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Infections Flashcards

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1
Q

Are narrow- spectrum antibacterials preferred or broad- spectrum?

A

Narrow- spectrum preferred
UNLESS it is clear clinically whats causing infection

Thats why you should test to see what organism is causing it

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2
Q

What does the dose of antibacterial drugs depend on? (5)

A
  • age
  • weight
  • hepatic function
  • renal function
  • severity of infection
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3
Q

What does the route of administration of an antibacterial drug depend on? (1)

A

severity of infection

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4
Q

What route of administration is usually used for life- threatening infections? (1)

A

IV

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5
Q

What does duration of therapy depend on? (2)

A
  • type of infection
  • the response of the infection to treatment
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6
Q

What are the disadvantages of un needed prolonged courses of antibacterial drugs? (3)

A
  • encourage resistance
  • may lead to side- effects
  • costly
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7
Q

What types of antibacterials are suitable for use during pregnancy? (3)

A
  • penicillins
  • cephalosporins
  • nitrofurantoin may be used BUT avoid at term
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8
Q

What antibacterials should be avoided during pregnancy? (3)

A
  • diaminopyrimidines
  • quinolones
  • trimethoprim PARTICULARLY in 1st trimester
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9
Q

What antibacterials should be avoided in renal impairment? (2)

A
  • tetracyclines
  • nitrofurantoin
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10
Q

If wanting to give aminoglycosides to someone with renal impairment, what must be done? (2)

A

Reduce the dose

As aminoglycosides are excreted by the kidney

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11
Q

Provide some examples of aminoglycosides: (5)

A
  • amikacin
  • gentamicin
  • neomycin
  • streptomycin
  • tobramycin
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12
Q

What is the mechanism of action of aminoglycosides? (4)

A

Bactericidal

Irreversibly binding to ribosomes

Inhibit protein synthesis

Causes fissure which ENHANCES UPTAKE of ANTIBIOTIC & LEAKAGE of cell contents

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13
Q

What type of bacteria are aminoglycosides active against? (2)

A

Broad- spectrum

Mostly against Gram - ve

But also some Gram + ve

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14
Q

What are the indications of aminoglycosides? (4)

A
  • CNS infections: endocarditis, septicaemia, meningitis

-Biliary-tract infection

  • Prostitis
  • Pneumonia
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15
Q

Which aminoglycosides are active against P. aeruginosa? (3)

A

Amikacin, Tobramycin and Gentamicin

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16
Q

Which aminoglycoside is active against M. tuberculosis? (1)

A

Streptomycin

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17
Q

What are side effects of aminoglycosides? (8)

A
  • may impair neuromuscular transmission
  • irreverisible ototoxicity
  • nephrotoxicity
  • nausea
  • vomiting
  • antibiotic associated colitis
  • peripheral neuropathy
  • electrolyte disturbances

MINNVAPE

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18
Q

Which patients should we take caution in when giving aminoglycosides? (1)

And we should also take caution when pts taking aminoglycosides with what drugs? (2)

A

caution in patients with clinical muscular weakness, e.g. myasthenia gravis

avoid concomitant use with ototoxic drugs, e.g. cisplatin and furosemide

avoid concomitant use with nephrotoxic drugs e.g. vancomycin and ciclosporin

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19
Q

What are examples of ototoxic drugs?

A

cisplatin and furosemide

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20
Q

What are examples of nephrotoxic drugs?

A

vancomycin and ciclosporin

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21
Q

Why are aminoglycosides given parenterally for systemic infections?

A

they are not absorbed from the gut

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22
Q

Although aminoglycosides are given parenterally, neomycin can be given orally for two indications. What can neomycin be given orally for? (2)

A

bowel sterilisation before surgery

liver failure

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23
Q

Are once-daily doses of aminoglycosides preferred over multiple daily doses?

A

Yes

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24
Q

What is the aminoglycoside of choice in the UK?

