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PharmEducate Notes > Infections > Flashcards

Infections Flashcards

1
Q

Which clinical bio markers suggest an infection?

A

^ CRP, ^ ESR, decreased BP, increased glucose levels

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2
Q

Side effects of antibiotics?

A

GI disturbance
Candidiasis (oral/vaginal)
Colitis

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3
Q

PT groups at highest risk of colitis?

A

Elderly
Renal impairment
Liver impairment

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4
Q

Antibiotics most associated with colitis?

A

Highest = Clindamycin

Others include: Broad spec antibiotics
E.g. Amoxicillin, 3rd and 4th gen cephalosporins and quinolones

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5
Q

Broad spec antibiotics?

A

A2 C3 QT

Amino-glycosides, amoxicillin, carbopenems, cephalosporins, chloramphenicol, Quinolones, tetracyclines

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6
Q

What route is avoided in children due to pain?

A

IM

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7
Q

What antibiotics are commonly offered in penicillin allergy?

A

Macrolides
e.g. Clarithromycin

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8
Q

Why are tetracyclines avoided in <12 and pregnant women?

A

Discolours teeth and growing bones yellow - grey

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9
Q

Which tetracyclines can be given to under 12s?

A

Doxycycline
Lymecycline

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10
Q

Can quinolones be given in pregnancy or adolescents?

A

No - can cause arthritis in weight bearing joints

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11
Q

Which tetracyclines can you use in renal impairment?

A

Doxycycline and minocycline

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12
Q

Which antibiotics are safest in pregnancy?

A

Penicillins and cephalosporins

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13
Q

Which antibiotics should be avoided in pregnancy?

A

Tetracyclines, Trimethoprim in 1st trimester (teratogenic), Nitrofurantoin at term (can cause haemolysis).

Nitrofurantoin can also cause Nausea so avoid in pts with morning sickness.

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14
Q

Examples of tetracyclines

A

Doxycycline
Minocycline
Demeclocycline
Etc.

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15
Q

Doxycycline typical dose?

A

200mg OD

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16
Q

Tetracycline side effects

A

Benign intracranial hypertension (headaches and visual disturbances),
Tooth and bone discolouration,
Dental hypoplasia

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17
Q

Which tetracyclines can you give in hepatic impairment?

A

None

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18
Q

Counselling for all tetracyclines?

A

Avoid antacids, zinc or iron 1H before or after

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19
Q

Which tetracyclines require counselling on photosensitivity - avoid sunlight

A

“Double - Ds”
Doxycycline and Demeclocycline

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20
Q

Which tetracyclines must you counsel the PT to avoid milk?

A

“DOT”
Demeclocycline, Oxtetracycline, Tetracycline

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21
Q

Which tetracyclines require the PT to swallow whole with fluently of fluids while sitting/standing?

A

“DMT”
Doxycycline (take with food)
Minocycline
Tetracycline

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22
Q

Which bacteria should quinolones never be used for?

A

MRSA due to resistance

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23
Q

MHRA alert for quinolones?

A

Long-term serious SEs so not prescribed for non severe infections

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24
Q

Examples of quinolones?

A

Ciprofloxacin
Levofloxacin
Moxifloxacin
Etc.

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25
Q

How often is ciprofloxacin given daily?

A

BD

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26
Q

Which quinolone causes the most QT prolongation?

A

Moxifloxacin

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27
Q

Which quinolone causes life-threatening hepatotoxicity?

A

Moxifloxacin

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28
Q

Side effects of quinolones?

A

Tendon damage (within 48H)
CNS disorders - report neuropathy or body weakness
Hallucinations
Aortic aneurysm - report sudden severe chest, back or abdomen pain
QT prolongation
Palpitations

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29
Q

Why are quinolones avoided in pregnancy?

A

Risk or arthropathy

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30
Q

Counselling for quinolones?

A

Avoid indigestion remedies, zinc and iron 1H before or after.
Avoid sunlight - particularly with oxifloxacin.

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31
Q

Which quinolone should PTs avoid taking with milk?

A

Ciprofloxacin

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32
Q

Quinolone + warfarin interaction?

A

Increased bleeding

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33
Q

Ciprofloxacin + NSAID/theophylline interaction?

A

Increased risk of seizures

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34
Q

Causative agent of skin/cellulitis infections and treatment?

