Medicines 9 - Infections

Question 1

What antibiotics can interact with alcohol

Answer 1

completely avoid drinking alcohol when taking:
metronidazole - an antibiotic sometimes used to clear dental, or vaginal, infections, or to clear infected leg ulcers, or pressure sores

tinidazole - an antibiotic sometimes used to treat many of the same infections as metronidazole, as well as to help clear bacteria called Helicobacter pylori (H pylori) from the gut.

co-trimoxazole - drinking alcohol while taking co-trimoxazole can occasionally cause a similar reaction to that of metronidazole or tinidazole, although this is very rare. Drinking alcohol in moderation does not normally cause a problem
linezolid - linezolid can interact with un-distilled (fermented) alcoholic drinks, such as wine, beer, sherry and lager
doxycycline - this is known to interact with alcohol and in people with a history of chronic alcohol consumption the effectiveness of doxyclycline may be reduced. It should not be taken by people with liver problems
erythromycin - there is some evidence or a minor interaction with alcohol that may slightly reduce or delay the effect of erythromycin

Question 2

What is flucloxacillin used to treat?

Answer 2

FLUCLOXACILLIN - Penicillin-resistant Staphylococcal infections except MRSA
e.g. skin infections: impetigo, cellulitis.

📌 Why MRSA is mentioned:
Flucloxacillin is specifically used for staph infections, and it works against most strains — except MRSA.
Since MRSA is resistant to all beta-lactams, including flucloxacillin, this exception is crucial to highlight.

Question 3

What is a key side effects to note with flucloxacillin

Answer 3

CHOLESTATIC JAUNDICE AND HEPATITIS
Up to two months after treatment.

Increasing age and >14 days treatment increases risk.

Question 4

What are the different spectrums of penicillins?

Answer 4

NARROW-SPECTRUM (beta-lactamase sensitive)
- BENZYLPENICILLIN “PEN G”
* PHENOXYMETHYLPENICILLIN “PEN V”

BROAD-SPECTRUM (inactivated by beta-lactamases)
* AMPICILLIN
- AMOXICILLIN

PENICILLINASE-RESISTANT
* FLUCLOXACILLIN - Penicillin-resistant Staphylococcal infections except MRSA

Question 5

What are the different indications for metronidazole?

Answer 5

• Treatment of anaerobic bacteria - e.g. dental infections, antibiotic-associated
• colitis, h.pylori, rosacea, bacterial vaginosis.
• Antibiotic-associated colitis caused by c.difficile – gram positive anaerobe
• Oral infections or aspiration pneumonia = gram negative anaerobes in mouth
• Surgical and gynaecological infections – gram negative anaerobes from colon
• Protozoal infections

Question 6

What are the key contraindications of metronidazole and SEs?

Answer 6

• Metabolised by CYP450 enzymes
• Severe liver disease – REDUCE total daily dose to 1/3 and give once daily
• Avoid alcohol – disulfiram-like effect = flushing, headache, nausea and vomiting (because metronidazole inhibits the enzyme that breaks down a compound of alcohol) = do not drink during or for 48 hours after treatment.
• topical use: avoid exposure to strong sunlight or UV light
• avoid large doses in pregnancy and breastfeeding

Question 7

How often is amoxicillin given dosing wise in a H.Pylori infection?

Answer 7

TWICE DAILY instead of common three

1 g twice daily for 7 days for first- and second-line eradication therapy; 10 days for third-line eradication therapy.

Question 8

What is the usual dosing schedule of clarithromycin

Answer 8

TWICE DAILY!!

Question 9

Whats the first line treatment for athletes foot?

Answer 9

Terbinafine 1% cream

Clotrimazole 1% cream (2% not licensed)
Miconazole 2% cream

Question 10

This antibiotic is bactericidal and acts by interfering with bacterial cell wall synthesis. It diffuses well into body tissues and fluids, but penetration into the cerebrospinal fluid is poor except when the meninges are inflamed. It is excreted in the urine in therapeutic concentrations

This describes which antibiotic

Answer 10

NARROW-SPECTRUM (beta-lactamase sensitive) penicillins

• BENZYLPENICILLIN “PEN G”
• PHENOXYMETHYLPENICILLIN “PEN V”

Question 11

What is a key caution with mefloquine

Answer 11

Neuropsychiatric reactions
Mefloquine is associated with potentially serious neuropsychiatric reactions. Abnormal dreams, insomnia, anxiety, and depression occur commonly. Psychosis, suicidal ideation, and suicide have also been reported. Psychiatric symptoms such as insomnia, nightmares, acute anxiety, depression, restlessness, or confusion should be regarded as potentially prodromal for a more serious event. Adverse reactions may occur and persist up to several months after discontinuation because mefloquine has a long half-life. For a prescribing checklist, and further information on side-effects, particularly neuropsychiatric side-effects, which may be associated with the use of mefloquine for malaria prophylaxis, see the Guide for Healthcare Professionals provided by the manufacturer.

