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PRE-REG own > Infections - key infections > Flashcards

Infections - key infections Flashcards

1
Q

What is 1st and 2nd line for c.diff? (1st episode of mild-moderate or severe)

A

Vancomycin 125mg QDS 10 days

2nd line: Fidaxomicin 200mg BD 10 days

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2
Q

If c.diff recurs within 12 weeks of treatment, what is used?

what if this is >12 weeks?

A

Fidaxomicin 200mg BD 10 days

> 12 weeks= Vanc 125mg QDS 10 days

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3
Q

What medications need to be reviewed in a patient with C.diff?

A

PPIs
Laxatives
loperamide
NSAIDS (may cause issues if patient gets dehydrated)

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4
Q

Who is most at risk of c diff?

A

Elderly >65

Women

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5
Q

Which antibiotics cause cdiff?

A

broad spect

  • clindamycin
  • ampicillin, amoxicillin
  • 2/3 gen cephalosporins
  • quinolones
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6
Q

What pneumonic is used to remember drugs associated with C.diff?

A

Crazy chimps buy fluorescent poo -

  • clindamycin
  • cephalosporin
  • broad spectrum abx
  • fluoroquinolones
  • ppis
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7
Q

What are the CURB65 scores?

A 
Confusion 
Urea >7mmol/L
Resp rate >30bpm
Blood pressure - low, <90 systolic, <60 diastolic
65 = age 65 or more
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8
Q

What are the classifications for severity of CAP using CURB65?

A

0=low risk
1-2 = interermediate
3-4 = high

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9
Q

what is used for low severity cap?

A

amoxicillin 500 mg three times a day for 5 days
Alternatively, if there is a penicillin allergy, or amoxicillin is unsuitable (for example atypical pathogens are suspected) options are:

  • oral doxycycline 200 mg on the first day then 100 mg once a day for 4 days (total course of 5 days)
  • oral clarithromycin 500 mg twice a day for 5 days, or oral erythromycin (in pregnancy) 500 mg four times a day for 5 days.
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10
Q

What is the treatment for moderate severity CAP?

A

oral amoxicillin 500 mg three times a day for 5 days

and (if atypical pathogens suspected) oral clarithromycin 500 mg twice a day for 5 days, or oral erythromycin (in pregnancy) 500 mg four times a day for 5 days.

Pen allergy: Doxycycline 200mg day 1 then 100mg day for 4 days OR oral clarithromycin 500 mg twice a day for 5 days.

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11
Q

Main abx for CAP?

A
  • amoxicillin
  • clarithromycin
  • doxycycline
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12
Q

In CAP, for young people aged 12–17 years, if symptoms or signs are non-severe-what is treatment?

A

Amoxicillin PO 500mg TDS 5 days

Alternatives:

  • clarithromcyin 250-500mg BD 5 days
  • erythromycin in prengnacy 250-500mg QDS 5 days
  • doxycycline 200mg day 1 then 100mg BD 4 days
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13
Q

Generally if using IV abx, when should they be reviewed with aims to step down to oral?

A

48hrs

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14
Q

What is the treatment for high severity CAP?

A

Co-amoxiclav 500/125mg TDS PO (or 1.2g IV TDS) 5 days
WITH
Clarithromycin 500mg BD PO/IV for 5 days

OR erythromycin if pregnancy - 500mg TDS 5 days

pen allergy: Levofloxacin 500mg BD PO /IV 5 days

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15
Q

What is Hospital acquired pneumonia and when to treat?

A

Develops 48hrs or more after admission
Treat within 4hrs
send samples

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16
Q

What is the treatment for early onset HAP <5 days? / non severe

A

Co-amoxiclav TDS 5 days

Pen allergy:

  • doxycycline 200mg day 1 then 100mg 4 days
  • Cefalexin (but caution pen allergy) - 500mg BD or TDS 5 days
  • co-trimoxazole 960mg BD 5 days
  • Levofloxacin 500mg OD or BD 5 days
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17
Q

what is treatment for severe HAP / >5 days onset

A 
Antipseudomonal - Tazocin 4.5g TDS 
Ceftazidime 2g TDS
Ceftriaxone 2g OD 
Cefuroxime
meropenem
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18
Q

What abx would you add if confirmed MRSA in HAP?

A

Vancomycin
Teicoplanin
Linezolid

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19
Q

What abx would you add if pseudomonas suspected in HAP?

A

Aminoglycoside e.g. gent

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20
Q

What colour phlegm indicates TB

A

dark red

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21
Q

What is treatment regimen for TB

A

2 months - RIPE (rifampicin, isoniazid, pyrazinamide, ethambutol + pyridoxine)
4months - rifampicin, isoniazid (+ pyridoxine)

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22
Q

what are symptoms indicative of TB

A 
Cough >3weeks
night sweats, fever 
coloured phlegm/dark red
weight loss
neck swelling
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23
Q

what is a side effect of ethambutol

A

visual changes

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24
Q

what TB drugs are hepatotoxic

A

All except for ethambutol

rif, ison, pyrazinamide

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25
Q

what are interactions of isoniazid

A

tyramine and histamine rich foods can cause tachy, hypotension, flushing, headache

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26
Q

What is treatment for lower UTI in non pregnant women and pregnant women?

