Endocarditis Flashcards
1
Q
Aminoglycosides (gentamicin)
Common indications
A
- Severe sepsis- including where the source if unidentified
- Pyelonephritis and complicated UTI
- Biliary and intra-abdominal sepsis
- Endocarditis
- NB- aminoglycosides lack activity against step and anaerobes so must combine with metronidazole or penicillin if sensitivity is not known
2
Q
Aminoglycosides (gentamicin)
MOA
A
- Aminoglycosides bind irreversibly to bacterial ribosomes (30s sub-unit) and inhibit protein synthesis.
- They are bacteriocidal, this may be due to unknown MOA
- Spectrum they cover: G-ve, Aerobes, staph, and mycobacteria
- Aminoglycoside enter into the cell by O2-dependent transport system- mechanism of resistance
- Another common mechanism of resistance is an enzyme which modifies the compound making it ineffective
3
Q
Aminoglycosides (gentamicin)
Important adverse effects
A
- Nephrotoxicity
- Ototoxicity
4
Q
Aminoglycosides (gentamicin)
Warnings
A
- Monitoring of plasma concentrations is very important particularly in neonates and the elderly who are more susceptible to renal impairment (AKI + CKD)
- Aminoglycosides can impair neuromusclar transmission so should not be given to people with myasthenia gravis
5
Q
Aminoglycosides (gentamicin)
Important interactions
A
- Ototoxicity- this is especially prevalent when co-prescribed with other drugs that do the same
- Diuretics- particularly furosemide
- Vancomycin
- Nephrotoxicity (same as ototoxicity)
- Ciclosporin
- Cisplatin
- Cephalosporins
- Vancomycin
6
Q
Aminoglycosides (gentamicin)
Communication
A
- Must monitor plasma concentration
- Look out for ringing in the ears or a change in hearing
- Renal function
7
Q
Vancomycin
Common indications
A
- Treatment of G+ve infections e.g. endocarditis, where infection is severe and or penicillins cannot be used due to resistance
- Antibiotic-associated colitis- caused by C.diff infection (usually second-line where metronidazole is ineffective or not tolerated
8
Q
Vancomycin
MOA
A
- Vancomycin inhibts growth and cross-linking of peptidoglycan chains, inhibiting synthesis of the cell wall of G+ bacteria
- Resistance is being increasingly reported- with one mechanism changing the cell wall structure to prevent vancomycin from binding
9
Q
Vancomycin
Important adverse effects
A
- Thrombophlebitis
- Red man syndrome- anaphylactoid reactions- erythema, hypotension and bronchospasm
- Anaphylaxis
- Nephrotoxicity
- Ototoxicity
- Blood discaries- Neutropenia and thrombocytopenia
10
Q
Vancomycin
Warnings
A
- Vancomycin treatment requires careful monitoring of plasma drug concentrations and dose adjustment to avoid toxicity
- Particular care should be taken for people with renal impairment and the elderly (hearing impairment)
11
Q
Vancomycin
Interactions
A
- Ototoxicity- co-prescribing with gent, ciclosporin and loop diuretics
12
Q
A