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PRE REG > Infection > Flashcards

Infection Flashcards

1
Q

Which factors must be considered when selecting an antibacterial?

A

The patient, the organism, the risk of resistance with repeated courses

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2
Q

Which factors related to the patient should be considered for antibacterial choice?

A

History of allergy, renal and hepatic function, susceptibility to infection, ability to tolerate drugs by mouth, severity of illness, risk of complications, ethnic origin, age, other medications, female and if pregnant, breast feeding or taking an oral contraceptive

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3
Q

Which antibiotics require iv therapy?

A

Serious life threatening infections.

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4
Q

How is early sepsis managed?

A

Patients identified as high risk of sepsis should be given a broad spec at the max dose without delay. Take microbiological samples and adjust antibacterial according to the results. Assess need for iv fluids, inotropes, vasopressors and oxygen without delay. Take into account systolic bp, lactate concentration.

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5
Q

State the antibiotics safe in pregnancy:

A

Penicillin and cephalosporins (cefalexin)

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6
Q

Which antibiotics are contraindicated in children:

A

Tetracyclines in under 12 years old
Quinolones as can arthropathy, tissue, cartilage damage – avoid

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7
Q

Which antibiotic has increased risk of clostridium difficile:

A

Clindamycin

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8
Q

Which antibiotics can cause nephrotoxicity:

A

Aminoglycoside and glycopeptide (vancomycin)

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9
Q

Which antibiotics should be avoided in renal impairment:

A

Tetracyclines (except minocycline / doxycycline)

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10
Q

Which antibiotics avoided in hepatotoxicity:

A

Rifampicin, tetracyclines

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11
Q

Which antibiotics can cause cholestatic jaundice:

A

Co-amoxiclav, flucloxacillin. Note: report diarrhoea to gp, as treatment may need changing

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12
Q

State the signs of sepsis in babies:

A

Blue, pale skin, lips or tongue
Rash that does not fade when you role a glass over it (same as meningitis) Difficulty in breathing
Weak high pitched cry
Sleepier than normal
Not feeding / or normal activities

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13
Q

State the signs of sepsis in adults:

A

Blue, pale skin, lips or tongue
Rash that does not fade when you role a glass over it (same as meningitis) Difficulty in breathing
Slurred speech, confused

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14
Q

State the treatment of Rheumatic fever: prevention of recurrence:

A

Phenoxymethylpenicillin OR sulfadiazine

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15
Q

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

A
  1. Phenoxymethlypenicilin
  2. Erythromycin
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16
Q

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

A
  1. Ciprofloxacin OR rifampicin OR IM ceftriaxone
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17
Q

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

A
  1. Rifampicin
  2. IV Ceftriaxone
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18
Q

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

A
  1. Erythromycin or another macrolide (azithromycin, clarithromycin)
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19
Q

State the treatment of pertussis, antibacterial prophylaxis:

A
  1. Clarithromycin (or azith / erythromycin).
    within 3 weeks of cough in the index case, give to all close contacts if there is someone not immunised or partially immunised
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20
Q

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

A
  1. Phenoxymethylpenicillin
  2. Erythromycin
    abx prophylaxis not fully reliable
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21
Q

State the treatment of animal and human bites:

A
  1. Co-amoxiclav (3 days for prophylaxis or 5 days for treatment)
  2. Doxycycline + Metronidazole
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22
Q

State treatment of meningitis causes by meningococci:

A
  1. Benzypenicillin
  2. Cefotaxime (or ceftriaxone)
  3. Chloramphenicol
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23
Q

State treatment of meningitis caused by pneumococci:

A
  1. Cefotaxime (or ceftriaxone)
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24
Q

State treatment of meningitis caused by haemophilus influenzae:

A
  1. Cefotaxime (or ceftriaxone)
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25
Q

State treatment of meningitis caused by listeria:

A
  1. Amoxicillin (or ampicillin) + gentamicin
  2. Co-trimoxazole
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26
Q

What should patients at risk of bacterial endocarditis be advised?

A
  • maintain good oral hygiene
  • recognise signs of endocarditis and when to seek advice.
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27
Q

Which abx is first line for septicaemia?

A

broad spec eg pip taz

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28
Q

What should be given if meningoccocal disease is suspected?

