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Year 3 > Antimicrobial Pharmacology > Flashcards

Antimicrobial Pharmacology Flashcards

1
Q

As part of the “start smart, then focus” antimicrobial stewardship programme, when should a clinical review and decision be made about focusing or changing antimicrobial therapy?

A

At 48 hours

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2
Q

Name two (antibiotic) core drugs that have a narrow therapeutic index

A

Gentamicin and Vancomycin

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3
Q

What pathogens are commonly implicated in the aetiology of CAP?

A

Streptococcus pneumonia
Haemophilus Influenza
Klebsiella pneumonia
S. Aureus
Atypical organisms
Viral (up to 13%)

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4
Q

What investigations should be carried out when considering a diagnosis of CAP?

A
  • CXR
  • Sputum sample
  • Sputum/throat swab for viral culture and immunofluorescence if immunocompromised patient or creatures suggestive of influenza during flu season
  • Serum and urine for pneumococcal and legionella testing if atypical features
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5
Q

What is the CURB-65 score used for?

A

To aid decisions regarding treatment of pneumonia

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6
Q

What clinical signs are implicated as indicators of pneumonia severity?

A

CURB-65 score: 1 point for each of the following-
- Confusion (new onset/ AMT < or = 8)
- Urea > 7 mmol/L
- RR > or = 30/min
- BP (SBP < 90 mmHg and/or DBP <60 mmHg)
> or = 65 years old

0-1: PO abx or home tx
2: Hospital tx
3 or >: Severe pneumonia, consider ITU (mortality 15-40%)

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7
Q

What factors should be considered when choosing an antibiotic for the tx of CAP?

A
  • Allergies, CURB-65 score (but also clinical picture), previous abx, recent travel, hobbies, renal function, hepatic function.
    Discuss with microbiology if recent flu
    Is there any need to isolate patient? (e.g. flu / TB risk) Discuss with infection team
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8
Q

How do you calculate ideal body weight?

A

IBW male = 50 kg + (2.3 x every inch over 5 ft)

IBW female = 45.5 kg + (2.3 x every inch over 5 ft)

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9
Q

What risks are associated with Gentamicin (aminoglycoside)?

A

Nephrotoxic. Monitor drug levels and serum creatinine. Also ototoxicity, vestibular toxicity.

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10
Q

Contraindications of gentamicin

A

Severe renal or liver failure, ascites, burns, high cardiac output states (e.g. anaemia, Paget’s), children, pregnancy

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11
Q

Signs of Gentamicin toxicity

A

Tinnitus, deafness, nystagmus, vertigo, renal failure

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12
Q

What is the trough level of Gentamicin and when is this measured?

A

Trough level should be <1 mg/L, which should be measured just before the next dose

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13
Q

What are the Beta-lactam antibiotics?

A

Penicillins- Amoxicillin and Flucloxacillin

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14
Q

Drug class: Beta lactam antibiotic + Beta-lactamase inhibitor

A

Co-Amoxiclav

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15
Q

Drug class of vancomycin?

A

Glycopeptide

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16
Q

Drug class of Doxycycline?

A

Tetracycline

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17
Q

Drug class of Clarithromycin, Erythromycin?

A

Macrolide

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18
Q

Drug class of Gentamicin?

A

Aminoglycoside

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19
Q

Drug class of Ciprofloxacin?

A

Quinolones

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20
Q

Drug class of Metronidazole?

A

Nitroimidazole

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21
Q

60-80% of cases of uncomplicated Pyelonephritis are caused by what organism?

A

E.Coli (gram negative)

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22
Q

MOA: Inhibition of bacterial cell wall synthesis. Inhibit enzymes responsible for cross-linking peptidoglycans in bacterial cell walls

A

Cephalosporins

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23
Q

Interaction: _________________ enhance the coagulation effect of warfarin by killing normal gut flora that synthesise Vitamin K.
Can cause nephrotoxicity if given with Gentamicin, Ibuprofen and celecoxib

A

Cephalosporins

24
Q

Adverse effects: GI upset is common (abdominal pain, diarrhoea). Less frequently, can cause C.diff. Leukopenia.

A

Cephalosporins

25
Q

Ceftriaxone is a _____ generation broad spectrum antibiotic

A

Third (Remember TRI and third)

26
Q

Which of the Cephalosporin drugs can be used to treat Pseudomonas infections?

A

Ceftazidime

27
Q

Indications: acute pyelophritis, lower UTIs, HAP

A

Cephalosporins

28
Q

DOC in MRSA infections?

A

Vancomycin

29
Q

Indication: NARROW SPECTRUM DRUG. Mainly against Gram-positive bacteria, including MRSA.

