Infection Flashcards
1
Q
What drug works against anaerobic infections and protozoa?
A
metronidazole
2
Q
If meningococcal septicaemia is suspected, a single stat dose of what should be given?
A
benzylpenicillin
(ceftaxime in penicillin allergy)
(chloramphenicol if both not suitable)
3
Q
What are the treatment options for C.Diff infections?
A
Vancomycin
Fidaxomicin
4
Q
What would be the treatment choice for bacterial vaginosis?
A
Metronidazole 5-7 days or single high dose stat
5
Q
What would be the treatment choice for chlamydia?
A
Azithromycin or doxycycline
6
Q
What is the treatment choice for pelvic inflammatory disease?
A
Doxy + Metro + single dose of IM ceftriaxone
7
Q
What would be the treatment choice for an acute cough?
A
Doxycycline
8
Q
What would be the first line choice for impetigo?
A
Hydrogen peroxide 1% cream
9
Q
Treatment of cellulitis?
A
Fluclox
(clari if not suitable)
10
Q
Prophylaxis of infection following animal or human bite?
A
Co-amox
(doxy with metro if unsuitable)
11
Q
Treatment with aminoglycosides should not last longer than how many day?
A
7
12
Q
What is the MHRA alert for aminoglycosides?
A
Ototoxicity
13
Q
What condition are aminoglycosides contra-indicated in?
A
myasthenia gravis
14
Q
What type of organisms do aminoglycosides work against?
A
gram negative
15
Q
How would you manage obese patients taking aminoglycosides?
A
Use IBW
16
Q
What is the therapeutic range of gentamicin for multiple daily dosing?
A
Peak: 5-10mg/L
Trough: <2mg/L
17
Q
What is the peak and trough range for gentamicin when treating endocarditis with multiple daily dosing?
A
Peak: 3-5mg/L
Trough: <1mg/L
18
Q
What specific bacteria is aminoglycosides active against?
A
pseudomonas aeruginosa
19
Q
What are the treatment uses of aminoglycosides?
A
severe sepsis, pyelonephritis, complicated UTI, endocarditis
20
Q
With once daily dosing, what is the renal cut off for gentamicin?
A
<20ml/min
21
Q
With multiple daily dosing of gentamicin, after how many doses should a serum level be measured?
A
3-4 doses or after dose change
22
Q
Which other drugs given alongside gentamicin, would be concerning for risk of ototoxicity?
A
Loop diuretics and cisplatin
23
Q
What specific bacteria are carbapenems active against?
A
They are beta-lactam antibacterials having activity against pseudomonas aeruginosa
24
Q
Why does imipenem have to be given alongside cilastatin?
A
Cilastatin is an enzyme inhibitor which prevents the renal enzymes from inactivating the imipenem
25
Name the carbapenems and what do they treat?
ertapenem - gynae infections, diabetic foot infections
meropenem - meningitis, endocarditis, chronic LRTI in CF
26
What is the only medication that interacts with meropenem?
sodium valproate
(decreases concentration of valproate)
27
Which cephalosporins are suitable against CNS infections?
ceftriaxone and cefotaxime
28
Cephalosporins have cross sensitivity with which other group of antibacterials?
penicillins
29
What is the treatment options and duration of treatment for bronchiectasis?
amox, doxy, clari
7-14 days
30
What is the treatment options and duration of treatment for COPD?
amox, doxy, clari
5 days
31
What is the treatment options and duration of treatment for acute bronchitis?
1st Doxy
amox, clari
5 days
32
What is the treatment options and duration of treatment for lower UTIs in women?
nitro or trimeth
fosfomycin
pivmecillinam
amox (only with susceptible)
3 days
33
What is the treatment options and duration of treatment for lower UTIs in men?
nitro or trimeth
fosfomycin
pivmecillinam
amox (only with susceptible)
7 days
34
What is the treatment options and duration of treatment for lower UTI in pregnant women?
1st Nitro
Amox or cefalexin
7-14 days
35
What is the treatment options and duration of treatment for acute prostatitis?
1st Ciprofloxacin
2nd Ofloxacin
14 days
36
What is the treatment options and duration of treatment for pyelonephritis?
