Abx and Antifungal

Question 1

When to measure Aminoglycosides

Answer 1

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

Question 2

Aminoglycosides concentration target

Answer 2

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

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

Question 3

Aminoglycosides, what happens if trough too high?

Answer 3

Increase dose interval

Question 4

Aminoglycosides, what happens if peak too high?

Answer 4

Reduce dose

Question 5

Aminoglycosides, what happens if renal impairment?

Answer 5

Increase dose internal/Reduce dose

Question 6

MHRA Warning - Aminoglycosides

Answer 6

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

Question 7

Can you take Chloramphenicol in pregnancy?

Answer 7

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

Question 8

OTC age for Chloramphenicol?

Answer 8

Aged 2+

Question 9

Clindamycin adverse effects?

Answer 9

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

Question 10

Can you take Glycopeptides in pregnancy?

Answer 10

Should be avoided in pregnancy unless benefits outweigh risks

Question 11

How do you give Glycopeptides?

Answer 11

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

Question 12

Do you measure both trough and peak concentration of Glycopeptides?

Answer 12

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)

Question 13

Adverse effects of Glycopeptides?

Answer 13

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

Question 14

Linezolid’s important safety information?

Answer 14

Severe optic neuropathy
- especially if treatment >28 days

Blood disorders
- especially if treatment >10-14 days

Question 15

Linezolid’s interactions?

Answer 15

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

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

Question 16

Macrolides’ caution?

Answer 16

Caution in Myasthenia Gracie

Avoid clarithromycin in pregnancy, erythromycin recommended as alternative

Question 17

Macrolides’ interactions?

Answer 17

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

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

Question 18

Is Macrolides enzyme inducer or inhibitor?

Answer 18

Enzyme inhibitor

Question 19

Metronidazole’s side effect?

Answer 19

Taste disturbance: metallic taste, furred tongue

N&V: take with or after food

Question 20

Should you drink metronidazole with alcohol?

Answer 20

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

Avoid alcohol during and 48 hours after treatment

Question 21

Can you take nitrofurantoin during pregnancy?

Answer 21

Yes, but not at term (>37 weeks)

Question 22

Can you take nitrofurantoin in renal impairment?

Answer 22

Avoid if eGFR <45

Question 23

Can Nitrofurantoin discolour urine?

Answer 23

Yes - yellow/brown

Question 24

Should you take nitrofurantoin with or without food?

Answer 24

Take it with or after food

Question 25

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

Answer 25

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

Question 26

Should you take flucloxacillin with or without food?

Answer 26

Take one hour before food or 2 hours after

Question 27

Which antibiotics can cause cholestatic jaundice and hepatitis?

Answer 27

Flucloxacillin or Co-Amoxiclav Can occur up to two months after treatment

Question 28

Can you give penicillin intrathecally?

Answer 28

No, it can cause encephalopathy which can be fatal

Question 29

What to be cautious with Quinolones?

Answer 29

- lowers seizure threshold - tendon damage - psychiatric reaction - hypersensitivity - avoid sunlight/UV exposure: can cause sensitive skin

Question 30

Quinolones’ important safety information?

Answer 30

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

Question 31

Quinolones’ interactions?

Answer 31

Avoid dairy products and mineral fortified drinks : reduces absorption QT prolongation NSAIDS - reduces seizure threshold

Question 32

Tetracyclines’ caution?

Answer 32

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

Question 33

Which tetracyclines can you take with milk?

Answer 33

Doxycycline Lymecycline Minocycline (Does Like Milk)

Question 34

Patient takes tetracyclines, develop headache and visual disturbances?

Answer 34

Stop and report - benign intracranial hypertension

Question 35

Tetracyclines’ side effects

Answer 35

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

Question 36

Can you give tetracyclines to children or pregnancy woman?

Answer 36

No, it can cause teeth discolouration and bone deposit

Question 37

Nitrofurantoin MHRA’s Alert?

Answer 37

Risk of pulmonary and hepatic events

Question 38

Trimethoprim’s side effects?

Answer 38

Blood dyscrasia Hyperkalaemia

Question 39

Can you take trimethoprim in pregnancy?

Answer 39

No, it is an anti folate Also avoid with MTX and phenytoin

Question 40

Which antibiotics should be taken with or after food?

Answer 40

Metronidazole Nitrofurantoin Clarithromycin MR Pivmecillinam

Question 41

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

Answer 41

Flucloxacillin Phenoxymethylpenicillin Tetracycline Azithromycin capsules (not tablets or liquid)

Question 42

Nephrotoxic antibiotics?

Answer 42

Nitrofurantoin Trimethoprim Aminoglycosides Glycopeptides Tetracycline

Question 43

Hepatotoxic antibiotics?

Answer 43

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

Question 44

Is Rifampacin an enzyme inducer or inhibitor?

Answer 44

Enzyme inducer

Question 45

Rifampicin’s side effects

Answer 45

Lens and bodily fluid discolouration - orangey red

Question 46

Isoniazid’s side effects

Answer 46

Peripheral neuropathy - prophylactic pyridoxine (vitamin B6 can help)

Question 47

Is Isoniazid enzyme inducer or inhibitor?

Answer 47

Enzyme inhibitor

Question 48

Ethambutol’s side effects

Answer 48

Visual impairment + ocular toxicity - annual eye check

Question 49

Which antifungals causes QT prolongation and hepatotoxicity?

Answer 49

Fluconazole (least risk) Itraconazole Ketocinazole Voriconazole

Question 50

Amphoteracin B’s caution

Answer 50

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