Infections Flashcards

Question

Treatment of Gonorrhoea - uncomplicated

Answer 1

Obtain cultures Contact tracing If less than 14 days since exposure - treat If more than 14 days since exposure - test and if positive treat Sex needs to be avoided for 7 days after pts and partners have completed treatment. 1st line: ceftriaxone - ciprofloxacin if sensitive - gentamicin plus azithromycin if allergy or contra-indicated. - cefixime plus azithromycin - azithromycin if all unable to take

Answer 2

Contact tracing recommended - doxycycline + metronidazole + single dose of i/m ceftriaxone - ofloxacin and metronidazole Duration of treatment is 14 days Severely Ill patients - doxycycline + IV Metronidazole + IV ceftriaxone then switch to oral doxycycline + metronidazole

Answer 3

Contact tracing recommended - benzathine benzylpenicillin Single dose normally Pregnancy second dose after a week Alternatives - doxycycline - erythromycin Duration of treatment is 14 days If late syphillis after two years Benzathine benzylpenicillin once weekly for 2 weeks Doxycycline (alternative) duration is 28 days

Answer 4

Not to generally treat Delayed prescription for pts systemically unwell and symptoms present for around 10 days. 1st line - (non- life threatening) phenoxymethylpenicillin 2nd line - worsening symptoms or systemically very unwell - co-amoxiclav PENICILLIN ALLERGY - clarithromycin or doxycycline PREGNANCY- erythromycin

Answer 5

Dentoalveolar abscess - phenoxymethylpenicillin - amoxicillin is better absorbed - co-amoxiclav is active against beta lactamase producing bacteria or if severe dental infection - metronidazole - anaerobic infections, penicillin allergies, resistance to penicillin. - cefalexin or cefradine (cephalosporin) used in oral infections. Others offer little advantage. - doxycycline (effective against oral anaerobes) longer half life than oxytetracycline or tetracycline - macrolids - useful in penicillin allergies or resistance to penicillin Clindamycin should not be used routinely If the oral infection fails to respond to antibiotics within 48 hours, the antibacterial should be changed. Failure to respond may also be due to incorrect diagnosis, lack of other measures like drainage, poor host resistance, or poor patient compliance.

Answer 6

Depends on the type and severity Non bullous impetigo - most common Bullous impetigo - not as common Localised non bullous - 1. topical hydrogen peroxide 1% cream 2. Fusidic acid or mupirocin 3. Flucloxacillin or macrolid Wide-spread non bullous, systemically well and no high risks of complications Topical or oral antibacterial 1. Fusidic acid or mupirocin 2. flucloxacillin or macrolid Non-bullous, unwell or high risk of complication / bullous impetigo ORAL antibacterial 1. Flucloxacillin or macrolid NOT TO GIVE BOTH ORAL AND TOPICAL TOGETHER.

Answer 7

1. Swab for microbiological testing 2. Drawing around and monitor can be considered 3. Manage any underlying conditions - diabetes - venous insufficiency - eczema - oedema 4. Refer patients to hospital if signs and symptoms suggest more serious illness. - orbital cellulitis - osteomyelitis - septic arthiritis - necrotising fasciitis - sepsis TREATMENT 1. Oral or Iv - flucloxacillin 2. Clarithromycin/erythromycin/doxycycline Infection near the eye or nose 3. Co-amoxiclav 4. Clarithromycin + metronidazole Severe infections 5. Co-amoxiclav 6. Clindamycin 7. Iv cefuroxime 8. IV ceftriaxone MRSA + vancomycin / teicoplanin / Linezolid If atleast 2 separate episodes in 12 months. Consider prophylactic antibiotic. Review every 6 months

Answer 8

Takes more than 4-6 weeks to heal. Signs and symptoms - redness - swelling spreading beyond the ulcer - localised warmth - increased pain - fever Step 1 Manage any underlying causes - venous insufficiency - oedema Step 2 Offer treatment to those with signs and symptoms of infection Step 3 Take a sample if the symptoms are worsening despite treatment or have not improved. Review the choice of treatment Treatment options Not severely unwell 1st line - flucloxacillin Alternative - erythromycin/clarithromycin or doxycycline 2nd line - co-amoxiclav Alternative- co-trimoxazole in pen allergies Severely unwell 1st line - - IV flucloxacillin +/- metronidazole or gentamicin - iv co-trimoxazole +/- IV gentamicin or metronidazole (penicillin allergies) 2nd line - IV pipercillin with tazobactam - IV ceftriaxone +/- metronidazole MRSA + IV vancomycin/teicoplanin/Linezolid

