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Antibiotics Flashcards

1
Q

Name the antibiotics that effect cell wall synthesis? Folate synthesis? Nucleic acid synthesis? Protein synthesis?

A

cell wall synthesis: beta lactams - Penicillins, cephalosporins, carbapenems, monobactam; glycopeptides - vancomycin, teicoplanin; polymyxins - colistin

Folate synthesis: Sulfamethoxazole, trimethoprim

Nucleic acid synthesis: DNA Synthesis - Fluoruquinolones, metronidazole; RNA polymerase - rifamycins

Protein synthesis: 30S subunit - Aminoglycosides, tetracyclines; 50s subunit - macrolides, clindamycin, linezolid, chloramphenicol, Fusidic acid

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2
Q

antibiotics in co-amxiclav?

A

amoxicillin and clavulanic acid

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3
Q

antibiotics in tazocin?

A

piperacillin and tazobactam

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4
Q

Cephalosporin structure?

A

Contain a beta-lactam ring attached to a six-membered nuclear structure
(five in penicillin) - allows synthetic modifi cation at two sites (one in penicillin) - therefore the largest group of available antibiotics

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5
Q

Which is the broadest spectrum beta lactam antibiotic?

A

Carbapenums

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6
Q

Which bacteria is Aztreonam active against? SEs? Class?

A

Monobactam
only active against Gram-negative species including Neisseria meningitidis,
Haemophilus influenzae, Pseudomonas. Given IV/IM. Inhaled preparation
for chronic pulmonary Pseudomonas (cystic fibrosis)

SEs: N&V, GI bleed, rash, raised LFTS, reduced plts, paraesthesia, seizures, bronchospasm.

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7
Q

Which are the non-beta lactam cell wall inhibitors?

A

Includes glycopeptides, eg vancomycin, teicoplanin, and

polymyxins, eg colistin

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8
Q

Nitrofurantoin MOA? uses? SEs?

A

Metabolites interfere with cell growth via ribosomes, DNA,
RNA, and cell wall. Multiple sites of attack means reduced resistance used in uncomplicated UTI
SES: haemolysis, pulmonary fibrosis,
hepatotoxicity

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9
Q

Name 6 penicillins

A

Penicillin G (benzylpenicillin), Penicillin V (Phenoxymethylpenicillin), amoxicillin/ampicillin (amoxicillin PO, ampicillin IV), Co-amoxiclax, Piperacillin+tazobactam, flucloxacillin

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10
Q

Benzylpencillin indiciations? route? SE?

A

Gram +ve: streptococci (chest, throat, endocarditis, cellulitis),
meningococcus, diphtheria, anthrax,
leptospirosis, Lyme disease

IV
SE: allergy,rash, N+V, C.diff, cholestasis

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11
Q

Penicillin V indications?

A

Prophylaxis: splenectomy/hyposplenism,

rheumatic heart disease

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12
Q

Ampicillin/amoxicillin MOA? indications? route? SE?

A

Amino acid side chain extends
penicillin spectrum to include enterobacteria

URTI, sinusitis, chest, otitis media, UTI, H. pylori

SE: as per penicillin G, rash with EBV.

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13
Q

Co-amoxiclav indications?

A

Used if resistance to narrower spectrum
antibiotics: chest,
pyelonephritis, cellulitis, bone

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14
Q

Piperacillin+tazobactam Indications? properties? SE?

A

Broad spectrum including Gram
+ve, Gram -ve, Pseudomonas:
neutropenic sepsis, hospitalacquired/
complicated infection.

Tazobactam has reduced penetration of blood brain barrier

SE: SE: as per penicillin G.
Myelosuppression with prolonged use (rare).

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15
Q

Flucloxacillin indications? SE?

A

beta-lactamase resistant, Staphylococcus:
skin, bone, post-viral
pneumonia.

SE: allergy, rash, N+V, cholestasis

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16
Q

Name the 1st, 2nd and 3rd generation cephalosporins

A

1st: Cefalexin
2nd: Cefuroxime,
3rd: Cefotaxime, ceftriaxone, ceftazidime

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17
Q

Cephalosporins SE? Caution? (4)

A

Reduced first line use in UK due to risk of C.diff

Caution: false +ve
urinary glucose and
Coomb’s test

SE: allergy, rash,
N&V, cholestasis.

Ceftriaxone can
precipitate in urinary
tract and biliary tree =
pseudolithiasis.

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18
Q

Indications of cefalexin?

A

Gram +ve infection: UTI, pneumonia

19
Q

Cefuroxime indications?

A

Gram +ve and Gram -ve (Enterobacteriaceae,

H. influenzae): UTI, sinusitis, skin, wound.

20
Q

cefotaxime indications?

A 
Broad spectrum (not Pseudomonas, Enterococcus
spp, Bacteroides).
21
Q

Ceftriaxone indications? SE?

A 
Meningococcus. Broad spectrum (not Pseudomonas,
Enterococcus spp, Bacteroides
Ceftriaxone can
precipitate in urinary
tract and biliary tree =
pseudolithiasis.
22
Q

Ceftazidime indications?

A

Broad spectrum including Pseudomonas but
reduced activity against Gram +ve: empirical treatment
of neutropenic sepsis.

23
Q

Name 3 carbapenems? SEs?

