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infection antimicrobials > Antibiotics And Antivirals > Flashcards

Antibiotics And Antivirals Flashcards

1
Q

Unknown cause sepsis

A

Flucoxacillin, metronidazole, gentimycin UHL

Meropenem KETS

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2
Q

Resp infections - generalised unknown source how would you manage

A

Give amoxicillin or co amoxicillin
This targets:
Gram positive bacteria e.g. Strep,staph
Gram negative bacteria: haemophillus, moxarella,

Allergic- give doxycycline or meropenem

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3
Q

Which microbes is amoxicillin effective against

A

This targets:
Gram positive bacteria e.g. Strep,staph
Gram negative bacteria: haemophillus, moxarella,
Also: helicobacter pylori, escheridia coli, proteus mirabilis, so use in GI inf.
Not effective : klebsilla, pseudomonas, serration, citrobacter, some gram negative aerobes

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4
Q

Mechanism of action of amoxicillin

A

Penicillin so beta lactam antibiotic
Disrupts cell wall synthesis in peptidoglycan cell walls so mostly effective against gram positive bacteria as rely more on their peptidoglycan cell wall.

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5
Q

Name other beta lactam antibiotics

A

Cephalosporins
Carbapenem- meropenem, eropenem.
Penicillins

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6
Q

Common causative organisms CAP. And their classification

A

Streptococcus pneumonia- gram positive cocci
Moxeralla catarhalis - gram neg, cocci
Haemophillus influenzae- gram negative bacilli

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7
Q

Curb 65

A 
CURB
C- confused? Ab. Mental state score <8
Urea >7
RR >30
BP <90 or <60 diastolic
65 > age

0-1 low risk manage at home
2 hospital general wards
3+ consider ITU

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8
Q

Management of CAP

A

Antibiotics - amoxicillin or doxycycline. PO
If 2+score then: add doxycline po and then change to co-amox IV
If 2+ allergic: add meropenem IV and can change doxy to clarithromycin IV

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9
Q

HAP common organisms

A

Psumodmonas aerunginosa

Kelbsiella pneumoniae

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10
Q

HAP antibiotics

A

(Co- amoxiclav) not pseudo

Tazocin - pipereracillin with taxobactam

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11
Q

Co- amoxiclav uses against which microorganism

A

Same as amoxicillin but also for resistant microorgnansims, klebsiella
NOT PSEUDOMONAS
Gram positive aerobes- staph, strep, enterococcus
Gram negatives - haemophillus, e.coli. Moxarella, klebsiella, helicobacter pylori . Also: neisseria gonorrhoea,
Also: anaerobic - bacterioides, fusobacterium, peptostreptococcus.

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12
Q

Mechanism of co- amoxiclav

A 
Amoxicillin- b lactamase inhibitor. Inhibit the binding oriteins that do cross linking in bacterial cell walls
Clavurinic acid- b lactamase inhibitor : class 2-5 -can really target gram negatives. But not pseudomonas 
Irreversible inhibitor of thenlactamases
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13
Q

CI in using co amoxiclav

A

Penicillin allergy,
Cholestatic jaundice or liver dysfunction
hepatic toxicity is usually reversible but still have caution - don’t use over 14 days

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14
Q

CI amoxicillin

A

Penicillinin celhalosporin allergy
C diff associated diarrhoea can occur

Can interact with methotrexate
Other antibiotics can interfere with amoxicillin (tetracyclines, macrolides)
Cna reduced effectiveness of OCP and oral antocoagulants

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15
Q

Antibiotics in aspiration pneumonia

A

Co amoxiclav Po or iv

Or meropenem

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16
Q

Antibiotics for acute COPD with acute lrti

A

Amoxicillin or co amox

Or doxyclijne

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17
Q

Doxycycline- class and mechanism of action

A

Broad spectrum tetracycline

Reversible inhibitor of 30s bacterial ribosome . Stops binding of tRNA to ribosome.

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18
Q

Name other classes of antimicrobials targeting ribosomes and which classes they treat

A

Tetracyclines- doxycycline - stop tRNA binding, work with gram positive, and negative and anaerobes
Aminoglycosides- gentimycin, streptomycin - gram neg. read mRNA abnormally .
Macrolides - erythromycin azithromycin. Gram positive and atypical pneumoniae . Stop mRNA translocation

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19
Q

Doxycline - uses, administration

A
  • LRTI if penicillin allergic, milder skin infections if penicillin allergic,
    Drugs of choice for intracellular organisms e.g. chlamydia trachomatus ,Lyme disease, mycoplasma, anthrax, rickettsia - all parasitic and penetrate well,