Answer 9

DOES NOT NEED ANTIBIOTICS. Redness, pain and swelling is often caused by inflammatory or allergic reactions. Symptoms rarely last longer than 10 days Tick bite = Lyme disease Outside of UK - Treat Signs and symptoms of infection - TREAT AS CELLULITIS 1. Flucloxacillin 2. Clarithromycin/erythro/doxycycline

Answer 10

Assess for risk of tetanus, rabies or blood borne viral infection. 1. Clean wound by irrigation and debrided as necessary 2. Refer patient to hospital if signs of more serious infection or condition. 3. Take swab 4. Offer prophylaxis antibiotic For cats, human and dogs and other traditional pets. TREATMENT OPTIONS 1. Co-amoxiclav 2. Doxycycline with metronidazole IV 3. Co-amoxiclav 4. Cefuroxime with metronidazole 5. Ceftriaxone with metronidazole

Answer 11

- Not absorbed from the gut - Given by injection for systemic infections - when used for blind therapy, usually given with metronidazole or a penicillin (or both) - loading and maintenance dose is calculated based on pts weight and renal function. - adjustments of doses are made based on serum gentamicin concentration - high doses are occasionally needed for serious infection especially in neonates, CF, or immunocompromised. - treatment should usually not be longer than 7 days - neomycin is too toxic for parenteral administration. - once daily dozing is more convenient however should be avoided in 4 people 1. Endocarditis caused by gram positive bacteria 2. HÁČEK endocarditis 3. Burns of more than 20% of total body SA 4. If the creatinine clearance is less than 20ml/minutes. MHRA - increased risk of deafness in patients with mitochondrial mutations - to minimise the risks of adverse effects continuous monitoring of renal and auditory function as well as hepatic and laboratory parameters Side-effects 1. Ototoxicity 2. Nephrotoxicity Pregnancy - risk of auditory and vestibular nerve damage in infants when ahminoglycosides are used in the second and third trimester. Monitoring requirements - after 3/4 doses in multiple daily dose regimen and after a dose change. - sample taken after an hour of administration. - doses adjusted based on peak and trough concentration.

Answer 12

- to avoid excessive dosage in obese patients use ideal body weight for height to calculate parenteral dose - MHRA: histamine- related adverse drug reactions with some batches. - no longer than 7 days course Must determine serum conc in:- 1. Elderly 2. Obese 3. High doses 4. Renal impairment 5. Cystic fibrosis Monitoring - multiple daily dosing - one hour peak conc 5-10mg/liter - pre dose trough conc < 2mg/liter Endocarditis = 2-5mg/l and < 1mg/l Side effects 1. Ototoxicity 2. Nephrotoxicity

Answer 13

- beta lactam antibacterials - not active against MRSA - used in severe and complicated infections - IMIPENEM partially inactivated in the kidney by enzymatic activity and is given with CILASTATIN an enzyme inhibitor which blocks the renal metabolism. The other carbipenams are fine - MEROPENEM has less seizure inducing potential and can be used to treat CNS infections AVOID if immediate hypersensitivity reactions to beta lactam antibacterials AVOID in PREGNANCY

Answer 14

- Broad spectrum - excretion is principally renal - penetrate the cerebrospinal fluid poorly unless the meningis is inflamed. - cross reactivity between penicillin and 1st and 2nd generation cephalosporin - upto 10% and 2-3% with 3rd generation. - MoA :- attach to the penicillin binding protein to interrupt cell wall synthesis, leading to bacterial cell lysis and death.

Answer 15

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Answer 16

- 1st generation - avoid in pregnancy - blood disorders - including leukopenia, granulocytopenia, thrombocytopenia, lymphopenia, eosinophilia, and increased leucocytes are reversible.

Answer 17

- 2nd generation - associated with protracted skin reactions especially in children.

