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Phase 3a topics > Pharmacology and microbiology > Flashcards

Pharmacology and microbiology Flashcards

1
Q

Pathogen - bronchiolitis

A

Respirtaory synctal virus (RSV)

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2
Q

Pathogen - UTI in children

A

E. coli (responsible for around 80% of cases)
Proteus
Pseudomonas

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3
Q

Antibiotic UTI children > 3 months?

A

Trimethoprim
Nitrofurantoin
Cefalexin
Amoxicillin

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4
Q

Management bacterial tonsilitis

A
  • Oral phenoxymethylpenicillin (penicillin V?) for 5 or 10 days
  • Clarithomycin or erythromycin(if penicillin allergic)5 days
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5
Q

Pathogen bacterial tonsilitis

A

GABS Group A Beta-haemolytic streptococcus
S.pyogenes

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6
Q

Pathogen epiglottitis

A

Haemophilus influenzae type B

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7
Q

Management of epiglottitis

A

Endotracheal intubation (ENT, anaesthesia)
IV antibiotics (e.g. ceftriaxone)
Steroids (i.e. dexamethasone)

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8
Q

Management of generalised tonic-clonic seizures?

A
  1. Sodium valproate
  2. Lamotrigine or carbamazepine
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9
Q

Management focal seizures?

A
  1. Carbamazepine or lamotrigine
  2. Sodium valproate or levetiracetam
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10
Q

Management of absence seizures?

A
  1. Sodium valproate or ethosuximide
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11
Q

Management atonic seizures?

A
  1. Sodium valproate
  2. Lamotrigine
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12
Q

What epilepsy syndrome benefits from ketogenic diet?

A

Lennox-Gastaut syndrome

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13
Q

Management juvenile myoclonic epilepsy

A
  1. Sodium valproate
  2. Lamotrigine, levetiracetam or topiramate
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14
Q

Management infantile spasms (west syndrome)

A
  1. Prednisolone or Vigabatrin
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15
Q

Pathogen most likely child or adult with pneumonia

A

Strep pneumoniae

treat with amoxicillin

macrolide if pen alllergic

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16
Q

Pathogen most likely child with moderate chronic pneumonia

A

Chlamydophila pneumoniae

treat with macrolides eg erythromycin

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17
Q

Pathogen most likely pneumonia - cheap hotel holiday and hyponatraemia

A

Legionella pneumophila.

hyponatraemia caused by SIADH

treat with macrolides eg erythromycin

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18
Q

Pathogen most likely pneumonia - parrot owner

A

Chlamydia pisttaci

treat with macrolides eg erythromycin

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19
Q

Pathogen most likely pneumonia with target lesion rash and nuerological symptoms

A

mycoplasma pneumoniae

treat with macrolides eg erythromycin

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20
Q

Pathogen most likely pneumonia farmer with flu like illness

A

Coxella burnetti

treat with macrolides eg erythromycin

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21
Q

Pathogen most likely pneumonia in alcohol dependence

A

Klebsiella pneumoniae

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22
Q

Bacterial meningitis 0-3 months

A
  1. Group B Streptococcus (most common cause in neonates)
  2. E. coli
  3. Listeria monocytogenes
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23
Q

Bacterial meningitis 3 months-6 years

A
  1. Neisseria meningitidis
  2. Streptococcus pneumoniae
  3. Haemophilus influenzae
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24
Q

Bacterial meningitis 6-60 years

A
  1. Neisseria meningitidis
  2. Streptococcus pneumoniae
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25
Q

Bacterial meningitis >60 years

A
  1. Streptococcus pneumoniae
  2. Neisseria meningitidis
  3. Listeria monocytogenes
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26
Q

Meningitis in immunocompromised

A

listeria monocytogenes

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27
Q

Children in community meningitis initial management

A

Benzylpenicillin IM or IV

< 1 year – 300mg
1-9 years – 600mg
> 10 years and adults – 1200mg

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28
Q

Meningitis initial empirical therapy < 3 months

A

IV cefotaxime + amoxicillin (or ampicillin)

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29
Q

Meningitis initial empirical therapy 3 months-50 years

A

IV cefotaxime

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30
Q

Meningitis initial empirical therapy > 50 years

A

IV cefotaxime + amoxicillin (or ampicillin)

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31
Q

Meningitis management - listeria

A

IV amoxicillin (or ampicillin)
+ gentamicin

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32
Q

When should dexamethasone be given for meningitis

A

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

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33
Q

Management meningococcal meningitis

A

IV benzylpenicillin or cefotaxime

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34
Q

Post exposure prophylaxis bacterial meningitis

A

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

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35
Q

Most common pathogen encephalitis in children and adults

A

herpes simplex HSV-1 from cold sores

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36
Q

Most common pathogen encephalitis in neonates

A

herpes simplex type 2 (HSV-2) from genital herpes, contracted during birth.

think “been passed on 2”

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37
Q

Management ?encephalitis

A

aciclovir (covers HSV and varicella zoster)

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38
Q

Management CMV encephalitis

A

Ganciclovir

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39
Q

Two most common bacterial causes of otitis externa?

A
  • pseudomonas aerginosa
  • staphlococcus aureus
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40
Q

management of otitis externa

A

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

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41
Q

Most common pathogen and others : otitis media

A

Streptococcus pneumoniae

Other common causes include:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus

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42
Q

If giving abx for otitis media, what is first line? what are alterantives?