A

Staphylococci
Give flucloxacillin

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35
Q

MRSA infection treatment?

A

Vancomycin ( OR Teicoplanin OR Linezolid )

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36
Q

Causative agent of throat infections and treatment?

A

Streptococcal
Pen G or Pen V

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37
Q

Causative agent of dental infections and treatment?

A

Anaerobic bacteria
Metronidazole

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38
Q

Pseudomonas auruginosa treatment?

A

Gentamicin
Or anti-pseudomonal penicillin

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39
Q

Linezolid drug class?

A

Reversible and non-selective MAOI

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40
Q

Linezolid side effects and subsequent monitoring?

A

Blood dyscrasias - monitor FBC especially if treatment > 10-14days

Optic neuropathy - monitor visual function if treatment > 28 days

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41
Q

Linezolid + Tyramine rich foods/ other meds which raise BP interaction and how long do you have to wait?

A

Hypertensive crisis - wait 2 weeks before taking Linezolid

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42
Q

Can chloramphenicol be used in pregnancy?

A

No - can cause grey-baby syndrome

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43
Q

Metronidazole dose?

A

400/500mg TDS 3 days

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44
Q

Metronidazole counselling?

A

With or after food
Avoid alcohol

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45
Q

Metronidazole side effects?

A

GI disturbances
Metallic taste
Oral mucositis
Furry tongue

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46
Q

Nitrofurantoin counselling?

A

Take with food

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47
Q

Nitrofurantoin side effects?

A

Yellow - brown urine
Nausea
Peripheral neuropathy - avoid if eGFR < 45
Lung reactions (pneumocystis) - Stop

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48
Q

Can nitrofurantoin be used in renal impairment?

A

Only if eGFR > 45

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49
Q

Can nitrofurantoin be given in pregnancy?

A

Yes but avoid at term

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50
Q

At what age can nitrofurantoin not be given?

A

Infants < 3 months

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51
Q

Is trimethoprim a folate?

A

No it is an anti folate

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52
Q

Trimethoprim dose?

A

200mg BD
OR 100mg ON for prophylaxis

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53
Q

Trimethoprim side effects?

A

Blood disorders
Hyperkalaemia
Mouth ulcers

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54
Q

Can trimethoprim be used in pregnancy?

A

No it is teratogenic

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55
Q

Examples of aminoglycosides?

A

Genamycin (1st choice)
Neomycin
Amikacin

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56
Q

Can neomycin be given parentally?

A

No - toxic

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57
Q

Gentamicin route?

A

Parenteral only

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58
Q

Normal Gentamicin therapeutic drug range?

A

Peak = 5 - 10mg/L
Trough = < 2

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59
Q

When is gentamicin TDR reduced and what are the new targets?

A

Endocarditis
Peak = 3-5mg/L
Trough = <1

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60
Q

When giving gentamicin, when is dose reduction preferred over interval increase in renal impairment?

A

When eGFR < 30

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61
Q

Gentamicin dose when given OD?

A

7mg/kg OD

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62
Q

When should once daily doses of Gentamicin be avoided?

A

When eGFR < 20ml/min

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63
Q

Monitoring requirements when giving multiple daily doses of gentamicin with normal renal function?

A

Monitor after 3-4 doses, then every 3 days, then after dose changes.

More frequent in renal impairment.

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64
Q

Can gentamicin be given in pregnancy?

A

Avoid due to ototoxicity in the baby during the 2nd and 3rd trimester

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65
Q

Side effects of gentamicin?

A

Ototoxicity
Nephrotoxicity
Peripheral neuropathy

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66
Q

Gentamicin MHRA alert?

A

Some batches contain histamine so monitor for anaphylaxis reactions

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67
Q

Examples of glycopeptides?

A

Vancomycin
Dalbeavancin
Teicoplanin

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68
Q

How often is Teicoplanin given daily?

A

OD

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69
Q

Vancomycin route of administration?

A

Parenteral

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70
Q

Vancomycin TDR?

A

10-20mg/L

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71
Q

Side effects of vancomycin?

A

Ototoxicity
Nephrotoxicity
Blood dyscrasias
Red-man syndrome (when given too rapidly)
Tinnitus - Stop if this occurs

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72
Q

What medication causes red-mans syndrome when given too rapidly and what are the symptoms?

A

Vancomycin
Symptoms = rash on face, torso and neck

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73
Q

Examples of macrolides?

