Infections 3 Flashcards
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
State when oral Ketoconazole is used
Reserved for specialists to treat cushings syndrome
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
Facts about Voriconazole
Avoid exposure to direct sunlight or use of sun beds
State when to seek medical attention for pts on voriconazole
If any sun burn or severe skin reaction following exposure to light/sun
Monitoring requirements for pt on voriconazole
LF before starting tx and at least one weekly for 1 month and then monthly during treatment
Patients advice for voriconazole
Pts should keep alerts card with them at all times
It’s hepatoxic and phototoxic
What part of the body dermatophyte affect?
Skin
Hair
Nail infection
Scientific name for ringworm on the skin
Tinea corporis
Scientific name for ringworm of the scalp
Tinea capitis
Infection of the nail scientific name
Tinea ungium
Risk factors for dermatophyte infection
Immunocompromised , diabetics, poor circulation , peripheral arterial disease
What does oral thrush look like
A white coating on the tongue like cottage cheese , this cannot be rub off easily
When do you give topical antifungal vs tablet
Topical is used for localised fungal skin infection eg tinea corporis and pedis
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
How is tinea capitis treated?
Systemically
How to tx threadworms
Anthelmintic combined with use of hygiene measures to break cycle of auto-infection
Treat all family members
What’s the drug of choice for threadworm infection
Mebendazole
Licensed for greater than 6months
Dose of mebendazole for tx threadworm
Give as single dose (100mg)
Second dose may be given after 2weeks to prevent reinfection
Whats the brand name for mebendazole
Ovex
At what age can you sell Ovex OTC
Adults and children greater than 2 years
Single dose is 100mg
Supplied in container <800mg
List the two types of herpes virus
Herpes simplex 1 and
Varicella zoster
What type of herpes simplex affect the mouth, lips and eye?
Herpes simplex 1
What type of herpes simplex infection affect the genitals
Herpes 2
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)
