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Pre-reg Exam 2021 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Which antibiotics are contraindicated in children?

A

Tetracyclines - not for < 12 years

Quinolones - cause arthropathy

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2
Q

Which antibiotics are contraindicated /cautioned in the elderly?

A

Clindamycin - highest risk of C. Diff

Careful in renal/liver impairment

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3
Q

Which antibiotics commonly cause allergic reactions?

A

Penicillins - also cross-sensitivity with cephalosporins and other B-lactam antibiotics

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4
Q

Which antibiotics can be used as alternatives in penicillin allergic patients?

A

Macrolides

Metronidazole (dental infections)

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5
Q

Which antibiotics cause nephrotoxicity?

A

Aminoglycosides

Glycopeptides

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6
Q

Which antibiotics should be avoided in renal impairment?

A

Tetracyclines - except minocycline/doxycycline

Nitrofurantoin - eGFR < 45

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7
Q

Which antibiotics cause hepatotoxicity?

A

Rifampicin
Tetracyclines
Reduce metronidazole dose if liver severely impaired

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8
Q

Which antibiotics cause cholestatic jaundice?

A

Co-amoxiclav

Flucloxacillin

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9
Q

Which antibiotics are contraindicated in pregnancy?

A

Tetracyclines
Trimethoprim
Nitrofurantoin - avoid at term as causes nausea

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10
Q

Which antibiotics should be avoided in pregnancy?

A

MCAT
Metronidazole, chloramphenicol, aminoglycosides, tetracyclines
Quinolones
Sulphonamides

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11
Q

Which antibiotics are safest in pregnancy?

A

Penicillins

Cephalosporins

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12
Q

What are the most common side effects of antibiotics?

A

GI

Nausea, vomiting, diarrhoea, abdominal pain

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13
Q

Which antibiotics can cause superinfection e.g. antibiotic associated colitis and thrush?

A

Clindamycin and broad spectrum antibiotics

C. Diff - antibiotics beginning with C most likely to cause, highest likelihood is clindamycin

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14
Q

Which of the following is most likely to be used in staphylococci infections?

A) Flucloxacillin
B) Vancomycin
C) Phenoxymethylpenicillin
D) Metronidazole
E) Gentamicin
A

A) Flucloxacillin

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15
Q

Which of the following is most likely to be used in MRSA infection?

A) Flucloxacillin
B) Penicillin V
C) Metronidazole
D) Tazosin
E) vancomycin
A

E) Vancomycin

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16
Q

Which of the following is most likely to be used in streptococci infection?

A) Phenoxymethylpenicillin
B) Erythromycin 
C) Metronidazole
D) Gentamicin
E) Flucloxacillin
A

A) Phenoxymethylpenicillin

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17
Q

Which of the following is most likely to be used in anaerobic infection?

A) Gentamicin 
B) Metronidazole 
C) Cefalexin
D) Flucloxacillin
E) Benzylpenicillin
A

B) Metronidazole

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18
Q

Which of the following is most likely to be used in pseudomonas aeruginosa infection?

A) Flucloxacillin 
B) Vancomycin
C) Metronidazole
D) Gentamicin
E) Trimethoprim
A

D) Gentamicin

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19
Q

What is the mechanism of action for clindamycin?

A

Inhibits protein synthesis

Narrow spectrum

Bacteriostatic

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20
Q

What are the most common side effects of clindamycin?

A

Antibiotic associated colitis

Most common in middle aged, elderly women, especially after operations

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21
Q

What is the patient counselling needed for clindamycin?

A

If diarrhoea develops stop and see GP

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22
Q

Which antibiotics reduce the efficacy of COCs?

Impairs bacterial flora responsible for recycling ethinylestradiol

A

Ampicillin
Amoxicillin
Doxycycline

Additional precautions required for duration of treatment and 7 days after stopping

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23
Q

What is the mechanism of action of linezolid?

A

Inhibits protein synthesis

Only active against gram positive bacteria e.g. MRSA and anaerobes

Narrow spectrum
Bacteriostatic

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24
Q

What is an alternative to vancomycin when used for MRSA infection?

A

Linezolid

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25
Q

What are the side effects of linezolid?

