OSCE

Question 1

Phenoxymethylpenicillin dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 1

S. pyogenes tonsillitis and pharyngitis , first line. 500mg bd for 10 days.
Skin infections if S. pyogenes is suspected, 500mg Q6H for 5 days.
Prevention of recurrent rheumatic fever when IM is not suitable, 250mg bd.
Can be used for rheumaitic fever when IM cannot be used. 500mg bd for 10 days.

Can be used for children and pregnancy.

Question 2

Amoxicillin dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 2

Exacerbation of chronic bronchitis, community-acquired pneumonia - 1g Q8h first line treat for 5-7 days.

Acute otitis media, sinusitis 500mg q8h for 5 days. FIrst line

UTI in pregnant women, not first line treatment. 500mg q8h for 5 days.

Eradication of H. pylori, first line with other agents. 1g bd for 7-14 days.

Safe in children and pregnancy, renal dosing adjustment IV CrCl <30ml/min

Question 3

Amoxicillin-clavulanate acid dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 3

Bites and clenched fist injuries - first line, 875/125 bd for 5 days.

Acute otitis media (unresponsive to amoxicillin) 875+125 mg orally, 12-hourly for 5 to 7 days.

Acute sinusitis (unresponsive to amoxicillin) - 875/125 bd for 5 days.

renal dosing adjustment IV CrCl <30ml/min
Safe in children and pregnancy.

Question 4

Cefalexin dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 4

Alternative for staphylococcus aeurus infections for those allergic to penicillins - not effective for MRSA - 500mg Q6h for 7-14 days.

Tonsillitis or pharyngitis - 1g bd for 10 days. For non-severe allergy to penicillins.

UTI for preganant women - second line 500 mg every 12 hours for 5 days for women.

Second line option for UTI prophylaxis - 250mg at night.
Consider reducing dose if CrCl <10 mL/minute. Safe in pregnancy and children.

Question 5

Ciprofloxacin dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 5

Aquatic skin infections (soiled water) - 500mg BD with fluclox

Complicated UTIs - not first line, used when not susceptible to first line antibacterials. 250 mg

Reduce dose if CrCl <30 mL/minute. Avoid use in children, not reccomended during pregnancy.

Question 6

Clarithromycin dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 6

Eradication of H. pylori, with other agents 500mg bd for 7-14 days.

CAP - used for atypical bacteria or if penicillins and doxycycline are not tolerated.

Pertussis - first line 500mg bd for 7 days.

Reduce dose if CrCl <30 mL/minute. Safe in pregnancy and children.

Question 7

Doxycycline dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 7

Acne - first line for severe. 50mg OD.

Rosacea (severe cases or failure of topical treatment) - 50 to 100 mg orally, once daily until a response is seen

Community-acquired pneumonia - when atypical bacteria is suspected, 100mg BD for 5-7 days.

Chlamydial (including lymphogranuloma venereum) and other non-gonococcal genital tract infections - first line 100mg BD for 7 days.

Malaria prophylaxis - first line, 1-2 days before leaving and 4 weeks returning, 100mg d.

Treatment of uncomplicated malaria, with quinine 100mg bd for 7 days. not first line.

Avoid high doses in hepatic impairment. Avoid use in <8 years. Safe for first 18 weeks of pregnancy then contraindicated.

Question 8

Metronidazole dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 8

Giardiasis - first line, 2g d for 3 days.

Clostridioides difficile-associated disease - first line, 400 mg every 8 hours for 10 days.

Bacterial vaginosis, first line, 400mg bd for 7 days.

Eradication of H. pylori (as part of a multidrug regimen) - used instead of amoxicillin in patients with hypersensitivity, 400 mg orally, twice daily for 7 to 14 days

Rosacea - first line topically, once or twice daily

Reduce dose in hepatic impairtment, safe in pregnancy and children.

Question 9

Trimethoprim dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 9

Empirical treatment for uncomplicated lower UTIs - first line 300mg for 3 days.

Contraindicated if CrCl <10 mL/minute; reduce dose if CrCl 10–30 mL/minute. Avoid use in pregnancy, safe in children.

