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Infections > Aminoglycosides & other drugs > Flashcards

Aminoglycosides & other drugs Flashcards

1
Q

Examples of Aminoglycosides?

A
  • Amikacin
  • Gentamicin
  • Neomycin
  • Streptomycin
  • Tobramycin
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2
Q

Which aminoglycosides are active against pseudomonas aeruginosa?

A

TAG
- Tobramycin
- Amikacin
- Gentamicin

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3
Q

How is Tobramycin administered?

A

Administered via nebulisation or inhalation

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4
Q

What is pseudomonas aeruginosa?

A

An organism that causes pneumonia, infections in the blood etc.

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5
Q

What is streptomycin active against?

A

Streptomycin is active against mycobacterium tuberculosis and reserved almost entirely for tuberculosis.

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6
Q

In what form must Streptomycin be given in and why?

A

As an injection because it cannot be absorbed from the gut

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7
Q

What is the preferred aminoglycosides?

A

Gentamicin because it is used to treat many infections including eye/ear infections, pneumonia etc.

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8
Q

What is the usual dose for aminoglycoside?

A

Once daily is preferred

Parenteral treatment should never exceed 7 days whenever possible.

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9
Q

What is the contraindication for aminoglycosides?

A

Myasthenia gravis - causes aminoglycosides to impair neuromuscular transmission.

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10
Q

What are the side effects of Aminoglycosides?

A
  • Ototoxicity
  • Nephrotoxicity
  • Neurotoxicity
  • Risk in pregnancy (auditory nerve damage in infants)
  • Skin reactions
  • Nausea and vomitting
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11
Q

What are the signs of Ototoxicity?

A
  • Tinnitus or ringing in ears
  • Hearing loss
  • Dizziness
  • Uncoordination in movements
  • Vestibular damage
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12
Q

What are the signs of Nephrotoxicity?

A
  • Decreased urine output
  • Fluid retention (swelling in legs, ankles or feet)
  • Fatigue
  • SOB (shortness of breathe)
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13
Q

Which drugs cannot be used alongside Aminoglycosides?

A
  • Loop diuretics
  • Cephalosporins, ciclosporin or vancomycin
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14
Q

Can loop diuretics be used alongside with Aminoglycosides and why?

A

No, because the risk of ototoxicity is increased when used alongside each other

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15
Q

Can cephalosporins, ciclosporin
or vancomycin be used alongside aminoglycosides and why?

A

No because risk of nephrotoxicity is increase when used alongside each other

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16
Q

What are the monitoring requirements for aminoglycosides?

A
  • Plasma concentration
  • Renal function (esp in the elderly) - as they are renally excreted
  • Auditory and vestibular function

Serum concentration monitored in patients receiving parental aminoglycosides.
Monitored in elderly, obesity, cystic fibrosis, renal impairment or high dose.

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17
Q

Which individuals need dose adjustments for aminoglycosides?

A

Patients with renal impairment

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18
Q

What dose adjustments must be made for people with renal impairment taking aminoglycosides?

A
  • Increase dose interval

But if renal impairment is severe - decrease dose

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19
Q

When should blood samples be taken for people on aminoglycosides?

A

Approximately 1 hour after administration (peak concentration) and just before next dose (trough concentration).

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20
Q

What is peak concentration?

A

The highest concentration of a drug in the blood after dose is given (1 hr after admin)

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21
Q

What is trough concentration?

A

The concentration of drug in the blood immediately before the next dose is administered

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22
Q

What must be done if the trough concentration is high?

A

Increase dose interval

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23
Q

What must be done if the peak concentration is high, within range and below range?

A

High - Decrease the dose

Within range - maintain dose

Below range - increase dose

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24
Q

What should be the peak and trough concentrations for Aminoglycosides?

A

For IM or IV use for multiple daily regimens:

  • Peak concentration: 5-10mg/L
  • Trough concentration: <2mg/L

For multiple daily regimens in endocarditis:
- Peak concentration: 3-5mg/L
- Trough concentration: <1mg/L

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25
Q

Which aminoglycosides can be used in gentamicin-resistant bacteria?

