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
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
3
Q
Which antibiotics require iv therapy?
A
Serious life threatening infections.
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.
5
Q
State the antibiotics safe in pregnancy:
A
Penicillin and cephalosporins (cefalexin)
6
Q
Which antibiotics are contraindicated in children:
A
Tetracyclines in under 12 years old
Quinolones as can arthropathy, tissue, cartilage damage – avoid
7
Q
Which antibiotic has increased risk of clostridium difficile:
A
Clindamycin
8
Q
Which antibiotics can cause nephrotoxicity:
A
Aminoglycoside and glycopeptide (vancomycin)
9
Q
Which antibiotics should be avoided in renal impairment:
A
Tetracyclines (except minocycline / doxycycline)
10
Q
Which antibiotics avoided in hepatotoxicity:
A
Rifampicin, tetracyclines
11
Q
Which antibiotics can cause cholestatic jaundice:
A
Co-amoxiclav, flucloxacillin. Note: report diarrhoea to gp, as treatment may need changing
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
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
14
Q
State the treatment of Rheumatic fever: prevention of recurrence:
A
Phenoxymethylpenicillin OR sulfadiazine
15
Q
State the treatment of invasive Group A streptococcal infection, prevention of secondary case:
A
- Phenoxymethlypenicilin
- Erythromycin
16
Q
State the treatment of meningococcal meningitis, prevention of secondary cases:
A
- Ciprofloxacin OR rifampicin OR IM ceftriaxone
17
Q
State the treatment of haemophilius influenzae type b disease, prevention of secondary cases:
A
- Rifampicin
- IV Ceftriaxone
18
Q
State the treatment of diptheria in non-immune patients, prevention of secondary cases:
A
- Erythromycin or another macrolide (azithromycin, clarithromycin)
19
Q
State the treatment of pertussis, antibacterial prophylaxis:
A
- 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
20
Q
State the treatment of pneumococcal infection in asplenia or patients with sickle cell disease:
A
- Phenoxymethylpenicillin
- Erythromycin
abx prophylaxis not fully reliable
21
Q
State the treatment of animal and human bites:
A
- Co-amoxiclav (3 days for prophylaxis or 5 days for treatment)
- Doxycycline + Metronidazole
22
Q
State treatment of meningitis causes by meningococci:
A
- Benzypenicillin
- Cefotaxime (or ceftriaxone)
- Chloramphenicol
23
Q
State treatment of meningitis caused by pneumococci:
A
- Cefotaxime (or ceftriaxone)
24
Q
State treatment of meningitis caused by haemophilus influenzae:
A
- Cefotaxime (or ceftriaxone)
25
State treatment of meningitis caused by listeria:
1. Amoxicillin (or ampicillin) + gentamicin
2. Co-trimoxazole
26
What should patients at risk of bacterial endocarditis be advised?
- maintain good oral hygiene
- recognise signs of endocarditis and when to seek advice.
27
Which abx is first line for septicaemia?
broad spec eg pip taz
28
What should be given if meningoccocal disease is suspected?