A

Non pregnant: nitrofurantoin 100mg MR BD 3 days (or trimethoprim)
Pregnant: nitrofuantoin 100mg MR BD 7 days (or amoxicilin or cefalexin)

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27
Q

What is 1st line for men with UTI

A

trimethoprim 200mg BD 7 days

28
Q

what is 1st line treatment for BV

A

metronidazole 400mg BD 5-7 days

29
Q

What is 1st line for chlamydia

A

doxycycline 100mg B D7 days (erythromycin in pregnancy)

30
Q

What is treatment for gonorrhoea

A

IM ceftriaxone 1g single dose

31
Q

What are some red flag referrals for cold sores

A 
painless ?cancer
Babies/young
immunocompromised
eyes
>2 weeks 
atopic eczema
32
Q

What is the treatment regimen for topical aciclovir cream for cold sores

A

5x a day for at least 4 days (max 10 days) - every 4hrs during waking hours

33
Q

what drug is contraindicated in c diff

A

Loperamide

34
Q

What are some symptoms indicative of meningitis

A 
non blanching rash 
stiff neck
photosensitivity 
floppy
bulging fontanelle
drowsy 
cold hands/feet
35
Q

What is used to treat septicaemia

A

Broad spectrum antipseudomonal - Tazocin
Addition of Vanc if MRSA
Addition of metronidazole if anaerobes
Other resistant strains=meropenem

36
Q

What are symptoms of sepsis

A

fever, cold hands/feet
joint pain and muscle pain
rapid breathing
stomach pain, cramps

37
Q

What is licensing for chloramphenicol OTC

A

2+ years

38
Q

What is the dosing for chloramphenicol eye drops and ointment for otc

A

Drops: every 2 hours for first 48 hours then every 4 hours during waking hours- 5 day

ointment: 3-4x daily for 5 days

39
Q

Name some red flag symptoms for eye conditions

A 
true eye pain
vision affected
photophobia 
cloudy eye, vision, headache 
trauma 
lenses
40
Q

If a patient had cloudy, painful eye and headache - what is best course of action

A

A&E referral due to risk acute angle closure glaucoma

41
Q

What is 1st line for impeigo? (non bullous)

A
  1. Hydrogen peroxide 1% cream 2-3 times day for 5 days

2. fusidic acid 2% TDS for 5 days

42
Q

What is treatment for bullous impetigo?

A
  1. flucloxacillin 500mg QDS 5 days

2. Clarithromycin 250mg BD 5 days

43
Q

How long would you advise someone with impetigo to stay off school for

A

until lesions healed/dry or 48 hours after abx started

44
Q

What is the option of abx if a pt has an animal bite but pen allergy?

A

Metronidazole + doxycycline together

45
Q

What is classed as high dose PPI in H pylori

A

Lansoprazole 30mg BD

Omeprazole 40mgBD

46
Q

What symptoms would indicate H pylori

A

Stomach pain worse when stomach is empty
Aching, burning
Bloating
loss of apetite

47
Q

What is treatment regimen for H pylori in patient with and without pen allergy
and what would affect abx choice?

A

7 days triple therapy - 2x abx with PPI

No pen allergy: Amoxicillin, Clari or metrondiazole with PPI
Pen allergy: Clari, metronidazole and PPI
(or metronidazole, tetracycline, bismuth subsalicylate)

But depends if had abx or that class before recently -wouldn’t give that ab

48
Q

What is typical treatment for oral infections

A

Metronidazole 400mg TDS 3 days

49
Q

What treatment would you NOT give in glandular fever

A

Amoxicillin- maculopapular rash

50
Q

What is main treatment options for otitis media

A

Amoxicillin
Co-amoxiclav
Clarithromycin

51
Q

Does ciprofloxacin cause visual disturbances

A

Yess

52
Q

When would you refer thrush?

A

<16 or >60
OTC failure >7 days
First episode
Recurrent >2 in last 6 months

53
Q

When would you refer fungal skin infections

A 
Diabetic or immunocompromised esp foot 
Facial /scalp 
lage area
broken skin, infected etc 
large area
toenails (>2 and toes athletes foot)
54
Q

When is treatment recommended for gonorrhoea?

A

Only within 14 days of exposure or> 14 days after exposure with positive test
If after 14 days only treat if positive test

55
Q

When do you start treatment for shingles

A

Within 72 hours of rash onset in >50 years old to reduce post herpatic neuralgia

56
Q

What is the most effective bite prevention in malaria prophylaxis

A

NETS impregnated with permethrin

57
Q

If applying sunscreen with DEET in which order?

A

Apply high factor sunscreen first then DEET 50%

58
Q

If a patient develops any illness esp within3 months to 1 year of travelling to malaria area what would you advise

A

refer! - potential malaria

59
Q

When would you start doxycycline when entering malaria area

A

1-2 days before

4 weeks after leaving

60
Q

What is MHRA warning regarding mefloquine

A

Serious neuropsychiatric reactions - psychosis, suicidal ideation
sleep issues, dizziness and convulsions
NOT used in psychiatric disorders mental health or convulsions
- dizziness occurs up to months after so beware of driving

61
Q

which anti malarial causes ocular toxicity

A

chloroquine

62
Q

which regimens require start 1-2 days before travel malaria?

A

Malarone (+ 1 week after)

Doxycycline (+4 weeks after)

63
Q

Which malaria regimens require a 1 week start before travel?

A

chloroquine

proguanil

64
Q

what is the advise regarding treatment of scabes and age licensing

A

Permethrin 5% cream 1st line fo 2+ years - single application and leave on overnight before washing off
Malathion (derbac M) also available for 6+ months, leaving on for 24hrs.

Would do 2 treatments 7 days apart and treat all contacts
Apply to entire body

65
Q

what are symptoms of scabies

A

Intense itching-worse at night
thread grey lines
between webs of hands

66
Q

What is used for mastitis in breastfeeding

A

Flucloxacillin

clarithromyin/ery

PRE-REG own (35 decks)

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