Administration: oral or iv

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20
Q

Tetracyclines
CI
SE

A

Bind to calcium e.g. Bones and teeth - so CI in young <8yrs, pregnant and lactating women. –> discoloured teeth

SE: N&V, C. difficile, thrush,idiopathic intercranial hypertension

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21
Q

New tetracycline - tigecycline - use and SE CI

A

Use: gram +ve -ve inc resistant strains. - skin soft tissue GI
CI - caution in liver
SE: inc LFTs, N&V, potosensitivity

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22
Q

Name some aminoglycosides, Their. Mechanisms of action. And overall sensitivity

A

Gentimycin, streptomycin, tobramycin, amikacin
Mechanisms: bactericidal antibiotics - strong ones, must give IV,
Bind to 30s ribosome and inhibit tRNA binding and ALSO promote misreading of mRNA
USe: gram negatives and gent/Tobramycin - can target pseudomonas.

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23
Q

Amino glycosides CI and SE

A

Ottotoxicity - damage 5th cranial nerve
Nephrotoxic - CI in renal failure. - Monitor aminoglycosides levels and serum creatinine
CI myasthenia gravis as impairs NM transmission

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24
Q

Resistance in aminoglycosides

A

Enzymes produced by the bacteria can inactivate the aminoglycosides

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25
Q

Use of aminoglycosides

A

Gentimycin
- unknown sepsis. - acute life threatening infection inc. pseudomonas. So use until sensitivities known.
- streptococcal endocarditis with penicillin and vancomycin
Amikacin - newest and has least resistance

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26
Q

Name some macrolides, their main use and mechanisms

A

Erythromycin, clarithromycin,
Gram positive - like penicillin - use in allergies
Mechansim: taken up by gram positive more than negatives - they bind to 50s sub unit and inhibit translocation

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27
Q

Erythromycin and clarithromycin uses, CI andSE

A

Oral or IV
Sim to penicillin - Gram positive cocci inc. MRSA, and B lactam resistant strains - so use in penicillin allergies!!
Also used in: mycoplasma pneumoniae and legionnaires

CI - not really
SE/interactions: liver metabolism and p450 inhibitors = accumulation of warfarin and inc. conc of statins (rhabdomyelosis) and calcineurin inhibitors etc.
SE: GI, Choletasis, inc. QT

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28
Q

Skin and bone infections/

A

Flucoxacillin

Or vancomycin if allergic

29
Q

SE of penicillins

A

Rashallergy
NV
C diff
Cholestasis

30
Q

First. Line antibiotic for c.difficile

A

Metronidazole oral

31
Q

Name some anaerobes , and what you could use to treat

A

C.difficile
Bacterial vaginosis
Intra-abdominal, pelvic oral soft tissue. — enclosed environments
E.coli, staphylococcus, clostridium - use metronidazole

Gram negatives:intra abdo infections , frusobacteroium (abscesses wounds), others causin aspiration pneumonia and soft tissue
Gram positives: clostridium, peptostreptococcus, other types causing pelvic neck and head. Infections.

32
Q

Side effects and CI f metronidazole

A

Caution withliver problems
Inhibits warfarin metabolism - p450 inhibitor
Can cause disulfuram like reaction with alcohol

33
Q

First line therapy UTI

A

Uncomplicated trimethoprim 3 days

34
Q

Complicated uti

A

Trimethoprim (women)
Or Co-amoxiclav - recommended more in men
7 days

35
Q

Pyelonephritis

A

Co-amoxiclav pO or IV if NBM

Allergic - ciprofloxacin or meropenem

36
Q

Use of cephalosporins and name example

A

Alternatives to penicillins when allergies or resistance

Cefriaxone - meningococcus
Ceftazidime - neutropenic sepsis (broad spec)

37
Q

Diabetic foot ulcers

A

Superficial flucoxacillin
Deep metronidazole - anaerobic

Allergic - doxycycline

38
Q

Use of vancomycin and teicoplanin - mechanism

A

Complicated gram positives including MRSA

Inhibits peptidoglycan formation - from positive
Use septicaemia or endocarditis with MRSA. Or psydomenranous colitis (c.diff)

39
Q

SE of teicoplanin and vancomycin

A

Nephrotoxic - monitor creatinine
Ototoxic
Platelet deficiency

Only IV - not oral

40
Q

Use and mechansim of carbapenems

A

B lactam inhibitors but very rewesistant to most b lactamases. Wide spec. Acts against gram negatives and gram positives inc. pseudomonas and MRSA
IV
Meropenem
Ertapenem (not for pseudomonas)

