Infections

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  • Created by: AJ-A
  • Created on: 25-05-22 08:57
signs & symptoms of infection
fever, aches & pain, pus, inflammation, drowsiness in children, confusion in elderly, worsening renal function
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clinical markers for infections
low BP, raised blood glucose, High ESR, C-reactive protein, temperature, increased respiratory rate
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tetracyclines are contraindicated in which age group?
<12 yrs
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side effects of Tetracyclines
Angiodema, Nausea, Vomiting, Diarrhoea, headache, purpura, photosensitivity, Skin reactions
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There's an increased risk of C.Diff infections in which group of patients?
The elderly especially with Clindamycin
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What are alternatives in penicillin allergies?
Macrolides
Metronidazole in dental infections
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In renal impairment which antibioitics should you avoid
Nitrofurantoin (egfr <45)
tetracyclines (except minocycline and doxycycline)
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Examples of Aminoglycosides and Glycopeptides
aminoglycosides (gentamicin, amikacin, streptomycin) and glycopeptide (vancomycin, teicoplanin, televancin)
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In hepatic impairment which antibiotics are used?
Rifampicin and tetracycline
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In cholestatic jaundice which antibiotics are used
co-amoxiclav and flucloxacillin
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What are the safest antibiotics in pregnancy
Penicillin / Cephalosporin
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Clindamycin is bacteriostatic and a narrow spec antibacterial, what counsel would you give a patient?
To stop taking the medication if experiencing any signs of associated colitis e.g. diarrhoea
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Examples of gram-positive bacteria includes:
MRSA, anaerobes
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Linezolid is a narrow spec antibiotic which is an alternative to vancomycin in treating MRSA infection, it works by...
inhibiting protein synthesis (bacteriostatic)
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Side effects of Linezolid include
blood disorders and optic neuropathy if > 28 days use
Pt to report any visual symptoms
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Trimethoprim is a narrow-spec antibacterial and works by...
inhibiting DNA synthesis (bactericidal)
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Trimethoprim is commonly used in UTI's what is the dosage instruction?
200mg BD
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Common side effects of trimethoprim
- acts as an antifolate so should be avoided in first trimester of pregnancy as it can be teratogenic.
- Blood dyscrasias [patient should report fever, sore-throat, bruising, bleeding]
- Hyperkalaemia
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Chloramphenicol is a broad spec antibiotic and works by
inhibiting protein synthesis (bacteriostatic)
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Chloramphenicol is reserved for life-threatening conditions such as
Typhoid fever, pneumonia, meningitis
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metronidazole is a narrow-spec antibiotic and acts by
inhibiting DNA synthesis and has high activity against anaerobes and protozoa
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Anaerobic infections include
dental infections, antibiotic associated colitis, h.pylori, rosacea and bacterial vaginosis
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examples of protozoal infections include
vaginal trichomoniasis, giardiasis
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side effects of metronidazole include
GI disturbaces, taste disturbances, oral mucositis and furred tongue
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Pt counselling for Metronidazole dosage
Take with/after food and avoid alcohol
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Nitrofurantoin is bactericidal and is a_____ spectrum antibiotic
narrow
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Nitrofurantoin is solely used in
UTI's
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s/e of Nitrofurantoin is nausea and is contraindicated in infants less than...
3 months old
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Pt counselling of nitrofurantoin
take with or after food
Colours urine yellow/brown
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Aminoglycosides include
Gentamicin (against pseudomonas aeruginosa)
Tobramycin
streptomycin
neomycin
amikacin
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Aminoglycosides are broad spec and bactericidal, they're used in...
severe sepsis, pyelonephritis, complicated UTI and endocarditis
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Gentamicin is associated with rare cases of ototoxicity, list some other side effects
nephrotoxicity, aphonia, bronchospasm, cough, nausea, diarrhoea, headache
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glycopeptides are narrow-spec antibiotics that inhibit cell wall synthesis which makes them
bactericidal
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examples of glycopeptides include
vancomycin (active against MRSA), teicoplanin and televancin
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when vancomycin is given parenterally what are the main side effects
[nephrotoxicity and ototoxicity]
others include red-man syndrome, blood dyscrasias, thrombophlebitis (inflammation of veins at infusion site) and skin disorders
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Tetracyclines are broad-spec work by inhibiting protein synthesis therefore are
bacteriostatic
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Tetracyclines are used in:
lowering respiratory tract infections, acne, rosacea (skin infection typically of the face), malaria and chlamydia
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Examples of tetracyclines
Doxycycline (used in malaria and chlamydia OD), Lymecycline, Minocycline (rarely used but broader spec), tigecycline, tetracycline
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S/E of tetracyclines
benign intracranial hypertension (stop if experiencig headaches and visual disturbances) ,
avoid direct exposure to sunlight (doxycycline and demeclocycline),
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Tetracyclines are contraindicated in
