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infections Flashcards

1
Q

What organisms do aminoglycoside cover

A

gram positive (pseudomonas auriginosa) and gram negative (mycobacterium TB)

inactive/ poor activity against anaerobes and streptococci

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2
Q

when should OD dosing be avoided with aminoglycoside?

A

CrCl <20
Gram positive endocarditis
HACEK endocarditis
burns covering more than 20% of body

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3
Q

what are the monitoring serum concentrations (peak and trough) and what do you do if they are too high

A

peak: 5-10mg/l or 3-5mg/l for endocarditis
reduce dose if too high

trough: <2mg/l or <1mg/l for endocarditis
increase interval if too high

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4
Q

contraindications for aminoglcyosides

A

myasthenia gravis
pregnancy unless benefit outweighs risk
perforated ear drums

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5
Q

interactions for aminoglycosides

A

drugs that cause ototoxicity: loop diuretics, vancomycin

drugs that cause nephrotoxicity: vancomycin, ciclosporin, tacrolimus, platinum chemotherapy, cephalosporins

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6
Q

MHRA warning for aminoglycosides

A

histamine related adverse reactions

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7
Q

what is the coverage of glycopeptides (vancomycin and tecioplanin)

A

gram positive and with oral use anaerobic cover (C.DIFF)

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8
Q

monitoring and serum concentrations of glycopeptides

A

renal function, ototoxicity, blood count
check serum levels after 3-4 doses or after dose change
trough level: 10-20mg/l but 15-20 recommended

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9
Q

side effects of glycopeptides

A 
ototoxicity
nephrotoxicity
red man syndrome
thrombophlebitis (pain at infusion site)
blood dyscrasias
skin disorders: steven johnson syndrome
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10
Q

name the different generation of cephalosporins

A

ORALLY ACTIVE - useful for UTI’s, RTI, otitis media, skin & soft tissue infections
1st gen: cefalexin, cefadroxil, cefadrine
2nd gen: cefuroxime, cefaclor (good activity against H. influenzae) give with food to increase absorption

PARENTERALLY ACTIVE
3rd gen: cefixime, ceftriaxone, cefotaxime, ceftazidime
5th gen: ceftaroline (CAP)

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11
Q

what coverage is cephalosporins

A

broad spectrum (differs between generations)

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12
Q

indications of cephalosporins

A

UTI, meningitis, septicaemia, pneumonia, peritonitis,

cefataxime and ceftriaxone can be used to treat meningitis

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13
Q

side effects of cephalosporins

A

hypersensitivity reactions
antibiotic associated colitis
C.difficile risk

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14
Q

interactions with cephalosporins

A 
warfarin = increased anticoagulant effects
aminoglycosides = increased risk of nephrotoxicity
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15
Q

coverage and indications of chloramphenicol

A

broad spectrum

indications: mainly eye infections, can be used for serious, life threatening infections

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16
Q

use of chloramphenicol in pregnancy and licensing OTC

A

pregnancy: avoid due to risk of grey baby syndrome (3rd trimester)
OTC: licensed for over 2 years of age
max duration: 5 days

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17
Q

coverage of clindamycin

A

gram positive including MRSA, anaerobe,

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18
Q

counselling and side effects of clindamycin

A

stop if diarrhoea develops- risk of C.difficile

Abx associated colitis

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19
Q

interactions of clindmycin

A

erythromycin

CYP3A4 inducer/ inhibitor

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20
Q

linezolid coverage and indications

A

gram positive and anaerobes

indications: pneumonia, soft tissue infections, cellulitis…

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21
Q

counselling and safety information of linezolid

A

ocular neuropathy: report visual disturbance
avoid tyramine rich food as linezolid is a reversible MAOI
risk of blood disorders
risk of hypertensive crisis

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22
Q

interactions of linezolid

A

Drugs inducing risk of serotonin syndrome: SSRI’s, TCA’s, dopaminergics…
tyramine rich foods
MAOI inhibitors within 2 weeks: phenelzine, selegeline, moclebemide
rifampicin

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23
Q

coverage of macrolides and indications

A

broad spectrum

indications: H.pylori, skin and soft tissue infections, RTI

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24
Q

caution and side effectsof macrolides

A 
prolongs QT interval 
myasthenia gravis 
hepatotoxicity
ototoxicity
GI disturbance (take with food)
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25
can macrolides be used in pregnancy
erythromycin preferred
26
interactions of macrolides
``` STATINS: increases risk of mypathy WARFARIN: increases bleed risk MHRA: erythromycin + rivaroxaban = increased bleeding risk drugs thats cause hypokalaemia drugs that prolong QT interval ```
27
antibiotics that prolong QT interval
macrolides | quinolones
28
indications for metronidazole
protoazoal: vaginosis | anaerobic infections: C.diff, H. pylori, gastro, dental infections...
29
cover for metronidazole
narrow spectrum- anaerobic
30
contraindications for metronidazole
liver impairment- reduce dose by 1/3
31
counselling and side effects of metronidazole
``` avoid alcohol until 48 hours after (due to disufuram reactions) take with food may discolour urine to brown colour metallic taste/ dry mouth GI disturbance ```
32
interactions of metronidazole
warfarin = bleed risk CYP inducers: rifampicin, phenytoin lithium = increases lithium toxicity
33
indication and coverage of nitrofurantoin
coverage: broad spectrum, MRSA indications: UTI
34
Contraindications of nitrofurantoin
eGFR <45ml/min pregnancy at term/ breastfeeding less than 3 months old G6PD deficiency
35
duration of treatment for men, women, pregnant and catheter
men/ pregnant/ catheter: 7 days | women: 3 days
36
counselling and side effects
brown/ yellow urine take with food/ milk se: nausea report signs of hepatotoxicity
37
4 types of penicillin and give example
broad spectrum: amoxicillin, ampicillin narrow spectrum: penicillin G (benzylpenicillin for meningitis), penicillin V (phenoxymethylpenicillin for RTI) antipseudomonas: piperacillin tazobactam (serious infections, psuedomonas, septicaemia, HAP) penicillinase resistant: fluclocxacillin
38
caution and SE of penicillins
rash, anaphylaxis, diarrhoea (broad spectrum), do not give intrathecally = risk of encephalopathy = fatal take ampicillin before food take flucloxacillin on empty stomach rare side effect of flucloxacillin = cholestatic jaundice
39
coverage of quinolones and indications
broad spectrum indications: RTI, UTI, avoid in MRSA Ciprofloxacin uniquely covers pseudomonas
40
4 MHRA ALERTS of quinolones
1. tendon damage 2. disabling SE of MSK/ CNS 3. aortic aneurysm: report any chest/ back pain 4. arthropathy
41
caution and interactions of quinolones
avoid NSAIDS = increased risk of seizure threshold caution in diabetics, epilepsy, children, avoid milk/ indigestion remedies 2 hours prior avoid dairy avoid other drugs that increase QT interval/ corticosteroids C. difficile risk anticoagulants = increased bleed risk theophylline = risk of toxicity myasthenia gravis reduce sunlight exposure may impair driving ability- enhanced by alcohol
42
tetracyclines indication and coverage
coverage: broad spectrum, atypical, MRSA, haemophillus influenzae indication: acne, rosacea, LRTI, malaria, chlamydia
43
contraindications of tetracyclines
under 12 years, pregnancy/ breast feeding, deposit onto growing bone and teeth - discolouration renal impairment (except doxycycline and minocycline)
44
cautions of tetracyclines
myasthenia gravis | hepatic impairment- tetracyclines are hepatotoxic- avoid other hepatotoxic drugs
45
counselling and side effects of tetracyclines