Answer 18

- third generation - precipitates of calcium ceftriaxone can occur in the gall bladder and urine (in the young dehydrated or those immobilised) consider discontinuing if symptomatic.

Answer 19

- glycopeptide antibiotic - similar to vancomycin but has significant longer duration of action which means it can be given as once daily dose after the loading dose. - active against aerobic and anaerobic gram positive bacteria including multi-resistance staph - should not be given by mouth for systemic infection because it’s not absorbed. - associated with a lower incidence of nephrotoxicity than vancomycin - pregnancy - only if benefits > risks

Answer 20

- narrow therapeutic index - active against aerobic and anaerobic gram positive bacteria including multi-resistant staph - penetration into the cerebrospinal fluid is poor - should not be given by mouth for systemic infections because it’s not absorbed significantly. Side effects - high incidence of nephrotoxicity - ototoxic - discontinue if tinnitus occurs - red-man syndrome - flushing of the upper body due to rapid infusion and can be associated with hypotension and bronchospasms - blood dyscrasias - skin disorders - Steven Johnson syndrome. Toxic epidermal necrolysis. Rash. Itching. - thrombophlebitis - pain and inflammation at the injection site. Pregnancy. - pregnancy if benefits > risks (monitor plasma conc to reduce fetal toxicity) Monitoring - initial dose based on body weight and dose adjustment based on serum vancomycin concentration. - serum vancomycin measurement is taken in the second day of treatment before the next dose if renal function is normal, earlier if there is impairment. - pre-dose (trough) = 10-20mg/L - RENAL FUNCTION - AUDITORY AND VESTIBULAR FUNCTION. - BLOOD COUNTS, hepatic and urinalysis Interaction - avoid drugs that cause ototoxicity - loop diuretics. Avoid concurrent or sequential use of other ototoxic drugs.

Answer 21

- used in 1. Steptococci 2. Penicillin resistant staph 3. Anaerobes - well concentrated in the bone and excreted in bile and urine - contra-indicated in diarrhoea (Discontinue) - associated with an increase risk of c.diff. Discontinue if suspected or confirmed. - pregnancy - not known to be harmful in 2nd and 3rd trimester - monitor liver and renal function if treatment longer than 10 days

Answer 22

- alternative in penicillin allergy - take with or after food Side-effects 1. QT interval prolongation 2. Hepatotoxicity 3. Ototoxic at high doses. Interactions - enzyme inhibitor - warfarin - statins - azithro - once daily dosing clairthromycin - BD, dose based on weight - Avoid in pregnancy (especially 1st trimester) Erythromycin - QDS dosing - MHRA - drug interaction with rivaroxiban (Increased risk of bleeding) - MHRA - known risk of infantile hypertrophic pyloric stenosis (found the risk to be the highest in the 1st 14 days after birth) - parents should be advised to seek medical attention if vomiting or irritable with feeding occurs in infants during treatment.

Answer 23

- QDS dosing - MHRA - drug interaction with rivaroxiban (Increased risk of bleeding) - MHRA - known risk of infantile hypertrophic pyloric stenosis (found the risk to be the highest in the 1st 14 days after birth) - parents should be advised to seek medical attention if vomiting or irritable with feeding occurs in infants during treatment. - can use in pregnancy

Answer 24

- highest activity against anaerobic bacteria and protozoa - contra-indicated in infants less than 3 months. - manufactures advice is avoid high doses in pregnancy - AVOID at term - Take with or after food - colours the unite yellow/brown - clinical and lab monitoring of treatment exceeds longer than 10 days

Answer 25

how it works? - Interferes with the bacterial cell wall synthesis. They diffuse well into the body tissue and fluid. - penetration into the cerebrospinal fluid is poor unless the meninges is inflamed. Side-effects - diarrhoea (can cause antibiotic associated colitis) - allergies to penicillin occurs in 1-10% of exposed individuals Specifics - benzylpenicillin is inactivated by gastric acid and absorption from the GI-tract is low; therefore given by injection. - phenoxymethylpenicillin - less active than benP. - gastric acid stable - not used for serious infections because absorption is unpredictable. - flucloxacillin - effective against penicillin-resistant staph infections. - acid stable and we’ll absorbed - given by both mouth and injection. - Ampicillin - given by mouth but less than half the dose is absorbed and further decreased by the presence of food - maculopapular rashes can occur but not always related to true penicillin allergy - amoxicillin - better absorbed than penicillin when given by mouth. So there’s high tissue and plasma concentration - not affected by the food in the stomach - co-amoxiclav - amoxicillin with clavulanic acid (beta lactamase inhibitor)