A

Azithromycin
Clarithromycin
Erythromycin

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74
Q

Which macrolide is available OTC to over 16s for chlamydia?

A

Azithromycin

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75
Q

Which macrolide is safest in pregnancy?

A

Erythromycin

76
Q

How often is azithromycin given daily?

A

OD

77
Q

How often is clarithromycin given daily?

A

BD

78
Q

How often is Erythromycin given daily?

A

BD or QDS

79
Q

Side effects of macrolides?

A

GI disturbance
Taste disturbance
Tongue discolouration
QT prolongation

80
Q

Which macrolide has the most GI effects and most likely to prolong QT?

A

Erythromycin

81
Q

Should azithromycin and Clarithromycin be taken with or without food?

A

Azithromycin = before food
Clarithromycin = after food

82
Q

Which two macrolides require a 2H gap when using indigestion remedies?

A

Azithromycin and clarithromycin

83
Q

Example of an antispseudomonal penicillin?

A

Piperacillin and Ticarcillin

84
Q

What route can you give antispseudomonal penicillins?

A

Parenteral

85
Q

Which penicillins can cause cholestatic jaundice?

A

Flucloxacillin
Co-amoxiclav

86
Q

Why should amoxicillin not be used for sore throats?

A

Could be glandular fever which presents as a maculopapular rash which could be mistaken for a pen allergy.

87
Q

What is the purpose of clavulanic acid in co-amoxiclav?

A

Protects amoxicillin against beta-lactamases

88
Q

Dose of amoxicillin for each age bracket?

A

1 - 11months = 125mg TDS
1 - 4years = 250mg TDS
Adults = 500 - 1000mg TDS

89
Q

What route must amoxicillin never be given due to risk of brain damage?

A

Intrathecally

90
Q

Which penicillins are hepatotoxic

A

Flucloxacillin and co-amoxiclav

91
Q

Interaction between amoxicillin and warfarin?

A

Increased bleeding

92
Q

Interaction between amoxicillin and methotrexate?

A

Increased toxicity

93
Q

How many generations of cephalosporins are there?

A

5

94
Q

Example of 1st gen cephalosporins?

A

“Cefa”
Cefalexin, Cefadroxil (BD), Cefradine

95
Q

Example of 2nd gen cephalosporins?

A

“2 foxes for tea”
Cefaroxime, Cefoxitin, Cefaclor

96
Q

Example of 3rd generation cephalosporins?

A

“Me/one”
Cefixime, Cefotaxime, Ceftazidime, Ceftriaxone

97
Q

Example of 4th generation cephalosporins?

A

“Pi”
Cefepime

98
Q

Example of 5th generation cephalosporins?

A

“Ol”
Ceftaroline, ceftobiprole

99
Q

Which cephalosporins are most associated with colitis?

A

3rd and 4th gen

100
Q

Can you use cephalosporins in penicillin allergy?

A

Avoid
Use 3rd gen or cefuroxime if necessary

101
Q

Which antibiotics do you take before food?

A

“DROP FAT”
Demeclocycline
Rifampicin
Oxtetracycline
Pen V
Flucloxacillin
Ampicillin/azithromycin
Tetracycline

102
Q

Side effects of co-trimoxazole?

A

Steven-Johnson’s syndrome

103
Q

Which penicillin can cause hypernatraemia in high doses?

A

Pen G

104
Q

Penicillin interactions?

A

“WAM”
Warfarin, allopurinol, methotrexate

105
Q

What is gastroenteritis and what are the common causes?

A

Food poisoning
Causes include = shigella, salmonella, E. Coli, rotavirus and noravirus

106
Q

How is gastroenteritis treated?

A

Typically self limiting but if antibiotics needed give ciprofloxacin

107
Q

C. Diff infection cause?

A

Elderly, PPI use, antibiotics

108
Q

Treatment of 1st episode C. Diff infections?

A

For 1st episode:
1st line = Vancomycin 125mg QDS
2nd line = Fidaxomycin 200mg BD

109
Q

Treatment of 2nd episode C. Diff infections?

A

If within 12weeks of 1st ep = fidaxomycin
If over 12weeks since first ep = fidaxomycin / vancomycin

110
Q

Causative agents for endocarditis?

A

Staphylococcus, streptococcus, enterococcus, HACEK

111
Q

Endocarditis treatment with native valve? Blind therapy

A

Amoxicillin +/- low dose gentamicin

112
Q

Endocarditis treatment with native valve and penicillin allergy or MRSA suspected? Blind therapy

A

Vancomycin +/- low dose gentamicin

113
Q

Endocarditis treatment with prosthetic valve? Blind therapy

A

Vancomycin + Rifampicin + low-dose gentamicin

114
Q

Endocarditis treatment once cultures come back?

A

Vancomycin if MRSA
Flucloxacillin if staphylococcal
Pen G if streptococcal

115
Q

Treatment of low-severity CAP?

A

Amoxicillin

116
Q

Treatment of low-severity CAP with penicillin allergy?

A

Clarithromycin + Doxycycline

117
Q

Treatment of low-mild severity CAP with penicillin allergy and pregnant?

A

Erythromycin + Doxycycline

118
Q

Treatment of mild severity CAP if atypical pathogens are the cause?

A

Amoxicillin + clarithromycin

119
Q

Treatment of high-severity CAP?

A

PO/IV Co-amoxiciav + clarithromycin (Erythromycin in pregnancy)

120
Q

Treatment of high-severity CAP with a penicillin allergy?

A

Levofloxacin

121
Q

Treatment of non-severe and low resistance risk HAP?

A

Co-amoxiclav

122
Q

Treatment of non-severe and low resistance risk HAP with a penicillin allergy?

A

Doxycycline or cefalexin

123
Q

Treatment of severe HAP?

A

Pippericillin tazobactam

124
Q

Treatment of meningitis in blind therapy?

A

Pen G

125
Q

Treatment of meningitis with penicillin allergy or pneumococcal cause?

A

Cefotaxime or chloramphenicol if immediate sensitivity

126
Q

Treatment for osteomyelitis?

A

Flucloxacillin

127
Q

Treatment for osteomyelitis in penicillin allergy?

A

Clindamycin

128
Q

What are the two types of impetigo?

A

Bullous and non-bullous

129
Q

What is the causative agent of impetigo?

A

Staphylococcus

130
Q

1st line treatment for local non-bullous impetigo not near the eyes?

A

Hydrogen peroxide 1% cream

131
Q

Treatment for local non-bullous impetigo if 1% hydrogen peroxide not suitable?

A

Fusidic acid
Or Mupirocin in resistance

132
Q

1st line treatment for wide-spread non-bullous impetigo but PT is not systemically unwell?

A

Fusidic acid

133
Q

1st line treatment for wide-spread non-bullous impetigo and PT is systemically unwell?

A

Flucloxacillin

134
Q

1st line treatment for wide-spread non-bullous impetigo and PT is systemically unwell and has a penicillin allergy?

A

Clarithromycin or erythromycin

135
Q

Interaction between fusidic acid and statins?

A

Rhabdomylosis - hold statin for up to 7 days post treatment with fusidic acid

136
Q

Cellulitis treatment?

A

PO/IV flucloxacillin

137
Q

Cellulitis treatment with penicillin allergy?

A

Clarithromycin or doxycycline or erythromycin

138
Q

Cellulitis treatment if near the eyes or nose?

A

PO/IV Co-amoxiclav

139
Q

Cellulitis treatment if near the eyes or nose if PT has a penicillin allergy?

A

Clarithromycin + Metronidazole

140
Q

Animal or human bite treatment?

A

PO/IV Co-amoxiciav

141
Q

Animal or human bite treatment in penicillin allergy?

A

Doxycycline + Metronidazole

142
Q

Treatment of pericoronitis/gingivitis?

A

Metronidazole or Amoxicillin

143
Q

Treatment of periapical periodontal abscesses?

A

Pen V or amoxicillin for up to 5days

144
Q

Otitis externa causative agents?

A

Staphylococcus or pseudomonas auruginosa

145
Q

Otitis externa treatment?

A

Flucloxacillin

146
Q

Otitis externa treatment in penicillin allergy?

A

Clarithromycin or Erythromycin or Azithromycin

147
Q

Otitis media treatment?

A

Amoxicillin or co-amoxiclav if worse after 2-3 days

148
Q

Otitis media treatment in penicillin allergy?

A

Clarithromycin or erythromycin

149
Q

Sinusitis treatment?

A

Pen V or co-amoxiciav if worse after 2-3 days

150
Q

Sore throat treatment?