A

A single dose of benzylpenicillin before urgent transfer to hospital

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29
Q

Discuss initial blind therapy in endocarditis

A

Native valve - amoxicillin and consider low dose gentamicin
prosthetic valve - vanc + rifampicin + low dose gent

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30
Q

State treatment for otitis externa:

A
  1. Analgesia for lain relief
  2. Topical acetic acid or topical neomycin with corticosteroid
  3. Flucloxacillin
  4. Clarithromycin
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31
Q

Acute otitis media:

A
  1. Amoxicillin
  2. Clarithromycin or (erythromycin preferred if pregnant)
  3. Co-amoxiclav for 2nd line
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32
Q

State treatment of scarlet fever:

A
  1. Phenoxymethylpenicillin
  2. Clarithromycin
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33
Q

State treatment for bacterial conjunctivitis:

A

chloramphenicol

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34
Q

State treatment of campylobacter enteritis:

A
  1. Clarithromycin
  2. Ciprofloxacin
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35
Q

State treatment of typhoid fever:

A
  1. Cefotaxime (or ceftriaxone)
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36
Q

State treatment of clostridium difficile:

A

when normal gut microbiota are suppressed, causing diarrhoea. Prompt tx with antibacterials if suspected
1. Metronidazole
2. Vancomycin
3. Fidaxomicin

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37
Q

State treatment of traveller’s diarrhoea:

A
  1. Azithromycin as standby
  2. Bismuth salicylate as prophylaxis
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38
Q

State treatment of bacterial vaginosis:

A
  1. Oral metronidazole
  2. Metronidazole 0.75% gel or clindamycin cream
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39
Q

State treatment of vaginal candiasis (thrush):

A
  1. Clotrimazole
  2. Fluconazole if recurrent
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40
Q

State treatment of genital herpes:

A
  1. Oral acyclovir
  2. Valaciclovir
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41
Q

State treatment of chlamydia / urethiritis:

A
  1. Doxycycline
  2. Azithromycin
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42
Q

State treatment of gonorrhoea:

A
  1. Ceftriaxone
  2. Ciprofloxacin
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43
Q

State treatment of trichomoniasis:

A
  1. Metronidazole
  2. Clotrimazole if pregnant
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44
Q

State treatment of PID:

A
  1. Ceftriaxone + metronidazole + doxycycline
  2. Metronidazole + ofloxacin
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45
Q

State treatment of early syphilis:

A
  1. Benzathine benzylpenicillin
  2. Doxycycline
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46
Q

State treatment of osteomyelitis:

A
  1. Flucloxacillin
  2. Clindamycin If penicillin allergic
  3. Vancomycin If MRSA suspected
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47
Q

State treatment of septic arthritis:

A
  1. Flucloxacillin
  2. Clindamycin if penicillin allergic
  3. Vancomycin if MRSA suspected
  4. Cefotaxime if gonococcal arthritis suspected
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48
Q

When should patients with sinusitis be offered antibacterials?

A

Acute sinusitis who are systemically unwell, have signs and symptoms of a more serious illness or at risk of complications due to pre existing co-morbidities. symptoms for more than 10 days may be prescribed a back up, if symptoms dont improve after another 7 days or suddenly worsen

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49
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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50
Q

State treatment of wide-spread non-bullous impetigo:

A
  1. Flucloxacillin
  2. Clartihomycin (erythromycin in pregnancy)
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51
Q

State treatment of mastitis during breastfeeding:

A
  1. Flucloxacillin
  2. Erythromycin
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52
Q

State treatment of scabies:

A
  1. Permethrin cream
  2. Malathion liquid
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53
Q

State treatment of shingles (herpes zoster):

A
  1. Acyclovir
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54
Q

State treatment of Tick bites Lyme disease:

A
  1. Doxycycline
  2. Amoxicillin
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55
Q

State treatment of Tick bites Lyme disease:

A
  1. Doxycycline
  2. Amoxicillin
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56
Q

State treatment of threadworms:

A
  1. Mebendazole if more than 6 months
  2. If pregnant then hygiene measure
    Note: mebendazole ONLY licensed for aged 2+ OTC
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57
Q

Which antibiotic is used for cellulitis?

A

Fluclox/co-amox

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58
Q

When should abx prophylaxis be given for a bit?