A

Imipenum (Imipenem
given with cilastatin to reduce renal
metabolism), meropenum, ertapenum

SE: N&V, C. difficile, rash, eosinophilia,
reduced plts, raised LFTs, seizures.

24
Q

Name two lipopeptides and two polmyxins

A

lipopeptides: vancomycin, teicoplanin
polymyxins: colistin, polymyxin B

25
Q

Lipopeptides indications? SEs? Monitoring?

A

Complicated Gram +ve
including MRSA. Oral for C.difficile (not absorbed).

SEs:
nephrotoxic (monitor creatinine, care with
other nephrotoxics) ototoxic, reduced plts.

monitor creatinine

26
Q

polymyxins indication? consideration?

A

nephrotoxicity occurs in 50%

Inhaled colistin for ventilator-associated pneumonia

27
Q

Name the antibiotics that inhibit protein synthesis?

A

Protein synthesis: 30S subunit - Aminoglycosides, tetracyclines; 50s subunit - macrolides, clindamycin, linezolid, chloramphenicol, Fusidic acid

28
Q

Name 3 aminoglycosides. Indications? SEs? Monitoring?

A

Gentamicin, tobramycin, amikacin

Gram Ωve infection (reduced activity against most Gram +ve and anaerobes). Tobramycin has
increased activity against Pseudomonas.
Amikacin has least resistance.

SEs: nephrotoxic (monitor drug
levels and serum creatinine),
vestibular toxicity, ototoxicity.

29
Q

Name 3 macrolides, indications, SEs?

A

Azithromycin, Clarithromyin, erythromycin

Gram +ve cocci (not enterococci and staphylococci), syphilis, chlamydia.

SEs (increased with erythromycin): GI,
cholestasis, prolonged QT.
Cytochrome P450 inhibition (reduced
with azithromycin): increased warfarin,
rhabdomyolysis with statins,
increased calcineurin inhibitor levels.
30
Q

Name three tetracyclines? Indications? CI? SE?

A

tetracycline, doxycycline and tigecycline

Exacerbation COPD, chlamydia, Lyme disease, mycoplasma, rickettsiae, brucella, anthrax, syphilis,
MRSA, malaria prophylaxis.

CI: pregnancy, <8yr (permanently stain teeth)

SEs:N&V, C. difficile, fatty liver, idiopathic intracranial hypertension.

tigecycline is used for Gram +ve and Gram -ve including
beta-lactam-resistant strains.
SEs: N&V, photosensitivity, raised LFTs.

31
Q

Clindamycin indications? SEs?

A

Gram +ve cocci (not enterococci),

MRSA, anaerobes

32
Q

Linezolid indications?

A

Gram +ve cocci, MRSA, VRE, anaerobes, mycobacteria

Its a weak monoamine oxidase inhibitor (check interactions) -
myelosuppression,
optic neuropathy.

33
Q

Chloramphenicol indications? considerations?

A

Gram +ve, Gram Ωve, anaerobes, mycoplasma, chlamydia, conjunctivitis
(topical).

Systemic use limited by myelosuppression

34
Q

Fusidic acid indication? SEs?

A

Staphylococci.

SES: GI, raised LFTs.

35
Q

Coagulase negative vs positive staphylococci examples? virulence?

A

Coagulase-negative staphylococci - Staph epidermidis
positive - staph aureus

coagulase negative is less virulent - pathogenicity only likely if underlying immune system dysfunction or foreign material (prosthetic valve/joint, IV line, PD catheter, pacemaker)

36
Q

Different presentations of coagulase positive staphylococcus?

A
  1. Toxin release causes disease distant from infection. Includes: Scalded skin syndrome (bullae and desquamation due to epidermolytic toxins
    (no mucosal disease, less skin loss compared to toxic epidermal necrolysis)
    preformed toxin in food - sudden D+V
    toxic shock: fever, confusion, rash, diarrhoea, low BP, AKI, multiorgan dysfunction.
    Tampon associated or occurs with (minor) local infection.
  2. Local tissue destruction: impetigo, cellulitis, mastitis, septic arthritis, osteomyelitis,
    abscess, pneumonia, UTI.
  3. Haematogenous spread: bacteraemia, endocarditis, ‘metastatic’ seeding.
37
Q

Symptoms of toxic shock? Causative organism

A

fever, confusion, rash, diarrhoea, low BP, AKI, multiorgan dysfunction.

coagulase positive staph

38
Q

How is staph aureus resistance defined?

A

by stability to

meticillin, ie meticillin-resistant Staph. aureus (MRSA)

39
Q

How is vancomycin resistance classified in staph aureus?

A

classified according to the amount of vancomycin needed to inhibit
bacterial growth: vancomycin-intermediate Staph. aureus (VISA) and vancomycin-
resistant Staph. aureus (VRSA).

40
Q

Risk factors for MRSA colonisation?

A

antibiotic exposure, hospital stay, surgery, nursing home residence.

41
Q

MRSA infection treatment?

A

vancomycin (for MRSA), teicoplanin

42
Q

oral agents with activity against MRSE?

A

clindamycin, co-trimoxazole, doxycycline, linezolid

43
Q

What are the major classes of gram positive cocci?

A

staphylococci
streptococci
enterococci

Drugs (12 decks)

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