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BNF Infections > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

what is the mode of action for tetracyclines?

A

Inhibit bacterial protein synthesis, binds to ribosomal 30s subunit

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2
Q

what is the spectrum of activity for tetracyclines?

A

Broad spectrum and bacteriostatic

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3
Q

what are tetracyclines used for?

A

Lower RTI, acne, rosacea, malaria and Chlamydia

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4
Q 
what are the following tetracyclines used for: 
Democlocyline
Doxycycline
Lymecycline
monocycline
oxytetracycline
tetracycline
tiegracycline
A

Democlocyline :
Doxycycline: used in malaria and chlamydia:OD
Lymecycline: acne
monocycline: broader spectrum, rarely used
oxytetracycline
tetracycline
tiegracycline: antibiotic structually related

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5
Q

what are side effects of tetracylines?

A

benign intercranial hypertension

Photosentisation particularly with demclocycline and doxycycline

Discolour teeth under 12

Angioedema
• Headache
• Nausea, Diarrhoea & vomiting
• Hypersensitivity
• Photosensitivity reaction
• Skin reactions
• Systemic Lupus Erythematosus
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6
Q

name 2 patient groups for which tetracyclines are contraindicated

A

children under 12

Pregnant and breastfeeding - deposits in growing teeth and bones - discolours enamel

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7
Q

how are tetracyclines used in renal impairement?

how are tetracyclines used in hepatic impairement?

A

renal: avoid all execept doxycline and minocycline

Hepatic : avoid or use with caution

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8
Q

what counselling points must be given when providing tetracyclines

A

avoid exposure to sunlight/sunlamps, (doxycycline, demecycline )

decreased absorption of : Al, Ca2I,Mg2+ and zinc sales
DOT- democycline,

oespahageal irritation - DMT - doxycycline
minocycline, tetracycline

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9
Q

Give examples of aminoglycosides

A

Amokacin gentamicin, tobramycin, neomycin,streptomycin

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10
Q

What are common indications of aminoglycosides

A

Sepsis, meningitis, endocarditis, pneumonia and surgical prophylaxis

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11
Q

Common side effects of aminoglycosides

A

Nephrotoxicity and ototoxicity

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12
Q

What is a key consideration when prescribing aminoglycosides

A

Can the patient monitor changes in hearing?

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13
Q

What needs to be monitored for a patient taking an aminoglycosides

A

Before and during Renal function -caution in renal failure
During Auditory and vestibular function
Serum concentration- monitor to avoid excessive and sub therapeutic levels and prevent toxicity
Must be monitored in parental admin and determined in elderly obese in CF, high doses of renal impairment

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14
Q

Administration of aminoglycosides

A

Once daily has superseded multiple daily dose

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15
Q

When should concentration be measured

A

After 3 of 4 doses of a multiple daily dose regimen or after a dose change

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16
Q

How are aminoglycosides excreted

A

Primarily Renally

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17
Q

When should bloods be taken for aminoglycosides for multiple daily dose regimens

A

1 hour after IV or IM admin (peak conc )
Just before next dose (trough)
If trough is high then the interval between doses must be increased
If peak is high the dose must be decreased

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18
Q

Mhra aminoglycosides info

A

Rare cases of ototoxicity- increased risk of deafness in patients with mitochondrial mutations - even for patients where concentration was in range

Must consider the need for aminoglycosides in patients at risk

Genetic testing needed but treatment shouldn’t be delayed

Those with mitochondrial mutations or family history Of ototoxicity should inform doctor or pharmacist before use
Continuous monitoring of auditory and renal function required

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19
Q

Dosing of gentamicin

A

Loading dose based of patient weight and renal function
Multiple daily dose regimen :

One hour peak conc : 5-10 mg/L
Pre dose trough conc: less than 2mg/l
Endocarditis peak conc: 3-5 mg/l
Endocarditis trough less than 1mg/L

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20
Q

Describe aminoglycosides spectrum of activity

A

Broad spectrum bacteriacidal

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21
Q

Describe carbapenams spectrum of activity

A

Broad spectrum
Beta lactase
Many gram positive and gram negative bacteria and anaerobes

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22
Q

carbapenams side effects

A 
Antibiotic associated colitis 
CNS toxicity (renal impairment)
Diarrhoea 
Rash
Injection site reactions
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23
Q

carbapenams indications

A

Severe or complicated resistant organisms

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24
Q

Which carbapemens are active against a significant organism

A

Imapenam and meropenem active against pseudamonas aurigonosa

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25
Q

carbapenams are not active against which serious infection

A

MRSA

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26
Q

Renal and hepatic impairment: carbapenams

A

Ertapenam- risk of seizures in renal impatient - dose limited to 500mg if eGFR is <30 ml/min
Imipenam - risk of CNS side effects dose reduced if CrCl <90ml/min
Meropenem-dose adjustments in renal impairment

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27
Q

When should carbapenams be avoided

A

When there is an immediate history of hypersensitivity to beta lactams

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28
Q

Cephalosporins spectrum of activity

A

Broad spectrum

29
Q

first gen Cephalosporins indications

A

Septacemia, UTI ,Skin reactions ,respiratory tract infections (pneumonia and meningitis)

