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Antibiotics Flashcards

1
Q

Timing of antibiotic surgical prophylaxis?

A

Ideally 30-60 min before surgical incision

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2
Q

Duration of antibiotic surgical prophylaxis? (5)

A
  • Single dose just before procedure
  • discontinue within 24 hours!
  • if > 3h procedure, may need repeat intra-op doses
  • re-administration indicated at intervals 1-2 times half life
  • if insert prosthetic value, prophylaxis for 24 h (3 dose regimen)
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3
Q

Major pathogen, in wound infection after clean surgery?

A

S aureus

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4
Q

Major pathogen, in wound infection after surgery of colon, Gynae, Genito urinary procedures?

A

Gram negative bacteria

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5
Q

Which agent, in general, is preferred for surgical prophylaxis?

A

Cephalosporins

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6
Q

Which cephalosporin is preferred for s aureus surgical prophylaxis?

A

First generation eg cefazolin because more active, less expensive, narrow spectrum activity, moderately long serum half life 1,8h

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7
Q

Which cephalosporin is preferred for colorectal surgical prophylaxis?

A

Cefoxitin preferred: gram positive, negative and anaerobic cover (second gen)
Or
Cefazolin ( aerobes only)( first gen) plus metronidazole (anaerobe)

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8
Q

Name 4 aminoglycosides

A
  • Gentamicin
  • topramycin
  • Amikacin
  • streptomycin
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9
Q

Spectrum of aminoglycosides?

A

Gram negative aerobes, gram positive cocci and pseudomonas

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10
Q

Adverse effect aminoglycosides? (2)

A

• Ototoxic
• nephrotoxic
Also neuromuscular paralysis, skin rash with neomycin

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11
Q

Name a first generation quinolone and spectrum

A

Nalidixic acid

Narrow spec, urinary tract

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12
Q

What are quinolones used for?

A
  • UTI

* prostatitis

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13
Q

Quinolones contraindication?

A

Pregnancy

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14
Q

Name 3 macrolides

A

•Erythromycin
• azithromycin
• clarithromycin
( ace)

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15
Q

Spectrum of macrolides?

A

Gram positive

Atypical: legionella, mycoplasma, mycobacteria, chlamydia, h influenza

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16
Q

First line treatment children for gas pharyngitis?

A

Penicillin V 50 mg/kg/day ÷ bid 10 days
Or
Amoxicillin 50 10 days

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17
Q

treatment children for gas pharyngitis if penicillin allergy?

A 
Cephalexin 10 days 50 mg/kglday ÷ bid
Or
Clarithromycin 10 days 15 mg/kglday bid
Or
Azithromycin 12 mg/kglday 5 days
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18
Q

First line treatment gas pharyngitis adults?

A

Penicillin V 600 mg bid 10 days

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19
Q

treatment gas pharyngitis adults if penicillin allergy? (2)

A

Cefadroxil ( first gen ) or
Cephalexin ( first gen ) or
Clarithromycin (macrolide) or
Azithromycin (macrolide)

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20
Q

When should antibiotics be switched to different class?

A

Worsening or no improvement after 3-5 days

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21
Q

First line treatment acute bacterial rhinosinusitis? (3)

A

Amoxicillin clavulanate (augmentin)
500 mg /125 mg TDS or 875 mg /125 mg bid
If at risk for resistance, give 2 g bid po ie immunocompromised

Or doxycycline
Or respiratory fluoroquinolone: levofloxacin, moxifloxacin
if penicillin allergy

(Higher doses if failure)

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22
Q

First line treatment acute otitis media?

A
  • Amoxicillin clavulanic acid 90 mg/kg/day ÷ bid
  • or macrolides
  • or clindamycin (anaerobes) if penicillin allergy.

Children <2 10 days, >2 5-7 days nb!

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23
Q

Empiric treatment conjunctivitis?

A

Erythromycin ointment
Or
Polymixin trimethoprim drops

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24
Q

Bacterial conjunctivitis treatment? (4)

