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PPT year 4 > masterclass 3: MSK and rheumatology > Flashcards

masterclass 3: MSK and rheumatology Flashcards

1
Q

Meningococcal disease organism

A

Neisseria meningitidis

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2
Q

meningitis classic triad

A

fever, headache and neck stiffness

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3
Q

meningitis signs of shock

A

tachycardia, hypotension, tachypnoea, low urine output, prolonged CRT, confusion, mottled skin, cold hands/feet

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4
Q

meningitis Kernig’s sign

A

pain and resistance on passive knee extension with hips fully flexed

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5
Q

meningitis Brudzinski’s sign

A

hips flex on bending the head forward

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6
Q

meningitis most common organisms above 3 months x3

A 
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae type b
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7
Q

4 organisms causing meningitis in neonates

A

Streptococcus agalactiae (group B strep)
Escherichia coli
S. pneumoniae
Listeria monocytogenes

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8
Q

meningitis transmission

A

close contact with droplets/secretions from upper respiratory tract

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9
Q

meningitis risk factors for catching x7

A

younger/older age, winter, splenectomy/asplenic, immunocompromised, organ dysfunction, smoking and crowding

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10
Q

how many serogroups for meningococcal meningitis

A

13

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11
Q

most common types of meningococcal meningitis

A

A, B, C, W, X and Y

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12
Q

Neisseria meningitidis gram…

A

gram-negative

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13
Q

Streptococcus pneumoniae gram…

A

gram-positive

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14
Q

Neisseria meningitidis anaerobic or aerobic

A

aerobic

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15
Q

Neisseria meningitidis shape

A

diplococcus

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16
Q

Streptococcus pneumoniae anaerobic or aerobic

A

anaerobic bacteria

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17
Q

Streptococcus pneumoniae shape

A

lancet shaped diplococcus structure

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18
Q

Benzylpenicillin class

A

Beta-lactam antibiotics (penicillins)

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19
Q

Benzylpenicillin moa

A

bind to penicillin-binding proteins and inhibit synthesis of the peptidoglycan layer of the cell wall

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20
Q

Benzylpenicillin is affective against gram…

A

aerobic gram-positive bacteria

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21
Q

Benzylpenicillin and gram-negative cocci

A

works okay

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22
Q

Benzylpenicillin and anaerobic organisms

A

works okay

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23
Q

Benzylpenicillin and gram-negative bacilli

A

useless

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24
Q

howdo bacteria get a resistance to Benzylpenicillin

A

production of beta-lactamases which hydrolyse the beta-lactam ring

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25
Q

Benzylpenicillin indications x7

A

Meningitis
Endocarditis
Intrapartum prophylaxis against group B streptococcal infection
Tonsillitis/otitis media/pneumonia/cellulitis

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26
Q

what are the beta-lactam antibiotics

A

penicillins, cephalosporins and carbapenems

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27
Q

beta-lactamase inhibitors example

A

clavulanic acid

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28
Q

whats co-amoxiclav

A

clavulanic acid and amoxicllin

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29
Q

Benzylpenicillin side effects

A 
Hypersensitivity
GI disturbance
CNS toxicity
Interstitial nephritis
Blood disorders
Antibiotic associated colitis
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30
Q

Benzylpenicillin interactions x2

A

Warfarin

Methotrexate

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31
Q

Benzylpenicillin and methotrexate interaction

A

risk of toxicity

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32
Q

which antibiotics can cause interstitial nephritis

A

Benzylpenicillin and Cefotaxime

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33
Q

Benzylpenicillin and blood disorders x3

A

haemolytic anaemia, leucopenia, thrombocytopenia

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34
Q

which drug does Benzylpenicillin reduce the clearance of

A

methotrexate

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35
Q

if people have a hypersensitivity Benzylpenicillin, what other drug might they have the same reaction to