Question 12

whats the MHRA alerts regarding chloroquine and hydroxychloroquine?

Answer 12

MHRA/CHM advice: Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions (February 2022)
An observational study has shown that co-administration of azithromycin with hydroxychloroquine in patients with rheumatoid arthritis was associated with an increased risk of cardiovascular events (including angina or chest pain and heart failure) and mortality. Healthcare professionals are reminded to consider the benefits and risks of co-prescribing systemic azithromycin, or other systemic macrolides, with hydroxychloroquine. If such use cannot be avoided, caution is recommended in patients with risk factors for cardiac events and they should be advised to seek urgent medical attention if any signs or symptoms develop.

A European safety review has reported that psychiatric reactions associated with hydroxychloroquine (including rare cases of suicidal behaviour) typically occurred within the first month of treatment; events have been reported in patients with no history of psychiatric disorders. Healthcare professionals are reminded to be vigilant for psychiatric reactions, and counsel patients and carers to seek medical advice if any new or worsening mental health symptoms develop.

Question 13

what is oseltamivir used to treat?

Answer 13

Reduces replication of influenza A and B viruses by inhibiting viral neuraminidase.

Question 14

which doac does not have a reversible agent?

Answer 14

EDOXABAN

dabigatran etexilate, apixaban, and rivaroxaban do have one.

Idarucizumab is licensed for the rapid reversal of dabigatran etexilate in life-threatening or uncontrolled bleeding, or for emergency surgery or urgent procedures.

Andexanet alfa is licensed for the reversal of apixaban or rivaroxaban in life-threatening or uncontrolled bleeding.

Question 15

What are the main indications of Minocycline?

Answer 15

Susceptible infections (e.g. chlamydia, rickettsia and mycoplasma)
Acne

Question 16

What key counselling points are of note with minocycline?

Answer 16

To reduce the risk of oesophageal irritation and ulceration, the capsules should be swallowed whole with plenty of fluid, while sitting or standing. Unlike other tetraacyclines, absorption of minocycline is not significantly impaired by food or moderate amounts of milk.

Question 17

What is the treatment and dose of acute lower UTIs in men

Answer 17

Trimethoprim 200 mg twice daily for 7 days.
OR
Nitrofurantoin 100 mg modified-release twice daily (or if unavailable 50 mg four times daily) for 7 days.

Question 18

What are the side effects of Cephalasporins?

Answer 18

Side effects
* GI upset: nausea, diarrhoea
* Antibiotic associated colitis – kill normal gut flora allowing c.difficile to grow – more common in 2nd and 3rd generations
* Hypersensitivity due to penicillins: rashes
* CNS toxicity: seizures

Question 19

What counselling is required with cephalasporins?

Answer 19

• Before you take cefalexin, make sure your doctor knows if you have ever had an allergic reaction to an antibiotic.
• Space out your doses evenly over the day and complete the full course.
• The most common side-effect is diarrhoea, which is usually mild and soon passes. If it becomes severe or lasts for more than 24 hours, you should speak with your doctor.
• If you are taking the contraceptive ‘pill’ at the same time as an antibiotic, the effectiveness of the ‘pill’ can be reduced if you have a bout of being sick (vomiting) or diarrhoea which lasts for more than 24 hours. If this should happen, ask your doctor or pharmacist for advice about what additional contraceptive precautions to use.

Question 20

What are the main uses of Amoniglycosides like Gentamycin

Answer 20

• Severe infections especially caused by gram negative aerobes incl. pseudomonas aeruginosa
• Severe sepsis – incl. where source is not identified
• Pyelonephritis and complicated UTI
• Biliary and other intra-abdominal sepsis
• Endocarditis

Given via parenteral injection; not absorbed by gut.

Question 21

What are the different aminoglycosides and their main uses?

