Abx Facts To Know Flashcards
Aminoglycoside - Gentamicin monitoring measurement??
Measure Serum Gentamicin conc
After 3 or 4 Doses
Measure 1hr (Peak) after dose and just before next dose (Trough)
Gentamicin multiple dose regimen
Peak serum conc?
5-10mg/L
However Endocarditis
3-5mg/l
Lower because coprescribed with other abx
Gentamicin multiple dose regimen
Trough serum conc?
<2mg/L
However
Endocarditis: <1mg/L
Lower because coprescribed with other abx
If trough Is too high in gentamicin?
Increase dose interval
If peak level is too high in gentamicin?
Increase dose
Gentamicin - Renal impairment
Increase dose interval
Gentamicin - Severe Renal impairment
Reduce dose as well
What is common MHRA warning with aminoglycosides?
OTOTOXICITY
What causes renal impairment which may as a result interact?
METFORMIN
ACE
ARBS
NSAIDS
MAAN Remember
Aminoglycoside contraindications
Myasthenia gravis
Aminoglycoside Pregnancy Avoid why?
Risk of AUDITORY or Vestibular NERVE DAMAGE
What are the 1st gen cephalosporins?
FAD, FAL, FRAD 3 brothers
Cefadroxil, Cefalexin, Cefradine
What are the 2nd gen cephalosporins?
FURRY FOX FACE ( Remember)
Cefuroxime, Cefoxitin, Cefaclor
What are 3rd and 5th gen cephalosporins?
Cefixime- parental
If pt is hypersensitive to penicillin or other beta lactams should they take cephalosporin?
NO
CROSS SENSITIVE
Chloramphenicol pregnancy?
AVOID
In 3rd trimester
RISK OF GREY BABY SYNDROME
risk of neonatal
Clindamycin interactions
And associated Colitis - infected diarrhoea
MORE COMMON IN ELDERLY
Vancomycin how should it be given?
Parenteral
Due to reduced absorption orally
Vancomycin pregnancy?
AVOID unless benefits overweigh risks
Vancomycin trough conc?
15-20mg/litre
Measure hour before
Vancomycin initial dose based on?
Body weight
Glycopeptides Interactions IMPORTANT
OTOTOXICITY
Nephrotoxicity
Glycopeptides side effect?
Cardiogenic shock
Anaphylactic reaction
Red man syndrome
Blood Dyscrasia
Steven Johnson syndrome
CARBS
Why should you not rapid infusion Glycopeptides?
Too quick causes cardiogenic shock
Also can lead to anaphylactoid shock
(Rotate sites)
Linzeloid RISKS
Optic Neuropathy
Monitor regularly over 28days
Blood Disorders
Monitor regularly over 10-14days
Linezolid interactions
Tyramine Rich foods
(Anything fermented)
Similar to MAOI
Can Linezolid lead to any other complications?
Serotonin syndrome
Too much serotonin
Macrolides usual dose
Clarithromycin BD
Erythromycin QDS
Azithromycin OD (tds in copd winter prophylactic)
THINK PACK SIZES
Macrolide cautions
MYASTHENIA GRAVIS
When to avoid clarithromycin
First trimester of pregnancy
Macrolide side effects
Hepatotoxicity
Ototoxicity (large dose hearing loss)
GI disturbances
QT Prolongation
HOGQ remember
Macrolide interactions with which meds
CYP INHIBITORS THEREFORE
- Statins - increased myopathy risk
- Warfarin - increased bleeding risk
Macrolides cause what electrolyte imbalance?
Hypokalaemia
Therefore
Avoid loop/thiazide diuretic, steroids, salbutamol, theophylline
Macrolides can cause what other interaction?
QT PROLONGATION
Avoid
Amiodarone, Domperidone, fluconazole
Lithium, methadone, ondansetron
Quinine, quinolones
Sotalol, SSRIs
Metronidazole Side effects
Alcohol - during & 48hrs after
Nausea and vomiting
Taste disturbance
ANT Remember
Nitrofurantoin when to avoid
AVOID IN PREGNANCY AT TERM
AVOID if egfr less than 45ml/min/1.73
Nitrofurantoin other side effects
DISCOLOUR URINE YELLOW/brown
Nitrofurantoin important MHRA
Risk of Pulmonary and hepatic events
What are narrow spectrum penicillins?
Phenoxymethylpenicillin ( Pen V)
Or Benzylpenicillin (Pen G)
Parenteral only due to unstable gastric acid
What are broad spectrum penicillins?
Ampicillin
Amoxicillin
Co-Amoxiclav
Common issue with broad spectrum penicillins?
