ABX Flashcards
LINEZOLID - Gram-+ve! Ocular neuropathy risk after 28 days!
Space the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stop
BP monitoring as CI in uncontrolled HTN, thyrotoxicosis, bipolar depression, schizophrenia
Counselling:
- Dizziness => don’t drive
- Report symptoms of visual impairment or disturbances
- Avoid tyramine rich foods = mature cheese, wine, soya bean extracts, draught beers
- Avoid OTC decongestant cold and flu meds - pseudoephedrine etc; SSRI, TCAs, MAOIs (wait 2 weeks after stopping), dopaminergics, opioids, 5HT1 agonists - hypertensive crisis!
SE:
- myelosuppression esp in elderly
- headache, hypertension
- anaemia, increased risk of infection
- constipation, diarrhoea,
- dizziness
- rare: tooth discolouration
Monitoring:
- visual function if treatment > 28 days
- weekly FBC, LFTs, U&E, lactate
- Close monitoring of bloods in groups where the duration is more than 10-14 days; pre-existing myelosuppression; and severe renal impairment
Interactions:
- serotonin syndrome - tramadol, SSRIs, triptans
- MAOI inhibitors - hypertensive crisis!
- rifampicin - inducer!
Clindamycin - Lincosamide - Gram +ve and Anaerobes!
High C. difficile risk!!!
- ABx associated colitis - FATAL => more common in elderly pts; discontinue and contact a dr STAT if severe, prolonged or bloody diarrhoea develops
- C.Difficile suspected, severe diarrhoea - DISCONT.
Take on an empty stomach
Fluclox
Oxytetracycline
Phenoxymethylpenicillin
Fosfomycin
Ampicillin
With a full glass of water
Doxycycline
Clindamycin
Metronidazole
Avoid indigestion remedies 2h before or after
Doxycycline
Minocycline
Azithromycin TABS
Avoid milk, indigestion remedies, zinc or iron containing meds 2h before or after
Tetracycline
Oxytetracycline
Ciprofloxacin
With or just after food
Metronidazole
Pivmecillinam
Nitrofurantoin
Giseofulvin
Itraconazole
Clarithromycin MR
TB - Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Pts with latent TB aged 35 - 65 years should be cleared of hepatotoxicity
Mantoux skin test for latent TB and if positive, a CXR used to rule out TB.
R:
- Discolours soft contact lenses and bodily fluids orange-red
- Enzyme inducer - CYP450 (warfarin, COC) - in contraceptives, use IUD instead!
- report hepatic disorders - abdo pain, N/V
- monitor: renal function, liver function, blood counts
I:
- Peripheral neuropathy - give prophylactic pyridoxine HCL (Vit B6) => increased risk in DM, renal impairment, alcohol dependence, malnourished patients, uraemic patients, pregnancy, HIV.
- Enzyme inhibitor - CYP450
- monitor: acetylator status (slow = increased risk of peripheral neuropathy), renal function, liver function
- counselling: tyramine and histamine (kimchi, pickled beetroot, pickled cucumbers, pickled peppers) rich foods can cause tachycardia, hypotension, flushing, headache, dizziness
- report signs of hepatic disorder => In patients with pre-existing liver disease or hepatic impairment monitor liver function regularly and particularly frequently in the first 2 months.
- caution: acute porphyrias
P:
- Hepatotoxic
- monitor: liver and renal function
- CI in acute attack of gout
E:
- Visual impairment and ocular toxicity => seek medical attention if visual disturbances occur!
- renal function
Malaria - prophylaxis treatment
Patient groups:
- Asplenic pts and pregnant ppl most at risk
- Pregnant = 5mg OD of folic acid due to neural tube defect risk with Proguanil. Tend to give PC.
