masterclass 3: MSK and rheumatology Flashcards
1
Q
Meningococcal disease organism
A
Neisseria meningitidis
2
Q
meningitis classic triad
A
fever, headache and neck stiffness
3
Q
meningitis signs of shock
A
tachycardia, hypotension, tachypnoea, low urine output, prolonged CRT, confusion, mottled skin, cold hands/feet
4
Q
meningitis Kernig’s sign
A
pain and resistance on passive knee extension with hips fully flexed
5
Q
meningitis Brudzinski’s sign
A
hips flex on bending the head forward
6
Q
meningitis most common organisms above 3 months x3
A
Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus) Haemophilus influenzae type b
7
Q
4 organisms causing meningitis in neonates
A
Streptococcus agalactiae (group B strep)
Escherichia coli
S. pneumoniae
Listeria monocytogenes
8
Q
meningitis transmission
A
close contact with droplets/secretions from upper respiratory tract
9
Q
meningitis risk factors for catching x7
A
younger/older age, winter, splenectomy/asplenic, immunocompromised, organ dysfunction, smoking and crowding
10
Q
how many serogroups for meningococcal meningitis
A
13
11
Q
most common types of meningococcal meningitis
A
A, B, C, W, X and Y
12
Q
Neisseria meningitidis gram…
A
gram-negative
13
Q
Streptococcus pneumoniae gram…
A
gram-positive
14
Q
Neisseria meningitidis anaerobic or aerobic
A
aerobic
15
Q
Neisseria meningitidis shape
A
diplococcus
16
Q
Streptococcus pneumoniae anaerobic or aerobic
A
anaerobic bacteria
17
Q
Streptococcus pneumoniae shape
A
lancet shaped diplococcus structure
18
Q
Benzylpenicillin class
A
Beta-lactam antibiotics (penicillins)
19
Q
Benzylpenicillin moa
A
bind to penicillin-binding proteins and inhibit synthesis of the peptidoglycan layer of the cell wall
20
Q
Benzylpenicillin is affective against gram…
A
aerobic gram-positive bacteria
21
Q
Benzylpenicillin and gram-negative cocci
A
works okay
22
Q
Benzylpenicillin and anaerobic organisms
A
works okay
23
Q
Benzylpenicillin and gram-negative bacilli
A
useless
24
Q
howdo bacteria get a resistance to Benzylpenicillin
A
production of beta-lactamases which hydrolyse the beta-lactam ring
25
Benzylpenicillin indications x7
Meningitis
Endocarditis
Intrapartum prophylaxis against group B streptococcal infection
Tonsillitis/otitis media/pneumonia/cellulitis
26
what are the beta-lactam antibiotics
penicillins, cephalosporins and carbapenems
27
beta-lactamase inhibitors example
clavulanic acid
28
whats co-amoxiclav
clavulanic acid and amoxicllin
29
Benzylpenicillin side effects
```
Hypersensitivity
GI disturbance
CNS toxicity
Interstitial nephritis
Blood disorders
Antibiotic associated colitis
```
30
Benzylpenicillin interactions x2
Warfarin
| Methotrexate
31
Benzylpenicillin and methotrexate interaction
risk of toxicity
32
which antibiotics can cause interstitial nephritis
Benzylpenicillin and Cefotaxime
33
Benzylpenicillin and blood disorders x3
haemolytic anaemia, leucopenia, thrombocytopenia
34
which drug does Benzylpenicillin reduce the clearance of
methotrexate
35
if people have a hypersensitivity Benzylpenicillin, what other drug might they have the same reaction to
cephalosporins
36
Benzylpenicillin route and why
orally - most is destroyed in the stomach by acid
| so IV/IM
37
Benzylpenicillin derivative
phenoxymethylpenicillin
38
phenoxymethylpenicillin route
can be administered orally
39
empirical antibiotic of choice for bacterial meningitis
cephalosporins
40
cephalosporins bacteriostatic or bacteriocidal
cidal
41
cephlapsorin and BBB
can cross
42
Cefotaxime class
Beta-lactam antibiotics – (Third generation Cephalosporins)
43
Cefotaxime moa
inhibit cell wall synthesis
44
why is Cefotaxime better than benzylpenicillin
more resistant to hydrolysis by beta-lactamases
45
Cefotaxime route
parenteral route as they are acid-labile
46
Cefotaxime indications x3
Meningitis
Haemophilus epiglottitis
Sexually transmitted infections
47
Cefotaxime contraindications x2
Hypersensitivity to cephalosporins
| Immediate hypersensitivity to penicillin
48
Cefotaxime adverse effects
```
Hypersensitivity
GI disturbance
Skin reactions
Cholestatic jaundice
Blood disorders
Antibiotic associated colitis
```
49
name a 3rd gen cephla
Cefotaxime
50
cephlasporins and generations
next gen is better at killing gram neg (worse at gram+) and increased ability to cross BBB
51
Cefotaxime interactions x3
Ibuprofen
Aminoglycosides
Methotrexate
52
Cefotaxime blood disorders x4
thrombocytopenia, leucopenia, haemolytic anaemia, neutropenia
53
Cefotaxime with NSAIDs, aminoglycoside antibiotics, methotrexate/chemotherapeutic agents interaction
nephrotoxicity
54
Dexamethasone class
Glucocorticoid
55
Dexamethasone job
mimicking the action of cortisol at steroid receptors
56
Dexamethasone moa
inhibit the activity of pro-inflammatory transcription factors
57
Dexamethasone and prostoglandins and leucotrines
reduced
58
Dexamethasone and wound healing
impaired
59
Dexamethasone affect on capillaries
decreased permeability
60
Dexamethasone metabolic effects
gluconeogenesis
protein degradation particularly in muscle
