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CPTP > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Q-SOFA

A

Resp rate >22
Altered GCS
Systolic BP <100

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2
Q

Sepsis

A

If vasopressors required to maintain MAP >65 +

Serum lactate > 2

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3
Q

Abnormalities in sepsis

A

FBC = WBC >12 or <4, Plt <100
U+E = Cr >310, acute oliguria <0.5ml/kg/hr
Lactate >2
Coag = PTT > 60, INR >1.5

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4
Q

Gram +ve bacteria

A

Cocci - staphylococcus (aureus and epidermis), streptococcus (pyogenes and pneumoniae), enterococcus

Rods - listeria, bacillus

Stain purple on gram stain

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5
Q

Gram -ve bacteria

A

Cocci - nessieria meningitides, gonorrhoea, bordetella
Rods - e.coli, Hib, pseudomonas, klebsiella
coliforms - enterococcus, salmonella, shigella

Stain pink

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6
Q

Don’t gram stain

A

Lack of a cell wall - mycoplasma, chlamydia, and mycobacterium TB

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7
Q

Antibiotic targets

A

Cell wall - B lactams, glycopeptides
Protein synthesis - macrocodes, tetracyclines, ahminoglycosides and clindamycin
Folate (DNA synthesis) - trimethoprim and sulphonamides
Nucleic acids - DNA = metronidazole, RNA - rifampicin

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8
Q

B-lactams

A

Encompasses the penicillins, cephalosporins and the carbopenams. All act to inhibit cell wall formation by inhibition of NAMA and NAG cross linking peptoglycan. This leads to weakness and lysis of the cell

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9
Q

Uses of penicillins

A

Flucloxicillin = cellulitis and skin infections
Amox/coamox = LRTI, UTI, URTI
Sepsis = Tazocin
Bacterial meningitis = Ben Pen

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10
Q

SE of penicillins

A

Generally well tolerated - GI upset diarrhoea and risk of c.diff esp with co-amox.

Hypersensitivity - skin rash, anaphylaxis, SJS, TIN

Fluxcloxicillin + coamoxiclav - cholestatic jaundice

Amoxicillin + EBV (glandular fever) = widespread maculopapular rash

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11
Q

Interactions of penicillins

A

Reduce efficacy of COCP, may increase INR due CY450 inhibitor effects

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12
Q

Generations of cephalosporins

A

1st - ceflaxin
2nd - cefuroxime
3rd - cefotaxime and ceftriaxone

1st generations = good cover against gram +ve
3rd = increased gram -ve cover

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13
Q

Indications of cephalosporins

A

Ceftriaxone - bacterial meningitis will penetrate meninges if they are inflamed

Bilary tract - cefuroxime
LRTI and epiglottis - cefotaxime

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14
Q

SE cephalosporins

A

10% cross reactivity with penicillin allergic!
Hypersensitivity - SJS and TEN
High c.diff risk!

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15
Q

Carbopenams

A

Meropenam and ertapenam. Broadest spectrum Abx against gram +ve, gram -ve and anaerobes

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16
Q

Indications for carbopenams

A

Pseudomonas infection

Complicated UTI/URTI

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17
Q

SE of carbopenams

A

N/V and diarrhoea - 5%, neurotoxicity and seizures esp in high doses or renal failure

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18
Q

Tetracyclines MOA

A

Target 30s ribosomal subunit reversibly binds blocking tRNA binding. It dose this by inhibiting aminoacyl tRNA and mRNA complex formation. Bacteriostatic - prevents replication

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19
Q

Indications for tetracyclines

A

Malaria prophylaxis
Mixed respiratory tract infections
Lymes(c.burnetti), brucella, chlamydia
Acne vulgaris/rosacea

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20
Q

Interactions of tetracyclines

A

Antacids, oral iron replacement and dairy products reduces their absorption and therefore efficacy
Risk of idiopathic intracranial HTN with retinoids
CYP450 inhibitors

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21
Q

SE tetracyclins

A

CI in children and pregnancy due to dental hypoplasia causing brown stained teeth and weak bones
Photosensitivity
Can cause oesophageal irritation and dysphagia

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22
Q

Aminoglycosides

A

Gentamicin and streptomycin

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23
Q

MOA aminoglycosides

A

Inhibit protein synthesis by triple blockade
i - misreading of mRNA
ii - block formation of initiation complex of peptide chain on 30s subunit
iii - block translocation of mRNA breaking up ribosomal clusters

Complete protein synthesis blockage. However ineffective against anaerobes as they need o2 dependent transporter to enter the cell

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24
Q

SE aminoglycosides

A

Ototoxic (Irreversible)
Nephrotoxic - usually reversible once stopped

Dose monitoring is crucial serum drug levels are taken 6-14hrs post dose when given OD, nomogram is then used to dictate subsequent frequency and dose.

