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INFECTIOUS DISEASES TOPIC- PRE REG > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are the different drugs of aminoglycoside groups

A

Amikacin, gentamicin, neomycin, streptomycin and tobramycin

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2
Q

What is there criteria of serum aminoglycoside concentration

A

Measured in all patients receiving parental aminoglycoside
Must be determined in obesity, high doses, cystic fibrosis and the elderly

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3
Q

When do you measure the serum gentamicin concentration

A

After 3 or 4 doses, then every 3 days and after a dose change (more frequently in renal impairment)

Measure 1 hour after dose (peak concentration)and just before the next dose (trough Concentration)

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4
Q

What is the dose regimen of peak and trough levels in aminoglycoside

A

For multiple daily dose regimens
- peak serum concentration 5-10mg/l
-endocarditis peak serum concentration 3-5mg/l
Usually lower as we co prescribe with other antibiotics

Trough serum concentration <2mg/l
-endocarditis trough level serum concentration <1mg/l

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5
Q

What is the dose adjustment in aminoglycoside if the peak or the trough is too high

A

If the trough is too high: increase the dose intervals
If the peak is too high: decrease the dose

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6
Q

What is the dose regimen in aminoglycoside in patients who have renal impairment

A

Renal impairment: increase the dose intervals
Severe renal impairment: reduce the dose as well

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7
Q

What do you avoid when using aminoglycoside

A

Avoid concomitant use of nephrotoxic drugs

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8
Q

What is the MHRA warning associates with aminoglycoside

A

The use of aminoglycoside is associated with ototoxicity

Interactions with ototoxicity
- Cisplatin
- loop diuretics (furosemide, bumetanide, torasemide)
-vancomycin
-vinca alkaloids (vinblastin, vincristine, vindesine, vinflunine)

Further interactions: drugs that cause renal impairment such as NSAIDs, ACE/ARBs, metformin

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9
Q

What are the contraindications of aminoglycoside

A

Myasthenia gravis (muscle weakness)

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10
Q

What are the cautions of aminoglycoside in pregnant women

A

In pregnancy it is avoided: risk of auditory or vestibular nerve damage
Monitor serum concentrations

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11
Q

How do you administer the correct dose for an obese person who is on aminoglycoside

A

Use ideal body weight based on height to calculate the parental dose

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12
Q

What are the 3 different generations of cephalosporins

A

First generation:
CaFADroxil, CeFALexin and CeFRADine
(FAD, FAL, FRAD)

Second generation cephalosporins:
CeFURoxime, CeFOXitin and CeFAClor
(FURRY, FOX, FACE)

Third and fifth generations are all parental apart from oral Cefixime

Patients with hypersensitivity to penicillins and other beta lactation,s should not receive a cephalosporin due to cross sensitivity

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13
Q

What is chloramphenicol used for and what are the guidelines associated with this

A

Most commonly used in eye infections

Avoid in pregnancy
- risk of neonatal ‘grey baby syndrome’ if used in the third trimester

OTC guidelines:
Children over aged 2+

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14
Q

What is clindamycin

A

Associated with antibiotic associated colitis- can be fatal
- more common in elderly people
- discontinue and contact a doctor immediately if severe, prolonged or bloody diarrhoea develops

In C.Diffe is suspected DISCONTINUE
- seek specialist medical advice when antibiotic cannot be stopped and the patient is experiencing severe diarrhoea

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15
Q

What drugs are in glycopeptides

A

Dalvavancin, teicoplanin, telavancin and vancomycin

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16
Q

How should vancomycin be taken

A

Should only be given parentally for systemic infections due to reduced absorption with oral intake

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17
Q

What is the advice of taking vancomycin in pregnancy

A

Should be avoided in pregnancy unless the benefits outweighs the risk

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18
Q

How is vancomycin administered

A

Initial dose is based on body weight then dose adjustments based on serum vancomycin concentration
- trough levels should be 15-20mg/l

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19
Q

What can glycopeptides cause

A

Can cause ototoxicity and nephrotoxicity
- same interactions as aminoglycoside

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20
Q

What are the side effects of glycopeptides

A

Red man syndrome
Severe cutaneous adverse reactions : SJS
Blood dyscrasia: agranulocytosis, eosinophilia and neutropenia
Cardiogenic shock on rapid IV injection
Risk of anaphylactoid reactions at infused sites- avoid rapid infusions and rotate sites

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21
Q

What is linezolid

A

Used for the indication of pneumonia, cellulitis and moderate diabetic foot but all usually under specialist care and rarely prescribed

Important safety information

Risk of optic neuropathy
- report visual impairments (blurry/altered visions
-monitored regularly if treatment is more than 28 days

Risk of blood disorders
- monitor full blood counts WEEKLY
-monitored regularly if treatment more than 10-14 days

