Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > What should I prescribe? Infection edition > Flashcards

What should I prescribe? Infection edition Flashcards

1
Q

C. diff (Clostridium difficile)

A

1st line (mild) - Metronidazole (400mg TDS 10 days)
2nd line if mild or 1st line if severe - oral Vancomycin (125mg QDS 10 days)
Also: stop other antibiotics, fluid resuscitation, probiotics

Gram +ve, anaerobic, spore-forming bacillus
Commonly hospital acquired, spores hard to get rid of
Antibiotic therapy (esp. broad spectrum) kills off other commensals -> overgrowth
Also faecal-oral route
Can be asymptomatic or diarrhoea (rarely bloody), abdo cramping
Complications: pseudomembranous colitis, toxic megacolon -> perforation

Toxins A & B
A- enterotoxin -> excessive secretion and inflammation
B- cytotoxin - dead cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Red Flag Sepsis (adult)

A

IV Meropenem 1g
(Carbopenem -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Severe Cellulitis
(Staph aurius / Strep pyrogenese)

A

1st line: IV Flucloxacillin 2g QDS 7 days
2nd line: IV Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Endocarditis

A

Gentamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Meningococcal sepsis

A

Ceftriaxone + Vancomycin + Dexamethazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Herpes Zoster (Shingles) caused by Varicella Zoster

A

Aciclovir 800mg 5x / 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Community-Acquired Pneumonia (CAP) - Mild to moderate:

A

1st line - Amoxicillin 500mg TDS for 5 days
2nd line - Doxycycline 200mg stat then 100mg OD for 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Community-Acquired Pneumonia (CAP) - Severe:

A

1st line - IV Co-amoxiclav 1.2g TDS and Clarithromycin enterally 500mg BD (uni says Co-amoxiclav + Doxycycline instead)
2nd line - IV/PO Levofloxacin 500mg BD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hospital-Aquired Pneumonia (HAP) - Mild to moderate:

A

5 day course of:
1st line - Co-amoxiclav 625mg TDS
2nd line - Doxycycline 200mg enterally then 100mg OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hospital-Aquired Pneumonia (HAP) - Severe:

A

5 day course of:
1st line - IV Co-amoxiclav 1.2g TDS
2nd line - IV Meropenem 1g TDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Atypical Pneumonia (Mycoplasma)

A

Macrolides e.g. clarythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

TB

A

1st line RIPE:
-Rifampicin
Cyp450 inducer, raised LFTs, orange secretions/urine
-Isoniazid (INAH)
Causes peripheral neuropathy so must give 10mg od pyridoxine (vitamin B6)
-Pyrazinamide
Hepatotoxicity
-Ethambutol
Can cause optic neuritis (-> visual disturbance)
All 4 drugs for 2 months -> Rifampicin + INAH for a further 4 months (total 6 moths).
Cure rate is 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complicatated influenza

A

1st - Oseltamivir 75mg OD 10 days
2nd - Zanamivir 5mg inhaled BD 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lower UTI - non-pregnant women/uncomplicated

A

1st - PO Nitrofurantoin 100mg BD for 3 days
2nd - PO Trimethoprim 200mg BD for 3 days (avoid if taken in last 3 months or Hx of resistance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lower UTI - complicated non-pregnant women/men

A

1st line - PO Nitrofurantoin 100mg BD for 7 days
2nd line - PO Trimethoprim 200mg BD for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lower UTI - pregnant women

A

1st line - PO Nitrofurantoin 100mg BD for 7 days
2nd line -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Suspected Bacterial Meningitis

A

Immediate start if severely ill - do not wait for lumbar puncture

1st line - IV Ceftriaxone 2g/12hrs
2nd line - IV Meropenem 2g/8hrs

Always prescribe with steroids (IV Dexamethazone (prevents hearing loss) 10mg/6hrs) before antibiotics
Stop steroid treatment if not pneumococcal meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pelvic inflammatory disease

A

Admit if unwell e.g. peritoniris, fever etc. (can progress to sepsis)
Oral Ofloxacin 400mg BD + oral Metronidazole 400mg BD for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pylelonephritis

A

1st line - Co-amoxiclav
2nd line - Ciprofloxin
3rd line - Gentomyocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tonsillitis

A

Viral causes most common - supportive treatment (fluids and pain killers)
Bacterial cause (up to 40%) - Strep pyogenes (beta-haemolytic) - Penicillin V 10 days

Inflammation of palatine tonsils (between palatoglossal and palatopharangeal arch), uvula unaffected

Symptoms: fever, sore throat, pain/difficulty swallowing, cervical lymph nodes, bad breath

FeverPAIN score (max 5 points)
- Fever (during previous 24 hours)
- Purulence (pus on tonsils)
- Attend rapidly (within 3 days after onset of symptoms)
- Severely Inflamed tonsils
- No cough or coryza (inflammation of mucus membranes in the nose)
Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Chlamydia
(Chlamydia trachomatis)

A

1st line - Doxycycline
2nd line - Erythromycin if allergic

Gram -ve, unique cell wall which inhibits phagolysosome fusion (virulence factor)
70% asymptomatic
Purulent discharge, post-coital/ inter-menstrual bleeding
Testicular pain, dysuria
Women: swab vulvo-vag/endocervical Men: Urine -NAAT (Nucleic acid amplification test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Gonorrhoea
(Neisseria gonorrhoeae)

A

Cephtriaxone and Azithromycin

Gram -ve, diplococci, unencapsulated, pilated
Most symptomatic - thick yellow discharge +/- dysuria
Women: vulvo-vag/endocervical swab
Men: Urethral swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HIV

A

Course of 3 anti-retrovirals
2 x nucleoside reverse transcriptase inhibitors e.g. Abacavir
1 x other class e.g. non-nucleoside reverse transcriptase inhibitor

ssRNA retrovirus

Reduced CD4+ cell count
Mild flu-like illness, gets better, then months later shows symptoms e.g. weight loss, skin lesions, fatigue, sore mouth etc.

Common opportunistic infections - thrush, pneumocystic pneumonia and Kaposi’s sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Trichomoniasis
(Trichomonas vaginalis)

A

Metronidazole

Protozoa with flagella
Female - copious frothy, yellow-green discharge + vulval itching and soreness, strawberry cervix
Women: High vag swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Thrush (candidiasis - Candida albicans)

A

Cloprimazole

Vulval/ vaginal itching, soreness and irritation
Discharge is usually white and cheese-like, non-malodorous

26
Q

Bacterial vaginosis (Gardnerella vaginalis)

A

Oral/intravag Metronidazole (2nd line: intravag Clindamycin)

Loss of lactobacilli -> Bacterial overgrowth, not itchy but fishy thin grey/white discharge

27
Q

Non-gonococcal urethritis (NGU)
(Chlamydia trichomatis, Mycoplasma genitalium or Trichomonas vaginalis, can be pathogen negative too)

A

???

Inflammation of the urethra with associated discharge (not caused by gonorrhoeae)

28
Q

Syphilis (Treponema pallidum)

A

Penicillin

Primary = painless ulcer
Secondary (untreated primary after 4-10 weeks) = Widespread rash, multisystem, can become latent
Tertiary (1-46 years after exposure) = neurological / CVS / gummatous

40% co-infected with HIV

29
Q

Pseudomembranous colitis
(can follow on from c.diff)

A

Faecal microbiota transplant
90% success rate for c.diff diarrhoea compared to 30% with vancomycin

Elevated yellow plaques join to form a pseudomembrane

30
Q

Gastroenteritis - Salmonella

A

Self-limiting (2-3 days) - supportive treatment e.g. fluids

Gram -ve bacilli, aerobic
N&V&D (mostly non-bloody), fever, abdo cramping
Small intestine involved - watery diarrhoea
Contaminated food/water, small infectious dose

31
Q

Gastroenteritis - Campylobacter

A

Generally self-limiting but can last days to weeks (longest lasting)
Supportive treatment with fluids
Consider antibiotics if bloody diarrhoea

Gram -ve bacilli, spiral/S shaped
Fever, abdo cramping & profuse diarrhoea (can be bloody)
Large intestine involvement
Risk of HUS

Mainly from eating contaminated poultry, faeco-oral route
Longer incubation period of 1-7 days

Haemolytic uraemic syndrome
Triad of: anaemia, thrombocytopenia and AKI

32
Q

Gastroenteritis - Shigella
(Shigellosis, dysentery commonly affecting young children)

A

Usually self-resolves within a week - supportive treatment

Gram -ve bacilli
Bloody diarrhoea with mucus and abdo cramping
Large intestine involvement - colonic abcesses
Risk of HUS

Only needs small dose - spreads easily in families
Spread from infected stools, person to person/ via flies
Commonly affects young children <5 y/o

Haemolytic uraemic syndrome
Triad of: anaemia, thrombocytopenia and AKI

33
Q

Gastroenteritis - Enterotoxigenic E-coli (ETEC)

A

Antibiotics may be useful

Gram -ve bacilli, produces enterotoxins -> hypersecretion of Cl- -> water follows into gut lumen
Watery diarrhea
Small intestine involved

Faecal-oral route via contaminated water
Common cause of travellers diarrhoea

34
Q

Gastroenteritis - Rotavirus

A

Supportive, manage dehydration

dsRNA virus
Faecal-oral route - very small dose required
Very common cause in under 5s - adults rarely infected (immunity lasts)
Vomiting with high fever -> diarrhoea for up to a week

Cl- secretion (created gradient -> increased Na into lumen -> water follows)
SGLT1 disruption (reduced Na/glucose uptake, water moves into lumen via osmosis)
Reduced brush border enzyme function (general malabsorption)

35
Q

Gastroenteritis - Norovirus

A

Oral rehydration therapy

RNA virus
Very common
Adults and children - don’t develop immunity as many strains
Very small dose required - highly contagious and resistant to cleansing
1-2 day incubation period, 1-3 days of symptoms
Vomiting, watery diarrhoea and fever

Infects small intestine and damages microvilli (brush border enzymes disrupted)
Anion secretion -> movement of water into gut lumen
Vomiting due to delayed gastric emptying, vomit to relieve pressure

36
Q

Gastroenteritis - Cryptosporidium

A

Normally self-limiting: Supportive treatment (fluids), may need anti-parasitics in at risk groups (AIDS)

Non-motile protozoa parasite - Sporozoan
Ingest oocyst via faecal-oral route but can also survive in bodies of water (infected by animal faeces)
Risk factors are contact with animals, water and children

Watery diarrhoea
- malabsorption (brush border enzymes)
- Cl- secretion

37
Q

Gastroenteritis - Giardia lamblia

A

Antibiotics! and fluid rehydration therapy

Motile protozoa parasite - Flagellate
Mostly asymptomatic, symptoms more common in children
Faecal-oral route with water supplies affected (developing countries)
10+ days incubation period
Symptoms if present: diarrhoea and abdo cramping (can last up to 6 weeks)
- damages proximal SI, villous atrophy

Common cause of persistent diarrhoea
Post-infection can cause lactose intolerance

38
Q

Gastroenteritis - Entamoeba histolytica

A

Anti-protozoals/Metronidazole

Motile protozoa parasite - Amoeba
Higher prevalence in developing countries
Excystation in colon -> invades mucosa
Most cases asymptomatic but if symptomatic: bloody diarrhoea, inflammatory changes similar to IBD and (rarely) liver abscesses
Faecal-oral route from contaminated food/water

Can lead to severe colitis or toxic megacolon

39
Q

Travellers diarrhoea

A

Mild/moderate (<6 stools / 24hrs): hydration, antidiarrhoeal agents for symptom control
Severe (>6): IV fluids and antibiotics if required
Antibiotics only recommended for vulnerable patients and only shortens duration of symptoms

Prevention most important - good hand hygiene, food and water precautions

Diarrhoea most common symptom of travel related illness
ETEC most common cause

3+ loose/watery stools +/- fever, abdo pain
14+ days duration - unlikely to be bacterial cause

Risk factors: <6y/o, PPIs, blood group O (shigellosis, cholera), location (south/east Asia, central America, west/north Africa), dietary exposure

40
Q

Malaria - P. falciparum (Most common)

A

1st line - Artesunate
2nd line (if unavailable) - Quinine + doxycycline

Vector - female Anopheles mosquito
Incubation: 6 days - 4 weeks (most cases)
Hx of fever, chills & sweats - cycle every 3-4 days
Few signs except fever +/- splenomegaly

Severe can affect CVS (tachycardia, hypotension, arrhythmias), resp (ARDS), GI (diarrhoea, deranged LFTs), AKI, confusion, cerebral malaria, thrombocytopenia, DIC etc.

Investigations:
- 3x Blood film - shows single-celled protozoa with headphone appearance
- FBCs, U+Es, LFTs, glu, coag
- Head CT if neuro signs, CXR

41
Q

Dengue fever

A

Supportive treatment only
Vaccine available for children in endemic regions

Virus
Vector - Aedes aegypti mosquito

Most 1st infection cases mild - asymptomatic to non-specific febrile illness
1-5 days duration
Improves 3-4 days after rash (widespread, macular, papular rash)

Reinfection with different serotype -> antibody dependent enhancement
- Dengue haemorrhagic fever
- Dengue shock syndrome (up to 30% mortality)

42
Q

Malaria - P. vivax (2nd most common)
Others - ovale, malaria
(also knowlesii)

A

Chloroquine (not suitable for falciparum due to resistance)
Give additional primaquine as can recur months-years later - dormant hypnozoites in liver

Vector - female Anopheles mosquito
Incubation (vivax/ovale): 6 days - up to 1 year+

Hx of fever, chills & sweats - cycle every 3-4 days
Few signs except fever +/- splenomegaly

Investigations:
- 3x Blood film - shows single-celled protozoa with headphone appearance
- FBCs, U+Es, LFTs, glu, coag
- Head CT if neuro signs, CXR

43
Q

Enteric fever - Typhoid & paratyphoid
(Salmonella typhi, Salmonella paratyphi)

A

1st line - IV Ceftriaxone (cephalosporin) 7-14 days
2nd line - Azithromycin (macrolide)
Pakistan travel Hx - Meropenem

Multi-drug resistant
Fluoroquinolones e.g. ciprofloxacin may work

Gram -ve bacillus, aerobic
Systemic disease (bacteraemia/sepsis)
7-14 day incubation period
Fever, headache, abdo pain, no diarrhoea, dry cough, relative bradycardia (would expect increased BP with fever)

Complications:
- intestinal haemorrhage & perforation
- untreated = 10% mortality
- chronic carrier state in 1-5%

Paratyphoid is generally milder

44
Q

Peritonsillar abscess (Quinsy)

A

IV benzylpenicillin and metronidazole (or in penicillin-allergic patients, clindamycin/clarithromycin monotherapy)
NSAIDs and a single dose of corticosteroid recommended + aspiration

Symptoms- severe throat pain, fever, bad breath, drooling, difficulty opening mouth, hot potato voice, deviated uvula
May also show signs of sepsis - altered mental state, fever, tachypnoea, tachycardia and hypotension

Can follow on from untreated / partially treated tonsillitis or on its own
Aerobic or anaerobic bacteria

Large abscess can cause Stertor (partial upper airway obstruction above the level of the larynx) - due to vibration of nasopharynx, oropharynx or soft palate - sounds like heavy snoring or gasping

Complications:
- deep neck space infection and potentially cause airway obstruction
- Mediastinitis (tracks down deep neck to mediastinum) life-threatening

45
Q

Epiglottitis

A

Treatment is usually conservative
IV or oral antibiotics, intubation may be needed

Rapid deterioration in children - don’t examine child as may get distressed
Usually secondary to bacterial infection e.g. Haemophillus influenzae

Rare but more common in 2-6 y/os

Symptoms: high fever, sore throat, dysphagia and drooling, sniffing position
If airway compromised - stridor, raised RR, distress, hypoxia, +/- cyanosis

46
Q

Croup

A

Common and usually not severe: self-resolves, managed at home
Severe (stridor at rest, cyanosis etc.): overnight observation, O2, steroids

Viral cause - mostly mild

Infants 6m-3y/o have characteristic barking cough, worse with agitation, can -> stridor if crying

47
Q

Laryngitis

A

Usually self limiting - resolves in 2-3 weeks
Supportive/symptomatic treatment = paracetamol for pain/fever, fluids, rest voice

Inflammation and oedema of the larynx, often involving true vocal cords

Usually viral and non-infectious

Symptoms: hoarse/weak voice (swelling increases bulk of cords) and sore throat, Hx of URTI

48
Q

Otitis externa
(Pseudomonas aeruginosa or Staph aureus)

A

Keep dry and treat with antibiotic ear drops

“Swimmer’s ear”
Inflammation of external ear
Symptoms: discomfort, pain, itch and discharge from external ear

Rare complication: Malignant otitis externa

49
Q

Malignant otitis externa

A

IV antibiotics - immediate admission

Rare complication of otitis externa
Very serious, potentially life-threatening, immunocompromised inc. diabetes at risk

Becomes invasive and erodes through petrous part of temporal bone

50
Q

Acute otitis media

A

Usually viral cause - symptomatic treatment e.g. paracetamol

Bulging of TM is secondary to bacterial cause (Strep pneumoniae or Haemophilus influenzae) - build-up of pus/exudate within middle ear - increases pressure -> otalgia +/- fever, red TM
- sudden relief when ruptures
1st line - Amoxicillin 5-7 days ear drops
2nd line - Co-amoxiclav ear drops
If penicillin allergy - Clarithromyocin

Complications:
- Mastoiditis
- Involvement of facial nerve (intrapetrous branches -> nerve to stapedius and chordae tamponae)
- Intercranial complications e.g. meningitis, sigmoid sinus thrombosis, brain absess

51
Q

Otitis media with effusion

A

Most resolve spontaneously in 2-3 months
If persistent or impedes speech and language development - referral to ENT, may need grommets to maintain equilibrium

“Glue ear”
TM retracted and sometimes evidence of fluid (mucus - can see air bubbles) within middle ear

52
Q

Mastoiditis

A

Urgent referral for IV antibiotics / surgery

As middle ear cavity communicates via mastoid antrum with mastoid air cells
Provides route for middle ear infections to spread into mastoid (temporal) bone

53
Q

Cholesteatoma

A

Surgery

Chronic -ve pressure in middle ear (ET dysfunction)
Pars flaccida (more vulnerable as less tense) forms pocket
Stratified squamous epithelia and keratin trapped -> proliferate -> cholesteatoma
Not malignant but slowly grows and expands - can lead to enzymatic bony destruction -> erode ossicles, mastoid/petrous bone, cochlea

Painless, often smelly otorrhea +/- hearing loss

54
Q

Acute labrynthitis

A

Usually self-limiting and resolves within 2 weeks - Supportive treatment e.g. fluids and rest

Hx of URTI (viral)
Involvement of all inner ear structures associated with hearing loss/tinnitus, vomiting and vertigo (very acute presentation)

55
Q

Acute vestibular neuronitis

A

Severe, initial symptoms usually last 2–3 days but usually recover gradually over a period of weeks through a process of central nervous system compensation

Symptomatic treatment can be used acutely e.g. oral prochlorperazine

Hx of URTI (viral)
Usually no hearing disturbance or tinnitus - just vestibular
Sudden onset vomiting and severe vertigo (lasting days)
Thought to be due to inflammation of the vestibular nerve

56
Q

Post-streptococcal glomerulonephritis

A

Antibiotics

1-3 weeks following group A beta-haemolytic streptococcal infection (e.g. Strep pyogenes) normally from tonsils, pharynx or skin

57
Q

Stye

A

Warm compresses +/- oral antibiotics

Superficial infection of lash follicle gland with staphylococcus
Red with white punctum
Lump on outer part (margin) of eyelid

58
Q

Meibomian cyst

A

1/3 resolve spontaneously, may need surgical incision if persists

Blocked duct of meibomian gland
Painless, firm and palpable lump deeper within the lid which enlarges gradually
Non-infective cause

59
Q

Blepharitis

A

Warm compress and lid hygiene

Inflammation of eye-lid margin
Crusting, dry eye-lids +/- swollen and red
Causes: Staphylococcus infection, meibomian gland dysfunction

60
Q

Pre-septal (periorbital) cellulitis

A

Broad-spectrum IV antibiotics
Refer if unsure (e.g. can’t open eye)

Infection involving superficial tissues (anterior to septum)
Secondary to superficial infections e.g. from bites, wounds
Painful
Ocular function (movements and vision) are unaffected

61
Q

Post-septal (orbital) cellulitis

A

Broad spectrum IV antibiotics - urgently refer (opthalmology, ENT +/- neurosurgery)

Infection involving tissues within orbit (posterior to septum)
Spread of infection from paranasal air sinus (sinusitis)
Proptosis/exopthalmous
Reduced +/- painful eye movements
Reduced visual acuity

Risk of spread intercranially -> cavernous sinus thrombosis, meningitis
Risk of permanent blindness

62
Q

Conjunctivitis

A

Self limiting but very contagious - good hygiene to avoid spread

Typically viral cause (e.g. adeno-)
Uncomfortable, gritty but not normally painful
Watery +/- discharge

Pharmacology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions