Antibiotic

Question 1

Monitoring for vancomycin (4)

Answer 1

Full blood count
Renal function
Auditory function
Urinalysis

Question 2

Advice for vancomycin to patient

Answer 2

Immediately report hearing issues, signs of infection, rash

Question 3

Therapeutic range of vancomycin

Answer 3

10-20mg/L trough levels

Question 4

Vancomycin with loop diuretics

Answer 4

Increased risk of ototoxicity

Question 5

Vancomycin with suxamethonium

Answer 5

Vancomycin enhances the effect of suxamethonium

Question 6

Vancomycin with ciclosporin, aminoglycosides, polymyxin antifungals

Answer 6

Increased risk of nephrotoxicity and ototoxicity

Question 7

Why do you look out for rash with vancomycin

Answer 7

Risk of red man syndrome (flushing of upper body)

Question 8

Which skin disorders are signs of vancomycin toxicity

Answer 8

Rash, necrosis, red man syndrome
Phlebitis

Question 9

Contraindication if vancomycin use

Answer 9

Previous hearing loss

Question 10

Which is more likely to cause kidney problems- vancomycin or teicoplanin?

Answer 10

Vancomycin

Question 11

Can you use vancomycin in pregnancy

Answer 11

Only if benefit outweighs risk
Ensure plasma vancomycin levels are monitored closely

Question 12

When do you measure vancomycin level

Answer 12

Second day immediately before next dose
Earlier in renal impairment

Question 13

Which patients should you be more careful with when giving quinolones (4)

Answer 13

Elderly
Kidney disease
Oragan transplant
Those taking corticosteroids

Question 14

Advise with quinolones

Answer 14

Report tendinitis or tendon rupture, muscle pain or weakness, joint pain and swelling, peripheral neuropathy, CNS effects

Question 15

Cardiac problems that arise from quinolone use

Answer 15

Small risk of heart valvue regurgitation and aortic aneurysm

Question 16

Quinolones mental side effects

Answer 16

Memory impairment
Depression
Fatigue
Sleeping disorders
Impairs sight, hearing, taste and smell

Question 17

Pain relating to quinolone usage

Answer 17

May cause neuropathies
May cause arthalgia

Question 18

Quinolone interactions of note (5)

Answer 18

Macrolides
Nsaids- increased risk of convulsions
Corticosteroids-increased tendon damage
Warfarin- increases anticoagulation
Iron and calcium salts, Sucrafalate- separate by 2 hours

Question 19

Gentamycin target therapeutic ranges

Answer 19

5-10 mg/L
3-5 mg/L in endocarditis
Less than 1 for trough

Question 20

What do you monitor with gentamycin (3)

Answer 20

Renal function
Auditory and vestibular function
Serum concentration to determine dose

Question 21

In which patients would you want to check serum gentamycin more often (4)

Answer 21

Elderly
Renal impairment
Obesity
Cystic fibrosis

Question 22

Who when do you measure gentamycin levels

Answer 22

After 3 days of 4 doses, then at least every 3 days & after a dose change
More frequently in renal impairment

Question 23

Which drugs increase the risk of nephrotoxicity for gentamicin

Answer 23

Ciclosporin tacrolimus vancomycin

Question 24

Which condition should aminoglycosides be avoided in as it may exacerbate it

Answer 24

Myasthenia gravis

Question 25

Who is more at risk of irreversible hearing loss with gentamycin

Answer 25

Mitochondrial mutations, those on loop diuretics and vancomycin

Question 26

Important counselling for gentamicin

Answer 26

Ensure you are adequately hydrated