Question 10

Trimethoprim-sulfamethoxazole dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 10

Prevention and treatment of pertussis (if a macrolide unsuitable) - 160/800 mg every 12 hours for 7 days.

Community-acquired MRSA infections, eg skin and soft tissue infections - 80/400–160/800 mg every 12 hours.

Bites and clenched-fist injuries, sensitive to penicillins. 160+800 mg bd for 3 days.

Contraindicated by the manufacturer if CrCl <15 mL/minute. Contraindicated in hepatic impairment and pregnancy. Safe for children.

Question 11

Aciclovir dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 11

Shingles and varicella - first line option, 800mg 5 times daily for 7 days.

Genital herpes - first line option, 400 mg orally, 8-hourly for 10 days. If clinical response is rapid, stop therapy after 5 days.

Dosage adjustment required in renal impairment. Safe in children and pregnancy.

Question 12

Famiciclovir dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 12

Shingles - first line option, 500 mg orally, 8-hourly for 7 days. For immunocompromised patients, the duration is 10 days.

Varicella adults - first line option, 500 mg orally, 8-hourly for 7 days

Avoid in pregnancy. Dosage adjustment required in renal impairment.

Question 13

Valaciclovir dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 13

Genital herpes prevention - 500mg bd, first line option.
Genital herpes - Initial infection, oral 500 mg twice daily for 5–10 days. first line.

Shingles and adult varicella - first line option, 1g 8 hourly for 7 days.

Avoid in pregnancy. Dosage adjustment required in renal impairment.

Question 14

Fluconazole dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 14

Vulvovaginal candidiasis where topical therapy has failed - Uncomplicated infection, oral 150 mg single dose.

Tinea corporis, cruris or pedis resistant to topical therapy - 50 mg once daily for 2–4 weeks.

Question 15

Miconazole dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 15

Oropharyngeal candidiasis - 2% gel 2.5 mL topically (then swallowed), 4 times daily, after food, for 7 to 14 days; continue treatment for at least 7 days after symptoms resolve. First line option.

Fungal skin infections - 2% cream topically, twice daily for 2 to 4 weeks. First line option.

Question 16

Amphotericin B dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 16

Treatment of oral and perioral candidiasis (lozenge) - first line, suck 1 lozenge (10 mg) 4 times daily for 7–14 days

Question 17

Flucoxacillin dosing for common indications?
Comment on indications, where it is used 1st line, and for whom?

Answer 17

Staphylococcal skin infections, boils, carbuncles, bullous impetigo (recurrent), - 500mg Q6H for 5 days, first line

Cellulitis (if purulent) - 500mg QID, first line

Seawater infection (with doxy) - 500mg QID, first line
Reduce dose if CrCl <10 mL/minute.
Safe in pregnancy and children.

Question 18

Amoxicillin-calvulanic acid spectrum of activity?

Answer 18

Broad spectrum due to beta-lactam inhibitor. Covers gram-positive, gram-neg and anaerobic bacteria. Streptoccous and MSSA.

Question 19

Amoxicillin spectrum of activity?

Answer 19

Moderate to broad spectrum with increased gram negative coverage against other penicillins. Covers some anerobes and a small amount of gram positive bacteria.

Question 20

Flucloxacillin spectrum of activity?

Answer 20

Provide improved resistance towards beta-lactamases, and activity towards Staphylococci but not MRSA. Covers streptococci Group A, B, C, G.
Narrow spectrum against only gram positive.

Question 21

Phenoxymethylpenicllin spectrum of activiy?

Answer 21

Narrow spectrum mainly against gram-positive bacteria (not including S. aureus). Covers some anerobes. Not effective against gram positive bacteria due to beta-lactamases. Covers Streptococci and Fusobacteria spp.

Question 22

Cefalexin spectrum of activity?

Answer 22

moderate-spectrum antibiotics, with activity mainly against Gram-positive bacteria. Covers staphyloccocus auerus not MRSA.

Question 23

Clarithromycin spectrum of activity?

Answer 23

Broad-spectrum, providing activity against some Gram-positive and -negative aerobic and anaerobic bacteria.

Question 24

Metronidazole spectrum of activity?

