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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
What antibiotics should be avoided in pregnancy?
``` metronidazole, chloramphenicol, aminoglycosides, tetracycline Quinolones Sulphonamides Tetracycline Trimethoprim Nitrofurantoin causes nausea so avoid at term ```
26
What's the safest antibiotics in pregnancy?
Penicillin | Cephalosporin
27
What antibiotic has the highest risk for causing C. Diff?
Clindamycin and other broad spectrum antibiotic Bc kill normal flora and allow selective organisms to thrive Can also cause oral and vaginal thrush candida
28
What antibiotic for staphylococci infection?
Flucloxacillin
29
What antibiotic for MRSA?
Vancomycin
30
What antibiotic for streptococci?
Benzyl penicillin or phenoxymethylpenicillin
31
What antibiotic for anaerobic bacteria?
Metronidazole
32
What antibiotic for pseudomonas aeruginosa?
Gentamicin
33
What possible fatal side effect is associated with clindamycin?
Antibiotic associated colitis | Most common in middle aged elderly women esp after operations
34
What patient counselling should you give with clindamycin?
If diarrhoea develops, stop and see gp as could be ciolitis
35
What is linezolid active against?
Only gram positive bacteria like MRSA and anaerobes
36
Whats the alternative antibiotic to vancomycin in MRSA infection?
Linezolid
37
What side effect does linezolid cause?
Blood disorder | Severe optic neuropathy if more than 28 days use
38
Linezolid interactions?
It's a reversible MAOI so.....raises BP ssri, tca, maois (wait 2wks after stopping), sympathomimetics, dopaminergics, opioid, Avoid tyramine rich food
39
Side effects of trimethoprim?
Blood dyscrasia bc inhibits dna synthesis Hyperkalaemia
40
Pt counselling in trimethoprim?
Report any fever, sore throat, rash, mouth ulcers, bruising and bleeding, purpura
41
Side effects of Co trimoxazole?
Steven johnsons | Photosensitivity
42
What's the main side effect of chloramphenicol?
Blood dyscrasia
43
What happens if you take chloramphenicol during pregnancy?
Grey baby syndrome so avoid
44
What infections are metronidazole used for?
Anaerobic | Protozial infections e.g. Vaginal trichomoniasis
45
Common side effects of metronidazole?
GI disturbances, taste disturbance, oral mucositis, furred tongue
46
Patient counselling on metronidazole?
Take with or after food | Avoid alcohol as can cause disulfiram like reaction
47
What's the common side effect of Nitrofurantoin?
Nausea | Risk of peripheral neuropathy in renal impairment
48
Why is Nitrofurantoin contra indicated in pregnancy?
Risk of neonatal haemolysis
49
Who is Nitrofurantoin contra indicated?
Infants below 3 months
50
Patient counselling on Nitrofurantoin?
Take with or after food | Colours urine yellow or brown
51
When should once daily regimen of gentamicin be avoided?
If renal impairment below 20 Gram positive endocarditis Burns covering more than 20 percent of body
52
What's the post dose peak gentamicin level after 1hr? What to do if its too high?
5-10mg/ml 3-5mg/ml for endocarditis Reduce dose
53
Whats the pre dose gebtamicin trough level before next dose? What to do if its too high?
Below 2mg/ml Below 1mg/ml for endocarditis Increase interval
54
Other than the 2 main side effect, what other side effects does gentamicin cause?
Peripheral neuropathy Impaired neuromuscular transmission so gentamicin is contra indicated in myasthenia gravis Histamin related drug reactions
55
What electrolyte imbalances does gentamicin cause?
Hypokalaemia Hypocalcaemia Hypomagnesium
56
What's the pre dose trough level for vancomycin?
10-15 mg/ml | 15-20mg/ml for endocarditis, less sensitive MRSA strains or complicated S. Aureus infections
57
Other than the 3 main side effects, what other side effects does vancomycin cause?
Blood dyscrasia Skin disorder - Stevens Johnson Thrombophlebitis - pain and inflammation of veins at infusion site
58
Important side effect of Tetracycline?
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
Why do children under 12 and preganant/bf lady have to avoid Tetracycline?
Deposit in growing bone and teeth and cause teeth discolouration and dental hypoplasia
60
When should you avoid Tetracycline?
Renal impairment except doxycycline and minocycline Hepatic avoid or caution esp if concomitant use with heoatotoxic drugs Tetracycline are hepatotoxic
61
Which Tetracycline should avoid sunlight?
DD demeclocycline Doxycycline
62
Which Tetracycline should avoid antacid? | Take 2hrs after or before
All Tetracycline
63
Who h Tetracycline should avoid milk?
DOT Demeclocycline Oxytetracycline Tetracycline
64
Which Tetracycline cause oesophageal irritation and thus should be swallowed whole with plenty of fluid during meals while sitting or standing?
DMT Doxycycline Minocycline Tetracycline
65
All Quinolones cause qt prolongation but which one especially?
Moxifloxacin
66
Which one of the Quinolones cause life threatening heoatotoxicity?
Moxifloxacin
67
Which Quinolones require caution in driving and skilled task?
All
68
Which Quinolones require leaving 2hrs before and after taking antacid, zinc and iron?
All
69
Which Quinolones require avoiding milk?
Ciprofloxacin and norfloxacin
70
Which Quinolones require protection from sunlight?