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25
Q

Interactions of aminoglycosides

A

Increased risk of nephrotoxicity with NSAIDs, ACEi, increased risk of ototoxicity with vancomycin, diuretics

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26
Q

CI aminoglycosides

A

Renal failure, myasthenia gravis

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27
Q

Indications aminoglycosides

A

Endocarditis
Bilary infections and pyelonephritis
Pseudomonas infections
Sepsis

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28
Q

Macrolides

A

Clarthromycin, erythromycin and azithromycin

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29
Q

MOA macrolides

A

Target 50s subunit of ribosome preventing the transfer of bacterial tRNA from A site to P site on the ribosome thus preventing elongation of the polypeptide chain

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30
Q

Indications of macrolides

A

Good against gram +ve, gram -ve and atypical organisms as doesn’t act on the cell wall

Atypical LRTI (legionella, mycoplasma) and otitis media
H.pylori eradication therapy
Chlamydia trachomatis
Bordatella pertussis

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31
Q

SE of macrolides

A

QT prolongation with possibility of degeneration to torsdes de pointes
Hepatotoxic
N/V, diarrhoea and abdo pain

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32
Q

Interactions of macrolides

A

CYP450 enzyme inhibitors preventing breakdown of drugs leading to increased levels - esp warfarin, theophylline, carbamazepine, digoxin

Statins = increased risk of myopathy. If myalgia stop immediate and monitor CK

33
Q

Glycopeptides

A

Vancomycin and teicoplanin

34
Q

MOA glycopeptides

A

Irreversibly block the elongation of peptidoglycan chains by preventing incorporation of NAMA and NAG subunits this prevents cell wall synthesis

35
Q

Indications of glycopeptides

A

Oral vancomycin = c.diff
Endocarditis
MRSA infections

Active against aerobic and anaerobic gram +ve bacteria!
High molecular weight means they are unable to penetrate cell walls of gram -ve organisms

36
Q

SE glycopeptides

A

Nephrotoxicity and Ototoxicity thus pre-dose trough and 1hr post dose peak should be monitored
Thrombophlebitis and necrosis @ injection site if extravasation
Rapid infusion can lead to mass histamine release causing red man syndrome

37
Q

Quinolones

A

Ciprofloacin and moxifloxacin

38
Q

MOA quinolones

A

Inhibit DNA gyrase and topoisomerase IV this prevents supercoiling of the bacterial DNA. Unable to do this leads to inability to replicate DNA.

39
Q

Indications for quinolones

A

Gram -ve, pseudomonas and atypicals
UTI, STI - gonorrhoea
GI infections and typhoid

40
Q

SE of quniolones

A

N/V, diarrhoea esp c.diff
tendon rupture and damage
depression, anxiety - neurotoxicity
QT prolongation esp with other drugs

41
Q

Interactions of quinilones

A

CYP450 inhibitors leading to increase concentrations of drugs. High risk of theophylline toxicity
Risk of tornadoes de pointes with other QT prolonging drugs

42
Q

CI quinolones

A

Tendon rupture or tendonitis
Pregnancy or adolescent due to neurotoxicity and c.diff
Avoid in CNS/MH

43
Q

Trimethoprim MOA

A

Targets dihydrofolate reductase by inhibiting its reduction to tetrahydrofolic acid. This is an essential precursor in the thymidine synthesis pathway

44
Q

Sulphonamides

A

Block thymidine and purine synthesis by inhibiting folic acid synthesis. SE = high incidence of SJS, TEN can cause macrocytic anaemia in prolonged use due to folate deficiency

45
Q

Indications for trimethoprim

A

1st line for UTI, cotriamozole for PCP in HIV +ve pts

46
Q

SE of trimethoprim

A

hyperkalemia due to similar structure to potassium sparing diuretic amiloride.
SJS, TEN, angioedema

47
Q

Interactions of trimethoprim

A

ACEi and ARB = increased risk of hyperkalemia

methotrexate = increased risk of haematological toxicity

48
Q

Chloramphenicol SE

A

Severe irreversible BM suppression

49
Q

Nitrofurantoin MOA

A

Reactive nitrofurantoin metabolites damage a number of macromolecules within bacterial cells including ribosomal proteins and DNA. Used for UTI - avoid in renal failure due to total renal excretion

50
Q

SE nitrofurantoin

A

N/V, diarrhoea
Peripheral neuropathy
Hepatic failure/ dysfunction
Pulmonary fibrosis

51
Q

CI nitrofurantoin

A

Renal function <60 consult specialist

Pregnancy @ term or infants <3months = haemorraghic disease of newborn

52
Q

CI trimethoprim

A

Pregnancy 1st trimester

53
Q

Metronidazole MOA

A

After reduction of their nitro group to a nitrosohydroxyl amino group they become trapped within the intracellular compartment of anaerobic organisms causing DNA strand breaks

