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Stage 3 Human Diseases > HD13 Antibiotics Use and Abuse > Flashcards

HD13 Antibiotics Use and Abuse Flashcards

1
Q

Can antibiotics be prescribed to manadge pain?

A

NO- they kill bacteria!

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2
Q

2 ways antibiotics can be directly dangerous?

A

1, fatal anaphylaxis - with penicillin 1:100,000 (babies/ young children)
2.Unwanted drug side effects

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3
Q

How can the abuse of antibiotics i.e. poor prescribing or pt complaince be indirectly dangerous?

A
  1. • Deadly rise in opportunistic infections
    - Clostridium difficile = gram positive spore-forming bacteria that cause diarrhoea. Can cause pseudomembranous colitis can cause nasty morbities.
  2. deadly rise in resistant organisms e.g. MRSA, Vantomycin-resistant Enterococcus (VRE), Multi-drug resistant Mycobacterium tuberculosis (MDR-TB)
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4
Q

Who are C.diff spores a concern for?

2) What do they cause?

A

1) it doesn’t infect healthy people as good/comensal bacteria stops the spores so those taking antiobiotics are 3 times more likely to be infected 2 and 3 months after taking antibiotics, and when taking and before a month after you are 7-10 fold more likely

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5
Q

What is an absolute contraindication to taking antibiotics?

A

If someone has a known hypersensitivity (however a lot of pencillin allergies are often not actually to penicillin)

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6
Q

What a relative contraindications to the use of antibiotics?

A
  1. liver disease: detoxification function of the liver is compromised - substances would normally be metabolized can accumulate in the liver or in the bloodstream – can become toxic to the body
  2. Kidney disease: kidneys are involved in elimination of drugs,
  3. HIV- avoid if possible to due interactions
  4. chronic lymphatic leukaemia
  5. glandular fever
  6. pre-exhisting diarrhoea : antibiotics could compound issue make pre-existing gut issues worse
  7. Preganancy
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7
Q

How does liver disease affect the prescribing of tetracyclines?

A 
preferably avoided (high risk of them increasing to toxis levels)
Dose related toxicity. In larger doses = jaundice, fever, and fatty liver. Hepatitis patients = require substitutes
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8
Q

How does liver disease affect the prescribing of Erythromycin?

A 
preferably avoided (high risk of them increasing to toxis levels)
damage to liver via bile retention and jaundice. Harmful effects – 10-14 days, incident rate 5-10%
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9
Q

How does liver disease affect the prescribing of metronidazole?

A
  • Reduce metronidazole dose
    o Extensively metabolised in the liver by the cytochrome P-450 family of enzymes.
    o Hepatic dysfunction = half-life and clearance is prolonged, increased incidence of adverse reactions
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10
Q

How does liver disease affect the prescribing of clindamycin?

A
  • Tetracycline’s, erythromycin and clindamycin preferably avoided (high risk of them increasing to toxis levels)
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11
Q

How does liver disease affect the prescirbing of penicillins?

A

the most “liver friendly”
o Least liver damage and only patients who are allergic may experience some side effects
o Safe for chronic hepatitis patients

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12
Q

Which antibiotic requires checks before prescirbing?

2) WHat is checked?
3. WHy?

A
  1. metronidazole
  2. dose adjustment is required if renal dysfunction means creatinine clearance is less that 10 mL/min
  3. Metro –major route of elimination of metro metabolites after liver breakdown is via the urine
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13
Q

What 2 antibiotics are relevant if a pt has chronic lymphatic leukaemia?

A

ampicillin and amoxicillin

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14
Q

In tonsillitis what antibiotic is not prescribed?

2) What is prescribed?
3) why?

A

1) - Ampicillin and Amoxicillin
2) Penicillin B
3) For tonisilliti give pencillin B rather than amoxicillin which causes rash associated with glandular fever. Ampicillin and Amoxicillin = irritating rashes unrelated to penicillin allergy in patients with chronic lymphatic leukaemia and glandular fever.
- Widespread maculopapular rash affecting the extensor surfaces of the limbs.

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15
Q

If you prescribe antibiotics, in pregancy what must you do:

A

Only prescribe if absolutely necessary: avoid first trimester (first day of missed period until 12th week) and monitor breastfed newborn for GI symptoms

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16
Q

Give 5 potential concerns of prescribing antibiotics to pregnant/ breastfeeding:

A

• Teratogenic (causing malformations/ birth defects) and toxic effects on developing foetus/newborn
• Pharmacokinetics and pharmocodynamic effects
• Blood vol doubles/ mechanism of metabolism is different
• Breastfed infants are exposed to maternal drugs
• Lactation – need to know antibiotic isn’t lost through breast milk
- can alter drug effectiveness

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17
Q

What is the safest antibiotic to prescribe to pregnant?

A

amoxicillin

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18
Q

What are the guidelines when prescribing metronidazole to woman in or after pregnancy?

A
  • High doses contraindicated in pregnancy and breast feeding

- Avoid in women at risk from preterm delivery

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19
Q

What are the guidelines when prescribing clindamycin to woman in or after pregnancy?

A
  • caution if breastfeeding - strips gut bacteria entirely/ lost to breastmilk
  • avoid if possible pregnant, risk of necrotising enterocolitis in newbron
20
Q

What are the guidelines when prescribing Co-amoxiclav to woman in or after pregnancy?

A
  • Avoid in women at risk from preterm delivery
21
Q

What are the guidelines when prescribing tetracycline to woman in or after pregnancy?