A

Gentamicin

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25
What is the therapeutic range of gentamicin like?
Narrow
26
What should the post- dose (peak) serum concentration be for multiple daily dose regimens of gentamicin? How would this change in endocarditis? (2)
Measured one hour after dose 5- 10mg/ L 3 - 5 mg/L for endocarditis (High levels suggest potential toxicity; reduce the dose accordingly)
27
What should the pre- dose (trough) concentration be for multiple daily dose regimens of gentamicin? How would this change in endocarditis? (2)
This is measured just before the next scheduled dose. < 2mg/ L <1mg/ L for endocarditis High levels suggest inadequate drug clearance; adjust dosing interval.
28
What should we monitor in all aminoglycosides? (3)
Renal function (as can cause nephrotoxicity) Auditory and vestibular function (as can cause irreversible ototoxicity) Serum- aminoglycoside in certain groups of patient
29
In which patients should serum- aminoglycoside concentration be determined? (6)
Elderly Those receiving parenteral treatment Renal impairment Obesity Cystic fibrosis Those receiving high doses
30
What warning signs should patients on aminoglycosides look out for and what should they do if they see these signs?(3)
Nephrotoxicity Ototoxicity (hearing impairment or disturbance) Dehydration (ensure patient is well hydrated before treatment to prevent dehydration) ## Footnote If these signs are seen, patients should REPORT all to their doctor immediately.
31
Can aminoglycosides be given in pregnancy? (2)
Risk of auditory and vestibular nerve damage in 2nd and 3rd trimester Avoid unless essential
32
What are drug interactions of aminoglycosides? (2)
Increased risk of ototoxicity when given with furosemide (loop diuretics), vancomycin,cisplatin Increased risk of nephrotoxicity when given with ciclosporin, tacrolimus, vancomycin
33
What are signs of nephrotoxicity? (2)
Low urine output/creatinine clearance high serum creatinine/urea (Make sure to assess renal function of patient before treatment; correct dehydration)
34
What reaction can some batches of aminoglycosides cause? (3)
histamine-related adverse drug reactions Monitor for signs of histamine-related reactions Exercise caution with concomitant drugs known to cause histamine release, especially in children and severe renal impairment.
35
What are the five generations of cephalosporins? (4)
1st cefalexin, cefradine, cefadroxil (bd) 2nd cefaclor, cefuroxime 3rd cefixime, ceftriaxone 5th ceftaoline fosamil
36
What is the mechanism of action of cephalosporins? (3(
Bactericidal Prevent cell wall synthesis By binding to enzymes called penicillin binding proteins (PBPs)
37
What types of bacteria are cephalosporins active against? (1)
Both Gram -ve and Gram +ve
38
What indications are cephalosporins given for?(4)
Pneumonia Meningitis Gonorrhoea UTIs
39
What are the side effects of cephalosporins?
Antibiotic associated colitis (rare but more common with 2nd and 3rd generation)
40
Which generations of cephalosporins tend to be given orally?
1st and 2nd
41
Which generation of cephalosporins tend to be given parenterally? Which one is an exception? (2)
3rd and 5th except for cefixime in the 3rd generation, which is orally active
42
Cephalosporins should not be administered to individuals with a history of what hypersensitivity? What would you do if no alternative is available? (2)
with a history of immediate penicillin hypersensitivity. Alternatives: If no alternative is available and essential, consider 3rd generation cephalosporins or cefuroxime (2nd generation)
43
Should cefuroxime (2nd gen) be given with or without food?
Needs to be given with food to maximise absorption as it is POORLY absorbed
44
Which generations of cephalosporins are less susceptible to inactivation by beta- lactamases?
2nd and 3rd generations
45
What are examples of glycopeptides?
Vancomycin, Teicoplanin, Telavancin
46
What is the mechanism of action of glycopeptides? (2)
Binds to cell wall precursor components Inhibits cell wall synthesis
47
What bacteria's are glycopeptides active against? (1)
Aerobic and anaerobic gram+ ve bacteria including MRSA
48
What are the indications of glycopeptides? (3)
Clostridium difficile infection Endocarditis Surgical prophylaxis when high risk of MRSA
49
What are the side effects of glycopeptides? (9)
Nephrotoxicity Ototoxicity Blood disorders Nausea Chills Fever Rashes Steven-Johnson syndrome Flushing of the upper body
50
Who should we avoid vancomycin in? (2)
The elderly patients with a history of auditory problems
51
What should we monitor when administering glycopeptides? (6)
In all glycopeptides, monitor: blood counts hepatic function renal function urinalysis plasma levels auditory function in elderly
52
Are glycopeptides narrow or broad spectrum?
Narrow spectrum
53
Are vancomycin and teicoplanin given orally for systemic infections?
No
54
Why may loading doses be required for vancomycin?
Have a long half- life
55
What should the pre- dose "trough" level be for vancomycin? How can this change for endocarditis, less sensitive MRSA strains, or complicated S. aureus infections? (2)
10-15mg/mL 15-20mg/L for endocarditis, less sensitive MRSA strains, or complicated S. aureus infections
56
What are warning signs of glycopeptides? What must patients do if they experience these? (6)
