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Infections November 23 > Infections part 4 Q 150-200 > Flashcards

Infections part 4 Q 150-200 Flashcards

1
Q

Q150: Which tetracyclines require sun protection?

A
  • Doxycycline
  • Demeclocycline (label 11)
  • DD(acronym)
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2
Q

Q151: Which tetracyclines can and can’t be taken with milk?

A
  • **With milk: **
  • Doxycycline,
  • Lymcycline,
  • Minocycline
  • ** Without milk:**
  • Demeclocycline, tetracycline, oxytetracycline, etc.
  • ** - Memory trick: remember Dox Likes Milk for tetracyclines that can be taken with milk.**
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3
Q

Q152: What are the main cautions with tetracyclines?

A

Increase muscle weakness in pts with myasthenia gravis

Antacids & Al, Ca, Fe, Mg, and Zn salts decrease absorption of tetracyclines

Milk can reduce absorption of some tetracyclines (DOT)

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4
Q

Q153: What are the main drug interactions with tetracyclines?

A

**- Hepatotoxicity with anything that damages the liver **

Label 7: Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after taking this medicine

Binds to divalent cations: Fe2+, Ca2+, and antacids, preventing absorption of tetracycline

Label 11: Protect your skin from sunlight—even on a bright but cloudy day.
Do not use sunbeds

Especially Demeclocycline and Doxy

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5
Q

Q154: What are the main contraindications for tetracyclines?

A
  • **Pregnancy + breastfeeding
  • Children < 12 years of age (permanently stains teeth)
  • Hepatic impairment**
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6
Q

Q155: What is trimethoprim used for?

A

UTI
Respiratory tract infections

(e.g., chronic bronchitis, pneumonia)

Acute pyelonephritis

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7
Q

Q156: How does trimethoprim work?

A
  • DHFR inhibitor
  • Prevents bacterial replication by inhibiting DNA synthesis
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8
Q

Q157: What are the main contraindications for trimethoprim?

A

-** Blood disorders **
- Avoid in pregnancy (folate antagonist)

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9
Q

Q158: What are the main side effects of trimethoprim?

A

- Diarrhea
- Electrolyte imbalance (HYPERKALEMIA)
- Fungal overgrowth
- Headache
- Nausea
- Skin reactions
- Vomiting
- Blood disorders

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10
Q

Q159: What are the monitoring requirements for trimethoprim, and what advice would you give to patients on long-term therapy?

A

- Monitor FBC on long-term therapy Patient & carer advice:
Recognize signs of blood disorders,
fever,
sore throat
rash,
mouth ulcers,
purpura, bruising, or bleeding.

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11
Q

Q160: What’s the main MHRA/CMH warning regarding linezolid?

A

**- Severe optic neuropathy risk,

  • especially if used for longer than 28 days.
  • Report signs of visual problems immediately to ophthalmology.
  • Blood disorders such as myelosuppression have been reported.**
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12
Q

Q161: What’s the main use of nitrofurantoin?

A

- UTIs (both treatment and prevention)
Genitourinary surgical prophylaxis

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13
Q

Q162: What are the main contraindications for nitrofurantoin?

A

- Acute porphyria
- - G6PD deficiency
- - Infants less than 3 months

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14
Q

Q163: What’s the advice regarding renal function with nitrofurantoin?

A

- Risk of peripheral neuropathy
- AVOID if eGFR < 45 mL/minute/1.73 m2; CAUTION if eGFR 30–44 mL/minute/1.73
- m2 - as a short-course only (3 to 7 days),
- to treat uncomplicated lower UTI caused by suspected
- or proven multidrug-resistant bacteria if benefit > risk.

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15
Q

Q164: What are the monitoring requirements for nitrofurantoin?

A

- On long-term therapy:
-Liver function
Lung function for pulmonary symptoms
(especially in the elderly; discontinue if deterioration)

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16
Q

Q165: What are the time frames for treating UTIs for each patient group of nitrofurantoin and trimethoprim?

A
  • ADD ANSWER (information not provided)
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17
Q

Q166: Which drugs are used for TB and how long are they used for?

A

- Initial phase lasts 2 months
- with RIPE
- (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol)
-
- Continuous phase lasts 4 months with RIISON (Rifampicin and Isoniazid)

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18
Q

Q167: What are the main monitoring requirements for TB drugs?

