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Management of Infection > Lecture 11 - Management of Infection > Flashcards

Lecture 11 - Management of Infection Flashcards

1
Q

What is pharmaceutical care?

A

a philosophy of practive in which the patient is the beneficiary of the pharmacists actions

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2
Q

What does pharmaceutical care focus?

A

the attitudes, behaviours, commitments, concerns, ethics, functions, knowledge, responsibilities and skills of the pharmacist on the provision of drug therapy with the goal of achieving definite therapeutic outcomes toward patient health and quality of life

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3
Q

What patients are at risk of infection?

A

immunocompromised patients

patients in ICU or post operation

malnourished

patients with cancer and diabetes

elderly or infirm

infants and neonates

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4
Q

Appropriate use of antibiotics?

A

correct diagnosis (known or presumed site of infection)

antibiotic culture and sensitivity

patient factors

site and severity

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5
Q

What patient factors need to be checked before treatment?

A

contraindications

interactions (medicines, foods)

allergies

renal and hepatic function

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6
Q

What is the preferred route of administration?

A

oral with adequate doses

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7
Q

What should be avoided when oral alternatives are available?

A

topical antibacterial agents

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8
Q

What is intravenous therapy needed for?

A

clinical symptoms of infection

CNS infection, joint infection, staph aureus bacteraemia, sepsis, oral route compromised

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9
Q

When should IV be used until?

A

there is clinical control of infection

indicators are returning to their reference range

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10
Q

What type of injection is more reliable?

A

IV more than IM

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11
Q

When should IV be switched to oral therapy?

A

in patients who have been on IV for 24-48 hours who have

settling temperature

falling indicators of infection

able to take oral therapy

oral therapy available

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12
Q

What is the BNF vs prescribed dose of penicillin?

A

BNF = 250-500mg four times a day

dose used = 500mg-1g four times a day

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13
Q

What is the BNF vs prescribed dose of gentamicin?

A

BNF = 80mg three times a day

dose used = 5-7mg/kg

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14
Q

What should patients therapy be modified based on?

A

patient factors
results of culture and sensitivity
patient response to therapy
therapeutic drug monitoring

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15
Q

Pharyngitis?

A

majority are viral, no antibiotic required

<20% bacterial

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16
Q

How to treat streptococcus pyogenes (pharyngitis)?

A

narrow spectrum penicillin

macrolide

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17
Q

Patient factors to consider with pharyngitis?

A

age - adult or child

penicillin allergy

oral administration (which formulation)

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18
Q

Otitis media?

A

usually viral or self limiting

symptoms for 2-3 days the they disappear

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19
Q

What causes otitis media and how to treat it?

A

haemophilus influenzae

penicillin e.g. amoxicillin
macrolide

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20
Q

Patient factors for otitis media?

A

normally a childhood condition

formulation

delayed prescribing - self limiting

surgical intervention (grommets)

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21
Q

What formulation is usually used for otitis media?

A

in a child so rarely use ear drops, liquid most likely

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22
Q

What causes sinusitis and how to treat it?

A

strep pneumoniae
haemophilus influenzae

penicillin e.g. amoxicillin
tetracycline

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23
Q

What is sinusitis?

A

sinuses are congested and infection grows

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24
Q

Patient factors of sinusitis?

A

nasal decongestants (potential rebound for congestion)
age
non drug treatments e.g. steam inhalation

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25
Q

Why is tetracycline contraindicated in children?

A

it can affect growing bones and teeth (can discolour teeth)

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26
Q

What are symptoms of COPD?

A

increased wheeze, increased shortness of breath, increased sputum volume and purulence

need 2/3 of these to have infective exacerbation of COPD

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27
Q

What is COPD?

A

chronic obstructive pulmonary disease

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28
Q

What causes exacerbation of COPD?

A

strep pneumoniae

haemophilus influenzae

moraxella catarrhalis

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29
Q

How to treat exacerbation of COPD?

A

penicillin
tetracycline
macrolide

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30
Q

What might be needed if exacerbation of COPD is severe?

A

IV therapy

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31
Q

Patient factors for lower respiratory tract infection?

A 
possibility of recurrent infection
previous therapy likely to be effective 
route of therapy (normally oral)
patient age (likely to be older)
other diseases (drug interactions)
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32
Q

What causes community acquired pneumonia?

A

strep pneumoniae

haemophilus influenzae

33
Q

Treatment of non severe CAP?

A

penicillin e.g. amoxicillin

tetracycline

macrolide (clarithromycin)

34
Q

Treatment of moderate CAP?

A

ask about foreign travel
possibility of legionella (esp if patient is confused)

penicillin e.g. amoxicillin and either tetracycline or macrolide

35
Q

Severe CAP treatment?

A

consider legionella if patient is confused

macrolide (IV or oral as appropriate) and either penicillin (or penicillin with beta lactamase inhibitor)

quinolone may be used in a patient with true penicillin allergy

36
Q

How to treat early HAP?

