A
  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
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57
Q

State treatment if recurrent vulvovaginal candidiasis:

A
  1. Oral fluconazole induction regimen, followed immediately by a maintenance regiment for 6 months
  2. Intravaginal imidazole
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58
Q

State treatment of genital herpes simplex virus:

A
  1. Acyclovir
  2. Famiclovir/valaciclovir
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59
Q

State treatment of chlamydia:

men + non- preg w

A
  1. Doxycycline
  2. Azithromycin
  3. Erythromycin
  4. Ofloxacin
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60
Q

State treatment of chlamydia if patient is pregnant

A

azithromycin/erythromycin/amoxicillin

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61
Q

State treatment of gonorrhea:

A

Ceftriaxone if antimicrobial susceptibility is unknown

Micro-organism is sensitive to ciprofloxacin

Alternatives:
- Gentamicin plus Azithromycin

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62
Q

State treatment of trichomoniasis:

A
  1. Metronidazole 400mg-500mg BD

or metronidazole 2g as single oral dose

a common sexually transmitted infection caused by a parasite.

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63
Q

State treatment of Pelvic inflammatory disease:

A

Contact tracing recommended

  1. Doxycycline + metronidazole + single dose of IM ceftriaxone or ofloxacin + metronidazole

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.

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64
Q

State treatment of early syphilis:

A
  1. Benzathine benzylpenicillin
  2. Doxycycline or erythromycin
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65
Q

State treatment of osteomyelitis:

A
  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)

inflammation of bone or bone marrow, usually due to infection.

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66
Q

State treatment of septic arthritis:

A
  1. Flucloxacilin
  2. Clindamycin if penicillin allergic
  3. Vancomycin if MRSA suspected
  4. Cefotaxime or ceftriaxone if gonococcal arthritis suspected
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67
Q

State treatment of localised non-bullous impetigo:

A
  1. Hydrogen peroxide 1%
  2. Fusidic acid 2% cream
  3. Topical mupirocin if MRSA present
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68
Q

what does Myasthenia gravis do?

A

impair neuromuscular transmission

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69
Q

State common side effects of aminoglycosides:

A

Tinnitus
skin reactions
hypomagnesaemia
OTOTOXCITY
NEPHROTOXICITY

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70
Q

If aminoglycosides are used in 2nd and 3rd trimester, what risk does this impose on the infant?

A

Risk of auditory or vestibular nerve damage

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71
Q

Which aminoglycoside has highest risk of auditory/vestibular nerve damage:

A

Streptomycin

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72
Q

What do you measure before and after initial dose of tobramycin:

A

Lung function

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73
Q

State which carbapenem has to be given with cilasatin as a dual treatment:

A

Imipenem

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.

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74
Q

State which carbanem has less seizure-inducing potential:

A

Meropenem

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75
Q

State which cephalosporins are useful for infections of the CNS - meningitis:

A

cefotaxime / ceftriaxone

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76
Q

What class is vancomycin:

A

Glycopeptide

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77
Q

Which antibiotic can cause red man syndrome/thrombophlebitis:

A

Vancomycin

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78
Q

State pre-dose trough for serum vancomycin:

A

10-20 mg

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79
Q

State monitoring requirements for vancomycin:

A

Monitor auditory function

Monitor full blood count, hepatic and

Monitor vestibular

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80
Q

State when to stop taking clindamycin (lincosamide):

A

Diarrhoea - stop and report to GP

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81
Q

Which macrolide is used for toxoplasmosis:

A

Spiramycin

82
Q

What can macrolides cause:

A

QT prolongation - avoid with other drugs causing QT prolongation

83
Q

What is the activity of metronidazole- what is active against :

A

Against anaerobic bacteria and protozoa

84
Q

Which macrolide is safe in pregnancy:

A

Erythromycin

85
Q

State treatment of tetanus:

A

Metronidazole or benzylpenicillin

86
Q

State treatment of shigellosis:

A

Ciprofloxacin or azithromycin

87
Q

State treatment of pneumocytis jiroveci poneumonia:

A

Co-trimoxazole

88
Q

State treatment of gonorrhea:

A

IV ceftriaxone

89
Q

State treatment of salmonella (non-typhoid):

A

Ciprofloxacin

90
Q

State treatment of dental abscess:

A

Amoxicillin

91
Q

State side effect of tetracyclines:

A

Intracranial hypertension

92
Q

State treatment of Q fever:

A

Doxycycline

93
Q

State treatment of cytomegalovirus retinitis:

A

IV ganciclov

94
Q

State treatment of erysipelas:

A

Flucloxacillin

95
Q

What can sulphonamides cause:

A

Steven-Johnson syndrome

96
Q

State some common side effects of macrolides:

A

QT interval prolongation, diarrhea, taste altered, tinnitus, vertigo, skin reactions

97
Q

State treatment of tetanus:

A

Metronidazole

98
Q

State treatment of early and late syphilis:

A

Benzathine benzylpenicillin

99
Q

Which antibiotics are maculopapular rashes common in:

A

Ampicillin / amoxicillin

100
Q

How do penicillin’s work:

A

Interfere with bacterial cell wall synthesis

101
Q

State side effects of penicillin’s:

A

Diarrhoea
nausea
skin reactions
vomiting
antibiotic associated colitis

102
Q

What is common in men and over aged of 65:

A

Cholestatic jaundice

103
Q

Which antibiotic has a common side effect of jarisch-herheimer reaction:

A

Benzylpenicillin

104
Q

what is amoxicillin dose: 1 month to 11 months

A

125 mg TDS

105
Q

what is the amoxicillin dose: 1 to 4

A

250 mg TDS

106
Q

what is the amoxicillin dose: 5 to 11

A

500 mg TDS

107
Q

what is the amoxicillin dose 12+ and adults

A

500 mg TDS

108
Q

Which antibiotic can increase risk of infection/cholestatic jaundice:

A

Co-amoxiclav

109
Q

What can quinolones induce:

A

Convulsions in patients with or without a history of convulsions

taking NSAIDs at the same time as them may also induce convulsions

110
Q

who are quinolones contraindicated in?

A

in patients with tendon damage

Patients over 60+

Risk of tendon damage is increased by concomitant use of corticosteroids

111
Q

what should be done if tendinitis suspected in pt taking quinolone?

A

quinolone should be discontinued immediately

112
Q

State MHRA side effects for quinolones and when to stop treatment:

A

Tendinitis

113
Q

What are symptoms of tendinitis?

A

Tendon damage
Muscle pain and weakness
Joint pain
peripheral neuropathy
CNS effects

114
Q

Why are quinolones contraindicated in children:

A

Joint inflammation - arthropathy

115
Q

State some cautions of quinolones:

A

Diabetes
Prolong QT interval prolongation
Exposure to excessive sunlight should be avoided

116
Q

What is co-trimoxazole:

A

Sulfamethoxazole and trimethoprim

117
Q

State treatment of pneumocystis jrovecii:

A

Co-trimoxazole

118
Q

Which tetracycline has an increased risk of lupus-erythematosus like syndrome and causes irreversible pigmentation:

A

Minocycline

119
Q

State one caution for tetracyclines:

A

Myasthenia gravis / systemic lupus erythematosus

120
Q

State common side effects of tetracyclines:

A

Diarrhea
angioedema
tooth discolouration
photosensitivity reactions
skin reactions
headaches and visual disturbances (may indicate benign intracranial hypertension- discontinue)

angiodema= where a part of the body suddenly becomes swollen

Intracranial hypertension (IH) is a build-up of pressure around the brain.

121
Q

State treatment dose of doxycycline for prophylaxis of malaria:

A

100 mg once daily, to be started 1-2 days before entering endemic area

and continues for 4 weeks after leaving

122
Q

Which tetracycline can cause tongue discolouration:

A

Minocycline

123
Q

State a side effect of chloramphenicol if used in 3rd trimester:

A

Gray baby syndrome

124
Q

State a side effect of vancomycin:

A

Red-man syndrome

125
Q

How long should topical fusidic acid cream be used for:

A

No longer than 10 days

126
Q

State a CHM important safety information for the drug linezolid (oxazolidinone):

A

Severe optic neuropathy if used longer than 28 days

(Report symptoms of visual impairment, blurred vision, visual field defect, acuity)

127
Q

State which conditions linezolid should be avoided in:

A

Uncontrolled hypertension
Carcinoid tumour
Bipolar depression
Schizophrenia
Thyrotoxicosis

128
Q

State monitoring requirements for linezolid:

A

FBC including platelet count weekly

129
Q

State contraception advice for patient taking tedizolid:

A

Effective contraception in women recommended

Additional method of contraception advised in women taking hormonal contraceptives - effectiveness reduced

130
Q

State pregnancy advice for patient wanting to take trimethoprim:

A

Teratogenic in first trimester
Manufacturer advised to avoid in pregnancy

131
Q

State a patient/ carer advice for patient taking trimethoprim:

A

Blood disorder

so recognise symptoms of sore throat, fever, rash, ulcer, bleeding, bruising, purpura develop

132
Q

State contraception advice for patients taking rifabutin:

A

Rifabutin induces hepatic enzymes and effectiveness of hormonal contraceptives is reduced

133
Q

State the treatment of multibacillary leprosy:

A

Combination of rifampicin, dapsone and clofazimine for at-least 2 years

134
Q

State treatment of paucibacillary leprosy:

A

Rifampicin and dapsone for 6 months

135
Q

What are rhe side effects of clofazimine?

