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PA- AP > Antibiotics/antifungals > Flashcards

Antibiotics/antifungals Flashcards

1
Q

Examples of broad spectrum penicillin

A

Co-amoxiclav
amoxicillin

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2
Q

spectrum of activity for broad spectrum penicillin

A

broad spectrum against G and G- cocci and bacilli(rods)
Resistance very likely so mixing it with a beta lactamase inhibitor e.g. co-amoxiclav is helpful for resistant bacteria

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3
Q

What drug type is broad spectrum penicillin

A

beta-lactam

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4
Q

Indication for broad spectrum penicillin

A
  • Amoxicillin:
    • Sinusitis
    • otitis media
    • com-aq pneumonia
    • UTI
    • H.pylori in PUD
  • Co-amoxiclav
    • pneumonia
    • UTI
    • Intrabdo infection
    • Cellulitis
    • Bone and join infection
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5
Q

Side effect for broad spectrum penicillin

A
  • Diarrhoea
  • Nausea/Vomiting
  • Hypersensitivity
  • antibiotic -associated colitis
  • Penicillin allergy
  • Acute liver injury
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6
Q

Contraindication for broad spectrum penicillin

A
  • sever allergy to beta lactam antibiotic
  • young people with sore throat
  • caution in people with risk of c.diff infection
  • Hx of penicillin associated liver injury
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7
Q

Monitoring for broad spectrum penicillin

A
  • check if symptoms are resolving
  • stop or review date according to local guidline
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8
Q

Patient education for broad spectrum penicillin

A
  • always check for allergies to any β- lactam antibiotic (including penicillins, cephalosporins, and carbapenems).
  • Seek medical advice f rash develops
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9
Q

Key interaction for broad spectrum penicillin

A
  • reduced renal excreation of methotrexate
  • Broad-spectrum penicillins can enhance the anticoagulant effect of warfarin by killing normal gut flora that synthesise vitamin K
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10
Q

MOA for broad spectrum penicillin

A
  • Penicillin’s inhibits enzymes responsible for cross-linking peptidoglycans.
  • This weakens the bacterial cell wall, reducing its ability to maintain an osmotic gradient causing cell swelling, lysis and death
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11
Q

Examples for narrow spectrum penicillin

A

flucloxacillin, benzylpenicillin, phenoxymethylpenicillin

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12
Q

Spectrum of activity narrow spectrum penicillin

A

narrow spectrum against G and G- cocci.

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13
Q

drug type narrow spectrum penicillin

A

beta-lactam

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14
Q

indication narrow spectrum penicillin

A
  • Benzylpenicillin/pen V
    • streptococcal infection e.g.: tonsillitis, pneumonia and endocarditis, meningitis
  • Flucloxacillin
    • Staphylococcal infection including skin, soft tissue , bone and joint infections , otitis externa and endocarditis
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15
Q

side effects narrow spectrum penicillin

A
  • Diarrhoea
  • Nausea/Vomiting
  • Hypersensitivity
  • antibiotic -associated colitis
  • Penicillin allergy
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16
Q

Monitoring narrow spectrum penicillin

A
  • check if symptoms are resolving
  • stop or review date according to local guidline
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17
Q

Contraindication narrow spectrum penicillin

A
  • dose reduction in severe renal impairment
  • Allergy to penicillin
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18
Q

Key interaction narrow spectrum penicillin

A

reduced renal excretion of methotrexate

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19
Q

Patient education narrow spectrum penicillin

A
  • always check for allergies to any β- lactam antibiotic (including penicillins, cephalosporins, and carbapenems).
  • Seek medical advice f rash develops
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20
Q

MOA narrow spectrum penicillin

A
  • Penicillin’s inhibits enzymes responsible for cross-linking peptidoglycans.
  • This weakens the bacterial cell wall, reducing its ability to maintain an osmotic gradient causing cell swelling, lysis and death
  • Penicillins comprise a β-lactam ring, responsible for bactericidal activity, and a side chain that modifies their properties and antimicrobial spectrum.
  • Some bacteria produce β-lactamase enzymes, which break the β-lactam ring, conferring resistance.
  • Flucloxacillin contains an acyl side chain that protects the β-lactam ring and is effective against β-lactamase-producing staphylococci. .
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21
Q