A

When a cat/dog bite has broken the skin
co-amoxiclav oral or iv

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59
Q

What do aminoglycosides work against:

A

Gram positive and gram negative

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60
Q

State examples of aminoglycosides:

A

Amikacin, gentamicin, neomycin, streptomycin, tobramycin

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61
Q

What is important for the administration of aminoglycosides?

A

Not absorbed from the gut so must be given by injection for systemic infections

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62
Q

How are doses of gentamicin calculated?

A

On the basis of the patients weight and renal function. Wherever possible, tx length should not exceed 7 days.

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63
Q

Aminoglycosides is contraindicated in which condition and why:

A

Myasthenia gravis – impair neuromuscular transmission

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64
Q

State common side effects of aminoglycosides:

A

Tinnitus, skin reactions, hypomagnesaemia
OTOTOXCITY / NEPHROTOXICITY
Risk of auditory or vestibular nerve damage in infant when aminoglycosides are used in 2nd and 3rd trimester

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65
Q

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

A

Streptomycin

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66
Q

State the one hour peak serum concentration:

A

5-10 mg

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67
Q

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

A

Lung function

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68
Q

What is the cumulative max dose of streptomycin?

A

100mg - increased risk of side effects above this

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69
Q

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

A

imipenem as it is partially inactivated by the kidney

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70
Q

State which carbanem has less seizure-inducing potential:

A

Meropenem - so can be used to treat central nervous system infection

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71
Q

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

A

Cefotaxime / ceftriaxone

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72
Q

What is the principal side effects if cephalosporins?

A

Hypersensitivity

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73
Q

What class is vancomycin:

A

Glycopeptide

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74
Q

Which antibiotic can cause red man syndrome/thrombophlebitis:

A

V ancomycin

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75
Q

State pre-dose trough for serum vancomycin:

A

10-20 mg

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76
Q

State monitoring requirements for vancomycin:

A

Monitor auditory function
Monitor full blood count, hepatic and renal Monitor vestibular

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77
Q

State when to stop taking clindamycin (lincosamide):

A

Diarrhoea – stop and report to gp. Antibiotic associated collitis - can be fatal. If c diff suspected stop and report to gp

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78
Q

Which macrolide is used for toxoplasmosis:

A

Spiramycin

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79
Q

What can macrolides cause:

A

QT prolongation – avoid with other drugs causing QT prolongation

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80
Q

What is a common interaction with macrolides?

A

Enzyme inhibitors. Stop statin whilst taking as can increase chances of myopathy

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81
Q

What are the MHRA alerts for erythromycin?

A

increased risk of cardiotoxicity due to QT interval prolongation
infantile hypertrophic pyloric stenosis risk increased two to three fold.

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82
Q

How does metronidazole work:

A

Against anaerobic bacteria and protozoa. Thought to produce free radicals, which can cause disulfram reaction with alcohol so avoid.

83
Q

Which macrolide is safe in pregnancy:

A

Erythromycin

84
Q

Why must benzylpenicillin be given by injection?

A

Because it is inactivated by gastric acid and absorption in the gi tract is limited

85
Q

How is ampicillin absorption affected by food in the gut?

A

Reduced absorption of the dose, it is unpredictable

86
Q

What commonly occurs with ampicillin?

A

Macropapular rashes

87
Q

What frequently occurs during oral penicillin therapy?

A

Diarrhoea, can cause antibiotic-associated collitis

88
Q

What is the most important side effect of penicillins

A

Hypersensitivity which causes anaphylaxis and rashes, can be fatal.

89
Q

What is the important safety information for benzylpenicillin

A

Intrathecal injection is not recommended

90
Q

State treatment of tetanus:

A

Metronidazole or benzylpenicillin

91
Q

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

A

Flu-like symptoms/hypomagnesaemia/hypokalaemia

92
Q

State treatment of shigellosis:

A

Ciprofloxacin or azithromycin

93
Q

State treatment of pneumocytis jiroveci poneumonia:

A

Co-trimoxazole

94
Q

State treatment of gonorrhoea:

A

IV ceftriaxone§

95
Q

State treatment of salmonella (non-typhoid):

A

Ciprofloxacin

96
Q

State treatment of dental abscess:

A

Amoxicillin

97
Q

State side effect of tetracyclines:

A

Intracranial hypertension

98
Q

State treatment of Q fever:

A

Doxycycline

99
Q

State treatment of cytomegalovirus retinitis:

