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50 Cards in this Set
- Front
- Back
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What does the Antibiotic (MINDME) stand for?
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M – Microbiology guides Tx wherever possible
I – Indications should be evidence based N – Narrowest spectrum required D – Dosage appropriate to site/type of infection M – Minimise duration of therapy E – Ensure monotherapy in most cases |
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What are the advantages of oral therapy?
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• Non-invasive
• Convenient • Cost efficient • Less equipment required • Decreased labour cost |
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What are the disadvantages of intravenous therapy?
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• Invasive
• Introduction of micro-organisms • Greater risk of serious AEs • Higher drug production cost • Additional equipment cost • Additional time for staff • Expertise needed for administration • Stability of reconstituted solutions |
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What is cellulitis and what are the typical features?
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Cellulitis is a common bacterial infection of the skin.
Typical features: Redness Swelling Increased warmth Tenderness Blistering (as rash progresses). May also be assoc. with fever & systemic SMx. |
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What are the likely causative pathogens in cellulitis?
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Streptococcus pyogenes (2/3)
Staphlycoccus aureus (1/3) |
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Name some predisposing factors for cellulitis.
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- Problems w/ venous or lymphatic drainage of the area
- Previous injury to limb - Diabetes - Fissured dermatitis - Alcoholism - Obesity - Swelling of the legs - Pregnancy - Tinea pedis in toes of affected limb |
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What antibiotics are used in mild early cellulitis?
(including dose & duration) |
Di/flucloxacillin 500mg every 6 hrs for 7-10 days.
If S.pyogenes confirmed: Phenoxymethylpenicillin 500mg every 6 hrs for 10 days Penicillin hypersensitivity: Cephalexin 500mg every 6 hrs for 7-10 days Immediate penicillin hypersensitivity: Clindamycin 450mg every 8 hrs for 7-10 days |
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What counselling would you provide for di/flucloxacillin for treatment of cellulitis?
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Finish the course of antibiotics even if the infection looks like it’s cleared
Take on an empty stomach at least half an hr before food or 2 hrs after food |
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What are some of the strategies utilised in the prevention & management of antimicrobial resistance?
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• Choosing appropriate anti-infectives (e.g. narrow spectrum) may slow emergence of resistance & prolong the life of currently available drugs.
• Last defence drugs against multi-resistant strains should be used only under expert direction • Single drugs unless combination therapy is required for efficacy • Dose should be high enough to ensure efficacy & to minimize risk of resistance selection, but low enough to minimise toxicity • Choice should be based on culture or sensitivity tests • Shortest duration possible • Long term prophylaxis only if benefits outweigh risk of resistance • Implementation of antimicrobial policies in hospitals (unrestricted, restricted, excluded drugs) |
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What are the pharmacological treatments for head lice?
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Maldison 0.5% or 1% (KP24) topically, leave for 8 hrs
OR Permethrin 1% topically, leave for minimum 20 mins OR Pyrethrins0.165% + piperonyl butoxide 0.65% to 4% (Banlice) topically, leave for minimum 20 mins Then use a fine tooth comb to remove the dead lice. Lice Tx should be repeated 7-10 days later, using the combing method twice between Tx |
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Whatare the non-pharmacological treatments for head lice?
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Heat treatment:
Apply heat via hairdryer to small sections of hair for 1-3 mins over a 30min period. Wet Combing: Comb hair with fine tooth comb after applying generous amount of conditioner to wet hair (stuns lice). Wipe conditioner from comb onto paper towel. Repeat every day for 10-14 days. |
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How is lice spread?
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Spread by direct head-to-head contact or sharing combs, brushes, head gear.
Lice survive up to 1-2 days w/out feeding on scalp so can be found on objects that have been in contact with an infested person It does not indicate poor hygiene |
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How do you minimise the risk of lice reinfection?
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Check other family members & treat if a live louse is found.
Wet combing every 2 days in b/w chemical Tx may increase effectiveness. No sharing hats & hairbrushes. Soak combs in hot water for 30 secs, wash pillowcases in hot water or put in dryer for 15 mins. Don't overuse Tx or use as prophylaxis - can result in resistant lice |
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What is the difference between a boil and a carbuncle?
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Boils & carbuncles are painful, pus-filled bumps that form under your skin when bacteria infect one or more of your hair follicles. They extend into the subcutaneous tissue.
A boil is a single bump, whereas a carbuncle is a cluster of boils. |
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What are the signs & symptoms of boils and carbuncles?
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Boils start as red, tender lumps that quickly fill with pus, growing larger & more painful until they rupture.
Carbuncles can cause fever, extreme pain, increased WBCs, exhaustion. |
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What is the likely causative pathogen of boils/carbuncles?