Answer 26

- hepatic events have been reported mostly in males and elderly. May be associated with prolonged use. Signs and symptoms occur during treatment or shortly after. But can sometimes occur several weeks after discontinuation. - pregnancy - avoid in preterm prelabour rupture of the membrane. Possible increased risk of necrotising entercolitis in neonate.

Answer 27

- hepatic disorders Cholestatic jaundice and hepatitis may occur very rarely upto 2 months, even after stopped. Administration for more than 2 weeks and increasing age are risk factors. - potentially life-threatening hypokaleamia can occur. Can be resistant to potassium supplementation. Regular monitoring is recommended in pts on high doses. - to take on an empty stomach.

Answer 28

- induces convulsions in patients with or without history of convulsions. - NSAIDS + quinolones also induces convulsions - tendon damage including rupture - within 48 hours of starting treatment and also several months after stopping. - increased risk of tendon damage if quinolones + corticosteroids - if tendinitis is suspected = discontinue. - increased risk of aortic aneurysm and dissection. - stop taking if symptoms develop (onset of severe abdominal pain, chest pain or back pain). - irreversible and long lasting side-effects - affecting MSK and nervous system. - small risk of heart valve regurgitation - to seek immediate medical attention if symptoms develop (shortness of breath especially when lying flat, swelling of ankles, feet or abdomen, or new onset heart palpitations) - cautions 1. Qt prolongation 2. Seizures 3. Diabetes (may affect blood glucose) 4. Exposure to excessive sunlight and UV radiation during and 48 hours after. - quinolones causes atrophy in weight bearing joints. Not recommended in growing children and adolescents. - avoid in pregnancy

Answer 29

- systemic side effects can occur with neubulised levofloxacin - BRONCHOSPASMS - if acute symptomatic brochospasms occour after receiving nebulised levofloxacin, patients may benefit from the use of short acting inhaled bronchodilator atleast 15 minutes to 4 hours prior to the doses.

Answer 30

- discontinue if blood disorders (including leucopenia, thrombocytopenia, megaloblastic, anemia, eosinophilia) or rash (Steven Johnson syndrome, or toxic epidermal necrolysis) develop. - teratogenic in pregnancy - 1st and 3rd trimester. - monitor - potassium and sodium Blood count

Answer 31

- B-road spectrum antibiotics but their use has now decreased due to increasing bacterial resistance. - have a role in the management of MRSA - little to choose between the different ones - minocycline has a broader spectrum. But no longer recommended because of the side effects (dizziness, vertigo). Also has a greater risk of lupus-erythematosus- like syndrome. And can also cause irreversible pigmentation - headaches and visual disturbances with tetracycline can indicate benign intracranial hypertension (discontinue if raised intracranial pressure develops) - AVOID in pregnancy - 1st trimester - effects on skeletal development and 2nd/3rd trimester - discolouration of the child’s teeth. - maternal hepatotoxicity has also been reported with high doses. - AVOID in breastfeeding. - teeth discolouration.

Answer 32

- avoid in pregnancy Can be used for malaria if no suitable alternatives. And if the treatment can be completed before 15 weeks gestation. - to take with plenty of fluid and sitting upright - photosensitivity - not to take indigestion remedies, zinc or iron - can have MILK

Answer 33

- contra-indicated in children under 8 years - avoid with indigestion remedies, iron and zinc - can have MILK

Answer 34

- contraindicated in children under 12 years - if prescribed for longer than 6 months, monitor for hepatotoxicity, pigmentation, systemic lupus erythematosus. Discontinue if they develop. - swallow whole with plenty of fluid and sitting upright - not to take indigestion remedies, zinc and iron. - can have MILK.

Answer 35

- contraindicated in under 12 years - can NOT take with MILK , indigestion remedies, zinc and iron. - WITHOUT FOOD.