A

Pen V for 5-10 days

151
Q

Sore throat treatment if penicillin allergy?

A

Clarithromycin or erythromycin for 5 days

152
Q

Chlamydia treatment?

A

Doxycycline or Azithromycin 1g for one day then 500mg for 2 days

153
Q

Bacterial vaginosis treatment?

A

Metronidazole 2g for one dose OR 400-500mg BD for 5-7days

Or topical clindamycin for 7 days
Or topical metronidazole for 5 days

154
Q

Causative agent for lower UTI?

A

E. Coli

155
Q

Treatment of lower UTI?

A

Nitrofurantoin or Trimethoprim
3 days for women 5 days for men

156
Q

Treatment of lower UTI in pregnancy?

A

Nitrofurantoin for 7 days
Or amoxicillin or cefalexin

157
Q

How many times is classed as recurrent UTI?

A

2 in 6 months
Or 3+ in 12months

158
Q

Signs of sepsis?

A

“SEPSIS”
Slurred speech
Extreme shivering/muscle pain
Passing no urine all day
Severe breathlessness
It feels like you are about to die
Skin mottled or discoloured

159
Q

Treatment of community acquired sepsis?

A

Antispseudomonal penicillin or cephalosporins

160
Q

Tuberculosis treatment?

A

“RIPE”

Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for 2 months

THEN
Rifampicin + Isoniazid for 4 months

161
Q

Tuberculosis symptoms?

A

Cough lasting 3+ weeks
Neck swelling
Night sweats or fever

162
Q

What colour does rifampicin turn urine?

A

Orange - red

163
Q

Which anti-tuberculosis medication can cause peripheral neuropathy and what can be done to prevent/treat this?

A

Isoniazid

Give with pyridoxine (vit. B6)

164
Q

Which anti-tuberculosis medication does the patient have to avoid tyramine or histamine rich foods?

A

Isoniazid

165
Q

Which anti-tuberculosis medication can cause visual disturbances?

A

Ethambutol

166
Q

Which anti-tuberculosis medication is NOT hepatotoxic?

A

Ethambutol

167
Q

Treatment of oral candidiasis?

A

Nystatin (POM) or Miconazole

168
Q

Vulval or vaginal thrush (candidiasis) treatment?

A

Flucloxacillin as a single oral dose
Or clotrimazole topically

169
Q

Malaria symptoms?

A

> 38degrees
Chills
Headache
Muscle aches
Diarrhoea and vomiting

170
Q

Are anti malarials 100% effective?

A

No

171
Q

Which antimalarials must you avoid in epilepsy?

A

Chloroquine and mefloquine

172
Q

Which antimalarials must you avoid in renal impairment?

A

Proguanil and Malarone if eGFR< 30

173
Q

Which antimalarials can you give in pregnancy?

A

Chloroquine and proguanil
Along with 5mg folic acid

174
Q

Which antimalarials must you avoid in pregnancy?

A

Doxycycline

175
Q

What must be done if a patient requires anti malarial prophylaxis but takes warfarin?

A

Start 2-3 weeks before travel as requires a stable INR before leaving.
Measure INR before starting, after 7 days and on completion.

176
Q

Which antimalarials can cause psychiatric reactions?

A

“Quines”
Chloroquine and mefloquine

177
Q

Typically how long before and after travel should antimalarials be taken?

A

1 week before and 4 weeks after

178
Q

Which antimalarials can be take 1-2 days before travel?

A

Doxycycline and Malorone

179
Q

Which antimalarials should be started 2-3 weeks before travel?

A

Mefloquine

180
Q

Which antimalarial should only be taken for 1 week after travel?

A

Malorone

181
Q

Which antimalarials should only be taken OD?

A

Malarone, doxycycline and proguanil

182
Q

Which antimalarials should only be taken once weekly?

A

“Quines”
Mefloquine and chloroquine

183
Q

When can quinine be given as stand by treatment for malaria?

A

If access to medical care is >24H away

184
Q

What written instructions must be given with quinine when given as stand by treatment for malaria?

A

Seek medical help if they have a fever >38degrees for over 7 days

185
Q

Which antibiotics are least likely to cause c. Diff infection?

A

Aminoglycosides

186
Q

Clarithromycin and Ciclosporin interaction?

A

Clarithromycin increases the concentration of Ciclosporin

PharmEducate Notes (8 decks)

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