Ototoxicity (hearing loss, vertigo, dizziness, tinnitus) Red man syndrome (flushing of the upper body) Blood disorders (fever, sore throat, mouth ulcers, unexplained bleeding or bruising) Phlebitis (drug irritates tissue causing inflammation) Nephrotoxicity (elevated serum creatinine levels) Skin disorders (rashes, pruritic, SJS) Patient must report all to a doctor immediately
57
What can happen if glycopeptides are administered too quickly?
Hypotension and anaphylaxis can occur
58
Can glycopeptides be given in pregnancy? (2)
Manufacturer advices avoiding If used, it is essential to monitor plasma concentration. This is to minimise foetal toxicity
59
Can glycopeptides be given when breastfeeding?
It is present in milk but significant absorption is unlikely
60
What are interactions of vancomycin (glycopeptides)? (3)
NEPHROTOXICITY AND OTOTOXCITY: Ciclosporin, aminoglycosides, polymyxin antifungals OTOTOXICTY: loop diuretics ENHANCES effects of suxamethonium
61
What is the mechanism of action of clindamycin (a lincosamide)? (3)
Bacteriostatic Binds to ribosomes Inhibits cell wall protein synthesis
62
What types of bacteria is clindamycin active against?
Gram +ve aerobes and anaerobes
63
What are the indications of clindamycin? (4)
Staphylococcal joint and bone infections Intra-abdominal sepsis Cellulitis Skin and soft- tissue infections
64
What individuals require monitoring when administering clindamycin? (2)
Infants(monitor hepatic and renal function) those being treated for > 10 days
65
What are side effects of clindamycin? (7)
GI disturbances Oesophageal disorders Taste disturbances Jaundice Blood disorders Rashes SJS
66
What should a patient on clindamycin do if they develop diarrhoea? (2)
DISCONTINUE treatment immediately if diarrhoea develops and CONTACT GP as antibiotic associated colitis can be fatal
67
Who should we not use clindamycin in?
Patients with existing diarrhoea
68
What type of individuals is antibiotic-associated colitis more common in? (2)
Middle-aged and elderly women Especially post-operation
69
What are examples of macrolides? (3)
erythromycin azithromycin clarithromycin
70
What is the mechanism of action of macrolides? (2)
Bacteriostatic Binds to ribosomes Inhibiting cell wall protein synthesis
71
What antibacterial is a good alternative in penicllin-allergic patients? (2)
Macrolides have similar activity to penicillin
72
What are indications of macrolides? (3)
respiratory tract infections e.g. whooping cough, lyme disease H Pylori Skin and soft tissue infections
73
What are side effects of macrolides (4)
Gi disturbances mainly with erythromycin hepatotoxicity rash (SJS) ototoxicity at high doses
74
What are contraindications of macrolides? (2)
may aggravate myasthenia gravis use in caution with patients predisposed to QT interval prolongation i.e electrolyte disturbances & taking drugs that prolong QT interval such as sotalol
75
What is telithromycin?
A derivate of erythromycin
76
What are side effects of telithromycin? (4)
May cause visual disturbances transient loss of consciousness affect performance of skilled tasks and driving hepatotoxicity: discontinue treatment and seek medical advice
77
Are macrolides broad or narrow spectrum?
broad
78
How should azithromycin be taken? (2)
OD leave a 2- hour gap before food/indigestion remedies
79
How should clarithromycin be taken?
BD
80
What is a side effect of clarithromycin?
taste disturbance
81
How should erythromycin be taken? (2)
QDS leave a 2- hour gap before indigestion remedies
82
What can spiramycin cause?
Toxoplasmosis
83
Are erythromycin and clarithromycin potent enzyme inhbiitors or inducers?
potent enzyme inhibitors
84
Why can macrolides interact with warfarin? (2)
potent enzyme inhibitors increased risk of bleeding
85
why can macriolides interact with statins?
increased risk of myopathy
86
What is the mechanism of action of metronidazole? (5)
Bactericidal a pro- drug the active form binds to DNA disrupts its helical structure inhibiting bacterial DNA synthesis
87
What types of bacteria does metronidazole have high activity against?
anaerobic bacteria and protozoa
88
What are the indications of metronidazole? (5)
ALTERNATIVE TO PENICILLIN for many ORAL infections where patients are either ALLERGIC to penicillin or the infection is being caused by PENICILLIN- RESISTANT anaerobes H. Pylori eradication Acute oral infections Leg ulcers Pressure sores
89
What are side- effects of metronidazole?(5)
GI disturbances Taste disturbances Furred tongue Oral mucositis Anorexia
90
When should we monitor patients on metronidazole?
if treatment exceeds 10 days
91
How should we take metronidazole? (2)
Take with or just after food Avoid alcohol whilst taking and for up to 48 hours after. Can cause disulfiram- like reaction with alcohol i.e nausea and vomiting.
92
Which penicillins are beta- lactamase sensitive? (3)
pen V Pen G Amoxicillin
93
Which penicillin is penicillinase- resistant?
Flucloxacillin
94
What is the mechanism of action of penicillins? (2)
Prevent peptidoglycan cross- linking Inhibit bacterial cell wall synthesis
95
Which bacterias is penicillin active against? (2)
Gram - ve and Gram + ve
96
What are the indications of penicillins? (5)
Oral infections Otitis media Cellulitis Respiratory tract infections Pneumonia
