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Revise pharma Infection Flashcards

1
Q

what is the importance of Abx stewardship?

A

prevent antibiotic resistance, avoid broad spec, prescribe with clinical evidence

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2
Q

what is the 1st line and 2nd line for human and animal bites?

A

1st line = co-amoxiclav
2nd = doxycycline + metronidazole

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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

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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

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5
Q

how long is the treatment for lyme disease?

A

21 days

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6
Q

when would you need to go for 2nd line treatment options in human and animal bites?

A

penicillin allergy

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7
Q

what would you use for an animal scratch opposed to a bite?

A

flucloxacillin

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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

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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
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10
Q

what the 1st line in cellulitis?

A

flucloxacillin

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11
Q

what are the options for cellulitis if patient has a penicillin allergy/unsuitable?

A

clarithromycin/erythromycin
doxycycline
co-amoxiclav (not if allergy)

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12
Q

what would you give a pregnant lady with a penicillin allergy for cellulitis?

A

erythromycin - cannot use clarithromycin in pregnancy

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13
Q

what abx is used for cellulitis if its near eyes or nose?

A

co-amoxiclav
penicillin allergy = clarithromycin + metronidazole

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14
Q

1st line for low severity CAP?
what about if penicillin allergy?

A

1st line = amoxicillin
2nd = doxy, clarithromycin (or erythromycin)

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15
Q

1st line for moderate severity CAP?
What if penicillin allergy?

A

1st line = amoxicillin + clarithryomycin (or erythromycin)
2nd = doxy or clarithromycin

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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

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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

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18
Q

whats the standy abx for travellers diarrhoea?

A

azithromycin - if remote area pt travelling to with little/no healthcare facilities

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19
Q

whats the prophylaxis/treatment for travellers diarrohea?

A

bismuth subsalicylate

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20
Q

1st line for otitis media?

A

amoxicillin

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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

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22
Q

whats the abx option for otitis media if pt has pen allergy?

A

clarithromycin or erythromycin if pregnant

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23
Q

whats the first line for otitis externa?

A

topical acetic acid 2%

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24
Q

whats 2nd line for otitis externa?

A

topical enomycin with corticosteroid

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25
Q

what PO abx would you give for otitis externa if systemic treatment needed?

A

flucloxacillin

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26
Q

how do you diagnose h pylori?
what are the restrictions around testing?

A
  • 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
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27
Q

what drugs make up the triple therapy to treat h pylori ?

A
  1. PPI (omeprazole, lansoprazole)
  2. amoxcillin 1g BD
  3. metronidazole 400mg BD or clarithromycin 500mg BD
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28
Q

what PPI should be prescribed for someone on clopidogrel with a H pylori infection?

A

lansoprazole due to interaction with clopidogrel and omeprazole

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29
Q

whats the 1st line for non-severe HAP? (adults and children)

A

co-amoxiclav

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30
Q

whats the 2nd line for non-severe HAP?
whats the 2nd line in children?

A

doxycycline or cefalexin, or co-trimoxazole, or levofloxacin
2nd line in children = clarithromycin

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31
Q

why can’t you use doxy in children ?

A

microdeposits on bone and teeth

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32
Q

whats the 1st & 2nd line for localsied non-bullous (mild) impetigo?

A

1st = hydrogen peroxide 1%
2nd = fusidic acid (muupirocin 2% if fusidic acid resistance suspected)

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33
Q

whats the 1st line for widespread non-bullous impetigo?

A

fusidic acid (mupirocin 2% if resistnace suspected)

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34
Q

whats the first and second line for bullus impetigo or if systemically unwell (severe)?

A

1st = fluclox
2nd = clarithroymcin, erythromycin in pregnancy

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35
Q

whats the limit on eGFR nitrofurantoin?

A

only use if 45ml/min and above

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36
Q

whats the 1st line Lower UTI in men?
how long is the treatment?

A

nitrofurantoin or trimethoprim
treatment = 7 days

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37
Q

1st and 2nd line for lower UTI in non-pregnant women?
how long is treatment for non-complicated UTI?

A

1st = nitrofurantoin or trimethoprim
2nd = pivmecillinam or fosfomycin
treatment = 3 days

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38
Q

whats the first and second line trestment for pregnant women with lower UTI?
how long is the treatment?

A

1st = nirofurantoin
2nd = cefalexin or amoxicllin
treatment = 7 days

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39
Q

how long is the treatment for catherther associated UTI?

A

7 days

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40
Q

why is trimethoprim avoided in pregnancy?