1st cefalexin
ciprofloxacin
14 days
37
What is the treatment options and duration of treatment for C.Diff infections?
1st vancomycin
2nd fidaxomicin
10 days
38
What is the treatment options and duration of treatment for campylobacter?
clari or azithro
Cipro (high resistance)
5-7 days
39
What is the treatment options and duration of treatment for diverticulitis?
1st co-amox
cefalexin + metro
trimethoprim + metro
5 days
40
What is the treatment options and duration of treatment for cellulitis?
Fluclox
Clari
Erythro (pregnancy)
Doxy
7 days
41
What is the treatment options and duration of treatment for animal bites?
co-amox
Doxy + metro
Prophylaxis: 3 days
treatment: 5 days
42
What is the treatment options and duration of treatment for localised non-bullous impetigo?
Hydrogen peroxide 1%
fusidic acid 2%
5 days
43
What is the treatment options and duration of treatment for widespread non-bullous impetigo?
fusidic acid 2%
Oral fluclox
5 days
44
What is the treatment options and duration of treatment for acute otitis media?
1st amox
2nd co-amox
clari if unsuitable
5-7 days
45
What is the treatment options and duration of treatment for acute otitis externa?
If pseudomonas suspected:
Ciprofloxacin
Or else:
Penicillin
Clari if not suitable
7-14 days
46
Which drugs are risk factors for developing C.Diff?
clindamycin
Cephalosporins
Broad spec penicillins
Fluoroquinolones
PPIs
47
What are CRB65 and CURB65 used to assess?
Severity of CAP
48
What dose CURB65 stand for?
Confusion
Urea > 7
Resp rate > 30
BP < 90/60
65 years or older
(0-1 low risk)
(2 intermediate risk)
(3-5 high risk)
49
Which of the following medications does not interact with methotrexate?
-amoxicillin
-cefalexin
-ciprofloxacin
-trimethoprim
cefalexin
50
What gram bacteria are glycopeptides active against?
gram positive
51
Which of the following can be used for MRSA infections?
-aminoglycosides
-glycopeptides
-penicillins
glycopeptides (vancomycin)
52
Which two glycopeptide medications must not be given orally when used for systemic infections?
Vancomycin and teicoplanin
53
What is the benefit to using teicoplanin over vancomycin?
teicoplanin has zero order kinetics, vancomycin has first
54
What is the drawback to using teicoplanin vs vancomycin?
does not cross the BBB
55
what is the target trough level for vancomycin for general infections vs endocarditis?
10-15 mg/mL for general
15-20 mg/mL for endo
56
What are side effects of vancomycin?
-nephrotoxicity
-ototoxicity
-red man syndrome
-blood dyscrasias
-skin disorders (SJS)
-thrombophlebitis (pain/ inflammation of veins at infusion site)
57
What symptoms can occur when vancomycin is given too quickly?
Red man syndrome (flushing of upper body)
hypotension
bronchospasms
58
What indications are clindamycin a treatment option for?
Bone and joint infections
59
What major side effect is clindamycin associated with?
antibiotic associated colitis
60
What counselling points should be made to patient taking clindamycin?
If diarrhoea develops, stop medication and see GP
61
which antibiotic is used against amoebic infections?
mepacrine
62
Name the macrolides?
erythromycin
clarithromycin
azithromycin
63
What would you need to monitor on an ECG for macrolides?
QT prolongation
64
What indications are macrolides for?
campylobacter enteritis, resp, skin infections, h.pylori eradication
65
Is clarithromycin an CYP450 enzyme inducer or inhibitor?
Inhibitor
66
Which of the macrolides are CYP450 inhibitors?
Erythromycin and clarithromycin
67
what are the counselling points for azithromycin, erythromycin and clarithromycin?
azithromycin - before food/ indigestion remedies (2 hrs)
erythromycin - before indigestion remedies (2 hrs)
clarithromycin - taste disturbance
68
What are common side effects of macrolides?
GI upset
QT prolongation
Hepatotoxicity
Ototoxicity at high doses
69
Can you give aminoglycosides during pregnancy? which ones are safer?
yes, but not routinely unless no other choice
gent and tobra safe
70
What effect does clarithromycin have on warfarin?