intracranial hypertension- report/ stop visual disturbance/ headache photosensitivity- avoid exposure to sunlight dysphagia/ oesophageal reactions- swallow whole, stand upright, avoid milk (except DLM: doxy, limocycline, minocycline) avoid indigestion remedies 2 hours before and after Lupus-erythematosus-like syndrome and irreversible pigmentation
46
trimethoprim coverage and indications
coverage: gram positive and negative, E.coli, pneumocystis jirovecci, staph indications: UTI, prostatitis, pylenephritis, diverticulitis, RTI
47
contraindications and cautions of trimethoprim
pregnancy- teratogenic in 1st trimester (antifolate) blood dyscrasias caution: acute porphyrias
48
side effects of trimethoprim
blood dyscrasias- report mouth ulcers, fever, sore throat, rash, bleed... hyperkalaemia
49
interactions of trimethoprim
antifolates: methotrexate, phenytoin
50
dosing of trimethoprim in normal and renal impairment
males: 200mg BD 7 days, females: 3 days eGFR 15-30: reduce dose by half after 3 days if eGFR <15: reduce dose by half
51
Dosing regimen for TB
``` initial treatment: 2 months - rifampicin - isoniazid - pyrazinamide - ethambutol continuous phase: 4 months - rifampicin - isoniazid ``` pyridoxine (vitamin b6) given to prevent peripheral neuropathy
52
dosing regimen for latent TB
rifampicin + isoniazid for 3 months OR | Isoniazid for 6 months
53
counselling points and cautions for TB drugs
all hepatotoxic except ethambutol rifampicin- CYP450 inducer, discolours contacts and bodily fluids red-orange isoniazid - enzyme inhibitor ethambutol- may cause ocular toxicity- report visual disturbance do not use contraceptive pill with rifampicin- use IUD/ barrier
54
drug treatment for animal bites (1st line and 2nd line)
1st line: co-amoxiclav 2nd line: doxycycline + metronidazole prophylaxis (no signs of infection): 3 days treatment: 5 days
55
drug treatment for animal scratches
flucloxacillin prophylaxis: 3 days treatment: 5 days
56
drug treatment for lyme disease/ tick bites)
1st line: doxycycline 100mg BD 2nd line: amoxicillin 1g TDS treatment: 21 days
57
treatment of mild and moderate/ severe diabetic foot
mild: 1st line: flucloxacillin 2nd line: macrolide (clarithromycin/ erythromycin - pregnancy)/ tetracycline (doxycycline) moderate/ severe/ osteomyelitis: 1st line: flucloxacillin OR co-amoxiclav +/- gentamicin and /or metronidazole 2nd line: co-trimoxazole +/- gentamicin and / or metronidazole
58
treatment for cellulitis
1st line: flucloxacillin 2nd line: macrolide (erythromycin for pregnancy)/ doxycycline/ co-amoxiclav if infection is near eyes or nose: 1st line: co-amoxiclav 2nd line: clarithromycin + metronidazole
59
treatment for CAP (mild, moderate and severe)
MILD: 1st line- amoxicillin 2nd line- doxycycline/ erythromycin/ clarithromycin MODERATE: 1st line: amoxicillin + clarithromycin/ erythromycin 2nd line: doxycycline/ erythromycin/ clarithromycin SEVERE: 1st line: co-amoxiclav + clarithromycin/ erythromycin 2nd line: levofloxacin
60
treatment for HAP
1st line: co-amoxiclav 2nd line: adults: doxycycline/ co-trimoxazole/ cefalexin/ levofloxacin children: clarithromycin
61
treatment for C.diff / diarhheoa
1st line: oral vancomycin 2nd line: fidoxamicin life threatening: vancomycin + IV metronidazole
62
treatment and prophylaxis for travellers diarrhoea
treatment/ prophylaxis: bismuth salicylate standby treatment when abroad: azithromycin
63
treatment and prophylaxis for travellers diarrhoea
treatment/ prophylaxis: bismuth salicylate standby treatment when abroad: azithromycin
64
treatment for otitis externa
1st line: acetic acid 2nd line: neomycin + corticosteroid if systemic treatment needed: flucloxacillin
65
treatment for otitis media
``` 1st line: amoxicillin 2nd line (if persists after 2-3 days of treatment): co-amoxiclav ``` penicillin allergy: clarithromycin or erythrmocyin (pregnancy)
66
