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YEAR 3 & 5 CORE CONDITIONS > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What is the antibiotic treatment for a community acquired pneumonia?

A

Amoxicillin

Doxycycline or clarithromycin for penicillin allergic

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2
Q

What is the basic mechanism of penicillins?

A

Cell wall synthesis inhibitors

They inhibit transpeptidase so remodelling of NAM + NAG chains can’t occur

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3
Q

If penicillin allergic, which other antibiotics should be avoided?

A

Cephalosporin (also beta-lactams)

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4
Q

When should you not give amoxicillin?

A

Sore throat in children - if it is EBV it will cause a rash

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5
Q

What are some indications for penicillins?

A
  1. Gram positive bacteria e.g. staph + strep
  2. Meningococci
  3. Pneumococcal infections
  4. Tetanus
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6
Q

What drug do penicillins interact with?

A

They reduce renal excretion of methotrexate which is a folate antagonist

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7
Q

What is generally used for skin infections?

A

Flucloxacillin

Erythromycin if allergic

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8
Q

Name some cephalosporins

A

Ceftriaxone
Cefazolin
Cefuroxime

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9
Q

How do cephalosporins work?

A

They inhibit enzymes involved in cross-linking the cell wall

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10
Q

What are cephalosporins used for?

A

UTIs
More severe infection
Antibiotic-resistant infections

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11
Q

What is the main risk of cephalosporins

A

C. difficile infection

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12
Q

What are the C. difficile causing antibiotics

A

Cephalosporins
Ciprofloxacin
Clarithromycin

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13
Q

What drug do cephalosporins interact with?

A

Warfarin - they kill the gut flora that synthesises vitamin K so the effect of warfarin is increased

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14
Q

Name some macrolides

A

Erythromycin
Clarithromycin
Azithromycin

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15
Q

How is azithromycin different to the other macrolides?

A

It is not a CYP450 inhibitor

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16
Q

What are the main indications for macrolides

A

LRTIs - particularly mycoplasma pneumoniae
Skin infections when penicillin allergic
Eradication of H. Pylori with amoxicillin and PPI

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17
Q

Describe the mechanism of macrolides

A

They bind to 50S ribosomal subunit to inhibit protein synthesis

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18
Q

What are the QT interval prolonging drugs

A 
Amiodarone
Lithium
SSRIs
Quinolones
Macrolides
Antipsychotics e.g. lithium
Antihistamines
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19
Q

What drugs do macrolides interact with and why?

A

They are CYP450 inhibitors

Increase the concentration of warfarin, statins, antidepressants

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20
Q

Name 2 quinolones

A

Ciprofloxacin

Levofloxacin

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21
Q

What are the indications for quinolones

A

UTI
GI infection - salmonella, shigella, campylobacter
HAP - pseudomonas aeroginosa

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22
Q

What is the other antibiotic used to treat pseudomonas aeroginosa?

A

IV gentamicin

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23
Q

What are some important side effects of quinolones?

A
  • C. difficile
  • Prolonged QT interval
  • Rupture of achilles tendon
  • Seizures
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24
Q

What condition can also cause rupture of achilles tendon?

A

Cushing’s (weak tendons)

25
Q

How do quinolones interact with other drugs?

A

They are CYP450 inhibitors

26
Q

Name the CYP450 inhibitors

A

Some Certain Silly Compounds Annoyingly Inhibit Enzymes, Grr

Sodium valproate
Ciprofloxacin
Sulphonamide 
Cimetidine/omeprazole
Antifungals, amiodarone
Isoniazid
Erythromycin/clarithromycin
Grapefruit juice
27
Q

What antibiotic is used for serious gram negative aerobe infections?

A

Gentamicin

28
Q

Name some indications for gentamicin

A

Endocarditis
Pyelonephritis/complicated UTI
Sepsis
Pseudomonas aeroginosa LRTI

29
Q

What drug class is gentamicin in? How do they work?

A

Aminoglycosides

Enter cells via oxygen transport system
Bind to 30S subunit of ribosomes and inhibit protein synthesis

30
Q

What antibiotics is gentamicin often used with and why?