A 
Erythromycin ointment
Or
Polymyxin trimethoprim drops
Or
Fluoroquinolone drops (preferred if contact lenses)
Or
azithromycin drops
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25
Treatment of severe blepharitis not responding to lid hygiene? (2)
Topical: erythromycin or bacitracin ointment Oral: tetracycline
26
Treatment acute exacerbations blepharitis?
Topical glucocorticoids
27
Empiric treatment pyelonephritis?
Iv ceftriaxone 3rd gen because penetrate tissue and good spectrum - best. Or Piperacillin tazobactam Or fluoroquinolone: ciprofloxacin, levafloxacin but avoid in pregnancy and children
28
Empiric treatment cystitis? (5)
``` Nitrofurantoin best: resistance uncommon, localised to urine, little systemic effect or Cefuroxime (2nd gen cephalo) or augmentin Or TMP/SMX if not resistant Or Fosfomycin: less efficacious, pseudomonas and acinnetobacter may be resistant ```
29
Which antibiotics are used for esbl producing organisms?
Carbapenems eg ertapenem
30
Treatment non severe community acquired pneumonia in young with no comorbidities
Amoxicillin (clavulanate) or ampicillin | Or macrolide / azalide if allergy
31
Treatment non severe community acquired pneumonia in elderly and or comorbid?
Amoxicillin clavulanate or | 2nd gen cephalosporin if allergy eg cefoxitin
32
Treatment severe community acquired pneumonia (3)
Amoxicillin clavulanate or 2nd or 3rd gen cephalosporin if allergy And Macrolide/ azalide
33
What type of drugs have better ability to cross BBB (2)
* Lipid soluble eg quinolones, metronidazole | * low molecular weight
34
Which antibiotics are bactericidal? (3)
``` B lactams: • Cephalosporins .Penicillins • carbapenems • monobactams eg aztreonam • beta lactase inhibitors eg clavulanic acid ``` * metronidazole * rifampicin
35
Which antibiotics are bacteriostatic? (3)
* Erythromycin * sulphonamides * tetracyclines
36
Penetration of aminoglycosides?
Does not penetrate BBB but does placenta
37
Name 3 important pharmacodynamic and pharmacokinetic components of aminoglycosides (killing, effect, dosage)
* Concentration dependant killing * PAE (post antibiotic effect) * highly polar thus dosage based on lean body mass.
38
Moa aminoglycosides?
Inhibit ribosome s30 protein synthesis. | Concentration dependent killing (maximize exposure time)
39
Name the 3 types of beta lactams and examples of each.
* Penicillins: amoxicillin * cephalosporins: cephtriaxone * carbapenems: meropenem
40
Moa beta lactams? (3)
Inhibit cell wall synthesis Time dependant killing (maximise exposure time) Bactericidal
41
Name 3 broad classes penicillins with examples
Penicinillase-sensible • natural, narrow spectrum penicillins: pen G , pen v (benzyl penicillins) • broad spec aminopenicillins: ampicillin, amoxicillin Penicinillase - resistant (.very narrow spec) • nafcillin, oxacillin, dicloxacillin Antipseudomonal extended spec • carboxipenicillins: ticarcillin, carbenicillin • ureidopenicillins: piperacillin, azlocillin, mezlocillin
42
Penicillins spectrum?
Gram positive. Primarily used for strep infections
43
Name 3 carbapenems
•Ertapenem • meropenem Imipenem with cylastatin (dihydropepidase inhibitor)
44
Which B lactam has broadest coverage?
Carbapenems: G positive, negative, anaerobes
45
Name 4 first generations cephalosporins
* Cefazolin * cepalexin * cephalothin * cefadroxil
46
Name 4 second generations cephalosporins
* Cefoxitin! * cefuroxime * cefotetan * cefador
47
Name 4 third generations cephalosporins
* Cefotaxime iv * ceftriaxone! Iv * cefpodoxime oral * cefixime oral
48
Name fourth generations cephalosporins
Cefepime iv/im
49
What has developed resistance against third and fourth generation cephalosporins?
S pneumonia
50
Which cephalosporin may be considered for pseudomonas?
Fourth gen: cefepime
51
Penetration of cephalosporins?
Cross BBB
52
Vancomycin moa?
Interfere with cell wall synthesis | Time and concentration dependant killing
53
Name example glycopeptide
Vancomycin
54
Vancomycin spectrum?
Gram positive only
55
Name 2 uses for vancomycin
* MRSA iv | * c diff only if severe beta lactam resistance or hypersensitivity. Take orally.
56
Name an important pharmacokinetic factor of vancomycin
Not absorbed in git
57
Name 2 nb side effects vancomycin
• Flushing red man syndrome (rapid infusion cause histamine release) • shock Also fever, chills, phlebitis at iv side
58
Name a second generation quinolone and spectrum
Ciprofloxacin Systemic aerobic gram negatives causing UTI Bone infection
59
Name 2 third generation quinolone and spectrum
• Levofloxacin • moxifloxacin Gram negative UTI, gram positive resp infect, atypical mycoplasma pneumonia
60
Name a fourth generation quinolone and spectrum
Trovafloxacin | Gram negative UTI, positive respiratory, atypical mycoplasma pneum, and anaerobes
61
Quinolones moa? (3)
Interfere with DNA: bind to topoisomerase 2 (DNA gyrase) Bactericidal Time and concentration dependant killing
62
Name 3 contraindications quinolones
* Pregnancy * Young * athletes * heart problems
63
Most common use for quinolones?
UTI
64
Name drug interactions with quinolones
Sucrulfate, antacid (al, mg) , diet supplements (fe, zn ), Ca = interfere with absorption
65
Name 2 adverse effects quinolones
• Connective tissue problems: great bv aneurysms, rupture tendons etc . Prolong qt interval
66
Name 5 drug interactions with macrolides
* digoxin toxicity: destruction gut flora, p-gp inhibition intestines and kidney * clozapine: inhibit cyp3a4 - seizures and disorientation * Midazolam: inhibit cyp3a4 - increased hypnotic effect * theophylline: inhibit cyp3a4 - tremors and tachycardia * quinidine: inhibit cyp3a4 and p-gp inhibition - prolonged qt interval, ventricular dysrhythmia
67
Name 3 tetracyclines
• Doxycycline • minocycline . Demeclocycline
68
Name 3 adverse effects tetracyclines
* Deposition bones and teeth growing children * vestibular problems * photo toxic * git
69
Which antibiotics have widespread resistance?
Tetracycline, especially to b lactam producing staph
70
Name an important pharmacokinetic property of tetracyclines
Forms unabsorbable chelates with Ca (don't take with dairy), mg, Al (antacids), fe 2+, fe 3+ Best to take on empty stomach
71
Name 2 uses for tetracyclines
* Rocky Mountain spotted fever: rickettsia ricketsi * STDs chlamydia * malaria
72
Moa tetracyclines? (2)
Inhibit protein synthesis: ribosome s30 | Bacteriostatic
73
Therapy of choice for salmonella?
Ceftriaxone or ciprofloxacin
74
Therapy of choice for neisseria meningitides?
Ceftriaxone
75
Which bugs are highly resistant to macrolides?
* S pneumonia | * hospital acquired staph
76
Which bug is highly resistant to third and fourth generation cephalosporins
S pneumonia
77
Which 2 bugs have high resistance to trimethorprim- sulfamethoxazole?
* s pneumonia | * H influenza

Pharmacology (34 decks)

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