Answer 36

- contraindicated in under 12 years - swallow whole with plenty of fluid and sitting upright or standing. - NOT to take with MILK, indigestion remedies, zinc or iron - WITHOUT FOOD

Answer 37

- potent B-road spectrum antibiotic - side effect - serious haematological side effect when given systemically. Reserve for life-threatening infections - AVOID in pregnancy - grey baby syndrome when given in third trimester.

Answer 38

- narrow spectrum antibiotic - with topical use - less than 10 days treatment to avoid development of resistance. - side-effect - elevated liver enzymes, hyperbilirubinaemia and jaundice can occur with systemic use. Reversible on withdrawl. - pregnancy not known to be harmful

Answer 39

reversible MAOI - optic neuropathy Severe, can occur rarely if used for longer than 28 days. Patients to report visual symptoms (blurred vision, visual field defects, changes in visual acuity and colour vision) - blood disorders Haemotopoietic disorders (thrombocytopenia, anemia, leucopenia) have been reported. Blood counts weekly. - Interactions hypertensive crisis. SSRI, MAOi, sympathomimetics, opioids, 5HT1 agonists, dopaminergics. avoid tyramine rich foods - caution - close observation and blood pressure monitoring possible. Linezolid needs to be avoided in 1. Acute confusional states 2. Bipolar depression 3. Carcinoid tumour 4. Phaechromocytoma 5. Schizophrenia 6. Thyrotoxicosis 7. Uncontrolled hypertension

Answer 40

- contra-indicated in blood dyscrasias - Blood disorders - patients need to be told how to recognise signs (fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develops) - teratogenic in pregnancy - AVOID - monitoring 1. FBC 2. Serum electrolyte (hyperkalaemia) 3. Renal function 4. Plasma trimethoprim concentration with long-term use.

Answer 41

- fever or malaise - aches and pain - pus, swelling or inflammation - drowsiness in children - confusion in elderly - worsening of renal function

Answer 42

- low Bp - raised blood glucose - high ESR - high C-reactive protein - temperature - high respiratory rate - high HR

Answer 43

1. Tetracycline 2. Quinolones

Answer 44

1. Drugs that increase risk of c.diff Clindamycin 2. Drugs that affect or affected by renal and liver function 3. Drug interactions

Answer 45

1. Aminoglycosides 2. Glycopeptides - vancomycin 3. Nitrofurantoin - AVOID if eGFR < 45 4. Tetracyclines (except minocycline and doxycycline.

Answer 46

1. Rifampicin - hepatotoxic 2. Tetracycline - hepatotoxic 3. Metronidazole- reduce dose if severely impaired 4. Co-amoxiclav 5. Flucloxacillin

Answer 47

1. Metronidazole 2. Chloramphenicol 3. Aminoglycosides 4. Tetracycline 5. Quinolones 6. Sulphonamides 7. Trimethoprim 8. Nitrofurantoin - avoid at term

Answer 48

1. Penicillin 2. Cephalosporins 3. Macrolids - erythromycin

Answer 49

DD 1. Demeclocycline 2. Doxycycline Avoid exposure to sunlight and sunlamps

Answer 50

DOT 1. Demeclocycline 2. Oxytetracycline 3. Tetracycline

Answer 51

DMT 1. Doxycycline 2. Minocycline 3. Tetracycline Swallow whole - with fluid and standing up right

Answer 52

Caused by a bite of a infected tick. Requires prompt and correct removal of the tick. This reduces the risk of infection. Signs and symptoms - erythema migrans rash (becomes visible 1-4 weeks after tick but can appear from 3 days to 3 months and can last for several weeks) - can be accompanied by non focal symptoms such as fever, swollen glands, malaise, fatigue, neck pain or stiffness, joint or muscle pain, headache, cognitive impairment or paraesthesia. - other signs and symptoms can appear months or years after the initial infection. Usually focal symptoms (including atleast 1 organ). Neurological, joint, cardiac or skin. Drug treatment Usual treatment options - oral doxycycline - amoxicillin - azithromycin - intravenous ceftriaxone. (Treatment depends on the signs and symptoms and affected area)

Answer 53

Treat If - severe - systemically unwell - symptoms do not improve after 12-14 hours of effective milk removal - culture indicated infection TREATMENT treat for 10-14 days 1. Flucloxacillin 2. Erythromycin