41
Q

Menigitis

A

Gram -ve cocci

Give cefriaxone

42
Q

Use of rifamycin

A

Mycobacterium
Legionella
Meningococcal prophylaxis

43
Q

Se and CI with rifamycin

A 
Epatitis
Gi 
Cna effects
Myelosu[rssion
Red secretions- urine sweat s alive tears
44
Q

Mechansim or tripmthroprim and co-trimoxazole

A

Folate synthesis inhibitors

45
Q

Tb treatment

A

Rifamycin 4 mths
Isoniazid 4 mths
Pyrazinamide 2 mths
Ethambutol 2 mths

46
Q

SE of ethambutol

A

CI optic neuritis - ocular toxicity and colour blindness

Don’t use in young. Kids

47
Q

Cholecytisis infection, peritonitis, or hepatobilary

A

Treat like sepsis IV - amoxicillin metronidazole gentimycin (or meropenem if allergic)

48
Q

Abdominal gastroenteritis or other complaint - not as severe

A

Ciprofloxacin or cefriaxone

49
Q

Use of gentimycin

A

Aminoglycosides

Gram negatives inc. pseudomonas

50
Q

SE of pyramizadole

A

CI in gout,
Caution in DM
Hepatotoxic, photosensitivity

51
Q

Se or isoniazid

A

Caution in liver disease
Peripheral neuropathy - caution in DM - common
Rare - psychotic episode

52
Q

Name some cutenous fungal infections

A

Dermatophytosis
Candidiasis
Malassezia

53
Q

What is dermatopytosis

A

Ringworm
Scale and pruitis - itchy
Can be circular
Also skin and blisters between toes

54
Q

Malassezia

A

Greasy skin - hypo or hyperpigmented ras - sebrharrhoeic dermatitis (scaling and danddruff)]
RF acne

55
Q

RF Diagnosis and treatment of superficial fungal infections

A

Immmunocop. Moist environments. Antibiotics
Diagnsis - clinical.skin scrapings
Treatment: topical -azole e.g. Imisazoles or triadazoles
. Or terbinafine 1-4wks
Topical nystatin (candidiasis )

56
Q

Name a common anti-fungal for superficial infections

A

Triazoles

- fluconazole

57
Q

Candiasis infections - superficial

A

Nystatin or amphotericin

Polyenes - antifungals

58
Q

Invasive fungal infections - name som organisms

A

Candidiasis– immunocomp
Cryptococcosis –> menigitis or pneumonia
Histoplasmosis –> from soil with bat or birt faeces
Blastomycosis

59
Q

RF for invasive fungal.

A

RF- infection malignancycritical illness e.g. ITU, transplant surgical - GI perforation, burns immunosuppressed

60
Q

Investigating serious infections - especially suspected fungal and those with RF

A

3 blood culture samples 3 different sites, same time/
Microscopy and immunohistocemistry
- consider antigen antibody testing

61
Q

Managing invasive candidiasis

A

Repeated tissue cultures
Remove potential source- catheter and sample
Give cocktail of antifungals: triazole e.g. Fluconazole. Ecinocandins (terbinafine) and others

62
Q

7 types of antiviral s

A

Think 7 steps

1) inhibit penetration - palivzumab (RSV propylaxis in infants at risk)
2) Inhibit uncoatting’ - rare
3) Integrase inhibitors - prevent integrating into nucleus
3) Replication - inhibit viral DNA polymerase- aciclovir, galciclovir. - herpes.
- antiretrovirals - NRTIs
4) inhibit exit - neuramindase inhbitors - oseltamavir, zanamivir
5) prevent maturation/bodies response
- protease inhibitors - prevent maturation of virus
- - immunomodulators - interferon alpha

63
Q

Treatment complicated influenza

A

Oseltamivir

64
Q

Treating HIV - pharm

A 
2x NRTI backbone - combo of 2 NRTIs e.g. Tenofovir emtricitabine
Plus. 1 of:
- Protease inhibitor- atazanavir
- NNRTI  
- Integrase inhibitor

Also monitor adherence, LFTs glucose, viral load,

65
Q

Managing HIV

A

Pharm
Counselling -
Screen forinfectins and malignancy - co-trimoxaloe prophylaxis
Base lines - CD4 viralload LFTelectrolytes pregnancy resistance
Review medications

66
Q

Antivirals in hepatitis - hep C

A

Interferons -modulate hosts response - old and now phased out for Hep C with serotype specific treatments

67
Q

Hepatitis B treatment

A

Generally upportive - avoid alcoholimmunise contacts Antivirals with interferon if. High risk of liver disease

68
Q

Hepatitis A treatment

A

Supportive avoid alcohol

infection antimicrobials (3 decks)

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