54
Q

Indications for metronidazole

A

Anaerobes!!
H.pylori eradication, c.diff
Surgical prophylaxis and abdo sepsis

55
Q

SE metronidazole

A

metallic taste in mouth, pancreatitis and hepatitis

56
Q

Interactions of metronidazole

A

Alcohol abstinence for length of course and 48hrs post. Otherwise hypotension, vominting and flushing

57
Q

Clindamycin

A

Inhibits ribosomal translocation by binding to 50s rNA of large bacterial subunit. Used for MRSA skin infections, toxic shock syndrome

High risk of c.diff

58
Q

Choosing Abx

A

Pt factors - allergies? pregnancy? renal impairment?
Drug - route, dose and SE
Disease - pathogen, site and severity

Cultures 1st before prescribing.

59
Q

Reviewing Abx

A

Review every 48hrs. Options are to

stop, change from IV to oral, change Abx if cultures/not effective, continue, outpatient therapy

60
Q

OPAT

A

Outpatient parenteral Ab therapy - Safe way to administer IV antibiotics in an outpatient or home setting. Used for chronic infections such a endocarditis, bone/joint, soft tissue, abcesses and TB

61
Q

Cellulitis

A

PC = fever, hot red swollen superficial skin wound. Causes by staph aureus, pseudomonas, strep pyogenes

62
Q

Anaerobes

A

Clostridium perfringes, difficile

63
Q

Risk factors for skin infections

A

Obesity, DM, PVD, ulcers or chronic oedema

64
Q

Mx cellulitis

A

IV fluxcloxicllin 48-72hrs (if MRSA = vancomycin IV)

65
Q

Meningitis Mx

A 
GP = 1.2mg benzylpenicillin stat
A&amp;E = IV ceftriaxone 2g stat +/- co-amoxiclav if >55 y/o to cover for listeria

Give corticosteroids if bacterial meningitis suspected!

If signs of increased ICP = CT scan, if no signs of increased ICP = LP stat

66
Q

Meningitis PC

A

Fever, headache and neck stiffness. May elicit photophobia, confusion, petichal non blanching rash, Kernigs and Brudinskis sign +ve

67
Q

Pathogen meningitis

A

Neonates - e.coli, group B strep
Adults - n. meningitides, strep pneumonia
Elderly - increase in listeria and Hib

68
Q

Signs of increasing ICP

A 
Cushing reflex = dropping HR, rising BP
Papilloedema, dilated pupils
Focal neurology
Vomiting and seizures
Falling GCS
69
Q

Complications of meningitis

A

Hemiparesis, blindness, hearing loss, loss of sense of smell, cognitive impairment and seizures. Cerebral abcess

70
Q

Notification of meningitis

A

Notify health protection england! Isolate pt for 24hrs
Chemoprophylaxis for all close contacts!
- Rifampicin BD 2 days, Ciprofloxicin 500mg PO stat

71
Q

Endocarditis

A

Inflammation of the inner surface of the heart commonly the valves. The vegetations which subsequently form can lead to embolic consequences

72
Q

Risk factors for endocarditis

A

Previous cardiac surgery and valve defects
IVDU
Mechanical heart valves

73
Q

Complications of endocarditis

A

Heart failure due to valve prolapse
Mycotic abcess in the the brain
Renal failure due to immune complex deposition
Stroke/acute limb ischemia

74
Q

PC and inv endocarditis

A

low grade pyrexia, new murmur, mitral stenosis

3 sets of blood cultures from 2x sites @ fever spike
Transoesophageal echo

75
Q

Dukes Criteria

A

2 major, 1 major and 1 minor, 3x minor

Major = echo result +ve (transoesophageal), 2 +ve blood cultures for typical organisms

Minor fever >38, IVDU, high CRP/ESR
Immune complex - Roth spots, osler nodes, GN
Embolic - septic emboli, Janeway, conjunctival haemorrhage, splinter haemorrhage

76
Q

Janeway vs Oslers

A 
Janeway = non tender macules on palms and soles
Osler = palpable painful nodules on distal pads of fingers
77
Q

Pathogens for endocarditis

A

Native valve - strep viridans
Prosthetic valve - staph aureus

Others = epidermis, HACEK, MRSA

78
Q

Mx endocarditis

A

Benzylpenicillin + gentamicin = strep viridans
Fluxcloxicillin + rifampicin = staph aureus

Vancomycin + gentamicin = MRSA

Prophylaxis only offer in high risk group!

79
Q

Aims for gentamicin and vancomycin levels

A

Gent trough <1mg/L
Vancomycin trough 10-15mg/L

If below hardford nomogram can be used to adjust dose or increase frequency

CPTP (11 decks)

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