Antibiotics Flashcards
What are the different types of antibiotics that work by inhibiting the cell wall
beta lactams
> penicillins
> cephalosporins
> carbapenams
> monobactams
glycopeptides (high risk)
Fosfomycin
what are two examples of substances that help protect the beta lactam ring
tazobactam
clauvanic acid
what are the three different types of penicillins
broad spectrum
narrow spectrum
intense broad spectrum
name an example of a broad spectrum penicillin
amoxicillin
co-amoxicillin
name an example of a narrow spectrum penicillin
flucloxicillin
name an example of a intense broad spectrum penicillin
piperacillin + tazobactam
what are the indications for penicillins
PNUEMONIA
MENINGITIS
Acute sore throat
Acute sinusitis
Acute otitis media
Soft tissue
skin
what are the side effects of penicillins
hypersensitivities reactions
> rash
GI side effects
Antibiotic associated collitis
Jaundice
Explain the concept of antibiotic associated collitis
Inflammation of the colon caused by an overgrowth of the C. diff bacteria.
What are the FOUR Cs
clindamycin,
cephalosporins,
co-amoxi- clav
ciprofloxacin
what are the counselling points for penicillins
check for allergy
tell them to complete the course
what are the contra-indications for penicillins
hypersensitivity
What penicillin has a higher risk of hepatic disorders
flucloxicillin
What is a cholestatic condition
Cholestasis is the slowing or stalling of bile flow through your biliary system
What penicillin has a higher chance of causing cholestatic jaundice
co-amoxiclav
what is the moa of penicillin
it is cell wall synthesis inhibitor, it binds to penicillin binding sites and inhibits the cross links forming between peptidoglycan.
This leads to an unstable cell wall and water to flow into the cell causing swelling and eventually cell lysis.
What are the 4 generations of cephalosporin I need to know
1st
2nd
3rd
5th
what are two examples of a first gen cephalosporin
cefalexin
Cefazolin
what are two examples of a 2nd gen cephalosporin
Cefaclor
Cefuroxime
what are two examples of a 3rd gen cephalosporin
ceftazadime
ceftriaxone
what is an example of a 5th gen cephalosporin
ceftaroline fosfamil
what is the mechanism of action of a cephalosporin
it is cell wall synthesis inhibitor, it binds to penicillin binding sites and inhibits the cross links forming between peptidoglycan.
This leads to an unstable cell wall and water to flow into the cell causing swelling and eventually cell lysis.
what is the spectrum of cephalosporins and how does it change with the newer generations
it is a broad spectrum of antibiotics
as the generations get newer they have a wider spectrum of gram -ve bacteria that they can help treat.
5th generation is a novel type of drugs used to treat difficult infections including mrsa and vancomycin-intermediate s
what are the 5 indications for a cephalosporin
septiceamia
uti
gonnorhea
pnuemonia
meningitis
what are the 2 major side effects for a cephalosporin
the main one is antibiotic associated collitis remember 4 cs
then gi disturbances including nvd
what are the contraindications for a cephalosporin
penicillin allergy due to the similar structure as they are both beta lactams
history of antibiotic associated collitis
what are the counselling points for a cephalosporin
check for penicillin allergy saying it has a similar structure so may have same effect if they are allergic
finish the course
name the two most high risk antibiotics
glycopeptides
aminoglycosides
what are the 5 glycopeptides i should be aware of
vancomycin
tycoplanin
televancin
dalbavancin
oritavancin
what is the mechanism of action of glycopeptides
it is cell wall synthesis inhibitor, it binds to penicillin binding sites and inhibits the cross links forming between peptidoglycan.
This leads to an unstable cell wall and water to flow into the cell causing swelling and eventually cell lysis.
what are the indications for glycopeptides
surgical prophylaxis when high risk of mrsa
c.diff
endocarditis
what are the 8 side effects of glycopeptides
nephrotoxicity
ototoxicity
blood disorders
rashes
sjs
red man syndrome
hepatic and renal impairment
what are the contraindications for glycopeptides
Dont take with other ototoxic drugs such as spironolactone
dont take with nephrotoxic drugs such as
ace, arbs or nsaids.
