Pharmacology and microbiology Flashcards
Pathogen - bronchiolitis
Respirtaory synctal virus (RSV)
Pathogen - UTI in children
E. coli (responsible for around 80% of cases)
Proteus
Pseudomonas
Antibiotic UTI children > 3 months?
Trimethoprim
Nitrofurantoin
Cefalexin
Amoxicillin
Management bacterial tonsilitis
- Oral phenoxymethylpenicillin (penicillin V?) for 5 or 10 days
- Clarithomycin or erythromycin(if penicillin allergic)5 days
Pathogen bacterial tonsilitis
GABS Group A Beta-haemolytic streptococcus
S.pyogenes
Pathogen epiglottitis
Haemophilus influenzae type B
Management of epiglottitis
Endotracheal intubation (ENT, anaesthesia)
IV antibiotics (e.g. ceftriaxone)
Steroids (i.e. dexamethasone)
Management of generalised tonic-clonic seizures?
- Sodium valproate
- Lamotrigine or carbamazepine
Management focal seizures?
- Carbamazepine or lamotrigine
- Sodium valproate or levetiracetam
Management of absence seizures?
- Sodium valproate or ethosuximide
Management atonic seizures?
- Sodium valproate
- Lamotrigine
What epilepsy syndrome benefits from ketogenic diet?
Lennox-Gastaut syndrome
Management juvenile myoclonic epilepsy
- Sodium valproate
- Lamotrigine, levetiracetam or topiramate
Management infantile spasms (west syndrome)
- Prednisolone or Vigabatrin
Pathogen most likely child or adult with pneumonia
Strep pneumoniae
treat with amoxicillin
macrolide if pen alllergic
Pathogen most likely child with moderate chronic pneumonia
Chlamydophila pneumoniae
treat with macrolides eg erythromycin
Pathogen most likely pneumonia - cheap hotel holiday and hyponatraemia
Legionella pneumophila.
hyponatraemia caused by SIADH
treat with macrolides eg erythromycin
Pathogen most likely pneumonia - parrot owner
Chlamydia pisttaci
treat with macrolides eg erythromycin
Pathogen most likely pneumonia with target lesion rash and nuerological symptoms
mycoplasma pneumoniae
treat with macrolides eg erythromycin
Pathogen most likely pneumonia farmer with flu like illness
Coxella burnetti
treat with macrolides eg erythromycin
Pathogen most likely pneumonia in alcohol dependence
Klebsiella pneumoniae
Bacterial meningitis 0-3 months
- Group B Streptococcus (most common cause in neonates)
- E. coli
- Listeria monocytogenes
Bacterial meningitis 3 months-6 years
- Neisseria meningitidis
- Streptococcus pneumoniae
- Haemophilus influenzae
Bacterial meningitis 6-60 years
- Neisseria meningitidis
- Streptococcus pneumoniae
Bacterial meningitis >60 years
- Streptococcus pneumoniae
- Neisseria meningitidis
- Listeria monocytogenes
Meningitis in immunocompromised
listeria monocytogenes
Children in community meningitis initial management
Benzylpenicillin IM or IV
< 1 year – 300mg
1-9 years – 600mg
> 10 years and adults – 1200mg
Meningitis initial empirical therapy < 3 months
IV cefotaxime + amoxicillin (or ampicillin)
Meningitis initial empirical therapy 3 months-50 years
IV cefotaxime
Meningitis initial empirical therapy > 50 years
IV cefotaxime + amoxicillin (or ampicillin)
Meningitis management - listeria
IV amoxicillin (or ampicillin)
+ gentamicin
When should dexamethasone be given for meningitis
Give if lumbar puncture reveals:
- frankly purulent CSF
-CSF white blood cell count greater than 1000/microlitre
- raised CSF white blood cell count with protein concentration greater than 1 g/litre
- bacteria on Gram stain
Withhold if:
- septic shock
- meningococcal
- septicaemia
immunocompromised
Management meningococcal meningitis
IV benzylpenicillin or cefotaxime
Post exposure prophylaxis bacterial meningitis
Ciprofloxacin single dose
This risk is highest for people that have had close prolonged contact within the 7 days prior to the onset of the illness
Most common pathogen encephalitis in children and adults
herpes simplex HSV-1 from cold sores
Most common pathogen encephalitis in neonates
herpes simplex type 2 (HSV-2) from genital herpes, contracted during birth.
think “been passed on 2”
Management ?encephalitis
aciclovir (covers HSV and varicella zoster)
Management CMV encephalitis
Ganciclovir
Two most common bacterial causes of otitis externa?
- pseudomonas aerginosa
- staphlococcus aureus
management of otitis externa
mild
1. acetic acid drops 2%
moderate:
1. Topical abtibiotic and steroid eg:
Otomize spray (Neomycin, dexamethasone and acetic acid)
Fungal:
1. Clotrimazole ear drops
Most common pathogen and others : otitis media
Streptococcus pneumoniae
Other common causes include:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
If giving abx for otitis media, what is first line? what are alterantives?