A

cephalosporins

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36
Q

Benzylpenicillin route and why

A

orally - most is destroyed in the stomach by acid

so IV/IM

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37
Q

Benzylpenicillin derivative

A

phenoxymethylpenicillin

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38
Q

phenoxymethylpenicillin route

A

can be administered orally

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39
Q

empirical antibiotic of choice for bacterial meningitis

A

cephalosporins

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40
Q

cephalosporins bacteriostatic or bacteriocidal

A

cidal

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41
Q

cephlapsorin and BBB

A

can cross

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42
Q

Cefotaxime class

A

Beta-lactam antibiotics – (Third generation Cephalosporins)

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43
Q

Cefotaxime moa

A

inhibit cell wall synthesis

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44
Q

why is Cefotaxime better than benzylpenicillin

A

more resistant to hydrolysis by beta-lactamases

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45
Q

Cefotaxime route

A

parenteral route as they are acid-labile

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46
Q

Cefotaxime indications x3

A

Meningitis
Haemophilus epiglottitis
Sexually transmitted infections

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47
Q

Cefotaxime contraindications x2

A

Hypersensitivity to cephalosporins

Immediate hypersensitivity to penicillin

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48
Q

Cefotaxime adverse effects

A 
Hypersensitivity
GI disturbance
Skin reactions
Cholestatic jaundice
Blood disorders
Antibiotic associated colitis
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49
Q

name a 3rd gen cephla

A

Cefotaxime

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50
Q

cephlasporins and generations

A

next gen is better at killing gram neg (worse at gram+) and increased ability to cross BBB

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51
Q

Cefotaxime interactions x3

A

Ibuprofen
Aminoglycosides
Methotrexate

52
Q

Cefotaxime blood disorders x4

A

thrombocytopenia, leucopenia, haemolytic anaemia, neutropenia

53
Q

Cefotaxime with NSAIDs, aminoglycoside antibiotics, methotrexate/chemotherapeutic agents interaction

A

nephrotoxicity

54
Q

Dexamethasone class

A

Glucocorticoid

55
Q

Dexamethasone job

A

mimicking the action of cortisol at steroid receptors

56
Q

Dexamethasone moa

A

inhibit the activity of pro-inflammatory transcription factors

57
Q

Dexamethasone and prostoglandins and leucotrines

A

reduced

58
Q

Dexamethasone and wound healing

A

impaired

59
Q

Dexamethasone affect on capillaries

A

decreased permeability

60
Q

Dexamethasone metabolic effects

A

gluconeogenesis
protein degradation particularly in muscle
fat redistribution
decreased osteoblast formation

61
Q

Dexamethasone onset of action

A

8 hours

62
Q

hydrocortisone mineralocorticoid or glucocorticoid

A

50/50

63
Q

prednisolone mineralocorticoid or glucocorticoid

A

4:0.8

64
Q

dexamethasone mineralocorticoid or glucocorticoid

A

glococorticoid all the way

65
Q

fludrocortisone mineralocorticoid or glucocorticoid

A

mineralocorticoid all the way

66
Q

hydrocortisone duration of action

A

short

67
Q

prednisolone duration of action

A

medium

68
Q

dexamethasone duration of action

A

long

69
Q

fludrocortisone duration of action

A

medium

70
Q

which steroid is equal to cortisol

A

hydrocortisone

71
Q

which steroid has the longest duration of action

A

dexamethasone

72
Q

dexamethasone indications x4

A

Cerebral oedema
Rheumatic disease
Suppression of inflammatory and allergic disorders
Symptom control in a palliative care setting

73
Q

dexamethasone contraindications x2

A 
Systemic infection
Live vaccines (if high dose)
74
Q

dexamethasone uses in palliative care

A

pain due to nerve compression, nausea and vomiting, dyspnoea due to bronchospasm/obstruction, anorexia and dysphagia