A

Discolour soft contact lenses
Hair colour changes (reversible)
May alter colour of breast milk
Skin discolouration of infant

Clofazimine is a medication that treats leprosy.

136
Q

State patient carer advice with dapsone:

A

bruising, bleeding

Rash with fever + eosinophilia = discontinue immediately

137
Q

State treatment of Lyme disease (tick bite):

A
  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
Q

State treatment of TB - tuberculosis:

A

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
Q

what should isoniazid be given wiith in the treatment of TB?

A

with pyridoxine hcl
(to prevent the development of peripheral neuropathy)

140
Q

How long should unsupervised treatment of TB be taken for:

A

6 months i.e. in pregnancy and breastfeeding

The unsupervised treatment regimen is for individuals who are likely to take antituberculosis drugs reliably and willingly without supervision

141
Q

State which conditions rifampicin is contraindicated in:

A

Acute porphyria’s and jaundice

142
Q

State common side effects of rifampicin:

A

Nausea
vomiting
sweat discolouration
tears discolouration
urine red
sputum discolouration
AKI

143
Q

State monitoring requirements for patients taking rifampicin:

A

Renal
Hepatic
FBCs

144
Q

State patient carer advice for those taking rifampicin:

A

Rifampicin discolours soft contact lenses
Recognise signs of liver disorder: vomiting, nausea, malaise, jaundice

145
Q

State side effect of bedaquiline:

A

QT interval prolongation

146
Q

State side effects of cycloserine:

A

CNS toxicity = severe = discontinue

Rashes or allergic dermatitis = severe = discontinue

147
Q

State patient carer advice for ethambutol:

A

Discontinue if visual impairment occurs
Not to be used in patients under 5 years old - caution

148
Q

Which bacteria is common in UTI:

149
Q

Which bacteria is common in sexually active young women:

A

Staph saprophyticus

150
Q

State a MHRA alert on nitrofurantoin:

A

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
Q

State treatment of acute prostatitis:

A
  1. Ciprofloxacin or ofloxacin or trimethoprim
  2. Levofloxacin or co-trimoxazole
152
Q

Which antifungal prescribes puts patients at an increased risk of heart failure:

A

Itraconazole

Also
Patients advises on liver disorder: dark urine, abdominal pain, nausea, vomiting, fatigue

153
Q

What is the patient carer advice for the antifungal: voriconazole

A

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
Q

State important contraception advice for patients taking griseofulvin:

A

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
Q

What is pneumonia caused by

A

Pneumocystis jirovecci

156
Q

State treatment of threadworms OTC

A

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
Q

State treatment of acute uncomplicated .falciparum malaria:

A
  1. Arterieter with lumenfantrine
  2. Artenimol with piperaquine phosphate

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
Q

State treatment of severe or complicated falciparum malaria:

A

IV artesunate

Plasmodium falciparum is a unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that causes malaria in humans.

159
Q

What is chloroquine used for:

A

Chloroquine + proguanil = prophylaxis of malaria in areas where there is little
resistance

160
Q

what is chloroquine and proguanil used to treat?

A

prophylaxis of malaria in areas where there is little
resistance

161
Q

State use of doxycycline in adults and children over 12:

A

Prophylaxis of malaria and used in areas of widespread mefloquine or chloroquine resistance

162
Q

What drug is used to eliminate the liver stages of p. vivax or p.ovale following chloroquine treatment:

A

Primaquine

163
Q

State doxycycline use and specific counselling for prophylaxis of malaria:

A

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
Q

how should we counsel patients taking doxycyline?

A

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
Q

How can patients protect themselves against malaria bites (apart from meds)?

A

Mosquito nets impregnated with permethrin (most effective)

Mats and vapourised insecticides

DEET solution 20-50% in adults and children over 2 months

166
Q

Can DEET be used by pregnant and breastfeeding ?

A

Yes

but breastfeeding moms should wash hands and breast tissue after

167
Q

Should suncreen be applied before DEET solution (malaria)?

168
Q

What sunscreen SPF should be used if pt using DEET (malaria)?

