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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
Q

Treatment of severe blepharitis not responding to lid hygiene? (2)

A

Topical: erythromycin or bacitracin ointment
Oral: tetracycline

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26
Q

Treatment acute exacerbations blepharitis?

A

Topical glucocorticoids

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27
Q

Empiric treatment pyelonephritis?

A

Iv ceftriaxone 3rd gen because penetrate tissue and good spectrum - best.
Or
Piperacillin tazobactam
Or fluoroquinolone: ciprofloxacin, levafloxacin but avoid in pregnancy and children

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28
Q

Empiric treatment cystitis? (5)

A 
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
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29
Q

Which antibiotics are used for esbl producing organisms?

A

Carbapenems eg ertapenem

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30
Q

Treatment non severe community acquired pneumonia in young with no comorbidities

A

Amoxicillin (clavulanate) or ampicillin

Or macrolide / azalide if allergy

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31
Q

Treatment non severe community acquired pneumonia in elderly and or comorbid?

A

Amoxicillin clavulanate or

2nd gen cephalosporin if allergy eg cefoxitin

32
Q

Treatment severe community acquired pneumonia (3)

A

Amoxicillin clavulanate or 2nd or 3rd gen cephalosporin if allergy
And
Macrolide/ azalide

33
Q

What type of drugs have better ability to cross BBB (2)

A
  • Lipid soluble eg quinolones, metronidazole

* low molecular weight

34
Q

Which antibiotics are bactericidal? (3)

A 
B lactams:
• Cephalosporins
.Penicillins
• carbapenems
• monobactams eg aztreonam
• beta lactase inhibitors eg clavulanic acid
  • metronidazole
  • rifampicin
35
Q

Which antibiotics are bacteriostatic? (3)

A
  • Erythromycin
  • sulphonamides
  • tetracyclines
36
Q

Penetration of aminoglycosides?

A

Does not penetrate BBB but does placenta

37
Q

Name 3 important pharmacodynamic and pharmacokinetic components of aminoglycosides (killing, effect, dosage)

A
  • Concentration dependant killing
  • PAE (post antibiotic effect)
  • highly polar thus dosage based on lean body mass.
38
Q

Moa aminoglycosides?

A

Inhibit ribosome s30 protein synthesis.

Concentration dependent killing (maximize exposure time)

39
Q

Name the 3 types of beta lactams and examples of each.

A
  • Penicillins: amoxicillin
  • cephalosporins: cephtriaxone
  • carbapenems: meropenem
40
Q

Moa beta lactams? (3)

A

Inhibit cell wall synthesis
Time dependant killing (maximise exposure time)
Bactericidal

41
Q

Name 3 broad classes penicillins with examples

A

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
Q

Penicillins spectrum?

A

Gram positive. Primarily used for strep infections

43
Q

Name 3 carbapenems

A

•Ertapenem
• meropenem
Imipenem with cylastatin (dihydropepidase inhibitor)

44
Q

Which B lactam has broadest coverage?

A

Carbapenems: G positive, negative, anaerobes

45
Q

Name 4 first generations cephalosporins

A
  • Cefazolin
  • cepalexin
  • cephalothin
  • cefadroxil
46
Q

Name 4 second generations cephalosporins

A
  • Cefoxitin!
  • cefuroxime
  • cefotetan
  • cefador
47
Q

Name 4 third generations cephalosporins

A
  • Cefotaxime iv
  • ceftriaxone! Iv
  • cefpodoxime oral
  • cefixime oral
48
Q

Name fourth generations cephalosporins

A

Cefepime iv/im

49
Q

What has developed resistance against third and fourth generation cephalosporins?

A

S pneumonia

50
Q

Which cephalosporin may be considered for pseudomonas?

A

Fourth gen: cefepime

51
Q

Penetration of cephalosporins?

52
Q

Vancomycin moa?

A

Interfere with cell wall synthesis

Time and concentration dependant killing

53
Q

Name example glycopeptide

A

Vancomycin

54
Q

Vancomycin spectrum?

A

Gram positive only

55
Q

Name 2 uses for vancomycin

A
  • MRSA iv

* c diff only if severe beta lactam resistance or hypersensitivity. Take orally.

56
Q

Name an important pharmacokinetic factor of vancomycin

A

Not absorbed in git

57
Q

Name 2 nb side effects vancomycin

A

• Flushing red man syndrome (rapid infusion cause histamine release)
• shock
Also fever, chills, phlebitis at iv side

58
Q

Name a second generation quinolone and spectrum

A

Ciprofloxacin
Systemic aerobic gram negatives causing UTI
Bone infection

59
Q

Name 2 third generation quinolone and spectrum

A

• Levofloxacin
• moxifloxacin
Gram negative UTI, gram positive resp infect, atypical mycoplasma pneumonia

60
Q

Name a fourth generation quinolone and spectrum

A

Trovafloxacin

Gram negative UTI, positive respiratory, atypical mycoplasma pneum, and anaerobes

61
Q

Quinolones moa? (3)

A

Interfere with DNA: bind to topoisomerase 2 (DNA gyrase)
Bactericidal
Time and concentration dependant killing

62
Q

Name 3 contraindications quinolones

A
  • Pregnancy
  • Young
  • athletes
  • heart problems
63
Q

Most common use for quinolones?

64
Q

Name drug interactions with quinolones

A

Sucrulfate, antacid (al, mg) , diet supplements (fe, zn ), Ca = interfere with absorption

65
Q

Name 2 adverse effects quinolones

A

• Connective tissue problems: great bv aneurysms, rupture tendons etc
. Prolong qt interval

66
Q

Name 5 drug interactions with macrolides

A
  • 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
Q

Name 3 tetracyclines

A

• Doxycycline
• minocycline
. Demeclocycline

68
Q

Name 3 adverse effects tetracyclines

A
  • Deposition bones and teeth growing children
  • vestibular problems
  • photo toxic
  • git
69
Q

Which antibiotics have widespread resistance?

A

Tetracycline, especially to b lactam producing staph

70
Q

Name an important pharmacokinetic property of tetracyclines

A

Forms unabsorbable chelates with Ca (don’t take with dairy), mg, Al (antacids), fe 2+, fe 3+
Best to take on empty stomach

71
Q

Name 2 uses for tetracyclines

A
  • Rocky Mountain spotted fever: rickettsia ricketsi
  • STDs chlamydia
  • malaria
72
Q

Moa tetracyclines? (2)

A

Inhibit protein synthesis: ribosome s30

Bacteriostatic

73
Q

Therapy of choice for salmonella?

A

Ceftriaxone or ciprofloxacin

74
Q

Therapy of choice for neisseria meningitides?

A

Ceftriaxone

75
Q

Which bugs are highly resistant to macrolides?

A
  • S pneumonia

* hospital acquired staph

76
Q

Which bug is highly resistant to third and fourth generation cephalosporins

A

S pneumonia

77
Q

Which 2 bugs have high resistance to trimethorprim- sulfamethoxazole?

A
  • s pneumonia

* H influenza

Pharmacology (34 decks)

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