Answer 54

Generally - vancomycin/teicoplanin or Linezolid. Skin and soft tissue infection - normal options and adding + vancomycin/teicoplanin/ Linezolid. Hospital acquired pneumonia - IV first line - pipercillin with tazobactam Add + vancomycin/teicoplanin/Linezolid Other options - cephalosporin Septicaemia - to add vancomycin or teicoplanin Endocarditis - vancomycin + low dose gentamicin + rifampicin Osteomyelitis - vancomycin or teicoplanin Septic arthritis - vancomycin or teicoplanin Urinary tract infection - oral doxycycline - trimethoprim - ciprofloxacin - co-trimoxazole - glycopeptide - vancomycin

Answer 55

Spread by breathing in infected respiratory droplets Most common form is in the lung (pulmonary) but it can spread to other body parts (extra pulmonary) In some cases the bacteria may become dormant and remain in the body with no symptoms (latent TB) or with symptoms (active TB). Standard treatment is completed in 2 phases. Initial phase and continuation phase. Two regimens: unsupervised or supervised.

Answer 56

Initial phase Offer 4 drugs 1. Rifampicin 2. Ethambutol 3. Pyrazinamide 4. Isoniazid with pyridoxine Continued for 2 months. Treatment to be started without waiting for culture results if the symptoms are consistent with TB diagnosis. To complete the course even if subsequent culture results are negative. Continuation phase Offer 2 drugs 1. Rifampicin 2. Isoniazid For 4 months if without CNS involvement And for 10 months if it includes CNS involvement with or without spinal involvement.

Answer 57

Latent TB is when you have TB but no symptoms. Management - 3 months of rifampicin and isoniazid - 6 months of isoniazid 35-65 Offer treatment if hepatotoxicity is not concern Under 35 Treatment with isoniazid + rifampicin If hepatotoxicity is a concern after an assessment of both liver function. Interaction with rifampicin or HIV Offer isoniazid for 6 months.

Answer 58

Unsupervised for reliable patients Supervised - usually daily or 3 times a week. Less than 3 times a week is not recommended.

Answer 59

Initial phase for 2 months with 4 drugs, and continuation for up-to 10 months. Treatment should be offered if clinical signs and lab findings are consistent with the diagnosis even if the diagnostic test is negative. An initial high dose of dexamethasone or prednisolone should be offered at the same time as the treatment then slowly withdrawn over 4-8 weeks.

Answer 60

Initial high dose of oral prednisolone offered at the same time as the TB drugs and then withdrawn over 2-3 weeks.

Answer 61

TB with no symptoms. Some individuals are at risk of developing active TB. If for any reason the individuals do not have treatment for latent TB. They need to be informed of the risks and symptoms of active TB.

Answer 62

Test them for latent TB Anyone under 65 with evidence of latent TB provide drug treatment.

Answer 63

Management - 3 months of rifampicin and isoniazid - 6 months of isoniazid 35-65 Offer treatment if hepatotoxicity is not concern Under 35 Treatment with isoniazid + rifampicin If hepatotoxicity is a concern after an assessment of both liver function. Interaction with rifampicin or HIV Offer isoniazid for 6 months.

Answer 64

A break in anti-TB drugs of atleast 2 weeks during the initial phase or missing more than 20% of the prescribed dose. Need to re-establish.

Answer 65

Side-effects: occurs with intermittent therapy includes - influenza-symptoms - respiratory symptoms (SoB) - collapse - shock - haemolytic anaemia. - thrombocytopenic purpura - acute renal failure. Reduces the effectiveness of normal contraception. Teratogenic at high doses in 1st trimester and in 3rd trimester increased risk of neonatal bleeding. Monitoring of Renal, hepatic and FBC If treatment is interrupted then re-introduce at low dose and increase gradually. Discolours the contact lenses Hepatic disorders - patients need to be advised on how to recognise signs and symptoms of liver problems and discontinue.