A
  • **- Renal and hepatic function before treatment
  • All TB drugs except ethambutol are hepatotoxic, so monitor signs of hepatotoxicity
  • Frequent liver checks for patients with pre-existing liver disease + alcohol dependence, especially in the first 2 months
    **
  • Rifampicin can discolor urine and color soft contact lenses red**
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19
Q

Q168: What are the main side effects of ethambutol, and what is done when this happens?

A
  • Ocular toxicity (visual impairment)
  • Early discontinuation of the drug almost always results in recovery of eyesight
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20
Q

Q169: What are the main side effects of isoniazid, and what is given to treat this side effect?

A

**- Liver toxicity: stop if this happens **
~~~
- Gout due to raised uric acid levels: colchicine or high- dose NSAIDs
- Peripheral neuropathy:
- oral B6/pyridoxine to prevent,
- especially in diabetics, alcoholics,
- chronic renal failure,
- pregnancy,
- HIV,
- malnourished individuals
~~~

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21
Q

Q170: What are the main side effects of rifampicin, and when should it be stopped?

A
  • Color urine red, normal with contact lenses **
  • Discontinue if signs of liver toxicity develop
  • Influenza-like symptoms
  • (chills, fever, dizziness, bone pain)
  • Shortness of breath
  • Acute renal failure
  • Discontinue if serious side effects develop**
22
Q

Q171: What are the main side effects of pyrazinamide, and what should be done in this case?

A
  • Main side effects:
  • Gout and hepatotoxicity (raises uric acid levels)
  • Stop pyrazinamide
  • Give acute gout meds such as colchicine or a high dose NSAID
  • Refer to specialist to give alternative antibiotics
23
Q

Q172: What are the main uses of metronidazole?

A

- Trichomonal vaginitis
- Bacterial vaginitis and vaginosis
- C. difficile infections
- Topical metronidazole used to reduce microbial odors in rosacea
- Oral infections (e.g., gingivitis)

24
Q

Q173: What are the main side effects of metronidazole?

A

- Nausea and vomiting
- Taste disturbance
- Anorexia (decreased appetite)

25
Q

Q174: What is the main warning label when dispensing metronidazole?

A

  • Label 9: Space doses evenly throughout the day, finish the course.
    -
  • Label 21: Take with or just after food.
  • Label 25: Swallow medicine whole.
  • Label 27: Take with a full glass of water.**
26
Q

Q175: What are the different classes of antifungals?

A

- Triazole
- Imidazole
- Polyene
- Echinocandin
- Memory trick: “TIPE”

27
Q

Q176: Give examples of triazole and imidazole antifungals?

A
  • Memory trick: both classes end in “conazole”
  • Examples:
  • Triazoles: Fluconazole, Itraconazole, Voriconazole
  • Imidazoles: Ketoconazole, Miconazole
28
Q

Q177: What’s the main MHRA advice around amphotericin B?

A

Liposomal and lipid-complex formulations:

Name change to reduce medication errors

  • Formulations are NOT interchangeable due to different bioavailability
29
Q

Q178: What are the main cautions with amphotericin B?

A

- Avoid rapid infusion (risk of arrhythmias)
- Close supervision necessary for parenteral use
- Anaphylaxis with IV use
- Use a test dose before the first infusion in a new course, followed by careful observation.
- Infusion-related reactions, prophylactic antipyretics or hydrocortisone can be used for patients who have previously experienced infusion-related reactions

30
Q

Q179: What are the monitoring requirements with amphotericin B?

A
  • Liver function
  • Renal function
  • Blood counts
  • Plasma electrolytes (potassium and magnesium)
31
Q

Q180: What is special about fluconazole in terms of drug interactions?

A

**It is an inhibitor
Liver toxicity: interacts with anything else that damages the liver,
like statins,
paracetamol, alcohol, etc.

QT prolongation when given together with drugs that prolong QT, e.g., Lithium, macrolides**

32
Q

Q181: What are the main side effects of fluconazole, and when should it be discontinued?

A

Main Side effects:
Liver toxicity,
diarrhea, nausea, vomiting

Safety Information: can cause heart failure, so use cautiously in patients with heart conditions

Stop immediately if any signs of liver toxicity such as abdominal pain,
dark urine,
jaundice, and itching all over

33
Q

Q182: What age can fluconazole be given OTC, and what’s the max dose?