- amoxicillin for 5 days
alternatives: erythromycin or clarythromycin
name 5 SSRIs
Sertraline
Citalopram
Escitalopram
Fluoxetine
Paroxetine
most common side effect ssris
GI disturbance
Complications of SSRIs
- QT prolongation / ventricular arrhythmias including torsade de pointes in citalopram
- Hyponatremia
- SSRI discontinuation syndrome
Interactions SSRIs
NSAIDs/aspirin: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
SSRI in first trimester can cause?
congenital heart defects
SSRI in third trimester can cause?
persistent pulmonary hypertension of the newborn
worst SSRI pregnancy
Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
SSRIs of choice in breastfeeding women
Sertraline or paroxetine
SSRI of choice post MI
Sertraline
SSRI of choice children
fluoxetine
Name 2 SNRIs
Venlafaxine
Duloxetine
Side effects SNRIs
include nausea/vomiting, sweating, loss of appetite, dizziness, headache, increase in suicidal thoughts, and sexual dysfunction.
Complication SNRI
HTN
(Elevation of norepinephrine levels can sometimes cause anxiety, mildly elevated pulse, and elevated blood pressure. )(monitor before initiation and after titration)
Name 3 TCAs
Imipramine
Clomipramine
Amitriptyline
Mechanism TCAs
inhibit the reuptake of serotonin and noradrenaline.
Side effects TCAs?
anticholinergic effects:
Can’t see (blurred vision)
Can’t pee (urinary retention)
Can’t spit (dry mouth)
Can’t shit (constipation)
TCAs can cause overflow incontinence due to chronic urinary retention
Drowsiness
Postural hypotension
lengthening of QT interval
Name 1 NaSSA
Mirtazapine
Mechanism NaSSA
Blocking alpha2-adrenergic receptors, which increases the release of neurotransmitters. Blocking α2-adrenergic autoreceptors and heteroreceptors, NaSSAs enhance adrenergic and serotonergic neurotransmission in the brain involved in mood regulation,[1] notably 5-HT1A-mediated transmission.
Side effects mirtazapine?
Sedative
Increases appetite
Name 3 MAOIs
Isocarboxazid
Phenelzine
Tranylcypromine
Complication MAOI
The tyramine cheese reaction is a classic side effect of MAOI (monoamine oxidase inhibitor) antidepressants, such as phenelzine. Consumption of foods high in tyramine (such as cheese) can result in a hypertensive crisis. Symptom: Throbbing headache at bottom of skull
antibiotics for meconium aspiration?
gentamicin and ampicillin
antibiotics neonatal sepsis
benzylpenicillin and gentamycin
Pathogen roseola infantum
human herpes 6
Pathogens hand, foot and mouth disease
Intestinal viruses of the Picornaviridae family (most commonly coxsackie A16 and enterovirus 71)
Management minimal change disease
High dose steroids (i.e. prednisolone) for 4 weeks
Low salt diet
Diuretics may be used to treat oedema
Albumin infusions may be required in severe hypoalbuminaemia
Antibiotic prophylaxis may be given in severe cases
Viral causes gastroenteritis
- rotavirus
- norovirus
Management gastroenteritis
- barrier nursing and goo hygeine
- stool culture
- fluid challenge then either oral or IV fluid
- antibiotics if culture grows bacteria
selegiline
MAO-B
parkinsons management
bromocriptine, cabergoline, apomorphine, ropinirole
dopamine receptor agonists
parkinsons management
How to reduce risk of miscarriage antiphospholipid syndrome?
Low dose aspirin
Low molecular weight heparin (LMWH)
Test for antiphospholipid syndrome
antiphospholipid antibodies
Medical abortion
Mifepristone (anti-progestogen)
Misoprostol (prostaglandin analogue) 1 – 2 day later
Rhesus negative women with a gestational age of 10 weeks or above having a medical TOP should have anti-D prophylaxis.
surgical abortion
Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)
Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)
Rhesus negative women having a surgical TOP should have anti-D prophylaxis. The NICE guidelines (2019) say it should be considered in women less than 10 weeks gestation.
antiemetic choices pregnancy
risks
- promethazine
- Cyclizine
- Prochlorperazine (stemetil)
- Ondansetron
- Metoclopramide
Ondansetron during pregnancy is associated with a small increased risk of cleft palate/lip
metoclopramide may cause extrapyramidal side effects. It should therefore not be used for more than 5 days
Phenytoin
try to avoid in pregnancy
associated with cleft lip
give vit K in last month of pregnancy to prevent clotting disorders in newborn
management of status epilepticus
- IV benzodiazepines such as lorazepam or diazepam. caan repeat once after 10-20 mins
or in the prehospital setting PR diazepam or buccal midazolam may be given
- If ongoing (or ‘established’) status it is appropriate to start a second-line agent such as phenytoin or phenobarbital infusion
If there is no response (‘refractory status’) within 30/ 45 minutes from onset, then the best way to achieve rapid control of seizure activity is induction of general anaesthesia. This is also known as Refractory status epilepticus (RSE) is defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug.