A single dose of benzylpenicillin before urgent transfer to hospital
29
Discuss initial blind therapy in endocarditis
Native valve - amoxicillin and consider low dose gentamicin
prosthetic valve - vanc + rifampicin + low dose gent
30
State treatment for otitis externa:
1. Analgesia for lain relief
2. Topical acetic acid or topical neomycin with corticosteroid
3. Flucloxacillin
4. Clarithromycin
31
Acute otitis media:
1. Amoxicillin
2. Clarithromycin or (erythromycin preferred if pregnant)
3. Co-amoxiclav for 2nd line
32
State treatment of scarlet fever:
1. Phenoxymethylpenicillin
2. Clarithromycin
33
State treatment for bacterial conjunctivitis:
chloramphenicol
34
State treatment of campylobacter enteritis:
1. Clarithromycin
2. Ciprofloxacin
35
State treatment of typhoid fever:
1. Cefotaxime (or ceftriaxone)
36
State treatment of clostridium difficile:
when normal gut microbiota are suppressed, causing diarrhoea. Prompt tx with antibacterials if suspected
1. Metronidazole
2. Vancomycin
3. Fidaxomicin
37
State treatment of traveller’s diarrhoea:
1. Azithromycin as standby
2. Bismuth salicylate as prophylaxis
38
State treatment of bacterial vaginosis:
1. Oral metronidazole
2. Metronidazole 0.75% gel or clindamycin cream
39
State treatment of vaginal candiasis (thrush):
1. Clotrimazole
2. Fluconazole if recurrent
40
State treatment of genital herpes:
1. Oral acyclovir
2. Valaciclovir
41
State treatment of chlamydia / urethiritis:
1. Doxycycline
2. Azithromycin
42
State treatment of gonorrhoea:
1. Ceftriaxone
2. Ciprofloxacin
43
State treatment of trichomoniasis:
1. Metronidazole
2. Clotrimazole if pregnant
44
State treatment of PID:
1. Ceftriaxone + metronidazole + doxycycline
2. Metronidazole + ofloxacin
45
State treatment of early syphilis:
1. Benzathine benzylpenicillin
2. Doxycycline
46
State treatment of osteomyelitis:
1. Flucloxacillin
2. Clindamycin If penicillin allergic
3. Vancomycin If MRSA suspected
47
State treatment of septic arthritis:
1. Flucloxacillin
2. Clindamycin if penicillin allergic
3. Vancomycin if MRSA suspected
4. Cefotaxime if gonococcal arthritis suspected
48
When should patients with sinusitis be offered antibacterials?
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
49
State treatment of localised non-bullous impetigo:
1. Hydrogen peroxide 1%
2. Fusidic acid 2% cream
3. Topical mupirocin if MRSA present
50
State treatment of wide-spread non-bullous impetigo:
1. Flucloxacillin
2. Clartihomycin (erythromycin in pregnancy)
51
State treatment of mastitis during breastfeeding:
1. Flucloxacillin
2. Erythromycin
52
State treatment of scabies:
1. Permethrin cream
2. Malathion liquid
53
State treatment of shingles (herpes zoster):
1. Acyclovir
54
State treatment of Tick bites Lyme disease:
1. Doxycycline
2. Amoxicillin
55
State treatment of Tick bites Lyme disease:
1. Doxycycline
2. Amoxicillin
56
State treatment of threadworms:
1. Mebendazole if more than 6 months
2. If pregnant then hygiene measure
Note: mebendazole ONLY licensed for aged 2+ OTC
57
Which antibiotic is used for cellulitis?
Fluclox/co-amox
58
When should abx prophylaxis be given for a bit?
When a cat/dog bite has broken the skin
co-amoxiclav oral or iv
59
What do aminoglycosides work against:
Gram positive and gram negative
60
State examples of aminoglycosides:
Amikacin, gentamicin, neomycin, streptomycin, tobramycin
61
What is important for the administration of aminoglycosides?
Not absorbed from the gut so must be given by injection for systemic infections
62
How are doses of gentamicin calculated?
On the basis of the patients weight and renal function. Wherever possible, tx length should not exceed 7 days.
63
Aminoglycosides is contraindicated in which condition and why:
Myasthenia gravis – impair neuromuscular transmission
64
State common side effects of aminoglycosides:
Tinnitus, skin reactions, hypomagnesaemia
OTOTOXCITY / NEPHROTOXICITY
Risk of auditory or vestibular nerve damage in infant when aminoglycosides are used in 2nd and 3rd trimester
65
Which aminoglycoside has highest risk of auditory/vestibular nerve damage:
Streptomycin
66
State the one hour peak serum concentration:
5-10 mg
67
What do you measure before and after initial dose of tobramycin:
Lung function
68
What is the cumulative max dose of streptomycin?
100mg - increased risk of side effects above this
69
State which carbapenem has to be given with cilasatin as a dual treatment:
imipenem as it is partially inactivated by the kidney
70
State which carbanem has less seizure-inducing potential:
Meropenem - so can be used to treat central nervous system infection
71
State which cephalosporins are useful for infections of the CNS – meningitis:
Cefotaxime / ceftriaxone
72
What is the principal side effects if cephalosporins?