A
  1. amoxicillin for 5 days

alternatives: erythromycin or clarythromycin

43
Q

name 5 SSRIs

A

Sertraline
Citalopram
Escitalopram
Fluoxetine
Paroxetine

44
Q

most common side effect ssris

A

GI disturbance

45
Q

Complications of SSRIs

A
  • QT prolongation / ventricular arrhythmias including torsade de pointes in citalopram
  • Hyponatremia
  • SSRI discontinuation syndrome
46
Q

Interactions SSRIs

A

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

47
Q

SSRI in first trimester can cause?

A

congenital heart defects

48
Q

SSRI in third trimester can cause?

A

persistent pulmonary hypertension of the newborn

49
Q

worst SSRI pregnancy

A

Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

50
Q

SSRIs of choice in breastfeeding women

A

Sertraline or paroxetine

51
Q

SSRI of choice post MI

A

Sertraline

52
Q

SSRI of choice children

A

fluoxetine

53
Q

Name 2 SNRIs

A

Venlafaxine
Duloxetine

54
Q

Side effects SNRIs

A

include nausea/vomiting, sweating, loss of appetite, dizziness, headache, increase in suicidal thoughts, and sexual dysfunction.

55
Q

Complication SNRI

A

HTN

(Elevation of norepinephrine levels can sometimes cause anxiety, mildly elevated pulse, and elevated blood pressure. )(monitor before initiation and after titration)

56
Q

Name 3 TCAs

A

Imipramine
Clomipramine
Amitriptyline

57
Q

Mechanism TCAs

A

inhibit the reuptake of serotonin and noradrenaline.

58
Q

Side effects TCAs?

A

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

59
Q

Name 1 NaSSA

A

Mirtazapine

60
Q

Mechanism NaSSA

A

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.

61
Q

Side effects mirtazapine?

A

Sedative
Increases appetite

62
Q

Name 3 MAOIs

A

Isocarboxazid
Phenelzine
Tranylcypromine

63
Q

Complication MAOI

A

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

64
Q

antibiotics for meconium aspiration?

A

gentamicin and ampicillin

65
Q

antibiotics neonatal sepsis

A

benzylpenicillin and gentamycin

66
Q

Pathogen roseola infantum

A

human herpes 6

67
Q

Pathogens hand, foot and mouth disease

A

Intestinal viruses of the Picornaviridae family (most commonly coxsackie A16 and enterovirus 71)

68
Q

Management minimal change disease

A

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

69
Q

Viral causes gastroenteritis

A
  • rotavirus
  • norovirus
70
Q

Management gastroenteritis

A
  1. barrier nursing and goo hygeine
  2. stool culture
  3. fluid challenge then either oral or IV fluid
  4. antibiotics if culture grows bacteria
71
Q

selegiline

A

MAO-B

parkinsons management

72
Q

bromocriptine, cabergoline, apomorphine, ropinirole

A

dopamine receptor agonists

parkinsons management

73
Q

How to reduce risk of miscarriage antiphospholipid syndrome?

A

Low dose aspirin
Low molecular weight heparin (LMWH)

74
Q

Test for antiphospholipid syndrome

A

antiphospholipid antibodies

75
Q

Medical abortion

A

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.

76
Q

surgical abortion

A

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.

77
Q

antiemetic choices pregnancy

risks

A
  1. promethazine
  2. Cyclizine
  3. Prochlorperazine (stemetil)
  4. Ondansetron
  5. 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

78
Q

Phenytoin

A

try to avoid in pregnancy

associated with cleft lip

give vit K in last month of pregnancy to prevent clotting disorders in newborn

79
Q

management of status epilepticus

A
  1. 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

  1. 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.

80
Q

When do you initiate anticoagulation for someone with a stroke and newly diagnosed AF

A

Anticoagulation should be commenced 14 days after an ischaemic stroke. Earlier anticoagulation may exacerbate any secondary haemorrhage.

treat with aspirin as normal

81
Q

Tibolone

A

a synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea)

82
Q

Management of epilepsy in pregnancy

A

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

83
Q

Management of rheumatoid arthritis during pregnancy

A

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

84
Q

Management of hypothyroidism in pregnancy

A

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.

85
Q

Hypertension medications and pregnancy

A

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)

86
Q

antibiotics used to prevent mum passing GBS onto baby

A

penicillin G or ampicillin

87
Q

Management of UTI in pregnancy

A

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)

88
Q

nitrofurantoin and pregnancy

A

avoid in third trimester as there is a risk of neonatal haemolysis

89
Q

trimethoprim and pregnancy

A

avoid altogether but especially in first trimester (neural tube defects)

90
Q

causes of UTI

A

e.coli
Klebsiella pneumoniae

91
Q

1st, 2nd and 3rd line for pre-eclampsia/PIH?

additional management for pre-eclampsia

A

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
92
Q

1st, 2nd and 3rd line antihypertensives after birth?

A

Enalapril (first-line)
Nifedipine or amlodipine (first-line in black African or Caribbean patients)
Labetolol or atenolol (third-line)

93
Q

management of eclampsia

A

IV magnesium sulphate

94
Q

what is HELLP syndrome?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

95
Q

monitoring PIH

A

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

96
Q

monitoring pre-eclampsia

A

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

97
Q

risk factors for gestational diabetes? what do you need to do?

A

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.)

98
Q

management of gestational diabetes

A

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

99
Q

Neisseria gonorrhoeae gram and shape

A

gram-negative diplococcus bacteria

100
Q

pathogen syphillis

A

Treponema pallidum

101
Q

pathogen bacterial vaginosis

A

Gardnerella vaginalis (most common)

102
Q

Management obstetric cholestasis

A
  1. 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

103
Q

managemet of acute fatty liver of pregnancy

A

obstetric emergency and requires prompt admission and delivery of the baby

104
Q

first-line treatment for magnesium sulphate induced respiratory depression?

A

Calcium gluconate

Phase 3a topics (39 decks)

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