A

Blood disorders

Optic neuropathy if > 28 days use

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26
Q

What is the patient counselling needed for linezolid?

A

Report visual symptoms

Blurred vision, visual field defects, changes in visual acuity and colour vision

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27
Q

What are the important interactions for linezolid?

A

Hypertensive crises - SSRI, TCA, MAOI (wait 2 weeks after stopping), opioids, 5HT agonists, buspirone, pethidine

Linezolid is a reversible MAOI
Avoid consuming large amounts of tyramine rich foods e.g. cheese, cured meats

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28
Q

What is the mechanism of action for trimethoprim?

A

Inhibits DNA synthesis

Narrow spectrum
Bactericidal

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29
Q

What is trimethoprim used for and what dose?

A

UTI

200mg BD

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30
Q

What are the important side effects of trimethoprim?

A

Anti-folate - teratogenic in first trimester

Blood dyscrasias - with long term use

Hyperkalaemia

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31
Q

Most important interaction for trimethoprim?

A

Methotrexate - DO NOT USE

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32
Q

What is co-trimoxazole used for?

Trimethoprim/sulfamthoxazole

A

Prophylaxis and treatment of pneumocystis jirovecii pneumonia

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33
Q

What are the side effects for co-trimoxazole?

A

Rashes, necrolysis, photosensitivity

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34
Q

What are the counselling points for trimethoprim?

A

Blood dyscrasias - report fever, sore throat, rash, mouth ulcers, purpura, bruising, bleeding

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35
Q

What is the mechanism of action for chloramphenicol?

A

Inhibits protein synthesis

Broad spectrum
Bacteriostatic

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36
Q

When is chloramphenicol used?

A

Bacterial conjunctivitis OTC

Life-threatening conditions

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37
Q

What are the side effects of chloramphenicol?

A

Blood dyscrasias
Grey baby syndrome - avoid in pregnant women

Unlikely to occur with eye drops but eye drops unlicensed for use in pregnant women OTC

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38
Q

What is the dosing regime for chloramphenicol eye drops for bacterial conjunctivitis OTC?

A

5 day course, if no improvement within 48 hours discontinue and seek medical advice

Optrex - one drop every 2 hours for the first 48 hours and 4 hourly thereafter. Use for 5 days even if symptoms improve

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39
Q

What age can chloramphenicol eye drops be used OTC?

A

Over the age of 2 as it contains boron which may impair fertility in the future

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40
Q

What is the dosing regimen for chloramphenicol ointment OTC?

A

Apply approximately 1 cm of ointment between the lower eyelid and the eye 3-4 times a day

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41
Q

What time of day chloramphenicol eye drops and eye ointment be used if using together?

A

Drops used during the day

Ointment used at night

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42
Q

Does chloramphenicol ointment need to be stored in the fridge?

A

No

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43
Q

Do chloramphenicol eye drops need to be stored in the fridge?

A

Yes

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44
Q

What is the mechanism of action for metronidazole?

A

Inhibits DNA synthesis
High activity against anaerobic bacteria and protozoa

Narrow spectrum and bactericidal

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45
Q

What is metronidazole used for?

A

Anaerobic infections e.g. dental, antibiotic associated colitis, h. Pylori, rosacea, bacterial vaginosis

Protozoal infections e.g. vagina, trichomoniasis, giardiasis

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46
Q

What are the common side effects of metronidazole?

A

GI disturbances, taste disturbances, oral mucositis, furred tongue

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47
Q

What are the counselling points for metronidazole?

A

Take with or after food

AVOID alcohol as it causes a disulfiram-like reaction

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48
Q

What is the mechanism of action for nitrofurantoin?

A

Damages bacterial DNA
Only active against urinary pathogens

Narrow spectrum
Bactericidal

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49
Q

What are the uses of nitrofurantoin?

A

UTIs

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50
Q

What are the side effects of nitrofurantoin?

A

Nausea

Peripheral neuropathy in renal impairment

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51
Q

Can nitrofurantoin be used in pregnancy?

A

Yes, but avoid at term as causes neonatal haemolysis

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52
Q

What are the contraindications for nitrofurantoin?

A

Infants less than 3 months

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53
Q

What are the counselling points for nitrofurantoin?