Answer 21

GENTAMICIN (Choice; active against pseudomonas aeruginosa)

TOBRAMYCIN (via inhaler for pseudomonal infection in cystic fibrosis)

STREPTOMYCIN (active against mycobacteria reserved for T B)

NEOMYCIN (Parenterally toxic. Use in bowel sterilization)

AMIKACIN (Gentamicin-resistant Gram-negative bacilli)

Question 22

What are the main side effects with aminoglycosides?

Answer 22

Dose-related; do not exceed 7 days.
Commonly occur in elderly and in renal failure; renally cleared.
* Nephrotoxicity – Aminoglycosides excreted by kidney. reduced urine output, rising serum creatinine and urea – may be reversible. Assess renal function before treatment and correct any dehydration.
* Ototoxicity – not usually noticed until after resolution of infection – hearing loss, tinnitus, vertigo = may be irreversible -
* Hypokalaemia

OTHER SIDE EFFECTS:
* PERIPHERAL NEUROPATHY
* IMPAIRED NEUROMUSCULAR TRANSMISSION
Contra-indicated in myasthenia gravis.
* ELECTROLYTES:
Hypo K, Ca and Mg.
MHRA/CHM advice (November 2017): potential for histamine-
related adverse drug reactions with some batches.
* Some batches may contain histamine residual from manufacturing process
* Monitor patients for signs of histamine-related reactions.
* Take particular caution in concomitant drugs known to cause histamine release, in children and severe renal impairment.

Question 23

What do you do regarding peak and trough doses with Gentamycin?

Answer 23

Monitor after 3 or 4 doses and after a dose change
but in renal impairment requires more frequent and earlier monitoring.

WHAT TO DO?
* Post-dose “peak” level after 1 hour is too high = Reduce dose
5-10mg/mL (3-5mg/mL for endocarditis)- Gentamicin
* Pre-dose “trough” level before next dose is too high = Increase interval
<2mg/mL (<1 mg/mL for endocarditis) - Gentamicin
* In renal impairment = increase interval
* In severe renal impairment (<30mI/min) = reduce dose

Question 24

WHat are the key counselling points with Metronidazole ?

Answer 24

• Swallow metronidazole tablets with plenty of water. Take them with a meal or a snack.
• Do not drink alcohol while you are on metronidazole, or for 48 hours afterwards.
• Space doses evenly throughout the day, and keep taking the tablets/medicine until the course is finished.
• urine may look a darker (dark or reddish-brown urine) colour than normal – this is nothing to worry about.

Question 25

What are the key side effects with trimethoprim?

Answer 25

* GI upset: nausea, vomiting, sore mouth * Skin rash * Severe hypersensitivity: anaphylaxis, drug fever, erythema multiforme = more common with sulphonamides = limits their use * Trimethoprim can impair haematopoiesis = haematological disorders: megaloblastic anaemia, leukopenia, thrombocytopenia - BLOOD DYSCRASIAS: with long-term use. Patient counseling: report fever, sore throat, rash, mouth ulcers, purpura, bruising, bleeding. * Hyperkalaemia * Increases plasma creatinine concentrations * Photosensitivity

Question 26

What is the effect when trimethoprim is given with the following drugs: * ACE inhibitors, ARBs, spironolactone * Amiodarone * Azathioprine * Ciclosporin, Tacrolimus * Coumarins * Digoxin * Phenytoin * Methotrexate * Repaglinide

Answer 26

* ACE inhibitors, ARBs, spironolactone – increased risk of hyperkalaemia * Amiodarone – increased risk of ventricular arrhythmias when trimethoprim (as co-trimoxazole) given with amiodarone—manufacturer of amiodarone advises avoid with co-trimoxazole * Azathioprine – increased risk of haematological toxicity * Ciclosporin, Tacrolimus – increased risk of nephrotoxicity when trimethoprim given with ciclosporin, also plasma concentration of ciclosporin reduced by intravenous trimethoprim * Coumarins – enhances anticoagulant effect by killing normal gut flora that synthesis vitamin K * Digoxin – increased concentrations of digoxin * Phenytoin – increases plasma concentration of Phenytoin (also increased antifolate effect) * Methotrexate – increased risk of severe bone marrow depression (fatalities reported) and other haematological toxicities * Repaglinide – enhances hypoglycaemic effect – avoid

Question 27

What are the main indications for chloramphenicol?

