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Pre-Reg November Exam '24 > Infections- HIGH > Flashcards

Infections- HIGH Flashcards

1
Q

What factors need to be considered when selecting antibacterials?

A
  • Allergies
  • Renal and hepatic function
  • Immunocompromised?
  • Severity of illness (e.g. life-threatening require IV admin.)
  • Other medication
  • Pregnant/breast-feeding
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2
Q

When may IV admin. be suitable in a non-life-threatening infection?

A
  • Nil-by-mouth patients e.g. swallow difficulties
  • Vomiting
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3
Q

What is phenoxymethylpenicillin used as prophylaxis for?

A
  • Prevent recurrence of rheumatic fever
  • Prevent streptococcal infection, pneumococcal infection in asplenia
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4
Q

What is isoniazide +/- rifampicin used as prophylaxis for?

A

Prevent TB in susceptible patients

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5
Q

What is IV gentamicin used as prophylaxis for?

A

Prevent infection in surgical procedures

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6
Q

What infection is associated with broad-spectrum cephalosporins?

A

Antibiotic associated colitis (C. diff)

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7
Q

When are anaphylaxis, urticaria and rash more common in patients?

A

Those with a history of atopic allergy e.g. bronchial asthma

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8
Q

Common side effects of penicillins?

A
  • Diarrhoea
  • Hypersensitivity
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9
Q

Which other antibiotics may allergic patients also react to due to similarity?

A
  • Cephalosporins e.g. cephalexin
  • Beta lactam antibiotics
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10
Q

Is a rash always an allergic reaction?

A

No- a non-pruritic rash restricted to a small area or occurring > 72 hours after admin. is probably not allergic

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11
Q

What is benzylpenicillin (penicillin G) indicated for?

Points to consider?

A

Indicated for throat infections, otitis media, cellulitis, meningococcal disease, septicaemia

  • MUST be given IV/IM- inactivated by gastric acid (and bacterial beta-lactamases)
  • May impair efficacy of oral contraceptives
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12
Q

What is Phenoxymethylpenicillin (Penicillin V) indicated for?

Points to consider?

A

Indicated for RTIs in children, strep tonsillitis

  • Should be given (orally) in divided doses (TDS/QDS) half an hour before meals
  • Total daily dose usually 1-2g in divided doses
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13
Q

What is flucloxacillin indicated for?

Points to consider?
MAX daily dose?

A

Indicated for otitis externa, cellulitis, osteomyelitis

  • Acid stable and well absorbed from gut (can be oral or IV)
  • Should NOT be used in hepatic dysfunction (can cause liver injury- DILI)
  • Take 30 mins before food
  • MAX: 500mg every 6 hrs
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14
Q

What kind of infections is temocillin reserved for?

A

Infections caused by beta-lactamase-producing strains of Gram-negative bacteria

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15
Q

What is ampicillin (broad spec) indicated for?

Points to consider?
MAX daily dose?

A

Indicated for chronic bronchitis, middle ear infections and UTIs

  • Inactivated by penicillinases
  • Less than half dose absorbed orally (take 30 mins before food)
  • Consider resistance- do not use for hospital patients without checking sensitivity
  • MAX 1g every 6 hours
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16
Q

What is amoxicillin (broad spec) indicated for?

A

Indicated for oral infections, sinusitis, pharyngitis, bronchitis, pyelonephritis

  • Better absorption than ampicillin
  • MAX daily dose 1g every 8 hours
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17
Q

What is co-amoxiclav indicated for?

Points to consider?
MAX daily dose?

A

Used to treat RTIs, UTIs and abdominal infection

  • Amoxicillin + Clavulanic acid
  • Active against beta-lactamase producing bacteria resistant to amoxicillin
  • Cholestatic jaundice 6x greater with co-amoxiclav than amoxicillin
  • MAX: one 500mg/125mg tab every 8 hrs
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18
Q

What is piperacillin + tazobactam indicated for?
What is its brand name?

A

Indicated for hospital acquired pneumonia (HAP), septicaemia, complicated UTIs

  • Brand: Tazocin
  • Given by IV infusion
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19
Q

What is clavulanic acid’s function?

