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DRUGS > antibiotics > Flashcards

antibiotics Flashcards

1
Q

amoxicillin

A

penicillin

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2
Q

mode of action of amoxicillin/penicillin?

A

inhibit enzymes repsonsible for cross linking peptidogylcans in cell wall

= weakens cell wall and causes cell swelling, lysis and death

amoxicillin increases activity against aerobic gram -ve bacteria = broad spectrum antibiotic

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3
Q

indications of amoxicillin

A 
susceptible infections
community acquired pneumonia
exacerbation of COPD, bronchiectasis
otitis media
lyme disease
dental abscess
meningitis - listerial 
endocarditis
H.pylori eradication
acute diverticulitis
UTI
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4
Q

contraindication for amoxicillin

A

penicillin allergy

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5
Q

side effects of amoxicillin

A

allergy - rash 7-10 days after first exposure

CNS toxicity with high dose where severe renal imapirment delays excretio

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6
Q

possible interactions of amoxicillin

A

reduces renal excretion of methotrexate so may precipitate overdose

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7
Q

cefalexin

A

cephalosporin

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8
Q

ceflexin/cephalosporin mode of action

A

weaken cell walls = bacterial cell lysis and death

more resistant to beta lactamase than penicillin

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9
Q

beta lactamase

A

enzymes produced by bacteria providing resistance against antibiotics

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10
Q

indications of ceflaxin/cephalosporin

A

oral cephalosporin = second and third line treatment options for UTI and respiratory tract infections

IV cephalosporins and carbapenems for very severe or complicated infections or antibiotic reistant organisms

broad spec so used for most indications

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11
Q

contrainidcations of cephalosporins

A

c.diff, those in hospital and elderly
history of penicillin, cephalosporin or carbapenem allergy espec. if anaphyactic repsonse

epilepsy = caution

dose reduction in renal impairment

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12
Q

side effects of cephalosporins

A

GI upset - nausea and diarrhoea
antibiotic associated colitis = Cdiff
allergy - hypersensitivity
CNS toxicity - seizures

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13
Q

interactions of cephalosporins

A

warfarin -can enhance anticoagulant effect by killing normal gut flora that synthesise vit K

increase nephrotoxicity of aminoglyosides

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14
Q

trimethoprim - how does it work

A

inhibits bacterial folate synthesis = slow bacterial growth

broad spectrum of action against gram +ve and -ve but activity reduced due to widespread resistance

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15
Q

indications of trimethoprim

A

first choice for uncomplicated UTIs - alternatives = nitrofurantoin and amoxicillin

co-trimoxazole (+sulfamethoxazole) used to treat and prevent pneumocytis penumonia with immunosuppresion

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16
Q

side effects of trimethoprim

A

GI upset and skin rash
hypersensitivity reactions
haematological disorders
hyperkalaemia

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17
Q

interactions of trimethoprim

A

use with potassium elevating drugs = hyperkalaemia

use with folate antagonists = adverse haematological effects

enhance anticoagulant effect of warfarin by killing gut flora that synthesise vit K

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18
Q

nitrofurantoin mode of action

A

metabolised by bacterial cells and its metabolites damage bacterias DNA and cause cell death = bacterialcidal effect

effective against gram -ve e coli and gram +ve staphylococcus saprophyticus common in UTIs

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19
Q

indications of nitrofuratoin

A

uncomplicated lower UTI - first line antibiotic

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20
Q

why is nitrofurantoin so good for UTIs

A

effective against commmon causative organisms

reaches therapeutic concentrations in urine thorugh renal excretion

bactericidal in acid environments such as urine

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21
Q

contraindications of nitrofurantoin

A

pregnancy or babies i< 3 months

renal impairment

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22
Q

side effects of nitrofurantoin

A

GI upset - nausea and diarrhoea
hypersensitivity reactions
chronic pulmonary reactions, hepatitis, peripheral neuropathy (prolonged administration)
haemolytic anaemia in neonates

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23
Q

doxycycline

A

tetracycline

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24
Q

doxycycline/tetracycline mode of action

A

inhibit bacterial protein synthesis

devleoped a while ago so there is resistance

25
Q

indications for doxycycline/tetracycline

A

acne vulgaris
LRTI- exacerbations of COPD, pneumonia, atyical pneumonia
chlamydial infection inc pelvic inflammatory disease
other infections - typhoid, anthrax, malaria and lyme disease

26
Q

contraindications of doxycycline/tetracycline

A

not prescribed during pregnancy, breastfeeding or children under 12 yo

avoid in renal impairment

27
Q

side effects of doxycycline/tetracyclines

A

nausea, vomiting, diarrhoea
hypersensitivity reactions
oesophageal irritation, ulceration and dysphagia
photosensitivty and discolouration and or hypoplasia of tooth enamal in children

intracranial hypertension is rare = headache and visual disturbance

28
Q

interactions of doxyxyline/tetracycline

A

not in 2hrs of calcium, antacids or iron (prevent antibiotic absorption)

enhance anticoagulant effect of warfarin

29
Q

gentamicin

A

aminoglycosides

30
Q

how do aminoglycosides/gentamicin work?

