Antibiotics

Question 1

Name 3 aminoglycosides

Answer 1

gentamacin
streptomycin
tobramycin

Question 2

When must serum aminoglycoside concentrations be measured?

Answer 2

in all patients receiving parenteral doses
in patients with obesity, high doses, cystic fibrosis and elderly

Question 3

How often should serum-gentamcin conc be measured?

Answer 3

after 3-4 doses then every 3 days and after a dose change. measure 1hr after a dose and just before next dose.
(more frequent in renal impairment)

Question 4

For multiple daily dose regimen what is the peak serum conc of gentamicin

Answer 4

5-10mg/L

Question 5

what is the peak serum conc of gentamicin for endocarditis?

Answer 5

3-5mg/L
lower than regular as it is being co-prescribed with other antibiotics

Question 6

What is the trough serum conc for gentamicin and for when it is used for endocarditis?

Answer 6

<2mg/L
endocarditis: <1mg/L

Question 7

What is the dose adjustments for when the Trough is too high or the peak is too high with gentamicin?

Answer 7

trough too high = increase dose interval

peak too high = decrease dose

Question 8

Which type of drugs should be avoided with aminoglycoside use?

Answer 8

nephrotoxic

Question 9

What is the MHRA warning with aminoglycosides?

Answer 9

use of aminoglycosides are associated with ototoxicity (hearing or balance problems)

Question 10

Which class of drugs cause an interaction with aminoglycosides to cause ototoxicity?

Answer 10

Cisplatin
loop diuretics (furosemide, bumetanide, torasemide)
vancomycin
vinca alkaloids (vinblastine, vincristine, vindesine, vinflunine)

Question 11

What condition is contraindicated with aminoglycosides?

Answer 11

Myasthenia Gravis

Question 12

Can aminoglycosides be used in pregnancy

Answer 12

No they should be avoided due to risk of auditory or vestibular nerve damage

Question 13

Name 3 first generation Cephalosporins?

Answer 13

Cefadroxil Cefalexin Cefradine
Fad Fal Frad

Question 14

Name 3 second generation cephalosporins

Answer 14

cefuroxime, cefoxitin and cefaclor
furry fox face

Question 15

All third and fifth generation cephalosporins are parenteral apart from which drug?

Answer 15

Oral Cefixime

Question 16

should patients with hypersensitivty to penicillin and other beta lactams receive cephalosporins?

Answer 16

No due to cross-sensitivity

Question 17

can chloramphenicol be used in pregnancy?

Answer 17

Avoid in pregnancy due to risk of neonatal grey baby syndrome if used in third trimester

Question 18

What age can chloramphenicol be bought OTC?

Answer 18

2+

Question 19

What side effect of clindamycin suggests antibioitc associated colitis?

Answer 19

severe, prolonged or bloody diarrhoea

Question 20

Name 4 glycopeptides?

Answer 20

Dalbavancin, Teicoplanin, Telvancin and VANCOMYCIN

Question 21

Why should vancomycin only be given parenterally for systemic infections?

Answer 21

Due to reduced absorption with oral intake

Question 22

Can glycopeptides be given during pregnancy ?

Answer 22

Avoid in pregnancy unless benefit outweighs risk

Question 23

What should the trough concentration of vancomycin be?

Answer 23

15-20mg/litre

Question 24

What are side effects of vancomycin?

Answer 24

Red man syndrom
Cutaneous adverse reactions - SJS
Blood dyscrasias
cardiogenic shock on rapid intravenous injection
risk of anaphylactoid reactions at infusion sites - avoid rapid infusion and rotate site

Question 25

What is there a risk of with taking Linezolid?

Answer 25

severe optic neuropathy report visual impairment (blurry/altered vision) monitor regularly if treatment more than 28 days risk of blood disorders monitor FBC weekly monitor regularly if treatment more than 10-14 days

Question 26

what type of food does linezolid interact with?

Answer 26

tyramine rich foods such as: MATURE CHEESE marmite yeast extract fermented soya bean extract some beers and wine

Question 27

Which drugs interact with Linezolid that can cause serotonin syndrome?

Answer 27

SSRIs, dopaminergics, 5-HT1 agonists, TCAs, Lithium, other MAOIs

Question 28

Name 3 Macrolides

Answer 28

Azithromycin (OD), Clarithromycin and Erythromycin

Question 29

Which macrolide is preferred in pregnancy?

Answer 29

Erythromycin avoid clarithromycin in 1st trimester of pregnancy

Question 30

What are some side effects of macrolides?

Answer 30

Hepatoxicity ototoxicity - hearing loss in large dose gastrointestinal disturbance - nausea, vomiting, diarrhoea QT prolongation hypokalaemia

Question 31

Why can macrolides have interactions with other medication

Answer 31

They are CYP enzyme inhibitors

Question 32

What are side effects of metronidazole?

Answer 32

taste disturbances - metallic taste, furred tongue nausea and vomiting - take with or after food avoid alcohol during and 48hrs after treatment - disulfiram reaction

Question 33

When during pregnancy should nitrofurantoin be avoided?

Answer 33

Avoid at term

Question 34

At what eGFR level should nitrofurantoin be avoided?

Answer 34

If eGFR is less than 45ml/min/1.73m2

Question 35

What colour can nitrofurantoin cause urine to change to?