Increased risk of bleeding
71
What effect does clarithromycin have on a statin?
Increased risk of myopathy
72
Which of the following medication does not interact with clarithromycin?
-colchicine
-carbamazepine
-ramipril
-ondansetron
-colchicine - increased colchicine toxicity
-carbamazepine - carb is enzyme inducer
-ramipril
-ondansetron - QT prolongation
73
which of the macrolides should not be taken during pregnancy? and which is safest?
Clarithromycin unsafe in pregnancy
Erythromycin preferred
74
What are the MHRA alerts for erythromycin?
- increased cardiac risks (QT prolongation) and risk of interaction with rivaroxaban
-risk of infantile hypertrophic pyloric stenosis
75
How do the following drugs interact with aminoglycosides?
-bisphosphonates
-loop diuretics
-digoxin
-bisphosphonates - hypocalcaemia
-loop diuretics - risk of ototoxicity and nephrotoxicity
-digoxin - dig toxicity
76
Which DOAC interacts with erythromycin?
rivaroxaban
77
What type of antibiotic is aztreonam?
Monobactam
78
What 3 things do you need to monitor with aminoglycosides?
-renal
-hearing
-levels
79
What is an example of an anaerobic infection?
Dental infections and bacterial vaginosis
80
What is an example of a protozoal infection?
vaginal trichomoniasis
81
What are the common side effects of metronidazole?
GI upset
Taste disturbance
oral mucositis
furred tongue
82
Important counselling points for metronidazole?
Take with or after food
Avoid alcohol during and for 48 hours after - disulfuram-like reaction (flushing, tachycardia and hypotension)
may discolour urine (dark urine)
taste disturbances
83
Which of the following does not interact with metronidazole?
-ciclosporin
-digoxin
-warfarin
-phenobarbital
-lithium
Digoxin
-ciclosporin - increases levels
-warfarin - increases INR
-phenobarbital - metronidazole metabolism increased
-lithium - increased levels
84
What is the formulation of choice for benpen and why?
By injection - inactivated by gastric acid
85
Which two of the penicillins are considered narrow spectrum?
benpen and penv
86
What is the antibiotic of choice for pneumoccocal meningitis?
Ceftriaxone/ cefotaxime
87
What is the antibiotic of choice for meningococcal meningitis?
Benpen
88
What is penv used to treat?
tonsillitis
sinusitis
89
What is penv used prophylactically for?
following rheumatic fever, splenectomy and sickle-cell disease
90
What is a common side effect of ampicillin?
maculopapular rashes
91
Are ampicillin and amoxicillin broad or narrow spectrum?
Broad
92
Why is clavulanic acid given alongside amoxicillin?
clavulanic acid inactivates beta-lactamases (benpen and penv innefective against) and allows its use against more resistant strains
93
Which penicillins are extended spectrum?
piperacillin (with tazobactam)
ticarcillin (with clavulanic)
94
Can penicillins easily penetrate into the CSF?
No, unless the meninges are inflamed
95
What are common side effects of penicillins?
diarrhoea, nausea, skin reactions, vomiting, hypersensitivity, antibiotic associated colitis
96
What has an increased risk of tendon damage when taken alongside quinolones?
corticosteroids
97
What has an increased risk of convulsions when taken with quinolones?
NSAIDs
98
Pip/taz can affect which electrolytes at high doses?
hypernatremia
99
What is the risk if you give penicillins intrathecally?
Encaphalopathy
100
cautions for amoxicillin?
cytomegalovirus infection, leukaemia , glandular fever
101
What is the MHRA alert for flucloxacillin and co-fluampicil?
cholestatic jaundice and hepatitis may occur up to 2 months after treatment
102
Can you use flucloxacillin in pregnancy?
yes
103
What increases the risk of cholestatin jaundice and hepatitis with flucloxacillin?
increasing age and more than 14 days treatment
104
If patients have a true allergy to penicillins, which other groups of antibiotics should not be given?
beta-lactam antibiotics
(cephalosporins, carbapenems, monobactams)
105
What are the uses of piperacillin and ticarillin?
serious infections - septicaemia, HAP
106
what is temocillin reserved for?
beta-lactamase producing strains of gram negative bacteria
107
Which of the following do not interact with penicillins?