A

IV ganciclovir
State treatment of erysipelas:
Flucloxacillin

100
Q

What can sulphonamides cause:

A

Steven-johnson syndrome

101
Q

State some common side effects of macrolides:

A

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

102
Q

State treatment of early and late syphilis:

A

Benzathine benzylpenicillin

103
Q

How do penicillin’s work:

A

Interfere with bacterial cell wall synthesis

104
Q

State side effects of penicillins:

A

Diarrhoea, nausea, skin reactions, vomiting, antibiotic associated colitis

105
Q

What is common in men and over aged of 65:

A

Cholestatic jaundice

106
Q

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

A

Benzylpenicillin

107
Q

State the common amoxicillin doses:

A

1 month to 11 months = 125 mg TDS
1 years old to 4 years old = 250 mg TDS 5 years old to 11 years old = 500 mg TDS 12 months + adults = 500 mg TDS

108
Q

Which antibiotic can increase risk of infection/cholestatic jaundice:

A

Co-amoxiclav

109
Q

What is the important safety information for flucloxacillin

A

Cholestatic jaundice and hepatitis can occur very rarely up to 2 months after tx has stopped. Do not use in patietns with hx of hepatic dysfunction, use with caution in hepatic impairment.

110
Q

What can quinolones induce:

A

Convulsions in patients with or without a history of convulsions, taking NSAIDs at the same time may also induce them
ALSO:
Quinolones CI in patients with tendon damage
Patients over 60+
Risk of tendon damage is increased by concomitant use of corticosteroids
Tendinitis suspected – quinolone should be discontinued immediately

111
Q

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

A
  • Tendinitis
  • Tendon damage
  • Muscle pain and weakness
  • Joint pain, peripheral neuropathy and CNS effects
112
Q

Why are quinolones contraindicated in children:

A

Joint inflammation – arthropathy

113
Q

State some cautions of quinolones:

A

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

114
Q

What is co-trimoxazole:

A

Sulfamexthoxazole and trimethoprim

115
Q

State treatment of pneumocystis jirovecii:

A

Co-trimoxazole

116
Q

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

A

Minocycline

117
Q

State one caution for tetracyclines:

A

Myasethnia gravis / systemic lupus erythematosus

118
Q

State common side effects of tetracyclines:

A

Diarrhoea, angioedema, tooth discolouration, photosensitivity reactions, skin reactions ALSO:
Headache and visual disturbances may indicate benign intracranial hypertension. Discontinue if raised IP develops.

119
Q

State counselling points for tetracyclines:

A

DD
Demeclocycline / Doxycycline Avoid exposure to sunlight/sunlamps
DOT
Demeclocycline / oxytetracycline / tetracycline Avoid milk
DMT
Doxycycline / minocycline / tetracycline
Oesophageal irritation – swallow whole with plenty of fluid during meals while sitting or standing

120
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

121
Q

Which tetracycline can cause tongue discolouration:

A

Minocycline

122
Q

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

A

Gray baby syndrome

123
Q

State a side effect of vancomycin:

A

Red man syndrome

124
Q

How long should topical fusidic acid cream be used for:

A

no longer than 10 days to avoid the development of resistance

125
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

126
Q

How can linezolid impact the blood?

A

Can cause haematopoietic disordres so full blood counts should be monitored weekly and close in patients who:
-receive tx for more than 10-14 days
- have pre-existing myelosuppression
- are recieving drugs that may impact haemoglobin, or have severe renal impairment

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

132
Q

What are the tx phases for tb?

A

Initial phase - using four drugs
continuation phase - using two drugs

133
Q

Which drugs make up the initial phase of tx for tb?

A
  1. rifampicin
  2. ethambutol
  3. pyrazinamide
  4. isoniazid (with pyridoxine)
    continued for 2 months
134
Q

Which drugs make up the continuation phase of tx for tb?

A

Rifampicin and isoniazide with pyridoxine for 4 months

135
Q

What is the contraception advice for rifampicin?

A

effectiveness of hormornal contraceptives is reduce by rifampicin

136
Q

What are the monitoring requirements for rifampicin?

A

Liver function - monitor every week for 2 weeks then every 2 weeks for 6 weeks.
check liver and renal function before tx
more frequent checks in those with alcohol dependance

137
Q

What is the pt/carer advice for rifampicin?