fat redistribution
decreased osteoblast formation
61
Dexamethasone onset of action
8 hours
62
hydrocortisone mineralocorticoid or glucocorticoid
50/50
63
prednisolone mineralocorticoid or glucocorticoid
4:0.8
64
dexamethasone mineralocorticoid or glucocorticoid
glococorticoid all the way
65
fludrocortisone mineralocorticoid or glucocorticoid
mineralocorticoid all the way
66
hydrocortisone duration of action
short
67
prednisolone duration of action
medium
68
dexamethasone duration of action
long
69
fludrocortisone duration of action
medium
70
which steroid is equal to cortisol
hydrocortisone
71
which steroid has the longest duration of action
dexamethasone
72
dexamethasone indications x4
Cerebral oedema
Rheumatic disease
Suppression of inflammatory and allergic disorders
Symptom control in a palliative care setting
73
dexamethasone contraindications x2
```
Systemic infection
Live vaccines (if high dose)
```
74
dexamethasone uses in palliative care
pain due to nerve compression, nausea and vomiting, dyspnoea due to bronchospasm/obstruction, anorexia and dysphagia
75
6 cautions of dexamethasone
CCF, diabetes, glaucoma, HTN, osteoporosis, peptic ulcer
76
dexamethasone syndrome they can develop
cushings syndrome
77
dexamethasone prolonged therapy issue
adrenal atrophy develops with suppression of the HPA axis
78
dexamethasone and adrenal atrophy prognosis
can last years afer stopping
79
dexamethasone abrupt withdrawl complications x2
adrenal insufficiency, hypotension
80
situations when to increase corticosteroid injections
significant intercurrent illness, trauma or surgical procedure
81
long term steroid patients should carry
steroid card
82
interaction of steroid with citalopram and venlafaxine
hypokalaemia
83
interaction of steroid with NSAIDs
bleeding
84
interaction of steroid with amiodarone
hypokalaemia
85
interaction of steroid with nicorandil
bowel perforation
86
interaction of steroid with antipsychotics
hypokalaemia
87
interaction of steroid with digoxin
digoxin toxicity
88
interaction of steroid with lithium
hypokalaemia
89
interaction of steroid with warfarin
increased anticoag affect
90
interaction of steroid with macrolides
hypokalaemia
91
interaction of steroid with clarithromycin
increases exposure to steroid
92
interaction of steroid with sildenafil
hypokalaemia
93
interaction of steroid with ketoconazole
increase in exposure to steroid
94
interaction of steroid with ondasteron
hypokalaemia
95
interaction of steroid with furosemide
hypokalaemia
96
interaction of steroid with methadone
hypokalaemia
97
is bacterial menigitis a notifiable disease
yeah
98
who to notify with bacterial menigitis
public health authority and the Consultant in Communicable Disease Control
99
who gets prophylaxis for bacterial menigitis
close contact past 7 days/exposed to big particles from the pt
100
when should prophylaxis be given for menigitis of those who are at risk
within 24 hours
101
drugs for bacterial menigitis prophylaxis
rifampicin or ciprofloxacin
102
which bacterial menigitis prophylaxis is preferred and why x3
widely available, less commonly interacts with other medications and is a one-off dose
103
prophylactic vaccines for menigitis x5
Hib, men B and men C, pneumococcal and quadrivalent men A, C, W, Y.
104
Encephalitis presentation
viral symptoms and change in behaviour
105
how is Encephalitis split into categories
acute viral encephalitis
| post-infectious encephalitis
106
whats acute viral Encephalitis
caused by infection of brain with virus
107
whats post infectious Encephalitis
autoimmune process following a viral infection elsewhere in the body
108
Encephalitis most common cause
HSV
109
Encephalitis triad
fever, headache and altered metal state
110
viral meningitis causative agents
enteroviruses and herpes viruses
111
first line for viral Encephalitis
aciclovir
112
Aciclovir class
guanosine analogue
113
what does guanosine do
inhibits synthesis of viral DNA
114
Aciclovir and cytotoxic affects on human cells
Requires phosphorylation by viral enzymes = wont harm human cells
115
Aciclovir target
DNA polymerase
116
Aciclovir most active against which agent
HSV
117
Aciclovir indications
Herpes simplex and varicella zoster infections only
118
Aciclovir and elderly patients
risk of neurological reactions
119
Aciclovir side effects x6
```
GI disturbance
Skin reactions and photosensitivity
Blood disorders
Renal impairment
CNS effects
Hepatic disorders
```
120
Aciclovir blood disorders x3
anaemia, leucopenia, thrombocytopenia
121
Aciclovir route for encephalitis
IV only
122
when is Aciclovir appropriate for oral route
chickenpox/shingles/herpes
123
Aciclovir min legth of treatment
Min 14 days
| Min 21 days if immunocompromised
124
Aciclovir when to stop for encephalitis
Repeat LP to confirm CSF is negative before stopping
125
Aciclovir and nephrotoxicity drugs x 5
NSAIDs, trimethoprim, methotrexate, aminoglycosides and cephalosporins
126
Aciclovir and Aminophylline
increased exposure of aminophyllines with concurrent use of aciclovir