caution with myasthenia gravis
what are the monitoring requirements that must be done for glycopeptides
we must take
bloods
urinalysis
elderly hearing function test
plasma level
hepatic + renal func
what are the dosing requirements for vancomycin
loading dose
10-15mg/L
15-20mg/L -> endocarditis or MRSA associated infection
what are the 5 examples of aminoglycosides
gentamycin
amicacin
neomycin
streptomycin
tobramycin
what is the mechanism of action of aminoglycosides
they are bacterialcidal and work against aerobic gram -ve bacteria
it binds to the 30s ribosomes in the bacteria and prevents them from producing protein eventually killing the cell as it can no longer sustain itself
what gram +ve bacteria are aminoglycosides effective against
staphlycoccus aureus
including methicillin resistant staph aureus
what are the primary side effects of aminoglycosides
ototoxicity
antibiotic associated colitis
nephrotoxicity and electrolyte imballance
Impact on neuromuscular transmission
peripheral neuropathy
what are the main indications for aminoglycosides
endocarditis
septicemia
meningitis
pnuemonia
what are the contraindications for aminoglycosides
history of ototoxicity or hearing problems
history of nephrotoxicity
use of other ototoxic drugs such as spironolactone
use of other nephrotoxic drugs such as
nsaids,ace - i, angiotension receptor blockers etc
what condition should we take caution with for aminoglycosides
myasthenia gravis
As aminoglycosides are high risk antibiotics what should we consider in terms of monitoring
renal function
auditory and vestibular function
serum concentration
what is auditory and vestibular function
Auditory function is the ability to hear and process sound, while vestibular function is the ability to maintain balance and spatial orientation.
Gentamycin is a type of aminoglycoside and has a narrow therapeutic index. Highlight the dosing requirements and explain peaks and troughs
Can have either multiple or daily dosing
If we are doing multiple though
1 hour after dosing it should be 5-10mg/l
a trough refers to a pre-dose level which should be around 2mg/l
Gentamycin is a type of aminoglycoside and has a narrow therapeutic index. Highlight the dosing requirements and explain peaks and troughs in respect to treating endocarditis
1 hour after dosing it should be 3-5mg/l
a trough refers to a pre dose level which when it comes to endocarditis will be <1mg/l
what are three examples of macrolides
erythromycin
clarithromycin
azithromycin
what is the moa for macrolides?
macrolides are bacteriostatic and work by binding to the 50s subunit inhibiting protein synthesis.
what are macrolides a good alternative too
penicillin antibiotics in patients who have penicillin allergies
what are the major indications of macrolides
pnuemonia
Exacerbation of COPD
Whooping cough
Eradication of H pylori
Cellulitis
Gonnorhea
Subsitutions for penicillins
acute sinusitis
acute otitis media
acute tonsilitis
what are the 5 major side effects of macrolides
GI disturbances
Hepatotoxicity
Rash
Steven johnsons syndrome
Tinitus
Prolonged qt interval [think about the contraindication for this]
What is the name of the macrolide that is most likely to cause GI disturbances
erythromycin - think e for error
what does e for error stand for
erythromycin as it is the most likely macrolide to cause gi side effects
what are the contraindications for macrolides
Aggravates myasthenia gravis
patients that are predisposed to a prolonged qt interval
When a patient is presenting signs of x when on a macrolide antibiotic we should discontinue it
hepatotoxicity
what are some signs of hepatotoxicity
Jaundice
Dark urine
Pale stools
Nausea
Vomiting
Fatigue
What medication should we advise to be stopped when a patient is going to begin a course of macrolides
statins
what is the reason statins must be stopped while on macrolides
statins are metabolised by cytochrome p450 which are then inhibited by macrolides.