A

avoid in preganancy and breastfeeding, due to developmental effects on dentition of baby, can also cause spinobifida

22
Q

What are the 2 types of hypersensitivity and allergy to antibiotics?

A

Allergy is mediated by antibodies (Type I-III hypersensitivity) or T-Cells (Type IV)

23
Q

Why are anaphylatic reactions life theatening

A

o due to swelling of airway may block and movement of fluid out of circulation into tissues, can cause circulatory collapse. = Shock (inability to perfuse tissus)

24
Q

If patients are allergic to penicillin what may you also not prescribe?
2) Why?

A

1) cephalosporins

2) cross reactivity

25
Q

What are the minor side effects of antibiotics?

5

A
  • GIT issues
  • Candida
  • Tongue discolouration
  • Diarrhoea
  • Stomach pain/cramps
26
Q

What are the major side effects of antibiotics?

A

1) - Psuedomembranous colitis (antibiotic associated colitis)
2) liver injury/damadge
3) Hypokalaemia (low potassium) (pencillin)
4) Developmental e..g tetracycline stains teeth, neural tube defects
5) Drug interactions

27
Q

What neural tube defects can be caused by antibiotics?

A

anencephaly and spina bifida

28
Q

What antibiotics can cause liver damage?

A

o Amoxicillin = Rare instances of idiosyncratic liver injury. can occur after the antibiotic is stopped. Symptoms of hypersensitivity.
o Co-Amoxiclav = most common cause of idiosyncratic acute liver injury. Hypersensitivity or allergy. Recurrence is highly likely.

29
Q

What is - Psuedomembranous colitis (antibiotic associated colitis)?

A

o Inflammation of the colon that occurs in some people who have taken antibiotics – almost always associated with C. diff
o Severe, uncontrollable diarrhoea which may be life-threatening
o Clindamycin

30
Q

What is the symptoms of hypokalaemia? (penicillin can cause this)

A

o Mild to moderate hypokalaemia may be asymptomatic, weakness, constipation, leg cramps, respiratory difficulties, ECG changes (U waves, T wave flattening, ST segment changes), cardiac arrhythmias, (especially in patients who are ischaemic, on digoxin or in heart failure, ascending paralysis (severe hypokalaemia)

31
Q

What is the treatment of hypokalaemia?

A

­ Remove causes
­ Gradual replacement of potassium (via oral route) is preferred, if clinically appropriate
­ An ECG is strongly recommended in patients with severe/symptomatic hypokalaemia, cardiac
­ Disease or renal impairment
­ Potassium must be replaced cautiously in patients with renal impairment or Oral potassium should be taken with plenty of fluid, with or after meals
­ Check magnesium levels - repletion of magnesium stores will facilitate more rapid correction of low potassium

32
Q

What antibiotic interacts with alcohol?

2) WHat can occur?

A

1) Metronidazole

2) Disulfiram reaction, build up of aldehyde,

33
Q

What are the symtoms of a disulfiram reaction that can occur if people drink alcohol while taking metronidazole?
2) How long after completetion of systemic metronidazole therapy should you wait before taking alcohol?

A

nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath)
2) 48 hours

34
Q

Which antibiotic interacts with warfarin and why?

A
  • Metronidazole/Warfarin
    o Metronidazole limits breakdown of warfarin
    o Warfarin effect increased as a result of enzyme inhibition
35
Q

Which and how do antibiotics increase methotrexate toxicity?

A

o Penicillins and tetracyclines by reducing excretion as are antimetabolites

36
Q

Which antibiotic causes a rash if taking allopurinol for gout?

A

amoxicillin

37
Q

Which oral contraceptives are not effective when taking antibiotics?

2) Why?
3) What is the solution?d

A

1) rifampicin or rifabutin
2) - Oral pill is broken down by gut bacteria then absorbed into blood stream
- Reduction in number of gut bacteria results in less contraceptive pill being absorbed into bloodstream
3) Use alternative birth control for dose length + 7 days

38
Q

How can antibiotics be used as an adjuvant therapy?

A
  • Acute odontogenic infections in addition to operative treatment
  • Periodontal conditions in addition to operative treatment (aggressive periodontitis – low dose doxycycline)
39
Q

What 3 thing sin dentistry are antibiotics not appropriate for?

A

• Inflammatory Conditions - early pericoronitis/ post-operative oedema
- Swelling increases volume of swelling to decrease [toxins]
• Fibrinolytic conditions - dry socket
• Non bacterial infections – fungal/ viral (no difference)

40
Q

How can prophylatic antibiotics be used?

A
  • Prevention of wound infection

* Prevention of distant infection

41
Q

Factors which predispose to wound infection:

A
  • Inherent predisposition due to site
  • Procedures lasting longer than 2 hours
  • Decreased patient resistance
42
Q

Prophylatic antibiotics are used in tooth transplantation, why?
2) In advanced implantology what is prescribed?

A

1) Prevention of radiation induced osteonecrosis

2) 3g amox prescribed 1 hr pre-op reduces failure rate

43
Q

Principles of the use of antibiotics to prevent wound infection

A
  1. Probability of wound infection must be high
  2. Select the appropriate antibiotic
  3. Initiate therapy at correct time
  4. Use for the appropriate length of time
44
Q

What is usually the appropriate antibiotic?

A

amoxicillin

45
Q

In surgery when is the correct time to initiate therapy ? why?

A

clot is impenetrable to antibiotics 3 hours after formation

Stage 3 Human Diseases (10 decks)

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