30
Q

First gen

A

Gram positive
Staphylococci
Streptococci

31
Q

First gen Cephalosporins

A

Cefalexin
Cefradine
Cefadroxil

32
Q

Side effects of Cephalosporins

A

Diarrhoea and hypersensitivity

33
Q

Cross sensitivity

A

10% in first gen cephlasporins
3-5 % in fourth gen
Patients wit history of immediate hypersensitivity to penicillin and other beta lactams should not receive a cephalosporins

34
Q

Indications of second gen Cephalosporins

A

Meningitis
UTI
RESPIRIATIORY
SKIN

35
Q

Activity of second gen

A

More gram negative than 1st gen and less gram positive

36
Q

Examples of second gen Cephalosporins

A

Cefaclor
Cefoxotin
Cefuroxime

37
Q

Side effects of second gen Cephalosporins

A

Antibiotic associated colitis

Hypersensitivity

38
Q

How to advice someone experience

A

Severe diarrhoea or longer than 24 hours of contains blood seek medical attention

39
Q

Examples of third gen Cephalosporins

A

cefixime, cefotaxime, ceftazidime, ceftriaxone

40
Q

Side effects of Side effects of second gen Cephalosporins

A

antibiotic associate colitis, hypersensitivity

41
Q

indications : third gen Cephalosporins

A

meningitis, GI infections, UTI, respiratory and skin infection

42
Q

third gen cephlasporins spectrum of activity

A

enhanced activity against gram negative bacteria

43
Q

glycopepticdes spectrum of activity

A

bactericidal activity against aerobic and aerobic gram positive bacteria including MRSA

no activity against gram negate bacteria

44
Q

glycopeptides indications

A

endocarditis, pneumonia, meningitis, skin infections, MRSA and antibiotic associated colitis

45
Q

glycopeptides side effects

A

Nephrotoxicity
blood disorders
red man syndrome
ototoxicity

46
Q

glycopeptides monitoring

A

auditory function and plasma concentrations

47
Q

vancomycin dosing based on what initially and following this

A

initial dosing based on bodyweight

following does adjusted based on serum concentration

48
Q

duration of action :glycopeptides

A

teicoplanin is similer but has significantly longer duration of action vancomycin, so can be dosed once daily

49
Q

vancomycin dosing and monitoring

Trough target

A

initial dosing based on bodyweight

following does adjusted based on serum concentration

all patients require serum levels measured on second day of treatment before the next dose if renal function is normal and earlier if there is renal impairment

pre dose conc : 10-20 mg/l

IV monitoring :
periodic testing of auditory function
blood counts, urinalysis, hepatic and renal functions periodically
monitor leukocyte cont regularly esp with other drugs causing neutropenia or agrunulocytosis
monitor vestibular and auditory function during and after in elderly - avoid concomitant use with other ototoxic drugs

oral monitoring
serial testing of auditory function to minimise risk of ototoxicity esp in patients with underlying hearing loss

50
Q

What are the main indications for quinolones

A

UTI
Respiratory
Eye infections
GI INFECTION

51
Q

What are the main side effects of quinolones

A 
Nausea and vomiting 
Diahorrea
Hypersensitivity 
Psychiatric 
Inc risk of convulsions with NSAIDs 
Tendonitis - tendon rupture - corticosteroids

small increased risk of aortic aneurysm and dissection

small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk

52
Q

Quinalone cautions

A 
Seizures 
G6pd deficiency 
Qt prolongation 
exposure to excessive sunlight and UV radiation should be avoided during treatment and for 48 hours after stopping treatment; 
Myasthenia gravis 
Diabetes
53
Q

Common interactions with quinolones

A

Milk or antacids or vitamin supplements containing iron or zinc
Avoid NSAIDS

54
Q

Which antibiotic is most associated with antibiotic associated colitis
What other groups can cause it

A 
Clindamycin 
Broad spectrum (penicillins ,cephalosporin, fluoroquinalones )
55
Q

Warning sign for antibiotic associated colitis

A

If diahorrea develops stops

56
Q

Who are most likely to develop antibiotic associated colitis

A

Women elderly and those who have just had surgery

57
Q

Antibiotics used against MRSA

A

Vancomycin and linezolid

58
Q

Linezolid side effects

A

Blood disorders
Optic neuropathy if used greater than 28 days
Possible hypertensive crisis

59
Q

Antibiotic for CDIFF infection

A

Vancomycin 125 mg every 6 hours for 10 days; increased if necessary to 500 mg every 6 hours for 10 days, increased dose if life-threatening or refractory infection.
Fidoxomicin

60
Q

contraindications with aminoglycosides

A

myasthenia gravis

61
Q

interactions with ahminoglycosides

A

cisplatin and furosemide

62
Q

monitoring aminoglycosides

A

renall function
auditory and vestibular function -
serum concentration

63
Q

examples of glycopeptides

A

vancomycin, teicoplanin , telavancin

64
Q

mode of action of glycopeptide

A

bacteriacidal inhibit cell wall synthesis

65
Q

spectrum of coverage for glycopeptides

A

gram positive( aerobic and anaerobic )

enterococci, staphylococci, streptococci

66
Q

patient groups that should avoid use of aminoglycosides

A

elderly and those with history of auditory problems

67
Q

how are aminoglycosides and glycopeptides used together in treatment of infective endocarditis

A

aminoglycosides have mainly gram negative coverage and so cover those organisms and glycopeptides cover gram positive broadly

68
Q

drugs to avoid using with

A

ototoxic drugs- furosemide

ciclosporin, ahminoglycosides, polymixin antifungals

BNF Infections (4 decks)

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