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Shared Care and Ocular Therapeutics > Anti-Infectives > Flashcards

Anti-Infectives Flashcards

1
Q

Types of Antibacterial Drug

A
  • Aminoglycosides
  • Cephalosporin
  • Macrolides
  • Quinolones
  • Chloramphenicol
  • Fusidic Acid
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2
Q

Aminoglycosides

A
  • Mechanism
    • Interfere with ribosome function affecting protein synthesis, producing an abnormal codon
    • Bacteriocidal
  • Indications
    • Broad indications against bacterial eye infections
    • Better against gram negative
  • Examples
    • Gentamicin (0.3% generic)
    • Neomycin (less suitable for prescribing)
    • Tobramycin (not available)
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3
Q

Gentamicin

A
  • Aminoglycoside
  • Toxic to ocular surface (usually not severe)
  • Cautions
    • Nephrotoxicity
    • Ototoxicity
    • Neuromuscular blocking effects
  • Contraindications
    • Allergy
    • Myasthenia gravis
  • Undesirable Effects
    • Local sensitivity
    • Blurred vision
    • Eye irritation
    • Burning/stinging/itching
  • Pregnancy & Breastfeeding
    • Only in life threatening situations in pregnancy
    • Relatively safe in breastfeeding
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4
Q

Cephalosporins

A
  • Mechanism
    • Interferes with cell wall synthesis
    • Bacteriostatic
  • Indications
    • Prophylaxis for endophthalmitis after cataract surgery
  • Examples
    • Cefuroxime
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5
Q

Cefuroxime

A
  • Cephalosporin
  • Cautions
    • Complicated surgery
    • Reduced endothelial cell count
    • Severe TED
  • Interactions
    • Can damage kidneys when combined with
      - Aminoglycosides
      - Aciclovir
      - Gancicolvir
      - Ketorolac
  • Pregnancy & Breastfeeding
    • Safe in both
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6
Q

Macrolides

A
  • Mechanism
    • Inhibits translocations during protein synthesis taking place at ribosomes
    • Bacteriostatic
  • Indications
    • Chlamydia trachomatis
    • Stubborn blepharitis (off license)
    • Bacterial conjunctivitis
    • Useful against gram positive bacteria
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7
Q

Azithromycin

A
  • Cautions
    • Treatment should cease after 3 days regardless of if symptoms remain
  • Contraindications
    • Hypersensitivity
  • Undesirable Effects
    • Eye discomfort
    • Blurred vision
    • Eye allergy
    • Angioedema
  • Pregnancy & Breastfeeding
    • Safe for both
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8
Q

Quinolones

A
  • Mechanism
    • Interferes with DNA gyrase to inhibit protein metabolism
    • Bacteriostatic
  • Medicinal Forms
    • Ciprofloxacin
    • Levofloxacin
    • Moxifloxacin
    • Ofloxacin
  • Indications
    • Eye infections (and corneal ulcers in the case of Ciprofloxacin)
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9
Q

Ofloxacin

A
  • Cautions
    • Safety and effectiveness in those below 1 year is unknown
    • Risk of corneal perforation in those with corneal defects
    • Caution in those with risk factors for longer QT interval
  • Interactions
    • Anti-arrhythmics
    • Tricyclic antidepressants
    • Macrolides
    • Antipsychotics
  • Contraindications
    • Allergy
  • Undesirable Effects
    • Ocular Irritation/Discomfort
    • Ventricular arrhythmia
  • Pregnancy and Breastfeeding
    • Not suitable for either
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10
Q

Chloramphenicol Mechanism

A
  • Inhibition of protein synthesis by interaction with bacterial ribosomes
  • Bacteriostatic
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11
Q

Chloramphenicol Preparations & Dosage

A
  • 0.5% Drops
    • 1 drop in infected eye every 2 hrs for 48 hrs
    • After this should be 4x a day during waking hours
    • Course of treatmenr should last 5 days
  • 1% Ointment
    • Small amount 4x daily for 2 days
    • Then 2x daily for 5 days
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12
Q

Chloramphenicol Indications and Restrictions

A
  • Indicated for superficial eye infections
  • Potent broad spectrum
  • Cost effective
  • Can be used from age 2 when supplied directly by entry-level optometrist and can write a written order in patients from age 1 month
  • Is available as branded eye drops (P Meds) and can only be used in patients over 2 for 5 days to treat acute bacterial conjunctivitis
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13
Q

Chloramphenicol Cautions & Limitations

A
  • Cautions
    • Small risk of aplastic anaemia
  • Interactions
    • Avoid in patients taking drugs likely to depress bone. marrow function
  • Contraindications
    • History of blood dycrasias (incl aplastic anaemia)
    • Allergy
  • Undesirable Effects
    • Irritation/burning/stinging
    • Dermatitis
  • Pregnancy & Breastfeeding
    • Not recommended in either
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14
Q

Fusidic Acid Mechanism & Indications

A
  • Inhibition of protein synthesis by inhibiting DNA translocation
  • Is bacteriostatic
  • Potent narrow spectrum antibiotic effective against gram positive bacterial
  • Indicated for:
    • Marginal keratitis
    • Blepharitis
    • Conjunctivitis
  • Can be used in children of any age
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15
Q

Fusidic Acid Preparations and Dosage

A
  • Fusidic Acid 1% Viscous Eye Drops
    • Apply 2x daily
    • Treatment should be continued for at least 48 hrs after eye returns to normal
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16
Q

Fusidic Acid Cautions & Limitations

A
  • Cautions
    • Not to be used with CL as can cause corneal scratches
    • Contains BAK
    • Don’t use with quinolone as they are antagonistic
  • Contraindications
    • Allergy
  • Pregnancy & Breastfeeding
    • Can be used in both
17
Q

Fusidic Acid Undesirable Effects

A

Common
- Blurred vision
- Burning/stinging
- Redness
Uncommon
- Hypersensitivity
- Eyelid oedema
- Lacrimation
- Skin rash
- Angioedema

18
Q

Diamides

A
  • Mechanism
    • Aromatic diamidine with anti-bacterial, anti-protozoal and anti-fungal properties
  • Indications
    • Topical treatment of minor eye infections e.g. conjunctivitis and blepharitis
    • Active against gram-positive non-spore forming organisms
  • Examples
    • Dibrompropmidine 0.15%
    • Propamidine Isethionate 0.1%
19
Q

Propramidine Isetionate Cautions & Limitations

A

Cautions
- If no significant improvement after 2 days, discontinue and consult a physician
- Unsuitable for use with CLs
- Discontinue if vision becomes worse
Contraindications
- Allergy
Undesirable Effects
- Eye discomfort
- Blurred vision
Pregnancy & Breastfeeding
- Not suitable for either

20
Q

Topical Antivirals

A
  • Active against HSV
  • Blocks ability to replicate DNA
  • Medicinal Forms
    • Ganciclovir 0.15%
    • Aciclovir 3%
21
Q

Ganciclovir

A
  • Used for HSK
  • Cannot be used in under 18s, whereas Aciclovir can
  • Cautions
    • Stinging on instillation
    • Avoid CL wear
  • Interactions
    • Avoid use with other drugs which are likely to depress bone marrow function
  • Contraindications
    • Allergy
    • Myelosuppression on previous exposure to chloramphenicol
    • History of blood dycrasias (incl aplastic anaemia)

Shared Care and Ocular Therapeutics (10 decks)

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