Infection Flashcards
1
Q
Name tetracyclines
A
doxycycline, demeclocycline, lymecycline, minocycline, oxytetracycline, tetracycline, tigecycline
2
Q
what is on the label of tetracyclines
A
do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
3
Q
which tetracyclines are okay with metal ions
A
- Doxycycline
- Lymecycline
- Minocycline
Does Like Milk
4
Q
Side effects of tetracyclines
A
- benign intracranial hypertension - stop & report headache/visual disturbance
- lupus-erythematous like syndrome and irreversible pigmentation in sunlight
- teeth discolouration and bone deposits
5
Q
which tetracycline has biggest risk of pigmentation in the sun
A
minocycline
6
Q
who should you avoid tetracycline in
A
- under 12 years old
- pregnant
7
Q
tetracyclines counselling points
A
- hepatotoxicity - avoid in liver failure
- photosensitivity = avoid sunlight/sunlamps
- dysphagia = swallow whole, plenty fluid, while sitting/standing
- caution in myasthenia gravis
8
Q
Metronidazole side effects
A
- taste disturbance (metallic taste/furred tongue)
- NV (take with/after food)
9
Q
What to avoid with metronidazole
A
- alcohol during and 48 hours after treatment
- causes disulfiram reactions (NV, flushing)
10
Q
When to avoid nitrofurantoin
A
- pregnant = avoid at term
- eGFR < 45
11
Q
Nitrofurantoin administration directions
A
with/after food
12
Q
Nitrofurantoin urine colour
A
yellow/brown
13
Q
Trimethoprim cautions
A
- blood dyscrasias - fever, sore throat, rash, mouth ulcers, bruising, bleeding
- antifolate so interaction with MTX, phenytoin, folic acid
- hyperkalaemia
- caution in renal impairment
14
Q
Name quinolones
A
ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin
15
Q
Quinolones cause
A
- reduce seizure threshold (avoid in epilepsy) - also with NSAIDs
- psychiatric and tendon disorders
- allergies
- reduce sunlight and UV exposure
- may impair driving ability
16
Q
Quinolones MHRA warnings
A
- tendonitis
- risk of aortic aneurysm and dissection - sever abdo, chest, back pain
- risk of heart valve regurgitation - SOB, peripheral oedema, new heart palpitations
17
Q
Quinolones cautions
A
- QT prolongation
- myasthenia gravis
- arthropathy in children/adolescents
- perforated tympanic membrane when used by ear
18
Q
Quinolones interactions
A
- dairy/mineral - fortified milk (reduces absorption)
- drugs causing QT prolongation
- drugs reducing seizure threshold (NSAIDs)
19
Q
Chloramphenicol common indication
A
eye infection
20
Q
Chloramphenicol OTC age
A
2 years and over
21
Q
Chloramphenicol contraindication
A
pregnancy - ‘grey baby syndrome’ if used in 3rd trimester
22
Q
Clindamycin side effects
A
- abx-associated colitis (fatal) - more common in elderly, discontinue & contact dr ASAP if severe, prolonged, or bloody diarrhoea
- suspected C. diff - stop, specialist advice if cant stop
23
Q
Linezolid side effects
A
- severe optic neuropathy - monitor eyes regularly if tx > 28 days
- blood disorders - FBC weekly if tx > 10-14 days
24
Q
Linezolid interactions
A
- tyramine - mature cheese, marmite, yeast extract, fermented soya bean extract, some beers and wines
- serotonin syndrome - SSRIs, dopaminergic, 5-HT1 agonists, TCAs, Lithium, MAOIs - altered cognitive state = coma
25
Name narrow spec penicillins
- Pen G (benzylpenicillin) - parenteral use only (not gastric acid stable)
- pen V (phenoxymethylpenicillin)
26
Name broad spec penicillins
- ampicillin
- amoxicillin
- co-amoxiclav (b-lactamase resistant)
27
Broad spec penicillins side effects
- diarrhoea common - abx-associated colitis
- maculopapular rashes common in patients with glandulofever - dont use broad spec blindly for sore throat
28
Name Penicillinase - resistant penicillins and give details
- flucloxacillin
- take on empty stomach 1 hour before or 2 hours after food (after hard as QDS)
- cholestatic jaundice/hepatitis risk unto 2 months after stopping. Risk = administration > 2 wks, increased age - same for co-amox