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22
Q

What are the interactions of linezolid

A

Interacts with tyrannies rich foods
-mature cheese
Marmite
Yeast extracts
Fermented soya bean extract
Some beers and wines

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23
Q

What can linezolid cause

A

Can cause serotonin syndrome
-SSRIS, Dopaminergics, 5-HT1 agonists, TCAs, lithium and other MAOIs

24
Q

What drugs fall under macrolides

A

Azithromycin (once daily) can be given 3x a week when it is for a prophylaxis in COPD patients in winter months
Clarithromycin
Erythromycin

25
Q

What cautions should be undertaken with macrolides

A

Patients with myasthenia gravis
Erythromycin preferred in pregnancy over Clarithromycin
- avoid Clarithromycin in first trimester of pregnancy

26
Q

What are the side effects associated with macrolides

A

Can be hepatotoxic

Can cause ototoxicity
- can cause hearing loss in large doses

High levels of GI disturbances
-nausea, vomiting, diarrhoea

Can cause QT prolongation

27
Q

What are the interactions of macrolides

A

Macrolides are CYP enzymes inhibitors
-statins cause increase risk if myopathy
-warfarin there is an increase risk of bleeding

Macrolides can cause hypokalemia
-loop/thiazide diuretics, steroids, salbutamol and theophylline

Macrolides increase The risk of QT prolongation
- amipdarone, domperidone, fluconazole, lithium, methadone, ondansetron, quinine, quinolones, sotalol, SSRIS etc

28
Q

What are the side effects of metronidazole

A

Taste disturbance- metallic taste, furred tongue

Nausea and vomiting- take this medication with and after food

Patients must not take alcohol with metronidazole
- disulfiram like side effects( nausea and vomiting and flushing)
- avoid alcohol during and 48 hours after treatment

29
Q

What are the precautions and side effects of nitrofurantoin

A

Pregnancy- avoid at term

Renal impairment- avoid if eGFR less than 45ml/min/1.73m2
If suspected resistant infection can give

May colour urine yellow or brown

Take this medication with or after food

30
Q

What are narrow spectrum penicillins

A

Narrow spectrum penicillins ( beta lactamase sensitive)- wouldn’t do anything if the bacteria is beta lactamase sensitive

Penicillin G: Benzylpencillin
- not gastric stable: parental use only

Penicillin V: phenoxymethylpenicillin
-gastric acid stable- suitable for oral administration

31
Q

What are broad spectrum penicillins

A

Broad spectrum penicillins (beta lactamase sensitive)
- ampicillin
- amoxicillin
— amoxicillin. + clavulanic acid ( co-amoxiclav) - beta lactamase resistant

Diarrhoea is most common with broad spectrum penicillins which can cause antibiotic associated colitis

Maculopapular rashes commonly occur in patients with glandular fever, do not use broad spectrum penicillins blindly for sore throat

32
Q

What care penicillin are resistant penicillins

A

Flucloxacillin
- take on an empty stomach and hour before food or 2 hour after
-cholestatic jaundice and hepatitis may occur very rarely, up to 2 months after treatment with Flucloxacillin has been stopped.
Administration for more than 2 weeks and increasing age are risk factors

Antipseudomonal penicillins
-piperacillin only available as combination with beta lactamase inhibitor tazobactam (resistant to beta lactamase )
-ticarcillin only available in combination with beta lactamase clavulanic acid

33
Q

What are the Sid effects of penicillins

A

Do not give intrathecally- can cause encephalopathy which can be fatal

Penicillin allergy- rashes or anaphylaxis
- true allergy: immediate rash- anaphylaxis
May not be allergic: minor rash, small, not itchy and non- confluent or rash after 72 hours

Cross sensitivity
Do not give cephlasporins in history of immediate penicillin hypersensitivity

34
Q

What drug should only be given via IV and not intrathecally

A

Vinca alkaloids

35
Q

what drugs are quinalones

A

Ciprofloxacin
Delafloxacin
Levofloxacin
Moxifloxacin
Ofloxacin

36
Q

What do quinalones cause and should be used in caution

A

Lowers the seizure threshold- avoid in epilepsy such as as tramadol, ibuprofen and sssris
Psychiatric disorders
Tendon disorders
Hypersensitivity reactions

Reduce sunlight and UV radiation exposure and may impair driving ability

37
Q

What are the MHRA warning in regard to quinalones

A

Tendinitis
- more common in patients over 60
-if tenditis is suspected: STOP and seek medical attention

Small risk of aortic aneurysm and dissection
Seek medical attention: sudden onset of abdominal, chest or back pain

Small risk of heart valve regurgitation (SOB, peripheral oedema and new heart palpitations)
- seek medical attention: SOB, peripheral, new heart palpitations

38
Q

What are the cautions of quinalones

A

QT prolongation
Myasthenia gravis
Arthropathy in children and adolescents
Perforated tympanic membrane (when used in ear)