Answer 27

* Superficial eye infections: conjunctivitis * Bacterial infection in otitis externa * Infections caused by haemophilus influenza and typhoid fever

Question 28

What are the key side effects and cautions of chloramphenicol? (think of formulation)

Answer 28

Side effects * Stinging in the eye * Blood disorders including aplastic anaemia- with IV * Depression – with IV * Neurological abnormalities: optic neuritis * Grey baby syndrome when used IV in neonates -AVOID Cautions and contraindications; conditions * Avoid prolonged use in the ear * Reduce dose or avoid in hepatic impairment * Avoid in severe renal impairment * Avoid repeated courses and prolonged treatment * Avoid in neonates – GREY BABY SYNDROME

Question 29

What are some key side effects of rifampicin?

Answer 29

* GI upset: nausea, vomiting, diarrhoea * May give rise to hepatitis- jaundice * Skin rashes and haematological abnormalities * Orange- red discolouration of tears – staining of contact lenses, urine and other bodily fluids * Eosinophilia, anaemia * Influenza like symptoms: fever, chills, bone pain

Question 30

What are some key counselling points with rifampicin?

Answer 30

* Rifampicin may discolour soft contact lenses, urine and other bodily fluids – don’t worry * Look out for signs of liver disorder: persistent malaise, nausea, vomiting, jaundice * Take your doses about an hour before a meal, or wait until two hours afterwards. * Use effective contraception

Question 31

What type of drug is vancomycin what are the main indications of Vancomycin

Answer 31

Glycopeptide antibiotic Gram-positive infection: endocarditis where infection is severe and or penicillins cannot be used due to resistance (MRSA) Antibiotic-associated colitis caused by c. difficile

Question 32

What are the side effects to note with vancomycin?

Answer 32

🔹 Thrombophlebitis – Pain & inflammation at infusion site ⚠️ Red Man Syndrome – Erythema, hypotension, bronchospasm (if infused too fast) 🩺 Nephrotoxicity – Risk of renal failure & interstitial nephritis 👂 Ototoxicity – Tinnitus & hearing loss 🩸 Blood Disorders – Neutropenia, thrombocytopenia (may occur after 1 week)

Question 33

What are the cautions/contraindications with vancomycin?

Answer 33

⚠️ Vancomycin – Cautions & Contraindications 🔹 Monitor plasma drug levels carefully 🔹 Renal impairment – Requires dose reduction 🔹 Elderly – Dose reduction due to higher risk of hearing impairment 🚫 Avoid in history of deafness

Question 34

What key interactions is there with Vancomycin?

Answer 34

⚠️ Vancomycin – Important Drug Interactions 🔹 Aminoglycosides – ↑ Risk of nephrotoxicity & ototoxicity 🔹 Amphotericin – ↑ Risk of nephrotoxicity 🔹 General Anaesthetics – May cause hypersensitivity-like reactions 🔹 Ciclosporin & Tacrolimus – ↑ Risk of nephrotoxicity 🔹 Loop Diuretics – ↑ Risk of ototoxicity

Question 35

What are the monitoring requirements for Vancomycin?

Answer 35

🔹 Renal Impairment – Regular plasma-vancomycin, renal, & auditory function monitoring 🔹 Plasma Levels – Measure after 3–4 doses (earlier if renal impairment or dose change) 🔹 Trough Levels: 10–15 mg/L (standard infections) 15–20 mg/L (endocarditis, MRSA, complicated S. aureus infections) 🔹 Consider Loading Dose – Follow local guidelines 🔹 Routine Tests for All Patients: Blood counts, urinalysis, renal function tests Elderly – Monitor hearing function

Question 36

What is a key SE to be aware of with clindamycin?

Answer 36

* ANTIBIOTIC- ASSOCIATED COLITIS Most frequently with Clindamycin — can be fatal Most common in middle-aged, elderly women, especially after operations Patient Counseling: if diarrhoea develops: STOP! and see GP.

Question 37

What antibacterial therapy can be used in COPD Prophylaxis

Answer 37

Treatment with azithromycin 500 mg three times per week, should be considered for a minimum of 6–12 months to assess evidence of efficacy in reducing exacerbations. (NICE)

Question 38

What are the main uses of fluconazole and nystatin?

