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CPT > Antibiotics > Flashcards

Antibiotics Flashcards

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1
Q

What are the first line antibiotics in the management of a UTI?

A
  • Nitrofurantoin
  • Trimethoprim
  • 3 day course in (non-pregnant) women
  • 7 day course in men
  • Pregnancy - nitrofurantoin 7 days is first line
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2
Q

What drug class is nitrofurantoin from?

A
  • Nitrofuran
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3
Q

What is the mechanism of action of nitrofurantoin?

A
  • Poorly understood
  • Affects protein synthesis
  • Activated by nitrofuran reductase within the cell
  • Reactive metabolites inhibit bacterial enzyme synthesis
  • Important proteins (DNA, RNA, cell wall protein) cannot be made
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4
Q

What allows nitrofurantoin to concentrate in the urine?

A
  • Up to 50% of the PO dose is excreted in the urine in an unchanged form
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5
Q

What are the indications of nitrofurantoin?

A
  • Treatment of lower UTI
  • Prophylaxis of UTIs
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6
Q

What are the adverse effects of nitrofurantoin?

A
  • Discolouration of urine
  • Pulmonary fibrosis
  • Hepatic disorders
  • Peripheral neuropathy
  • Anaemia/thrombocytopenia/agranulocytosis
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7
Q

What are the contraindications of nitrofurantoin?

A
  • Avoid in renal impairment (renally excreted)
  • Avoid in pregnancy at term (risk of neonatal haemolysis)
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8
Q

What are the indications of trimethoprim?

A
  • Treatment of lower UTI
  • Prophylaxis of UTI
  • Treats other infections such as pyelonephritis/prostatitis/diverticulitis
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9
Q

What is the mechanism of action of trimethoprim?

A
  • Folate antagonist
  • Inhibits bacterial dihydrofolate reductase
  • Bacterial nucleic acids (RNA, DNA) and proteins can’t be made
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10
Q

What are the adverse drug reactions of trimethoprim?

A
  • Risk of teratogenicity in the first trimester
  • Avoid in pregnancy
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11
Q

What is a major DDI of trimethoprim?

A
  • Both folate antagonists
  • Both inhibit dihydrofolate reductase
  • Consequence is severe bone marrow suppression
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12
Q

What is the drug class of gentamicin?

A
  • Aminoglycoside
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13
Q

What are the other drugs in the aminoglycoside drug class?

A
  • Vancomycin
  • Streptomycin
  • Neomycin
  • Tobramycin
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14
Q

What is the mechanism of action of gentamicin?

A
  • Inhibit protein synthesis
  • Binds to 30s subunit of bacterial ribosome
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15
Q

What are the indications of gentamicin?

A
  • Septicaemia
  • Otitis externa
  • Meningitis
  • Biliary tract infection
  • Pneumonia
  • Prostatitis
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16
Q

What are the adverse effects of gentamicin?

A
  • Nephrotoxicity
  • Ototoxicity (hearing loss/vertigo/tinnitus)
17
Q

Why do we need to monitor aminoglycosides therapeutically?

A
  • Monitor serum aminoglycoside concentration due to narrow therapeutic index
18
Q

What else needs to be monitored when treating a patient with aminoglycosides?

A
  • Check U&Es before and during treatment
  • Also monitor auditory and vestibular function during treatment
19
Q

When can aminoglycosides not be used?

A
  • In renal impairment, clearance of gentamicin is reduced and toxicity can occur
20
Q

What is the mechanism of action of amoxicillin?

A
  • Inhibition of cell wall synthesis
  • Binds to transpeptidase’s active site and blocks its activity
  • Interrupts bacterial cross-linking and cell wall synthesis
21
Q

Why is the addition of clavulanic beneficial for treating certain infections?

A
  • It is a beta-lactamase inhibitor
  • Overcomes resistance in beta-lactamase secreting bacteria
22
Q

When should antibiotic prescriptions be reviewed?

A
  • Following a senior review of the patient
  • Following any change in clinical condition
  • Daily, typically on ward round
  • Following the receipt of relevant investigation/culture results
23
Q

What factor is most important for determining when to change IV antibiotics to the enteral route?

A
  • The overall clinical picture and patient improvement
24
Q

Outline CURB-65

A
  • Confusion = 1 point
  • Urea >7 mmol/L = 1 point
  • RR >30 = 1 point
  • BP <90/60 mmHg = 1 point
  • Age >65 = 1 point
25
Q

What is the mechanism of action of clarithromycin?

A
  • Inhibition of protein synthesis
26
Q

What drug class is clarithromycin in?

A
  • Macrolides
27
Q

Which drug should be withheld when a patient is on erythromycin?

A
  • Statins
28
Q

Which antibiotic is used to treat paediatric meningococcal sepsis?

A
  • Ceftriaxone
29
Q

Which antibiotic class does ceftriaxone belong to?

A
  • Beta lactams
  • It is a cephalosporin
30
Q

What is cephalosporin good for?

A
  • Provides good broad spectrum cover against gram positive, gram negative and anaerobic organisms
31
Q

What is the mechanism of action of acyclovir?

A
  • Converted to acyclovir monophosphate
  • Then to acyclovir triphosphate - a potent inhibitor of viral DNA polymerase
  • Acyclovir monophosphate form incorporates into replicating DNA, causing chain termination
32
Q

What are the indications for acyclovir?

A
  • Herpes simplex virus (HSV 1 and HSV 2)
  • Causes encephalitis, genital herpes and cold sores
  • Varicella zoster virus
  • Causes shingles, chickenpox
  • Acyclovir also prevents infection in the immunocompromised and pregnancy

CPT (22 decks)

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