Hypersensitivity
73
What class is vancomycin:
Glycopeptide
74
Which antibiotic can cause red man syndrome/thrombophlebitis:
V ancomycin
75
State pre-dose trough for serum vancomycin:
10-20 mg
76
State monitoring requirements for vancomycin:
Monitor auditory function
Monitor full blood count, hepatic and renal Monitor vestibular
77
State when to stop taking clindamycin (lincosamide):
Diarrhoea – stop and report to gp. Antibiotic associated collitis - can be fatal. If c diff suspected stop and report to gp
78
Which macrolide is used for toxoplasmosis:
Spiramycin
79
What can macrolides cause:
QT prolongation – avoid with other drugs causing QT prolongation
80
What is a common interaction with macrolides?
Enzyme inhibitors. Stop statin whilst taking as can increase chances of myopathy
81
What are the MHRA alerts for erythromycin?
increased risk of cardiotoxicity due to QT interval prolongation
infantile hypertrophic pyloric stenosis risk increased two to three fold.
82
How does metronidazole work:
Against anaerobic bacteria and protozoa. Thought to produce free radicals, which can cause disulfram reaction with alcohol so avoid.
83
Which macrolide is safe in pregnancy:
Erythromycin
84
Why must benzylpenicillin be given by injection?
Because it is inactivated by gastric acid and absorption in the gi tract is limited
85
How is ampicillin absorption affected by food in the gut?
Reduced absorption of the dose, it is unpredictable
86
What commonly occurs with ampicillin?
Macropapular rashes
87
What frequently occurs during oral penicillin therapy?
Diarrhoea, can cause antibiotic-associated collitis
88
What is the most important side effect of penicillins
Hypersensitivity which causes anaphylaxis and rashes, can be fatal.
89
What is the important safety information for benzylpenicillin
Intrathecal injection is not recommended
90
State treatment of tetanus:
Metronidazole or benzylpenicillin
91
State which of the following is most characteristically associated with amphotericin B
Flu-like symptoms/hypomagnesaemia/hypokalaemia
92
State treatment of shigellosis:
Ciprofloxacin or azithromycin
93
State treatment of pneumocytis jiroveci poneumonia:
Co-trimoxazole
94
State treatment of gonorrhoea:
IV ceftriaxone§
95
State treatment of salmonella (non-typhoid):
Ciprofloxacin
96
State treatment of dental abscess:
Amoxicillin
97
State side effect of tetracyclines:
Intracranial hypertension
98
State treatment of Q fever:
Doxycycline
99
State treatment of cytomegalovirus retinitis:
IV ganciclovir
State treatment of erysipelas:
Flucloxacillin
100
What can sulphonamides cause:
Steven-johnson syndrome
101
State some common side effects of macrolides:
QT interval prolongation, diarrhoea, taste altered, tinnitus, vertigo, skin reactions
102
State treatment of early and late syphilis:
Benzathine benzylpenicillin
103
How do penicillin’s work:
Interfere with bacterial cell wall synthesis
104
State side effects of penicillins:
Diarrhoea, nausea, skin reactions, vomiting, antibiotic associated colitis
105
What is common in men and over aged of 65:
Cholestatic jaundice
106
Which antibiotic has a common side effect of jarisch-herxheimer reaction:
Benzylpenicillin
107
State the common amoxicillin doses:
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
Which antibiotic can increase risk of infection/cholestatic jaundice:
Co-amoxiclav
109
What is the important safety information for flucloxacillin
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
What can quinolones induce:
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
State MHRA side effects for quinolones and when to stop treatment:
- Tendinitis
- Tendon damage
- Muscle pain and weakness
- Joint pain, peripheral neuropathy and CNS effects
112
Why are quinolones contraindicated in children:
Joint inflammation – arthropathy
113
State some cautions of quinolones:
Diabetes
Prolong QT interval prolongation
Exposure to excessive sunlight should be avoided
114
What is co-trimoxazole:
Sulfamexthoxazole and trimethoprim
115
State treatment of pneumocystis jirovecii:
Co-trimoxazole
116
Which tetracycline has an increased risk of lupus-erythematosus like syndrome and causes irreversible pigmentation:
Minocycline
117
State one caution for tetracyclines:
Myasethnia gravis / systemic lupus erythematosus
118
State common side effects of tetracyclines:
Diarrhoea, angioedema, tooth discolouration, photosensitivity reactions, skin reactions ALSO:
Headache and visual disturbances may indicate benign intracranial hypertension. Discontinue if raised IP develops.