Answer 24

Bactericidal activity against most anaerobic bacteria, and some protozoa (e.g. Trichomonas, Entamoeba, Giardia), but is not effective against Gram-positive pathogens.

Question 25

Ciprofloxacin spectrum of activity?

Answer 25

Broad spectrum, strong Gram-negative coverage, including Pseudomonas aeruginosa, but its Gram-positive coverage is limited.

Question 26

Doxycycline spectrum of activity?

Answer 26

Broad-spectrum antimicrobial activity against mostly Gram-positive and some Gram-negative organisms. Effective for MRSA.

Question 27

Trimethoprim spectrum of activity?

Answer 27

Narrow specturm only against gram positive bacteria, e. coli is important for UTI.

Question 28

Trimethoprim-sulfamethoxazole spectrum of activity?

Answer 28

Broad spectrum against gram-pos and gram-neg bacteria.

Question 29

Famciclovir spectrum of activity?

Answer 29

Antiviral primarily used for herpes simplex, shingles.

Question 30

Valaciclovir spectrum of activity?

Answer 30

Antiviral primarily used for
herpes simplex, shingles, CMV.

Question 31

Aciclovir spectrum of activity?

Answer 31

Antiviral primarily used for herpes simplex, shingles.

Question 32

Fluconazole spectrum of activity?

Answer 32

Yeasts, dimorphic and dermatophytes. Does not cover moulds.

Question 33

Miconazole spectrum of activity?

Answer 33

Broad spectrumazole antifungal with some activity against Gram-positive bacteria as well.

Question 34

Amphoteracin B spectrum of activity?

Answer 34

Yeasts, moulds, dimorphic moulds and mucorales.

Question 35

Amoxicillin-Clavulanate (Coamoxiclav) - Comment on monitoring, adverse drug reactions and important counselling points

Answer 35

This medicine is absorbed best if taken with food.
monitor hepatic function if treatment lasts for >14 days, especially if there are other risk factors
monitor complete blood count and renal and hepatic function during prolonged high-dose treatment (>10 days)
Take with food.
diarrhoea, nausea, pain and inflammation at injection site (less common with benzylpenicillin), superinfection (including candidiasis) especially during prolonged treatment with broad-spectrum penicillins, allergy.

Question 36

Amoxicillin - Comment on monitoring, adverse drug reactions and important counselling points

Answer 36

use frequent doses of penicillins for maximal antibacterial effect
Monitor complete blood count and renal and hepatic function during prolonged high-dose treatment (>10 days)
Diarrhoea, nausea, superinfection (including candidiasis) especially during prolonged treatment, allergy
Rare - black tongue, electrolyte disturbances
Can be taken with or without food, food can reduce nausea. Finish the entire course of antibiotics.

Question 37

Flucloxacillin - Comment on monitoring, adverse drug reactions and important counselling points

Answer 37

This medicine is absorbed best if taken on an empty stomach at least half an hour before food or 2 hours after food.
Diarrhoea, nausea, superinfection (including candidiasis) especially during prolonged treatment, allergy
Rare - black tongue, electrolyte disturbances
Monitor complete blood count and renal and hepatic function during prolonged high-dose treatment (>10 days).
Monitor hepatic function if treatment continues for >2 weeks, especially if there are other risk factors.

Question 38

Phenoxymethylpenicillin (Penicillin V) - Comment on monitoring, adverse drug reactions and important counselling points

Answer 38

Diarrhoea, nausea, superinfection (including candidiasis) especially during prolonged treatment, allergy
Rare - black tongue, electrolyte disturbances
Monitor complete blood count and renal and hepatic function during prolonged high-dose treatment (>10 days).
Food slightly reduces absorption of phenoxymethylpenicillin but efficacy is unaffected.

Question 39

Cefalexin - Comment on monitoring, adverse drug reactions and important counselling points

Answer 39

• diarrhoea, nausea, vomiting, rash, headache, dizziness, allergy, Clostridioides difficile-associated disease, superinfection
• monitor renal function and complete blood count during prolonged (>10 days) and/or high-dose treatment.