A

inhibit protein synthesis = bactericidal

31
Q

indications of aminoglycosides/gentamicin

A

severe infections, particularly caused by gram -ve aerobes

severe sepsis inc where source is unidentified
pyelonephritis and complicated UTI
biliary and other intra-abdo spesis
endocarditis

32
Q

contraindications of aminoglycosides/gentamicin

A

monitoring plasma drug concentrations to prevent renal, cochlear and vesitublar damage particularly in neonates and elderly

33
Q

side effects of aminoglycosides/gentamicin

A

reversible nephrotoxicity and irrecersible toxicity = reduced urine output and raised creatinine and urea

34
Q

interactions of aminoglycosides/gentamicin

A

ototoxicity more likely if aminoglycosides co prescribed with loop diuretics or vancomycin

nephrotoxicity is more likely if aminoglycosides are co prescribed with ciclosporin, chemo, cephalosporins or vancomycin

35
Q

erythromycin

A

macrolides

36
Q

how does erythromycin/macrolides work?

A

macrolides inhibit bacterial protein synthesis

37
Q

indications of erythromycin/macrolides

A

treatment of respiratory and skin soft tissue infections when penicillin is contraindicated by allergy

severe pneumonia added to penicillin to cover atypical organisms

eradication of H.pylori in combo w PPI and amoxicillin or metronidazole

38
Q

contraindications of erythromycin/macrolides

A

history of macrolide hypersensitivity

39
Q

side effects of erythromycin/macrolides

A

irritant, causing nausea, vomiting and abdo pain and diarrhoea when taken orally

thrombophlebitis when given IV

allergy, antibiotic associated colitis, lvier abnormalities, arrhythmias and toxicity at higher doses

40
Q

possible interactions of erythromycin/macrolides

A

inhibits cytochrome P450 enzymes, so increases plasma conc and adverse effects with drugs metabolised by P450 enzymes
- warfarin (increased bleeding risk) and statins (increased risk of myopathy)

41
Q

ciprofloxacin

A

quinolones

42
Q

how does ciprofloxacin/quinolones work?

A

inhibit DNA synthesis in bacteria and hence kill

particularly against aerobic gram -ve

43
Q

indications of ciprofloxacin

A

second or third line treatment due to potential for rapid emergence of resistance associated with cdiff infection

UTI, severe GI infection, psudomonas aeruginosa

44
Q

contraindications of ciprofloxacin

A

quinolones used with caution in ppl at particular risk of adverse effects - inc risk of seizures, growing and risk factors for QT prolongation (cardiac disease or electorlyte disturbance)

45
Q

side effects of ciprofloxacin

A

GI upset
hypersensitivity reactions
class specific adverse reactions inc neurological effects , inflammation and rupture of muscle tendons

prolong QT interval and increase risk of arrhythmias

promote Cdiff colitits

46
Q

interactions of ciprofloxacin

A

calcium and antacids reduce absipriton of quinolones

inhibits cytochrome P450 enzymes, so increase risk of toxicity in some drugs e.g. theophylline

47
Q

metronidazole

A

anaerobic antimicrobial

48
Q

how does metronidazole work?

A

reduces DNA synthesis, cuasing DNA degradation and cell death in anaerobic bacteria

49
Q

indications of metronidazole

A

antibiotic associated colitis caused by Cdiff (gram +ve anaerobe)

oral infections or aspiration pneumonia caused by gram +ve anaerobes

surgical and gynaecological infections caused by gram -ve anaerobes from colon

50
Q

contraindications of metronidazole

A

metaoblised by cytochrome P450 enzymes - dose reduced in those w severe liver disease

alcohol - can cause disulfiram like reaction - flushing, headache, nausea and vomiting

51
Q

side effects of metronidazole

A

GI upset - nausea and vomiting
hypersensitivity reactions
neurological adverse effects inc peripheral and optic neuropathy, seizures and encephalopathy in prolonged courses

52
Q

interactions of metronidazole

A

inhibitory effect on cytochrome P450 enzymes

  • risk of bleeding with warfarin
  • risk of toxicity in phenytoin
  • increased risk fo toxicity with lithium
  • phenytoin and rifampicin cna causes decreases antimicrobial efficacy
53
Q

vancomycin

A

glycopeptide

54
Q

how does vancomyci/glycopeptides work?

A

inhibits cell wall synthesis in gram +ve bacteria

resistance repeatedly reported

55
Q

indications of vancomycin/glycopeptides

A

treatment of gram +ve infections e.g. endocarditis, where severe infection and penicillins cannot be used due to resistance

treatment of antibiotic associated colitis by CDiff (second line to metronidazole)

surgical prophylaxis when high chance of MRSA

56
Q

contraindications of vancomycin/glycopeptides

A

careful monitoring of plasma drug conc and dose adjustment to avoid toxicity

dose reduction when renal impairment and elderly

57
Q

side effects of vancomycin/glycopeptides

A

thrombophlebitis at infusion site
anaphylaxis - red man syndrome = generalised erythema and hypotension and bronchospasm

IV can lead to nephrotoxicity, ototoxicity and blood disorders

58
Q

interactions of vancomycin/glycopeptides

A

increases risk of toxicity and or nephrotoxicity when prescribed with aminoglycosides, loop diuretics or ciclosporin (immunosuppresent)

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