A

Take with or after food

Colours urine YELLOW or BROWN

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54
Q

What are the aminoglycosides?

A 
Gentamicin
Tobramycin
Streptomycin
Neomycin
Amikacin
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55
Q

What is the mechanism of action of aminoglycosides?

A

Bind irreversibly to bacterial ribosomes
Active against gram negative aerobe pseudomonas aeruginosa

Broad spectrum
Bactericidal

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56
Q

What are the aminoglycosides used for?

A

Severe sepsis
Pyelonephritis
Complicated UTI
Endocarditis

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57
Q

Why are aminoglycosides given parenterally?

A

They are not absorbed by the gut

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58
Q

Which of the following aminoglycosides is most likely to be used for pseudomonas aeruginosa infection?

A) Amikacin
B) Neomycin
C) Gentamicin
D) Streptomycin
E) Tobramycin
A

C) Gentamicin

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59
Q

Which of the following aminoglycosides is most likely to be used via an inhaler for pseudomonal infection in cystic fibrosis?

A) Amikacin
B) Neomycin
C) Gentamicin
D) Streptomycin
E) Tobramycin
A

E) Tobramycin

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60
Q

Which of the following aminoglycosides is most likely to be used in TB?

A) Amikacin
B) Neomycin
C) Gentamicin
D) Streptomycin
E) Tobramycin
A

D) Streptomycin

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61
Q

Which of the following aminoglycosides is most likely to be used in bowel sterilisation?

A) Amikacin
B) Neomycin
C) Gentamicin
D) Streptomycin
E) Tobramycin
A

B) Neomycin

Neomycin is parenterally toxic

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62
Q

Which of the following aminoglycosides is most likely to be used for gentamicin-resistant gram-negative bacilli?

A) Amikacin
B) Neomycin
C) Gentamicin
D) Streptomycin
E) Tobramycin
A

A) Amikacin

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63
Q

What is gentamicin used for?

A

Active against pseudomonas aeruginosa

Blind therapy in serious infection - with metronidazole/penicillin

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64
Q

What are the monitoring requirements for gentamicin?

A

Plasma concentrations - narrow therapeutic index

Serum concentration in: 
Elderly
Obesity
Cystic fibrosis
High doses
Renal impairment
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65
Q

When do you avoid a once daily dosing of gentamicin?

A

Avoid in renal impairment < 20ml/min, HACEK or gram positive endocarditis, burns covering > 20% of body

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66
Q

When do you monitor serum concentration for gentamicin multiple dose regimens?

A

Monitor after 3 or 4 doses and after a dose change

In renal impairment requires more frequent and earlier monitoring

67
Q

When do you reduce the dose of gentamicin?

A

When the post-dose peak level after 1 hour is too high - 5-10mg/ml, (3-5mg/ml for endocarditis)

In severe renal impairment (<30 ml/min)

68
Q

When do you increase the interval with gentamicin dosing?

A

Pre-dose trough level before next dose is too high
Needs to be less than 2mg/ml (< 1mg/ml for endocarditis)

In renal impairment

69
Q

Is gentamicin dosing based on body weight or ideal body weight?

A

Ideal body weight

70
Q

Can you give gentamicin in pregnancy?

A

Yes but avoid unless essential

Monitor serum concentrations

71
Q

What are the side effects of gentamicin?

A 
Dose related - do not exceed 7 days
Commonly occur in elderly and renal failure
Nephrotoxicity 
Ototoxicity
Peripheral neuropathy
Impaired neuromuscular transmission
Hypokalaemia 
Hypocalcaemia
Hypomagnesaemia
72
Q

What are the signs of nephrotoxicity?

A

Low urine output
Creatinine clearance
High serum creatinine
High urea

73
Q

The concomitant use of gentamicin with these drugs causes nephrotoxicity. Which drugs are these?

A

Ciclosporin
Tacrolimus
Vancomycin

74
Q

What are the counselling points for gentamicin?

A

Report hearing loss, tinnitus or vertigo - irreversible ototoxicity

75
Q

What interaction causes an increased risk of ototoxicity when used with gentamicin?

A

Loop diuretics - separate by as long a period as possible

Cisplatin

76
Q

What is the 2017 MHRA warning for gentamicin?