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Staphylococcus aureus
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What antibiotics would you use to treat boils/carbuncles?
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Di/flucloxacillin 500mg every 6 hrs for 5 days.
Penicillin hypersensitivity: Cephalexin 1g bd for 5 days Immediate penicillin hypersensitivity: Clindamycin 450mg tds for 5 days |
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In addition to antibiotic therapy, what other non-drug therapies can be used in the management of boils and carbuncles?
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Surgical incision & drainage
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What is pityriasis versicolor?
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A yeast infection caused by Malassezia - found on normal skin.
More common in hot, humid climates or in those who sweat heavily. Can cause hyperpigmentation or depigmentation. |
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What drug therapy would you recommend for pityriasis versicolor and what counselling would you provide?
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Econazole 1% solution (Pevaryl) topically to wet skin at night. Allow to dry and leave overnight for 3 nights.
To prevent relapse, repeat 1 and 3 months after initial course. |
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What are the signs and symptoms of bacterial vaginosis?
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Malodorous vaginal discharge usually without redness or soreness.
Fishy amine odour becomes stronger after coitus & menses when discharge is more alkaline. Itching or irritation can occur. |
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What are the signs and symptoms of genital herpes?
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Recurrent painful blisters on genital area that rapidly erode leaving ulcers that heal over 2 weeks.
Lesions can also occur on surrounding skin Other SMx include feeling unwell, headaches, pain in the back/legs. |
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What would you use to treat bacterial vaginosis?
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Metronidazole 400mg orally bd for 7 days
OR Clindamycin 2% vaginal cream, 1 applicatorful intravaginally for 7 nights |
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What would you use to treat genital herpes?
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Valaciclovir 500mg bd for 5 days,
OR Aciclovir 400mg tds for 5 days OR Famciclovir 125mg bd for 5 days |
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What are the usual causative organisms for bacterial vaginosis?
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Anaerobic bacteria
Gardnerella vaginalis Atopobium vaginae Mycoplasma hominis |
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What is the usual causative organism for genital herpes?
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Herpes simplex virus
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What is the likely indication for the following antibiotic regimen, and causative pathogen?
Trimethoprim 300mg po daily for 3 days, OR Cephalexin 500mg po bd for 5 days, OR Amoxycillin + clavulanate 500+125mg bd for 5 days, OR Nitrofurantoin 50mg qid for 5 days |
Acute cystitis (non-pregnant women)
Pathogen: E.coli |
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What is the likely indication for the following antibiotic regimen, and what is a possible causative pathogen?
Cephalexin 250mg at night OR Trimethoprim 150mg at night |
Recurrent UTI
Pathogen: E.coli |
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What is the likely indication for the following antibiotic regimen, and what is the likely causative pathogen?
Metronidazole 2g orally as 1 dose OR Tinidazole 2g orally as 1 dose |
Trichomoniasis
Pathogen: Trichomonas vaginalis |
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What is epididymo-orchitis and what in general are the causative pathogens?
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Inflammation of epididymis & testis which can be caused by infection.
Pathogens are G-ve coliform bacteria e.g.: E.coli Klebsiella Enterobacter Citrobacter |
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What antibiotics would be prescribed for epididymo-orchitis due to a urinary tract source?
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Mild-moderate:
Trimethoprim 300mg daily for 14 days, OR Cephalexin 500mg bd for 14 days If resistant: Norfloxacin 400mg bd for 14 days For severe infection: Amoxy/ampicillin 2g IV every 6 hrs PLUS Gentamicin 4-6mg/kg IV daily |
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What diagnostic tests would you expect to be done to diagnose and guide therapy for epididymo-orchitis?
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• Clinical examination by physician
• Urinalysis • Urine culture • Tests to screen for Chlamydia & gonorrhea • Doppler ultrasound • Testicular scan |
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Besides antimicrobial therapy, what other drug and non-drug strategies can be utilised in management of gastrointestinal infections assoc. with diarrhoea & that are contagious.
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• Achieve & maintain adequate hydration via oral rehydration solutions.
• Isolate source of pathogen & limit exposure. • +/- Antimotility drugs • Hygiene, handwashing, disinfecting of toilet areas |
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What are the predisposing factors that can affect host defences against pathogens infecting the lower respiratory tract & causing pneumonia?
Give at least one example for each. |
• Alteration in level of consciousness (stroke, seizures, drug/alcohol intoxication, anesthesia)
• Impaired mucociliary activity (smoking, old age, viral disease, malnutrition, cystic fibrosis) • Impaired cell mediated and/or humoral immunity (old age, HIV, malnutrition, immunosuppressive therapy) • Mechanical obstruction (tumour) |
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What is the definition of Community Acquired Pneumonia (CAP) and Hospital Acquired Pneuonia (HAP)?