A

It is a beta-lactamase inhibitor- protecting beta-lactam antibiotics from breakdown

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20
Q

What is Ticarcillin + clavulanic acid indicated for?
What is its brand name

Points to consider?

A

Indicated for infections due to pseudomonas and proteus species

  • Cholestatic jaundice associated with clavulanic acid
  • Given by IV infusion
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21
Q

Which generations of cephalosporins are good for unresponsive UTI or UTI in pregnancy?

A

First and second

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22
Q
A
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23
Q

What is cefaclor (Distaclor, Distaclor LA) indicated for?

Typical dosing schedules?

A

Indicated for pneumonia, lower UTI

  • 250mg every 8 hrs (doubled in severe)
  • Distaclor LA (375mg BD with food, double in pneumonia)
  • Distaclor LA forte (500mg BD)
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24
Q

What is cefalexin indicated for?

Typical dosing schedules?

A

Indicated for UTI prophylaxis, HAP

  • 250mg every 6 hrs, or 500mg every 12 hrs
  • 125mg nocte for UTI prophylaxis
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25
Q

What is cefuroxime indicated for?

Typical dosing schedule?

A

Indicated for haemophilus influenzae, RTI, pyelonephritis

500mg BD

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26
Q

What is ertapenem indicated for?

A

Community-acquired pneumonia (CAP)

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27
Q

What is meropenem indicated for?

A

Hospital-acquired septicaemia

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28
Q

What is imipenem indicated for?

A

Hospital-acquired septicaemia

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29
Q

Points to consider re macrolides?
SE etc?

A
  • Similar spectrum to penicillin- alternative in penicillin allergy
  • Caution in patients predisposed to QT interval prolongation
  • S/E: GI upset
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30
Q

What is azithromycin indicated for?

Dosing schedule?

A

Indicated for RTI, otitis media, gonorrhoea and chlamydia

  • 500mg OD for 3/7
  • 1g single dose for gonorrhoea and chlamydia
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31
Q

What is clarithromycin (Klacid) indicated for?

Dosing schedule?
Points to consider?

A

Indicated for RTI, otitis media and H. Pylori (with PPI)

  • CYP3A4 inhibitor
  • 250-500mg BD for 7-14 days
  • Klacid MR: one 500mg tab daily
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32
Q

What is erythromycin indicated for?

Dosing schedule?
Points to consider?

A

Indicated for RTI, pneumococcal infection, chlamydia and syphilis

  • CYP3A4 inhibitor
  • 1-2g daily in divided doses
  • 250-500mg every 6 hrs (Alternatively 0.5-1g every 12 hrs)
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33
Q

Preferred macrolide with patient on warfarin?

A

Erythromycin preferred- greater risk of increased INR (bleeding risk)

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34
Q

Points to consider for tetracyclines?

A
  • Broad spectrum
  • May increase muscle weakness in patients with myasthenia gravis
  • Antacids, milk, Ca, Mg, Fe, Zn, Al salts decrease absorption (take 1-2 hours before)
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35
Q

When are tetracyclines contraindicated?

A
  • Pregnancy/BF- effects skeletal development and causes tooth discolouration
  • < 12 y/o- deposits in teeth and bone causing staining & dental hypoplasia
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36
Q

S/E of tetracyclines?

A
  • GI upsets, dysphagia, oesophageal irritation
  • Hepatotoxicity
  • Photosensitivity

To reduce oesophageal irritation, take whole with plenty of fluid, while sitting or standing

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37
Q

What is tetracycline indicated for?

Dosing schedule?
S/E?

A

Indicated for acne

  • 500mg every 6-8 hrs
  • S/E: skin discolouration
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38
Q

What is doxycycline indicated for?

Dosing schedule? MAX daily dose?

A

Indicated for sinusitis, malaria prophylaxis

  • Longer duration of action than tetracycline or oxytetracycline- allows OD dosing
  • 100mg day one, then 100mg daily
  • MAX: 200mg daily
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39
Q

What is lymecycline indicated for?

Dosing schedule?

A

Indicated for acne

  • 408mg daily for at least 8 weeks
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40
Q

What is minocycline (Minocin SA(MR)) indicated for?

Points to consider?
Dosing schedule?

