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14 Pharmacology > Anti-bacterials > Flashcards

Anti-bacterials Flashcards

1
Q

Anaerobes (2)

Aerobes (8)

A

Clostridium, Bacteroides

Streptococcus, Staph, Entero, E-coli, other coliforms, Pseudomonas, haemophilus, Neisseria

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2
Q

Why does an organism stain gram positive?

Give 4 examples

A

Thick peptidoglycan wall outside cell membrane. In gram negative, this is thin, with a second outer cell membrane, so the stain is not retained.

  1. Streptococcus
  2. Enterococcus
  3. Saphylococcus
  4. Clostridium
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3
Q

What classes of antibiotics are b-lactams?

What is their MOA?

A

Penicillins, Cephalosporins, Carbapenems

Inhbit bacterial cell-wall synthesis by inhibiting peptidoglycan linking in cell wall sythesis

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4
Q

Examples and MOA for:

Aminoglycosides

Macrolides

Tetracyclines

Glycopeptides

trimethoprim

Ciprofloxacin

Rifampicin

A
  1. Gentamicin, amikacin; protein synthesis - covers Pseudomonas
  2. Erythromycin, Clarithromycin; protein
  3. Tetracycline, Doxycline; protein
  4. Vancomycin, teicoplanin; cell wall synthesis
  5. DNA syntehsis (folate antagonist)
  6. DNA synthesis - inhibits gyrase
  7. Inhibits transcription by binding RNA polymerase
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5
Q

What organisms cause URTI?

What is appropriate treatment?

OM

OE

Sinusitis

Tonsilitis/Pharyngitis (risk with amoxicillin?)

If allergic to penicillins?

A

Most commonly viral, but if bacterial then Streptococcus, Haemophilius

In most cases, symptoms will resolve spontaneously, try to avoid over medication…

Amoxicillin 500mg tds 5d/Erythromycin 500mg qds 5d

Fluclox 500mg qds 5d/Erythromycin

7 days: Amoxicllin/Doxycycline

10d: Phenoxymethyl penicillin 500mg qds/Erythro; if meet 3 of centor criteria (no cough, tender cervical LA, exudate, fever)

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6
Q

CAP

Common organisms?

CURB-65?

Mild (OP)

Non-severe hospital

Severe hospital (≥3)

A

Pneumococcus, Haemophilus, Staph + Atypicals (Legionella, Mycoplasma, Chlamydophila - add macrolide or tetracycline)

OP: Amoxicillin/Clarythromycin

NSH: Amoxicillin+Clarythromycin / Clarythromycin

SH: IV Co-amox + Clarithromycin / Ertapenem + Clarithro

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7
Q

Hospital Acquired Pneumonia

Common organisms

Treatment

A

Pneumococcus, Staph, Pseudomonas, E.coli, Haemophilius

IV

NO ABx since admission:

Co-amox + Gentamicin/Meropenem + Gentamicin

ABx since admission

Tazocin + Gentamicin/Meropenem + Gentamicin

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8
Q

UTI

Common organisms

Treatment at home - ABX must be able to get into urine

In hospital?

Complicated UTI?

A

E.coli, pseudomonas (catherter), ESBL, enterococcus

Trimethoprim 200mg bd

or

Nitrofurantoin 50mg qds

Review after 3 days in women, 5d in men

Risk in pregnancy - mum needs to have normal folate status and be well-nourished

Previous infection or previous ABx

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9
Q

Meningitis

Causative organisms?

Treatment?

A

Depends on age

  • 0-3 months GBS, Listeria (LM), E.coli
  • 3m-6m- NM, Pneumococcus, Haemophilus
  • 6m-65y NM, Pneumococcus
  • 65y NM, P, Consider also Listeria again

Community - Benzyl penicllin IM

Hospital: Ceftriaxone 4g IV + Amoxicillin IV if suspect LM

Chloramphenicol IV if allergy

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10
Q

Cellulitis

Non-severe

Severe

A

Non-severe: Oral Fluclox/Doxycycline or Erythro

Severe: IV fluclox + Clindamycin + gentamicin/

Vancomyin + Clindamycin + gentamicin

In each case, if MRSA suspected, use Non-pen alternative to fluclox (in bold)

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11
Q

Sepsis

Can be many organisms…

Unclear source

Line-associated

urinary

Remember…

A

Empirical ALL IV

Unclear source:

BenPen/Vanc +Gent + Metronidazole

Line-associated:

Fluclox/Vanc + Gent

Urinary:

Co-amoxiclav/Ertapenem + Gent

gentamicin is 5mg/kg lean body mass

Remember to review and switch to targeted treatment once sensitivities known

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12
Q

Gentamicin monitoring? And dosing?

vancomycin?

A

Give gentamicin over 60 minutes infusion; don’t wait for levels if normal renal function. Do trough levels. Most people not on for more than 48h

Weight based on lean body mass

Pre-dose level should be <1.0g/ml; if CrCl 41-60 - change to 36hrly, if 21-40 then 48 hrly

Vanc - levels before 4th or 5th dose - steady state - 12-15mg/L

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13
Q

What info on all abx prescrptions?

A

Indication

Length of Course

Review Date

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14
Q

C-Dif

What is progression depending on severity?

What if already had first line?

A

C-Dif

< 3 motions a day = Mild

  • Start with Oral metronidazole 400mg tds 14d

3-5 motions = moderate

  • Oral vancomycin 125mg qds if no response after 48 h metro

> 5 Add = severe

  • Vanc to 500+ IV metronidazole
  • ? vanc by NG-tube

If precious metro - vanc is first line

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14 Pharmacology (8 decks)

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