children under 12, pregnancy and breastfeeding,
in renal impairment only use doxycycline and minocycline, avoid (or use with caution) in hepatic impairment
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Quinolones are broad spec and work by inhibiting DNA synthesis therefore are
bactericidal
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Quinolones are used in
RTI's, UTI's
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quinolones should be avoided in
MRSA infections
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Examples of quinolones include
ciprofloxacin, levofloxacin, ofloxacin, Moxifloxacin (QT prolongation and life threatening hepatotoxicity), nalidixic acid (used in UTI but avoid if egfr <20)
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Side effects of quinolones include
seizures, QT prolongation, tendon damage, arthropathy (joint disease, avoid in pregnancy, children and adolescents)
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When to discontinue quinolones
psychiatric, neurological, hypersensitivity
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Quinolones interact with NSAIDs by inducing...
convulsions
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There's an increased risk of seizures when ciprofloxacin is given with
theophylline
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There's an increased risk of QT prolongation / Ventricular arrhythmia when quinolones are given with
Antipsychotics, SSRI, macrolides, Amiodarone and quinine
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Avoid milk with which quinolones?
Ciprofloxacin and Norfloxacin
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Protect from direct sunlight with which quinolone
ofloxacin
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Macrolides are broad spec and are an alternative to penicillins that work by
inhibitng the 50s unit of the ribosome to stop protein synthesis (bacteriostatic)
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macrolides are used in
H.pylori, RTI's, skin and soft-tissue infections
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Examples of macrolides include
Azithromycin, Erythromycin, Clarithromycin, telithromycin and spiramycin
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S/E of macrolides include
GI disturbances, QT prolongation, Hepatotoxicity, Ototoxicity (at high doses)
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Take macrolides how?
with or after food
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Erythromycin and Clarithromycin are enzyme...
inhibitors
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Penicillins are broad-spec bactericidal antibiotics and are not useful in CNS infections except
Meningitis
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Narrow spec penicillins are B-lactamase sensitive and include
benzylpenicillin and phenoxymethylpenicillin
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Broad spec penicillins are inactivated by B-lactamase and include
amoxicillin and ampicillin
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Which antibiotic is penicllinase resistant
flucloxacillin (take before food)
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why is penicillin not given by intrathecal injection?
Encephalopathy
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amoxicillin (co-amoxiclav) should not exceed 14 days due to
cholestatic jaundice
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Cephalosporins are broad spec and work by
inhibiting bacterial cell-wall synthesis (bactericidal)
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cephalosporins are used in
UTI's sinusitis and otitis media
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Cephalosporins are mainly excreted how?
renally
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First gen cephalosporins include
cefalexin, cefadroxil and cefradine
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Second gen cephalosporins include
cefaclor, cefuroxime
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Third gen cephalosporins include
cefixime, cefotaxime, ceftazidime and ceftriaxone
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Fifth gen cephalosporins include
ceftaroline
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Side effects of Cephalosporins are
hypersensitivity, antibiotic associated colitis (common in 2nd and 3rd gen)
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Chemoprophylaxis with doxycycline counselling points
Take 1-2 days before entering endemic area and continue for 4 weeks after leaving,
Protect skin from sunlight, do not take indigestion remedies or other zinc/iron containing tablets 2 hours before or after
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Side effects of mefloquine include
serious neuropsychiatric reactions (C/I in pts with historty of psychiatric disorders or convulsions).
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antibiotics are usually given one week before for antimalarial prophylaxis except
doxycycline and malarone (1-2 days before)
mefloquine (2-3 weeks)
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Antimalarials are usually given 4 weeks after travel except
malarone (1 week after)
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Those with epilepsy should avoid which antimalarials?
Chloroquine and Mefloquine
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Antimalarials to use in renal impairment
Doxycycline or Mefloquine
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Which antimalarial to use in pregnancy
Chloroquine and proguanil (given with folic acid)
Doxycycline is C/I
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Antibiotic used to treat:
Staphylococci
MRSA
Streptococci
Anaerobic bacteria
Pseudomonas Aeruginosa
- flucloxacillin
-Vancomycin
-Benzypenicillin / Phenoxymethylpenicillin
- Metronidazole
-Aminoglycosides
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First-line treatment for antibiotic-associated colitis (mainly clindamycin)
Oral metronidazole
second- vancomycin/fidaxomicin
loperamide is C/I
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First line treatment for endocarditis
Amoxicillin +/- gentamicin
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Treatment options for Community Acquired Pneumonia
Treat for 7 days (unless staphylococci 14-21 days)
Mild: amoxicillin alt. clarithromycin/doxycycline
Moderate: amoxicillin + clarithromycin or doxycycline alone
severe: benzylpenicillin + clarithromycin/doxycycline
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Trmt options for hospital acquired pneumonia
Treat for 7 days
early onset co-amoxiclav or cefuroxime

