Infections 3 Flashcards by Ofonmbuk Urom

State why MHRA suspended oral Ketoconazole

Because the use of oral Ketoconazole to tx fungal infections is associated with the risk of hepatoxicity is greater than the benefit in treating fungal infections

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State when oral Ketoconazole is used

Reserved for specialists to treat cushings syndrome

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Patient and carer advice with oral use of Ketoconazole

Recognise signs of liver disorder ( Anorexia, vomiting, nausea, fatigue etc)
Dizziness may affect the performance of skilled task

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Facts about Voriconazole

Avoid exposure to direct sunlight or use of sun beds

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State when to seek medical attention for pts on voriconazole

If any sun burn or severe skin reaction following exposure to light/sun

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Monitoring requirements for pt on voriconazole

LF before starting tx and at least one weekly for 1 month and then monthly during treatment

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Patients advice for voriconazole

Pts should keep alerts card with them at all times
It’s hepatoxic and phototoxic

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What part of the body dermatophyte affect?

Skin
Hair
Nail infection

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Scientific name for ringworm on the skin

Tinea corporis

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Scientific name for ringworm of the scalp

Tinea capitis

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Infection of the nail scientific name

Tinea ungium

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Risk factors for dermatophyte infection

Immunocompromised , diabetics, poor circulation , peripheral arterial disease

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What does oral thrush look like

A white coating on the tongue like cottage cheese , this cannot be rub off easily

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When do you give topical antifungal vs tablet

Topical is used for localised fungal skin infection eg tinea corporis and pedis

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When to give systemic antifungal

If topical fails
Many areas affected
If site of infection is difficult to tx eg nail bed and scalp

Oral terbinafine and itraconazole preferred over Griseofulvin because they are broader spectrum

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How is tinea capitis treated?

Systemically

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How to tx threadworms

Anthelmintic combined with use of hygiene measures to break cycle of auto-infection
Treat all family members

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What’s the drug of choice for threadworm infection

Mebendazole
Licensed for greater than 6months

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Dose of mebendazole for tx threadworm

Give as single dose (100mg)
Second dose may be given after 2weeks to prevent reinfection

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Whats the brand name for mebendazole

Ovex

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At what age can you sell Ovex OTC

Adults and children greater than 2 years
Single dose is 100mg
Supplied in container <800mg

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List the two types of herpes virus

Herpes simplex 1 and
Varicella zoster

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What type of herpes simplex affect the mouth, lips and eye?

Herpes simplex 1

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What type of herpes simplex infection affect the genitals

Herpes 2

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When should tx for herpes simplex infection start?

Within 5days of appearance of infection

What is the cause of chicken pox?

Varicella zoster

Facts about chicken pox

More severe in adolescents and adult than children Antiviral tx started within 24hrs of onset of rash may reduce Severity and duration of symptoms Those at risk of complications may need varicella zoster immunoglobulin prophylaxis

What's the scientific name for shingles

Herpes zoster

State when to start antiviral tx for shingles

Within 72hrs of onset of rash Continue for 7-10days

State how to tx immunocompromised patients at high risk suffering from shingles

Parenteral antiviral

How to tx herpes

Aciclovir Famciclovir Valcocovir-

List the types of malaria

Non falciparum Falciparum

What's the difference between falciparum and non falciparum malaria

Falciparum is fatal whereas non falciparum isn't fatal

Facts about falciparum malaria

Caused by plasmodium faciparum Most deadly form Multiplies rapidly in blood Very dangerous in pregnancy esp last trimester

Facts about Non falciparum malaria

Non fatal Caused by plasmodium vivax

Tx for non- falciparum malaria

Chloroquine( Avloclor) P med Used for tx and prophylaxis of non- falciparum malaria Used with proguanil when resistance to chloroquine ( regimen may not give optimal protection (paludrine /avloclor

What's the brand name for mefloquine

Lariam

Indication of Lariam

Used for malaria prophylaxis now rarely due to resistance

An antimalarial that causes neuropsychiatric reactions is called

Lariam( pom) mefloquine) Do not use in epilepsy

State what antimalarial is not suitable for prophylaxis treatment on it own

Proguanil ( P med)

What medication is licensed for tx of acute uncomplicated malaria

Malarone( proguanil and atovaquone It's a POM

Indication of malarone

Used for falciparum malaria prophylaxis Tx of uncomplicated falciparum Tx of non falciparum malaria

Malarone is used as alternative to..

Doxycycline or mefloquine

Malarone is suitable for short trips because

Only needs to be taken 7days after leaving endemic area

Indication of quinine

Used in the tx of non falciparum malaria It's associated with QT prolongation

Whats the P version of malarone licensed for 18years plus?

Maloff

List other P meds used as antimalarial licensed for 1year plus

Avloclor Paludrine P

Advice you give pt to prevent them from insect bites

Wear long sleeves and trousers after dusk to protect from bites DEET( diethyltoluamide) 20-50% ( available as sprays and Mr formulations) is safe and effective when applied to skin of adults and greater than 2months

How long should mefloquine be taken before and after travel

Before travel= 2-3weeks After = 4weeks OD

How long should you take Doxycycline before and after travel?

Before travel = 1-2days After travel= 4weeks OD

How long should you take malarone before and after travel?

Before travel= 1-2days After= 1 week OD

Length of tx for other antimalarial (prophylaxis)

Before travel= 1 week After= 4weeks

Which antimalarial can be used for long term prophylaxis

Chloroquine and proguanil (resistance caution) > 5years

Doxycycline can be used for up to...

2years

Malarone and mefloquine can be used for up to....

I year

Advice to give patient on returning from malaria areas region

Any illness that occurs within 1 year especially within 3months of return may be malaria Advice travellers to report any illness to their doctor immediately particularly if its within 3months of return from malaria area

What antimalarial are recommended for prophylaxis with epilepsy?

Proguanil alone is recommended in areas without chloroquine resistance Doxycycline or malarone recommended in areas with chloroquine resistance

Malaria prophylaxis to avoid in epilepsy

Avoid chloroquine, mefloquine in epileptic patients

Which antimalarial prophylaxis is safe for pregnancy

P.C Avoid travelling to malarial areas if possible Chloroquine and Proguanil can be given Proguanil alone( give folic acid for ist trimester)

Malaria prophylaxis to avoid in pregnancy

Malarone, Doxycycline and mefloquine unless there is no alternative and not used in first trimester

Antimalarial prophylaxis to give in renal impairment

Mefloquine or Doxycycline

Antimalarial to avoid in renal impairment

Proguanil, malarone and chloroquine

When should patients on Warfarin start malaria prophylaxis before travelling?

Pts on Warfarin would start chemoprophylaxis 2-3weeks before travel INR should be stable before travel

State when to measure INR for pt on malaria prophylaxis

It should be measured before starting prophylaxis 7days after starting and after completing course Check INR at regular intervals for prolonged stays

What antimalarial medication are used for tx of falciparum malaria

Quinine (together or followed by Doxycycline or Clindamycin) Malarone Riamet( artemether plus lumefantrine

Treatment of falciparum malaria in pregnancy

Avoid Doxycycline, malarone and riamet High dose of quinine are Teratogenic esp in first trimester but in malaria benefits outweighs risk (Clindamycin can be given after quinine)

Safety info for quinine

QT interval prolongation

Safety info for mefloquine

Discontinue if neuropsychiatric symptoms eg abnormal dreams, anxiety, depression, restlessness, confusion and Insomnia)

Safety info for chloroquine

Ocular toxicity in adults if dose exceeds 4mg/kg Daily

Treatment of viral infection ( influenza)

Most effective tx if started within a few hours of onset of symptoms Licensed for use within 48hours of first symptoms Reduce duration by 1-1.5days Reduces risk of complications from Influenza in elderly and pts with chronic disease

Examples of antiviral used to tx influenza

Oseltamivir (tamiflu), Zanamivir (Relenza)