A

Sunscreen SPF 30-50

169
Q

In the prophylaxis of malaria how should the following antimalarial be given: Atovaquone with proguanil(Malarone)

A

1-2 days before entering endemic and 1 week after

170
Q

In the prophylaxis of malaria how should the following antimalarial be given:Chloroquine / proguanil

A

1 week before

171
Q

In the prophylaxis of malaria how should the following antimalarial be given: Mefloquine

A

2-3 weeks before

172
Q

What is the longest time the following antimalarial can be given for malaria prophylaxis: doxycyline

A

up to 2 years

173
Q

What is the longest time the following antimalarial can be given for malaria prophylaxis: chloroquine+ proguanil

A

up to 5 years

174
Q

What is the longest time the following antimalarial can be given for malaria prophylaxis :Mefloquine / malarone

A

up to 1 year

175
Q

What do you check for when patient is mefloquine or chloroquine:

A

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
Q

Which antimalarial safe in pregnancy:

A

Chloroquine / proguanil ( Folic acid 5 mg given with proguanil)

Mefloquine can be used in first trimester if benefit outweighs the risk

177
Q

Why is folic acid given with proguanil in pregnant women?

A

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
Q

Which antimalarials do you avoid in renal impairment:

A

Avoid proguanil

Avoid malarone (proguanil with atovoquanone) and chloroquine if egfr is less than 30

179
Q

A patient has EGFR less than 30, what antimalarials should they avoid?

A

malarone
chloroquine

180
Q

What two drugs make up malarone?

A

proguanil with atovoquanone

181
Q

what are normal egfr values?

A

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

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
Q

what egfr shows kidneys not working properly?

A

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
Q

What advice do you give to patients on warfarin + taking antimalarials:

A

Begin prophylaxis 2-3 weeks before

AND INR should be stable before departure

Monitor INR before, 7 days after starting and after treatment

184
Q

Which group of patients are at a severe risk of contracting malaria:

A

Asplenia / severe splenic dysfunction

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
Q

What is falciparum malaria caused by:

A

the protozoa: Plasmodium falciparum

(most deadly kind of malaria)

186
Q

What are contraindications for chloroqiuine?

A

Diabetes (may cause hypo)
May lower seizure threshold
Myasthenia gravis

due to its potential to cause hypoglycemia (low blood sugar levels)

187
Q

State some side effect of chloroquine:

A

Ocular toxicity
OT interval prolongation
Chloroquine very toxic in overdose as can cause arrythmias and convulsions

188
Q

What can chloroquine overdose cause?

A

chloroquine is very toxic in overdose

can cause arrhythmias and convulsions

189
Q

State contraindications for mefloquine:

A

History of psychiatric disorders
depression
convulsions

190
Q

State important patient carer advice for patients taking mefloquine:

A

Stop and seek immediate help, if neuropsychiatric symptoms occur such as

depression / suicidal thoughts, insomnia, nightmares, abnormal dreams, anxiety, suicide, confusion

191
Q

Why can the symptoms of mefloquine stay for several months?

A

because it has a very long half- life

192
Q

state some MHRA warnings with quinine?

A

Dose-dependent QT interval prolongation

193
Q

Which 2 drugs are licensed for post-exposure prophylaxis of influenza:

A

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
Q

for post-exposure prophylaxis of influenza: how soon should olseltavmavir be given?

A

within 48 hours

195
Q

for post-exposure prophylaxis of influenza: how soon should zamanavir be given?

A

within 36 hours

Zamanivir should be reserved for patients who are severely immunocompromised

196
Q

State treatment of Covid-19:

A

Dexamethasone should be offered to patients with Covid-19 who need supplemental oxygen

Hydrocortisone or prednisolone

197
Q

State treatment of Covid-19 for patients hospitalised or for symptomatic patients who are at a high risk of progression to severe disease:

A
  • Remdesivir, molnupiravir or nirmatrelvir with ritonavir
  • Sotrovimab
  • Tocilizumab
  • Baricitinib
198
Q

In the prophylaxis of malaria how should the following antimalarial be given:Doxycycline

A

1-2 days before entering endemic and 4 weeks after

199
Q

State which of the following is most characteristically associated with amphotericin B

A

Flu-like symptoms

hypomagnesaemia

hypokalaemia

200
Q

State treatment of late latent syphilis:

A
  1. Benzathine benzylpenicillin
  2. doxycycline

a period when there are no visible signs or symptoms of syphilis

a type of sexually transmitted infection.

201
Q

how are pseudmonas aeruginosa infections treated?

A

gentamicin

afsha - infections (57 decks)

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