A

Potential for histamine related adverse reactions with some batches

77
Q

What are the glycopeptides?

A

Vancomycin
Teicoplanin
Televancin

78
Q

What is the mechanism of action for glycopeptides?

A

Inhibits cell wall synthesis
Only active against gram positive bacteria including MRSA

Narrow spectrum
Bactericidal

79
Q

Which glycopeptides cannot be given by mouth for systemic infections?

A

Vancomycin

Teicoplanin

80
Q

Which glycopeptide is most likely to be used in HAP?

A

Televancin but only when other antibiotics are unsuitable

81
Q

Which glycopeptide is more likely to be used for MRSA?

A

Vancomycin

82
Q

What is vancomycin used for?

A

Antibiotic associated colitis, MRSA infections

Given parenterally for serious infections

83
Q

What are the monitoring requirements for the plasma concentrations of vancomycin?

A

Plasma concentrations:
All patients
After 3-4 doses and after a dose change
Renal impairment- earlier and regular monitoring = reduce dose

Pre-dose trough level = 10-15 mg/mL
15-20 mg/mL for endocarditis, less sensitive MRSA strains or complicated S. aureus infections

84
Q

Can vancomycin be used in pregnancy?

A

Avoid unless essential

85
Q

What are the parenteral side effects of vancomycin?

A 
Nephrotoxicity
Ototoxicity 
Red man syndrome 
Blood dyscrasias 
Skin disorders 
Thrombophlebitis
86
Q

What needs to be monitored for vancomycin?

A

Renal function
Auditory function
FBC - neutropenia

87
Q

What are the counselling points for vancomycin?

A

Report tinnitus, hearing loss, vertigo, dizziness

Discontinue if tinnitus occurs

88
Q

The concomitant use of vancomycin with which drugs causes nephrotoxicity?

A

Ciclosporin

89
Q

The concomitant use of vancomycin with which drugs causes ototoxicity?

A

Loop diuretics

90
Q

What is the mechanism of action for tetracyclines?

A

Inhibits bacterial protein synthesis
Binds to ribosomal 30S subunit

Broad spectrum, bacteriostatic

91
Q

What are tetracyclines used for?

A 
Lower RTIs
Acne
Rosacea
Malaria
Chlamydia
92
Q

What are the tetracyclines?

A 
Demeclocyline
Doxycycline
Lymecycline
Minocycline
Oxytetracycline 
Tetracycline
Tigecycline
93
Q

Which tetracycline is most likely to be used in malaria?

A

Doxycycline OD

94
Q

Which tetracycline is most likely to be used in chlamydia?

A

Doxycycline

95
Q

Which tetracycline has the broadest spectrum?

A

Minocycline

96
Q

What are the side effects of tetracyclines?

A 
Benign intracranial hypertension
Teeth discolouration
Dental hypoplasia
Photosensitivity 
Decreased absorption of salts and iron
Oesophageal irritation
97
Q

What are the side effects of minocycline?

A

Vertigo
Dizziness
Irreversible pigmentation
Lupus erythymatosus like syndrome

98
Q

What are the contraindications of tetracyclines?

A

Children under 12

Pregnancy and breastfeeding

99
Q

What happens when you use tetracyclines in pregnancy and breastfeeding?

A

Deposit in growing bone and teeth causing discolouration and dental hypoplasia

100
Q

Which tetracyclines can you use in renal impairment?

A

Doxycycline

Minocycline

101
Q

Can you use tetracyclines in hepatic impairment?

A

Avoid or use with caution as tetracyclines are hepatotoxic

102
Q

What are the counselling points for tetracyclines?

A

Avoid exposure to sunlight - demeclocycline, doxycycline

Do not take antacids (Al, Mg2+, Ca2+, Iron, Zinc salts), leave gap of 2 hours before/after taking

Avoid milk - demeclocycline, oxytetracycline, tetracycline

Swallow whole with plenty of fluid during meals while sitting or standing - doxycycline, minocycline, tetracycline

103
Q

What is the mechanism of action for quinolones?

A

Inhibits DNA synthesis

Broad spectrum
Bactericidal

104
Q

What are quinolones used for?

A

Lower RTIs, UTIs

Avoid in MRSA

105
Q

What are the quinolones?

