Endocarditis Flashcards

1
Q

Aminoglycosides (gentamicin)

Common indications

A
  1. Severe sepsis- including where the source if unidentified
  2. Pyelonephritis and complicated UTI
  3. Biliary and intra-abdominal sepsis
  4. Endocarditis
  • NB- aminoglycosides lack activity against step and anaerobes so must combine with metronidazole or penicillin if sensitivity is not known
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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
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3
Q

Aminoglycosides (gentamicin)

Important adverse effects

A
  • Nephrotoxicity
  • Ototoxicity
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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
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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
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6
Q

Aminoglycosides (gentamicin)

Communication

A
  • Must monitor plasma concentration
  • Look out for ringing in the ears or a change in hearing
  • Renal function
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7
Q

Vancomycin

Common indications

A
  1. Treatment of G+ve infections e.g. endocarditis, where infection is severe and or penicillins cannot be used due to resistance
  2. Antibiotic-associated colitis- caused by C.diff infection (usually second-line where metronidazole is ineffective or not tolerated
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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
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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
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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)
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11
Q

Vancomycin

Interactions

A
  • Ototoxicity- co-prescribing with gent, ciclosporin and loop diuretics
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12
Q
A
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