97
What are side effects of penicillins? (6)
Hypersensitivity (1- 10%) Anaphylaxis (<0.05%) Maculopapular rash is common with ampicillin and amoxicillin Diarrhoea Antibiotic associated colitis CNS toxicity: rare but serious. Caused by encephalopathy due to cerebral irritation, occurs at high doses or renal impairment
98
Maculopapular rash is common with which penicillins? (2)
Ampicillin and Amoxicillin
99
What the side effect of penicillins CNS toxicity caused by? When does it occur? (2)
Caused by encephalopathy due to cerebral irritation occurs at high doses or renal impairment
100
Which patients prescribed penicillin are at higher risk of experiencing an anaphylaxis reaction? (2)
with a history of penicillin allergy patients with atopic allergy e.g. asthma, hay fever, eczema
101
A patient experiences a rash 72 hours after administering penicillin. Is this anaphylaxis?
No
102
What is common with most- broad spectrum antibiotics?
Diarrhoea/ antibiotic associated colitis
103
How should penicillins be taken? (2)
On an empty stomach An hour before food or 2 hours after
104
What is a side effect of co- amoxiclav? Who is this side effect more common in?
Cholestatic jaundice More common in patients above the age of 65 years and in men
105
You cannot give co- amoxiclav for more than how many days?
14 days
106
Is jaundice fatal?
No. It is usually self- limiting and very rarely fatal
107
What may occur very rarely to patients taking flucloxacillin up to two months after treatment? (2)
Cholestatic jaundice and hepatitis Particularly if they took it for more than 2 weeks and the older u are, the higher the risk
108
In which patients should flucloxacillin not be used in? (3)
Hypersensitivity reactions to beta- lactam antibacterial In patients with a history of hepatic dysfunction associated with flucloxacillin Use with caution in patients with hepatic impairment
109
What are examples of quinolones? (5)
Ciprofloxacin Levofloxacin Moxifloxacin Norfloxacin Ofloxacin
110
What is the mechanism of action of quinolones?
Inhibits enzymes necessary for bacterial DNA replications
111
Which bacteria's are quinolones active against?
Gram +ve and Gram -ve
112
What are indications of quinolones? (4)
Respiratory tract infections Anthrax Gonorrhoea UTIs
113
Which patients should quinolines be used with caution in? (5)
history of joint disorders epilepsy or predisposition to seizures G6PD deficiency Myasthenia gravis children or adolescents (risk of arthropathy)
114
Can quinolones be used in pregnancy?
No, avoid
115
What should we counsel on when they are taking quinolines? (2)
Avoid exposure to EXCESSIVE sunlight Avoid concomitant use with NSAIDs (increased convulsion risk)
116
What are side effects of quinolines? (7)
GI disturbances (rarely antibiotic associated colitis) headache dizziness moxifloxacin associated with QT interval prolongation life- threatening hepatotoxicity may induce convulsions in pts with/ without history. Also if they take NSAIDs at same time. Rare risk of tendon damage within 48 hours of starting treatment
117
Who is at risk of experiencing the rare risk of tendon damage caused by quinolones? (2)
patients over 60 concomitant use of corticosteroids
118
What are examples of diaminopyrimidines? (2)
Co- trimoxazole Trimethoprim
119
What is the mechanism of action of diaminopyrimidines?
Block different steps in the synthesis of nucleic acids essential to many bacteria
120
Which bacterias are diaminopyrimidines effective against?
Gram +ve and Gram -ve
121
What are indications of diaminopyrimidines? (4)
Pneumonia Respiratory tract infections Shigellosis UTIs
122
What are side effects of diaminopyrimidines? (2)
SJS blood disorders especially in the elderly
123
What are contraindications of diaminopyrimidines? (5)
Blood dyscrasia Asthma GP6PD deficiency Elderly Predisposition to folate deficiency or hyperkalaemia
124
Can we give diaminopyrimidines in pregnancy?
Avoid in first trimester of pregnancy (folate antagonist is teratogenic)
125
What should we monitor for patients on long- term therapy of diaminopyrimidines?
Blood count
126
How should we counsel patients taking diaminopyrimidines? (2)
Maintain adequate fluid intake Seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop
127
Why are there restrictions on the use of co- trimoxazole? (2)
drug of choice in the prophylaxis and treatment of penumocytits jivorecci pneumonia also other indications but need good reason to use
128
What are examples of tetracyclines? (3)
Tetracycline Doxycyline Minocycline
129
What is the mechanism of action of tetracyclines?
Taken up into bacterial cells Inhibit protein synthesis So inhibit cell growth
130
What are the indications of tetracyclines? (4)
Chlamydia Rickettsia Acne Rosacea
131
What are the side effects of tetracyclines? (9)
GI disturbances Antibiotic-associated colitis Dysphagia Oesophageal irritation Hepatotoxicity Blood disorders Photosensitivity Hypersensitivity Headache and visual disturbances indicate increased intracranial pressure (discontinue treatment)
132
A patient is taking tetracyclines and complains of headache and visual disturbances. What can this indicate and what must the patient do? (2)
Headache and visual disturbances indicate increased intracranial pressure Patient should discontinue treatment
133
