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GPhC Exam Revison > Infections > Flashcards

Infections Flashcards

1
Q

Are narrow or broad spec antibiotics preferred?

A

Narrow are preferred, except for serious infections where broad-spec is needed

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2
Q

What are examples of tetracyclines?

A

Doxycycline
Lymecycline

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3
Q

What age are tetracyclines contraindicated in?

A

<12 years old

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4
Q

Which macrolide has the highest risk of c.difficile?

A

Clindamycin

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5
Q

What is a patient at risk of if they are hepatically impaired and take co-amoxiclav?

A

Cholestatic jaundice

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6
Q

What are examples of aminoglycosides?

A

Gentamicin
Streptomycin
Neomycin

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7
Q

What class of drug is vancomycin?

A

Glycopeptide

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8
Q

What eGFR should you avoid giving nitrofurantoin to?

A

If <45ml/min

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9
Q

Which specific antibiotics should you avoid during pregnancy?

A

Remember MCAT

Metronidazole
Chloramphenicol
Aminoglycosides
Tetracyclines

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10
Q

Which class of organisms generally requires metronidazole to treat?

A

Anaerobic infections

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11
Q

Is clindamycin bacteriostatic or bacteriocidal?

A

Bacteriostatic

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12
Q

How often during the day is clindamycin usually given?

A

Four times a day

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13
Q

What should you monitor with clindamycin if patient is taking it for >10 days?

A

Renal/liver function

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14
Q

Which specific side effects should you report if a patient is taking linezolid?

A

Blood disorders
Visual issues (optic neuropathy)

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15
Q

What class of drug is linezolid?

A

A reversible MAOI

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16
Q

What foods should you avoid with linezolid?

A

Tyramine rich foods, e.g. cheese, salami, wine, soy sauce

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17
Q

Is trimethoprim bactericidal or bacteriostatic?

A

Bactericidal

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18
Q

What are the side effects of trimethoprim which patients should report?

A

Blood disorders
Hyperkalaemia

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19
Q

What can trimethoprim cause in pregnancy?

A

Teratogenicity because it is an anti-folate

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20
Q

When is chloramphenicol used?

A

Only for severe life-threatening infections

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21
Q

What can chloramphenicol cause if used during pregnancy?

A

Grey baby syndrome

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22
Q

What are some side effects of metronidazole?

A

GI disturbances
Taste disturbances
Oral mucositis
Furred tongue

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23
Q

Why should patients taking metronidazole avoid alcohol? How long should they avoid alcohol for?

A

Because it can cause disulfiram-like effects.

Must stop alcohol during and 2 days after stopping treatment

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24
Q

What colour can nitrofurantoin cause urine to change into?

A

Yellow/brown

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25
Q

How do aminoglycosides work?

A

They irreversibly bind to ribosomes and hence inhibit protein synthesis

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26
Q

How are aminoglycosides usually given? What is their frequency?

A

They are usually given once a day by injection as they are not absorbed by the gut

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27
Q

What 2 specific side effects could occur with aminoglycosides and glycopeptides?

A

Oto and nephrotoxity - must monitor renal and auditory function

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28
Q

How is the loading and maintenance dose of aminoglycosides calculated?

A

Based on weight and renal function

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29
Q

When should you perform more frequent and earlier monitoring if a patient is receiving an aminoglycoside?

A

If they are renally impaired

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30
Q

What are the signs of nephrotoxicity?

A

Low urine output/creatinine clearance
High creatinine/urea

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31
Q

What drugs can increase the risk of ototoxicity if given alongside an aminoglycoside?

A

Loop diuretics
Macrolides
Antimalarials

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32
Q

What electrolyte disturbances can be caused from aminoglycosides?

A

Hypokalaemia
Hypocalcaemia
Hypomagnasaemia

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33
Q

How do glycopeptides work?

A

They inhibit cell wall synthesis

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34
Q

Which glycopeptide is active against MRSA?

A

Vancomycin

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35
Q

How is vancomycin given?

A

Slow infusion to avoid anaphylactic reactions

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36
Q

How often should vancomycin plasma conc. be monitored?