A

Can discolour soft contact lenses and can cause hepatic disorders. Patient and carers should be advised to watch out for signs of hepatic disorders eg fever, nausea, vomitting, malaiase

138
Q

State contraception advice for patients taking rifabutin:

A

Rifabutin induces hepatic enzymes and effectiveness of hormonal contraceptives is reduced

139
Q

State patient carer advice with dapsone:

A

Blood disorder to recognise symptoms of sore throat, fever, ulcer, purpura, rash, bruising, bleeding
Rash with fever + eosinophila = discontinue immediately

140
Q

State treatment of lyme disease (tick bite):

A
  1. Doxycycline 2. Amoxicillin
  2. Azithromycin
141
Q

How long should unsupervised treatment of TB be taken for:

A

6 months ie in pregnancy and breastfeeding

142
Q

State which conditions rifampicin is contraindicated in:

A

Acute porphyria’s and jaundice

143
Q

State common side effects of rifampicin:

A

Nausea, vomiting, sweat discolouration, tears discolouration, urine red, sputum discolouration, AKI

144
Q

State monitoring requirements for patients taking rifampicin:

A

Renal
Hepatic
FBCs

145
Q

State patient carer advice for those taking rifampicin:

A

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

146
Q

State side effect of bedaquiline:

A

QT interval prolongation
State side effects of cycloserine:
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:

A

E.Coli

149
Q

What is given alongside isoniazid to prevent peripheral neuropathy?

A

Pyridoxine hydrochloride prophylactically since the start of tx. Most likely to occur with pre-existing risk factors such as alcohol dependance and diabetes

150
Q

What are the common signs and symptoms of a lower UTI

A

Dysuria, increased urinary frequency and urgency, urine that is strong smelling, abscess or failure, cloudy or contains blood, persistent lower abdominal pain.

151
Q

What are the common signs/symptoms of an upper uti

A

Loin pain and fever

152
Q

What is associated with asymptomatic bacteruria in pregnant women?

A

Risk factor for pyelonephritis and premature labour.

153
Q

When are UTIs considered recurrent?

A

After at least 2x episodes in six months or three or more episodes within 12 months.

154
Q

What is the non drug tx advice for UTIs?

A

drink plenty of water. wipe from front to back, do not delay urination, do not wear occlusive underwear

155
Q

State treatment of lower UTI in women:

A
  1. Trimethoprim or nitrofurantoin for 3 days
156
Q

State treatment of lower UTI in men:

A
  1. Trimethoprim for 7 days
  2. Nitrofurantoin (if egfr more than 45 ml)
157
Q

State treatment of lower UTI in pregnant women:

A
  1. Nitrofurantoin
  2. Amoxicillin
  3. Cefalexin
158
Q

State treatment of acute prostatitis:

A
  1. Quinolones ciprofloxacin, ofloxacin
  2. Trimethoprim
159
Q

What is the tx for pyelonephritis?

A

Cefalexin

160
Q

Discuss the tx for recurrent UTI

A

for postmenopausal women: consider vaginal oestrogen at lowest effective dose.

161
Q

What is used for long term treatment or recurrent uncomplicated lower uti

A

Mehtanamine hippurate

162
Q

What is a side effect of nitrofurantoin?

A

Acute pulmonary reactions can occur within the first week and are reversible with tx cessation

may discolour the urine, this is harmless

163
Q

When should the use of nitrofurantoin be avoided?

A

egfr less than 45ml/min

164
Q

What is the patient/carer advice for nitrofurantoin

A

Seek immediate medical attention if signs or symptoms of pulmonary, hepatic, haematological or neurological adverse reactions develop

165
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

166
Q

Which antifungal has this patient carer advice, 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:

A

V oriconazole

167
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

168
Q

What is pneumonia caused by:

A

Pneuomocystiis jiroveccii

169
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

170
Q

State treatment of acute uncomplicated falciparum malaria:

A

Artemeter with lumenfantrine

171
Q

State treatment for prophylaxis of falciparum malaria + acute uncomplicated falciparum malaria:

A

Atovaquone with proguanil hydrochloride

172
Q

What is the length of prophylaxis for anti malarials?

A

Chloroquine and proguanil - 1week before
1-2 days pre for atovaquone and proguanil or doxy
continued for 4 weeks after leaving the area, except for atovaquone and proguanil which is stopped after one weel

173
Q

What is the licensing of anti malarials

A

Mefloquine, atovquone and proguanil up to one year, doxy up to 2 years,

174
Q

What is important to remember upon return from malaria areas?

