Infections Flashcards
What are the indications of Quinine?
Nocturnal leg cramps
Non-falciparum malaria
Falciparum malaria (in adults and children)
What is the main safety information of quinine?
Dose dependant QT Prolongation
Caution in patients with an increased risk of QT Prolongation and Atrioventricular Block
What are the contraindications of Quinine?
Remember: TOM Hiddleston
- Tinnitus
- Optic Neuritis,
- Myasthenia Gravis,
- Haemoglobinemia
What drugs cause a definite risk of haemolysis in G6PD-deficient patients?
Mnemonic: MNOPQRS (Alphabetical)
- Methylthioninium Chloride
- Nitrofurantoin
- dapsone and Other sulfones
- Primaquine
- Quinolones (ciprofloxacin, moxifloxacin, norfloxacin, ofloxacin)
- Rasburicase
- Sulfonamides (including co-trimoxazole)
What’s drugs cause a possible risk of haemolysis in some G6PD-Deficient patients?
- Aspirin
- Chloroquine
- Menadione, water soluble derivatives (eg. Menadiol sodium phosphate)
- Quinine (may be acceptable in acute malaria)
- sulfonylureas
- naphthalene in mothballs
What are the drugs which cause C. Diff?
The 4 C’s
Cephalosporins
Clindamycin
Ciprofloxacin
Co-amoxiclav
Also
Other broad spec Penicillins
PPIs
What are the main side effects of Nitrofurantoin?
Mnemonic: Bob Can Pee Alright
- Blood Disorders
- Acute Pulmonary Reactions
- Peripheral Neuropathy
- Cholestatic Jaundice
A patient has an eGFR of 38 and the doctor wishes to put them onto nitrofurantoin.
What advice would you give the prescriber with regarding their treatment?
Give them a short course only
A patient has an eGFR of 27 and the doctor wishes to start them on nitrofurantoin?
What advice would you give the prescriber regarding their treatment?
Nitrofurantoin should be avoid in eGFR <30
What counselling advice would you give patients regarding nitrofurantoin?
- Report any signs of new or worsening respiratory symptoms
- Report any signs of hepatic dysfunction (abdo pain, swelling legs, jaundice etc)
- Take with or after food
- This tablet may discolour the urine, it is of no concern
Can you give chloramphenicol to someone who is pregnant? Yes or no, and if no, why?
No - Avoid
Risk of neonatal ‘Grey-Baby syndrome’
What are the antibiotic choices for Lower UTI?
Mnemonic: Can Not Avoid the Treatment For Peeing
- Cefalexin
- Nitrofurantoin
- Amoxicillin
- Trimethoprim
- Fosfomycin
- Pivemecillinam
What are the side effects of Amoxicillin?
- Nausea
- Diarrhoea
- Antibiotic-Associated Colitis
- Skin Rash
What are the main interactions of Amoxicillin?
- Methotrexate: Reduced clearance
- Allopurinol: Increased Risk of Rash
What are the main side effects of Trimethoprim?
Remember: ‘HACk SiR’
- Hyperkalaemia
- Agranulocytosis
- Cholestatic Jaundice
- Skin rashes
- Raised serum Creatinine
What are the contra-indications of Trimethoprim?
- Severe Hepatic or Renal Impairment
- Blood Dyscrasias
What are the side effects of Pivmecillinam?
- Diarrhoea
- Vulvovaginal Fungal Infection
What are the contra-indications of Pivmecillinam?
- Carnitine Deficiency
- GI Obstruction
What are the main interactions with Pivmecillinam?
- Methotrexate: Reduced clearance
- Valproate - Increased risk of Carnitine Depletion
What are the main interactions with penicillins?
- Methotrexate: may reduce MTX clearance and increase risk of toxicity
- Allopurinol: Increased risk of rash with Amoxicillin
- Warfarin: May increase INR Levels
What are the main interactions with Quinolones (-floxacins)?
- Drugs that prolong QT Interval
- NSAIDs: Increase risk of seizures
- Theophylline: Plasma levels increased
- Corticosteroids: Increased risk of tendon damage
- Ciclosporin: Risk of nephrotoxicity and increased conc.
- Phenytoin: Increase or decrease levels
- Methotrexate: may increase plasma levels of MTX
What are the main interactions with Trimethoprim?
- Methotrexate: Increased risk of bone marrow suppression
- Phenytoin: Reduced risk of Phenytoin toxicity
- Digoxin: Increased Digoxin levels
- Azathioprine: Risk of haematological toxicity increased
- Warfarin: May increase levels