119
State counselling points for tetracyclines:
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
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
121
Which tetracycline can cause tongue discolouration:
Minocycline
122
State a side effect of chloramphenicol if used in 3rd trimester:
Gray baby syndrome
123
State a side effect of vancomycin:
Red man syndrome
124
How long should topical fusidic acid cream be used for:
no longer than 10 days to avoid the development of resistance
125
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
126
How can linezolid impact the blood?
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
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
Recognise symptoms of sore throat, fever, rash, ulcer, bleeding, bruising, purpura develop
132
What are the tx phases for tb?
Initial phase - using four drugs
continuation phase - using two drugs
133
Which drugs make up the initial phase of tx for tb?
1. rifampicin
2. ethambutol
3. pyrazinamide
4. isoniazid (with pyridoxine)
continued for 2 months
134
Which drugs make up the continuation phase of tx for tb?
Rifampicin and isoniazide with pyridoxine for 4 months
135
What is the contraception advice for rifampicin?
effectiveness of hormornal contraceptives is reduce by rifampicin
136
What are the monitoring requirements for rifampicin?
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
What is the pt/carer advice for rifampicin?
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
State contraception advice for patients taking rifabutin:
Rifabutin induces hepatic enzymes and effectiveness of hormonal contraceptives is reduced
139
State patient carer advice with dapsone:
Blood disorder to recognise symptoms of sore throat, fever, ulcer, purpura, rash, bruising, bleeding
Rash with fever + eosinophila = discontinue immediately
140
State treatment of lyme disease (tick bite):
1. Doxycycline 2. Amoxicillin
3. Azithromycin
141
How long should unsupervised treatment of TB be taken for:
6 months ie in pregnancy and breastfeeding
142
State which conditions rifampicin is contraindicated in:
Acute porphyria’s and jaundice
143
State common side effects of rifampicin:
Nausea, vomiting, sweat discolouration, tears discolouration, urine red, sputum discolouration, AKI
144
State monitoring requirements for patients taking rifampicin:
Renal
Hepatic
FBCs
145
State patient carer advice for those taking rifampicin:
Rifampicin discolours soft contact lenses
Recognise signs of liver disorder: vomiting, nausea, malaise, jaundice
146
State side effect of bedaquiline:
QT interval prolongation
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
What is given alongside isoniazid to prevent peripheral neuropathy?
Pyridoxine hydrochloride prophylactically since the start of tx. Most likely to occur with pre-existing risk factors such as alcohol dependance and diabetes
150
What are the common signs and symptoms of a lower UTI
Dysuria, increased urinary frequency and urgency, urine that is strong smelling, abscess or failure, cloudy or contains blood, persistent lower abdominal pain.
151
What are the common signs/symptoms of an upper uti
Loin pain and fever
152
What is associated with asymptomatic bacteruria in pregnant women?
Risk factor for pyelonephritis and premature labour.
153
When are UTIs considered recurrent?
After at least 2x episodes in six months or three or more episodes within 12 months.
154
What is the non drug tx advice for UTIs?
drink plenty of water. wipe from front to back, do not delay urination, do not wear occlusive underwear
155
State treatment of lower UTI in women:
1. Trimethoprim or nitrofurantoin for 3 days
156
State treatment of lower UTI in men:
1. Trimethoprim for 7 days
2. Nitrofurantoin (if egfr more than 45 ml)
157
State treatment of lower UTI in pregnant women:
1. Nitrofurantoin
2. Amoxicillin
3. Cefalexin
158
State treatment of acute prostatitis:
1. Quinolones ciprofloxacin, ofloxacin
2. Trimethoprim
159
What is the tx for pyelonephritis?
Cefalexin
160
Discuss the tx for recurrent UTI
for postmenopausal women: consider vaginal oestrogen at lowest effective dose.