29
Name antipseudomonal penicillins
- piperacillin only available with tazobactam
- ticarcillin only available with clavulanic acid
30
Penicillins side effects
- DONT give intrathecally - encephalopathy = FATAL
- true pen allergy = immediate rash, anaphylaxis
- may not be allergy = minor rash, small, not itchy, non-confluent, rash after 72 hours
- cross-sensitivity = cephalosporins
31
Name 1st gen cephalosporins
- Cefadroxil
- Cefalexin
- Cefradine
Fad, Fal, Frad
32
Name 2nd gen cephalosporins
- Cefuroxime
- Cefoxitin
- Cefaclor
Furry Fox Face
33
3rd and 5th gen cephalosporins
all parenteral except oral cefixime
34
Cephalosporins contraindications
penicillins and other b-lactams due to cross sensitivity
35
Name glycopeptides
dalbavanacin, teicoplanin, telavancin, vancomycin
36
Vancomycin details
- parenterally for systemic infections (reduced absorption orally)
- avoid in preg unless benefits > risk
- initial dose by body weight then adjust based on levels
37
Vancomycin levels
- trough = 15-20mg/L
- measure before next dose
38
Vancomycin interactions
- ototoxicity - cisplatin, vinka alkaloids, aminoglycosides, loop diuretics
- nephrotoxicity - NSAIDs, ACEi, ARBs, Metformin, diuretics
39
Vancomycin side effects
- red man syndroms
- steven johnson syndrome
- blood dyscrasias
- cardiogenic shock on rapid IV injection
- anaphylactoid reactions at infusion sites - avoid rapid infusion, rotations sites
40
Name macrolides
- azithromycin - OD (COPD prophylaxis = 3x week)
- clarithromycin - BD
- erythromycin - QDS
41
Macrolides cautions
- myasthenia gravis
- erythro > clarithro in pregnancy
- avoid clarithro in 1st trimester
42
Macrolides side effects
- hepatotoxicity
- ototoxicity in large doses
- increased GI disturbances
- QT prolongation
43
Macrolides interactions
- macrolides = CYP inhibitors so increase levels of statins and warfarin (myopathy/bleeding)
- hypokalaemia - diuretics, steroids, salbutamol, theophylline
- increased QT prolongation - amiodarone, domperidone, fluconazole, lithium, SSRIs, methadone, ondansetron, quinine, quinolones, sotalol
44
Name aminoglycosides
- amikacin, gentamicin, neomycin, streptomycin, tobramycin
45
Who should serum concentrations of aminoglycosides be taken for
- all patients receiving parenteral aminoglycosides
- must be determined in obesity, high doses, cystic fibrosis, elderly
46
Gentamicin levels
- after 3 or 4 doses, then every 3 days or after a dose change, more frequent if renal impairment
- measure 1 hour after dose and just before next dose
47
Gentamicin multiple daily dose regimen level targets
- peak = 5-10mg/L
- peak in endocarditis = 3-5mg/L bcos co-prescribed with other abx
- trough = <2 mg/L
- trough in endocarditis = < 1 mg/L as co-prescribed with other abx
48
Gentamicin dose adjustments based on levels
- trough too high = increase dose interval
- peak too high = decrease dose
- renal impairment = increase interval, decrease dose if severe - avoid concomitant use of nephrotoxics
49
Gentamicin interactions
- ototoxicity - cisplatin, loop diuretics, vancomycin, vinka alkaloids
- nephrotoxicity - NSAIDs, ACEi, ARBs, Metformin, diuretics
50
Gentamicin contraindications
- myasthenia gravis
- pregnancy - risk of auditory or vestibular nerve damage - monitor serum concs
51
Gentamicin dose in obesity
use ideal body weight based on height to calculate parenteral dose
52
Aims of antimicrobial stewardship
- prevents resistance
- less unnecessary treatment, more caution
- higher risk of resistance with broad spec abx
53
Antimicrobial stewardship NICE guidance
- only start abx if clinical evidence of bacteria
- follow local guidelines
- futures to narrow spectrum
- avoid broad spec if possible
- avoid widespread use of topical abx especially if systemic available
54
Which abx come with risk of C. diff, MRSA, abx resistant UTIs
- co-amox
- quinolones (ciprofloxacin)
- cephalosporins
- clindamycin
55
