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Exam Bits > Abx and Antifungal > Flashcards

Abx and Antifungal Flashcards

1
Q

When to measure Aminoglycosides

A

After 3-4 doses, then every 3 days and after a dose change (more frequently in renal impairment)

Measure 1 hour after dose and just before next dose

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2
Q

Aminoglycosides concentration target

A

Peak: 5-10 mg/L
Endocarditis peak: 3-5 mg/L

Trough: <2 mg/L
Endocarditis trough: <1 mg/L

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3
Q

Aminoglycosides, what happens if trough too high?

A

Increase dose interval

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4
Q

Aminoglycosides, what happens if peak too high?

A

Reduce dose

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5
Q

Aminoglycosides, what happens if renal impairment?

A

Increase dose internal/Reduce dose

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6
Q

MHRA Warning - Aminoglycosides

A

Ototoxicity, especially with drugs:
- cisplatin
- loop diuretics
- vancomycin
- vinca alkaloids

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7
Q

Can you take Chloramphenicol in pregnancy?

A

No, avoid in pregnancy due to risk of grey-baby syndrome if used in third trimester

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8
Q

OTC age for Chloramphenicol?

A

Aged 2+

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9
Q

Clindamycin adverse effects?

A

Abx-associated Colitis : can be fatal
(More common in elderly)
Discontinue if colitis/c.diff happens

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10
Q

Can you take Glycopeptides in pregnancy?

A

Should be avoided in pregnancy unless benefits outweigh risks

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11
Q

How do you give Glycopeptides?

A

Based in ideal body weight, then adjust dose according to serum concentration

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12
Q

Do you measure both trough and peak concentration of Glycopeptides?

A

No, only trough level is routine measured
Trough concentration should be: 10-20 mg/L depending on type of infection (15-20 mg/L if deep seated)

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13
Q

Adverse effects of Glycopeptides?

A

Ototoxicity
Nephrotoxicity
Red man syndrome (more common in vancomycin)
SJS
Blood dyscrasia
Cardiogenic shock on rapid IV
Risk of anaphylactoid reaction at infusion sites - avoid rapid infusion and rotate site

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14
Q

Linezolid’s important safety information?

A

Severe optic neuropathy
- especially if treatment >28 days

Blood disorders
- especially if treatment >10-14 days

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15
Q

Linezolid’s interactions?

A

Tyramine-rich food (eg: mature cheese, marmite, yeast extract)

Serotonin syndrome
(Eg: SSRI, Triptans, Tramadol, Lithium, TCAs, other MAOIs)

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16
Q

Macrolides’ caution?

A

Caution in Myasthenia Gracie

Avoid clarithromycin in pregnancy, erythromycin recommended as alternative

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17
Q

Macrolides’ interactions?

A

Hypokalaemia
(Eg: loop/thiazide diuretics, steroids, salbutamol, theophylline)

QT prolongation
(Eg: Amiodarone, sotalol, fluconazole, lithium, methadone, ondansetron, domperidone, quinolones, citalopram)

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18
Q

Is Macrolides enzyme inducer or inhibitor?

A

Enzyme inhibitor

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19
Q

Metronidazole’s side effect?

A

Taste disturbance: metallic taste, furred tongue

N&V: take with or after food

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20
Q

Should you drink metronidazole with alcohol?

A

No, it can cause disulfiram-like reaction (eg: N&V, flushing)

Avoid alcohol during and 48 hours after treatment

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21
Q

Can you take nitrofurantoin during pregnancy?

A

Yes, but not at term (>37 weeks)

22
Q

Can you take nitrofurantoin in renal impairment?

A

Avoid if eGFR <45

23
Q

Can Nitrofurantoin discolour urine?

A

Yes - yellow/brown

24
Q

Should you take nitrofurantoin with or without food?

A

Take it with or after food

25
Q

What happens if you give broad-spectrum penicillins for sore throat?

A

Maculopapular rash can occur in patients with glandular fever (avoid using broad-spectrum penicillin blindly)

26
Q

Should you take flucloxacillin with or without food?

A

Take one hour before food or 2 hours after

27
Q

Which antibiotics can cause cholestatic jaundice and hepatitis?

A

Flucloxacillin or Co-Amoxiclav

Can occur up to two months after treatment

28
Q

Can you give penicillin intrathecally?

A

No, it can cause encephalopathy which can be fatal

29
Q

What to be cautious with Quinolones?

A
  • lowers seizure threshold
  • tendon damage
  • psychiatric reaction
  • hypersensitivity
  • avoid sunlight/UV exposure: can cause sensitive skin
30
Q

Quinolones’ important safety information?

A

Tendonitis (more common in patients >60)

Risk of aortic aneurysm (symptoms: sudden onset of severe abdominal, chest or back pain)

Risk of heart valve regurgitation (symptoms: SOB, heart palpitations)

Risk of suicidal thoughts and behaviour

31
Q

Quinolones’ interactions?

A

Avoid dairy products and mineral fortified drinks : reduces absorption

QT prolongation

NSAIDS - reduces seizure threshold

32
Q

Tetracyclines’ caution?

A

Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

33
Q

Which tetracyclines can you take with milk?

A

Doxycycline
Lymecycline
Minocycline
(Does Like Milk)

34
Q

Patient takes tetracyclines, develop headache and visual disturbances?

A

Stop and report - benign intracranial hypertension

35
Q

Tetracyclines’ side effects

A

Lupus-erythematosus-like syndrome and irreversible pigmentation: when exposed to sunlight (highest risk with minocycline)

36
Q

Can you give tetracyclines to children or pregnancy woman?

A

No, it can cause teeth discolouration and bone deposit

37
Q

Nitrofurantoin MHRA’s Alert?

A

Risk of pulmonary and hepatic events

38
Q

Trimethoprim’s side effects?

A

Blood dyscrasia

Hyperkalaemia

39
Q

Can you take trimethoprim in pregnancy?

A

No, it is an anti folate

Also avoid with MTX and phenytoin

40
Q

Which antibiotics should be taken with or after food?

A

Metronidazole
Nitrofurantoin
Clarithromycin MR
Pivmecillinam

41
Q

Which antibiotics have to be taken with an empty stomach (1-2 hours before food, or at least 2 hours after)

A

Flucloxacillin
Phenoxymethylpenicillin
Tetracycline
Azithromycin capsules (not tablets or liquid)

42
Q

Nephrotoxic antibiotics?

A

Nitrofurantoin
Trimethoprim
Aminoglycosides
Glycopeptides
Tetracycline

43
Q

Hepatotoxic antibiotics?

A

Flucloxacillin
Co-Amoxiclav
Macrolides
Rifampacin + Isoniazid + Pyrazinamide
Chloramphenicol
Nitrofurantoin
Tetracyclines

44
Q

Is Rifampacin an enzyme inducer or inhibitor?

A

Enzyme inducer

45
Q

Rifampicin’s side effects

A

Lens and bodily fluid discolouration - orangey red

46
Q

Isoniazid’s side effects

A

Peripheral neuropathy - prophylactic pyridoxine (vitamin B6 can help)

47
Q

Is Isoniazid enzyme inducer or inhibitor?

A

Enzyme inhibitor

48
Q

Ethambutol’s side effects

A

Visual impairment + ocular toxicity - annual eye check

49
Q

Which antifungals causes QT prolongation and hepatotoxicity?

A

Fluconazole (least risk)
Itraconazole
Ketocinazole
Voriconazole

50
Q

Amphoteracin B’s caution

A
  • caution in renal failure
  • anaphylaxis risk
  • maintain same formulation (serious harm and fatal overdoses)

Exam Bits (6 decks)

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