A 
Ciprofloxacin
Levofloxacin
Moxifloxacin
Nalidixic Acid
Norfloxacin
Ofloxacin
106
Q

Which quinolone is the most likely to cause QT prolongation?

A

Moxifloxacin

107
Q

Which quinolone is most likely to cause life threatening hepatotoxicity?

A

Moxifloxacin

108
Q

Which quinolone is most likely to be avoided if the eGFR < 20ml/min?

A

Nalidixic acid

109
Q

What are the side effects of quinolones?

A

Seizures - with or without previous history
Tendon damage - stop if tendinitis suspected
QT prolongation - leads to ventricular arrhythmias
Arthropathy - avoid in pregnancy, children, adolescent

110
Q

When should quinolones be discontinued?

A

Psychiatric, neurological or hypersensitivity reactions occur

111
Q

Which of the following is most likely to cause convulsions if used concomitantly with quinolones?

A) Fluoxetine
B) Amiodarone
C) Clarithromycin 
D) Naproxen
E) Aripiprazole
A

D) Naproxen - NSAIDs induce convulsions

The others cause an increased risk of QT prolongation

112
Q

Which medications cause an increased risk of QT prolongation when used with quinolones?

A 
SSRIs
Quinine
Amiodarone
Macrolides
Antipsychotics
113
Q

Which medication causes an increased risk of seizures when used with ciprofloxacin?

A) Salbutamol
B) Ramipril
C) Theophylline
D) Amiodarone
E) Quinine
A

C) Theophylline - pharmacokinetic and pharmacodynamic interaction - ciprofloxacin is an enzyme inhibitor and causes theophylline toxicity. Theophylline side effect is convulsions

114
Q

What are the counselling points for quinolones?

A

Take care when driving as impairs performance of skilled tasks

Antacids, zinc/iron - leave 2 hours before/after taking a quinolone

Avoid milk with ciprofloxacin and norfloxacin

Protect skin from sunlight. Avoid sunbeds- ofloxacin

115
Q

What is the mechanism of action for macrolides?

A

Inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome

Broad spectrum
Bacteriostatic

116
Q

What are macrolides used for?

A

Penicillin alternative
H. Pylori
RTIs
Skin and soft tissue infections

117
Q

Which of the following macrolides is most likely to be taken once daily?

A) Azithromycin
B) Clarithromycin
C) Erythromycin

A

A) Azithromycin

Take before food/indigestion remedies - leave a 2 hour gap

118
Q

What side effect is common in clarithromycin?

A

Taste disturbance

119
Q

How often is clarithromycin taken?

120
Q

How often is erythromycin taken?

A

QDS/BD

Before indigestion remedies - 2 hour gap

121
Q

What is telithromycin used for?

A

B-lactam resistant infections

122
Q

What are the common side effects of telithromycin?

A

Visual disturbances
Hepatotoxicity
Loss of consciousness

123
Q

What is an unlicensed use for spiramycin?

A

Toxoplasmosis in pregnancy

124
Q

What are the common side effects of macrolides?

A

GI effects
QT interval prolongation
Hepatotoxicity
Ototoxicity at high doses

125
Q

Which of the following macrolide is most likely to cause nausea, vomiting, abdominal discomfort and diarrhoea?

A) Clarithromycin 
B) Azithromycin 
C) Spiramycin
D) Telithromycin
E) Erythromycin
A

E) Erythromycin

126
Q

What re the risk factors for QT interval prolongation in macrolides?

A 
Bradycardia
Heart disease
Hypokalaemia
Hypomagnesaemia 
QT prolongation drugs
127
Q

Should macrolides be taken on an empty stomach?

A

Take with or after food, 2 hour gap with indigestion remedies

128
Q

What are the most important interactions for macrolides?

A

Erythromycin and Clarithromycin are enzyme inhibitors

Warfarin - increased risk of bleeding
Statins - increased risk of myopathy

129
Q

What is the mechanism of action of penicillins?

A

Interfere with bacterial cell wall synthesis
Not useful in CNS infections except meningitis

Broad spectrum
Bactericidal

130
Q

Which penicillins are narrow spectrum (beta-lactamase sensitive)?

