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Inori Pre Reg > Infection > Flashcards

Infection Flashcards

1
Q

Important safety info on gentamicin?

A

Histamine related ADRs

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2
Q

Important safety info on streptomycin?

A

Increased side effects after a cumulative dose of 100g

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3
Q

Important safety info on benzyl penicillin?

A

No intrathecal injection

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4
Q

Important safety info on flucloxacillin, co-fluampicil (ampicillin/flucloxacillin)?

A

Cholestatic jaundice and hepatitis can occur up to 2 months after treatment with flucloxacillin stopped
Administration for longer than 2wks and increasing age are risk factors
Avoid if history of hepatic dysfunction, hypersensitivity

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5
Q

Important safety info on Quinolones?

A

Convulsions, risk increased if taking with NSAIDs

Tendon damage/rupture
Increased risk if over 60, taking corticosteroids

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6
Q

Important safety info on fluoroquinolones?

A

Same as Quinolones plus increased risk of aneurysm and dissection
Increased risk of long lasting, potentially irreversible disabling adverse reactions affecting musculoskeletal and nervous system
Stop if any tendinitis, muscle pain, muscle weakness, joint pai
Avoid concomitant use with corticosteroids

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7
Q

Important safety info on co-trimoxazole?

A

Use and stewardship

Use only in pneumocystits, jirovecil pneumonia, stenotrophomobas maltophila and toxoplasmosis

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8
Q

Important safety info on sulfadiazine?

A

Don’t confuse with sulfasalazine

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9
Q

Important safety info on linezolid?

A

Severe optic neuropathy esp if used for more than 28 days
Report if any visual impairment, blurred vision, colour vision

Blood disorder e.g. Thrombocytopenia, anaemia
FBC should be monitored weekly esp if using for 10-14 days and Severe renal impairmenr

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10
Q

Important safety info on itraconazole?

A

Heart failure

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11
Q

Important safety info on chloroquine

A

Ocular toxicity

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12
Q

Important safety info on quinine

A

Dose dependent qt interval prolongatiom

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13
Q

Important safety info on direct acting antivirals for hepatitis C?

A

Interaction with vit K antagonist so inr changes

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14
Q

Important safety info o. Direct acting antiviral interferon free regiments for hepatitis C?

A

Risk of hepatitis b activation

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15
Q

Important safety info on glecaprer + pibrentasrir for hep c

A

Reactivation of hep b if Co infected, possibly fatal

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16
Q

Important safety info on dolutegrair

A

Neural tube defects, avoid in preg

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17
Q

Important safety info on dolutegrair

A

Neural tube defects, avoid in preg

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18
Q

What happens if clarithromycin and Station are Co administered?

A

Increased risk of myopathy

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19
Q

Co administering rifampicin and methadone?

A

Changed level in methadone

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20
Q

Co administering rifampicin and oestrogen?

A

Oestrogen level change

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21
Q

Co administering Co trimoxazole and ace inhibitor?

A

Hyperkalaemia

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22
Q

Interaction between ciprofloxacin, erythromycin, trimethoprim with warfarin?

A

Increased effectiveness of warfarin

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23
Q

What antibiotics should be avoided in renal impairment?

A

Aminoglycosides
Glycopeptides
Tetracycline except minocycline and doxycycline
Nitrofurantoin if egft below 45

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24
Q

What antibiotics should be avoided in hepatic impairment?

A

Rifampicin
Tetracycline

Reduce metronidazole dose if severe

If cholestatic jaundice. Co amoxiclav and flucloxacillin

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25
Q

What antibiotics should be avoided in pregnancy?

A 
metronidazole, 
chloramphenicol, 
aminoglycosides, 
tetracycline
Quinolones
Sulphonamides
Tetracycline
Trimethoprim
Nitrofurantoin causes nausea so avoid at term
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26
Q

What’s the safest antibiotics in pregnancy?

A

Penicillin

Cephalosporin

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27
Q

What antibiotic has the highest risk for causing C. Diff?

A

Clindamycin and other broad spectrum antibiotic
Bc kill normal flora and allow selective organisms to thrive
Can also cause oral and vaginal thrush candida

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28
Q

What antibiotic for staphylococci infection?

