Revise pharma Infection Flashcards
1
Q
what is the importance of Abx stewardship?
A
prevent antibiotic resistance, avoid broad spec, prescribe with clinical evidence
2
Q
what is the 1st line and 2nd line for human and animal bites?
A
1st line = co-amoxiclav
2nd = doxycycline + metronidazole
3
Q
how long is the treatment for human and animal bites?
when would you continue onto a treatment dose?
A
prophylaxis = 3 days
treatment = 5 days
only continue for treatment dose if sign of infection
4
Q
what are the 1st and 2nd line drugs and doses for tick bites (Lyme disease)?
A
1st = doxycycline 100mg BD
2nd = amoxicillin 1g TDS
5
Q
how long is the treatment for lyme disease?
A
21 days
6
Q
when would you need to go for 2nd line treatment options in human and animal bites?
A
penicillin allergy
7
Q
what would you use for an animal scratch opposed to a bite?
A
flucloxacillin
8
Q
what is used for a mild (less than 2cm) diabetic foot infection?
what if patient has a penicillin allergy?
A
flucloxacillin
if pt has penicillin allergy use clarithromycin/erythromycin/doxycycline
9
Q
how is a severe diabetic foot treated (abcess, osteomyelitis)? What about penicillin allergies?
A
- fluclox or co-amoxiclav +/- gentamicin
- penicillin allergy: co-trimoxazole +/- gent
10
Q
what the 1st line in cellulitis?
A
flucloxacillin
11
Q
what are the options for cellulitis if patient has a penicillin allergy/unsuitable?
A
clarithromycin/erythromycin
doxycycline
co-amoxiclav (not if allergy)
12
Q
what would you give a pregnant lady with a penicillin allergy for cellulitis?
A
erythromycin - cannot use clarithromycin in pregnancy
13
Q
what abx is used for cellulitis if its near eyes or nose?
A
co-amoxiclav
penicillin allergy = clarithromycin + metronidazole
14
Q
1st line for low severity CAP?
what about if penicillin allergy?
A
1st line = amoxicillin
2nd = doxy, clarithromycin (or erythromycin)
15
Q
1st line for moderate severity CAP?
What if penicillin allergy?
A
1st line = amoxicillin + clarithryomycin (or erythromycin)
2nd = doxy or clarithromycin
16
Q
1st line for high severity CAP?
2nd line if allergy?
A
1st line = co-amoxiclav and clarithromycin (ery in preg)
2nd line = levofloxacin
17
Q
1st line and 2nd line for c diff infection?
what if pt has severe, life threatening c diff?
A
1st line = vanc
2nd line = fidaxomicin
life threatening = vanc + IV metronidazole
18
Q
whats the standy abx for travellers diarrhoea?
A
azithromycin - if remote area pt travelling to with little/no healthcare facilities
19
Q
whats the prophylaxis/treatment for travellers diarrohea?
A
bismuth subsalicylate
20
Q
1st line for otitis media?
A
amoxicillin
21
Q
when would you give a 2nd line abx in otitis media and what is it?
A
if worsening symtpoms despite 2 - 3 days of treatment
give co-amoxiclav
22
Q
whats the abx option for otitis media if pt has pen allergy?
A
clarithromycin or erythromycin if pregnant
23
Q
whats the first line for otitis externa?
A
topical acetic acid 2%
24
Q
whats 2nd line for otitis externa?
A
topical enomycin with corticosteroid
25
what PO abx would you give for otitis externa if systemic treatment needed?
flucloxacillin
26
how do you diagnose h pylori?
what are the restrictions around testing?
- test using urea breath test
- shouldn't be performed within 2 weeks of taking PPIs
- shouldn't be performed within 4 weeks of taking abx
27
what drugs make up the triple therapy to treat h pylori ?
1. PPI (omeprazole, lansoprazole)
2. amoxcillin 1g BD
3. metronidazole 400mg BD or clarithromycin 500mg BD
28
what PPI should be prescribed for someone on clopidogrel with a H pylori infection?
lansoprazole due to interaction with clopidogrel and omeprazole
29
whats the 1st line for non-severe HAP? (adults and children)
co-amoxiclav
30
whats the 2nd line for non-severe HAP?
whats the 2nd line in children?
doxycycline or cefalexin, or co-trimoxazole, or levofloxacin
2nd line in children = clarithromycin
31
why can't you use doxy in children ?
microdeposits on bone and teeth
32
whats the 1st & 2nd line for localsied non-bullous (mild) impetigo?
1st = hydrogen peroxide 1%
2nd = fusidic acid (muupirocin 2% if fusidic acid resistance suspected)
33
whats the 1st line for widespread non-bullous impetigo?
fusidic acid (mupirocin 2% if resistnace suspected)
34
whats the first and second line for bullus impetigo or if systemically unwell (severe)?
1st = fluclox
2nd = clarithroymcin, erythromycin in pregnancy
35
whats the limit on eGFR nitrofurantoin?
only use if 45ml/min and above
36
whats the 1st line Lower UTI in men?
how long is the treatment?
nitrofurantoin or trimethoprim
treatment = 7 days
37
1st and 2nd line for lower UTI in non-pregnant women?
how long is treatment for non-complicated UTI?
1st = nitrofurantoin or trimethoprim
2nd = pivmecillinam or fosfomycin
treatment = 3 days
38
whats the first and second line trestment for pregnant women with lower UTI?
how long is the treatment?
1st = nirofurantoin
2nd = cefalexin or amoxicllin
treatment = 7 days
39
how long is the treatment for catherther associated UTI?
7 days
40
why is trimethoprim avoided in pregnancy?
anti-folate so teratogenic
41
what bacteria cause strep throat and scarlett fever?
Streptococcus
42
whats the 1st and 2nd line for strep throat and scarlett fever?
1st phenoxymethylpenicillin
2nd = clarithromycin
43
what are the symptoms of scarlett fever?
- flu like (high temp, swollen glands)
- red rash with small raised bumps, rough like sandpaper
- white coating on tounge
44
what are the 1st line treatments for acne vulgaris?
adapelen, clindamycin, benzyl peroxide, lymecycline
45
abx for BV and trichomoniasis?
metronidazole
46
abx for chlamydia?
doxycycline
47
conjunctivitis and blepharitis abx?
chloramphenicol
48
abx for dental absess?
amoxicillin or metronidazole
49
abx for gonorrhea?
ceftriaxone or ciprofloxacin
50
1st line for menengitis?
benylpenicillin
51
1st line for scabies
permethrin
52
sinusitis 1st line abx? 2nd line of penicillin allergy?
1st = phenoxymethylpenicillin
2nd = doxycycline
53
1st line for threadworm?
mebendazole
54
what age can't you give medebazole to?
under 2 yrs
pregnant as well
55
what pathogen causes CAP?
streptocuccus pneumoniae
56
what pathogen causes UTI?
e coli
57
what pathogen causes thrush?
candida albicans
58
what pathogen causes cellulitis?
staph aureus
59
what pathogen causes meningitis?
streptococcus pneumoniae
60
what aminoglycoside is the most common?
gentamicin
61
gentamicin requires TDM, in what patients must the serum concentrations be determined in?
obese, those on high doses? CF. elderly
62
after how many doses do you meausre serum gent levels?
then at what intervals do you measure them?
3 or 4 doses
then measure every 3 days and after a dose change
63
what pt group would you more frequently measure gent levels?
with renal impairment
64
at what time point do you take a sample to measure gent?
1 hours after dose (peak) and just before dose (trough)
65
what is the range of peak gent serum levels we look for?
how and why is this different in endocarditis?
5 - 10 mg/l
endocarditis - 3 - 5mg/l because treat endocarditis with additonal abx as well
66
wha trough levels do we look for in gent monitoring?
what about in endocarditis?
<2mg/l
endocarditis <1mg/l
67
what do you do to gent dosing if trough level too high?
increase the dose interval
68
what do you do to gent dosing if peak levels are too high?
reduce the dose
69
what do you do to the dose of gent in renal impairment? What if it's really severe impairment?
- increase dose interval
- severe impairment need to decrease dose too
70
what drug interactions should you look out for with aminoglycoside?
avoid concomitant use of nephrotoxic drugs
(NSAIDs, ACEi/ARBs, metformin)
71
what are the MHRA warning for aminoglycosides?
to avoid with other drugs causing ototoxicity
- cisplatin
- loop diuretics
- vanc
- vinca alkaloids
72
what patients are aminoglycosides contraindiacted in and why?
myasthenia gravis
pregnancy - risk of auditory or vestibular nerve damage - must moitor serum conc if give
73
what body weight should you sue for obese patients?
ideal body weight - don't want to go over dosing threshold
74
what are the 3 first generation cephalosporins? fad, fal frad
cefadroxil
cefalexin
cefradine
75
what are the 2nd gen cephalosporins? Furry Fox Face
cefuroxime
cefoxitin
cefaclor
76
what is the only po 3rd/5th gen cephalosporin?
cefixime
77
what patients should not receive a cephalosporin?
those with hypersentivity to other beta lactams due to cross sensitivity
78
why do you need to avoid chloramphenicol in pregnancy?
grey baby syndrome
79
what age can you sell chloramphinicol OTC
2yrs +
80
what condition ascociated with clindamycin can be fatal? what should you do in terms of the treatment?
abx-associated colitis - discontinue treatment
81
t is the most common glycopeptides?
vancomycin
82
what route is vanc best given for systemic infections?
parenterally
83
vanc is dosed on bodyweight then dose adjustments made on levels - what levels do we look at and whats the range?
trough only (1hr before next dose)
level - 15 - 20mg/l
84
what are the main SE if vanc?
ototoxicity
red man syndrome (esp at injection site)
nephrotoxicity
blood dyscrasias
SJS
85
whats the risk of injections vanc too quickly?
cardiogenic shock
86
what are the key safety info with linezolid?
1. optic neuropathy
- report visual impairment
- monitor regularly if >28 days
2. blood disorders
- full blood count weeky
- monitor regularly if treatment more than 10 - 14 days
87
what adverse effects can linezolid have which are similar to another class of drug?
simialr to MAOI
1. tyramine reaction
2. serontonin syndrome
88
what macrolide is used in pregnancy?
erythromcyin
must avoid clarithromycin in 1st trimester
89
what is macrolide use cautioned in?
myasthena gravis
90
what are the 4 SE to monitor for macrolides?
1. hepatotoxicity
2. ototoxicity
3. high level of GI disturbances
4. QT prolongation
91
what are the main 3 interactions are associated with macrolides? Name some drugs which cause each type of interaction.
1. macrolides are CYP inhibitors = increase statin and warfarin exposure
2. cause hypokalameia - other drugs = diuretics, steroids, salbutamol, theophylline
3. QT prolongation
other drugs = amiodarone, domperidone , fluconazole, lithium, methadone, ondasteron, sotalol, SSRIs
92
what are 3 common SE of metronidazole?
taste disturbance, metallic taste, furred tongue
93
what can't patients drink alcohol with metronidazole?
how long should patients avoid drinking alchohol after the treatment?
disulfiram reaction - causes N&V and flushing
avoid drinking 48 hours after treatment
94
what eGFR do you need to avoid nitrufurantoin?
45ml/min
95
what 2 counselling points should you give patients taking nitrufurantoin?
yellow/brown urine
take with or after food
96
name 2 narrow spec penicillins.
what part of the bacteria are they sensitive to?
benzylpenicillin
phenoxymethylpenicillin
senstive to beta lactamase
97
what routes are benzypenicillin and phenoxymethylpenicillin given?
benpen = parenteral only as not gastric acid stable
phenoxymethylpenicillin = suitable for oral
98
what broad spec penicillins are beta lactamse sensitive?
How would you upgrade one to be beta lactamase resistant?
ampicillin
amoxicillin
amoxicillin + clavulanic acid = resistant
99
what happens if you give someone with glandular fever broad spec penicillin?
maculopapular rash in glandular fever
100
alongside clavulanic acid, what other penicillin is resistant? (to penicillinase)
what are the SE?
can this persist after treatment has finished?
cholestatic jaundice and hepatitis
this can still happen once treatment finished - must be taken on empty stomach
101
what are the 2 antipseudomonal penicillins?
can they be given on thier own?
1. piperacillin - only given with tazobactam
2. ticaracillin - only given iwth clavulanic acid
102
can you give penicllins intrathecally?
no - can cause encaephalopathy which can be fatal
103
what do quinolones end in?
floxacin
104
name 4 conditions quinolones should be caustioned in
1. avoid in epilepsy - lowers seizure threshold
2. psychiatric disorders
3. tendon disorders
4. hypersensitivity
105
what counselling points should you tell patients prescribed quinolones?
reduce sunlight and UV RADIATION EXPOSURE AND MAY IMPAIR DRIVING ABILITY
106
what are the 3 MHRA warnings with quinolones?
1. tendinitis - stop if suspected, more common if >60yrs
2. arotic aneurysm and dissection - medical attention if sudden abdo/chest/back pain
3. heart valve regurgitation - SOB, palpitations
107
what are the 4 cautions with quinolones?
1. QT prolongation
2. myasthenia gravis
3. arthropathy in children or adolescents
4. perforated tympanic membrane (when used by ear)
108
what are the 3 interactions to be aware of for quinolones?
1. food and drinks - avoid dairy products and mineral fortified drinks - reduces absorption
2. drugs that cause QT prolongation
3. reduce siezure threshold - quinolones + NSAIDs
109
whats the common label warning for tetracyclines?
what 3 can be taken with milk (DOES LIKE MILK)
do not take milk, indigestion remedies, or medicnies containing iron or zinc, 2 hours before or after you take this medicnes.
doxycycline
lymecycline
minocycline
110
what are 3 side effects you should look out for with tetracyclines?
1. benign intracrainial hypertension - stop and report on headache and visual disturbances
2. lupus-erythmatous like syndrome and irreversible pigmentation (highest risk with minocycline)
3. teeth discolouration and bone deposits - do not give to pregnant women and children under 12yrs
111
name 4 tetracycline counselling points
1. hepatotoxic - avoid in liver failure
2. photosensiivty - avoid exposure to sun
3. can cause dysphagia - should be swallowed whole with plenty of fluid while sitting/standing
4. caution in myasthenia gravis
112
what is the main risk of trimethoprim?
cause blood dyscrasias (sore throat, mouth ulcers, bruising)
113
what patients must it be avoided in and why?
avoid in 1st trimester of pregnancy as teratogenic
is an antifolate so avoid with other antifolates (methotrexate, phenytoin)
114
what electrolyte disturbance can trimethoprim cause?
hyperkalaemia
115
is trimethoprim fine in renal impairment?
no caution
avoid in eGFR <15ml/min
reduce dose if 15 - 30ml/min
116
what are the narrow spec abx? (PG TLC)
penicllin (V & G)
glycopeptides
trimethoprim
linezolid