A

Amikacin

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26
Q

Which aminoglycoside is more stable to enzyme activation than gentamicin?

A

Amikacin

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27
Q

Which Aminoglycoside are too toxic for parenteral administration?

A

Neomycin sulfate

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28
Q

What MHRA warning/advice is attached to Aminoglycosides?

A

Aminoglycosides increase the risk of deafness [ototoxicity] in patients with mitochondrial mutations.

Potential histamine-related adverse drug reactions (like rashes) with some batches - caution with pts on drugs which release histamine (e.g opioids).

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29
Q

What are carbapenems?

A

Beta lactam antibiotics and they are structurally similar to penicillin and cephalosporins.

They are broad spectrum.

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30
Q

What are examples of Carbapenems?

A

Ertapenem, Imipenem, Doripenem, Meropenem

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31
Q

What are Imipenem and Meropenem used for?

A

Used for severe hospital acquired infections like: septicaemia, complicated UTI, Hospital acquired pneumonia (HAP) etc.

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32
Q

What must Imipenem be given with and why?

A

It must be given with Cilastatin because Imipenem is partially inactivated by kidney enzymes

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33
Q

Do Meropenem, Doripenem and ertapenem need to be given with cilastatin?

A

No because they are stable in renal enzymes

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34
Q

What are the side effects of Carbapenems?

A
  • Diarrhoea
  • Headache
  • Nausea
  • Vomiting
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35
Q

Cautions for carbapenems?

A

Caution in pts with sensitivity to beta lactam antibacterials.

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36
Q

What are cephalosporins?

A

Broad-spectrum antibiotics.

Structurally similar to penicillin.

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37
Q

Examples of 1st Generation Cephalosporins?

A
  • Cefalexin
  • Cefadroxil
  • Cefradine
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38
Q

What do all 1st generation cephalosporins begin with?

A

Cefa / Cefra
Except for Cefaclor

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39
Q

Examples of 2nd generation cephalosporins?

A
  • Cefuroxime
  • Cefaclor
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40
Q

Examples of 3rd generation Cephalosporins?

A
  • Cefotaxime
  • Ceftazidime
  • Ceftriaxone
  • Cefixime
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41
Q

What do all 3rd generation cephalosporins contain?

A

The letter ‘T’

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42
Q

How are cephalosporins excreted?

A

Excreted renally

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43
Q

What are the indications for Cephalosporins?

A
  • Septicaemia
  • Pneumonia
  • Meningitis
  • Biliary tract infections
  • Peritonitis
  • UTI
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44
Q

Which Cephalosporins can be used to treat infections of the CNS like meningitis?

A

Third generations -
Cefotaxime & Ceftriaxone

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45
Q

What are the side effects for Cephalosporins?

A
  • Hypersensitivity – approximately 0.5 – 0.6% of penicillin-sensitive patients are also sensitive to cephalosporins.

SO IF PATIENT IS ALLERGIC TO PENICLLIN, DO NOT GIVE CEPHALOSPORINS!

  • Antibiotic associated colitis (mainly presented as diarrhoea)- this is more common in 2nd and 3rd generation cephalosporins
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46
Q

What is the drug action for Vancomycin?

A

It is a glycopeptide antibacterial.

Bactericidal activity against aerobic and anaerobic for only gram positive bacteria - so narrow spec antibiotic

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47
Q

What is Vancomycin used for?

A

Commonly used to treat antibiotic associated colitis caused by C. diff infection

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48
Q

How should Vancomycin be adminstered?

A

Preferably by IV route because it is not absorbed effectively via the oral route

49
Q

What are the initial doses and subsequent doses of Vancomycin based on?

A

Initial doses are based on body weight.
Subsequent doses are based on serum-vancomycin concentration.

50
Q

What is the Trough concentration range for Vancomycin?

A

10-20mg/L

51
Q

What must be monitored when taking Vancomycin?

A
  • Monitor FBC, renal, and hepatic function
  • Monitor vestibular and auditory function (avoid concurrent use of ototoxic drugs like furosemide)
52
Q

What are the side effects of Vancomycin?