161
What is used for long term treatment or recurrent uncomplicated lower uti
Mehtanamine hippurate
162
What is a side effect of nitrofurantoin?
Acute pulmonary reactions can occur within the first week and are reversible with tx cessation
may discolour the urine, this is harmless
163
When should the use of nitrofurantoin be avoided?
egfr less than 45ml/min
164
What is the patient/carer advice for nitrofurantoin
Seek immediate medical attention if signs or symptoms of pulmonary, hepatic, haematological or neurological adverse reactions develop
165
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
166
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:
V oriconazole
167
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
168
What is pneumonia caused by:
Pneuomocystiis jiroveccii
169
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
170
State treatment of acute uncomplicated falciparum malaria:
Artemeter with lumenfantrine
171
State treatment for prophylaxis of falciparum malaria + acute uncomplicated falciparum malaria:
Atovaquone with proguanil hydrochloride
172
What is the length of prophylaxis for anti malarials?
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
What is the licensing of anti malarials
Mefloquine, atovquone and proguanil up to one year, doxy up to 2 years,
174
What is important to remember upon return from malaria areas?
Any illness that occurs within the first year, but especially within the first 3 months could be malaria.
175
Discuss anti-malarials and epilepsy
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
What is the advice for patients with asplenia travelling to a malaria area
At a particular risk of severe malaria, take rigorous precautions
177
What is the travel advice for pregnant women to malaria risk regions
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
What is the advice for patients taking anticoagulants requiring chemoprophylaxis?
Warfarin - start 2-3 weeks pre departure and ensure INR is stable. Check frequently
179
What is chloroquine used for:
Chloroquine + proguanil = prophylaxis of malaria in areas where there is little resistance
180
State use of doxycycline in adults and children over 12:
Prophylaxis of malaria and used in areas of widespread mefloquine or chloroquine resistance
181
What drug is used to eliminate the liver stages of p.vivax or p.ovale following choloroquine treatment:
Primaquine
182
State doxycycline use and specific counselling for prophylaxis of malaria:
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
Protection against bites:
- 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
Length of prophylaxis of antimalarials:
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
State the longest treatment it can be used for prophylaxis:
Doxycycline = up to 2 years
Mefloquine / malarone = up to 1 year
Chloroquine with proguanil = up to 5 years
186
What do you check for when patient is mefloquine or chloroquine:
1. CI in patients with history of seizures
2. Doxycycline given (but may interact too)
3. Atovaquone with proguanil
187
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
188
Which antimalarials do you avoid in renal impairment:
Avoid proguanil
Avoid malarone (proguanil with atovoquanone) and chloroquine if egfr is less than 30
189
What is falciparum malaria caused by:
Plasmodium falciparum
190
State some CI for chloroquine:
Diabetes (may lower it)
May lower seizure threshold Myasthenia gravis
191
State some side effect of chloroquine:
Ocular toxicity
QT interval prolongation
Chloroquine very toxic in overdose. Can cause arrythmias and convulsions
192
State contraindications for mefloquine:
History of psychiatric disorders, depression, convulsions
193
State important patient carer advice for patients taking mefloquine:
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
State mHRA warning with quinine:
Dose-dependent QT interval prolongation
195
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
196
What is the tx of HIV?
2 NRTIS plus an integrase inhibitor, or an NNRTI or PI
197
What is the recommended tx for HIV in pregnancy
NRTI of either tenofovir or abacavir with either emtricitabine and efavirenz or atazanavir
198
What is appropriate for pre-exposure prophylaxis for HIV
Emtricitabine with tenofovir
199
What is appropriate for post exposure prophylaxis in HIV
emtricitabine with tonofovir plus raltegravir for 28 days.
200
Which drugs are NRTIS
Abacavir, emtricitabine, tenofovir
201
Which drugs are NNRTIs
Etravirenz, etravirine
202
Which drugs are protease inhibitors
Atazanavir, darunavir, ritonavir
203
Which drugs are Integrase inhibitors
Carbotegravir, dolutegravir, elvitegravir
204
What has been reported in HIV patients with long term exposure to combination antiretroviral therapy
Osteonecrosis