Answer 38

🔹 Local fungal infections – Oropharynx, vagina, skin (nystatin, clotrimazole topically; fluconazole orally) 🔹 Systemic fungal infections – Invasive, disseminated infections (fluconazole) 🔹 Nystatin – First-line for oral thrush

Question 39

❓ How do ketoconazole and nystatin work?

Answer 39

🦠 Fungal cell membranes contain ergosterol, absent in human cells 🔹 Polyene antifungals (Nystatin) – Bind to ergosterol, forming pores → leaks intracellular ions → fungicidal 🔹 Azoles (Clotrimazole, Fluconazole, Ketoconazole) – Inhibit ergosterol synthesis via CYP450-dependent 14α-lanosterol demethylation

Question 40

What are the key side effects of ketoconazole, nystatin, and fluconazole?

Answer 40

🧴 Topical Nystatin & Clotrimazole: Local irritation, itching 🚫 Clotrimazole creams may damage condoms 💊 Fluconazole: Common: GI upset, headache, rash Severe: Hepatitis, QT prolongation (arrhythmias), anaphylaxis 🚫 Ketoconazole: Oral use not recommended – Severe hepatotoxicity Topical: Erythema, itching, irritation

Question 41

What cautions and contraindications should be considered for nystatin, clotrimazole, fluconazole & ketoconazole antifungals?

Answer 41

🧴 Nystatin & Clotrimazole: 🚫 Avoid contact with eyes & mucous membranes 💊 Fluconazole: ⚠️ Liver disease – Risk of hepatotoxicity ⚠️ Renal impairment – Reduce dose 🚫 Pregnancy – Risk of fetal malformation ⚠️ QT prolongation risk 🚫 Ketoconazole: Avoid oral use in pregnancy & breastfeeding

Question 42

What are the key drug interactions with fluconazole?

Answer 42

🔹 ↑ Plasma Levels of: Aminophylline, Theophylline Amitriptyline, Diazepam (↑ sedation) Atorvastatin, Simvastatin (↑ myopathy risk) Carbamazepine, Phenytoin Ciclosporin, Tacrolimus (↑ immunosuppressant levels) Fentanyl, Quetiapine 🔹 ↓ Effectiveness of: Clopidogrel (↓ antiplatelet effect) Rifampicin (↑ fluconazole metabolism) 🔹 Avoid with: Erythromycin (QT prolongation risk) 🔹 ↑ Anticoagulant Effect: Warfarin (Coumarins)

Question 43

📊 What monitoring is required for antifungal use?

Answer 43

🔹 Ketoconazole (Oral Use): ECG – Before & 1 week after initiation Adrenal Function – Within 1 week, then every 3–6 months Liver Function – Before, then weekly for 1 month, monthly for 6 months 🔹 Fluconazole: Monitor LFTs in high doses or long-term use

Question 44

📝 What patient counselling is needed for antifungals? 🧴 Nystatin: 🧴 Clotrimazole: 🧴 Ketoconazole: 💊 Fluconazole:

Answer 44

🧴 Nystatin: Use 4× daily after food Hold in mouth before swallowing for better contact with lesions 🧴 Clotrimazole: If no improvement in 7 days, see a doctor Limit to 2 courses in 6 months without medical advice Pessary & intravaginal cream – Insert at bedtime 🚫 Can damage condoms – Use alternative contraception 🧴 Ketoconazole: Apply 1–2× daily (twice for athlete’s foot) Continue until infection fully clears Groin/genital infections may take 6 weeks 💊 Fluconazole: Vaginal thrush – Single 150 mg dose Can be taken with or without food Longer courses for systemic infections

Question 45

💊 What are the main uses of Terbinafine?

Answer 45

✅ Tinea infections – Athlete’s foot (Tinea pedis), Ringworm (Tinea corporis), Jock itch (Tinea cruris) ✅ Dermatophyte nail infections ✅ Cutaneous candidiasis Dosage: Oral – Once daily Topical – 1-2× daily

Question 46

⚙️ What is the mechanism of action of Terbinafine?

Answer 46

🔹 Inhibits squalene epoxidase → blocks ergosterol synthesis, an essential fungal cell membrane component 🔹 Leads to fungal cell death (fungicidal action)

Question 47

⚠️ What are the side effects of Terbinafine?

Answer 47

GI upset: Abdominal discomfort, anorexia, dyspepsia, diarrhoea Liver toxicity: Jaundice, cholestasis, hepatitis Severe skin reactions: Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN)

Question 48

⚠️ What are the cautions & contraindications for Terbinafine?