A

within 4 days of hospital admission - treat as CAP

37
Q

How to treat HAP within 7 days of discharge or 5 days after admission?

A

CURB <2

penicillin with beta lactamase inhibitor
tetracycline

38
Q

Within 7 days of discharge or 5 days after hospital admission (CURB<3)?

A

penicillin and extended spectrum penicillin

39
Q

Pneumonia patient factors?

A

patient age - adult or child

severity of infection (need for IV)

severe infection may affect absorption

comorbidities

40
Q

What might need to be done if patient has sepsis?

A

may need to withhold other meds e.g. antihypertensives

41
Q

Treatment of UTI?

A

male, female and pregnant woman all need to be treated differently

42
Q

Uncomplicated UTI in men ad non-pregnant women cause?

A

E. coli

proteus spp

enterococci

43
Q

Uncomplicated UTI in men ad non-pregnant women treatment?

A

trimethoprim

nitrofurantoin

44
Q

UTI in pregnant woman treatment?

A

nitrofurantoin

penicillin

45
Q

Women with upper UTI without sepsis?

A

trimethoprim

nitrofurantoin

46
Q

Men with upper UTI without sepsis?

A

trimethoprim

penicillin with beta lactamase inhibitor

47
Q

Upper UTI with sepsis treatment?

A

Women, men and pregnant women

penicillin with beta lactamase inhibitor and aminoglycoside

48
Q

UTI in pregnancy?

A

possibility of teratogenicity (much higher risk in 1st and 2nd trimester)

which trimester?

49
Q

Catheter with a UTI?

A

makes it hard to eradicate the infection without removing the catheter

50
Q

Length of treatment for a UTI?

A

3 days may be enough

51
Q

Additional counselling for a patient with a UTI?

A

avoid perfumed wipes, hygiene, post coital infections, increase fluids, avoid coffee

52
Q

What causes cellulitis?

A

staph aureus, strep pyogenes

53
Q

Treatment of mild cellulitis/erysipelas?

A

narrow spectrum penicillin
tetracycline
macrolide

54
Q

Treatment of moderate cellulitis?

A

narrow spectrum penicillin

glycopeptide IV

55
Q

Treatment of human or animal bite?

A

penicillin with beta lactamase inhibitor

tetracycline and metronidazole

56
Q

Patient factors for skin and soft tissue infections?

A

site of infection
comorbidities
age of the patient
is the infection bacterial only (possibility of viral or fungal infection at the same time)

is topical treatment possible

57
Q

What is necrotising fasciitis?

A

a rapidly spreading infection caused by strep pyogenes

58
Q

How to treat necrotising fascittis?

A

benzylpenicillin 2.4mg every 6 hours and flucloaxillin 2g every 4-6 hours

gentamicin IV and clindamycin IV every 6 hours and metronidazole IV 500mg every 8 hours

59
Q

What might be needed in necrotising fasctiitis?

A

surgical treatment to cut the infection away to stop it extending

60
Q

Pyrexia of unknown origin?

A

sepsis or severe sepsis

61
Q

Treatment of pyrexia of unknown origin?

A

penicillin and aminoglycoside IV

glycopeptide IV and aminoglycoside iV

62
Q

What might be difficult if a patient is hypertensive?

A

IV access

63
Q

Clostridium difficile infection?

A

antibiotic associated diarrhoea

related to broad spectrum antibacterial therapy

64
Q

Treatment of non severe C diff?

A

metronidazole 400mg every 8 hours

vancomycin 125mg every 6 hours

65
Q

Treatment of severe C diff?

A

vancomycin 125mg every 6 hours

66
Q

Treatment of complicated C diff?

A

vancomycin 125mg every 6 hours +/- metronidazole 400mg every 8 hours

67
Q

Treatment of relapsing C diff?

A

consider faecal transplant, re-establishing the microbiome

68
Q

Why is vancomycin given orally in C diff?

A

we want local treatment in the GI tract

69
Q

Treatment of herpes simplex?

A

cold sores

aciclovir topically

70
Q

Treatment of herpes zoster?

A

chickenpox, shingle

aciclovir 800mg five times a day

valaciclovir 1g every 8 hours

71
Q

Patient factors for viral infections?

A

age

onset of symptoms

formulation of treatment

72
Q

When is antiviral treatment not appropriate for chicken pox?

A

when the patient has had it for more than 72 hours

73
Q

How to treat tinea causing athletes foot?

A

antifungal powders/ointment

74
Q

How to treat ringworm?

A

topical antifungal

75
Q

What does candida cause?

A

oral and vaginal infections

76
Q

How to treat vaginal infections caused by candida?

A

azole antifungals - usually oral

e.g. fluconazole

77
Q

Patient factors for candida infections?

A

age, other treatments e.g. inhaled or oral steroids

78
Q

Prescribing factors?

A

allergies

sensitivities

under/over dosing

resistance local differences

side effects

Management of Infection (36 decks)

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