A
  • Agranulocytosis
  • Dizziness
  • Neutropenia
  • Drug fever
  • Hypersensitivity
  • Ototoxicity
  • Skin reactions
  • Nephrotoxicity - higher risk than teicoplanin
  • Red man syndrome - infusion related reaction
  • Tinnitus - discontinue drug if this occurs
53
Q

What is Clindamycin active against?

A

Active against gram positive bacteria

It is a narrow spec

54
Q

What are the indications for Clindamycin?

A
  • Bone and joint infections (joint infection, osteomyelitis, peritonitis bone).
  • Alternative to macrolides, especially in penicillin-sensitive patients
55
Q

What is contraindicated with Clindamycin?

A
  • Diarrhoeal states

If patient starts getting diarrhoea, only with this antibiotic though, they must stop the medication straight away as clindamycin causes serious colitis.

Contact the doctor straight away

56
Q

What are the side effects of Clindamycin?

A
  • Fatal antibiotic-associated colitis - usually occurs with clindamycin
  • Discontinue if c-difficile infection is suspected or confirmed (diarrhoea, watery, stool)
57
Q

When should Clindamycin be discontinued?

A
  • Discontinue if C. diff infection is suspected or confirmed.
  • Discontinue if diarrhoea occurs and contact GP.
58
Q

What must be monitored with Clindamycin?

A

Monitor liver and renal function if treatment exceeds 10 days

59
Q

Examples of Macrolides?

A

Azithromycin, clarithromycin, and erythromycin

60
Q

What is the mechanism of action for macrolides?

A

Bacteriostatic (stops bacterial cell growth)

It is broad spec and the alternative for penicillin allergic pts.

61
Q

What are the common indications for Macrolides?

A
  • Respiratory and skin/soft tissue infections
  • Severe pneumonia
  • Eradication of H. Pylori
62
Q

What are the interactions of macrolides?

A

When taken with warfarin or simvastatin, their plasma concentration is increased.

63
Q

What are the side effects of Erythromycin and its cautionary labels?

A

Nausea, vomiting and diarrhoea.

Cautionary labels: 5, 9 & 25

64
Q

What are the contraindications and cautions for Erythromycin?

A

Hepatic impairment - may cause hepatoxicity

Renal impairment - can cause ototoxicity in adults and children at high doses

It is the macrolide preferred in pregnancy and breastfeeding but only when benefits outweighs the risk.

65
Q

Which macrolide is preferred?

A

CLARITHROMYCIN because it has a slightly higher activity compared to erythromycin.

It is also more stable, and causes fewer side effects.

66
Q

Which macrolide is the least active?

A

Azithromycin - less active over gram-positive bacteria but has enhanced activity over some gram-negative bacteria

67
Q

What is the usual dose for Azithromycin?

A

Once daily dosage due to long tissue half life

68
Q

What are the cautionary labels for Azithromycin?

A

5,9 and 23 for capsules

69
Q

When can Azithromycin be given over the counter?

A

Max single dose if 1g, max daily dose of 1g and pac size of 1g.

70
Q

What are the important information for Clarithromycin?

A

It is more commonly prescribed because Erythromycin has greater activity, it is more stable and has fewer side effects.

Usual dose is twice daily.

Avoid in 1st trimester; only use in 2nd n 3rd if benefit outweighs the risk.

Hepatic and renal impairment - avoid.

Cautionary labels: 9,21, 25, 13

71
Q

What is used to treat Lyme disease?

A

Erythromycin, azithromycin and clarithromycin.

72
Q

What are the five classes of penicillin?

A

1) Beta-lactamase sensitive (penicillin V, penicillin G)

2) Penicillinase-resistant penicillins (flucloxacillin)

3) Broad-spectrum penicillins (amoxicillin, ampicillin, co-amoxiclav)

4) Antipseudomonal penicillins (piperacillin, ticarcillin)

5) Mecillinam-type penicillins (pivmecillinam)

73
Q

How do pencillins work?

A

They are bacteridial and intefere with cell wall synthesis

74
Q

When should penicillin be stopped?

A

If anaphylaxis, hives, or an immediate rash occurs to penicillin

75
Q

What must be given instead of penicillin if there’s a reaction?