Answer 35

yellow or brown

Question 36

Should nitrofurantoin be taken before or after food?

Answer 36

with or after food

Question 37

What is the MHRA update for nitrofurantoin?

Answer 37

Risk of pulmonary and hepatic events

Question 38

What are examples of narrow spectrum penicillin

Answer 38

Penicillin G: benzylpenicillin (only parental use) - not gastric acid stable Penicillin V Phenoxymethylpenicillin (suitable for oral administration) - gastric stable

Question 39

What are examples of broad spectrum penicillins?

Answer 39

Ampicillin Amoxicillin or Co-Amoxiclav (beta lactamase resistant)

Question 40

Which type of antibiotics is diarrhoea most common in?

Answer 40

broad spectrum penicillins (risk of antibioitic associated colitis)

Question 41

What is a side effect of broad spectrum penicillins if patient has glandular fever?

Answer 41

macropapular rashes

Question 42

What is an example of a penicillinase resistant penicillin?

Answer 42

Flucloxacillin

Question 43

Should flucloxacillin be taken before or after food?

Answer 43

Take on empty stomach an hour before food or 2 hours after food

Question 44

What are rare conditions that can occur up to 2 months after treatment with flucloxacillin has been stopped?

Answer 44

cholestatic jaundice and hepatitis

Question 45

What are 2 antipseudomonal penicillins?

Answer 45

Piperacillin Ticarcillin

Question 46

What must piperacillin be combined with?

Answer 46

beta-lactamase inhibitor Tazobactam

Question 47

what must ticarcillin be combined with?

Answer 47

Beta lactamase inhibitor clauvanic acid

Question 48

Can penicillins be given intrathecally?

Answer 48

no as they can cause encephalopathy which can be fatal

Question 49

What is a true penicillin allergy?

Answer 49

Immediate rash - anaphylaxis

Question 50

can a patient have cephalosporins if they have a history of penicillin hypersensitivity?

Answer 50

no due to cross sensitivity

Question 51

what are examples of quinolones?

Answer 51

Ciprofloxacin, delafloxacin, levofloxacin

Question 52

What conditions can quinolones cause and be used in caution with?

Answer 52

avoid in epilepsy psychiatric disorders tendon disorders hypersensitivity reactions

Question 53

What are some counselling points for quinolones?

Answer 53

reduce sunlight and uv radiation. may impair driving ability

Question 54

What is the MHRA update for quinolones?

Answer 54

risk of suicidal thoughts and behaviour

Question 55

What are signs of aortic aneurysm and dissection associated with quinolone use?

Answer 55

sudden onset of severe abdominal, chest or back pain

Question 56

what are signs of heart valve regurgitation associated with quinolone use?

Answer 56

SOB, new heart palpitations and peripheral oedema

Question 57

What are cautions for quinolones?

Answer 57

QT prolongation Myasthenia gravis arthropathy in children or adolescents perforated tympanic membrane (when used bye ear)

Question 58

What foods should be avoided with quinolone use and why?

Answer 58

avoid dairy products and mineral fortified drinks - reduces absorption

Question 59

Give 3 examples of tetracyclines?

Answer 59

doxycycline, democlocycline, lymecycline

Question 60

which tetracyclines can you have milk with?

Answer 60

doxycycline lymecycline minocycline does like milk

Question 61

A patient taking a tetracycline (doxycycline) reports signs of headache and visual disturbances. what is this side effect called?

Answer 61

benign intracranial hypertension.

Question 62

What side effect has the highest risk with minocycline

Answer 62

lupus-erythematosus like syndrom and irreversible pigmentation

Question 63

What is a side effect that makes tetracyclines unsuitable for children under 12 or pregnant women?

Answer 63

teeth discolouration and bone deposit

Question 64

What are counselling points for tetracyclines?

Answer 64

hepatotoxic - avoid in liver failure photosensitivity - avoid sunlight or sun lamps dysphagia - swallow whole with plenty of fluid standing or sitting

Question 65

What should be monitored carefully for patients on trimethoprim for long term treatment?

Answer 65

Blood dyscrasias: fever, sore throat, rash, mouth ulcer bruising or bleeding development

Question 66

is trimethoprim safe in pregnancy?

Answer 66

teratogenic risk in first trimester - avoid in pregnancy

Question 67

trimethoprim is an antifolate, what are other examples of antifolates it interact with?

Answer 67

methotrexate and phenytoin

Question 68

is trimethoprim bacteriostatic or bactericidal?

Answer 68

bacteriostatic when used alone but bactericidal when combined with sulfonamides

Question 69

Which 4 antibiotics should be taken with or after food?

Answer 69

metronidazole nitrofurantoin clarithromycin pivmecillinam (PC MN)

Question 70

which 5 antibiotics should be taken on an empty stomach (1hr before food or 2hrs after)

Answer 70

flucloxacillin phenoxymethylpenicillin azithromycin capsules (not tablets or liquid) tetracycline oxytetracycline

Question 71

which 4 classes of antibiotics should be taken in caution in myasthenia gravis?

Answer 71

Quinolones aminoglycosides macrolides tetracyclines

Question 72

Which 5 antibiotics are nephrotoxic (taken in caution or avoided in pts with kidney failure)

Answer 72

Avoid: nitrofurantoin aminoglycosides glycopeptides Caution: tetracyclines trimethoprim