A

Benzylpenicillin (PEN G)

Phenoxymethylpenicillin (PEN V)

131
Q

Which penicillins are broad spectrum (inactivated by beta-lactamases)?

A

Ampicillin

Amoxicillin

132
Q

Which penicillin is penicillinase resistant?

A

Flucloxacillin

133
Q

Which penicillin is antipsuedominal (extended spectrum)?

A

Piperacillin (with tazobactam)

Ticaricillin (with clavulanic acid)

134
Q

What are the common side effects of penicillins?

A

Penicillin allergy - rash or anaphylaxis

True allergy - Immediate rash. Anaphylaxis. Hives
Do not use any beta-lactam antibiotic - cephalosporins, carbapenems, monibactams

May not be allergic - minor rash, rash after 72 hours
Do not withhold penicillin for serious infections

135
Q

Can penicillin be given as an intrathecal injection?

A

No - causes encephalopathy and can be fatal

136
Q

What are the risks associated with broad spectrum penicillins?

A

Do not give blindly for sore throat - causes maculopapular rash in glandular fever

Can cause antibiotic associated colitis

137
Q

Does ampicillin have high or low antibiotic resistance?

138
Q

What is ampicillin used for?

A

UTIs
Otitis media
Acute COPD exacerbations

139
Q

How do you take ampicillin?

A

Before food

140
Q

What is amoxicillin active against?

A

Beta lactamase producing strains

141
Q

What does co-amoxiclav contain?

A

Amoxicillin and clavulanic acid

142
Q

What is an important side effect of amoxicillin, especially if it is used for more than 14 days?

A

Cholestatic jaundice

143
Q

What is PEN G uses for?

A

Meningitis

144
Q

Can benzylpenicillin be taken orally?

A

No. Parenteral only as not gastric acid stable

145
Q

What is PEN V uses for?

A

RTIs in children

E.g. streptococcal throat, tonsilitis

146
Q

Is PEN V able to be taken orally?

A

Yes. It is gastric acid stable

147
Q

What is Flucloxacillin used for?

A

Penicillin resistant staphylococcal infections except MRSA e.g. skin infections, impetigo, cellulitis

148
Q

If an elderly person uses flucloxacillin for more than 14 days, this increases the risk of…?

A

Cholestatic jaundice and hepatitis

This can occur up to two months after treatment

149
Q

How do you take flucloxacillin?

A

Before food

150
Q

What are piperacillin with tazobactam, and ticaricillin with clavulanic acid used for?

A

Septicaemia
Complicated UTI
HAP
Effective against pseudomonas aeruginosa

151
Q

What is temocillin used for?

A

Beta lactamase producing strains of gram negative bacteria

152
Q

What is the mechanism of action of cephalosporins?

A

Interferes with bacterial cell wall synthesis
They have a similar spectrum of activity to penicillins

Broad spectrum
Bactericidal

153
Q

What are the cephalosporins used for?

A

UTI (pregnancy or second line)
Sinusitis
Otitis media

154
Q

What are the first generation cephalosporins?

A

Cefalexin
Cefadroxil
Cefradine

155
Q

Which of the following is a BD dose?

A) Cefalexin
B) Cefadroxil
C) Cefradine

A

B) Cefadroxil

156
Q

What are the second generation cephalosporins?

A

Cefuroxime

Cefaclor

157
Q

What is a common side effect of cefaclor?

A

Protracted skin reactions, especially in children

158
Q

What are the third generation cephalosporins?

A

Cefixime
Ceftriaxone
Cefotaxime
Ceftazidime

159
Q

Which is the only third generation cephalosporin that is orally active?

A

Cefixime

The others are parenteral

160
Q

Which 3rd generation cephalosporin is used OD?

A

Ceftriaxone

161
Q

Which two cephalosporins are most likely to be used in meningitis?

A

Ceftriaxone

Cefotaxime

162
Q

When if ceftaroline used? (5th generation cephalosporin)

A

CAP

Complicated skin and soft tissue infections

163
Q

What are the common side effects of cephalosporins?

A

Hypersensitivity - do not give in history of immediate penicillin hypersensitivity. If no alternative give 3rd generation or cefuroxime

Antibiotic associated colitis- most common in 2nd and 3rd generation

Pre-reg Exam 2021 (79 decks)

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