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Antibiotics > Antibiotic Classes > Flashcards

Antibiotic Classes Flashcards

1
Q

Mechanism of antibiotic resistance?

A

– Prevent access to bug (Pseudomonas sp)

– Bug produces destructive enzyme (penicillins, cephalosporins)

– Bug changes drug binding site (penicillins)

– Drug pumped out of bug (tetracyclines)

– Bug creates bypass pathways to overcome loss of function (sulphonamides)

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2
Q

Mechanisms of beta lactam resistance

A

beta- lacatamase

modification of penicillin binding protein

no access to PBP

Efflux pump

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3
Q

safety issues with penecillins

A

allergy

hepatotoxicity

renal clearance ↓ by probenecid

oral contraceptive failure

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4
Q

half life of penicillins?

A

30-75 mins (with normal kidney clearance)

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5
Q

What are the classifications of penicillins?

A

Narrow spectrum

Narrow spectrum with anti-staph action

moderate spectrum

broad spectrum

broad spectrum with anti pseduomonas

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6
Q

Narrow spectrum penicillins

A

penicillin G/ Benzyle penicillin

Penicillin V/ phenoxymethyl penicillin

benzathine penicillin

procaine penicillin

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7
Q

What are narrow spectrum penicillins used for?

A

pneumococcus

meningococcus

streptococcus

syphilis

actinomycosis

listeria

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8
Q

What route can narrow spectrum penicillins be given?

A

IM or IV generally
(not acid stable, degraded in stomach)

Penicillin V can be given orally, except with food

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9
Q

Narrow spectrum anti-staph penicillin?

A

flucloxacillin (cloxacillin, dicloxacillin, methicillin)

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10
Q

What route can narrow spectrum with anti-staph property penicillins be given?

A

oral or IV

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11
Q

safety issues with narrow spectrum with anti-staph property penicillins

A

specific risk of cholestatic jaundice

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12
Q

moderate spectrum penicillins?

A

amoxycillin (ampicillin)

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13
Q

routes of moderate spectrum penicillins?

A

oral or IV

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14
Q

Common uses of moderate spectrum penicillins?

A

bacterial URTIs
bacterial bronchitis
UTIs (not best choice given patchy coverage)

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15
Q

How does spectrum of moderate spectrum penicillins differ compared to narrow spectrum?

A

less gram +ve coverage, but more gram -ve

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16
Q

safety issues with moderate spectrum penicillins

A

high risk or rash when given during some viral infections such as glandular fever
(does not contraindicate all future penicillin)

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17
Q

Broad spectrum antibiotics

A

β-lactam plus β-lactamase inhibitor
- amoxycillin + clavulanate
- tazocin

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18
Q

What are the broad spectrum with anti Pseudomonas activity penicillins?

A

carbenicillin, piperacillin, ticercillin (+/- clavulanate)

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19
Q

How does spectrum of cephalosporins compare to penicillins?

A

broader spectrum than penicillins but probably less
effective than penicillin for sensitive organisms

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20
Q

Safety issues with cephalosporins?

A

risk of allergy in severe penicillin-allergic patients

causes OCP failure

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21
Q

1st gen cephalosporins?

A

cefazolin

cephalexin

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22
Q

3rd gen cephalosporins

A

cefotaxamine, ceftriaxone, ceftazidime

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23
Q

which cephalosporins can be given PO?

A

cephalexin

some 2nd gens (cefaclor, cefuroxime)

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24
Q

Side effects of cephalosporins?

A

diarrhoea, rash, electrolytedisturbance, fever, neutropaenia, hepatic toxicity

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25
Q

Common uses of cephalosporins?