-allopurinol
-colchicine
-warfarin
-phenindione
-methotrexate
Colchicine
-allopurinol - increased risk of rash
-warfarin - increase INR
-phenindione -increase INR
-methotrexate - reduced clearance of MTX
108
Should fluclox and phenoxymethyl be taken with food?
no, empty stomach
109
Which penicillins cause hepatic disorders?
co-amoxicillin and fluclox
110
What is a specific side effect to amoxicillin?
black hairy tongue
111
penicillins can increase the risk of which diarrhoeal infection?
c.diff
112
What are the 5 MHRA alerts for quinolones?
- tendinopathy
- convulsions
- aortic aneurysm/ dissection
- heart valve regurgitation
- long lasting disabling side effects (peripheral neuropathy)
113
cautions for quinolones?
history of seizures, diabetes
114
what are the side effects of quinolones?
qt prolongation (especially moxofloxacin), GI upset, fungal infection
115
What is the risk of quinolones in children and pregnancy?
athropathy of weight bearing joints
116
When would it be appropriate to give a pregnant patient a dose of ciprofloxacin?
prevention of secondary meningococcal meningitis
117
what is the difference between early and latent syphilis?
early < 2 years
latent > 2 years
118
name the quinolones?
ciprofolxacin, deflafloxacin, levofloxacin, moxifloxacin, ofloxacin
119
What is the interaction between fluclox and methotrexate?
increased risk of hepatotoxicity
120
retinoids interact with tetracyclines to cause what?
increased intracranial pressure
121
why should tetracyclines be avoided in children?
risk of bone and teeth deposits
122
which tetracyclines have the greatest risk of oesophageal issues?
tetracycline, doxycycline and minocycline
123
what antibiotic is associated is associated with toxic megacolon?
co-amoxiclav
124
what antibiotics affect the eyes?
ethambutol and linezolid
125
which antibiotics do not require renal dosing?
doxycyline, ceftriaxone, clarithromycin, erythromycin, clindamycin, moxofloxacin
126
which 5 antibiotics should be taken with meals?
clarith, erith, trimeth, nitro, metro
127
how should sulfonamides be taken?
empty stomach
128
how should pivmecillinam be taken?
empty stomach
129
which of the tetracyclines has the broadest spectrum and is associated with increased risk of lupus-erythamatosus and irreversible pigmentation?
minocycline
130
which two of the tetracyclines have the most risk of photosensitivity?
doxy and dema
131
what are some common side effects of tetracyclines?
angiodema, photosensitivity, tooth discolouration, headache and visual disturbances (discontinue if happens)
132
what is the age range for tetracyclines?
>12 years
133
why should you not give tetracyclines in pregnancy?
effects on skeletal development
134
how should tetracyclines be taken?
with a full glass of water
135
name the two sulfonamides?
co-trimoxazole (trimethoprim & sulfamethoxazole)
sulfadiazine
136
side effects of sulfonamides?
diarrhoea, electrolytes imbalance, fungal overgrowth, skin reactions
blood dyscrasias and rash - discontinue if apparent
137
cautions of sulfonamides?
acute porphyrias, asthma, G6PD deficiency
138
co-trimoxazole is contraindicated in what?
SJS, TEN or thrombocytopenia previously
139
is chloramphenicol broad or narrow spectrum?
broad
140
what is the indication for chloramphenicol?
infections caused by haemophilus influenzae
141
what is the risk of chloramphenicol in pregnancy?
grey-baby syndrome
142
which tetracyclines can you continue in renal impairment?
doxy and mino
143
what should be done if psychiatric, neurological or hypersensitivity occurs with quinolones?
discontinue
144
what is the interaction between ciprofloxacin and theophylline?
cipro is an enzyme inhibitor causing theophylline
145
what is an important side effect regarding daptomycin?
unexplained muscle pain/ tenderness/ weakness/ cramps - measure CK every 2 days
146
fusidic acid should not be used for longer than how many days due to the risk of resistance?
