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Year 3 Drug > antibiotics 1 > Flashcards

antibiotics 1 Flashcards

1
Q

what is the classname of nitrofurantoin

A

nitrofurantoin

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2
Q

indiction for nitrofurantoin

A

1st line treat for uncomplicated UTI

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3
Q

MOA for nitrofurantoin

A

it is metabolised in bacterial cells by nitrofuran reductase and its active metabolite damages bacterial DNA and causes cell death

Nitrofurantoin is active against the G-ve (eg E.coli) and G+ve ( Staph sap) that commonly cause UTI

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4
Q

contraindication for nitrofurantoin

A

should not be use in pregnant women or for bodies tin the first 3 months of life

renal impairment - impaired excretion inc toxicity and reduces efficacy due to lower urinary drug conc

caution for chronic use for long term prevention - inc risk of side-effect esp in elderly pts

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5
Q

side effect for nitrofurantoin

A

GI upset (N+v)

can cause delayed
hypersensitivity

turn urine yellow or dark

can cause chronic pulmonary reactions (inc inflammation and fibrosis)

hepatitis

peripheral neuropathy

in neonates - haemolytic anaemia - RBC can not mop up nitrofurantoin-stimulated superoxides

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6
Q

interaction of nitrofurantoin

A

N/A

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7
Q

typical dose of nitrofurantoin

A

50-100mg 6 hourly

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8
Q

what is the class name for trimethoprim

A

trimethoprim

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9
Q

what are 2 examples of trimethorim

A

trimethoprim and co-trimoxazole (trimethoprim and sulfamethoxazole)

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10
Q

main indication for trimethoprim

A

first choice for uncomplicated UTI

co-trimoxazole is used to treat and prevent pneumocystis pneumonia in people with immunosuppression

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11
Q

MOA for trimethorpim

A

trimethoprim - inhibits bacteria folate synthesis (as bacteria are unable to use folate present in human body) and so it is bacteriostatic

sulfonamides also inhibit bacterial folate synthesis but slightly different pathway to trimethoprim, but together with trimethoprim, a complete bactericidal action

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12
Q

contra-indication for trimethoprim

A

first trimester of pregnancy (folate antagonist)

avoid use in ppl with folate deficiency

a reduced dose should be used in ppl with renal impairment

cautious use in neonate, elderly and ppl with HIV

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13
Q

side effect of trimethoprim

A 
GI upset (N+V) 
skin rash (rare) 
can impair haematopoiesis causing haematological disorder such as megaloblastic anaemia, leucopenia, thrombocytopenia 
can also cause hyperkalaemia
elevation of plasma creatinine conc
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14
Q

interaction of trimethoprim

A

use with potassium-elevating drugs eg (aldosteron antagonist, ACEi, angiotensin receptor blockers) - predisposes to hyperkalaemia

use with other folate antagonist eg methotrexate and drugs that inc folate metabolism - inc risk of adverse haematological effects

can also enhance the anticoagulant effect of warfarin by killing normal gut flora that synthesise vit K

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15
Q

what is the doses of trimethoprim

A

200mg 12 hourly

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16
Q

what are the different examples of penicillin

A

benzylpenicillin, phenoxymethylpenicillin

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17
Q

what are some examples of broad spectrum penicillin

A

amoxicillin and co-amoxiclav

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18
Q

MOA for broad spectrum penicillin

A

Beta lactam

amoxicillin - beta-lactam has side chain attached to the beta lactam ring and this side chain can modified to increase antibacterial ability. amoxicillin has additional amino acids group for inc ability

co-amoxiclav - addition of beta-lactamase inhibitor, clavulanic acid, inc the spectrum of antimicrobial activity to include beta-lactamase-producing bacteria eg staph aureus, gram -ve anaerobes)

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19
Q

main indication for broad spectrum penicillin

A
  • empirial treatment for pneumonia (can be due to both gram +ve and gram -ve pathogens
  • empirial treatment for UTI (most common caused by E.coli)
  • part of combined treatment for H.pylori-associated peptic ulcers
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20
Q

main contra-indications for broad spectrum penicillin

A

pt at inc risk of C.Diff infection

allergy dose should be reduced in those with severe renal impairment

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21
Q

adverse effect of broad spectrum penicillin

A

GI upset eg N+V
antibiotic colitis- normal flora got killed
allergy
cholestatic jaundice - co-amoxiclav

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22
Q

interaction of broad spectrum penicillin

A

reduce renal excretion of methotrexate - inc risk of toxicity

can enhance the anti-coagulant ability of warfarin by killing gut flora which produce Vita K

23
Q

typical dose for amoxicillin

A

severe infection - 1g 8-hrly then switch to oral

mild-moderate - 250-500mg 8 hrly

24
Q

what are the group name for benzypenicillin, phenoxymethypenicillin

A

penicillins

25
Q

MOA for benzypenicillin and phenoxymethypencillin

A

Beta lactam

the side chain to the beta lactam ring is the characteristic for the medicine

26
Q

main indication for benzypenicillin and phenoxymethypenicillin

A
  • strep infection - incl tonsillitis, pneumonia (combine with macrolide if severe), endocarditis and skin and soft tissue infections (added to fluxcloxacilline if severe)