What are contraindications of tetracyclines? (3)
Hepatic and renal impairment Myasthenia gravis: may increase muscle weakness May exacerbate systemic lupus erythematous
134
Should tetracyclines be avoided in children under 12?
Yes
135
Can tetracyclines be given to pregnant/ breast feeding women? (2)
No avoid As tetracyclines can leave deposition in growing bone and also stain teeth
136
What things can decrease the absorption of tetracyclines? (7)
Antacids Aluminium Calcium iron Magensium Zinc salts Also milk MAY reduce its absorption too
137
How should tetracyclines be taken?
The tablets and capsules should be swallowed WHOLE with plenty of fluid while standing or sitting to avoid irritation of the jaw and throat
138
Which tetracycline should be taken with food?
Doxycycline
139
When should daptomycin be discontinued?
If patient has unexplained muscular symptoms with significantly elevated creatine kinase (measure creatinine kinase every 2 days)
140
Give an example of an oxazolidinone?
Linezolid
141
What is the mechanism of action of linezolid? (2)
Selectively inhibits bacterial protein synthesis It is a reversible, non- selective monoamine oxidade inhibitor (MAOI)
142
What is linezolid active against? (3)
Gram + bacteria MRSA vancomycin- resistant cocci
143
What are indications of linezolid? (2)
Pneumonia Complicated skin & soft- tissue infections
144
What are side- effects of linezolid? (6)
Diarrhoea eosinophilia headache GI disturbances taste disturbances optic neuropathy
145
What are contraindications of linezolid? (5)
Confusional states Bipolar depression Elderly (increased risk of blood disorders) History of seizures Uncontrolled hypertension
146
What should we monitor in patients taking linezolid?
Monitor full blood count weekly
147
What should patients taking linezolid avoid eating/ drinking?
Avoid eating large amounts of tyramine- rich foods (such as mature cheese, undistilled alcoholic beverages, and fermented soya bean products).
148
What medications should linezolid not be given with? (3)
linezolid should not be given with another MAOI or within 2 weeks of stopping another MAOI should also be avoided in those recieving SSRIs, 5HT1 agonists ('triptans'), tricyclic antidepressants, sympathomimetics, dopaminergics, buspirone, pethidine and possibly other opiod analgesics
149
Linezolid can cause blood disorders. We should closely monitor the full blood count in the following patients:
those who recieve treatment for more than 10- 14 days have pre- existing myelosuppresion are recieving drug that may have adverse effects on haemoglobin, blood counts or platelet function have severe renal impairment
150
What should be done if significant myelosuppresion occur when taking linezolid?
Treatment should be stopped unless it is considered essential in which case intensive monitoring of blood counts and appropriate management should be implemented.
151
What side effect may RARELY occur if linezolid is used for longer than 28 days?
Severe optic neuropathy
152
To ensure that a patient taking linezolid is not experiencing severe optic neuropathy, what should patients do?
patients should be warned to report symptoms of visual impairment immediately (including blurred vision, visual field defect, changes in visual acuity and colour vision)
153
What should be done for patients on linezolid experiencing new visual symptoms? (3)
evaluate the patient promptly and refer to an opthalmologist if necessary regardless of treatment duration
154
What should we monitor regularly for patients taking linezolid for longer than 28 days?
visual function
155
The MANAGEMENT of TB is divided in to two stages. What are these?
Initial phase Continuous phase
156
What the is initial phase of treating TB designed to do?
The initial phase is designed to rapidly reduce the population of M . tuberculosis, to minimise bacterial resistance
157
What four drugs are involved in the treatment of TB in the initial phase? How long are these drugs given for?
The four drugs are: isoniazid, rifampicin, pyrazinamide, ethambutol The initial phase treatment lasts for two months
158
What two drugs are involved in the continuous phase? How long are these drugs given for?
Isoniazid and rifampicin The continious phase treatment lasts for four months
159
What should we monitor in patients taking anti- tuberculosis drugs? (8)
Drug levels Visual acuity Blood counts hepatic function renal function urinalysis plasma levels auditory function in elderly
160
What is nitrofurantoin? (3)
A broad spectrum antibacterial Active against the majority of urinary pathogens It is bactericidal in renal tissue and throughout the urinary tract
161
What are the side effects of nitrofurantoin? (5)
Pulmonary reactions Nausea and anorexia Hypersensitivity Peripheral neuropathy Blood disorders
162
What must we monitor in patients taking long- term therapyy of nitrofurantoin (especially in the elderly)? (2)
Hepatic function Pulmonary function
163
Nitrofurantoin discolours the urine to?
dark yellow or brown
164
Before starting nitrofurantoin, a specimen of urine should be collected for culture and sensitivity testing in the following patients: (7)