Diarrhoea - antibiotic associated colitis
Why not use broad spectrums for sore throats all the time?
Glandular fever pt can have maculopapular rashes appear
Fluclox label requirement?
Empty stomach or 2 hours after
___Adherence issue
Fluclox rare but possible side effects
Chloestatic jaundice
Hepatitis
Can occur up to 2 months after stopping treatment
Risk factors of this: increased age or use for more than 2wks
What are some antipseduomonal penicillins
Piperacillin - combo with Tazobectam
Ticarcillin - combo with clavulanic acid
SERIOUS HOSPITAL PENICILLINS
Penicillin can I give intrathecally?
NO DO NOT GIVE INTRATHECALLY
can cause encephalopathy
What is defined as true allergy to penicillin?
Immediate rash
Quinolones - Ciprofloxacin, levofloxacin, Moxifloxacin, ofloxacin
They may cause what?
Psychiatric Disorders
Lowers seizure threshold
Tendon disorders
Hypersensitivity reaction
PLT-H Remember
Quinolones what to counsel?
Reduce sunlight and UV RADIATION
MAY IMPAIR DRIVING ABILITY
Tendinitis in quinolones?
Common over 60yrs
Stop and seek medical attention
Qujnlones with abdominal chest back pain
Seek medical attention
Quinolones shortness of breath, palpitations, oedema
Seek medical attention
MHRA WARNING W/ Quinolones
Suicidal thoughts and behaviour
Quinlones cautions
QT prolongations
Myasthenia Gravis
Arthropathy in children/youth
Perforated tympanic membrane
Q-MAP Remember
Quinolones interactions
AVOID DAIRY and mineral fortified drink
QT prolongation drugs
Seizure threshold reduction
Tetracycline label
No milk, indigestion remedies or zinc/iron meds 2 hours before or after taking this med
Which tetracyclines can I take with milk?
Doxycycline
Lymecycline
Minocycline
DOES LIKE MILK
Which tetracyclines can I take with milk?
Doxycycline
Lymecycline
Minocycline
DOES LIKE MILK
Tetracycline side effects
Benign intercrannial hypertension
Lupus erythematosus (minocycline highest risk)
Teeth discolour and bone deposit
(Avoid children under 12/ pregnant)
BLT Remember
Tetracycline counselling points?
Dysphagia
Hepatotoxic - Avoid Liver failure
Photosensitivity
Myasthenia Gravis
D-HMP Remember
Trimethoprim can cause?
Blood Dyscrasia - bruising, bleeding , sore throat, fever, rash
Teratogenic in 1st trimester
Interacts with other antifolates:
Methotrexate and phenytoin
What electrolyte imbalance can trimethoprim cause?
Hyperkalaemia
Trimethoprim caution in?
Renal impairment
Pregnancy - 1st trimester
Which drugs to avoid with Trimethoprim?
Methotrexate
Or
Phenytoin
When trimerhoprim used alone?
Bacteriostatic
When trimethoprim combined with Sulfonamides?
Bactericidal
Narrow spectrum abx list?
Glycopeptides
Penicillin G and V
Trimethoprim
Linezolid
Clindamycin
GP TLC Remember
Broad spectrum abx list?
Chloramphenicol
Aminoglycoside
Penicillin (amox & amp)
Tetracycline
Nitrofurantoin
Macrolides
Cephalosporins
Quinolones
CAPTN MCQ Remember
Which are bacteriostatic abx? (Prevents bacterial growth)
Chloramphenicol
Macrolides
Tetracycline
Linezolid
Clindamycin
CM TLC Remember
Which are bactericidal abx? (Kills bacteria)
Everything else other than CM TLC
Empty stomach abx
Phenoxymethylpenicillin
Flucloxacillin
Azithromycin
Tetracycline
PFAT Remember
With or after food abx
Pivmecillinam
Clarithromycin mr
Nitrofurantoin
Metronidazole
PCN - M Remember
Hepatotoxic Abx
Co-amoxiclav
Macrolides
Flucloxacillin
Rifampacin
Isoniazid
Pyrazinamide
CM FRIP Remember
NOT IFAMBUTOL TB 4th med
Nephrotoxic Antibiotic
Nitrofurantoin
Aminoglycoside
Glycopeptides
NAG Remember
Myasthenia Gravis Abx
Quinolones
Macrolides
Aminoglycoside
Tetracycline
Q-MAT Remember
4 antibiotics that cause C Difficile?
4 C’s!!!!
Clindamycin
Cephalosporins
Co-amoxiclav
Ciprofloxacin