A

Flucloxacillin

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29
Q

What antibiotic for MRSA?

A

Vancomycin

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30
Q

What antibiotic for streptococci?

A

Benzyl penicillin or phenoxymethylpenicillin

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31
Q

What antibiotic for anaerobic bacteria?

A

Metronidazole

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32
Q

What antibiotic for pseudomonas aeruginosa?

A

Gentamicin

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33
Q

What possible fatal side effect is associated with clindamycin?

A

Antibiotic associated colitis

Most common in middle aged elderly women esp after operations

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34
Q

What patient counselling should you give with clindamycin?

A

If diarrhoea develops, stop and see gp as could be ciolitis

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35
Q

What is linezolid active against?

A

Only gram positive bacteria like MRSA and anaerobes

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36
Q

Whats the alternative antibiotic to vancomycin in MRSA infection?

A

Linezolid

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37
Q

What side effect does linezolid cause?

A

Blood disorder

Severe optic neuropathy if more than 28 days use

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38
Q

Linezolid interactions?

A

It’s a reversible MAOI so…..raises BP
ssri, tca, maois (wait 2wks after stopping), sympathomimetics, dopaminergics, opioid,

Avoid tyramine rich food

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39
Q

Side effects of trimethoprim?

A

Blood dyscrasia bc inhibits dna synthesis

Hyperkalaemia

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40
Q

Pt counselling in trimethoprim?

A

Report any fever, sore throat, rash, mouth ulcers, bruising and bleeding, purpura

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41
Q

Side effects of Co trimoxazole?

A

Steven johnsons

Photosensitivity

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42
Q

What’s the main side effect of chloramphenicol?

A

Blood dyscrasia

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43
Q

What happens if you take chloramphenicol during pregnancy?

A

Grey baby syndrome so avoid

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44
Q

What infections are metronidazole used for?

A

Anaerobic

Protozial infections e.g. Vaginal trichomoniasis

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45
Q

Common side effects of metronidazole?

A

GI disturbances, taste disturbance, oral mucositis, furred tongue

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46
Q

Patient counselling on metronidazole?

A

Take with or after food

Avoid alcohol as can cause disulfiram like reaction

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47
Q

What’s the common side effect of Nitrofurantoin?

A

Nausea

Risk of peripheral neuropathy in renal impairment

48
Q

Why is Nitrofurantoin contra indicated in pregnancy?

A

Risk of neonatal haemolysis

49
Q

Who is Nitrofurantoin contra indicated?

A

Infants below 3 months

50
Q

Patient counselling on Nitrofurantoin?

A

Take with or after food

Colours urine yellow or brown

51
Q

When should once daily regimen of gentamicin be avoided?

A

If renal impairment below 20
Gram positive endocarditis
Burns covering more than 20 percent of body

52
Q

What’s the post dose peak gentamicin level after 1hr? What to do if its too high?

A

5-10mg/ml
3-5mg/ml for endocarditis

Reduce dose

53
Q

Whats the pre dose gebtamicin trough level before next dose? What to do if its too high?

A

Below 2mg/ml
Below 1mg/ml for endocarditis

Increase interval

54
Q

Other than the 2 main side effect, what other side effects does gentamicin cause?

A

Peripheral neuropathy
Impaired neuromuscular transmission so gentamicin is contra indicated in myasthenia gravis

Histamin related drug reactions

55
Q

What electrolyte imbalances does gentamicin cause?

A

Hypokalaemia
Hypocalcaemia
Hypomagnesium

56
Q

What’s the pre dose trough level for vancomycin?

A

10-15 mg/ml

15-20mg/ml for endocarditis, less sensitive MRSA strains or complicated S. Aureus infections

57
Q

Other than the 3 main side effects, what other side effects does vancomycin cause?

A

Blood dyscrasia
Skin disorder - Stevens Johnson
Thrombophlebitis - pain and inflammation of veins at infusion site

58
Q

Important side effect of Tetracycline?

A

Benign intracranial Hypertension so stop if headache and visual disturbances

Minocycline - Broad spectrum but rarely used causes vertigo, dizziness, irreversible pigmentation and has greatest risk of lipus erythematosus like syndrome

59
Q

Why do children under 12 and preganant/bf lady have to avoid Tetracycline?

