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3rd Year Drugs > Antibiotics Part 2 > Flashcards

Antibiotics Part 2 Flashcards

1
Q

Name aminoglycosides

A

Gentamicin

Amikacin

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2
Q

How do we give aminoglycosides

A

IV as they are highly polarised

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3
Q

Indications for aminoglycosides

A

1) Severe sepsis
2) Pyelonephritis and complicated UTI
3) Biliary and intra-abdominal sepsis
4) Endocarditis

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4
Q

What do aminoglycosides lack action against

A

Strep. and anaerobces

Hence combine them with penicillin and/or metronidazole when the organism is unkown

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5
Q

Action of aminoglycosides

A

Bind irreversibly to bacterial 30S ribosomes and inhibit protein synthesis

THey are bacteriocidial

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6
Q

Range of action of aminoglycosides

A

Epctrum includes gram -ve aerboic bacteria
Staphylococci
Mycobacteria

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7
Q

How do aminoglycosides enter bacteria

A

Via an oxygen dependent transport system

This is absent in strep and anaerobes hence they have innate resistance

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8
Q

ADVERSE Effects of Aminoglycosides

A

Nephrotxicity - potentailly reversibly
Ototoxicity –> may be ireversible

They accumulate in renal tubular epithelial and cochlear and vestibult hair cells –> here they trigger apoptosis and cell death

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9
Q

How does nephrotoxicitiy with aminoglycosides present

A

Reduced urine output

Increased urea and creatinine

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10
Q

How does ototoxcitiy with aminoglycosides present

A

Often not notived until after resolution of acute infection

May complain of hearing loss, tinnitus (cocheal damage) and vertigo (vestibular damage)

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11
Q

Warnigns of using aminoglycosides

A

Caregul monitoring or plasma conc. in neonates, elderly and renal impairment

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12
Q

Contraindications of aminoglycosides

A

Myasthenia gravis –> c an impair neuromuscular transmission

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13
Q

Interactions of aminoglycosides

A

1) Loop diuretics or vancomycin –> increased risk of ototoxictiy
2) Ciclosporin, platinum chemotherapy, cephalosporins, vancomycin –> increased risk of nephrotoxicity

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14
Q

Name cepaholosprins

A

Cefalexin

Cefotaxime

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15
Q

Name carbapenems

A

Meropenem

Ertapenem

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16
Q

Indicatiosn for cepaholosporins and carbapenens

A

1) 2nd and 3rd line treatment for urinary and respiratory tract infections –> oral cephalosporins
2) Very severe/complicated infections caused by antibitoics resitant organisms –> reserve IV ccephalosporins and carbapenems for this

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17
Q

Actions of cepaholosporins and carbapenems

A

Inhibit enzyme responsible for cross linking peptidoglycans in bacterial cell walls –> cant maintain an osmotic gradient –> bacterial cell swilling –> lysis and death

Both have a broad spectrum of activity

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18
Q

Why are cepaholosporins and carbapenems more resistant to beta lactamases then penicillines

A

As the fusion of a beta lactam ring with a dihydrothiazine ring (cephalosporins and a unique hydroethyl side chain in carbapenems

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19
Q

Adverse effects of cepaholosporins and carbapenems

A

1) GI upset
2) Hypersesntivity
3) CNS toxicity –> including seizures. Particularly with high dose carbapenems in those with renal impairment

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20
Q

Warnings of using cepaholosporins and carbapenems

A

Risk of C. DIff

Caution of carabapenems and epilepsy

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21
Q

Interactinos of cepaholosporins and carbapenems

A

Can enhance warfarin effect

Cephalosporins increase the nephrotoxicty of aminoglycosides

Carbapenems decrease the plasma conc. and efficacy of valproate

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22
Q

Name the pencillin with anti-pseudomonal action

A

Piperacillin with tazobactam aka Tazocin

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23
Q

Indication of anti-pseudomonal penicillin

A

Severe infections - particularlly when there is a broad spectrum of potential pathogens
Antibitoic resistance is likely (i.e. hospital acquired infetions)