Question 40

Clarithromycin - Comment on monitoring, adverse drug reactions and important counselling points

Answer 40

Taste disturbance, pulmonary infiltration with eosinophilia, torsades de pointes, nausea, vomiting, diarrhoea, abdominal pain and cramps, candidal infection.
This medicine interacts with many drugs; tell your doctor and pharmacist that you are taking this medicine before starting or stopping any medicines, including herbal and over-the-counter products.

Question 41

Metronidazole - Comment on monitoring, adverse drug reactions and important counselling points

Answer 41

• monitor blood count and for neurotoxic reactions when treating for >10 days
• Take metronidazole tablets with food to reduce stomach upset.
• This medicine may make you feel dizzy or confused; avoid driving if you are affected like this.
• Avoid alcohol during treatment and for 24 hours after finishing the course to prevent nausea, vomiting, flushing, headache and palpitations (sometimes occur when alcohol is taken with metronidazole).
• Stop taking metronidazole and check with your doctor immediately if you have any numbness, tingling, pain or weakness in hands or feet.
• Nausea, anorexia, abdominal pain, vomiting, diarrhoea, metallic taste, CNS effects (eg dizziness, headache), furry tongue, glossitis, stomatitis, paraesthesia.

Question 42

Ciprofloxacin - Comment on monitoring, adverse drug reactions and important counselling points

Answer 42

Ciprofloxacin is absorbed best if you take it 1 hour before, or 2 hours after, meals; drink plenty of fluids while taking it.

Dairy products, iron, zinc or calcium supplements, and aluminium- or magnesium-containing antacids may reduce the absorption of ciprofloxacin; do not take them within 2 hours of a ciprofloxacin dose.

It may increase the effects of caffeine in some people; you may need to reduce your caffeine intake.

Avoid sun exposure, wear protective clothing and use sunscreen.

This medicine may cause dizziness or faintness, which can affect your ability to drive and/or operate machinery. Drinking alcohol may worsen these effects.

Stop taking this medicine and see your doctor as soon as possible if you have any tendon soreness or inflammation (and don’t exercise), or if you develop numbness or tingling in your fingers or toes.
Side effects - rash, itch, nausea, vomiting, diarrhoea, abdominal pain, dyspepsia or headache.

erythema, itch, phototoxicity, fixed drug eruption, crystalluria, prolonged QT interval (very rare).

Question 43

Doxycycline - Comment on monitoring, adverse drug reactions and important counselling points

Answer 43

Nausea, vomiting, diarrhoea, epigastric burning; tooth discolouration, enamel dysplasia; photosensitivity (depends on tetracycline, dose and degree of sun exposure).
Doxycycline, minocycline: take with food or milk to reduce stomach upset.
Take with a large glass of water, and remain upright (do not lie down) for an hour after taking a tetracycline. This is to stop tablets or capsules sticking on the way to your stomach, and causing painful damage to the lining of your throat.
Do not take antacids, iron, calcium or zinc supplements within 2 hours of a tetracycline as they may interfere with its absorption.
Avoid sun exposure, wear protective clothing and use sunscreen while taking this medicine.
If used for malaria prophylaxis counsel on avoid mosquito bites.
Unlikely to stain teeth in children <8 years; it can be used short term (up to 21 days) for serious infections

Question 44

Trimethoprim - Comment on monitoring, adverse drug reactions and important counselling points

Answer 44

• monitor complete blood count and folate status during prolonged or high-dose treatment
• monitor serum potassium in patients taking trimethoprim for more than 3 days and at risk of hyperkalaemia
• give at night to maximise urinary concentration for UTI
• fever, itch, rash, nausea, vomiting, hyperkalaemia or sore mouth.

Question 45

Trimethoprim-sulfamethoxazole (cotrimoxazole) - Comment on monitoring, adverse drug reactions and important counselling points

Answer 45

Precipitation in urine (crystilisation), fever, nausea, vomiting, diarrhoea, anorexia, rash, itch, sore mouth, hyperkalaemia, thrombocytopenia (rarely significant), headache, drowsiness, photosensitivity.