in men in pregnant women in children under 3 years of age in patients with suspected upper urinary- tract infection, complicated infection or recurrent infection if resistant organisms are suspected if urine dipstick testing gives a single positive result for leucocyte esterase or nitrite if clinical symptoms are not consistent with results of dipstick testing. (NOTE: treatment should not be delayed while waiting for results)
165
What type of patients may receive antifungal drugs prophylactically? (2)
immunocompromised patients as they are at high risk of fungal infections
166
which antifungal drugs are the choice of drug for fungal infection prophylaxis?
oral triazole antifungals
167
Out of fluconazole and itraconazole, which one is more reliably absorbed?
fluconazole
168
Why is a test IV dose of the antifungal drug amphotericin B needed before it is fully given? (3)
as risk of anaphylaxis patients need test dose and patients need to be carefully observed for at least 30 minutes after the test dose (only use prophylactic antipyretics or hydrocortisone in pts who have previously experienced acute adverse reactions)
169
Are different brands of amphotericin IV interchangeable? (3)
No prescribers need to specify the brand as each one varies pharmacodynamics
170
Who taking itraconazole is at risk of experiencing heart failure? (5)
patients recieving high doses and longer treatment courses older patients and those with cardiac disease patients with chronic lung disease associated with pulmonary hypertension patients recieving treatment with negative inotropic drugs e.g. calcium channel blockers
171
What is a rare risk of itraconazole? (2)
life threatening hepatotoxicity discontinue if signs develop
172
who should itraconazole be avoided in? (2)
avoid or use with caution if history of hepatotoxicity with other drugs or in active liver disease
173
when should we monitor liver function in patients taking itraconazole? (3)
if treatment continues for longer than one month if receiving other hepatotoxic drugs if history of hepatotoxicity with other drugs, or in hepatic impairment
174
when should patients on itraconazole seek prompt medical attention?
if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain or dark urine develop
175
how should itraconazole be taken?
oral preparations should be taken on an empty stomach
176
what are side effects of voriconazole? (2)
hepatotoxicity phototoxicity
177
in which pts is the side effect: hepatotoxicity of voriconazole increased? what symptoms would require pts to seek immediate medical attention? (2)
risk is increased with haematological malignancy seek immediate medical attention if symptoms such as: persistent nausea, vomiting, malaise or jaundice
178
how should pts on voriconazole reduce the risk of the side effect: phototoxicity (4)
to avoid intense or prolonged exposure to direct sunlight to avoid use of sunbeds cover skin in sun sunscreen with high sun protection factor
179
what should we monitor in pts on voriconazole? (2)
renal function hepatic function before starting treatments, then at least weekly for 1 month, then monthly during treatment
180
what should we monitor in patients on ketoconazole? (3)
ECG Adrenal function can cause adrenal insufficiency i.e fatigue, anorexia, vomiting, hypotension, hyponatraemia, hypoglycaemia hepatic function
181
what do signs of liver toxicity include? (6)
severe abdominal pain dark urine jaundice nausea vomiting fatigue
182
what are helminth infections?
most are parasitic worms that infect the large intestine of humans
183
what are symptoms of threadworm? (4)
itching around the anus and vagina loss of appetite weight loss sleep disturbance
184
what are symptoms of whipworm? (3)
GI disturbances colitis bloody- diarrhoea
185
What are symptoms of hookworm? (2)
most people dont have any symptoms severe infections may cause weight loss and anaemia
186
what are symptoms of roundworm? (3)
high temeprature dry cough worm in stools
187
what is the drug of choice for treating most helminth infections? *2)
mebendazole (same dose for adults and children over 2)
188
What measures can be taken to prevent mosquito bites and reduce the risk of mosquito-borne infections? (3)
Prevention is not absolute and ; breakthrough infection can occur. Personal protection against being bitten is very important. wear long sleeves and trousers after dusk, using mosquito nets impregnated with permethrin, and using mats and vaporized insecticides.
189
What is the recommended formulation of Diethyltoluamide (DEET) for adults and children over 2 months of age?
DEET formulations of 20–50% are considered safe and effective when applied to the skin of adults and children over 2 months of age.
190
How does DEET interact with sunscreen?
DEET reduces the SPF of sunscreen, so a sunscreen of SPF 30-50 should be applied first, followed by the application of DEET.
191
When should prophylaxis generally be initiated before traveling to an endemic area? (2)
Prophylaxis should generally be started one week before travel into an endemic area. but does depend on anti- malarial drug
192
when before travel should mefloquine prophylaxis be started
Mefloquine prophylaxis should be started 2–3 weeks before travel into an endemic area.
193
How soon before travel should prophylaxis with Malarone® or doxycycline be started?
Prophylaxis with Malarone® or doxycycline should be initiated 1–2 days before travel into an endemic area.
194