A

anti-folate so teratogenic

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41
Q

what bacteria cause strep throat and scarlett fever?

A

Streptococcus

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42
Q

whats the 1st and 2nd line for strep throat and scarlett fever?

A

1st phenoxymethylpenicillin
2nd = clarithromycin

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43
Q

what are the symptoms of scarlett fever?

A
  • flu like (high temp, swollen glands)
  • red rash with small raised bumps, rough like sandpaper
  • white coating on tounge
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44
Q

what are the 1st line treatments for acne vulgaris?

A

adapelen, clindamycin, benzyl peroxide, lymecycline

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45
Q

abx for BV and trichomoniasis?

A

metronidazole

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46
Q

abx for chlamydia?

A

doxycycline

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47
Q

conjunctivitis and blepharitis abx?

A

chloramphenicol

48
Q

abx for dental absess?

A

amoxicillin or metronidazole

49
Q

abx for gonorrhea?

A

ceftriaxone or ciprofloxacin

50
Q

1st line for menengitis?

A

benylpenicillin

51
Q

1st line for scabies

A

permethrin

52
Q

sinusitis 1st line abx? 2nd line of penicillin allergy?

A

1st = phenoxymethylpenicillin
2nd = doxycycline

53
Q

1st line for threadworm?

A

mebendazole

54
Q

what age can’t you give medebazole to?

A

under 2 yrs
pregnant as well

55
Q

what pathogen causes CAP?

A

streptocuccus pneumoniae

56
Q

what pathogen causes UTI?

57
Q

what pathogen causes thrush?

A

candida albicans

58
Q

what pathogen causes cellulitis?

A

staph aureus

59
Q

what pathogen causes meningitis?

A

streptococcus pneumoniae

60
Q

what aminoglycoside is the most common?

A

gentamicin

61
Q

gentamicin requires TDM, in what patients must the serum concentrations be determined in?

A

obese, those on high doses? CF. elderly

62
Q

after how many doses do you meausre serum gent levels?
then at what intervals do you measure them?

A

3 or 4 doses
then measure every 3 days and after a dose change

63
Q

what pt group would you more frequently measure gent levels?

A

with renal impairment

64
Q

at what time point do you take a sample to measure gent?

A

1 hours after dose (peak) and just before dose (trough)

65
Q

what is the range of peak gent serum levels we look for?
how and why is this different in endocarditis?

A

5 - 10 mg/l
endocarditis - 3 - 5mg/l because treat endocarditis with additonal abx as well

66
Q

wha trough levels do we look for in gent monitoring?
what about in endocarditis?

A

<2mg/l
endocarditis <1mg/l

67
Q

what do you do to gent dosing if trough level too high?

A

increase the dose interval

68
Q

what do you do to gent dosing if peak levels are too high?

A

reduce the dose

69
Q

what do you do to the dose of gent in renal impairment? What if it’s really severe impairment?

A
  • increase dose interval
  • severe impairment need to decrease dose too
70
Q

what drug interactions should you look out for with aminoglycoside?

A

avoid concomitant use of nephrotoxic drugs
(NSAIDs, ACEi/ARBs, metformin)

71
Q

what are the MHRA warning for aminoglycosides?

A

to avoid with other drugs causing ototoxicity
- cisplatin
- loop diuretics
- vanc
- vinca alkaloids

72
Q

what patients are aminoglycosides contraindiacted in and why?

A

myasthenia gravis
pregnancy - risk of auditory or vestibular nerve damage - must moitor serum conc if give

73
Q

what body weight should you sue for obese patients?

A

ideal body weight - don’t want to go over dosing threshold

74
Q

what are the 3 first generation cephalosporins? fad, fal frad

A

cefadroxil
cefalexin
cefradine

75
Q

what are the 2nd gen cephalosporins? Furry Fox Face

A

cefuroxime
cefoxitin
cefaclor

76
Q

what is the only po 3rd/5th gen cephalosporin?

77
Q

what patients should not receive a cephalosporin?

A

those with hypersentivity to other beta lactams due to cross sensitivity

78
Q

why do you need to avoid chloramphenicol in pregnancy?

A

grey baby syndrome

79
Q

what age can you sell chloramphinicol OTC

80
Q

what condition ascociated with clindamycin can be fatal? what should you do in terms of the treatment?

A

abx-associated colitis - discontinue treatment

81
Q

t is the most common glycopeptides?

A

vancomycin

82
Q

what route is vanc best given for systemic infections?

A

parenterally

83
Q

vanc is dosed on bodyweight then dose adjustments made on levels - what levels do we look at and whats the range?

A

trough only (1hr before next dose)
level - 15 - 20mg/l

84
Q

what are the main SE if vanc?

A

ototoxicity
red man syndrome (esp at injection site)
nephrotoxicity
blood dyscrasias
SJS

85
Q

whats the risk of injections vanc too quickly?

A

cardiogenic shock

86
Q

what are the key safety info with linezolid?

A
  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
Q

what adverse effects can linezolid have which are similar to another class of drug?

A

simialr to MAOI
1. tyramine reaction
2. serontonin syndrome

88
Q

what macrolide is used in pregnancy?

A

erythromcyin
must avoid clarithromycin in 1st trimester

89
Q

what is macrolide use cautioned in?

A

myasthena gravis

90
Q

what are the 4 SE to monitor for macrolides?

A
  1. hepatotoxicity
  2. ototoxicity
  3. high level of GI disturbances
  4. QT prolongation
91
Q

what are the main 3 interactions are associated with macrolides? Name some drugs which cause each type of interaction.

A
  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
Q

what are 3 common SE of metronidazole?

A

taste disturbance, metallic taste, furred tongue

93
Q

what can’t patients drink alcohol with metronidazole?
how long should patients avoid drinking alchohol after the treatment?

A

disulfiram reaction - causes N&V and flushing

avoid drinking 48 hours after treatment

94
Q

what eGFR do you need to avoid nitrufurantoin?

95
Q

what 2 counselling points should you give patients taking nitrufurantoin?

A

yellow/brown urine
take with or after food

96
Q

name 2 narrow spec penicillins.
what part of the bacteria are they sensitive to?

A

benzylpenicillin
phenoxymethylpenicillin
senstive to beta lactamase

97
Q

what routes are benzypenicillin and phenoxymethylpenicillin given?

A

benpen = parenteral only as not gastric acid stable
phenoxymethylpenicillin = suitable for oral

98
Q

what broad spec penicillins are beta lactamse sensitive?
How would you upgrade one to be beta lactamase resistant?

A

ampicillin
amoxicillin
amoxicillin + clavulanic acid = resistant

99
Q

what happens if you give someone with glandular fever broad spec penicillin?

A

maculopapular rash in glandular fever

100
Q

alongside clavulanic acid, what other penicillin is resistant? (to penicillinase)
what are the SE?
can this persist after treatment has finished?

A

cholestatic jaundice and hepatitis
this can still happen once treatment finished - must be taken on empty stomach

101
Q

what are the 2 antipseudomonal penicillins?
can they be given on thier own?

A
  1. piperacillin - only given with tazobactam
  2. ticaracillin - only given iwth clavulanic acid
102
Q

can you give penicllins intrathecally?

A

no - can cause encaephalopathy which can be fatal

103
Q

what do quinolones end in?

104
Q

name 4 conditions quinolones should be caustioned in

A
  1. avoid in epilepsy - lowers seizure threshold
  2. psychiatric disorders
  3. tendon disorders
  4. hypersensitivity
105
Q

what counselling points should you tell patients prescribed quinolones?

A

reduce sunlight and UV RADIATION EXPOSURE AND MAY IMPAIR DRIVING ABILITY

106
Q

what are the 3 MHRA warnings with quinolones?

A
  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
Q

what are the 4 cautions with quinolones?

A
  1. QT prolongation
  2. myasthenia gravis
  3. arthropathy in children or adolescents
  4. perforated tympanic membrane (when used by ear)
108
Q

what are the 3 interactions to be aware of for quinolones?

A
  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
Q

whats the common label warning for tetracyclines?
what 3 can be taken with milk (DOES LIKE MILK)

A

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
Q

what are 3 side effects you should look out for with tetracyclines?

A
  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
Q

name 4 tetracycline counselling points

A
  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
Q

what is the main risk of trimethoprim?

A

cause blood dyscrasias (sore throat, mouth ulcers, bruising)

113
Q

what patients must it be avoided in and why?

A

avoid in 1st trimester of pregnancy as teratogenic
is an antifolate so avoid with other antifolates (methotrexate, phenytoin)

114
Q

what electrolyte disturbance can trimethoprim cause?

A

hyperkalaemia

115
Q

is trimethoprim fine in renal impairment?

A

no caution
avoid in eGFR <15ml/min
reduce dose if 15 - 30ml/min

116
Q

what are the narrow spec abx? (PG TLC)

A

penicllin (V & G)
glycopeptides
trimethoprim
linezolid

Pre-reg (47 decks)

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