A

Macrolide can be given if there’s a if anaphylaxis, hives, or an immediate rash occurs to penicillin

76
Q

Examples of Quinolones?

A

Ciprofloxacin, Ofloxacin, Norfloxacin, Nalidixic acid

77
Q

What are the examples of convulsions?

A
  • May induce convulsions (reduces seizure threshold) in people with or without a history of convulsions
  • Can cause tendon damage (risk increased over the age of 60)
78
Q

What drug when taken with Quinolones can increase the risk of convulsions?

A

NSAIDs can increase the risk of convulsions

79
Q

What drug when taken with Quinolones can increase the risk of tendon damage?

A

Corticosteroids can increase the risk of tendon damage, when taken with Quinolones

80
Q

When must Quinolones be discontinued?

A

If tendonitis is suspected

81
Q

Examples of Tetracyclines?

A

Demeclocycline, Doxycycline, Lymecycline, Minocycline, Oxytetracycline

82
Q

What are the common indications for Tetracyclines?

A
  • Acne
  • Pneumonia
  • Chlamydia
  • Rickettsia
  • MRSA infections
83
Q

What are the side effects of Minocycline?

A

It has a greater risk of lupus-like syndrome, and can sometimes cause irreversible skin pigmentation

84
Q

What are the side effects of Tetracyclines?

A
  • Intracranial hypertension (discontinue if headaches or visual disturbances occur)
  • Photosensitivity reactions (especially with doxycycline and demeclocycline)
  • Discolouration of tooth enamel in children (not to be used in children under 12)
  • Dysphagia and oesophageal/stomach irritation
85
Q

What are the indications of Trimethoprim?

A

It is an antifolate used for:

  • UTI
  • Respiratory tract infections (chronic bronchitis, pneumonia)
86
Q

What is the mode of action for Trimethoprim?

A

Bacteriostatic

Folate antagonist

87
Q

When should Trimethoprim be avoided?

A
  • Pregnancy - it is teratogenic; so avoid esp in 1st trimester but in general
  • Breastfeeding (but short term use is not known to be harmful
  • Children under 12
  • Patients with blood disorders
88
Q

What is the side effect of Trimethoprim?

A
  • Blood disorders
  • Diarrhoea
  • Electrolyte imbalance
  • Fungal overgrowth
  • Headache
  • Nausea
  • Skin reactions
  • Vomiting
89
Q

What must be monitored when taking Trimethoprim?

A

Monitor FBC in long-term therapy

90
Q

What patient & carer advice must be given with Trimethoprim?

A

Advise on how to recognise signs of blood disorders - fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develops - seek immediate medical attention

Cautionary label - 9

91
Q

What dose adjustment needs to be done for Trimethoprim?

A

In adults:
Manufacturer advises dose reduction to half normal dose after 3 days if eGFR 15–30 mL/minute/1.73 m2.

Manufacturer advises dose reduction to half normal dose if eGFR less than 15 mL/minute/1.73 m2.

In children:
Manufacturer advises dose reduction to half normal dose after 3 days if estimated glomerular filtration rate 15–30 mL/minute/1.73 m2.

Manufacturer advises dose reduction to half normal dose if estimated glomerular filtration rate less than 15 mL/minute/1.73 m2.

92
Q

What is the indication of Metronidazole?

A

Used to treat:
- trichomoniasis
- bacterial vaginitis
- vaginosis

It is the first-line treatment for gingivitis (200mg TDS for 3 days)

  • Can also be used to treat C.diff infection
93
Q

What is metronidazole an alternative for?

A

An alternative for penicillin to treat oral infections.

94
Q

What is topical metronidazole used for?

A

To reduce microbial odours and rosacea

95
Q

What caution is linked to Metronidazole?

A

It can produce a disulfiram-like reaction with alcohol - vomiting, flushing, throbbing headache, hang over like symptoms

SO AVOID ALCOHOL

96
Q

What are the side effects of metronidazole?

A
  • Nausea & Vomiting
  • Taste disturbances
  • Anorexia
97
Q

What are the various treatments for uncomplicated UTI?

