Antibiotic Questions - MIDTERM Flashcards
Study notes say: Know the most common, the unique side effects & dangerous adverse effects
xx
- What factors determine which antibiotic should you choose?
-Local resistance patterns
-Organism & susceptibility
-Allergies
- History of recent antibiotic use
Common side effects of abx?
- GI upset (diarrhea & nausea)
- Yeast infection or other superinfection (C. Dif)
- Rash
- Dizziness
- QT prolongation
- Photosensitivity - doxycycline
- Which class of antibiotics are most frequently used? Why?
- Beta lactams: penicillin, cephalosporins….
- broad spectrum?
- If your patient report severe diarrhea during antibiotic therapy or shortly after completing a course of antibiotics? What comes to your mind?
- C. Diff infection – get stool sample
- If a patient is taking metronidazole, why can’t they drink alcohol?
- Disulfuram-like reaction: Flushing, tachycardia, palpitations, nausea & vomiting. Unknown mechanism (like Antabuse). Be mindful if taking any OTC meds with ethanol included.
- “Asian flush” same disulfuram rxn – highly sensitive to alcohol.
- Why fluoroquinolones are not used as first-line treatment for community acquired pneumonia? If possible, we shouldn’t use fluoroquinolones in children? Why?
- High adverse reaction profile.
- Not give to people <18 yrs old d/t risk of tendon injury (but still given in complicated UTI, traveller’s diarrhea, anthrax)
o Also can occur in elderly
o Aortic rupture has been reported as well
MUMS: Fluoroquinolones should be reserved for treatment failures, comorbidities with recent antibiotic use, allergies or documented infections with highly drug-resistant pneumococci or Legionella. This is due to their broad-spectrum of activity, concerns over the rapid emergence of fluoroquinolone-resistant pneumococci and C. difficile-associated disease.
Which abx are fluoroquinolones?
ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin
- What are the antibiotics that are effective against pseudomonas infection?
Fluoroquinolones (cipro common)
meropenem
pip-taz
- Which classes of antibiotics are known to cause QTc prolongation?–give an example of a drug from each class
Macrolide (erythromycin) and
fluoroquinolone antibiotics (ciprofloxacin)
some antifungal (fluconazole)
and antiviral drugs
- Which antimycobacterial drugs (TB treatment) can turn tears, sweats, saliva and urine reddish-orange? What patient teaching do you need to do?
Rifampin
- Not permanent except tooth staining
- Not harmful
- Don’t wear soft contacts d/t staining
- Which antimycobacterial drugs can cause peripheral neuropathy? What’s the solution for this?
- isoniazid
- Can take Pyridoxine (Vit B6) to prevent this from happening
What monitoring parameters are needed when pt on first line drugs for TB? (this would be good to know when collaboratively managing patients with specialists)
Patients receiving combination antituberculous therapy should undergo baseline measurement of liver function tests (serum bilirubin, alkaline phosphatase, and transaminases). In addition, testing for hepatitis B and C should be pursued for patients with epidemiologic risk factors [78]. Counseling and testing for HIV infection should also be performed. Other baseline tests prior to initiation of antituberculous therapy should include complete blood count, creatinine, and uric acid [1].
Ethambuton: Assess colour vision and visual acuity at baseline and monitor monthly in patients receiving ethambutol for longer than 2 months
- When Rifampin is prescribed, women on oral contraceptives should use an additional nonhormonal form of birth control—What’s the rationale for this?
Rifamycin antibacterials induce the CYP enzymes that metabolize estrogens and progestins; this may lead to reduced contraceptive hormone levels and potential contraceptive failure (CPS)