Medication groups:
- Epilepsy - AVOID chloroquine and mefloquine
- Warfarin - begin treatment 2 - 3 weeks before departure; INR should be stable prior to departure => measure INR b4 anti-malaria, 7 days after starting, and after completing course; prolonged stays = check INR regularly
Malarone (Atovoquone with Proguanil)
Before travel: 1-2 days
During: 1 OD
After travel: 1 week
Max use: 1 year
Doxycycline:
Before travel: 1-2 days
During: 1 OD
After travel: 4 wks
Max use: 2 years
Proguanil:
Before travel: 1 week
Dosage: 1 OD
After travel: 4 weeks
Max use: LT > 5 years
Chloroquine:
Before travel: 1 week
Dosage: 1 OW
After travel: 4 weeks
Max use: LT > 5 years
Mefloquine:
Before travel: 2-3 weeks
Dosage: 1 OW
After travel: 4 weeks
Max use: 1 year
Anti-malarials
Stand-by treatment of malaria => QUININE - dose-dependent QT-prolongation and CI in myasthenia gravis
Malarone:
- Avoid if eGFR < 30mL/min
Doxycycline:
- Avoid exposure to sunlight
- don’ take indigestion remedies, or meds containing iron or zinc, 2h before or after you take the meds.
- Caps should be swallowed whole with plenty of fluid during meals while sitting or standing
Proguanil:
- Renal impairment - reduce dose!
- Manufacturer advises tablet may be crushed and mixed with food such as milk, jam, or honey just before administration.
Chloroquine:
- History of convulsions
- CAn be retinotoxic
- Avoid if eGFR < 30mL/min
- MHRA/CHM advice: Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics (azithromycin) - this is with pts with RA; reminder of psychiatric reactions.
- cautions: Acute porphyrias, G6PD deficiency
Mefloquine:
- Not licensed for kids under 5kg AND under 3 months
- History of convulsions
- History of neuropsychiatric disorders (psychosis, suicidal idealation; prodromal symptoms for a serious event = abnormal dreams, insomnia, nightmares, depression, anxiety, restlessness, confusion) - if these develop, STOP and seek medical attention
- Dizziness and disturbed sense of balance - can last for months afterwards due to long half-life. Don’t drive!
Anti-virals
Aciclovir: Nucleoside analogues
- Herpes Simplex Virus can affect lips, mouth and eyes
Olseltamivir: Neuraminidase inhibitors
- Prophylaxis of influenza.
- Reduces symptoms by 1 day
- At risk groups: 65+, DM, immunocompromised etc.
- Start within 48h of symptoms or without symptoms on exposure!
- If suspension not available, manufacturer advises capsules can be opened and the contents mixed with a small amount of sweetened food, such as sugar water or chocolate syrup, just before administration.
Anti-fungals
Fluconazole, Itraconazole, Ketoconazole, Voriconazole
- QT prolongation
- Hepatotoxicity
- There’s more risk in KETOCONAZOLE, voriconazole and itraconazole; least risk with FLUCONAZOLE
Itraconazole:
- Carbonated drinks improves bioavailability
- SE: HF and hepatotoxicity
- Interactions: Antacids - needs acidic pH for absorption
Ketoconazole:
- MHRA: Life-threatening hepatotoxicity - PO treatment suspended
- QT prolongation
Voriconazole:
- Phototoxicity occurs uncommonly - avoid sunlight exposure! Carry alert card
- Broad spec licensed in life-threatening condition
Amphotericin B
- Caution in renal failure
- Anaphylaxis risk in IV - test dose with 30 mins observation => prophylactic antipyretics or hydrocortisone in pts with previous reactions
- Maintain same formulation between conventional, liposomal and lipid complex formulations - serious harm and fatal overdoses have occurred - SAME BRAND!
- SE: abnormal liver function, anaemia, arrhythmia, blood disorders, HYPO K+, Mg2+
- Monitor: LFT, RFT, Blood counts, K+, Mg2+
Terbinafine:
- Hepatotoxicity
Myasthenia Gravis - Caution!
Quinolones
Aminoglycosides
Macrolides
Tetracyclines
Nephrotoxic Abx - caution or avoided in kidney failure
Nitrofurantoin
Aminoglycosides
Glycopeptides
Tetracyclines
Trimethoprim
Hepatotoxic Abx - caution or avoided in pts with liver failure
Macrolides
Flucloxacillin
Co-amoxiclav
RIP out of RIPE for TB
Chloramphenicol
Nitrofurantoin
Tetracyclines