39
Q

What are the interactions of quinalones

A

Food and drinks
- avoid dairy products and mineral fortified drinks- reduces absorption

Drugs that causes QT prolongation

Reduces seizure threshold
- quinalones + NSAIDs

40
Q

What are the drugs in tetracyclines

A

Doxycycline
Lymecycline
Demeclocycline
Minocycline
Oxtetracycline
Tetracyclines
Tigecycline

41
Q

What does it say on the drug label of tetracycline medications

A

Do not take milk, ingestion remedies or remedies containing iron or zinc, 2 hours before or after you are taking this medication

42
Q

What 3 tetracyclines drugs can you have with milk

A

Doxycycline
Lymecycline
Minocycline

Does Like Milk

43
Q

What are tetracyclines side effects

A

Benign intercranial hypertension
- stop and report on headache and visual disturbances

Lupus erythematous like syndrome and irreversible pigmentation
-highest risk Minocycline
Avoid the sunlight

Teeth discolouration and bone deposits
- do not give to children under the age of 12 or pregnant women

44
Q

What are the counselling points of tetracyclines

A

Hepatotoxic- avoid in liver failure

Tetracyclines cause can photosensitivity
- avoid exposure to sunlight and sunlamps

Tetracyclines can cause dysphagia
- tablets should be swallowed whole with plenty of fluid while sitting or standing

Can cause myasthenia gravis

45
Q

What is trimethoprim

A

May cause blood dyscrasias
- long term treatment, look out for signs of blood disorders
- fevers sore throat, rash, mouth ulcers, bruising and bleeding development

Trimethoprim is an antifolate
-teratogenic risk in the first trimester- avoid in pregnancy
-interactions with other folates such as methotrexate and phenytoin

Trimethoprim can also cause hyperkalemia

Caution in renal impairment

46
Q

List the narrow spectrum antibiotics

A

Penicillin (G and V)
Glycopeptides
Trimethoprim
Linezolid
Clindamycin

Anaerobic
Metrondiazole

PG TLC

47
Q

List the broad spectrum antibiotics

A

Chloramphenicol
Aminoglycoside
Penicillins (amoxicillin and ampicillin)
Tetracyclines
Nitrofurantoin
Macrolides
Cephlasporins
Quinalones

CAPTN MCQ

48
Q

List the antibiotics that are bacteriostatic (prevents bacteria growth)

A

Chloramphenicol
Linezolid
Tetracyclines
Macrolides
Clindamycin

CLT Mc

49
Q

List the antibiotics that are bactericidal (kills bacteria)

A

Cephlasporins
Aminoglycoside
Nitrofurantoin
Trimethoprim
Quinolones
Metrondiazole
Glycopeptides
Penicillins

CANT QM GP

50
Q

What antibiotics should be taken with or after food

A

Metrondiazole
Nitrofurantoin
Clarithromycin MR
Pivmecillin

51
Q

What antibiotics should be taken on an empty stomach

A

30-60 minutes before a meal or snack or at leat 2 hours after:

Flucloxacillin
Phenoxymethylpenicillin
Azizthromycin capsules (not tablets or liquids)
Tetracyclines + oxytetracycline

52
Q

Antibiotics and myasthenia gravis

A

The following antibiotics should be taken in caution in patients with myasthenia gravis

Quinolones
Aminoglycoside
Macrolides
Tetracyclines

53
Q

What antibiotic are nephrotoxic

A

The following antibiotics are nephrotoxic and should be taken with caution or avoided in patients with kidney failure

Nitrofurantoin
Aminoglycoside
Glycopeptides

Tetracyclines
Trimethoprim

54
Q

List the following antibiotics that causes hepatotoxicity

A

The following antibiotics are hepatotoxic and should be taken with caution or avoided in patients with liver failure

Macrolides
Flucloxacillin
Co- amoxiclav

Chloramphenicol
Nitrofurantoin
Tetracyclines
Rifampicin + isoniazid + Pyrazinamide (3/4 of TB medication)

55
Q

Side effects of all macrolides

A

GI disturbances
At prolongation
Hepatotoxicity
Taste alteration
N and v
Insomnia
Pancreatitis
Steven Johnson syndrome- skin reactions
Headache

56
Q

Side effects of all macrolides

A

GI disturbances
At prolongation
Hepatotoxicity
Taste alteration
N and v
Insomnia
Pancreatitis
Steven Johnson syndrome- skin reactions
Headache

57
Q

MRHA warning about erythromycin

A

Avoid in patients with ventricle arrhythmias or predispositions to qt prolongation
Erythromycin can cause significant qt prolongation

Caution use in neonates under 2 weeks
Due to increased risk of infantile hypertrophic pyloric stenosis
Report nausea and vomiting and irritability when feeding

INFECTIOUS DISEASES TOPIC- PRE REG (7 decks)

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