A

Deposit in growing bone and teeth and cause teeth discolouration and dental hypoplasia

60
Q

When should you avoid Tetracycline?

A

Renal impairment except doxycycline and minocycline

Hepatic avoid or caution esp if concomitant use with heoatotoxic drugs
Tetracycline are hepatotoxic

61
Q

Which Tetracycline should avoid sunlight?

A

DD
demeclocycline
Doxycycline

62
Q

Which Tetracycline should avoid antacid?

Take 2hrs after or before

A

All Tetracycline

63
Q

Who h Tetracycline should avoid milk?

A

DOT
Demeclocycline
Oxytetracycline
Tetracycline

64
Q

Which Tetracycline cause oesophageal irritation and thus should be swallowed whole with plenty of fluid during meals while sitting or standing?

A

DMT
Doxycycline
Minocycline
Tetracycline

65
Q

All Quinolones cause qt prolongation but which one especially?

A

Moxifloxacin

66
Q

Which one of the Quinolones cause life threatening heoatotoxicity?

A

Moxifloxacin

67
Q

Which Quinolones require caution in driving and skilled task?

A

All

68
Q

Which Quinolones require leaving 2hrs before and after taking antacid, zinc and iron?

A

All

69
Q

Which Quinolones require avoiding milk?

A

Ciprofloxacin and norfloxacin

70
Q

Which Quinolones require protection from sunlight?

A

Ofloxacin

71
Q

Wchih macrolides need 2hrs gap between antacids?

A

Azithromycin

Erythromycin

72
Q

Which macrolides need to be take before food?

A

Azithromycin

Other than azithromycin, macrolides needs to be taken with or after food

73
Q

Which macrolides cause taste disturbance?

A

Clarithromycin

74
Q

Side effects of macrolides

A 
GI esp with erythromycin
QT prolongation
Hypokalaemia
Hypomagnesium
Hepatotoxicity
Ototoxicity at high dose
75
Q

What drug contributed to antibiotic associated colitis?

A

Clindamycin (most)
Amoxicillin/ampicillin
2nd/3rd gen cephalosporin
Quinolones

76
Q

How to treat antibiotic associated colitis?

A

First episode of mild to moderate = oral metronidazole for 10-14days

Subsequent epi or severe infection or unresponsive to met = or a vancomycin or fidoxamicin for 10-14 days

Loperamide is contra indicated

77
Q

How long is CAP treatment for?

A

7 days

78
Q

How long is CAP treatment caused by staphylococci?

A

14-21days

79
Q

Treatment for CAP mild severity?

A

Amoxicillin

Alternatively clarithromycin or Doxycycline

80
Q

Moderate severity CAP treatment?

A

Amoxicillin + clarithromycin

Or doxycycline alone

81
Q

High severity CAP treament?

A

Benzyl penicillin and clarithromycin /doxycycline

Add flucloxacillin if staphylococci susoected
Add vancomycin if MRSA suspected

82
Q

How long is HAP treatment for?

A

7 days

83
Q

HAP treatment？

A

If early onset of less than 5 days
Co amoxiclav or cefuroxime

If severe or onset longer than 5 dayd
Anti pseudomonas penicillin or Broad spectrum cephalosporin or Quinolones

Add vancomycin if MRSA suspected
Add aminoglycosides for pseudomonas Aeruginosa

84
Q

Treatment of osteomyelitis?

A

(bone infection)

Flucloxacillin

Clindamycin if penicillin allergic

If MRSA suspected, vancomycin

85
Q

Impetigo treatment?

A

Fusidic acid 7 days if small area affectted

Flucloxacillin for 7days if widespread

86
Q

Animal and humanbites treatment?

A

Co-amoxiclav
Or
Doxycycline + metronidazole

87
Q

Skin and soft tissue MRSA infection treatment?

A

Tetracycline
Or
Sodium fusidate + rifampicin

Alternative clindamycin

If severe Glycopeptides or if unsuitable linezolid

88
Q

Dental infection treatments?

A

Metronidazole 200mg TDS for 3 days

Alternative is Amoxicillin
Or doxycycline if periodontitis

Chnage antibiotic if no response in 48hrs
May be combined penicillin or macrolides with metronidazole

89
Q

What typically causes sore throat?