How long should prophylaxis be continued after leaving an endemic area, and are there any exceptions? (2)
Prophylaxis should generally be continued for 4 weeks after leaving an endemic area, except for Malarone® which should be stopped 1 week after leaving.
195
What should travelers do if they develop any illness within a year of returning from a malarial region?
Travelers should go immediately to a doctor if they develop any illness. As any illness within 1 year and especially within 3 months of return from a malarial region might be malaria.
196
Why are chloroquine and mefloquine considered unsuitable for patients with epilepsy?
due to the risk of neuropsychiatric reactions.
197
What advice is given for individuals with asplenia regarding malaria prevention?
they are at an increased risk of severe malaria and need to be extra cautious against contracting malaria.
198
What precautions should be taken for patients with renal impairment regarding malaria prophylaxis?
Proguanil should be avoided, and Malarone® should not be used in patients with EGFR <30.
199
What advice is given regarding travel to malarious areas for pregnant individuals?
Pregnant individuals are advised to avoid travel to malarious areas. If taking proguanil, folic acid should be given for the first trimester. Doxycycline is contraindicated during pregnancy but can be used after 15 weeks' gestation. Malarone® should be avoided during pregnancy.
200
Why do breast-fed infants require prophylaxis against malaria?
as the amounts of antimalarial drugs in breast milk are too variable to provide reliable protection.
201
What precautions should travelers taking warfarin take regarding chemoprophylaxis? (5)
Travelers taking warfarin should begin chemoprophylaxis 2–3 weeks before departure Their INR should be stable before departure and should be measured before starting chemoprophylaxis, 7 days after starting and 7 days after completing the course.
202
What is the recommended daily dose of Chloroquine (Avloclor) to minimize the risk of ocular toxicity?
4mg/kg daily (or less)
203
What is the main concern regarding Mefloquine (Lariam) in individuals with a history of psychiatric disorders? (2)
Mefloquine is contraindicated in individuals with a history of psychiatric disorders due to the risk of neuropsychiatric reactions. These reactions include abnormal dreams, insomnia, anxiety, depression, and, in severe cases, psychosis, suicidal ideation, and suicide.
204
What should patients do if they experience neuropsychiatric symptoms while taking Mefloquine?
If neuropsychiatric symptoms occur, patients should discontinue Mefloquine immediately and seek immediate medical attention. It's important to note that adverse reactions may continue for several months after stopping Mefloquine due to its long half-life.
205
How might Mefloquine affect a person's ability to perform skilled tasks like driving?
Mefloquine can cause dizziness or a disturbed sense of balance , which may affect the performance of skilled tasks like driving. These effects can persist for several months after stopping Mefloquine.
206
When using Quinine for malaria treatment, which salt forms are doses valid for? (2)
The recommended doses of Quinine for treating malaria apply to specific forms of the drug: quinine hydrochloride, quinine dihydrochloride, and quinine sulfate. However, these doses do not apply to quinine bisulfate.
207
What drugs are commonly used to treat herpesvirus infections? (3)
aciclovir famciclovir valaciclovi
208
What is the typical treatment approach for herpes simplex infections? (3)
Treatment for herpes simplex infections should start as early as possible, usually within 5 days of the appearance of the infection. Mild superficial infections are treated with topical antiviral drugs like aciclovir cream while more severe infections and genital herpes require treatment with systemic antiviral drugs such as aciclovir tablets.
209
How should neonates with varicella-zoster (chickenpox virus) infections be treated?
Neonates with varicella-zoster infections should be treated with parenteral antiviral to reduce the risk of severe disease. (However, in healthy children between 1 month and 12 years, antiviral treatment is usually not required unless the disease is severe)
210
What is the recommended timing for initiating and continuing antiviral treatment in herpes zoster (shingles) infections? (2)
In herpes zoster infections, systemic antiviral treatment should be started within 72 hours of the onset of rash and is usually continued for 7–10 days.
211
What is the main goal of treatment for HIV infection? What drugs is this achieved through? (2)
The main aim of treatment for HIV infection is to prevent mortality and morbidity while minimizing drug toxicity and reducing the risk of HIV transmission to sexual partners. This is achieved through a combination of drugs known as 'highly active antiretroviral therapy', which includes drugs like zidovudine, abacavir, didanosine, lamivudine, and tenofovir.
212
What drugs are effective for reducing the replication of influenza A and B viruses? When are they most effective? (2)
Oseltamivir and zanamivir are effective for reducing the replication of influenza A and B viruses. They are most effective when started within a few hours of the onset of symptoms.
213
What are the symptoms of Varicella Zoster (chicken pox)? (2)