A

Any illness that occurs within the first year, but especially within the first 3 months could be malaria.

175
Q

Discuss anti-malarials and epilepsy

A

Both chloroquine and mefloquine are unsuitable with a hx of epilepsy. In these patients, doxy or atavaquone with proguanil must be used. doxy may need dose adjustment

176
Q

What is the advice for patients with asplenia travelling to a malaria area

A

At a particular risk of severe malaria, take rigorous precautions

177
Q

What is the travel advice for pregnant women to malaria risk regions

A

Avoid, if unavoidable then warn about risks and benefits of effective prophylaxis. Chloroquine and proguanil can be given but not very effective. Folic acid should be given with proguanil. Mefloquine can be considered in the second or third trimester or pregnancy and during first if benefits outweigh the risks.

178
Q

What is the advice for patients taking anticoagulants requiring chemoprophylaxis?

A

Warfarin - start 2-3 weeks pre departure and ensure INR is stable. Check frequently

179
Q

What is chloroquine used for:

A

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

180
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

181
Q

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

A

Primaquine

182
Q

State doxycycline use and specific counselling for prophylaxis of malaria:

A

Take 1-2 days before entering the endemic area and continue for 4 weeks after leaving 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

183
Q

Protection against bites:

A
  • Mosquito nets impregnated with permethrin (most effective)
  • Mats and vapourised insecticides
  • DEET 20-50% in adults and children over 2 months
  • DEET Can also be used in pregnancy and breastfeeding, however breastfeeding moms
    should wash hands and breast tissue before handling infants
  • Sunscreen first and then the DEET
  • Sunscreen SPF 30-50 is recommended
184
Q

Length of prophylaxis of antimalarials:

A

Atovaquone with proguanil = 1-2 days before entering endemic and 1 week after Doxycycline = 1-2 days before entering endemic and 4 weeks after
Chloroquine / proguanil = 1 week before
Mefloquine = 2-3 weeks before

185
Q

State the longest treatment it can be used for prophylaxis:

A

Doxycycline = up to 2 years
Mefloquine / malarone = up to 1 year
Chloroquine with proguanil = up to 5 years

186
Q

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

A
  1. CI in patients with history of seizures
  2. Doxycycline given (but may interact too)
  3. Atovaquone with proguanil
187
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
188
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

189
Q

What is falciparum malaria caused by:

A

Plasmodium falciparum

190
Q

State some CI for chloroquine:

A

Diabetes (may lower it)
May lower seizure threshold Myasthenia gravis

191
Q

State some side effect of chloroquine:

A

Ocular toxicity
QT interval prolongation
Chloroquine very toxic in overdose. Can cause arrythmias and convulsions

192
Q

State contraindications for mefloquine:

A

History of psychiatric disorders, depression, convulsions

193
Q

State important patient carer advice for patients taking mefloquine:

A

Stop and seek immediate help, if neuropsychiatric symptoms occur such ass depression / suicidal thoughts, insomnia, nightmares, abnormal dreams, anxiety, suicide, confusion Mefloquine has very long half-life so symptoms can stay for several months

194
Q

State mHRA warning with quinine:

A

Dose-dependent QT interval prolongation

195
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

196
Q

What is the tx of HIV?

A

2 NRTIS plus an integrase inhibitor, or an NNRTI or PI

197
Q

What is the recommended tx for HIV in pregnancy

A

NRTI of either tenofovir or abacavir with either emtricitabine and efavirenz or atazanavir

198
Q

What is appropriate for pre-exposure prophylaxis for HIV

A

Emtricitabine with tenofovir

199
Q

What is appropriate for post exposure prophylaxis in HIV

A

emtricitabine with tonofovir plus raltegravir for 28 days.

200
Q

Which drugs are NRTIS

A

Abacavir, emtricitabine, tenofovir

201
Q

Which drugs are NNRTIs

A

Etravirenz, etravirine

202
Q

Which drugs are protease inhibitors

A

Atazanavir, darunavir, ritonavir

203
Q

Which drugs are Integrase inhibitors

A

Carbotegravir, dolutegravir, elvitegravir

204
Q

What has been reported in HIV patients with long term exposure to combination antiretroviral therapy

A

Osteonecrosis

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