10 days
147
what gram bacteria is linezolid active against?
gram positive including MRSA
148
what are the two warnings surrounding linezolid?
- optic neuropathy (increased risk if >28 days treatment)
- blood disorders
149
what is the risk from the interaction between linezolid and SSRIs, TCAs, MAOIs, opioids
hypertensive crisis
150
counselling points for linezolid?
avoid tyramine rich foods during and 2 weeks after (mature cheese, wines) - causes hypertensive crisis
151
trimethoprim cautions?
blood dyscrasias
152
what electrolyte can be affected by trimeth?
hyperkalaemia
153
side effects of trimethoprim?
SJS, toxic epidermal necrolysis, photosensitivity
154
How long is the treatment with Atovaquone with progaunil (malarone)?
1-2 days before, and 1 week after leaving
155
How long is the treatment with doxycycline?
1-2 days before, and 4 weeks after leaving
156
How long is the treatment with chloroquine?
1 week before, and 4 weeks after
157
How long is the treatment with proguanil?
1 week before, and 4 weeks after
158
How long is the treatment with mefloquine?
2-3 weeks before, and 4 weeks after
159
Which two anti-malarial are once a week?
chloroquine and mefloquine
160
contraindications for mefloquine?
psychiatric disorders (including any sleep disorders) and convulsions
cautioned with hypersensitivity to quines
161
contraindications for chloroquine?
convulsions
162
contraindications for malarone?
CrCl < 30
nausea - vomiting decreases absorption
163
interactions with malarone?
antivirals, metoclopramide, antacids (should take 2 hours apart)
164
counselling for malarone?
should be taken with milk
165
what should you look out for after coming back from a high risk area of malaria?
any symptoms for the first year, especially the first 3 months
166
what non-pharmacological advice could be given to people travelling to high risk areas for malaria?
deet 50%
167
what are the four antimalarials?
-chloroquine
-proguanil
-mefloquine
-doxycycline
168
contraindications for nitrofurantoin?
under 3 months, acute porphyrias, GP6D deficiency
169
side effects of nitrofurantoin?
nausea, risk of peripheral neuropathy in renal impairment?
170
what is the renal cut off for nitrofurantoin?
45
171
patient counselling for nitrofurantoin?
- take with food
- colours urine (yellow/ brown)
172
what is the effect of antacids on azole antifungals?
Interacts, azoles need acidic pH for absorption, reduces bioavailability
172
what is the effect of carbonated drinks on azole antifungals?
Interacts, carbonated drinks are acidic, would increase the bioavailability of azole
173
What is the effect of grapefruit juice on azole antifungals?
Interacts, reduces bioavailability
174
What are two side effects of itraconazole?
heart failure and hepatoxicity
175
What is the MHRA alert for ketoconazole?
Risk of fatal hepatotoxicity is greater than benefit of treating fungal infections
176
What are two side effects of voriconazole?
Phototoxicity (causes pre-malignant lesions or skin cancer - avoid direct sunlight and sunlamps) and hepatotoxicity
177
what is the indication for amphoteracin B?
serious fungal infections
178
What is the side effect for amphoteracin B?
nephrotoxicity
anaphylaxis with first doses IV - test dose
179
What is the MHRA alert for chloroquine?
increased cardiovascular risk with macrolides
180
what are the two types of protein synthesis?
50s and 30s
181
Which two antibiotics inhibit the 30s subunit?
aminoglycosides and tetrocylines
182
Which antibiotics inhibit the 50s subunit?
lincosamide, linezolid, macrolides, chloramphenicol
183
which antibiotics work by folate synthesis?
trimethoprim, sulfonamides, dapsone
184
which antibiotics inhibit DNA gyrase synthesis?
flouroquinolones
185
which antibiotics inhibit RNA polymerase?
rifampicin
186
Which antibiotics inhibit cell well synthesis?
penicillins, carbapenems, cephalosporins, glycopeptides
187
treatment for human and animal bites?
1st co-amox
2nd doxy + metro
3 days for prophylaxis
5 days for treatment
188
treatment for tick bites?
