Infection Flashcards
1
Q
What is the first line tx for human and animal bites?
A
co-amoxiclav
tx - 5dy
prophylaxis - 3dy
2
Q
What is the second line tx for human and animal bites?
A
doxycyclinr + metronidazole
tx - 5dy
prophylaxis - 3dy
3
Q
what do you use to tx human and animal scratches?
A
flucloxacillin
4
Q
what is 1st line for tick bites (lyme disease)
A
doxycycline 100mg BD 21dy
5
Q
what is 2nd line for tick bites (lyme disease)
A
amoxicillin 1g TDS 21dy
6
Q
1st line for diabetic foot infection less than 2cm
A
flucloxacillin
7
Q
2nd line or penicilin allergy for diabetic foot infection less than 2cm
A
clarithyromycin, erythromycin or doxycycline
8
Q
1st line for diabetic foot infection - severe abscess or oestomyelitis
A
flucloxacillin or co-amox +/- gentamicin
9
Q
2nd line or pen allergy for diabetic foot infection - severe abscess or oestomyelitis
A
co-trimoxazole +/- gentamicin
10
Q
1st line for cellulitis
A
flucloxacillin
11
Q
tx for cellulitis if pen allergy or if flucloxacillin unsuitable
A
clarithyromycin, erythromycin
doxycycline
co-amox
12
Q
tx if infection near nose/eyes
A
co-amox
13
Q
tx if infection near nose/eyes + pen allergy
A
clarithromycin + metronidazole
14
Q
tx for low severity community acquired pneumonia
A
1st - amox
2nd doxy / clarithy / erytho
15
Q
tx for moderate severity community acquired pneumonia
A
1st amox + clarith
2nd doxy or clarith
16
Q
tx for high severity community acquired pneumonia
A
1st co-amox + clarith
2nd levofloxacin
17
Q
c.diff tx
A
1st vancomycin
2nd fidaxomicin
life threat - vanco + iv metronidazole
18
Q
travellers diarrhoea tx
A
Aithromycin
prophylaxis/tx - bismuth subsalicylate
19
Q
otitis media
A
1st amox
2nd co-amox
or clarith/erytho if allergy
20
Q
otitis externa
A
1st acetic acid 2%
2nd topical neomycin + corticosteriod
if systemic = fluclox
21
Q
h.plyori tx
A
-triple therapy
-PPI (x omeprazole if clopidogrel) with amox 1g BD or metronidazole 400mg BD or clarithromycin 500mg BD
22
Q
how do you diagnose h.pylori
A
urea 13C breath test x 2WK after PPI or 4WK after antibiotics
23
Q
non-severe hospital acquired pneumonia tx
A
-1st co-amox
-2nd (adults) doxycl or cefalexin or co-trimox or levofloxacin
-2nd (child) clarithromycin
24
Q
impetigo localised non-bullous
A
1st hydrogen peroxide
2nd fusidic acid or mupirocin 2%
25
impetigo wide spread non-bullous
fusidic acid or mupirocin
26
impetigo bullous or systemically unwell
1st flucloxacillin
2nd clarithy
27
lower uti men
1st nitrofurantoin or trimethoprim for 7DY
28
lower uti non preg
1st nitrofurantoin or trimethoprim
2nd pivmecillinam or fosfomycin
if uncomplicated 3DY
29
lower uti pregn
1st nitrofurantoin (if egfr >45)
2nd cefalexin or amox
7DY tx
30
what causes strep throat and scarlet fever and what is the tx?
-streptococcus
-1st phenoxymethylpenicillin
-2nd clarithromycin
31
scarlet fever symptoms
- flu like symp - high temp, swollen neck glands
-red rash small raised bumps rough feeling = sandpaper
-white coating on tongue
32
tx of acne vulgaris
adapalene, clindamycin, benzoyl peroxide, lymecycline
33
tx of bacterial vaginosis _ trichomoniasis
metronidazole
34
tx of chlamydia
doxy
35
tx of conjunctivitis b+ blepharitis
choramphenicol x under 2 (POM) or pregn
36
tx of dental absess
amox or metronidazole
37
tx of gonorrhoea
ceftriaxone or ciprofloxacin
38
tx of meningtisis
benzylpenicillin
39
tx of scabies
permethrin ( whole body)
40
tx of sinusitis
phenoxymethylpencillin or doxycl
41
tx of threatworm
mebendazole x under 2 or pregn
42
what pathogen causes community acquired pnuem
streptococcus pneumoniae
43
what pathogen causes uti
e.coli
44
what pathogen causes thrush
candida albicans
45
what pathogen causes cellulitis
staphylococcus aures
46
what pathogen causes meningitis
steptococcus pneumoniae
47
what are aminoglycosides
amikacin, gentamicin, neomycin, streptomycin, tobramycin
48
when does serum aminoglycosides conc need to be measured
all pt with parental
obesity, high doses, cystic fibrosis and elderly
measure after 3-4 doses then every 3DY and after dose change
49
what is peak concentration
level after 1hr after dose - if high lower dose.