Answer 66

Ocular symptoms. Discontinue treatment if any visual impairments. Early discontinuation almost always cause recovery in eyesight. Causes ocular toxicity Should not be given in children less than 5 Ok to use in pregnancy. Monitoring Peak (after 2-2.5 hours) 2-6mg/Liter Trough (before dose) <1mg/liter Renal function Visual acuity

Answer 67

Peripheral neuropathy. Pyridoxine is given prophylactically. It is more likely if the patient has pre-existing risk factors like: - diabetes - alcohol dependence - chronic renal failure - pregnancy - malnutrition - HIV infection Hepatitis - common in those aged over 35 years and those with a daily alcohol intake - if hepatic symptoms develop - the discontinue and seek advice. Pregnancy Not known to be harmful

Answer 68

- contra-indicated in gout - hepatitis - advise patients to report signs and symptoms of liver problems and to discontinue treatment.

Answer 69

Associated with developmental delay, cerebral palsy in infants and fetal death

Answer 70

Acute, uncomplicated UTI - self-limiting - delayed antibiotics If symptoms worsen or antibiotics needed FOR 3 days. - oral 1st line 1. Nitrofurantoin 2. Trimethoprim - oral 2nd line (if no improvement after atleast 48 hours) 1. Nitrofurantoin 2. Pivmicilinum 3. Amoxicillin 4. Fosfomycin

Answer 71

Immidiate antibacterial Mid-stream urine analysis FOR 7 DAYS Choices - oral 1st line 1. Nitrofurantoin 2. Trimethoprim - oral 2nd line Consider pyelonephritis or Prostatitis

Answer 72

Immediate antibiotics Mid-stream urine sample FOR 7 DAYS CHOICES Oral 1st line 1. Nitrofurantoin Oral 2nd line 1. Amoxicillin 2. Cefalexin Asymptomatic bacteriuria Above 3 options

Answer 73

Immediate antibacterial Mid-stream urine sample Refer patients to hospital if no improvement in 48 hours or more serious condition is suspected Choices - Oral 1st line 1. Ciprofloxacin 2. Ofloxacin 3. Trimethoprim - oral 2nd line 1. Levofloxacin 2. Co-trimoxazole IV 1st line - amikacin/gentamicin - ceftriaxone/cefuroxime - ciprofloxacin/levofluoxacin

Answer 74

Immediate antibacterial Mid-stream urine sample Men and women 1st line oral options 1. Cefalexin 2. Ciprofloxacin 3. Trimethoprim 4. Co-amoxiclav 1st line IV options 1. Aminoglycoside 2. Ceftriaxone/cefuroxime 3. Ciprofloxacin 4. Co-amoxiclav Pregnant women Oral 1st line - cefalexin IV 1st line - cefuroxime

Answer 75

Discontinue if patients develop haematological or neurological syndrome (peripheral neuropathy) Hepatic reactions - including fatal cases. Discontinue if signs of hepatitis develop Pulmonary reactions - discontinue if pulmonary reactions develop. Can occur within the first week of treatment. Reversible on discontinuation.

Answer 76

Can be treated with either locally acting anti-fungal (clotrimazole) or oral fluconazole/itraconazole.

Answer 77

Topical therapy - nystatin or miconazole Oral therapy - itraconazole

Answer 78

Mild localised fungal infection responds to topical therapy. Systemic therapy is given if topical fails, many sites are affected, or site of infection is too difficult to treat. Options - imidazole - triazole - itraconazole - terbinafine (Broader spectrum of activity and shorter duration of treatment)

Answer 79

Treated systemically Additional topical antifungal can reduce transmission. Options - terbinafine - griseofulvin

Answer 80

Topical therapy can be given If topical is ineffective then systemically. Options - itraconazole - fluconazole Terbinafine is not effective

Answer 81

- asymptomatic no treatment is required - systemic antifungal is more effective than topical. Options - terbinafine - itraconazole Itraconazole can also be given as a intermittent ‘pulse’ therapy.

Answer 82

These patients are at high risk of getting fungal infections. So anti-fungal may be given prophylactically. Options - fluconazole - itraconazole (caused by aspergillus) - posaconazole - micafungin

Answer 83

Nystatin and amphotericin B Nystatin is not absorbed when given by mouth Amphotericin B - given by IV infusion. It is highly protein bound. And has toxic side effects like nephrotoxicity.