A

Sold for vaginal candidiasis + candida balanitis

` Age 16-60 years`

Pack size not >150mg → max dose 150mg

34
Q

Q183: What’s the important safety information regarding Itraconazole?

A

Reports of heart failure associated with itraconazole

At-risk patients include
PT receiving higher daily doses and longer courses,
patients with cardiac disease,
chronic lung disease,
& receiving treatment with calcium channel blockers Avoid in patients with ventricular dysfunction, i.e., a history of congestive heart failure

35
Q

Q184: What’s the CPMH warning regarding oral ketoconazole?

A

Not to be used to treat fungal infections

Too much liver toxicity compared to other antifungals
Patients taking it to treat fungal infections need to be taken back to their GP’s

However, it can be taken orally for Cushing syndrome

36
Q

Q185: What non-infectious disease can ketoconazole be used for? (Gloria)

A

Cushing syndrome

37
Q

Q186: What are the 2 main side effects of voriconazole that patients are advised about?

A 
- Hepatotoxicity
- Phototoxicity

Memory trick: all “azole” antifungals are toxic to the liver.
V for UV, which means light

38
Q

Q187: What parts of the body do dermatophyte infections affect?

A

Skin
Hair
Nail

39
Q

Q188: What are the most common dermatophyte infections seen in practice?

A

Tinea pedis (foot)
Tinea corporis (body)
Tinea capitis (head)
Tinea unguium (toes)
Tinea cruris (moist areas of the body)

40
Q

Q189: What are the main features seen in fungal infections?

A

Clear boundary between healthy skin and the infected part
Raised skin
Red rash

41
Q

Q190: What is tinea pedis, and what’s used to treat it?

A

Fungal foot infection
Clotrimazole 1% (Canesten)
Ketoconazole 2% (Daktarin)
Terbinafine 1% (Lamisil)
Miconazole 2% (C/I warfarin)
Also powder but not as effective as cream

42
Q

Q191: What is tinea corporis, and what’s used to treat it?

A

Fungal infection, also known as ringworm
Main symptoms: ring-like red rash, scaly edges, itching
Main treatments: ketoconazole, itraconazole, Terbinafine
Memory trick: Ringworm KIT

43
Q

Q192: What is tinea capitis, and what’s used to treat it?

A

Fungal infection of the scalp
Miconazole,
clotrimazole,
terbinafine

44
Q

Q193: What is tinea unguium, and what’s used to treat it?

A

Fungal nail infection

Systemic treatment more effective than topical

Refer to GP if more than 2 nails are infected

45
Q

Q194: What are the main risk factors for getting fungal infections?

A

Diabetes
Immunocompromised (e.g., HIV)
Poor circulation
(peripheral arterial disease)

46
Q

Q195: What are the main symptoms of measles, and what’s used to treat it?

A

Urgent appointment with GP, notifiable disease

Symptoms:
high temperature,
runny or blocked nose,
sneezing, coughing, red sore watery eyes,
** small white spots in the mouth** (Koplick spots)

Treatments: Paracetamol, Ibuprofen,

avoid aspirin in children under 16 years

47
Q

Q196: What’s contact dermatitis, and what’s used to treat it?

A

Eczema/dermatitis after CONTACT with something
Treatment:
avoid the trigger,
emollient creams,
steroid creams such as hydrocortisone **(10 and above) **
or clobetasone (12 and above)

48
Q

Q197: What is oral thrush, and what’s used to treat it?

A

A white coating on the tongue like cottage cheese,

Can’t be rubbed off easily
**Nystatin**, **miconazole**

49
Q

Q198: What’s molluscum contagiosum, and what’s used to treat it?

A

Viral infection that affects the skin
Small, firm, raised papules (spots) with a characteristic small dimple in the middle.
Not painful but can be itchy
Treatment usually recommended for adults and older children with unsightly spots affecting their quality of life

Potassium hydroxide,
podophyllotoxin,
imiquimod,
benzoyl peroxide,
tretinoin

50
Q

Q199: When do you give topical antifungals vs. oral antifungals?

A

Topical for mainly skin infections,
mild or localized cases + internal infections are wide-spread or topical treatment fails
Oral for systemic infections and when topical treatment is contraindicated

51
Q

Q200: What is used to treat threadworms, and what’s the patient advice?

A

Treatment:
Mebendazole

Treat all family members regardless of symptoms
Repeat treatment if symptoms persist after 2 weeks

52
Q
A

Infections November 23 (5 decks)

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