A

After 3-4 doses
After dose changes

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37
Q

What can happen is a vancomycin infusion is given too slowly?

A

Red man syndrome

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38
Q

What other side effects are involved with vancomycin?

A

Blood disorders
Skin disorders - steven-johnson syndrome
Thrombophlebitis

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39
Q

What are signs of headaches/visual disturbances a sign of if taking a tetracycline?

A

Benign intracranial hypertension

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40
Q

What are the contra-indications of taking a tetracycline?

A

If <12years old
Pregnant/breastfeeding
If severe hepatic impairment present

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41
Q

What are some common side effects of tetracyclines?

A

Photosensitivity
Skin reactions
Discolouration of teeth (in children)
Poor skeletal development

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42
Q

When should a patient take antacids/iron if they are also taking a tetracycline?

A

2h before/after

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43
Q

What is the dose of doxycycline for malarial prophylaxis?

A

100mg OD 1-2 days before, during travel, and 4 weeks after coming back

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44
Q

What are examples of quinolones?

A

Ciprofloxacin
Levofloxacin
Ofloxacin

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45
Q

Why should you avoid quinolones in MRSA infections?

A

Because there is resistance present

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46
Q

What are some side effects of quinolones?

A

Seizures
Tendon damage
QT prolongation
Arthropathy

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47
Q

When can tendon damage occur if a patient is taking a quinolone?

A

Within 48h of taking the quinolone

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48
Q

How can heart valve regurgitation present if a patient is taking a quinolone?

A

Swollen ankles/feet
New onset palpitations
SOB

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49
Q

Why should patients avoid NSAIDs with quinolones?

A

Because they can induce seizures/convulsions

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50
Q

Which part of the ribosome do macrolides bind to and inhibit protein synthesis from?

A

50s subunit of ribosome

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51
Q

Why is azithromycin usually given OD?

A

Because it has a half life of 2-4 days

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52
Q

Which macrolide can be given four times a day?

A

Erythromycin

53
Q

Which macrolide can cause taste disturbances?

A

Clarithromycin

54
Q

Which macrolide has the highest risk of QT prolongation and GI side effects?

A

Erythromycin

55
Q

Are macrolides taken with food or empty stomach?

A

With or just after food

56
Q

Why should rivaroxiban and erythromycin be avoided together?

A

Because erythromycin is a strong enzyme inhibitor which can increase the patients bleeding risk if given with rivaroxiban

57
Q

Why is Pen G (benzylpenicillin) only given by injection?

A

Because it is inactived by the GI system

58
Q

Which specific patient group is at risk of having a penicillin allergy?

A

Those with atopic conditions, e.g. eczema, hay fever, asthma

59
Q

What symptoms can present during a penicillin allergy?

A

Immediate rash
Anaphylaxis (swelling)
Hives

60
Q

What is a maculopapular rash a sign of if a patient is given a penicillin for a sore throat?

A

Glandular fever

61
Q

What should you do to the dose of amoxicillin if a patient has an eGFR of <30ml/min?

A

Reduce dose due to risk of convulsions

62
Q

What is the dose of benzylpenicillin if a patient has suspected meningitis before transferring to hospital?

A

1.2g for 1 dose

63
Q

Which penicillin is used for penicillinase-resistant infections?

A

Flucloxacillin

64
Q

When can cholestatic jaundice/hepatitis occur if a patient is taking flucloxacillin?

A

Up to 2 months after treatment

65
Q

Which electrolyte imbalance is a patient at risk of if they take high doses of piperacillin + tazobactam?

A

Hypernatraemia

66
Q

Can you give a cephalosporin to a patient who is also penicillin allergic?

A

No - risk of cross-sensitivity

67
Q

What is an example of a 1st generation cephelasporin?

A

Cephalexin

68
Q

What are some examples of 2nd generation cepahlosporins?

A

Cefuroxime
Cefaclor

69
Q

What are some examples of 3rd generation cepahlosporins (given only parentally0?

A

Cefixime
Ceftriaxone
Cefotaxime
Ceftazidime

70
Q

Why is cefadroxil given BD?

A

Because it has a long duration of action

71
Q

What are some examples of carbapenems?

A

Meropenem
Imipenem

72
Q

Can you given carbapenems to patients with a penicillin allergy?

A

No - risk of cross-sensitivity

73
Q

What can increase the risk of a patient developing C.difficile?

A

Long-term PPIs
>65yrs old
Prolonged hospitalisation
Hx of C.difficile

74
Q

What is the 1st and 2nd line treatment for first episode mild/moderate/severe C.difficile?

A

1st: Oral vancomycin
2nd: oral fidaxomicin

75
Q

What is given for relapsing or life-threatening C.difficile?

A

Oral Vancomycin (+ metronidazole IV if life-threatening)

76
Q

What are the symptoms of endocarditis?

A

Chest pain
Flu like symptoms
Heart murmur
SOB
Swollen feet/ankles

77
Q

What is the treatment for endocarditis?

A

IV Amoxicillin +/- gentamicin

78
Q

What is classified as hospital acquired pneumonia?

A

If patient develops it >48h after hospital admission

79
Q

Which tool measures the severity of a patients pneumonia? What does each letter stand for?

A

CURB-65

Confusion
Urea
Respiratory depression
Blood pressure
>65yrs old

80
Q

What antibiotics are given if a patient has a low CURB-65 score (0-1)?

A

Amoxicillin

If penicillin allergic: doxycyline, or clarithromycin

If pregnant: erythromycin

81
Q

What antibiotics are given if a patient has a moderate CURB-65 score (1 or 2)?

A

As low severity, PLUS clarithromycin or erythromycin if atypical pathogens present

82
Q

What antibiotics are given if a patient has a high CURB-65 score (>3)?

A

Co-amoxiclav WITH clarithromycin (or erythromycin if pregnant)

If penicillin allergic: levofloxacin

83
Q

What is the treatment for severe HAP?

A

IV piperacillin + tazobactam or ceftriaxone

84
Q

What are the symptoms of meningitis?

A

Stiff neck
Non-blanching rash
Photophobia
Back rigidity
Unusual skin colour

85
Q

What is the 1st and 2nd line treatment for meningitis?

A

1st: benzylpenicillin (Pen G) 2.4g IV every 4h

2nd: chloramphenicol or cefotaxime

86
Q

What is osteomyelitis?

A

Inflammation or swelling of the bone tissue resulting in infection

87
Q

What is the 1st and 2nd line treatment for osteomyelitis?

A

1st: Flucloxacillin 8g daily
2nd: clindamycin

88
Q

How often is chloramphenicol eye ointment used for bacterial conjunctivitis?

A

3-4 times a day

89
Q

What is the treatment for viral conjunctivitis?

A

Artificial tears
Cold-compress
Antihistamines
Alternatively nothing as it can go away on its own

90
Q

What is the difference between bullous and non-bullous impetigo?

A

Bullous: fluid-filled blisters, yellow crust forming (more severe)

Non-bullous: water-filled pustules that burst and form a yellow/gold crust usually around mouth

91
Q

What is the treatment for non-bullous impetigo/systemically well?

A

1st line: Hydrogen peroxide 1% cream 5/7

2nd: fucidic acid cream 5/7, or mupirocin 2% 5/7

92
Q

What is the treatment for bullous impetigo/systemically unwell/widespread?

A

1st: flucloxacillin 500mg QDS 5/7

2nd of prenicillin allergic: clarithromycin 250mg BD 5/7

93
Q

What is the 1st and 2nd line treatment for cellulitis/erysipelas?

A

1st: flucloxacillin 500mg QDS

2nd: clarithromycin, or erythomycin if pregnant, or oral doxycyline

94
Q

What is given as 1st line for a animal/human bite?

A

Co-amoxiclav 500/125mg TDS 5/7

95
Q

What are the treatment options for dental infections?

A

Co-amoxiclav
Metronidazole
Amoxicillin
Macrolides (but not clindamycin)

96
Q

What is the 1st line treatment for a strep. sore throat infection?

A

Pen V 500mg QDS 5/7

97
Q

What age is clarinase (mometasone nasal spray) licensed for?

A

> 18 years old

98
Q

What is the organism that causes tuberculosis?

A

Mycobacterium tuberculosis

99
Q

What is the vaccine given for TB?

A

BCG

100
Q

What are the drugs, and for how long, which are used for the initial phase of TB?

A

Initial phase: 4 drugs for 2 months; remember RIPE

Rifampicin
Isoniazid (+pyridoxine/vit. B6)
Pyrazinamide
Ethambutol

101
Q

What are the drugs, and for how long, which are used for the continuation phase for TB?

A

Continuation phase: 2 drugs for 4 months

Rifampicin
Isoniazid (+pyridoxine)

102
Q

What colour can rifampicin stain contact lenses/bodily fluids?

A

Red/orange

103
Q

What should be monitored whilst a patient is on rifampicin?

A

LFTs - risk of hepatotoxicity
FBC

104
Q

What should patients taking ethambutol report?

A

Optic nerve damage/visual problems
Renal symptoms

105
Q

Why is vitamin B6 (pyridoxine) given alongside isoniazid?

A

To reduce the risk of peripheral neuropathy

106
Q

Which specific parameter should you monitor if a patient is taking itraconazole for >1 month?

A

LFTs

107
Q

Which patients are at risk of HF if they take itraconazole?

A

High doses
Longer courses
Patients already with CVD
Patients taking CCBs

108
Q

Why should you refer back prescriptions of oral ketoconazole?

A

Because there is a big risk of hepatotoxicity - risk outweighs benefits

109
Q

Why are brands of amphotericin B not interchangeable?

A

Because there is a risk of harm and fatal overdoses

110
Q

Which antifungal has a liposomal formulation?

A

Ambisome

111
Q

What is the treatment for oral thrush (POM and P)?

A

POM: nystatin oral drops QDS 7/7

P: miconazole oral gel (Daktarin oral gel)

112
Q

What is the usual oral dose of aciclovir?

A

200mg x5 times a day 5/7

113
Q

Which antiviral is used as prophylaxis of influenza for high risk groups?

A

Olseltamivir

114
Q

What does the acronym ABCD for malaria stand for?

A

Awareness of risk
Bite prevention
Chemoprophylaxis
Diagnosis

115
Q

How can a traveller prevent malarial bites?

A

Impregnated permethrin nets
DEET 20-50% spray/lotion
Protecting skin after dusk

116
Q

Can DEET spray/lotion be used in pregnant/breast feeding women?

A

Yes

117
Q

Which specific patients should you avoid giving mefloquine to?

A

Those with depression
Epilepsy
<3months of age

118
Q

Which specific side effect should patients taking mefloquine report?

A

Psychosis
Suicidal ideation
Other neuropsychiatric reactions

119
Q

How is mefloquine taken as malarial prophylaxis?

A

Weekly 2-3 weeks before, during, and 4 weeks after travel

120
Q

How is maloff/malarone taken as malarial prophylaxis?

A

1-2 days before, during, and 1 week after travel

121
Q

Which 2 antimalarials should you avoid in epileptic patients?

A

Chloroquine
Mefloquine

They can both reduce seizure threshold levels

122
Q

Which antimalarials can you give in renally impaired patients?

A

Doxycycline
Mefloquine

123
Q

Which anti-malarials can you give in pregnancy?

A

Maloff Protect
5mg folic acid also to be taken

124
Q

Why is mefloquine given weekly?

A

Because it has a very long half life

125
Q

Can you take maloff protect/malarone with food?

A

Yes, preferably with food or milky drink

126
Q

What is the brand of mefloquine?

A

Lariam

127
Q

When do symptoms of malaria generally occur after travel?

A

First 3 months after returning

128
Q

Which drug can be used to treat malaria?

A

Quinine 600mg TDS 5/7

Alternatively Malarone

129
Q
A

GPhC Exam Revison (5 decks)

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