A

Beta-lactams

To weaken the cell wall and make it more effective

31
Q

What are the 2 main side effects of gentamicin?

A

Ototoxicity

Nephrotoxicity

32
Q

When is gentamicin contraindicated?

A

Myasthenia gravis - it impairs neuromuscular transmission

33
Q

What other drugs cause ototoxicity?

A

Loop diuretics
Macrolides at high doses
Gentamicin
Vancomycin

34
Q

Which drugs would increase risk of nephrotoxicity if given with gentamicin?

A

Ciclosporin
Chemotherapy
Cephalosporins

35
Q

How is co-amoxiclav effective against anaerobes?

A

Penicillins aren’t effective against anaerobes.

However, the acid component (clavulanic acid) breaks down the beta-lactamases that make bacteria anaerobic

36
Q

Name a tetracycline

A

Doxycycline

37
Q

What are tetracyclines used for?

A
  1. Acne vulgaris - Propionibacterium acnes
  2. LRTIs - Chlamydia pneumoniae
  3. Chlamydia
  4. Typhoid
  5. Anthrax
  6. Malaria
  7. Lyme disease
38
Q

What are the main side effects of tetracyclines

A

Photosensitivity

Discolouration of teeth

39
Q

Who should you not give tetracyclines to?

A

Pregnant women and children
Harms teeth, bones and liver
Blue/black discolouration

40
Q

What decreases absorption of tetracyclines?

A

Divalent cations e.g. calcium, antacids, iron

41
Q

What gram bacteria is vancomycin only effective against?

A

Gram positive

42
Q

Name some indications for vancomycin

A
  1. MRSA
  2. Severe C. difficile infection when metronidazole could not treat it
  3. Endocarditis
43
Q

What kind of reaction can occur due to vancomycin?

A

Anaphylactoid reaction -> Red man syndrome

44
Q

What other side effects can vancomycin cause?

A
  • Thrombophlebitis if given IV
  • Ototoxicity
  • Nephrotoxicity
  • Neutropenia
  • Thrombocytopenia
45
Q

What drug class is vancomycin in ?

A

Glycopeptides

46
Q

Name an anaerobic antimicrobial. How do they work

A

Metronidazole

They enter bacteria and are reduced, which releases a free radical that prevents DNA synthesis

47
Q

What is the main contraindication for metronidazole?

A

Alcohol - it inhibits acetyldehydrogenase

48
Q

What are the main indications for metronidazole

A
  1. Bacterial vaginosis
  2. C. difficile
  3. Dental abscesses
  4. Endocarditis
  5. H. Pylori eradication with amoxicillin + PPI
49
Q

What side effects might you get with metronidazole?

A

Metallic taste
Dark urine
Peripheral neuropathy
Seizures

50
Q

What drug does metronidazole particularly interact with?

A

Lithium

51
Q

Which antibiotic inhibits folate synthesis? What should you not give it with?

A

Trimethoprim

Don’t give with methotrexate (folate antagonist)

52
Q

What is trimethoprim used for?

A
  1. UTIs

2. Pneumocystis pneumonia - co-trimoxazole (trimethoprim + sulfamethoxazole)

53
Q

What is an important interaction with trimethoprim?

A

It enhances the effect of warfarin

54
Q

What are the main side effects of trimethoprim?

A

Hyperkalaemia

Impaired haematopoiesis - folate deficiency

55
Q

Who should you not give trimethoprim to?

A
  • Pregnant women particularly in first trimester
  • Folate deficiency
  • Renal impairment
  • Neonates, elderly, HIV
56
Q

Which antibiotic is used in long term UTIs or UTI prophylaxis?

A

Nitrofurantoin

57
Q

Which organisms is nitrofurantoin particularly effective against?

A

E. Coli

Staphylococcus saprophyticus

58
Q

Who should not be given nitrofurantoin?

A

Pregnant women and neonates - risk of haemolytic anaemia in the baby

People with renal impairment

59
Q

Name some side effects of nitrofurantoin?

A
  • Dark brown urine
  • Peripheral neuropathy
  • Pulmonary reactions - acute and chronic

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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