A

indicated for acne (min. 6 weeks and max. 6 months)

  • 100mg BD
  • Minocin MR- 100mg OD for acne
  • If no response after 6 months, discontinue and try other therapies
  • Unlike other tetracyclines, absorption not impaired by food or milk
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41
Q

What is oxytetracycline indicated for?

A

Indicated for acne, rosacea

  • MAX dose 500mg every 6 hrs
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42
Q

What are the S/E of aminoglycosides?

Where are they more common?

A

Nephrotoxicity and ototoxicity

  • Dose related
  • Elderly more susceptible to ototoxicity
  • Most common in elderly & renal failure
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43
Q

How can aminoglycoside S/E be managed?

A
  • Dose reduction may be required in elderly
  • Monitor serum-concentration
  • Do not give with ototoxic drugs i.e. cisplatin, furosemide
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44
Q

Monitoring requirements for aminoglycosides?

A
  • Renal function before and during treatment
  • Auditory and vestibular function tests during treatment
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45
Q

What is gentamicin indicated for?

Usually combined with…?
Points to consider?

A

Indicated for septicaemia, neonatal sepsis, CNS infection and HAP

  • Usually given with a penicillin or metronidazole
  • Loading & maintenance doses calculated by weight/renal function/serum concentrations
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46
Q

What is neomycin sulfate indicated for?

A

Used in bowel sterilisation prior to surgery

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47
Q

What is streptomycin indicated for?

What should peak and trough serum conc. be while monitoring?

A

Active against Mycobacterium tuberculosis- entirely reserved for TB

  • One-hour (‘peak’) concentration should be 15-40mg/L
  • Pre-dose (‘trough’) concentration should be < 5mg/L (less than 1mg/L in renal impairment or those > 50 y/o)
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48
Q

What is tobramycin indicated for?

Monitoring?
Points to consider?

A

Indicated for septicaemia, meningitis, HAP, UTI, Chronic Pseudomonas aeruginosa in cystic fibrosis

  • Taken by IV or inhalation
  • Measure lung function before and after treatment
  • Monitor bronchospasm
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49
Q

What is chloramphenicol indicated for?

A

indicated for superficial eye infections, bacterial infection in otitis externa (topical)

Life-threatening infections, particularly those caused by Haemophilus influenzae (systemic use)

Typhoid (systemic use)

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50
Q

S/E for chloramphenicol?

A
  • Serious haematological S/E i.e. aplastic anaemia when given systematically
  • Chronic exposure has lead to bone marrow hyperplasia
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51
Q

Dosing for chloramphenicol drops and ointment?

A
  • Drops: 1-2 drops applied to affected eyes up to 6 times daily
  • Ointment: Apply 1cm ribbon 3-4 times daily
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52
Q

What is sodium fusidate (Fucidin) indicated for?

A

Penicillin-resistant staphylococci i.e. osteomyelitis, as it concentrates in bone

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53
Q

Points to consider for sodium fusidate?

A
  • Fusidic acid salt- consider low sodium diet
  • Narrow spectrum
  • Contraindicated with statins!!- risk of rhabdomyolysis, discontinue statin treatment with systemic Fucidin. Advise patients seek medical aid if experiencing muscle weakness, pain or tenderness
54
Q

Dosing schedule for fusidic acid

A

500mg every 8 hrs

55
Q

What is daptomycin indicated for?

A

Complicated skin and soft tissue infections i.e. MRSA

56
Q

Resistance to which other antibiotic initiates daptomycin use?

A

Vancomycin

57
Q

S/E associated with daptomycin?

A

Muscle side effects:
* Myositis
* Weakness
* Myalgia
* Rhabdomyolysis

58
Q

Monitoring requirements for daptomycin

A

Creatinine clearance before and during treatment

59
Q

What is linezolid indicated for?

A
  • Community acquired pneumonia (CAP)
  • Skin/ soft tissue infections
  • MRSA
60
Q

Points to consider for linezolid?

A
  • Resistance can develop in prolonged or under dosed treatment
  • Only initiated in hospital setting
  • MAX 28 days duration
61
Q

S/E associated with linezolid?

A
  • Diarrhoea
  • Optic neuropathy
  • Blood disorders
  • Myelosuppression
62
Q

Typical dosing schedule for linezolid?

A

600mg every 12 hours for 10-14 days

63
Q

Monitoring requirements for linezolid?