Most common pathogen of CAP
streptococcus pneumoniae
56
Most common pathogen of UTIs
escherichia coli
57
Most common pathogen of thrush
candida albicans
58
Most common pathogen of cellulitis
staphylococcus aureus
59
Most common pathogen of meningitis
streptococcus pneumoniae
60
Most common pathogen of sore throat
streptococci
61
Treatment of human/animal bites
1. co-amox
2. doxy + metro
- prophylaxis = 3 days, Tx = 5 days
- scratches = fluclox
62
Treatment of tick bites (Lyme disease)
1. doxy (100mg BD)
2. amoxicillin (1g TDS)
- Tx = 21 days
63
Cellulitis treatment
1. fluclox
- alt: clarithro (erythro-preg), or doxy, or co-amox
1. near eyes/nose = co-amox
- alt: clarithro and metro
64
mild CAP treatment
1. amox
2. doxy or clarithro (erythro-preg)
65
mod CAP treatment
1. amoxicillin and clarithro (erythro-preg)
2. doxy or clarithro (erythro-preg)
66
severe CAP treatment
1. co-amox and clarithro (erythro-preg)
2. levofloxacin
67
mild (<2cm) diabetic foot infection treatment
1. fluclox
- alt: clarithro (erythro-preg)
68
mod/severe diabetic foot infection (abscess, osteomyelitis)
1. fluclox or co-amox +/- gent
- alt: co-trimox +/- gent
69
C. diff treatment
1. vancomycin
2. fidoxamicin
- life threatening = vancomycin and IV metro
- 10 days tx
70
travellers diarrhoea treatment
- standby: azithromycin
- prophylaxis/tx = bismuth subsalicylate
71
Otitis media treatment
1. amoxicillin
2. co-amox (if worsening after 2-3 days
- alt: clarithro (erythro-preg)
72
Otitis externa treatment
1. topical acetic acid 2%
2. topical neomycin + hydrocortisone
- if systemic tx required - fluclox
73
H. pylori treatment
- Urea 13c breath test not within 2 wks PPI or 4 wks abx
1. PPI + amoxicillin + clarithro
- pen allergy = metro
74
mild HAP treatment
1. co-amox
2. adults = doxy or cefalexin or co-trimox or levofloxacin
2. children = clarithro
(doxy in children = teeth/bone deposits, discolouration of teeth, avoid in < 12 yrs)
75
localised non-bullous impetigo treatment
1. hydrogen peroxide 1%
2. fusidic acid (resistant = mupirocin 2%)
76
Chloramphenicol eye drops dosage
- 1 drop every 2 hours during waking hours for the first 48 hours then 1 drop 4 hourly for the next 72 hours during waking hours
- 5 day course total
77
widespread non-bullous impetigo treatment
1. fusidic acid (resistant = mupirocin 2%)
78
bullous or systemically unwell impetigo treatment
1. fluclox
2. clarithro (erythro-preg)
79
lower UTI men tx
nitro or trimeth
80
lower UTI non-preg tx
1. nitro or trimethoprim
2. pivmecillinam or fosfomycin
81
lower UTI preg tx
1. nitro
2. cefalexin or amoxicillin
82
lower UTI tx cautions
- trimethoprim = teratogenic, interacts with folic acid, MTX, phenytoin
- nitro not in eGFR < 45
- men, preg, catheter = 7 days tx
- uncomplicated = 3 days tx
83
strep throat and scarlett fever tx
- both part of streptococcus bacteria family
1. phenoxymethylpenicillin
2. clarithro (erythro-preg)
84
What is scarlett fever
- flu-like symptoms
- swollen neck glands
- red rash with small raised bumps
- rough feeling like sandpaper
- white coating on tongue
85
acne vulgaris treatment
adapalene, clindamycin, benzoyl peroxide, lymecycline
86
BV and trichomoniasis treatment
metronidazole
87
chlamydia treatment
doxycycline
88
conjunctivitis and blepharitis tx
chloramphenicol (not OTC < 2 yrs)
89
dental abscess tx
amoxicillin or metro
90
gonorrhoea tx
ceftraxone or ciprofloxacin
91
meningitis tx
benzylpenicillin
92
scabies tx
permethrin - whole body neck down - tx whole house
93
sinusitis tx
phenoxymethylpenicllin (allergy = doxy)
94
threadworm tx
mebendazole - not <2 yrs, preg - tx whole house
95
Name narrow spec antibiotics
- Pen V and G
- Glycopeptides
- Trimethoprim
- Linezolid
- Clindamycin
PG TLC
96
Name broad spec antibiotics
- Chloramphenicol
- Aminoglycosides
- Penicillins (amoxicillin, ampicillin)
- Tetracycline
- Nitrofurantoin
- Macrolides
- Cephalosporins
- Quinolones
CAPTN MCQ
97
Name anaerobic antibiotics
