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308: Clinical Pharmacology and Therapeutics > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Main antibiotics to know about

A

Penicillins

Cephalosporins

Glycopeptides

Aminoglycosides

Macrolides

Quinolones

Metronidazole

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2
Q

Principles of rational antibiotic prescribing

A

The aetiological agent
- potential for AMR

The patient

The drug

  • mechanism of action
  • mechanism of resistance
  • ket pharmacology

Monitoring

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3
Q

Antimicrobial stewardship

A

Key feature of healthy policy in NHS

Trusts must be able to evidence good practice in this area

Set of coordinated strategies to improve the use of antimicrobial medications with the goal to enhance patient health outcomes, reduce antibiotic resistance and decrease unnecessary costs

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4
Q

TARGET

A

Treat antibiotics reasonably, guidance, education, tools

Influences prescribers and patients to optimal antibiotic prescribing

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5
Q

Key principles about rational antibiotic prescribing decisions

A

Initial prescription

  • microbial aetiology
  • patient factors
  • antimicrobial resistance issues
  • knowledge
  • guidelines- choice of agent, duration of therapy

Then

  • monitoring
  • test results

Review and revise

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6
Q

Amoxicillin

A

Penicillin

Used in the treatment of S. pyogenes infections, pneumococcal infections and coliform infections

  • good oral bioavailability
  • 20% protein binding
  • metabolism not significant
  • 1 hour half life
  • excreted through urine
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7
Q

Amoxicillin mechanism of action

A

Inhibition of bacterial cell wall synthesis

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8
Q

Amoxicillin standard dose

A

250-1000mg 8 hourly

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9
Q

Amoxicillin adverse effects

A

Allergy

Damage to commensal microflora

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10
Q

Amoxicillin interactions

A

Can increase levels of other protein bound drugs

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11
Q

Beta-lactam antibiotics

A

Penicillin

Amoxicillin- easy oral penicillin

Flucloxacillin- for staoh aureus

Piperacillin- for pseudomonas

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12
Q

Beta lactam allergy

A

Penicillin allergy- a class effect

Immediate/ accelerated type 1

  • 0-72 hours after exposure
  • IgE mediated, mast cell mediated
  • urticaria, wheeze, life threatening

Delayed- mixed mechanism

  • > 72 hours after exposure
  • will worsen with repeated dose
  • dose not become immediate type
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13
Q

Cephalosporin allergy

A

Very complicated- lots of potential haptens involved

Not a class effect

Penicillin X reactivity more with 1st and 2nd generations

Risk 8% if previous penicillin allergy

Less with 3rd generation

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14
Q

Clarythromycin

A

Macrolide

USed for patients with penicillin allergy for treatment of S.pyogenes, pneumococcal and coliform infections

  • good oral bioavailability
  • high protein binding
  • hepatic metabolism
    1-6 hour half life
  • excreted as metabolites in bile
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15
Q

Clarythromycin mechanism of action

A

Inhibition of protein synthesis in the bacterial ribosomes (50S subunit)

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16
Q

Clarythromycin standard dose

A

500mg 12 hourly

17
Q

Clarythromycin adverse effets

A

Nausea and diarrhoea

May alter cardiac conduction- arrhythmias

18
Q

Clarythromycin interactions

A

Inhibit enzymes (cytochrome p450 enzymes) involved in metabolism of other drugs

19
Q

Vancomycin

A

Glycopeptide

Only against gram positive bacteria and many resistant strains including MRSA

  • very low oral bioavailability
  • 50% protein binding
  • no metabolism
  • 4-8 hour half life
  • excreted in urine
20
Q

Vancymycin mechanism of action

A

Inhibits bacterail cell wall (peptidoglycans) formation by a different target to beta lactams

21
Q

Vancomycin standard dose

A

500-1500mg 12 hourly

Narrow therapeutic window

Dose by drug levels in blood

22
Q

Vancymycin adverse effects

A

Nephrotoxic

Ototoxic

23
Q

Vancymycin interactions

A

Other ototoxic and nephrotoxic drugs

24
Q

Doxycycline

A

Tetracycline

Good activity against gram positive and some gram negatives and cell wall defiant bacteria

  • good oral bioavailability
  • moderate protein binding
  • no metabolism
  • 6-12 hour half life
  • excreted in urine and bile
25
Q

Doxycycline mechanism of action

A

Inhibition of protein synthesis in the bacterial ribosome (30S subunit)

26
Q

Doxycycline standard dose

A

100-200mg daily

27
Q

Doxycycline adverse effeccts

A

Dyspepsia

Photosensitivity

Avoid in pregnancy/ children (teeth)

28
Q

Doxycycline interactions

A

Competes for protein binding

Warfarin, digoxin etc

29
Q

Nitrofurantoin

A

Nitrofuran

Wide spectrum, esp E.coli

Used for lower urine infections only

  • good oral bioavailability
  • moderate protein binding
  • no metabolism
  • 1 hour half life
  • excreted in urine
30
Q

Nitrofurantoin mechanism of action

A

Complex

Damages bacterial DNA

31
Q

Nitrofurantoin standard dose

A

50mg qds

32
Q

Nitrofurantoin adverse effects

A

Very well tolerated

Safe in early pregnancy- avoid late

Avoid in renal impairment- peripheral neuropathy, doesn’t penetrate urine if eGFR low

33
Q

Nitrofurantoin interactions

A

No major issues

308: Clinical Pharmacology and Therapeutics (14 decks)

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