This then leads to an increase in side effects as the levels of the statin are not being reduced as readily
What are the 5 quinolones to be aware of
Ciprofloxacin
Levofloxacin
Moxifloxacin
Norfloxacin
Ofloxacin
What is the MOA of quinolones
inhibits bactertial DNA replication against both gram +ve and gram -ve
Name one important gram -ve bacteria that quinolones work against
psuedomonas aruginosa
What are the indications for Quinolones
Respiratory Tract infections
Anthrax
Gonorrhea
UTI
What are the 6 cautions we need to be aware of for quinolones
Joint disorders
epilepsy
G6PD deficiency
Myasthenia gravis
Children
Pregnant
what exacerbates epilepsy risk while on quinolones
NSAIDS
What are four examples of NSAIDS
Ibuprofen
Naproxen
Diclofenac
Celecoxib
What are the 3 major csm warnings when it comes to quinolones
Epilepsy
Tendon damage
Aorticc aneurysm
What are the main side effects of quinolones
Gi disturbance
Antibiotic associated colitis
Headache and dizzyness
Life threatening hepatotoxicity
what are two examples of diaminopyrimidines
co-trimoxazole
trimethoprim
what is the moa of diaminopyrimidines
blocks steps in the synthesis of nucleic acids
is effective against both gram +ve and gram -ve
Trimethoprim = bacteriastatic
Co-trimmoxazole = bacteriocidal
[Remember T for Teratogenic]
Remember T for Teratogenic
what are the primary indications for diaminopyrimidines
pnuemonia
respiratory tract infections
shingellosis
uti
what are the primary side effects of diaminopyrimidines
steven johnson syndrome
blood disorders
who is more susceptible to having blood disorders while taking a diaminopyrimidine
elderly patients
what is the main contraindication for diaminopyrimidine
acute porphyrias
what is acute porphyrias and what antibiotic does it relate to as a primary contra indication
a group of rare disorders that result from a build up of poryrins in the body
they are needed to make part of hemoglobin however if the enzymes are deficient to do this it can lead to a build up
symptoms can include nervous system and skin
and it is a primary contraindication for diaminopyrimidines
what are the cautions for diamminopyrimidines
abnormality in bloods
asthma
g6pd deficiency
elderly
predisposition to folate deficiency
pregnant
In what trimester of pregnancy should diaminopyrimidines be avoided
1st
monitoring requirements for diaminopyrimidines
blood counts for long term therapy
what is metronidazole an example of
prodrug
what is the moa of metronidazole
Metronidazole is converted to its active form as it is a prodrug
it then binds to DNA and distrupts the nucleic accid synthesis
what does metronidazole have good activity against
anaerobes
protozoa
what are the indications for metronidazole
H.pylori
Oral infections
leg ulcers
C.difficile
what can metronidazole sometimes substitute
penicillins
what are the side effects of metronidazole
Gi disturbances
taste disturbances
furry tongue
oral mucositis
anorexia
what are the monitoring requirements for metronidazole
if treatment exceeds 10 days then we should carry out
full blood count and liver function tests
what advise can we give around metronidazole
avoid alcohol for up to 2 days after finishing the course
take with or after food
what is another name for clindamycin
lincosamides
what is the mechanism of action for clindamycin
it is bacteriostatic and works by binding to ribosomes to prevent protein synthesis
it works against BOTH gram +ve and -ve aerobes and anaerobes
what are the indications for clindamycin
staphyloccocal joint and bone infections
intra abdominal sepsis
skin and soft tissue infections
what are the side effects for clindamycin
gi disturbances
oesophageal disorders
taste disturbances
jaundice
blood disorders
rash
sjs
what is the monitoring that is required for clindamycin
any treatment lasting longer than 10 days and for infants we should review the hepatic and renal function
what are the cautions and contraindications for clindamycin
existing diarrhoea
elderly -> incresased risk of c.diff and diarrhoea
post operatively
What type of antibiotic are carbapenams
beta lactams
what is the mechanism of action of carbapenams
they inhibit the cell wall synthesis by interrupting crosslinks between peptidoglycan
this then causes instibility and water to flow into the cell leading to swelling and lysis.
what is the spectrum of coverage of carbapenams
gram +ve
gram -ve
anaerobes
What are some examples of carbapenams
ertapenam
meropenam
imipenam + cislastatin
what is the role of cislasatin when given with imipenam
Imipenem is partially inactivated in the kidney by enzymatic activity and is therefore administered in combination with cilastatin
a specific enzyme inhibitor, which blocks its renal metabolism.
What are some indications of carbapenams
Diabetic foot infection
Surgical prophylaxis
Abdominal infections
Pnuemonia
UTI and other gynaecological infections
What are the main side effects of carbapenams
Gi
Antibiotic associated collitis
Nephrotoxicity
Dizzyness and seizures
Injection site reaction
what are the cautions with carbapenems
CNS disorders as there is an increased risk of seizures
Renal Impairment as there is chance of nephrotoxicity
Elderly patients
Pregnant
Breastfeeding
what is the only route of carbapenems
IV injection