Answer 84

- miconazole - clotrimazole - evonazole - ketoconazole - ticonazole

Answer 85

fluconazole - Well absorbed - penertrates into the cerebrospinal fluid and used to treat fungal meningitis - excreted largely unchanged Itraconazole - requires and acidic environment in the stomach for optimal absorption - associated with liver damage Posaconazole - invasive fungal infections unresponsive to normal treatment options Voriconazole - B-road spec anti-fungal used in life-threatening infections.

Answer 86

-polyene antifungal - MHRA / CHM Liposomal and lipid complex formulation. Name change to reduce medication errors. Serious harm and fatal overdose have occurred. Not interchangeable Caution: further info Anaphylaxis. Test dose should be given and monitor patient for 30 minutes before. Infusion related reactions. Prophylactic antipyretic or hydrocortisone can used in patients who experienced previous reactions

Answer 87

Rash can occur. Discontinue Severe cutaneous reactions are more likely in patients with AIDs

Answer 88

- susceptibility to congestive heart failure. Especially with high doses and long duration, pts with cardiac disease, chronic lung disease, treatment with CCB. To avoid in patients with ventricular dysfunction and history of congestive heart failure. - potentially life threatening hepatotoxicity- discontinue if signs of hepatitis develop.

Answer 89

- hepatotoxicity - phototoxicity - consider treatment discontinuation. Monitor for pre-malignant skin lesions and squamous cell carcinomas. Discontinue if they occurs. - to avoid direct sunlight. Seek help if sunburn occurs - keep alert card on them.

Answer 90

Treat with medication and hygiene. All members of the family are treated. Adult threadworms don’t live longer than 6 weeks. MEBENDAZOLE for those ages 6 months and over. Treat with a single dose then re-treat after 2 weeks.

Answer 91

Live in the upper small intestine and draws blood from the site of attachment to the host. Causing anemia Need to treat to get rid of the hookworm. MEBENDAZOLE / ALBENDAZOLE LEVAMISOLE Also need to treat the anaemia.

Answer 92

1) mosquito bed nets impregnated with insecticide likes permethrin 2) vaporised insecticides 3) long sleeves, long trousers and socks 4) insect repellents 5) diethyltoluamide DEET

Answer 93

Apply the sunscreen first then DEET after. DEET reduces the SPF of sunscreen.

Answer 94

1) chloroquine and proguanil 2) atovaquone and proguanil 3) mefloquine 4) doxycycline

Answer 95

Length of prophylaxis - 1 week before - 4 weeks after CANNOT be used in patients with epilepsy Can be given during pregnancy however they are not very effective. Folic acid to be given alongside proguanil.

Answer 96

Length of prophylaxis - 1-2 days before - 1 week after Can be used for up-to 1 year Can be used epilepsy AVOID during pregnancy. Maybe considered in 2nd or 3rd trimester if no suitable alternative. Have to give Folic acid with proguanil.

Answer 97

Length of prophylaxis - 2-3 weeks before - 4 weeks after Can be used for up-to 3 years CANNOT be used in epilepsy Can be used in pregnancy in 2nd and 3rd trimester. Used in 1st with caution.

Answer 98

Length of prophylaxis - 1-2 days before - 4 weeks after Can be used for up-to 2 years Can be used in epilepsy It may interact with anti-epileptic medication. Dose may need adjusting. Avoid in pregnancy. Contra-indicated If other regimens are unsuitable then it can be used as option if the entire course can be finished before week 15 gestation.

Answer 99

When you return from a malaria region… Any illness that occurs within 1 year and especially within 3 months could be malaria.

Answer 100

Anti-malarials should be started 2-3 weeks before departure and INR should be stable before leaving. INR to be measured before starting, after 7 days and after completing the course.

Answer 101

For those whom chloroquine would be appropriate for prophylaxis, can stay on hydroxychloroquine.

Answer 102

Patients should carry a standby emergency treatment if they are going to be more than 24 hours away from medical care. Written instructions should be provided which includes seeking urgent medical attention if fever is greater than 38 after 7 days of more from arrival to malaria area. Self treatment if indicated if medical help is not available within 24 hours of fever onset. Drug that is used for chemoprophylaxis should not be used for standby emergency treatment. - concerns if toxicity and drug resistance.

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Infections Flashcards

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