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Pharm Y2S2 > Cystic Fibrosis & Resistance > Flashcards

Cystic Fibrosis & Resistance Flashcards

1
Q

What is Cystic Fibrosis?

A

A genetic disease caused by ~300 mutations with cause the CFTR gene to be faulty.

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2
Q

What are some symptoms of CF?

A

Cough
Chest infections
Steatorrhoea
Poor weight gain

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3
Q

At what age is there is the highest S.aureus infection risk in CF?

A

<2 years old

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4
Q

Which antibiotic is used as prophylaxis at diagnosis?

A

Flucloxacillin

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5
Q

By what age do most CF patients have their first pseudomonas colonisation?

A

8 years old

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6
Q

What is pseudomonal colonisation associated with?

A

Delayed growth and mortality

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7
Q

What are the characteristics of pseudomonas bacteria?

A

Opportunistic
Narocomial
Gram negative
Single polar flagellum

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8
Q

How big are pseudomonal bacterial?

A

0.5 - 3.0µm

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9
Q

What kind of pigment do pseudomonal bacterial produce?

A

A green looking pigment - pyocyanin

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10
Q

Where are pseudomonal bacteria found?

A

Water, soil, plants, humans and animal surfaces

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11
Q

Can pseudomonal bacteria be present in the human flora?

A

Yes, generally in low numbers

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12
Q

What can be used to mark pseudomonal bacteria?

A

Positive oxidase reactions

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13
Q

Are pseudomonal bacteria aerobes or anaerobes?

A

They are obligate aerobes but can grow anaerobically in the presence of NO3

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14
Q

What are pseudomonas bacteria’s virulence factors?

A
  • Invasive
  • Toxigenic
  • Minimal nutritional requirements
  • Produce proteases to assist adhesion and invasion
  • Produce alginates to aid in biofilm formation
  • Can resist body temp, high salt concentrations, weak antiseptics and many antibiotics
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15
Q

What are biofilms?

A

Mechanisms of survival rather than causes of disease and they can form in environmental sources or invasive medical devices

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16
Q

How are pseudomonas bacterial identified?

A
  • bacterial culture
  • urine analysis
  • FBC
  • corneal scrapings
  • fluorescence under UV
  • distinctive odour
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17
Q

Give examples of diseases caused by Pseudomonas aeruginosa.

A
  • respiratory tract infections
  • bacteraemia
  • keratitis
  • genito-urinary tract infections
  • wound infection
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18
Q

What is the pathophysiology of pseudomonas?

A

Colonises in the lower RT and grows to cover the epithelium through biofilm proliferations, scarring and access formations.
(different strains have different susceptibility)

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19
Q

How long can early intervention eradicate pseudomonas for?

A

2 years - this is done through oral or inhaled antibiotics which reduce the risk of recolonisation and pulmonary exacerbation

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20
Q

What are some advantages of inhaled antibiotics?

A
  • discrete and portable
  • no loss of efficacy
  • easy to use for all ages
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21
Q

Give 2 examples of dry powder inhaled antibiotics?

A
  • tobramycin
  • amikacin
    (aminoglycosides)
22
Q

Give 2 examples of ultrasonic nebuliser antibiotics.

A
  • Colistin

- Tobramycin

23
Q

Which 2 oral antibiotics are used for pseudomonal infection?

A
  • Ciprofloxacin

- Azithromycin

24
Q

What does ciprofloxacin do to hepatic metabolism?

A

Increases it in CF patients

25
Q

What is the usual dose of ciprofloxacin for children?

A

10-20mg/kg - this can be increased to 30mg\kg

26
Q

What does azithromycin do to biofilms?

A

Interferes with biofilm adhesion to the epithelium - modifies structure and growth

27
Q

What dose of azithromycin improves FEV1?

A

100mg/kg

28
Q

Definition of infective exacerbation (according to CF trust clinical standards)

A
  • reduction in FEV to <50%
  • acute changes on X-ray
  • increased breathlessness or decreased tolerance to exercise
29
Q

What actions would be taken in CF diagnosis in hospital?

A
  • sputum sample
  • IV access
  • admission
  • Empirical antibiotics
30
Q

Give 2 examples of empirical antibiotics

A
  • Ceftazidime: 3rd gen cephalosporin with a large MIC range

- Tobramycin: aminoglycoside with favourable nephrotoxicity

31
Q

What are cephalosporins?

A

Beta lactam antibiotics which work in a similar to way to pencillin by blocking cell wall synthesis.

32
Q

What particular drug class is resistant to beta-lactamases

A

3rd generation cephalosporins

33
Q

Which bacteria produce “Extended spectrum beta lactase”?

A

E.coli and Enterbacter cloacae - the genes for resistance are transferred by plasmid DNA transfer

34
Q

At what level are aminoglycosides nephrotoxic?

A

2mg/L

35
Q

At what level are aminoglycosides ototoxic?

A

8-12mg/L

36
Q

What is IVAB therapy?

A

Given to CF patients experiencing frequent exacerbations. 3 month cycles of 2 weeks treatment and 3 monthly sputum samples. This reduces hospital admission and suppresses the development of infection.

37
Q

What is MRSA?

A

A gram negative coccoid bacterium resistant to all beta lactam antibiotics.

38
Q

Which antibiotics is MRSA resistance to?

A
  • penicillins
  • cephalosporins
  • carbapenems

some are resistant to: macrocodes, quinolone and clindamycins.

39
Q

What percentage of the population is colonised with S.aureus?

A

~30% - most are asymptomatic

40
Q

What are the usual sites of S.aureus infection?

A

Anterior nares, axilla and perineum

41
Q

How can S.aureus infection be reduced?

A
  • screening at risk patients,
  • isolating patients with MRSA
  • decontaminating with skin wash, nasal ointment and mouthwash for 5
42
Q

What symptoms with patients with a S.aureus infection have?

A
  • high temp
  • high white cell count
  • inflammation at infection site
43
Q

What is the 1st line treatment for S aureus ?

A

IV vancomycin or teicoplanin for systemic infections

44
Q

What is the 2nd line treatment for S aureus?

A

Linezolid, daptomycin and tigecycline

45
Q

What are multi-resistant coliforms?

A

Gram negative bacilli found in the gut such as E.coli, Klebsiella pneumoniae and enterobacter.

46
Q

Where are enterococci found?

A

In the gut

47
Q

What kind of patients are easily colonised by enterococci?

A

Patients who take antibiotics frequently - infections are i/v line associated.

48
Q

How can CDI be acquired?

A

cross infection or toxigenic strain

49
Q

What are the symptoms of CDI?

A
  • mild diarrhoea
  • ulceration
  • bleeding from the colon
50
Q

What is mild CDI treated with?

A

Metronidazole

51
Q

What is severe CDI treated with?

A

Vancomycin

52
Q

Which antibiotics should be avoided in CDI?

A

Fluoroquinolone, cephalosporins and clindamycin

Pharm Y2S2 (26 decks)

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