A

Monitor for muscle S/E

FBCs weekly
* High risk patients i.e. pre-existing anaemia, granulocytopenia, thrombocytopenia, or patients receiving other medication that affect blood counts

64
Q

Example of glycopeptide antibiotics

A

Vancomycin (Vanocin)

65
Q

What are glycopeptide antibiotics e.g. vancomycin indicated for?

A
  • Parenterally in treatment of endocarditis
  • Orally for C. diff
66
Q

What is rifaximin indicated for?

A
  • Travellers diarrhoea
  • Prevent hepatic encephalopathy
67
Q

Typical dosing schedule for rifaximin?

68
Q

What is co-trimoxazole? (Septrin)

A

Trimethoprim + Sulfamethoxazole (1:5)

69
Q

What is co-trimoxazole indicated for?

70
Q

S/E associated with co-trimoxazole?

A

S/E are rare but can be very serious, discontinue if the following occurs:

  • Blood disorders
  • Rash (including Stevens-Johnson syndrome or toxic epidermal necrolysis)
71
Q

Typical dosing schedule for co-trimoxazole?

A

960mg every 12 hours

72
Q

What is trimethoprim indicated for?

A
  • UTI
  • Chronic bronchitis
73
Q

When should trimethoprim be avoided?

A
  • Renal impairment
  • Low folate status, or taking folate antagonist i.e. antiepileptic, proguanil
74
Q

Where does trimethoprim concentrate?

A

The bladder

75
Q

Can trimethoprim be taken during pregnancy?

A

Not in the first trimester- teratogenic risk during this period

76
Q

Typical dosing schedule for trimethoprim acute infections

77
Q

Typical dosing schedule for trimethoprim prophylaxis of infections

78
Q

Counselling points for patients on trimethoprim

A

Recognising blood disorders i.e. fever, sore throat, rash, mouth ulcers

79
Q

What class of antibiotic is clindamycin?

A

Lincosamide antibiotic

80
Q

What is clindamycin indicated for?

A

Staphylococcal joint and bone infections i.e. osteomyelitis

81
Q

When should clindamycin be discontinued?

A

Associated with antibiotic-associated colitis - discontinue if diarrhoea develops

82
Q

Which medication’s efficacy is affected by clindamycin?

A

Can reduce efficacy of oral contraceptives- take extra precaution during treatment i.e. barrier methods

83
Q

Typical dosing schedule for clindamycin?

A

150-300mg every 6 hours

84
Q

What are the treatment steps for anti-tuberculosis drugs?

A

Initial phase:

  • 4 drugs, 2 months duration (rifampicin, isoniazid, pyrazinamide, ethambutol)

Continuation phase:

  • 2 drugs, 4 months duration (isoniazid, rifampicin)

6 months treatment course

85
Q

Which of the 4 anti-TB drugs are associated with liver toxicity?

How is this managed

A
  • Pyrazinamide
  • Rifampicin
  • Isoniazid

Monitor before and during treatment

Advise patients on recognising liver symptoms e.g. jaundice, abdominal pain and swelling etc

86
Q

What are the monitoring requirements for anti-TB drug regimen?

A
  • Hepatic function- LFTs
  • Renal function- eGFR + U&Es
  • Visual acuity- before starting ethembutol
87
Q

Common S/E of isoniazid?

A
  • Peripheral neuropathy
  • Hepatic disorders
88
Q

Common S/E of pyrazinamide?

A

Hepatic disorders

89
Q

How should patients be counselled to watch for hepatic disorders?

A
  • Persistent nausea
  • Vomiting
  • Diarrhoea
  • Malaise
  • Jaundice
90
Q

Common S/E and points to consider regarding rifampicin?

A
  • Red colouration of the urine, sweat, sputum and tears
  • Discolours soft lenses
  • POTENT CYP INDUCER
  • Take tabs at least 30 mins before meal or 2 hours after
  • Reduces efficacy of hormonal activity
91
Q

What is metronidazole indicated for?

A
  • Trichomonal vaginitis
  • Bacterial vaginitis
  • Giardia Lambia
  • C. diff
  • Dental infections

Often the alternative to penicillins for oral infections

92
Q

Usual dosing regimen and points to consider for metronidazole?

