Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Consultation skills > Infection prescribing > Flashcards

Infection prescribing Flashcards

1
Q

How do we diagnose an infection?

A

Physical examination:

  1. Hot to the touch
  2. Swollen
  3. Raised
  4. Black or red coloured.
  5. Temperature raised/spiking
  6. RR high

Test results:

  1. WCC raised
  2. Raised CRP - infection and inflammation.
  3. Cultures

Scans/Xrays:

  1. X ray of lungs.
  2. MRI scans.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the CURB65 tool?

A 
Helps to determine how severe CAP is. 
Confusion
Urea >7mmol/l
RR >30/min
BP low, SBP<90, DBP<60.
65: are they over 65.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the CURB65 tool take into account?

A 
Confusion
Urea >7mmol/l
RR >30/min
BP low, SBP<90, DBP<60.
65: are they over 65.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A urea result of higher than what would result in 1 point from CURB65?

A 
Confusion
Urea >7mmol/l
RR >30/min
BP low, SBP<90, DBP<60.
65: are they over 65.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RR of higher than what is 1 point in CURB65?

A 
Confusion
Urea >7mmol/l
RR >30/min
BP low, SBP<90, DBP<60.
65: are they over 65.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

BP values of what are 1 point in CURB65?

A 
Confusion
Urea >7mmol/l
RR >30/min
BP low, SBP<90, DBP<60.
65: are they over 65.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the PEDIS score?

A

The severity of the ulcers in diabetic patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A PEDIC score of greater than or equal to what is when a patient will typically feel very unwell?

A

4 or higher.

They are now systemically unwell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the general treatment plan for an infection?

A
  1. Are cultures and sens availabe?
    If no: start EMPIRICAL until cultures become available at which time you modify treatment.
    If yes: start TARGETED therapy. If adequate response, continue until Iv->oral switch possible.
    If not adequate response, ESCALATE.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When creating EMPIRICAL guidelines, what needs to be decided? [4]

A
  1. Agent(s)
  2. Route
  3. Dose
  4. Duration

These all depend on the nature and factors of the infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cellulitus is typically caused by

A

Staph.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What infection factors affect the choice of antibiotics?

A
  1. Type of infection/organism
  2. Site of infection
  3. Severity of infection
  4. Properties of the antibiotic
  5. The concentrations needed to treat the infection. MIC of organism.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why would a patient have a one off shot of gentamycin?

A

when they are catherterised as a one off prophylaxis againt UTI caused by E.coli.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would a patient with CAP be started on IV antibiotics straight away?

A

When CURB65 >3.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we monitor the effectiveness of antibiotic treatment? [4]

A
  1. Physical symptoms
  2. Physiological parameters: BP, Temperature.
  3. Infective markers: CRP, WCC.
  4. Radiology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which antibiotics need therapeutic drug monitoring? [3]

A

Vancomycin
Gentamicin
Teicoplanin - not worried about toxicity from this drug, just monitor for efficacy where as the other two we monitor for both toxicity and efficacy.

17
Q

What is the most common side effect of antibiotics?

A

N + Vomiting.

18
Q

What other side effect should we look out for?

A

Rashes - could indicate allergic reaction.

19
Q

What impact would the presence of a deep seated infection have on choice of antibiotic agent and duration of treatment?

A

Need an agent known to penetrate well into tissue.

May need a longer duration of therapy to ensure adequate treatment of the infection.

20
Q

What are some of the key criteria that must be met before switching from IV to oral?

A 
Temp <37.5 deg C for 24 hours. 
Improving condition/stable. 
S + S improving. 
Decreasing ESR/CRP/WBC
Oral formulation available. 
No absorption problems: Crohns, gastric surgery etc.
21
Q

What are some high-risk infections which are not suitable for switching from IV/oral?

A 
Bacteria in blood. 
Gangrene/soft tissue infections.
Bone infections. 
Prosthetic related infections. 
Chemotherapy related infections - compromised immune system.
MRSA
C/diff
22
Q

What patient factors migh affect the choice of therapy?

A 
Weight
Age
Renal function
LFT
Allergy status
Can they swallow?
Other disease states?
Other drugs which interact with antibiotic?
23
Q

Why do we not use tetracyclines in children?

A

They end up with brown teeth - gets deposited in bone and teeth.

24
Q

Why would we not use aminoglycosides in patients with renal impairment?

A

They are renally toxic.

25
Q

Why would we not use rifamicins in patients with hepatic impairment?

A

They are hepatotoxic

26
Q

Why should we not use quinolone antibiotics in patients on epilepsy treatment?

A

They lower the seizure threshold.

27
Q

Can someone with an allergy for penicillin be treated with cephalosporins or carbapenems?

A

There exists cross sensitivity between penicillins/cephalosporins/carbapenems.

28
Q

What do Drs and Nurses not remember about tazocin?

A

That it contains penicillin

29
Q

Ciprofloxacin has what effect on the levels of warfarin, methotrexate and theophylline?

A

Cipro: Enzyme inhibitor: increased levels of warfarin, methotrexate, theophylline.

30
Q

How does Ciprofloxacin increase levels of warfarin, methotrexate and theophylline?

A

It inhibits enzymes involved in their degradation.

31
Q

Can ciprofloxacin and tizanidine be used together?

A

Contraindicated.

32
Q

Rifampicin has what effect on the levels of warfarin, antiepileptics and other drugs?

A

It decreases them as it is a potent enzyme INDUCER.

33
Q

How does rifampicin reduce levels of warfarin and antiepileptics?

A

It is a potent enzyme inducer, increases efficacy of enzymes involved in their degradation etc.

34
Q

What are two drugs of the macrolide class?

A

Erythyromycin + Clarithyromycin.
Enzyme inhibitors, incease the levels of other drugs.
Warfarin and statins: increased risk of myopathy (stop statin for duration of macrolide + 2 days after).

35
Q

What impact do the macrolides (erythyromycin + clarith) have on the levels of warfarin and statins? How?

A

Enzyme inhibitors, incease the levels of other drugs.

Warfarin and statins: increased risk of myopathy (stop statin for duration of macrolide + 2 days after).

36
Q

How should the use of a macrolide and statins be managed?

A

Enzyme inhibitors, incease the levels of other drugs.

Warfarin and statins: increased risk of myopathy (stop statin for duration of macrolide + 2 days after).

37
Q

Linezolid has many interactions with MAOIs. What are these typically used to treat?

A

Depression.

Avoid cheese etc.

38
Q

Additional contraceptive methods are recommended only for patients taking enzyme ________ antibiotics (or other drugs).

A

Inducers: less levels of contraceptive as induced metabolism.

39
Q

What are the 6 steps to the antibiotic prescribing decision process?

A
  1. Diagnosis
  2. Agent (or agents) - informed by empirical guidelines or MC&S.
  3. Route: IV or oral.
  4. Dose: based on what? Does it need reducing?
  5. Duration or review date (Iv to oral switch?) - MUST BE DOCUMENTED.
  6. Monitoring and safety netting - how do we know if the patient is getting better? if not, what next?

Consultation skills (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions