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BNF Chapter 5 Infection > antibacterials > Flashcards

antibacterials Flashcards

1
Q

BEFORE STARTING THERAPY, The follow must be considered?

A

Viral infections should not be treated with
antibacterials
• Samples should be taken for culture and
sensitivity testing
• Narrow-spectrum antibacterial are preferred
Dose varies
Route of administration varies
Duration varies

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2
Q

The dose varies according to factors including?

A

age, weight, hepatic function, renal function, and severity of infection

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3
Q

Route of administration of an antibacterial often depends on t

A

the severity of the infection, usually IV for life-threatening

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4
Q

Duration of therapy depends on?

A

the nature of the infection and the response to treatment, undue prolonged courses encourage resistance, may lead to side-effects and are costly

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5
Q

General antibacterials suitable for pregnancy?

A

Penicillin and cephalosporins, Nitrofurantoin may also be used but it should be avoided at term

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6
Q

2 classes of antibiotics that should be avoided in pregnancy?

A

Diaminopyrimidines and quinolones

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7
Q

should also preferably be avoided particularly in the first trimester?

A

Trimethoprim

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8
Q

Antibacterials normally excreted by the kidney accumulate with resultant toxicity unless the dose is reduced; especially?

A

Antibacterials normally excreted by the kidney accumulate with resultant toxicity unless the dose is reduced; especially?

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9
Q

List down the 5 aminoglycosides ?

A

Amikacin, Gentamicin, Neomycin, Streptomycin, Tobramycin

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10
Q

Mechanism of action of aminoglycosides?

A

Bactericidal by irreversibly binding to ribosomes inhibiting protein synthesis; fissure result which enhances antibiotic uptake as well as leakage of cell contents.

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11
Q

Aminoglycosides are active against?

A

Active against some gram +ve bust mostly gram -ve

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12
Q

7 main Indication of aminoglycosides?

A

Endocarditis, septicaemia, meningitis and other CNS infections, biliary-tract infection, prostitis, and pneumonia.

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13
Q

3 aminoglycosides active against P. aeruginosa?

A

Amikacin, tobramycin and gentamicin

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14
Q

Aminoglycoside active against M. tuberculosis?

A

streptomycin

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15
Q

8 main Side-effects of aminoglycosides?

A

May impair neuromuscular transmission, irreversible ototoxicity, nephrotoxicity. Nausea, vomiting, antibiotic associated colitis, peripheral neuropathy, electrolyte disturbances.

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16
Q

Contraindications and cautions?aminoglycosides

A

Caution in patients with clinical muscular weakness e.g. myasthenia gravis;
avoid concomitant use with ototoxic drugs e.g. cisplatin and furosemide, and nephrotoxic drugs e.g. vancomycin and ciclosporin

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17
Q

Route of administration for aminoglycosides?

A

Aminoglycosides are not absorbed from the gut and therefore are given parenterally for systemic infections

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18
Q

Which aminoglycoside can be given orally for bowel sterilisation prior to surgery or in hepatic failure

A

Neomycin

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19
Q

Dosing of aminoglycosides?

A

Once daily doses preferred over multiple daily doses, need to consult local guidelines.

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20
Q

is the aminoglycoside of choice in the UK.

A

Gentamicin, has a narrow therapeutic index

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21
Q

Therapy with gentamicin requires x with dosing?

A

Loading dose,

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22
Q

narrow therapeutic Range for gentamicin?

A

multiple daily dose regimens one-hour (peak) serum concentration should be 5 to 10mg/L (3 to 5 mg/L for endocarditis);

pre-dose (trough) concentration should be < 2mg/L (< 1mg/L for endocarditis);

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23
Q

Monitoring for all aminoglycosides?

A 
Renal function (nephrotoxicity); 
auditory and vestibular function (ototoxicity which is irreversible);
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24
Q

serum-aminoglycoside concentration must be determined in?

A

the elderly, all patients receiving parenteral treatment, those with renal impairment, in obesity and cystic fibrosis, and if high doses given.

25
Q

Warning sign of gentamicin toxicity?

A

Nephrotoxicity
• Ototoxicity (hearing impairment or hearing disturbance)
• Dehydration (ensure patient is well hydrated before treatment to prevent dehydration)

26
Q

Caution for Pregnancy and breastfeeding using gentamicin ?

A

Risk of auditory or vestibular nerve damage in 2nd and 3 rd trimester, avoid unless essential

27
Q

Gentamicin Drug Interactions?

A

Increased risk of nephrotoxicity when given with ciclosporin, tacrolimus, vancomycin • Increased risk of ototoxicity when given with loop diuretics, vancomycin

28
Q

List down CEPHALOSPORINS?