A

• skin and soft tissue including staph - 1st gen
• gonorrhoea (due to penicillin resistance) - 3rd gen
• empirical meningitis - 3rd gen
• serious enteric infections - 3rd gen
• 4th gen – empirical treatment of nosocomial infections

26
Q

Aminoglycasides

A

gentamycin, streptomycin, Tobramycin

27
Q

route of aminoglycasides

A

IM/ IV – not bioavailable orally but well absorbed from wounds / irrigation

28
Q

elimination of aminoglycasides

A

100% renally eliminated – need to adjust dose in renal impairment

29
Q

safety issues with amino glycasides

A

nephrotoxicity
(reversible)

ototoxicity - deafness or balance
(usually irreversible)

30
Q

use of aminoglycasides

A

Serious Gm-ve infections
– Pyelonephritis
– Sepsis
– Synergistic with penicillin for bacterial endocarditis

31
Q

route for metronidazole?

A

IV or PO

32
Q

metronidazole drug interactions?

A

alcohol (decreased acetaldehyde function)

warfarin

33
Q

side effects of metronidazole

A

many
• nausea, vomiting, constipation, diarrhoea
• dizziness, headache
• bitter metallic taste

34
Q

macrolides

A

erythromycin,

clarithromycin,

azithromycin,

roxithromycin

35
Q

Adverse effects of macrolides?

A

• motilin agonist → high rate of GI upset; dose dependent

• cholestatichepatitis

• drug metabolising enzyme inhibitor

36
Q

quinolones

A

ciprofloxacin, moxifloxacin, norfloxacin, ofloxacin (eye drops only)

37
Q

spectrum of quinolones

A

broad Gm-ve coverage including Pseudomonas, variable Gm+ve coverage

38
Q

use for quinolones

A

• urinary tract infection
• enteric infections including typhoid, shigella,
travellers’s diarrhoea
• bronchitis, pneumonia, cystic fibrosis
• osteomyelitis

39
Q

AE of quinolones

A

– GI,
– hallucination, delirium, seizures
– photosensitive rash
– tendon rupture
– long QT (moxifloxacin)

40
Q

lincosamides

A

clindamycin

lincomycin

41
Q

elimination of lincosamides

A

mostly through the liver

42
Q

adverse effects lincosamides

And example of lincosamide

A

very severe diarrhoea (can be c diff)

allergy/ rash

Clindamycin

43
Q

elimination of vancomycin

A

renally

44
Q

adverse effects of vancomycin

A

nephrotoxic

ototoxic

anaphylaxis

red man syndrome

45
Q

tetracyclines

A

tetracycline, minocycline, doxycycline

46
Q

uses of tetracyclines

A

limited due to wide spread resistance

• rickettsia, mycoplasma, trachoma, Lyme disease
• community acquired pneumonia,
• pelvic inflammatory disease
• acne

47
Q

adverse effects of tetracyclines

A

teeth discolouration (don’t give to kids)

OCP failure

GIT

Skin

Fungal overgrowth

48
Q

empiric treatment for mild HAP (ETG)

A

augmentin duo

49
Q

empiric treatment for moderate HAP (ETG)

A

3rd gen cephalosporin
(ceftriaxone or cefotaxamine)

50
Q

empiric treatment for severe HAP (ETG)

A

tazocin

51
Q

empiric treatment for mild CAP (ETG)

A

amoxycillin or doxycyline PO

52
Q

empiric treatment for moderate CAP (ETG)

A

Benzylpenicillin IV + doxycycline PO

53
Q

empirical treatment for severe CAP (ETG)

A

3rd gen cephalosporin
(ceftriaxone or cefotaxamine)

+

azithromycin

54
Q

empiric treatment for meningitis?

A

benzylpenicillin or ceftriaxone

55
Q

empirical treatment for COPD exacerbation?

A

amoxycillin or doxycycline

56
Q

empirical treatment for acute gastroenteritis?

A

ciprofloxacin or norfloxacin

57
Q

empirical treatment for mild acute pyelonephritis?

A

augmentin duo or copra of Ax

Then target

58
Q

empirical treatment for severe acute pyelonephritis?

A

gentamycin + amoxy/ampicillin

59
Q

empirical treatment for acute cystitis?

A

1st line - trimetheprim (unless preggers)
2nd line - cephalexin

60
Q

empirical treatment for cellulitis (with systemic symptoms)

A

flucloxacillin (If SA suspected - purulence, skin wound)

if SA not suspected - benzylpenicillin

Antibiotics (3 decks)

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