metronidazole
98
Name bacteriostatic antibiotics
- prevents bacterial growth
- Chloramphenicol
- Linezolid
- Tetracyclines
- Macrolides
- Clindamycin
99
Name bactericidal antibiotics
- kills bacteria
- Cephalosporins
- Aminoglycosides
- Nitrofurantoin
- Trimethoprim
- Quinolones
- Metronidazole
- Glycopeptides
- Penicillins
100
Which antibiotics should be taken with/after food
- metronidazole
- clarithromycin MR
- nitrofurantoin
- pivmecillinam
101
Which antibiotics should be taken on an empty stomach (30-60 mins pre/2 hours after food)
- flucloxacillin
- phenoxymethylpenicillin
- azithromycin capsules (not tabs or liquid)
- tetracycline
- oxytetracycline
102
What is myasthenia gravis
muscle weakness especially in face (droopy eyes, slurred speech)
103
Which antibiotics should be taken in caution with myasthenia gravis
- Quinolones
- Aminoglycosides (gent)
- Macrolides
- Tetracyclines
104
Which antibiotics are nephrotoxic
- nitrofurantoin (<45 - avoid)
- aminoglycosides (gent)
- glycopeptides (vancomycin, teic)
- tetracyclines and trimethoprim - lower risk
105
Which antibiotics are hepatotoxic
- macrolides
- fluclox
- co-amox
- rifampicin, isoniazid, pyrazinamide
- chloramphenicol, nitrofurantoin, tetracyclines - lower risk
106
Malaria - bite protection
- mosquito nets covered in permethrin
- DEET 20-50% - okay for > 2 months old - avoid ingestion
- DEET suitable if pregnant/breastfeeding - was breast before feeding
- DEET after sunscreen - reduces SPF so use high SPF lotion
107
Malaria - patient groups
- asplenia - risk of severe malaria
- preg = avoid malaria areas, only chloroquine or proguanil suitable but risk of NTD so take folic acid 5mg
108
Malaria - medication groups
- epilepsy - avoid chloroquine and mefloquine - reduces seizure threshold
- warfarin = start 2-3 wks before, measure INR before tx, 7 days after and after completing course. prolonged stays = check regularly
109
Mefloquine cautions
- psychiatric disorder - stop and medical attention
- convulsions
110
Chloroquine cautions
- convulsions
- retinotoxic
111
Proguanil cautions
- renal impairment - reduce dose
112
Malaria - Doxycycline cautions
avoid exposure to sunlight
113
Malaria - standby treatment
- carry emergency tx if likely to be more than 24 hrs away from medical care
- avoid self-medication if possible
- provide written instructions: seek attention if fever develops 7 days after arriving in malarious area, self treat if help not available within 24 hours of fever onset
114
Atovaquone/proguanil details
- malarone (POM) or Maloff protect (P) - OTC > > 18 yrs, > > 40kg (6st 4lbs)
- start 1-2 days before until 1 week after
- 1OD
- max use = 1 year
115
Chloroquine details
- OTC alone or with proguanil
- start 1 week before until 4 weeks after
- 1 a week
- max use = long-term (PC Long)
116
Proguanil details
- OTC alone or with chloroquine
- start 1 week before until 4 weeks after
- 1OD
- max use = long term (PC Long)
117
Mefloquine details
- POM
- start 2-3 weeks before until 4 weeks after
- 1 weekly
- max use = 1 year
118
Doxycycline details
- POM
- start 1-2 days before until 4 weeks after
- 1OD
- max use = 2 years
119
Malaria advice
illness within 1 year, especially 3 months of return, might still be malaria - see dr early mention malaria
120
Tuberculosis treatment
- initial 2 months = RIPE
- continue for further 4 months = RI
- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol
- total 6 months treatment
121
Latent TB treatment
- 3 months rifampicin and isoniazid or 6 months isoniazid
- if 35 - 65 years old, should be cleared of hepatotoxicity
122
Rifampicin details
- discolours soft contact lenses and bodily fluids red/orange
- CYP 450 inducer
123
Isoniazid details
- peripheral neuropathy - give B6 (pyridoxine)
- CYP 450 inhibitor
124
Pyrazinamide details
- hepatotoxic
125
Ethambutol details
- visual impairment and ocular toxicity
126
Varicella zoster (chicken pox, herpes zoster, shingles) treatment