A
  • Nitrofurantoin (AVOID AT TERM)
  • Trimethoprim (AVOID IN PREGNANCY)
  • Amoxicillin, ampicillin, or an oral cephalosporin
98
Q

Can nitrofurantoin be given in pregnancy?

A

Yes but avoid at term (3rd trimester

99
Q

When should Trimethoprim be avoided?

A

Avoid in pregnancy

100
Q

How long is the treatment for uncomplicated UTI for nitrofurantoin?

A

3 day treatment

7 days in males and pregnant women.

101
Q

What is the side effect of Nitrofurantoin?

A

Can discolour the urine - turn it into a dark yellow / brownish colour.

102
Q

What is the contraindication and caution of nitrofurantoin?

A

Contraindication: Acute porphyria, G6PD deficiency, infants less than 3 months

Caution: Anaemia, diabetes, electrolyte imbalance, folate deficiency, pulmonary disease, vitamin B deficiency

103
Q

What must be done for patients with renal impairment for nitrofurantoin?

A

Avoid if eGFR is less than 45ml/min/1.73

Can be used with caution if eGFR 30-44ml/min/1.73 as a short course ONLY (3-7 days), to treat uncomplicated lower urinary-tract infection caused by suspected or proven multidrug resistant bacteria and only if potential benefit outweighs risk.

104
Q

What must be monitored with nitrofurantoin?

A
  • Liver function (discontinue if liver function decreases)
  • Pulmonary symptoms like fever, chills, cough, chest pain, dyspnoea, pulmonary infiltration, eosinophilia and pleural effusion.

Esp in elderly patient

105
Q

What is Linezolid?

A

It is a reversible, Monoamine oxidase inhibitor (MAOIs) antibacterial drug.

It is also an antidepressant but the dose used for antibiotic doesn’t have an antidepressant effect.

106
Q

What should be avoided with patients taking Linezolid and why?

A

Consuming large amounts of tyramine-rich foods as it could cause hypertensive crisis

107
Q

What are examples of tyramine rich food?

A

Mature cheese, salami, pickled herring, Bovril

108
Q

What are the side effects of Linezolid?

A
  • Severe optic neuropathy (visual impairment) particularly if used longer than 28 days
  • Blood disorders
109
Q

What should be monitored when taking Linezolid?

A
  • Monitor FBC (including platelet count) weekly.
  • Monitor blood disorders
110
Q

What patient and carer advice should be given with Linezolid?

A

Report symptoms of visual impairment - blurred vision, visual field defect, changes in colour vision and visual acuity.

111
Q

How is Tuberculosis treated?

A

It is treated in two phases:

  • Phase ONE (Initial Phase) – 4 drugs for 2 months (RIPE - rifampicin, isoniazid, pyrazinamide, ethambutol)
  • Phase TWO (Continuous Phase) – 2 drugs for 4 months (RI - rifampicin and isoniazid)
112
Q

What side effect is linked to all TB drugs?

A

Hepatoxicity - expect for Ethambutol

Discontinue if signs of liver disorder develop.

113
Q

What is the mechanism of action for Rifampicin?

A

It is an enzyme inducer

114
Q

What is the side effect for Rifampicin?

A
  • Discolours soft contact lenses
  • Colours urine orange/red

This is patient n carer advice as well

115
Q

What is the side effect for Isoniazid?

A

May cause peripheral neuropathy.

Give pyridoxine hydrochloride (vitamin B6) for prophylaxis.

116
Q

What must be given for Prophylaxis of the Isoniazid side effect?

A

Pyridoxine hydrochloride (vitamin b6)

117
Q

What is the side effect for Ethambutol?

A

Causes visual side effects

Discontinue if there is any visual deterioration.

118
Q

What must be monitored for TB?

A
  • Monitor signs of hepatoxicity - jaundice, itching, fatigue, abdominal pain, nausea n vomiting
  • Check renal and hepatic function prior to treatment
  • Patients with pre-existing liver disease and/or alcohol dependence should have frequent liver checks, particularly in the first 2 months.
  • If there is no liver disease, further checks are only necessary if the patient has fever, malaise, vomiting, jaundice, or unexplained deterioration.

Infections (6 decks)

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