Answer 48

🚫 Discontinue if: Liver toxicity (jaundice, cholestasis, hepatitis) Severe skin rash (SJS, TEN) ⚠️ Caution in: Hepatic impairment (oral use) – Reduces elimination Renal impairment – Half the dose Avoid in breastfeeding

Question 49

💊 What are the important drug interactions of Terbinafine?

Answer 49

🔹 Increases Plasma Levels of: Tricyclic Antidepressants Fluconazole 🔹 Reduces Plasma Levels of: Ciclosporin Rifampicin (reduces terbinafine levels) 🔹 Other Effects: Cimetidine ↑ terbinafine levels Oestrogens, Progestogens – Risk of breakthrough bleeding with hormonal contraception

Question 50

📝 What patient counselling is needed for Terbinafine?

Answer 50

✅ For Oral Use: Take once daily and complete the full course ✅ For Topical Use: Apply thinly to affected area 1-2× daily for 1 week Wash & dry affected area before applying cream Wash clothes & bedding frequently to remove fungus Avoid sharing towels Wear loose clothing & cotton socks (if treating feet) Keep feet cool & dry – choose breathable footwear Avoid scratching to prevent spread Wash hands after touching the infected area ✅ Additional Advice: Terbinafine 1% cream can be sold OTC to people >16 years Terbinafine solution >18 years

Question 51

💊 What are the main uses of Mebendazole?

Answer 51

✅ Threadworm infections ✅ Hookworm infections ✅ Roundworm infections

Question 52

⚙️ What is the mechanism of action of Mebendazole?

Answer 52

🔹 Binds to β-tubulin in the worm cells 🔹 Prevents polymerization of tubulin 🔹 Inhibits glucose uptake, organelle production, and ATP production 🔹 Parasite dies due to lack of energy

Question 53

⚠️ What are the side effects of Mebendazole?

Answer 53

GI issues: Abdominal pain, diarrhoea, flatulence Other effects: Dizziness, rash Severe reactions: Stevens-Johnson syndrome, hepatitis

Question 54

⚠️ What are the cautions and contraindications for Mebendazole?

Answer 54

🚫 Avoid in: Pregnancy – give lifestyle measures instead Children under 2 years ⚠️ High doses: Close monitoring with regular blood counts

Question 55

What are the drug interactions with Mebendazole?

Answer 55

🔹 Cimetidine – May inhibit Mebendazole metabolism, increasing plasma concentratio

Question 56

📝 What patient counselling is needed for Mebendazole?

Answer 56

✅ Mebendazole tablets can be sold OTC for the treatment of enterobiasis in adults and children over 2 years. ✅ Treat everyone in the family on the same day to prevent the spread of infection. 🔹 Wash hands and scrub nails after using the toilet and before eating meals. 🔹 Mebendazole doesn’t kill eggs, so good hygiene is essential to prevent re-infestation.

Question 57

💊 What are the main uses of Aciclovir?

Answer 57

✅ Herpes simplex infection: Usual treatment for 5 days ✅ Varicella zoster virus (shingles): Usual treatment for 7 days

Question 58

⚠️ What are the side effects of Aciclovir?

Answer 58

Eye use: Local inflammation and irritation Systemic use: Abdominal pain, diarrhoea, fatigue Headache, nausea Photosensitivity, pruritus, rash

Question 59

⚠️ What are the cautions and contraindications for Aciclovir?

Answer 59

🚫 Renal impairment – reduce frequency and dose ⚠️ Caution in elderly with oral use due to risk of neurological reactions ⚠️ Avoid contact with eyes for the cream ⚠️ Parenteral dose should be calculated based on ideal weight for height in obese patients

Question 60

💊 What drugs interact with Aciclovir?

Answer 60

🔹 Aminophylline, theophylline – increases plasma concentration 🔹 Ciclosporin, tacrolimus – increased risk of nephrotoxicity

Question 61

📝 What patient counselling is needed for Aciclovir?

Answer 61

Drink plenty of water to avoid dehydration Photosensitivity: Avoid strong sunlight and sunbeds; use a high SPF sunscreen Avoid sexual contact in genital herpes, as the virus can still be passed on

Question 62

What are the main bacteria that cause impetigo?

Answer 62

Staphylococcus aureus or Streptococcus pyogenes.