A

Five generations of this antibiotic group exist:

  1. Cefalexin, cefradine
  2. Cefaclor, Cefuroxime
  3. Cefixime, Ceftriaxone
  4. Ceftaoline fosamil
29
Q

Mechanism of action of cephalosporins?

A

Prevent cell wall synthesis by binding to enzymes called penicillin binding proteins (PBPs).

30
Q

Cephalosporins are bactericidal to?

A

both gram -ve and gram -ve activity

31
Q

Indications of cephalosporins?

A

Pneumonia, meningitis, gonorrhoea, and UTIs

32
Q

Cephalosporins side-effects?

A

Antibiotic associated colitis (rare but more common with 2nd and 3rd generation)

33
Q

Cephalosporins Contraindications and cautions?

A

Hypersensitivity (0.5-6% of penicillin-sensitive patients will also be allergic to cephalosporins

34
Q

less susceptible to inactivation by beta-lactamases?

A

2nd and 3rd gen are less susceptible

35
Q

List down glycopeptides?

A

Vancomycin, Teicoplanin, Telavancin

36
Q

Glycopeptides mechanism of action ?

A

Inhibit cell wall synthesis by binding to the cell wall precursor components, this leads to interference of the PBP enzymes preventing cell wall synthesis

37
Q

Glycopeptides Are Active against?

A

aerobic and anaerobic gram +ve bacteria including MRSA

38
Q

Glycopeptides indication?

A

Clostridium difficile infection, endocarditis, surgical prophylaxis when high risk of MRSA

39
Q

Glycopeptides side effects?

A

Nephrotoxicity, blood disorders, ototoxicity, nausea, chills, fever, rashes, SJS (Steven-Johnson syndrome), flushing of the upper body

40
Q

Glycopeptides Contraindications and cautions?

A

Avoid vancomycin in elderly, and in patients with a history of auditory problems

41
Q

Glycopeptides Monitoring?

A

Differs between glycopeptides: blood counts, hepatic and renal function, urinalysis, plasma levels, auditory function in elderly

42
Q

Vancomycin doing may require? Why?

A

Loading doses may be required due to long half-life;

43
Q

Vancomycin therapeutic range?

A

trough 10 to 15mg/L (15 to 20mg/L for endocarditis or less sensitive strains of methicillin-resistant Staphylococcus aureus or complicated infections caused by S. aureus)

44
Q

Monitoring (all glycopeptides)

A

blood counts, hepatic and renal function, urinalysis, plasma levels, auditory function in elderly

45
Q

Vancomycin in pregnancy and breast feeding?

A

Manufacturer advises to avoid – if used plasma concentration monitoring essential to minimise foetal toxicity; present in milk, significant absorption unlikely

46
Q

Drug Interactions with vancomycin?

A

ciclosporin, aminoglycosides, polymixin antifungals- Increased risk of nephrotoxicity and ototoxicity

loop diuretics- ncreased risk of ototoxicity
Vancomycin enhances effects of suxamethonium

47
Q

What drug is a lincosamides??

A

Clindamycin

48
Q

Mechanism of action of clindamycin?

A

Binds to ribosomes inhibiting cell wall protein synthesis

49
Q

Clindamycin bacteriostatic action against ?

A

gram +ve aerobes and anaerobes

50
Q

Clindamycin indication?

A

Staphylococcal joint and bone infections, intra abdominal sepsis, cellulitis, skin and soft-tissue infections

51
Q

Clindamycin monitoring?

A

Hepatic and renal function in infants, and in all patients where treatment exceeds 10 days

52
Q

Clindamycin side effects

A

GI disturbances, oesophageal disorders, taste disturbances, jaundice, blood disorders, rash, and SJS

53
Q

discontinue treatment immediately if clindamycin causes

A

if diarrhoea develops , Antibiotic associated colitis can be fatal

54
Q

Clindamycin contraindication and caution

A

Do not use in patients with existing diarrhoea; antibiotic associated colitis is more common in middle-aged and elderly women, especially post operation.

55
Q

List down macrolides

A

Erythromycin, azithromycin, clarithromycin

56
Q

MACROLIDES MOA?

A

Binds to ribosomes inhibiting cell wall protein synthesis; similar activity to penicillin thus are an alternative in allergic patients

57
Q

MACROLIDES, indication?

A

Respiratory tract infections e.g. pertussis (whooping cough; Lyme disease

58
Q

MACROLIDES, side effects?

A

GI disturbances mainly with erythromycin; hepatotoxicity, rash (SJS)

59
Q

MACROLIDES Contraindications and cautions?

A

May aggravate myasthenia gravis; use in caution with patients predisposed to QT interval prolongation (i.e. electrolyte disturbances and taking drugs the prolong QT interval e.g. sotalol)

BNF Chapter 5 Infection (1 decks)

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