Immunocompromised patients

24
Q

Specific clinical infections treated with tazocin

A

1) LRTI
2) Intra-abdominal sepsis
3) UTI
4) Skin and soft tissue infections

25
Why does tazocin have activity against pseudomonas
As in piperacillin the side chain has been converted to a form of urea This increases activity to include pseudomonas Tazocin is a beta-lactamase inhibitor --> therefore has activity against beta-lasctamase producing bacteria e.g. S. Aureus and gram-ve anaerobes
26
Adverse effects of anti-pseudomonal penicllines
1) GI Upset 2) antibiotic associated colitis 3) Hypersensitivity
27
Warning of using tazocin
1) Caution if risk of C. DIff infection | 2) Reduce dose in moderate/severe pencillin allergy
28
Interactions of tazocin
1) Methotrexate - reduces renal excretion hence increased risk of toxicity 2) enhances warfarin
29
can you get tazocin in the community
No 0 it is hospital only Each dose of tazocin contains about 10mmol of Na and is infused in 50-150mls of fluid Remember to take this into account when determining the need for supplementary fluid, particularly in heart failure.
30
Name broad-spectrum penicllines
Amoxicillin | Co-amoxiclav (amoxicllin and clavulinac acid)
31
Indications for the use of broad-spectrum antibiotics
1) empirical pneumonia treatment - due to gram +ve (S. pneumonia) or gram -ve (H. Influenzae) 2) Empirical UTI treatment (most commonly due to E. Coli) 3) Part of combo treatment for intra-abdominal sepsis or hospital acquired infections 4) Part of treatment for H. Pylori associated ulcers
32
Action of broad-spectrum antibitoics
Inhibits enzymes that cross-link peptidoglycan in bacterial cell walls - weakened walls cant maintain osmontic gradient --> uncontroled water entry --> lysis and death
33
Why does amoxicllin hace increased activity against gram-ve bacteria
As in amoxicillin the addition of an amino group o the beta-lactam ring increases their activity against gram-ve bacteria Hence this makes them more broad spectrum
34
What is co-amoxiclav
Amoxicillin and clavulanic acid
35
What is the action of clavulanic acid in co-amoxiclav
It is a beta-lactamse inhibitor THis increases the spectrum of cover further to include beta-lactamse producing bacteria (S. aureus and gram-ve anaerobes)
36
Adverse effects of broad spectrum penicillins
1) GI Upset 2) Antibiotic associated collitis 3) Allergy
37
Warnings of broad spectrum penicillin
1) caution if risk of C. diff e.g. hospital or elderly | 2) Lower dose in severe renal impairment --> risk of crystaluria
38
Interactions of broad spectrum penicillin
1) Methotrexate - reduces renal exretion, hence increasd risk of toxicity 2) Enhance warfarin
39
Name penicillinase resistant penicillins
Flucloaxcillin
40
Indications of flucloxacillin
STAPHYLOCOCCAL INFECTIONS e.g. 1) Skin and soft tissue 2) Osteomyeltis and septic arthritis 3) Endardatiis
41
How does flucloxacillin have activity against beta-lactamase producing bacteria
It has an axyl side chain on the beta-lactam ring | This protects the ring from beta-lactamases
42
How does MRSA resist flucloaxcilllin
It reduces the penicillin binding affinity
43
Adverse effects of flucloxacillin
1) GI Upset 2) Allergy 3) Liver toxicity --> including cholestasis and hepatitis 4) CNS toxicity - in high doses or severe renal impairment
44
Warninngs of flucloxacillin
1) Renal failure - may require dose reduction
45
Interactions of flucloaxcillin
2) Methotrexate - redudces its renal excretion hence increased risk of toxicity
46
How long should you give flucloxacillin for deep seated infections
6 weeks e.g. endocarditis and osteomyelitis It has a short plasma half life and is rapidly renallyexcreted hence give every 6 hours
47
Name standard penicllins
Benzylpenicillin | Phenoxymethylpenicillin (penV)
48
Indications for pencillin
1) Streptococcal infection - includes tonsilitis, pneumonia (with macrolide if severe), endocarditis, skin & soft tissue infections (with flucloxacillin if severe) 2) Clostridial Infections e.g. tetanus 3) Meningococcal infections e.g. meningitis and septicaemia
49
actions of penicillins
Inhibits the enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
50
How do bacteria acquire resistance to pencillins
Bacteria make beta-lactamase enzymes | This breaks the beta-lactam ring
51
How common are pencillin allergy
affects 1-10% of people Usually skin rash 7-10 days after first exposure or 1-2 days after repeat Less commonly is an anaphylactoid reaction - hypotension, bronchial spasm, angioedema
52
Adverse effects of pencillins
1) allergy | 2) CNS Toxicity --> including convulsions and coma
53
Warnings of using penicillins
1) Renal Impairment
54
Interactions of penicillins
1) methotrexate - reduces its renal excretion hence increased risk of toxicity
55
How can you give benzypenicillinsn
IV or IM as hydrolysis by gastric acid prevents GI absorption
56
How can you give PenV
It is stable in gastric acid hence can be given orally
57
What would you prescrive for young person with a sore throat
If it requires antibitoics GIVE PENV (not amoxicillin) | This is because if the sore throat due to EBV amoxicillin it causes rash - mistaken for allergy

3rd Year Drugs (10 decks)

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