Examples of macrolides

A

Clarithromycin, azithromycin and erythromycin

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22
Q

Spectrum of activity of macrolides

A

Broad spectrum , G+ and some G- (h.infuenza & legionella)

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23
Q

what drug type is macrolide

A

Inhibit translocation of proteins

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24
Q

Indication for macrolide

A
  • Resp, skin and soft tissue infection alternative to penicillin (allergy)
  • severe pneumonia (added to a penicillin)
  • H.pylori in PUD
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25
Q

side effect for macrolide

A

decreased appetite

diarrhoea

dizziness

Headache

insomnia

thrombophlebitis when given IV.

prolongation of QT interval

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26
Q

Contraindication for macrolide

A
  • Hx of macrolide hypersensitivity
  • severe hepatic impairment
  • reduced dose in severe renal impairment
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27
Q

Monitoring or macrolide

A
  • check symptoms resolves
  • stop or review date according to local guidelines
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28
Q

Patient education

A
  • Check allergy
  • seek advice if rash seen
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29
Q

Key interaction for macrolides

A
  • Erythromycin and clarithromycin (but not azithromycin) inhibit
    cytochrome P450 (CYP) enzymes so risk with drugs metabolised by CYP enzyme like statins and warfarin
  • amiodarone,
    antipsychotics, quinine, quinolone antibiotics, and selective serotonin
    reuptake inhibitors (SSRIs) → drugs that prolong qt interval
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30
Q

MOA for macrolides

A
  • Macrolides inhibit bacterial protein synthesis.
  • They bind to the 50S subunit of the bacterial ribosome and block translocation, a process required for elongation of the polypeptide chain.
  • Inhibition of protein synthesis is bacteriostatic (stops bacterial growth), which assists the immune system in killing and removing bacteria from the body.
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31
Q

Examples of metronidazole

A

metronidazole, tinidazole

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32
Q

spectrum of activity of metronidazole

A

Anaerobic bacteria and protozoa

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33
Q

Drug type of metronidazole

A

Inhibits DNA synthesis and breaks down DNA

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34
Q

Indication for metronidazole

A
  • Oropharyngeal G- anaerobes
    • dental infection
    • human/ animal bite
    • aspiration pneumonia
  • H.pylori
  • Intraabdo infection and Pelvic inflammatory disease
  • Protozoal infection
    • trichomonal vaginal infection
    • amoebic dysentery
    • giardiasis
  • C.difficle colitis → IV
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35
Q

Side effects of metronidazole

A
  • IV
    • Dry mouth, myalgia, nausea
  • **Topical**
    • Skin reaction
  • **Vaginal use**
    • pelvic discomfort, vulvovaginal candidiasis
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36
Q

Monitoring for metronidazole

A
  • treatment exceeding 10 days→ do fbc and liver enzyme test
  • Stop and review date according to local guidlines
37
Q

Contraindication for metronidazole

A
  • reduces dose in severe liver disease
  • Avoid alcohol
38
Q

Key interaction for metronidazole

A
  • reduced metabolism of warfarin and phenytoin
  • increases the risk of toxicity with lithium.
39
Q

Patient education for metronidazole

A
  • Check allergy
  • DO NOT take alcohol during or for 48 hrs after treatment
40
Q

MOA for metronidazole

A
  • Metronidazole enters bacteria by passive diffusion.
  • In anaerobic bacteria, reduction of metronidazole generates a nitroso free radical.
  • This binds to DNA, reducing synthesis and causing widespread damage, DNA degradation, and cell death (bactericidal).
41
Q

examples of Tetracycline

A

Doxycycline and lymecycline

42
Q

Spectrum of activity of tetracycline

A

Broad spectrum against G+ & G-

43
Q

drug type of tetracycline

A

Inhibit protein synthesis

44
Q

Indication of tetracycline

A
  • Acne vulgaris
  • LRTI:
    • infective exacerbation of COPD
    • Pneumonia
  • Chlamydial infection
  • Typhoid, malaria and lyme disease
  • severe skin, soft-tissue, and abdominal
    infections
45
Q