A

400mg every 8 hours

No alcohol during treatment

93
Q

Common S/E of macrolides and points to consider?

A

S/E: GI upset, headache, dizziness

  • Caution in epilepsy
  • Can prolong QT interval
  • Causes arthropathy in weight-bearing joints of growing children
  • Tendon damage and rupture reported- contraindicated in tendon disorders and patients > 60
94
Q

What is ciprofloxacin indicated for?

Points to consider?

A

RTI and UTI

May impair performance of skilled tasks, effects enhanced by alcohol

95
Q

MAX dosing regimen for ciprofloxacin?

A

MAX: 750mg BD

96
Q

Usual dosing regimen for levofloxacin?

97
Q

Points to consider for moxifloxacin?

A

Contraindicated in patients at risk of QT prolongation

98
Q

Knock-on effect of UTI in renal impairment?

A

Antibiotics excreted by the kidney can accumulate in kidney failure, leading to toxicity

99
Q

Points to consider in UTI during pregnancy?

A
  • UTI may be asymptomatic
  • May require prompt treatment to prevent progression to acute kidney infection (pyelonephritis)
  • Penicillins and cephalosporins are suitable, nitrofurantoin may be used
100
Q

Cautions and S/E with nitrofurantoin?

A

Avoid in renal impairment

S/E: GI upset, anorexia

101
Q

Dosing regimens for nitrofurantoin for acute uncomplicated infection, prophylaxis and using MacroBID

A
  • Acute uncomplicated: 50mg every 6 hrs with food (100mg in severe)
  • Prophylaxis: 100mg nocte
  • MacroBID: 1 cap BD with food
102
Q

What is fluconazole indicated for?

A

Vaginal candidiasis

Fungal meningitis

103
Q

Points to consider for fluconazole

A
  • Good penetration into CSF to treat fungal meningitis
  • Excreted largely unchanged in the urine (can be used to treat candiduria)
  • inhibits CYP2C9, CYP3A4, CYP2C19

Many interactions, avoid other meds metabolised by these enzymes that prolong QT interval

104
Q

Dosing regimen for fluconazole in vaginal candidiasis?

A

150mg capsule single dose

105
Q

Points to consider with itraconazole (Sporanox)

A
  • Requires an acidic environment in the stomach for optimal absorption
  • Associated with life threatening liver damage - discontinue if signs of hepatotoxicity
  • Avoid in history of liver damage and always monitor LFTs
  • Increased risk of heart failure due to CYP3A4 and p-glycoprotein inhibition
  • Contraindicated in pregnancy (women of childbearing age must use contraception)
106
Q

Dosing regimen for vulvovaginal candidiasis?

A

200mg BD for one day

107
Q

Points to consider for posaconazole?

A
  • Contraindicated with HMG-CoA reductase inhibitors e.g. amlodipine, atorvastatin
  • CYP3A4 inhibitor
  • Associated with hepatotoxicity and QT prolongation

Monitor LFTs

108
Q

Points to consider for voriconazole (Vfend)

A
  • CYP3A4 inhibitor
  • Associated with hepatotoxicity and QT prolongation

PHOTOTOXICITY:

  • Avoid intense/prolonged exposure to sunlight, sunbeds and direct sunlight
  • Use high SPF and cover skin
  • Seek medical attention if skin reaction (monitor for pre-malignant skin lesions, squamous cell carcinoma)

HEPATOTOXICITY:

  • Associated with life-threatening liver damage
  • Counsel patients on recognising symptoms of liver damage i.e. anorexia, GI upset, dark urine
109
Q

What is amphotericin and what is it indicated for?

A

A polyene antifungal

  • Used to treat systemic fungal infections
  • Not absorbed by mouth, given IV
110
Q

What is nystatin and what is it indicated for?

A

A polyene antifungal

Treat oral, oropharyngeal, perioral, candida skin infections

111
Q

What is griseofulvin indicated for?

Points to consider?

A

Effective in widespread dermatophyte infection (e.g. tinea barbae, capitis, corporis, cruris, pedis, unguium) where topical therapy is not working

  • Take after a high fat meal, for increased absorption and minimising GI distress
  • Personal hygiene is important
  • Reduces effectiveness of oral contraception, use barrier methods too
  • Continue treatment for at least 2 weeks after all signs if infection clear
  • CYP3A4 INDUCER
112
Q

What is terbinafine indicated for?