A

Vancomycin

30
Q

Adverse effects of this drug class include “infusion reaction” (formerly known as “red man syndrome”), nephrotoxicity and ototoxicity

A

Glycopeptide (Vancomycin)

31
Q

MOA: Inhibits peptidoglycan formation. Prevents incorporation of NAM and NAG peptide units from being incorporated into the peptidoglycan matrix, which forms the major structural component of Gram+ cell walls

A

Vancomycin

32
Q

MOA: Inhibition of protein synthesis in the 50s subunit of the bacterial ribosome

A

Clarithromycin (Macrolide)
(Also Chloramphenicol has same MOA)

33
Q

Indication: Broad spectrum antibiotic to treat Strep pyogenes, Pneumococcal infections, and cell wall deficient bacteria (Chlamydia). Examples include cellulitis, CAP, HAP, and H.pylori (in combination with other drugs)

A

Clarithromycin (macrolide)

34
Q

Adverse effects of this drug class include GI effects and PROLONGATION OF QT INTERVAL, which can lead to ARRYTHMIAS

A

Macrolides (Clarithromycin, Erythromycin)

35
Q

Drug interaction: INHIBITOR of p-450 enzyme

A

Macrolides

(“Sickfaces” inhibit)
Sodium valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Alcohol & grapefruit juice, Chloramphenicol, Erythromycin, Sulfonamides, Ciprofloxacin, Omeprazole, Metronidazole

36
Q

Important adverse effects include “Gray baby syndrome” (vomiting, diarrhoea, flaccidity, low temp, and an ashen-gray colour when prescribed in neonates) and also severe bone marrow depression (PANCYTOPENIA)

A

Chloramphenicol

37
Q

Interaction: Inhibits CYP3A4 and CYP2C19, preventing the metabolism of drugs

A

Chloramphenicol

38
Q

Adverse effects include DEPOSITION IN TEETH, bone growth inhibition, phototoxicity, and gastric discomfort

A

Doxycycline

39
Q

MOA: This drug binds reversibly to the 30s subunit of the bacterial ribosome. This action prevents binding of tRNA to the mRNA- ribosome complex, thereby inhibiting bacterial protein synthesis

A

Doxycycline

40
Q

Interaction: Enhances anticoagulant effect of Warfarin due to competitive interaction for albumin binding

A

Doxycycline

41
Q

Which two core antibiotics are given IV as they are not absorbed orally?

A

Vancomycin and Gentimicin

42
Q

MOA: Inside the cell, they bind the 30s ribosomal subunit and cause 3 effects- block formation of the initiation complex, miscoding of amino acids in the emerging peptide chain d/t misreading of the mRNA, block translocation on mRNA

A

Gentamicin

43
Q

Adverse effects of Gentamicin?

A

Nephrotoxic, ototoxic

44
Q

MOA: Inhibition of DNA gyrases- topoisomerase II and IV- which are needed for supercoiling, replication, and separation of circular bacterial DNA —> rapid bacterial cell death

A

Ciprofloxacin (Quinolones)

45
Q

Interactions: Inhibits CYP1A2-mediated metabolism and may inhibit CYP3A4 metabolism.
Should be avoided with dairy products

A

Ciprofloxacin (Quinolones)

46
Q

Adverse effects: TENDONITIS, TENDON RUPTURE, PROLONG QT INTERVAL, nausea, vomiting, headache, dizziness, CNS effects (hallucinations, anxiety, insomnia, confusion, seizures) peripheral neuropathy, phototoxicity

A

Ciprofloxacin (Quinolones)

47
Q

Are the following bacteria gram negative or gram positive?
E. Coli
Klebsiella
Proteus
Pseudomonas
Enterobacter

A

Gram negative

48
Q

What is the first choice of antibiotic for uncomplicated pyelonephritis?

A

Cefalexin (Cephalosporin)
Other choices include Co-Amoxiclav and Ciprofloxacin, depending on result of MC&S

49
Q

First choice of IV antibiotic in Pyelonephritis if patient is vomiting or extremely unwell?

A

Co-amoxiclav or Ceftriaxone

50
Q

Choice of antibiotic for pyelonephritis in patient who is pregnant?

A

Cefalexin (not known to be harmful in pregnancy or breastfeeding)

51
Q

Most common organisms causing cellulitis? (2)

A

Streptococcus pyogenes and Staph aureus

52
Q

First line choice of drug in cellulitis (oral)?

A

Flucloxacillin (Penacillin)

53
Q

Which two drug classes bind to the 50s subunit of bacterial ribosomes, blocking transpeptidation?

A

Macrolides and Chloramphenicol

54
Q

Which of the following sx may be a signal to the physician to stop gentamicin therapy?
Eosinophilia, headache, nausea, salivation, tinnitus

A

Tinnitus

55
Q

MOA of tetracycline antibiotics?

A

Binds reversibly to the 30s subunit of the bacterial ribosome.

56
Q

Which drug class is contraindicated in children < 8 due to deposition in bone and teeth, as well and stunting growth?

A

Tetracyclines (Doxycycline)

57
Q

Which of the following antibiotics may have contributed to tendon rupture?
Amoxicillin/clavulinic acid
Cefalexin
Ciprofloxacin
Minocycline

A

Ciprofloxacin (Quinolones)

Year 3 (23 decks)

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