75
Q

6 cautions of dexamethasone

A

CCF, diabetes, glaucoma, HTN, osteoporosis, peptic ulcer

76
Q

dexamethasone syndrome they can develop

A

cushings syndrome

77
Q

dexamethasone prolonged therapy issue

A

adrenal atrophy develops with suppression of the HPA axis

78
Q

dexamethasone and adrenal atrophy prognosis

A

can last years afer stopping

79
Q

dexamethasone abrupt withdrawl complications x2

A

adrenal insufficiency, hypotension

80
Q

situations when to increase corticosteroid injections

A

significant intercurrent illness, trauma or surgical procedure

81
Q

long term steroid patients should carry

A

steroid card

82
Q

interaction of steroid with citalopram and venlafaxine

A

hypokalaemia

83
Q

interaction of steroid with NSAIDs

A

bleeding

84
Q

interaction of steroid with amiodarone

A

hypokalaemia

85
Q

interaction of steroid with nicorandil

A

bowel perforation

86
Q

interaction of steroid with antipsychotics

A

hypokalaemia

87
Q

interaction of steroid with digoxin

A

digoxin toxicity

88
Q

interaction of steroid with lithium

A

hypokalaemia

89
Q

interaction of steroid with warfarin

A

increased anticoag affect

90
Q

interaction of steroid with macrolides

A

hypokalaemia

91
Q

interaction of steroid with clarithromycin

A

increases exposure to steroid

92
Q

interaction of steroid with sildenafil

A

hypokalaemia

93
Q

interaction of steroid with ketoconazole

A

increase in exposure to steroid

94
Q

interaction of steroid with ondasteron

A

hypokalaemia

95
Q

interaction of steroid with furosemide

A

hypokalaemia

96
Q

interaction of steroid with methadone

A

hypokalaemia

97
Q

is bacterial menigitis a notifiable disease

A

yeah

98
Q

who to notify with bacterial menigitis

A

public health authority and the Consultant in Communicable Disease Control

99
Q

who gets prophylaxis for bacterial menigitis

A

close contact past 7 days/exposed to big particles from the pt

100
Q

when should prophylaxis be given for menigitis of those who are at risk

A

within 24 hours

101
Q

drugs for bacterial menigitis prophylaxis

A

rifampicin or ciprofloxacin

102
Q

which bacterial menigitis prophylaxis is preferred and why x3

A

widely available, less commonly interacts with other medications and is a one-off dose

103
Q

prophylactic vaccines for menigitis x5

A

Hib, men B and men C, pneumococcal and quadrivalent men A, C, W, Y.

104
Q

Encephalitis presentation

A

viral symptoms and change in behaviour

105
Q

how is Encephalitis split into categories

A

acute viral encephalitis

post-infectious encephalitis

106
Q

whats acute viral Encephalitis

A

caused by infection of brain with virus

107
Q

whats post infectious Encephalitis

A

autoimmune process following a viral infection elsewhere in the body

108
Q

Encephalitis most common cause

A

HSV

109
Q

Encephalitis triad

A

fever, headache and altered metal state

110
Q

viral meningitis causative agents

A

enteroviruses and herpes viruses

111
Q

first line for viral Encephalitis

A

aciclovir

112
Q

Aciclovir class

A

guanosine analogue

113
Q

what does guanosine do

A

inhibits synthesis of viral DNA

114
Q

Aciclovir and cytotoxic affects on human cells

A

Requires phosphorylation by viral enzymes = wont harm human cells

115
Q

Aciclovir target

A

DNA polymerase

116
Q

Aciclovir most active against which agent

A

HSV

117
Q

Aciclovir indications

A

Herpes simplex and varicella zoster infections only

118
Q

Aciclovir and elderly patients

A

risk of neurological reactions

119
Q

Aciclovir side effects x6

A 
GI disturbance
Skin reactions and photosensitivity
Blood disorders
Renal impairment
CNS effects
Hepatic disorders
120
Q

Aciclovir blood disorders x3

A

anaemia, leucopenia, thrombocytopenia

121
Q

Aciclovir route for encephalitis

A

IV only

122
Q

when is Aciclovir appropriate for oral route

A

chickenpox/shingles/herpes

123
Q

Aciclovir min legth of treatment

A

Min 14 days

Min 21 days if immunocompromised

124
Q

Aciclovir when to stop for encephalitis

A

Repeat LP to confirm CSF is negative before stopping

125
Q

Aciclovir and nephrotoxicity drugs x 5

A

NSAIDs, trimethoprim, methotrexate, aminoglycosides and cephalosporins

126
Q

Aciclovir and Aminophylline

A

increased exposure of aminophyllines with concurrent use of aciclovir

PPT year 4 (7 decks)

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