Infection 2 Flashcards
When would you not give Clindamycin and what would you give instead
STOP
Give Vancomycin
What is clindamycin used to treat (2)
Osetomylisis
Skin Bone and Joint Infection
What is the biggest side effect with clindamycin and of which cohort of patients
c.diff
Eldery and women
What is the side effect on Linezolid (5)
Serotonin syndrome Hypertensive crisis Interaction with MOAI’s Blood dyscariasia Optic Neuropathy
What monitoring with Linezolid is needed
Full weekly blood counts
What drug interaction need to be thought of when prescribing vancomycin with people who take SSR1s
Serotonin syndrome , patients should stop taking TCA 2 weeks before
Is Linezolid a reversible MOAI
Yes – so avoid tyramine rich food
What are the side effects of Trimethoprim (3)
Antifolate
Hyperkalaemia
Blood dyscraisas
When is trimethoprim contraindicated
1st and 2nd trimester
What are the three uses of co-trimoxazole
PCP prophylaxis and treatment
Toxoplasmosis
Nocardiosis
What are the side effects of co-trimoxazole (2)
SJS
Photosensitivity
Blood disorders
What is chloramphenicol used for and what do you need to measure
Life threatening conditions
Monitor plasma levels
Side effect of chloramphenicol (2)
Grey baby syndrome
Haematological side effects
Does metronidazole need to be taken with food
YES
What is metronidazole used for
Anaerobic infections
What side effects does metronidazole cause (5)
Disulphide reaction with alcohol Flurried tongue GI disturbances Taste disturbances Oral mucosa
Side effects of nitrofurantoin
Peripheral Neurophathy
Pulmonary fibrosis
Jaundice
Nausea
When should you avoid nitrofurantoin
In patients with EGFR 45ml/min
Name the five Aminoglycosides
TANGS Torbomycin Aminoglycoside Neomycin Gentamycin Streptomycin
What is the aminoglycoside of choice in the UK and what is second line
Gentamycin / Amikacin
Which aminoglycoside can only be used via inhaler
Turbomycin
Which aminoglycoside can only be used through mucosal layers
Neomycin
Which patient group do you need to monitor gentamycin levels especially in (5)
Elderly Renal impairment Cystic Fibrosis High doses Obese
What are the side effects of gentamycin (5)
Ototoxicity
Nephrotoxicity
Peripheral Neuropathy
Myopathy – Especially in pt. with myasthenia gravis
Electrolyte disturbances (Hypo K / Mg / Ca)
Should you avoid aminoglycosides in pregnancy
Yes, causes Ototoxicity
As aminoglycosides can cause ototoxicity what should also be avoided
Loop diuretics
As aminoglycosides can cause nephrotoxicity what should also be avoided
Cisplatin / Ciclosporin / Vancomycin
What should the one hour peak concentration of gentamycin
5-10
3-5 with endocarditis
What is the target Predose of gentamycin?
2
1 with endocarditis
When would you avoid once only dosing of gentamycin
HACK
Burns more than 20%
EGFR less than 20ml/min
Endocarditis
What would you do if the:
o Post dose peak level after 1 hour is too high =
o Post dose trough level is too high before next dose =
o Renal impairment =
o Severe renal impairment =
o Post dose peak level after 1 hour is too high = Reduce dose
o Post dose trough level is too high before next dose = Increase interval
o Renal impairment = Increase interval
o Severe renal impairment = Reduce dose
Examples of glycopeptides
Vancomyin , teolplnaina
What is vancomycin used for
MRSA and c.diff
What is the target level for vancomycin
10 -15
15-20 in endo
When would you monitor treatment for vancomycin
You don’t need to only when trough is too high and you would monitor after every 3-4 doses
Does vancomycin have a long half life
Yes – so given BD
Would you give vancomycin in pregnancy?
NO
What are the monitoring requirements for vancomycin
Ear
Renal
Blood
What are the side effects for vancomycin
Ototoxicity Nephrotoxicity Photosensitivity Skin disorders Blood disorders Red man syndrome (if IV is too fast) Thrombophlebitis at the site of the infection
What are examples of tetracyclines
Demeclocycline / Doxycycline / Oxytetracyline / Tetracycline / Minocycline
What are the side effects of tetracyclines
Skin
Oesophageal Irritation
Intercranial hypertension
Visual disturbances
Do you avoid tetracyclines in renal impairment
Yes – apparent from Doxycycline Minocycline
What counselling needs to be given with tetracyclines and with which tetracyclines
DD - Demeclocycline Doxycycline
(avoid sun)
DOT Demeclocycline Oxytetracyline Tetracycline
(avoid milk)
DMT – Doxycycline Minocycline and Tetracycline
(Oesophageal Irritation)
Examples of quinolones
Ciprofloxacin / Levofloxacin / Moxifloxacin / Norfloxacin.
When are quinolones mostly used
Lower RTI and UTIs
When would you avoid giving quinolones
Pregnancy to arthropathy
What are your side effects of quinolones
- Tendonitis
- Lower seizure threshold
- QT prolongation – leads to ventricular arrythmia
When would you discontinue quinolones
- Psychiatric
- Neurological
- Hypertensive reaction
What are the interaction of quinolones
- NSAIDs
- Theophylline
- QT prolongation
What are the counselling points for quinolones
- Impaired driving
- DO not take with antacids
- Drink with a full glass of water
- Protect your skin
When would you give macrolides
People who can’t take penicillin’s
What consideration do you need to take when prescribing quinolones for people who take warfarin
Warfarin = Increase risk of bleeding
What consideration do you need to take when prescribing quinolones for people who take statins
Statins = Increase risk of myopathy
What is the dosing of quinolones
Azithromycin OD / Clarithromycin BD / Erythromycin QDS/ Telithromycin / Spiramycin
What patient group do you avoid macrolides
Myesthesia gravis – because it causes electrolyte imbalances
What are the side effect of macrolides
GI
QT interval prolongation
Hepatoxicity
Ototoxicity
What are the four classes of penicillin’s
- Broad
- Narrow
- Penicillinase resistant
- Antipseudomonal
What are examples of your narrow-spectrum penicillin’s + Side effects
- Benzylpenicillin (penG)/
- Phenoxymethylpenicillin (penV)
What are examples of your Broad spec antibiotics + Side effects
- Ampicillin / Amoxicillin
- Can cause C/diff
- Amoxicillin can cause jaundice
What are your examples of the penicillinase Resistant + Side effects + Uses + Length of treatment
- Flucloxacillin
- Used : Staph
- Side effects: Jaundice
- Length of treatment: 14 days
What are your examples of your antipseudomonal + Side effects?
- Piperacillin / Ticarcillin
- Uses: Serious infection / complicated UTI’s / HAP
Can we give penicillin’s intrathecally
NO : Can cause encephalopathy
Which one is gastric stable PenV or PenG
PenV: Phenoxymethylpenicillin (oral use)
Examples of cephalosporins
Cefixime / Ceftriaxone / Cefotaxime
Side effects of cephalosporins
C.diff
Hypersensitivity