Side effects for tetracycline

A
  • angioedema
  • diarrhoea
  • headache
  • hypersensitivity
  • Photosensitivity
46
Q

Contraindication of tetracycline

A
  • Pregnancy
  • Breastfeeding
  • children under or equal to 12 yrs
  • caution in renal impairment
47
Q

Monitoring of tetracycline

A
  • resolution by symptoms
  • set a stop and review date
48
Q

Patient education of tetracycline

A
  • Hx of allergy
  • seek help if rash develops
  • Taken during a meal with full glass of water
  • avoid indigestion remedies and medicine containing zinc or iron 2 hrs before and after taking antibiotic
  • During treatment protect skin form sunlight
49
Q

Key interaction for tetracycline

A

not given within2 hrs of calcium, antacids or iron

enhance warfarin effect

50
Q

MOA of tetracycline

A
  • Tetracyclines inhibit bacterial protein synthesis.
  • They bind to the ribosomal 30S subunit, which is specific to bacteria.
  • This prevents binding of transfer RNA to messenger RNA, interfering with the addition of amino acids to growing polypeptide chains.
  • Inhibition of protein synthesis is bacteriostatic (stops bacterial growth), which assists the immune system in killing and removing bacteria.
51
Q

Spectrum of activity of nitrofurantoin

A

active against most organism that cause uncomplicated UTI incl. E.coli (G-) and g+

52
Q

Indication for nitrofurantoin

A
  • first line for acute, uncomplicated lower UTI
  • prophylaxis of recurrent UTIs
53
Q

Side effects for nitrofurantoin

A
  • Diarrhoea
  • Hypersensitivity
  • chronic pulmonary reaction
  • hepatitis
  • peripheral neuropathy
54
Q

Contraindication for nitrofurantoin

A
  • Pregnant women towards term
  • babies in first 3 month of life
  • G6PD deficiency
  • Renal impairment
55
Q

Monitoring for nitrofurantoin

A
  • resolution of symptoms
  • for prophylaxis→ check UTI freq before and after
56
Q

Patient education for nitrofurantoin

A
  • Check allergy
  • Advice urine may term yellow or brown
  • If used for prophylaxis then let them know this is long tern and should be renewed
  • unexplained symptoms should be reported e.g. pins and needles or breathlessness
57
Q

Key interaction for nitrofurantoin

A
  • amiodarone
  • isoniazid
  • metronidazole
  • Phenytoin
58
Q

MOA for nitrofurantoin

A
  • Nitrofurantoin is metabolised (reduced) in bacterial cells by nitrofuran reductase.
  • Its active metabolite damages bacterial DNA and causes cell death (bactericidal).
59
Q

Drug class of vancomycin

A

this is a glycopeptide antibiotic

60
Q

Spectrum of activity of vancomycin

A

narrow against G+

61
Q

drug type of vancomycin

A

Inhibit cell wall synthesis

62
Q

indication for vancomycin

A
  • First line for C. difficile colitis
  • complicated skin and soft tissue, bone and joint infections; infective endocarditis
63
Q

Side effects for vancomycin

A
  • Pian
  • Thrombophlebitis
  • dizziness
  • nausea
  • Vancomycin infusion reaction with IV
64
Q

Contraindication for vancomycin

A
  • caution in people with immune -mediated hypersensitivity
  • Hearing impairment (whoa re at risk for ototoxicity
  • people at risk for reduced renal function
65
Q

Monitoring for vancomycin

A
  • parenteral therapy, pre-dose (trough) plasma drug concentrations
    should be measured.
  • Daily measurement of renal function
  • Platelet and leukocyte count checked in prolonged courses
  • Set a stop and review date
66
Q