Costridial infection eg tetanus

meningococcal infection eg meningitis, septicaemia (blood poisoning)

27
Q

contra-indication for benzypenicillin and phenoxymethypenicillin

A

pt with renal impairment

allergy

28
Q

side effect for benzypenicillin and phenoxymethypenicillin

A

allergy

CNS toxicity - can occur with high dose of penicillin

29
Q

interaction of benzypenicillin and phenoxymethypenicillin

A

methotrexate - pencillin reduce renal exercretion - inc conc

30
Q

what is penicillin V

A

phenoxymethypenicillin

31
Q

what is an example of penicillin with antipseudomonal

A

piperacillin with tazobactam (Tazocin)

32
Q

MOA for Tazocin

A

beta lactam

for piperacillin, side chain = a form of urea which improve affinity to penicillin binding proteins - inc spectrum of antimicrobialactivity to include pseudomonas aeruginosa

tazobactam - confers antimicrobial activity against beta lactamase producing bacteria eg staphy aureus, gram -ve anaerobes

33
Q

main indication for Tazocin

A

reserved for severe infections - where broad spectrum of potential pathogens (incl pseudomonas aeruginosa) and antibiotic resistance is likely or pts who are immunocompromised

lowere Resp tract inf
UTI
Intra-abdominal sepsis
skin and soft tissue infection

34
Q

contra-indication for Tazocin

A

caution in pt at risk of C.diff

allergy
renal impairment

35
Q

side effect of Tazocin

A

GI upset
antibiotic associated colitis - killing of normal gut flora
allergy

36
Q

interaction of Tazocin

A

methotrexate

inc risk of warfarin toxicity - killing of normal gut flora which produce vita K

37
Q

which of the penicillin medication should be used with a pathogen which is penicillinase-resistant

A

Flucloxacillin

38
Q

MOA for flucoxacillin

A

an acyl side chain protects the beta lactam from beta lactamases

makes flucloxacillin effective against beta lactamase producing staphylococci

MRSA resist the flucloxacillin by reducing penicillin binding affinity

39
Q

contra-indication for flucloxacillin

A

renal impairment

allergy

40
Q

side effect of flucloxacillin

A

GI upset
allergy
CNS toxicity - when high dose

41
Q

interaction of flucloxacillin

A

methotrexate

42
Q

what are some examples of cephalosporins and carbapenem

A

cefalexin and cefotaxime

meropenem ertapenem

43
Q

MOA of ceflaxin and cefotaxime and meopenem and ertapenem

A

beta lactam ring but inhibit enzymes responsible for cross-linking peptidoglycanrs in the bacterail cell wall during cell growth

broad spectrum

both are more resistant to beta-lactamases than pencillin due to fusion of the β-lactam ring with a dihydrothiazine ring (cephalosporins) or a unique hydroxyethyl side chain (carbapenems).

44
Q

main indication for cephalosporins and carbapenems

A
  • oral cephalosporins - 2nd or 3rd line treatment options for UTI and resp tract infection
  • IV injections of both types are reserved for severe or complicated infection
  • cAN BE USED FOR MOST INFECTION DUE TO BROAD SPECTrum
45
Q

contra-indication for cephalosporin and carbapenems

A

pt at risk of C.diff
allergy
carbapenems - caution in pt with epilepsy
renal impairment in both

46
Q

side effect for cephalosporin and carbapenems

A 
GI upset 
antibiotic associated collitis 
allergy 
CNS system toxicity - when high doses 
renal impairment
47
Q

interaction of cephalosporins and carbapenems

A

warfarin

cephalosporins - inc nephrotoxicity of aminoglycosides

carbapenems - reduce plasma conc of valproate

48
Q

examples for tetracyclines

A

doxycycline, lymecycline

49
Q

MOA for doxycycline and lymecycline

A

inhibit bacterial protein synthesis

binds to ribosomal 30s subunit found specifically in bacteria - bacteriostatic

broad spectrum

50
Q

indication for tetracyclines

A

acne vulgaris

lower RTI incl infective exacerbation of COPD, pneumonia and atypical pneumonia

chlamydial infection incl pelvic inflammatory disease

typhoid, anthrax, malaria and Lyme disease

51
Q

contra-indication for tetracyline

A

oesophageal and bone - teeth deformity - avoid in infant as they are still growing, pregnancy, breast feeding

renal impairment

52
Q

side effect of tetracycline

A

GI upset

ulceration and dysphagia

photosensitivity

discolour and hypoplasia of tooth enamel

intracranial hypertension - rare

53
Q

interaction of tetracycline

A

They shouldn’t be given within 2 hours of calcium, antacids or iron

Enhance warfarin

54
Q

indication for flucloxaillin

A

skin and soft tissue - eg cellulitis (with benzypenicillin)
Osteomyelitis and septic arthritis
endocarditis

Year 3 Drug (12 decks)

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