for aminoglycosides conc = 5-10mg/l endocarditis - 3-5mg/l
50
what is trough concentration
level before next dose - if high increase interval
for aminoglycosides conc = <2 mg/l endocarditis -<1mg/l
51
renal impairment and aminoglycosides
increase dose interval if severe decrease dose
avoid co-comitant use of nephrotoxic drugs
52
what is the MHRA warning with aminoglycosides
use of aminoglycosides assoc with ototoxicity
- interactions with cisplatin, loop diuretics (furosemide, bumentide, torsemide), vancomycin, vinca alkaloids (vinblastine, vinasitine, vindesine, vinflusline)
53
CI with aminoglycosides
myarthesria gravis
pregn - risk of auditory or vestibular nerve damage
obesity - ideal body weight for parental dose
54
1st gen of cephalosporins
cefadroxil, cefalexin, cefradine
55
2nd gen of cephalosporins
cefuroxime, cefoxitin, cefaclor
56
3rd + 5th gen of cephalosporins
all parental apart from oral cefixime
57
is cephalosporins okay in penicillin allergy?
if hypersensitivity to penicillin or other beta-lactams there is cross sensitivity so NO
58
s/e of clindamycin
-antibiotic assoc-colitis can be fatal high risk in elderly contact doc if severe, prolonged or bloody diarrhoea
-in c.diff if suspected discontinue
59
what are glycopeptides
dalbavancin, teicoplanin, tstevancin + vancomycin
60
caution with glycopeptides
-for systemic infections use parental route with vancomycin due to low absorption with oral route
-avoid in pregn (benefit vs risk)
-initial dose based on weight then adjust based on vanco conc = trough = 15-20
-can cause ototoxicity and nephrotoxicity
61
glycopeptides s/e
-red man syndrome
-severe cutaneous adverse steven-johnson syndrome
-blood dyserasis - agranulocytosis, eosinophilia + neutropenia
-cardiogenic shock on rapid IV inj
-risk of anphylactoid reactions at infusion site avoid rapid infusion and rotate site
62
linezolid caution
-risk of severe optic neuropathy - report visual impairment + monitor reg if tx more than 28DY
-risk of blood disorders - weekly monitor FBC regular if tx more than 10-14DY
63
linezolid interactions
-tyramine rich foods - mature cheese, marmite, yeast extract, fermented soya bean extract, beers and wine
64
linezolid + serotonin syndrome
- SSRI, dipaminergics, 5-HT1 agonists, TCAs, lithium + MOAIs
65
what are macrolides
azithromycin (OD), clarithromycin (BD), erythromycin (QDS)
66
macrolides caution
-myasthenia gravis
-pregn only erytho
67
macrolides s/e
-hepatoxity
-ototoxicity (hearing loss in high dose)
- high GI s.e N+V+D
-QT prolongation
68
macrolides interactions
- cyp450 inhibitors - statins inc myopathy, warfarin inc bleeding
-hypokalaemia - loop diureitcs/thiazides, steroids, salbutamol, theophylline,
-QT prolongation - amiadrone, domperidone, fluconazole, lithium, methadone, ondansetron, quinine, quinolones, SSRIs, sotalol
69
metronidazole s/e
-taste disturbance, metallic taste, furred tongue
-n+v
- x alcohol (48hr after)
70
nitrofurantoin caution
-x pregn
-renal impairment avoid if egfr <45
-may discolour urine yellow/brown
-with/after food
71
narrow spectrum penicillin (beta lactamase sensitive)
-penicilin G benzylpenicillin
-->x gastric acid safe so only parental
-penicillin V phenoxymethylpenicillin
--> gastric safe
72
broad spectrum penicillin (beta lactamase sensitive)
-amox
-amox + clavulanic acid (co-amox) --> beta lactamase resistant
73
broad spectrum penicillin side effects
-diarrhoea
-maculopapular rashes commonly occur in pt = glandular fever x use broad spec in sore throats blindly
74
penicillinase resistant penicillin
- fluclox