1st doxy 100mg BD
2nd amox 1g TDS
21 days
189
treatment for diabetic foot infection?
MILD (< 2cm):
1st fluclox
OR clari, erthro, doxy
MODERATE/ SEVERE (abscess or osteomyelitis):
1st fluclox or co-amox +/- gent
OR co-trimox +/- gent
190
treatment for cellulitis?
1st fluclox
OR clari, erythro, doxy, co-amox
IF NEAR EYES/ NOSE:
1st co-amox
OR clari + metro
191
treatment for diarrhoea?
C.DIFF:
1st oral vanc
2nd fidax
If life threatening - oral vanc and IV metro
10 days
TRAVELLERS DIARRHOEA:
standby: azith
prophylaxis/ treatment: bismuth subsalicylate
192
treatment for ear infections?
OTITIS MEDIA:
1st amox
2nd co-amox (2-3 days treatment failure and worsening symptoms)
OR clari, erythro (pregnancy)
OTITIS EXTERNA
1st topical acetic acid 2%
2nd topical neomycin sulphate with topical corticosteroid
3rd fluclox if systemic
193
treatment for H.pylori?
TRIPLE THERAPY:
PPI + 2 of:
amox 1g BD (included unless pen allergy)
clari 500mg BD
metro 400mg BD
194
how do you diagnose h.pylori?
urea breath test - should not be performed within 2 weeks of taking PPI, and 4 weeks of taking antibiotics
195
treatment for impetigo?
LOCALISED NON-BULLOUS:
1st hydrogen peroxide 1%
2nd fusidic acid 2% OR mupirocin 2% if resistance suspected
WIDESPREAD NON BULLOUS:
fusidic acid 2% OR mupirocin 2% if resistance suspected
BULLOUS/ SYSTEMICALLY UNWELL:
1st fluclox
2nd clari (erythro if pregnant)
196
treatment for UTI?
MEN:
1st nitro OR trimeth
7 days
WOMEN (NON-PREGNANT):
1st nitro OR trimeth
2nd pivmecillinam OR fosfomycin
3 days
WOMEN (PREGNANT):
1st nitro
2nd cefalexin OR amox
7 days
197
treatment for CAP?
LOW SEVERITY:
1st amox
2nd doxy, clari
MODERATE SEVERITY:
1st amox + clari
2nd doxy OR clari
HIGH SEVERITY:
1st co-amox + clari
2nd levofloxacin
198
treatment for HAP?
NON SEVERE:
1st co-amox
2nd doxy, cefalexin, co-trimox, levofloxacin (adults)
2nd clari (children)
199
treatment for acne vulgaris?
adapalene gel
clindamycin gel
benzyl peroxide
lymecycline
200
treatment for chlamydia?
doxycycline
201
treatment for bacterial vaginosis?
metronidazole (high dose STAT or course)
202
treatment for dental abscess?
amox
metronidazole
203
treatment for gonorrhoea?
ceftriaxone
ciprofloxacin
204
treatment for meningitis?
benpen
205
treatment for scabies?
permethrin cream (apply to whole body)
206
treatment for sinusitits?
phenoxy
doxy in allergy
207
treatment for conjunctivitis?
chloramphenicol
208
which of the following is least appropriate for treatment of covid?
-dexamethasone
-remdesivir
-paracetamol
-aciclovir
aciclovir
209
Cold sores are associated with which virus?
herpes simplex virus serotype 1
210
shingles and chickenpox are associated with which virus?
varicella-zoster
211
What anti-virals are appropriate for shingles in aged over 50?
aciclovir
apply all over body including head and scalp
212
which two antivirals are used for both treatment and post-exposure prophylaxis of influenza?
zanamivir and oseltamivir
213
a patient with asthma has developed sever flu, which of the following is the more appropriate option?
-zanamivir
-oseltamivir
oseltamivir
(zanamivir has risk of bronchospasm and should be avoided in sever asthma)
214
what is the treatment of choice for threadworm, what is the age range and duration?
mebendazole
treat whole family, given as single dose and treated after 2 weeks (reinfection very common)
215
what is treatment options for vaginal thrush?
clotrimazole
itraconazole for resistant infection