Patient education for vancomycin

A
  • Report any ringing in the ear or change in hearing during treatment
  • Check HX of allergy
67
Q

Key interaction for vancomycin

A
  • loop diuretics
  • aminoglycosides
  • NSAIDS
  • Ciclosporin
68
Q

MOA for vancomycin

A
  • Glycopeptide antibiotics inhibit growth and cross-linking of peptidoglycan chains.
  • This inhibits synthesis of the cell wall in Gram- positive bacteria, causing cell lysis (bactericidal).
  • They are inactive against most Gram-negative bacteria, which have a different (lipopolysaccharide) cell wall structure.
69
Q

Examples of cephalosporin

A

Cefuroxime, Ceftriaxone, cefalexin, meropenem

70
Q

spectrum of activity of cephalosporin

A

broad spectrum , G+ G-

71
Q

drug type of cephalosporin

A

Modified beta lactam

72
Q

Indication of cephalosporin

A

second line for urinary UTI , Pneumonia and other resp tract infection

73
Q

side effect of cephalosporin

A
  • Abdo pain
  • Diarrhoea
  • Dizziness
  • Eosinophilia
74
Q

contraindication of cephalosporin

A
  • used in caution with people risk of c. difficle infection
  • Allergy to a beta lactam antibiotic
  • Dose reduction in renal impairment
75
Q

Monitoring of cephalosporin

A
  • resolution of symptoms
  • set a stop and review
76
Q

Patient education of cephalosporin

A
  • check allergy
  • seek medical help for any rashes
77
Q

Key interaction of cephalosporin

A

enhance warfarin effect

78
Q

MOA of cephalosporin

A
  • Like penicillins, their bactericidal effect is due to their β-lactam ring.
  • During bacterial cell growth, cephalosporins and carbapenems inhibit enzymes responsible for cross-linking peptidoglycans in bacterial cell walls.
  • This weakens cell walls, preventing them from maintaining an osmotic gradient, resulting in bacterial cell swelling, lysis, and death.
79
Q

examples of fluroquinolones

A

Ciprofloxacin, Levofloxacin, Ofloxacin and moxifloxacin

80
Q

Spectrum of activity of fluroquinolones

A

Broad spectrum, best against G-
Cipro great against pseudomonas aeruginosa
Moxi and levo better against G+

81
Q

drug type of fluroquinolones

A

Inhibit DNA transcription

82
Q

Indication of of fluroquinolones

A
  • UTI
  • Severe gastroenteritis
  • Lower resp tract infection incl. infective exacerbation of copd and pneumonia
83
Q

Side effect of fluroquinolones

A

decreased appetite

diarrhoea

dizziness

dyspnoea

84
Q

Contraindication of fluroquinolones

A
  • pregnancy
  • children and young adults
  • adults over 60 years
  • renal impairment
  • people at risk of neurological or cardiovascular morbidity
85
Q

Monitoring of fluroquinolones

A
  • check resolution of symptoms
  • set a stop and review date according to local guideline
86
Q

patient education of fluroquinolones

A
  • explain potential side effects and that these are prescribed as last resort
  • Watch out for any pain, swelling or changes in sensation
  • Cipro should not be taken with dairy product
  • It must be separated from calcium/iron
    supplements and antacids by at least 2 hours
87
Q

Key interaction of fluroquinolones

A
  • Calcium, iron and antacids reduce absorption of quinolones
  • Ciprofloxacin inhibits certain
    cytochrome P450 (CYP) enzymes, increasing risk of toxicity from some
    drugs, notably theophylline.
  • Co-prescription of NSAIDs increases
    the risk of seizures, and prednisolone increases the risk of tendon rupture.
88
Q

MOA of fluroquinolones

A

Quinolones kill bacteria (bactericidal effect) by inhibiting DNA
synthesis.

fluroquinolones are modified quinolones by the addition of a fluorine

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