-empty acid 1hr before food / 2hr after food
- cholestastic jaundice + hepatitis = v rare but up to 2 MT POST TX
-if more than 2wk inc s.e with age
75
antipseudomonal penicillin
-piperacillin + tazobactam
- ticarcillin + clavulanic acid
76
s/e of penicillin
- x intrathecathy - encephalopathy = fatal
- true penc allergy ; rashes or anaphylactic
- x allergy ; minor rashes, small, hot, itchy + con-confluent or rash after 72hr
-cross sens - x give cephlasporins
77
quinolones
ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin
78
quinolones caution + s/e
-lower seizure threshold avoid in epilepsy
- psychotic disorders
- tendon disorders
-hypersen reactions
- sunlight + uv radiation lower exposure
- impair driving
79
quinolones MHRA
-tendinitis - higher in 60+, stop and seek advice if suspected
- small risk of aneurysm + dissection (sudden onset, severe abdominal chest back pain)
-small heart valve regurgitation (SoB, peripheral, new heart palpations, odema)
80
quinolones caution
-qt prolongation
-myasthenia gravis
-arthropathy in children and teens
-perforated tympanic membrane (ear)
81
quinolones interaction
food, water - avoid dairy products, mineral fortified drinks, lower absorption of drugs - qt prolongation
-seizure threshold + NSAIDs (ibuprofen)
82
tetracyclines
doxycycline, demeclocycline, lymecycline, minocycline, oxytetracycline, tetracycline + tigecycline
-x milk, indigestion remedies (iron, zinc) 2hr before or after
83
tetracyclines + milk
DOES LIKE MILK
doxy, lymcy, minocycl
84
tetracyclines s/e
-benign intracranial hypertension - stop if headache + visual impairment
-lupus -erythematosus like syndrome + irreversible pigmentation - more in minocyc
-teeth discolouration + bone deposits x under 12 or preg
85
tetracyclines counselling points
-hepatotoxic - avoid liver failure
-photosensitivity - avoid exposure to sunlight or sunlamps
- dysphagia - swallowed whole while standing
-caution myasthenia gravis
86
trimethoprim interactions
-may cause blood dyscrasis - long tx look for blood disorder signs (fever, sore throat, rash, mouth ulcers, bruising, or bleeding)
-antifolate x pregn interaction with methotrexate + phenytoin
-renal impairment
-hyperkalaemia
87
narrow spectrum antibiotics
-less stomach s/e
- penicillin V + G
-glycopeptides
-trimethoprim
-linezolid
-clindamycin
88
broad spectrum antibiotics
-chloramphenicol
-aminoglycosides
-penicillin (amox _ ampicillin)
-tetracycline
-nitrofurantoin
-macrolides
-cephalosporins
-quinolones
89
anaerobic antibiotic
metronidazole
90
bacteriostatic antibiotics
prevents bacterial growth
-chloramphenicol
-linezolid
-tetracycline
-macrolides
-clindamycin
91
bactericidal antibiotics
kills bacteria
-cephalosporins
-aminoglycosides
-nitrofurantoin
-trimethoprim
-quinolones
-metronidazole
-glycopeptides
-penicillin
92
antibiotics with/after food
-metronidazole
-nitrofu
-clarith MR
- pivermecilinam
93
antibiotics empty stomach 30-60mins before/2hr after
-fluclox
-phenoxymeth
-azithro caps
-tetracy + oxytetracycline
94
caution in myasthenia gravis
-quinolones
-aminoglycosides
-macrolides
-tetracyc
95
nephrotoxic antibiotics
-nitrofur
-aminoglycosides
-gylcopepides
-tetracycl
-trimetho
96
heptotoxic antibiotics
-macrolides
-flucloxacillin
-co-amox
-chloramphenicol
-nitrofur
-tetracycli
-rifampicin + isoniazid + pyrazinamide
97
TB initial phase tx
TWO MONTHS
-rifampicin
-isoniazid
-pyrazinamide
-ethambutol
98
TB continuous phase tx
FOUR MONTHS
-rifampicin
-isoniazid
99
latent TB tx
3 MONTHS of rifampicin + isoniazid or 6 MONTHS of isoniazid
100
TB medication