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CAP is pneumonia occurring in individuals who are not in hospital (or have been in hospital for < 48 hrs) & who are not significantly immunocompromised.
HAP is pneumonia that is not incubating at time of admission to hospital, & develops in a patient hospitalized for > 48 hrs. |
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What are the factors that should be assessed/reviewed when suspecting a diagnosis of CAP/HAP?
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• Assess the patient
• Assess the setting • Examination of chest X-ray • Laboratory evaluation (e.g. sputum, bronchial lavage, MCS, FBE, U&E) |
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What lab data or diagnostic tests/exams would you expect with respect to the diagnosis & monitoring of a patient with pneumonia?
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• Expectorated sputum
• Stains & microbiological culture • Arterial blood gas • CBC (complete blood count) • Lung biopsy (in some cases) • Examination of pleural effusions • Blood cultures • Direct fluorescent tests • ELISA • Silver stain • PCR |
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Which types of data would be important for a clinical pharmacist to review to ensure that antibiotic therapy is safe & effective?
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• U&Es:
Serum creatinine to check if drugs are causing renal impairment or to guide dosage of a renally excreted drug in renal impairment. • MCS: To aid in directing AB therapy. • FBE: Response to AB therapy would result in a decrease in WBC. • TDM: If patient is on vancomycin or gentamicin |
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When dispensing medication for a child, what further information do you need?
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Age, weight, allergies, medical Hx
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What counselling would you give for an amoxycillin mixture?
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• Shake bottle well before use
• Refrigerate, do not freeze • Discard contents 14 days after opening • Give ... ml by metric measure ... times a day for ... days • Space doses as evenly as possible during waking hours • If skin rash occurs, seek medical advice • SE’s of amoxicillin – nausea, diarrhea, gastric upset • Recommend an appropriate analgesic mixture & dose to manage child’s pain, fever assoc. with otitis media |
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What are the signs and symptoms of otitis media?
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• Ear pain
• Purulent discharge if ear drum perforates • May be degree of hearing impairment • Fever, vomiting • Distinct erythema of the tympanic membrane |
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Is antibiotic therapy always prescribed for otitis media?
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Immediate ABs usually unnecessry in children with no systemic features (vomiting, fever) as they are likely to have a good outcome.
>2 yrs = symptomatic Tx for 48 hrs then consider ABs if SMx still present 6m-2yrs = symptomatic Tx for 24 hrs then consider ABs if SMx still present < 6m = treat with antibiotics |
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When is antibiotic therapy indicated in otitis media?
Which antibiotics are given? |
If systemic SMx are present (e.g. fever, vomiting).
• Amoxycillin 15 mg/kg up to 500mg, tds for 5 days, OR • Amoxycillin 30mg/kg up to 1g bd for 5 days Penicillin hypersensitivity (excl. immediate): • Cefuroxime for 5 days • Cefaclor for 5 days |
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What are the 3 main pathogens in otitis media?
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Streptococcus pneumoniae
Haemophilus influenzae Streptococcus pyogenes |
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Prior to commencing therapy for tuberculosis, what pre-therapy screening tests should be performed?
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• Baseline weight
• LFTs • Renal function tests • Visual acuity & color vision testing • FBE • HIV test • Contraceptive advice for fertile female patients |
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What is the duration of the standard short course therapy for pulmonary tuberculosis?
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6 months
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Which of the 4 commonly used anti-microbials in tuberculosis (isoniazid, rifampicin, ethambutol, pyrazinamide) is most likely associated with numerous drug interactions?
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Rifampicin
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Which of the 4 commonly used anti-microbials in tuberculosis (isoniazid, rifampicin, ethambutol, pyrazinamide) is prescribed with pyridoxine to prevent peripheral neuritis/neuropathy?
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Isoniazid
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Which of the 4 commonly used anti-microbials in tuberculosis (isoniazid, rifampicin, ethambutol, pyrazinamide) is known to cause optic neuritis as a side effect & hence the patient's visual acuity/color vision needs to be monitored?
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Ethambutol
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What information would you provide when counselling a newly diagnosed patient commencing on rifampicin?
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• Take at least half an hr before food
• Urine, faeces, sweat, tears may be coloured red or orange • Soft contact lenses may be discoloured • Report any signs of hepatic damage (fatigue, jaundice, dark urine, pale faeces) • Pre-existing hepatic disease & use of other hepatotoxic drugs can increase risk of jaundice • Non-hormonal forms of contraception should be used during Tx and for 4 weeks after Tx • May induce metabolism of other medicines • Ask your doctor or pharmacist before using any other medicine incl. OTC or other health products |