When do you initiate anticoagulation for someone with a stroke and newly diagnosed AF
Anticoagulation should be commenced 14 days after an ischaemic stroke. Earlier anticoagulation may exacerbate any secondary haemorrhage.
treat with aspirin as normal
Tibolone
a synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea)
Management of epilepsy in pregnancy
Women with epilepsy should take folic acid 5mg daily from before conception to reduce the risk of neural tube defects.
Levetiracetam, lamotrigine and carbamazepine are the safer anti-epileptic medication in pregnancy
Sodium valproate is avoided as it causes neural tube defects and developmental delay
Phenytoin is avoided as it causes cleft lip and palate
Management of rheumatoid arthritis during pregnancy
Methotrexate is contraindicated, and is teratogenic, causing miscarriage and congenital abnormalities
Hydroxychloroquine is considered safe during pregnancy and is often the first-line choice
Sulfasalazine is considered safe during pregnancy
Corticosteroids may be used during flare-ups
Management of hypothyroidism in pregnancy
Untreated or under-treated hypothyroidism in pregnancy can lead to several adverse pregnancy outcomes, including miscarriage, anaemia, small for gestational age and pre-eclampsia.
Hypothyroidism is treated with levothyroxine (T4). Levothyroxine can cross the placenta and provide thyroid hormone to the developing fetus. The levothyroxine dose needs to be increased during pregnancy, usually by at least 25 – 50 mcg (30 – 50%). Treatment is titrated based on the TSH level, aiming for a low-normal TSH level.
Hypertension medications and pregnancy
Medications that should be stopped as they may cause congenital abnormalities:
ACE inhibitors (e.g. ramipril)
Angiotensin receptor blockers (e.g. losartan)
Thiazide and thiazide-like diuretics (e.g. indapamide)
Medications that are not known to be harmful:
Labetalol (a beta-blocker – although other beta-blockers may have adverse effects)
Calcium channel blockers (e.g. nifedipine)
Alpha-blockers (e.g. doxazosin)
antibiotics used to prevent mum passing GBS onto baby
penicillin G or ampicillin
Management of UTI in pregnancy
7 days abx
Nitrofurantoin (avoid in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin
generally avoid trimethoprim (risk of neural tue defects in 1st trimester)
nitrofurantoin and pregnancy
avoid in third trimester as there is a risk of neonatal haemolysis
trimethoprim and pregnancy
avoid altogether but especially in first trimester (neural tube defects)
causes of UTI
e.coli
Klebsiella pneumoniae
1st, 2nd and 3rd line for pre-eclampsia/PIH?
additional management for pre-eclampsia
Labetolol is first-line as an antihypertensive
Nifedipine (modified-release) is commonly used second-line
Methyldopa is used third-line (needs to be stopped within two days of birth)
- Intravenous hydralazine may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia
- IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures
- Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
1st, 2nd and 3rd line antihypertensives after birth?
Enalapril (first-line)
Nifedipine or amlodipine (first-line in black African or Caribbean patients)
Labetolol or atenolol (third-line)
management of eclampsia
IV magnesium sulphate
what is HELLP syndrome?
Haemolysis
Elevated Liver enzymes
Low Platelets
monitoring PIH
admission if 160/110 mmHg
weekly urine dip
weekly blood test (fbc, liver, renal)
Monitoring fetal growth by serial growth scans
PlGF testing on one occasion
monitoring pre-eclampsia
BP every 48 hours
Scoring systems are used to determine whether to admit the woman (fullPIERS or PREP‑S)
two weekly ultrasound monitoring of the fetus, amniotic fluid and dopplers is performed two weekly
risk factors for gestational diabetes? what do you need to do?
Previous gestational diabetes
Previous macrosomic baby (≥ 4.5kg)
BMI > 30
Ethnic origin (black Caribbean, Middle Eastern and South Asian)
Family history of diabetes (first-degree relative)
oral glucose tolerance test at 24 – 28 weeks gestation
Normal results are:
Fasting: < 5.6 mmol/l
At 2 hours: < 7.8 mmol/l
( 5 – 6 – 7 – 8.)
management of gestational diabetes
Fasting glucose less than 7 mmol/l: trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin
Fasting glucose above 7 mmol/l: start insulin ± metformin
Fasting glucose above 6 mmol/l plus macrosomia (or other complications): start insulin ± metformin
Neisseria gonorrhoeae gram and shape
gram-negative diplococcus bacteria
pathogen syphillis
Treponema pallidum
pathogen bacterial vaginosis
Gardnerella vaginalis (most common)
Management obstetric cholestasis
- Ursodeoxycholic acid It improves LFTs, bile acids and symptoms.
Symptoms of itching can be managed with:
Emollients (i.e. calamine lotion) to soothe the skin
Antihistamines (e.g. chlorphenamine) can help sleeping (but does not improve itching)
Water-soluble vitamin K can be given if clotting (prothrombin time) is deranged. (bile acids needed to absorb vit k)
consider early birth eg 37 weeks
managemet of acute fatty liver of pregnancy
obstetric emergency and requires prompt admission and delivery of the baby
first-line treatment for magnesium sulphate induced respiratory depression?
Calcium gluconate