Ofloxacin
71
Wchih macrolides need 2hrs gap between antacids?
Azithromycin | Erythromycin
72
Which macrolides need to be take before food?
Azithromycin Other than azithromycin, macrolides needs to be taken with or after food
73
Which macrolides cause taste disturbance?
Clarithromycin
74
Side effects of macrolides
``` GI esp with erythromycin QT prolongation Hypokalaemia Hypomagnesium Hepatotoxicity Ototoxicity at high dose ```
75
What drug contributed to antibiotic associated colitis?
Clindamycin (most) Amoxicillin/ampicillin 2nd/3rd gen cephalosporin Quinolones
76
How to treat antibiotic associated colitis?
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
How long is CAP treatment for?
7 days
78
How long is CAP treatment caused by staphylococci?
14-21days
79
Treatment for CAP mild severity?
Amoxicillin Alternatively clarithromycin or Doxycycline
80
Moderate severity CAP treatment?
Amoxicillin + clarithromycin | Or doxycycline alone
81
High severity CAP treament?
Benzyl penicillin and clarithromycin /doxycycline Add flucloxacillin if staphylococci susoected Add vancomycin if MRSA suspected
82
How long is HAP treatment for?
7 days
83
HAP treatment？
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
Treatment of osteomyelitis?
(bone infection) Flucloxacillin Clindamycin if penicillin allergic If MRSA suspected, vancomycin
85
Impetigo treatment?
Fusidic acid 7 days if small area affectted Flucloxacillin for 7days if widespread
86
Animal and humanbites treatment?
Co-amoxiclav Or Doxycycline + metronidazole
87
Skin and soft tissue MRSA infection treatment?
Tetracycline Or Sodium fusidate + rifampicin Alternative clindamycin If severe Glycopeptides or if unsuitable linezolid
88
Dental infection treatments?
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
What typically causes sore throat?
Streptococci
90
What typically causes otitis externa?
Staphylococci aureus
91
How to treat sore throat with antibiotics if needed?
Phenoxylmethylpenicillin If severe, initiate with benzylpenicillin Clarithromycin if pen allergy
92
How to treat sinusitis with antibiotics?
Amoxicillin or clarification or doxycycline
93
How to treat otitis externa?
Flucloxacillin Clari if pen allergic Treat if systemically unwell
94
Treatment of otitis media?
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
Side effect of itraconazole?
Heart failure and hepatotoxicity
96
Important interactions of itraconazole?
Antacids | Needs acidic pH for absorption
97
MHRA warning on oral ketoconazole?
Risk of fatal hepatotoxicity is greater than the benefit of treating fungal infections Refer back prescription
98
Side effect of voriconazole?
``` Phototoxicity and hepatotoxicity Causes pre malignant lesions it skin cancer Avoid direct sunlight and sunlamos Use high factor SPF Carry alert card ```
99
What is amphiterucin B used for?
Serious fungal infections
100
Side effects of amphiterucin B?
Nephrotoxicity Anaphylaxis with IV preps so do a test dose and monitor for 30mins Specify brands as not interchangeable
101
How to treat oral thrush? Candidiasis
Nystatin (POM) | Or Daktarin oral gel
102
Treatment of vaginal thrush?
Oral fluconazolr Or Topical imidazole like clotrimazole
103
Treatment of tinea chapatis, corporis, cruris and pedis?
Miconazole or Clotrimazole or Terbinafine (for athlete's foot)
104
What's fungal nail infection called?
Tinea ungium
105
Treatment of fungal ungium?
Amorolfine
106
Can azithromycin be sold?
Yes. Azithromycin tablets can be sold to the public for the treatment of confirmed, asymptomatic Chlamydia trachomatis genital infection in those over 16 years of age, and for the epidemiological treatment of their sexual partners, subject to maximum single dose of 1 g, maximum daily dose 1 g, and a pack size of 1 g.
107
What is olseltamivir used for?
Prophylaxis of influenza. Reduces symptoms by 1 days | Used for at risk groups 65+, DM, immunocompromisrd etc
108
When to take olseltamivir?
Start within 48hrs of symptoms or without symptoms on exposure
109
What test should be used for the diagnosis of H. Pylori?
Urea 13C breath test and stool helicobacter antigen test
110
H. Pylori diagnosis test should not be performed?
Within 2wks of treatment with PPIs Or Within 4wjs of antibacterial treatment As it can lead to false negatives
111
When can retesting for H. Pylori be done if needed (recurrent, was done inappropriately)
At least 4wks, ideally 8wks after treatment
112
How long does triple therapy for H. Pylori last?
7 days
113
Normally antibiotic treatmebt for H. Pylori is BD unless?
Combined with omeprazole, Amoxicillin can be 500mg TDS and metronidazole 400mg TDS
114
Antibiotics if metronidazole and clarithromycin cannot be used (3rd line treatmnt for H. Pylori)
Tetracycline unlicensed | If tetra cannot be used levofloxacin
115
Last resort treamtnet tfor 10days on specialist if the usual 3 antibiotics cannot be used?
``` Bismuth subsalicylate And Either 2 antibacterial from previous steps not used Or Rifabutin Or Furazolidone ```
116
Antibiotic choice if pen allergy and clarithromycin been used previously for H. Pylori treatment?
Bismuth + metro + tetracycline for 7 days Or Metronidazole + levo (2nd line)

Inori Pre Reg (22 decks)

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