-clear hepatotoxicity 35-65
-rifampicin - discolour soft contact lesnes + bodily fluids orangey red. enzyme inducer
-isoniazid - neuropathy - prophylactic pyridoxine HCL (vit b6) given - cyp450 inhibitor
-pyrazinamide = heptatotoxic
-ethambutol = visual impairment + ocular toxicity
101
tx of aspergillons
voriconazole
102
tx of cryptococlosis
amphotericin B
103
tx of thrush
-vaginal - clotrimazole / fluconazole or itraconazole
- oral - nystatin/miconazole/fluconazole/ itraconazole
104
tx of skin + nail infections
topical therapy -> systemic therapy itraconazole, terbinafine
105
tinea (ringworm)
tinea capitis - head
tinea corporis - body
tinea crusis - groin
tinea pedis - feet
tinea uriguium/longchontosis - nails
106
tinea (ringworm) tx
topical antifungal cream or terbinafine
107
duration of nail region terbinafine or amorofine nail laquer
OW for 1 yr
refer to gp if l<18, 2+ nails, diabetic, pregnant/BF
108
antifungal medications
fluconazole, itraconazole, ketoconazole, voriconazole
qt prolongation + heptatotoxicity (less in flucon,ketocon,voricom,itracon)
109
amphotericin B
-caution in renal failure,
-anaphylaxiss risk in IV - 30 min observation
-maintain same formulation between conventional, liposomal, lipid-complex formulation
110
Itraconazole
carbonated drinks inc bioavailability
111
ketoconazole
life threatening hepatotoxicity - oral tx suspended
112
voriconazole
photosensitivity occurs uncommonly - avoid sunlight exposure
113
terbinafine
hepatotoxicity
114
tx of varicella zoster, chickenox, herpes zoster, shingles
Aciclovir, valaclovir (prodrug)
115
chickenpox
-pt 14+ = antiviral 24hr onset
116
herpes/shingles
-tingling sensation, burning, fluid filled blisters,
-shingles follow pattern of individual nerve on one side of body looks like blet/half belt around ribcage/torso
117
malaria bite protection
-not absolute
-mosquito net impregnated permethrin
-diethyltoluamide (DEET) 20-50% (50% longer protection)
-->suitable for 2+ MT
-->avoid ingestion - wash hands
-->suitable pregn + BF
-->apply SPF then DEET
118
malaria prophylaxis tx
malarone, chloroquine, proguanil, mefloquine, doxycycline
IF ILLNESS OCCURS IN 1 YR ESP 3MT AFTER RETURN = MALARIA
119
malarone + atorvaquone + proguanil
-before travel - 1-2DY
-dosage - 1OD
-after travel - 1WK
-max use - 1YR
120
chloroquine
-before travel -1WK
-dosage - OW
-after travel -4WK
-max use -LONG TERM
121
progunanil
-before travel -1WK
-dosage -1OD
-after travel -4WK
-max use -LONG TERM
122
mefloquine
-before travel -2-3WK
-dosage -OW
-after travel -4WK
-max use -1YR
123
doxycycline
-before travel -1-2DY
-dosage -1OD
-after travel -4WK
-max use -2YR
124
malaria pt groups
-asplenia - high risk of malaria
-pregn - avoid travelling to regions with malaria. can give chloroquine + proguanil + 5mg folic acid (neural tube defect risk)
125
malaria medication groups
-epilepsy avoid chloroquine + mefoloquine
- warfarin - start tx 2-3wk before travel
--> INR stable before travel
-->INR measured before antimalarials, 7DY after starting + after completing
-->prolonged stay check INR regularly
126
antimalarial caution
-mefloquine - psychiatric disorders develops stop. convulsions
-chloroquine - convulsions, retinotoxic
-proguanil - renal impairment lower dose
- doxyc avoid sunlight exposure
127
malaria standby tx
-travelling = emergency standby tx if 24+HR away from medical care
-avoid self medication if access available
-written instructions provided - seek urgent if fever (38+) develops 7DY after arriving
-self tx if no help available within 24hr of fever onset