Take this medicine with food to reduce stomach upset. Drink a lot of fluid (at least 2–3 L daily) during prolonged or high-dose treatment.

To reduce risk of rash from the sun avoid sun exposure, wear protective clothing and use sunscreen.

Tell your doctor straight away if you get a sore throat, fever, troublesome rash, cough, difficulty in breathing, joint pain, dark urine or pale stools.

complete blood count and folate status during prolonged or high-dose treatment
renal function and obtain urinalysis each month during prolonged treatment, particularly in people with pre-existing renal impairment
serum potassium in patients taking trimethoprim for more than 3 days and at risk of hyperkalaemia; risk factors include high dose, renal impairment, older age and use of other drugs that can cause hyperkalaemia

Question 46

Famciclovir - Comment on monitoring, adverse drug reactions and important counselling points

Answer 46

headache, vomiting, diarrhoea, confusion, dizziness.

This medication may make you feel dizzy or confused. Don’t drive or operate machinery if you are affected.

Recurrent herpes simplex infections: carry a course of tablets with you so that you can start them as soon as you notice symptoms.

Question 47

Valaciclovir - Comment on monitoring, adverse drug reactions and important counselling points

Answer 47

Drink plenty of fluids (at least 1.5 L daily).

Recurrent herpes simplex infections: carry a course of tablets with you so that you can start them as soon as you notice symptoms.

Neurological effects are more likely to occur in people with renal impairment or those taking high doses for CMV prophylaxis. nausea, vomiting, diarrhoea, hallucinations (high dose), headache, agitation, vertigo, confusion, dizziness, oedema, renal impairment, arthralgia, sore throat, abdominal pain, constipation, rash, weakness

Question 48

Aciclovir - Comment on monitoring, adverse drug reactions and important counselling points

Answer 48

nausea, vomiting, diarrhoea, hallucinations (high dose), headache, agitation, vertigo, confusion, dizziness, oedema, renal impairment, arthralgia, sore throat, abdominal pain, constipation, rash, weakness

Recurrent herpes simplex infections: carry a course of tablets with you so that you can start them as soon as you notice symptoms.

Dosage 5 times daily: take every 4 hours during waking hours.

This medication may make you feel dizzy or confused. Don’t drive or operate machinery if you are affected.

ensure adequate hydration (especially if receiving high doses) to minimise renal adverse effects; changes in renal function during treatment usually respond to rehydration, dosage reduction or stopping the drug

Question 49

Fluconazole - Comment on monitoring, adverse drug reactions and important counselling points

Answer 49

This medicine interacts with many drugs; tell your doctor and pharmacist that you are taking this medicine before starting or stopping any medicines, including herbal and over-the-counter products.

Tell your doctor if you feel unusually tired, nauseous or are not eating, or if you notice dark urine, pale faeces or yellowing of the whites of your eyes or skin.

measure liver function and serum potassium concentration at baseline and at regular intervals, depending on dose and duration of treatment

rash, headache, dizziness, nausea, vomiting, abdominal pain, diarrhoea, elevated liver enzymes.

Question 50

Miconazole - Comment on monitoring, adverse drug reactions and important counselling points

Answer 50

Used topically so not many adverse effects, mild GI disturbances.

It is best to use the gel after (rather than before) a meal or drink; keep it in your mouth for as long as possible before swallowing. Continue using the gel for several days after symptoms disappear.

If you are giving this to a young child or someone who can’t swallow properly, be careful to apply it at the front of the mouth in small amounts so that they don’t choke; for young babies, smear the gel on the affected areas.

Oral candidiasis associated with dentures: apply gel to dentures after cleaning and leave overnight.

Counselling on application.

Question 51

Amphoteracin B - Comment on monitoring, adverse drug reactions and important counselling points

Answer 51

check renal function before starting treatment; monitor renal function and electrolytes (especially potassium, magnesium and sodium) at least 3 times a week and complete blood count and hepatic function twice a week during treatment and until stable after treatment stops.

It is best to use the lozenge after (rather than before) a meal or drink. Continue to use them for several days after your symptoms disappear.

Mild nausea, vomiting, diarrhoea, anaphylactoid reactions, hyperkalaemia.