A

Streptococci

90
Q

What typically causes otitis externa?

A

Staphylococci aureus

91
Q

How to treat sore throat with antibiotics if needed?

A

Phenoxylmethylpenicillin
If severe, initiate with benzylpenicillin
Clarithromycin if pen allergy

92
Q

How to treat sinusitis with antibiotics?

A

Amoxicillin or clarification or doxycycline

93
Q

How to treat otitis externa?

A

Flucloxacillin
Clari if pen allergic
Treat if systemically unwell

94
Q

Treatment of otitis media?

A

Treatment is given if there is no improvement after 72hrs or earlier if systemic symptoms, mastoiditis, bilateral otitis media in under 2yrs

Amoxicillin
Clarithromycin if pen allergic

95
Q

Side effect of itraconazole?

A

Heart failure and hepatotoxicity

96
Q

Important interactions of itraconazole?

A

Antacids

Needs acidic pH for absorption

97
Q

MHRA warning on oral ketoconazole?

A

Risk of fatal hepatotoxicity is greater than the benefit of treating fungal infections
Refer back prescription

98
Q

Side effect of voriconazole?

A 
Phototoxicity and hepatotoxicity
Causes pre malignant lesions it skin cancer
Avoid direct sunlight and sunlamos
Use high factor SPF
Carry alert card
99
Q

What is amphiterucin B used for?

A

Serious fungal infections

100
Q

Side effects of amphiterucin B?

A

Nephrotoxicity
Anaphylaxis with IV preps so do a test dose and monitor for 30mins

Specify brands as not interchangeable

101
Q

How to treat oral thrush? Candidiasis

A

Nystatin (POM)

Or Daktarin oral gel

102
Q

Treatment of vaginal thrush?

A

Oral fluconazolr
Or
Topical imidazole like clotrimazole

103
Q

Treatment of tinea chapatis, corporis, cruris and pedis?

A

Miconazole or
Clotrimazole or
Terbinafine (for athlete’s foot)

104
Q

What’s fungal nail infection called?

A

Tinea ungium

105
Q

Treatment of fungal ungium?

A

Amorolfine

106
Q

Can azithromycin be sold?

A

Yes. Azithromycin tablets can be sold to the public for the treatment of confirmed, asymptomaticChlamydia trachomatisgenital infection in those over 16 years of age, and for the epidemiological treatment of their sexual partners, subject to maximum single dose of 1g, maximum daily dose 1g, and a pack size of 1g.

107
Q

What is olseltamivir used for?

A

Prophylaxis of influenza. Reduces symptoms by 1 days

Used for at risk groups 65+, DM, immunocompromisrd etc

108
Q

When to take olseltamivir?

A

Start within 48hrs of symptoms or without symptoms on exposure

109
Q

What test should be used for the diagnosis of H. Pylori?

A

Urea 13C breath test and stool helicobacter antigen test

110
Q

H. Pylori diagnosis test should not be performed?

A

Within 2wks of treatment with PPIs
Or
Within 4wjs of antibacterial treatment
As it can lead to false negatives

111
Q

When can retesting for H. Pylori be done if needed (recurrent, was done inappropriately)

A

At least 4wks, ideally 8wks after treatment

112
Q

How long does triple therapy for H. Pylori last?

A

7 days

113
Q

Normally antibiotic treatmebt for H. Pylori is BD unless?

A

Combined with omeprazole, Amoxicillin can be 500mg TDS and metronidazole 400mg TDS

114
Q

Antibiotics if metronidazole and clarithromycin cannot be used (3rd line treatmnt for H. Pylori)

A

Tetracycline unlicensed

If tetra cannot be used levofloxacin

115
Q

Last resort treamtnet tfor 10days on specialist if the usual 3 antibiotics cannot be used?

A 
Bismuth subsalicylate
And
Either 2 antibacterial from previous steps not used
Or
Rifabutin
Or
Furazolidone
116
Q

Antibiotic choice if pen allergy and clarithromycin been used previously for H. Pylori treatment?

A

Bismuth + metro + tetracycline for 7 days
Or
Metronidazole + levo (2nd line)

Inori Pre Reg (22 decks)

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