- aciclovir/valaciclovir (pro drug)
- chicken pox = never NSAIDs - age 14 yrs + = antiviral within 24 hours of onset
- herpes/shingles = tingling sensation, burning, fluid filled blisters - follows nerves on one side of body - belt/half-belt around rib cage/torso
127
Aspergillosis treatment
voriconazole
128
cryptococcosis treatment
amphotericin B
129
vaginal thrush treatment
- clotrimazole/fluconazole
- resistant = itraconazole
130
oral thrush treatment
- nystatin/miconazole/fluconazole
- resistant = itraconazole
131
fungal skin and nail infections treatment
- topical therapy
- systemic therapy (itraconazole, terbinafine)
132
Name all the places of Tinea (ringworm)
- Tinea capitis = head
- Tinea corporis = body
- Tinea cruris = groin
- Tinea pedis = feet
- Tinea unguium/onchomyosis
133
Tinea (ringworm) treatment
topical anti fungal cream or terbinafine
134
OTC antifungals
- terbinafine or amorolfine nail laquer
- OTC for 18 yrs +, refer to GP if <18yrs, 2 + nails affected, diabetic, preg, breastfeeding
- once weekly for upto 1 year, have to wait for whole nail to grow out
135
Name antifungal medications
fluconazole, itraconazole, ketoconazole, voriconazole
136
antifungal meds cautions
- QT prolongation
- hepatotoxicity
- less risk in fluconazole, more risk in itraconazole, ketoconazole, voriconazole
137
Itraconazole details
carbonated drinks improve bioavailability
138
Ketoconazole side effect
life threatening hepatotoxicity - oral tx suspended
139
Voriconazole side effect
phototoxicity uncommonly - avoid sunlight
140
Terbinafine side effect
hepatotoxicity
141
Amphotericin B cautions
- renal failure
- anaphylaxis risk with IV - test with 30 min observations
- prophylactic antipyretics or hydrocortisone if previous reaction
- maintain same formulation between conventional, liposomal, and lipid complex formulations - serious harm/fatal
142
Phenoxymethylpenicillin administration instructions
take on empty stomach, 1 hour before or 2 hours after food
143
Pyridoxine dose
for prevention of isoniazid associated peripheral neuropathy: 10 - 20mg daily
144
Gentamicin max length of treatment for multiple daily dose regimen
7 days
145
Mefloquine contra indications
- psychiatric disorders
- depression
- anxiety
- abnormal dreams
146
Which antibiotics are appropriate for UTI
- nitrofurantoin
- timethoprim
- pivmecillinam
- oral cephalosporins
147
Quinolones - increased risk of tendon damage with:
- concomitant use of corticosteroids
- > 60 years old
- history of tendon disorders
148
Miconazole cream length of treatment
continued for 10 days after lesions cleared
149
Gentamicin once daily levels how many hours after dose
20 hours
150
Antibiotics appropriate in chest infection
- amoxicillin
- doxycycline
- azithromycin
151
Exacerbation of chronic bronchitis treatment
- amoxicillin/ampicillin
- tetracycline
152
Which antibiotic can be used for pseudomonas infections
tobramycin
153
Which antibiotic can be used for staphylococcus infections
flucloxacillin
154
Endogenous Cushing's Syndrome treatment
ketoconazole 400-600mg in 2-3 doses, increased to 800mg to 1200mg. Maintenance = 400 to 800mg daily in 2-3 doses
155
Chlamydia treatment
- azithromycin 1g stat
- doxycycline 7 days
156
Phenoxymethylpenicillin dose for 6-11 year old
250mg QDS
157
Recurrent vaginal thrush treatment
fluconazole 150mg every third day for a total of 3 doses followed by 150mg once weekly for 6 months
158
threadworm treatment for children 6 months and under
hygiene measures alone
159
no interaction between metronidazole and
carbamazepine
160
severe renal impairment eGFR
<30
161
TB drugs and hepatotoxicity
- Rifampicin, Isoniazid, Pyrazinamide, Pyridoxine cause hepatotoxicity
- Ethambutol is the ONLY one that does not cause hepatotoxicity
162
Oseltamivir for influenza prophylaxis eligibility
can have if 'at-risk', includes > 65 years, one or more chronic conditions including diabetes