if >5 days, antipseudomonal penicillin or broad spec cephalosporin or quinolone
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Causative agent for meningitis
neisseria meningitidis
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trmt options for meningitis
benzylpenicillin, chloramphenicol if immediate penicillin allergy, cefotaxime if penicillin allergy
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Trmt options for osteomyelitis
flucloxacillin
Clindamycin if penicillin allergic
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Trmt options for impetigo
fusidic acid for 7 days
fluclox for 7 days if widespread
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trmt for cellulitis
flucloxacillin
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Trmt for animal / human bites
Co-amox or
doxycycline + metronidazole
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Trmt options for skin and soft tissue MRSA infection
tetracycline or sodium fusidate + rifampicin
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Trmt options for dental infections
Metronidazole 200mg tds for 3 days
Alt. amoxicillin
or doxycycline (for peridontitis)
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Trmt options for sore throat
phenoxymethylpenicillin
if severe start with benzylpenicillin

Claithromycin if allergic to penicillin
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trmt options for sinusitis
Amoxicillin
or
Clarithromycin
or
Doxycycline
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Trmt options for otitis externa/media
flucloxacillin / amoxicillin
(clarithromycin if allergic)
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Trmt options for TB
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
- For 2 months

Continuation with rifampicin and isoniazid - 4 months
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Key points about Rifampicin
Enzyme inducer - do not use oral contraceptives (insert IUD)
Report signs of hepatotoxicity
Colours contact lenses and urine red/orange
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Key points about isoniazid
Enzyme inhibitor
Report signs of hepatotoxicity
peripheral neuropathy - overcome by pyridoxine
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key points about pyrazinamide
hepatotoxicity
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key points about ethambutol
report visual changes immediately
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Itraconazole is used in the treatment of fungal infetions and it interacts with antacids as it needs an acidic pH to be absorbed what are the side effects?
heart failure and hepatotoxicity
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If oral ketoconazole is prescribed for fungal infections what should you do?
return prescription as the risk for fatal hepatotoxicity outweighs benefit of treatment
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Trmt for oral thrush
nystatin or miconazole (daktarin gel)
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trmt for vulval or vaginal thrush
oral fluconazole or topical imidazole (clotrimazole)
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Amorolfine is used for
nail infections
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Herpes Simplex can affect lips, mouth and eyes and is treated with
aciclovir
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Other cards in this set

Card 2

Front

clinical markers for infections

Back

low BP, raised blood glucose, High ESR, C-reactive protein, temperature, increased respiratory rate

Card 3

Front

tetracyclines are contraindicated in which age group?

Back

Preview of the front of card 3

Card 4

Front

side effects of Tetracyclines

Back

Preview of the front of card 4

Card 5

Front

There's an increased risk of C.Diff infections in which group of patients?

Back

Preview of the front of card 5
View more cards

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