Usual dosing regimen?

A
  • Fungal nail infections
  • Ringworm

250mg daily

  • for 2-4 weeks (Tinea cruris)
  • for 4 weeks (Tinea corporis)
  • for 2-6 weeks (Tinea pedis)
  • for 6 weeks-3 months (Onychomycosis- fungal nail infections)
113
Q

Points to consider for HIV infection and treatment

A
  • No cure- drugs slow progression, reduce complications and risk of transmission
  • Drugs associated with severe S/E
  • Optimal time to initiate treatment depends on CD4 cell count
  • Antiretrovirals associated with metabolic S/E
    • Fat redistribution
    • Insulin resistance
    • Dyslipidaemia
    • Lipodystrophy syndrome
  • Associated with osteonecrosis of the jaw
114
Q

What is aciclovir indicated for?

What is the typical dosing regimen?

A
  • Herpes simplex
  • varicella zoster- chicken pox

800mg five times daily for 7/7 (omit night time dose

115
Q

Which drugs are used to treat chronic Hep B?

A
  • Adefovir
  • Entecavir
  • Telbivudine
116
Q

Which drugs are used to treat chronic hepatitis C?

A
  • Telaprevir
  • Boceprevir
  • Telbivudine
117
Q

Which medications are used for influenza infection post-exposure prophylaxis?

A
  • Oseltamivir (Tamiflu)
  • Zamavir (Relenza)
118
Q

Prophylaxis and treatment doses for Oseltamivir (Tamiflu)

A

Treatment: one 75mg tab BD for 10/7

Prophylaxis: one 75mg tab OD for 10/07

119
Q

Prophylaxis and treatment doses for Zamavir (Relenza)

By which method is it administrated?

A

Treatment: 10mg BD for 10/7

Prophylaxis: 10mg OD for 10/7

Admin. by inhalation

120
Q

What is falciparum malaria?

A

A form of malaria (malignant)

  • Resistant to chloroquine in most parts of the world
  • VERY dangerous in pregnancy
121
Q

How can patients travelling to risk zones help prevent malaria?

A
  • Permethrin-impregnated mosquito nets
  • DEET 20-50% roll on, lotions and sprays for adults and children
    • Apply DEET after sunscreen
  • Wear long sleeves
122
Q

For how long after travelling to a risk zone may an illness be potentially malaria?

123
Q

Which patient group is particularly at risk of severe malaria?

A

Asplenic patients (no spleen)

124
Q

Which antimalarials are not suitable in epilepsy?

A

Chloroquine and mefloquine

125
Q

Points to consider in pregnancy regarding malaria?

A
  • Avoid travelling to risk zones
  • Doxycycline is contraindicated
  • Prophylaxis is required in BF, as amount passed through milk are too variable for reliable protection
126
Q

Dosing regimen, S/E and instructions for atovaquone + proguanil (Malarone) for malaria prophylaxis and treatment

A

Treatment: one tab daily for 3 days
Prophylaxis: one tab 1-2 days before, during and 1 week after

S/E: GI upset, headache, depression, appetite decrease

Take same time each day with milk food or drink

127
Q

Points to consider for threadworm infections?

A
  • All family members require treatment
  • Hygiene measures are important to break auto-infection cycle
  • Only live for 6 weeks- ova must be swallowed and exposed to digestive juices
128
Q

What hygiene measures must be taken in threadworm infection

A
  • Wash hands and scrub nails before meals and after toilet
  • Take a bath in morning to remove ova laid overnight
129
Q

What is the drug of choice for threadworm infections?

A

Mebendazole (Vermox)

130
Q

Dosing regimen, S/E for mebendazole for threadworm infection

Points to consider?

A

Dose: 100mg BD for 3/7

S/E: Abdominal pain, flatulence

Dose depends on type of worm

131
Q

List of antibiotics to avoid in pregnancy

A
  • Metronidazole
  • Macrolides
  • Quinolones
  • Tetracyclines
132
Q

List of antibiotics to avoid in breast feeding

A
  • Quinolones
  • Tetracyclines

Pre-Reg November Exam '24 (10 decks)

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