treatment and diagnosis for h.pylori
PPI + 2Abx (at least amoxicillin unless allergy) omeprazole + amoxicillin 1g BD/ metronidazole 400mg BD/ Clarithromycin 500mg BD urea 13C breath test - do not do within 2 weeks of PPI or 4 weeks of antibiotic therapy
67
treatment for impetigo
non-severe (non-bullous) 1st line: hydrogen peroxide 2nd line: fusidic acid (or mupirocin if resistance) widespread non-bullous 1st line: fusidic acid (or mupirocin if resistance) systemic/ bullous 1st line: flucloxacillin 2nd line: clarithromycin or erythromycin (pregnancy)
68
treatment for scarlett fever/ strep throat
caused by streptococcus, symptoms: flu like symptoms, swollen lymph nodes, red rash, feels like sandpaper 1st line: phenoxymethylpenicillin 2nd line: clarithromycin or erythromycin in pregnancy
69
treatment for lower urinary tract infection
1st line: nitrofurantoin or trimethoprim (not in pregnancy) (male/ pregnant 7 days, female 3 days) 2nd line: fosfomycin or pivmecillinam 2nd line pregnancy: cefalexin or amoxicillin
70
treatment for chlamydia
doxycycline
71
treatment for bacterial vaginosis and trichomoniasis
metronidazole
72
treatment for dental abscess
amoxicillin or metronidazole
73
treatment for meningitis
benzylpenicillin
74
treatment for gonorrhoea
ceftriaxone or ciprofloxacin
75
treatment for scabies
permethrin
76
treatment for sinusitis
phenoxymethylpenicillin (doxycycline if penicillin allergy)
77
treatment for threadworm
mebendazole
78
treatment of aspergillosis
voriconazole
79
treatment of crytococcosis
amphotericin B
80
treatment for thrush
vaginal: clotrimazole/ fluconazole oral: nystatin/ miconazole/ fluconazole resistant oral/ vaginal -> itraconazole
81
what is used to treat ringworm (tinea)
topical antifungals if difficult to treat area (such as scalp and nails) or multiple areas can use oral imidazole / triazole antifungal such as itraconazole or terbinafine for nail: amolorfine or terbinafine can be used for tinea: micronazole, clotrimazole or terbinafine can be used
82
what are the side effects of antifungals
QT prolongation and hepatotoxic itraconazole: heart failure and hepatotoxicity oral ketoconazole: MHRA risk of hepatotoxicity outweighs benefits- do not use orally voriconazole: hepatoxicity and phototoxicity amphotericin B: caution in renal failure and risk of anaphylaxis with IV- test dose needed with 30 min observation first. maintain on same brand
83
treatment of varicella zoster, shingles, chicken pox, herpes
aciclovir | valaciclovir (pro-drug)
84
treatment of chicken pox
patients over 14 should take antivirals | do not use NSAIDs - increases risk of skin infection
85
symptoms of shingles/ herpes
herpes: tingling sensation, fluid filled blisters shingles: looks like a belt around half the body, follows pattern on individual nerves on one side of body
86
malaria bite prevention methods
mosquito nets impregnated with permethrin apply DEET 20-50% after suncream - suitable for above 2months and pregnancy and breast feeding long sleeve and trousers
87
name the different malaria chemoprophylaxis
``` malarone (atorvaquone + proguanil) chloroquine proguanil mefloquine doxycycline ```
88
what is the regimen for malarone (atorvaquone + proguanil)
start taking 1-2 days before travel take 1 daily take for 1 week after travel can use for a maximum of 1 year
89
what is the regimen for chloroquine
take 1 week before travel 1 weekly take for 4 weeks after travel maximum long term use
90
what is the regimen for proguanil
take 1 week before 1 daily take for 4 weeks after travel maximum use long term
91
regimen for mefloquine
take 2-3 weeks before travel 1 weekly take for 4 weeks after travel maximum 1 year use

pre reg Thammis cards (8 decks)

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