Varicella Zoster (chicken pox) presents with a red rash and itchy spots that turn into fluid-filled blisters after 12 hours. These blisters will crust over after a week.
214
Describe the symptoms of Herpes Zoster (shingles).
Herpes Zoster (shingles) typically begins with pain, followed by a tingling or numb rash that develops into itchy blisters, similar in appearance to chickenpox.
215
What are the symptoms of Herpes simplex (cold sores)?
Herpes simplex (cold sores) is characterized by a tingling, itching, or burning sensation around the mouth, followed by the appearance of small fluid-filled sores.
216
Describe the symptoms of Impetigo.
Impetigo presents with red sores that quickly burst, leaving behind thick, golden crusts, typically around 2cm across.
217
What are the symptoms of Hand, foot and mouth disease?
Hand, foot, and mouth disease is characterized by mouth ulcers appearing after one or two days, followed by a rash made up of small, raised red spots on the skin. These spots may turn into small grey blisters.
218
Describe the appearance of Molluscum contagiosum.
Molluscum contagiosum presents as small, firm, raised, flesh-colored spots on the skin, with a thick yellowish-white substance released if the spots are popped.
219
What are the symptoms of Scarlet fever?(6)
sore throat headache swollen glands red rash that feels like sandpaper red cheeks white or red tongue.
220
What are the symptoms of Slapped cheek syndrome?
Slapped cheek syndrome presents with a bright red rash on the cheeks, temperature, sore throat, runny nose, and headache.
221
How do Verrucas typically appear?
Verrucas appear on the soles of the feet as white with a black dot in the center, and they are flat rather than raised.
222
Describe the appearance of Warts.
Warts are typically round or oval-shaped, firm, and raised
223
Which herpes simplex virus (HSV) is generally associated with infections of the mouth and lips, as well as the eye?
Herpes simplex virus type 1 (HSV-1)
224
What types of herpes simplex virus (HSV) are most often associated with genital infections?
Genital infections are most often associated with both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
225
What are some general signs and symptoms of infections?
General signs and symptoms of infections include fever, malaise, and aches and pains.
226
What localized signs and symptoms might indicate an infection?
Localized signs and symptoms of infections include the presence of pus, swelling, and inflammation at the site of infection.
227
How might infections manifest differently based on age? (2)
drowsiness in children confusion in the elderly
228
What clinical markers might indicate an infection with a focus on the renal system?
worsening renal function.
229
What vital signs might be indicative of an infection? (2)
low blood pressure raised blood glucose levels
230
Which lab values could suggest the presence of an infection? (5)
high erythrocyte sedimentation rate (ESR high C-reactive protein levels elevated temperature increased respiratory rate elevated pulse rate.
231
What is the mechanism of action of Chloramphenicol?
Chloramphenicol inhibits protein synthesis.
232
What is the spectrum of activity of Chloramphenicol?
Chloramphenicol has a broad-spectrum of activity.
233
How does Chloramphenicol typically act on bacteria?
Chloramphenicol exerts a bacteriostatic effect, meaning it inhibits the growth of bacteria.
234
What are the risks associated with Chloramphenicol use? Who should it be avoided in? (2)
The risks associated with Chloramphenicol use include blood dyscrasias and Grey Baby Syndrome. It should be avoided in pregnant women.
235
Which tetracyclines are photosensitive so pts need to avoid excessive light? (2)
Demeclocycline Doxycycline (DD)
236
With which tetracyclines should milk be avoided? (3)
Demeclocycline Oxytetracycline Tetracycline (DOT)
237
Which tetracyclines can cause oesophageal irritation and thus need to be swallowed whole? (3)
Doxycycline (capsules) Minocycline (tabs/ caps) Tetracycline (tabs) (DMT)
238
Which anti- TB drugs have side effect: liver toxicity? (3)
Isoniazid rifampicin pyrazinamide
239
Which anti- TB drug has side effect: peripheral neuropathy? (1)
Isoniazid
240
Which anti- TB drug has side effect: ocular toxicity
ethambutol
241
242
Describe the symptoms of Scabies.
Scabies is characterized by intense itching, a rash with tiny red spots, and burrow marks that appear as wavy, silver-colored lines on the skin.
243
What are the symptoms of Mumps?
Mumps is characterized by swollen salivary glands, fever, headache, and joint pain.
244
What are the symptoms of Tinea corporis (ringworm)?
Tinea corporis (ringworm) affects the arms and legs, presenting as round, red, or silvery patches of skin that may be scaly, inflamed, and itchy.
245
What are the symptoms of Measles/Rubella?
Measles/Rubella presents with cold-like symptoms and a red-brown blotchy rash that lasts for 3 days.
246
What is the presentation of Tinea cruris?
Tinea cruris manifests as a fungal groin infection, characterized by itchy inflammation with a visible patch of dry scaly skin.
247
Out of fluconazole and itraconazole which one is preferred in patients at risk of invasive aspergillosis?
itraconazole
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