Infection abx classes Flashcards
1
Q
AMINOGLYOSIDES- EXAMPLES? cins
A
Amikacin
Gentamicin
Neomycin
Streptomycin
Tobramycin
2
Q
AMINLOGLCYCOSIDES
serum concs measured in all patients receiving parenteral aminoglycosides.
Must be determined in…?
A
Obesity
High doses
Cystic fibrosis
Elderly
3
Q
AMINOGLYCOSIDES
When do you measure serum-gentamicin conc?
A
After 3/4 doses
Every 3 days
After a dose change (more common in renally impaired)
4
Q
Aminoglycosides
Peak conc?
Trough conc?
A
Peak? 1hr after dose
Trough? Just before next dose
5
Q
Aminoglycosides
why in conc measured more freq in renally impaired
A
aminoglycs can cause nephrotox
6
Q
AMINOGLYCOSIDES- MULTIPLE DAILY DOSE REGIMEN CONC TARGETS
peak and trough
A
peak 5-10mg/L
trough <2mgl/L
7
Q
AMINOGLYCOSIDES- MULTIPLE DAILY DOSE REGIMEN CONC TARGETS
peak and trough for endocarditis
A
peak <2mg/L
trough <1mgl/L
8
Q
why do we aim for lower peak and trough serum concs for endocarditis?
A
due to co-prescribing other abx for tx, thus high conc not needed
9
Q
AMINOGLYCOSIDES- DOSE ADJUSTMENTS
what to do if
a. TROUGH TOO HIGH?
b. PEAK TOO HIGH?
A
TROUGH TOO HIGH? Increase dose interval
PEAK TOO HIGH? Decrease dose
10
Q
AMINOGLYCOSIDES- DOSE ADJUSTMENT
RENAL IMPAIRMENT?
SEVERE RENAL IMPAIRMENT?
A
RENAL IMPAIRMENT? Increase dose interval
SEVERE RENAL IMPAIRMENT? Reduce dose as well
11
Q
Aminoglycosides, avoid concomitant use of…?
A
Nephrotoxic drugs eg NSAIDs, ACEi, loop diuretics
12
Q
MHRA, aminoglycosides can cause what 3 problems/ tox?
A
nephrotox
ototox
renal impairment
13
Q
AMINOGLYCOSIDES- MHRA WARNING
Drugs that cause ototoxicity? CLVV
A
Interactions w/ Ototoxicity?
Cisplatin
Loop Diuretics (Furosemide)
Vancomycin
Vinca Alkaloids (vinblastine, vincristine, vindesine, vinflunine)
- contribute to/ cause ototox too
14
Q
AMINOGLYCOSIDES- MHRA WARNING
Drugs that cause renal impairment?
A
NSAIDs
ACEi
ARBs
MTX
same as glycopeptides
15
Q
contraindication for aminoglycosides is myasthenia gravis commonly known as?
A
muscle weakness
(chronic, autoimmune disease of muscles)
16
Q
aminoglycosides avoided in pregnancy why?
A
risk of auditory or vestibular nerve damage
if must use, monitor serum concs
17
Q
can you give aminoglycosides to obese pts?
A
can do, use ideal body weight based on height to calculate parenteral dose
if actual BW used, risk of OD
18
Q
CEPHALOSPORINS
1ST GENERATION? Fad, Fal, Frad
A
CeFadroxil
CeFalexin
CeFradine
19
Q
CEPHALOSPORINS
2ND GENERATION? Furry Fox Face
A
CeFuroxime
CeFoxitin
CeFaclor
20
Q
CEPHALOSPORINS
3rd & 5th GENERATION?
A
All parenteral except from oral Cefixime (3rd)
21
Q
which pts are allergic to cephalosporins?
A
pts allergic to penicillins!
22
Q
are first gen cephalosporins harmful in preg?
A
no.
think 2nd line UTI tx in preg. cefalexin, fine
23
Q
Patients with hypersensitivity to penicillin should not receive a cephlaosporin due to…?
A
Cross-sensitivity
24
Q
CHLORAMPHENICOL
USE?
AVOID IN?
OTC AGE?
A
USE? Eye infections
AVOID IN? Pregnancy- grey-baby syndrome, if used in third trimester
OTC AGE? 2years+
25
CLINDAMYCIN
use is associated with what fatal event?
Antibiotic-associated colitis (inflammation of lining of colon- diarrhea
can be FATAL esp in elderly
Discontinue+contact a doctor ASAP if severe/prolonged/bloody diarrhoea develops
26
CLINDAMYCIN
Clostridium difficile suspected?
STOP!
Can’t stop ABx/severe diarrhoea? Seek specialist advice
27
GLYCOPEPTIDES- EXAMPLES? VDTT
VANCOMYCIN
DALBAVANCIN
TEICOPLANIN (can be used in CAP)
TELAVANCIN
28
GLYCOPEPTIDES
WHICH DRUG MUST BE GIVEN PARENTERALLY FOR SYSTEMIC INFECTIONS DUE TO REDUCED ABSORPTION W/ ORAL INTAKE..?
vancomycin
29
GLYCOPEPTIDES
vancomycin should be avoided in?
Pregnancy unless benefit > risk
30
initial doses of glycopeptides i.e. vancomycin are given based on pt Body Weight then adjusted based on serum vancomycin concs.
what should the trough concs be?
should be 15-20mg/L
we dont measure peak concs with vancomycin, only troughs. usually done 1hr before next dose due
31
glycopeptides can cause which 2 toxicities?
ototox
nephrotox
similar to aminoglycosides
32
GLYCOPEPTIDES
Vancomycin oral, monitor?
Conc. in inflammatory intestinal disorders
33
GLYCOPEPTIDES- SIDE-EFFECTS?
NO CRABS
Nephrotox
Ototox
Cardiogenic shock on rapid IV injection
Red man syndrome
Anaphylactoid reactions at infusion site- avoid rapid infusion+rotate site
Blood dyscrasias: agranulocytosis/eosinophilia/neutropenia
Severe cutaneous ARs (SCARs) eg SJS syndrome
34
first dose/ rapid infusion of vancomycin causes what?
red man syndrome usually at site of infusion
35
a hypersensitivity/ SE of vancomycin and other glycopeptides is cardiogenic shock, what is this?
if given too quickly, pt heart suddenly cant pump enough blood to meet body's needs
36
LINEZOLID- SAFETY INFORMATION
RISK OF SEVERE OPTIC NEUROPATHY?
Report visual impairment (blurry/altered vision)
Monitor regularly if treatment >28 days
37
LINEZOLID- SAFETY INFORMATION
RISK OF BLOOD DISORDERS?
Monitor full blood counts weekly
Close monitoring if treatment>10-14 days/renal impairment
38
two risks associated with linezolid?
- severe optic neuropathy
- blood disorders
39
linezolid initialed under specialist supervision
primarily attacks gram + bacteria
indications?
- pneumonia (if vancomycin cant be used)
- cellulitis
40
LINEZOLID- INTERACTIONS
tyramine rich foods
(exactly like MAO inhibitors)
- mature cheese
- marmine
- yeast extract
- fermented soya bean extract
- some beers/wines
41
linezolid can inetract with some drugs to cause seratonin syndorme. -> impaired cognition, hyperth.., coma.
list examples of drugs
SSRIs
Dopaminergics (levodopa)
5-HT1 agonists
TCAs
Lithium
Other MAOIs
42
MACROLIDES- EXAMPLES?
A
C
E
AZITHROMYCIN (OD)
CLARITHROMYCIN (BD)
ERYTHROMYCIN (QDS)
43
MACROLIDES
AZITHROMYCIN three times a week given for..?
Prophylaxis in COPD patients
normally in winter months when high risk
44
with azithromycin, what to avoid 2 hrs before taking it?
antacids
45
MACROLIDES
CAUTIONED IN..?
Patients w/ myasthenia gravis
Pregnancy? Erythromycin>Clarithromycin
Avoid Clarithromycin in 1st trimester of pregnancy (teratogenicity)
46
MACROLIDES- SIDE-EFFECTS?
HOG-QT
HEPATOXICITY
OTOTOXICITY
GI DISTURBANCES
QT PROLONGATION
47
why are macrolides advised to take w food?
GI disturbance.
reduce GI SEs nausea, vom, diarrhoea etc
48
MACROLIDES- INTERACTIONS
Macrolides are CYP ENZYME INHIBITORS (AV MEDICC)
(so will increase levels of CYP enzyme substrates) such as
STATINS- Increased risk of myopathy
WARFARINS- Increased risk of bleeding
49
MACROLIDES- INTERACTIONS
HYPOKALAEMIA?
LOOP/THIAZIDE DIURETICS
STEROIDS
SALBUTAMOL
THEOPHYLLINE
ABCDE-I
amino/theoph
b2agonist
corticosteroids
diuretics
erythro/clarithro
insulin
50
MACROLIDES- INTERACTIONS
what other drugs cause QT PROLONGATION thus interacting with macrolides
AMIODARONE
DOMPERIDONE
FLUCONAZOLE
LITHIUM
METHADONE
ONDANSETRON
QUININE
QUINOLONES
SOTALOL
SSRIs
51
METRONIDZOLE- SIDE-EFFECTS
TNVDA
TASTE DISTURBANCE- metallic taste, furred tongue
N&V- take w/ OR after food
52
when on metronidazole, pts must not drink alcohol!! why and how long to wait?
disulfiram like side-effect (N&V, flushing)
AVOID ALCOHOL during & >/=48hrs after treatment
53
take nitrofurantoin with or without food?
with or after to dec GI SEs and nausea, vomiting
54
MHRA: risk of what 2 events w nitrofurantoin
pulmonary and hepatic
55
can pregnant women take nitrofurantoin?
avoid at term may produce neonatal haemolysis
56
when to avoid nitrofurantoin in renal impairment, at what gfr?
Avoid if eGFR<45mL/min/1.73m^2
57
se of nitrofurantoin?
may discolour urine yellow/ brown, counsel pt. normal
58
PENICILLINS
interact with what 2 main meds?
warfarin and MTX
59
NARROW-SPECTRUM PENICILLINS tend to be beta-lactamase sensitive therefore?
if infection is caused due to beta-lactamase bacteria they WONT WORK
60
narrow spec penicillins include penicillin G (benzylpenicillin) and penicillin v (phenoxymethylpenicillin). which is gastic stable and which is not?
pen G: NOT gastric stable: parenteral use only
pen V: gastric stable: suitable for oral admin
61
what is penicillin g used for
meningitis
62
name 2 broad spec penicillins (beta lactamase sensitive)
ampicillin
amoxicillin
63
PENICILLINS- BROAD-SPECTRUM
Beta-lactamase resistant combo?
Amoxicillin+Clavulanic Acid (Co-amoxiclav)
64
BROAD-SPECTRUM PENICILLINS
SIDE-EFFECTS?
DIARRHOEA most common -> antibiotic-associated colitis
MACULOPAPULAR rash- most common in patients w/ glandular fever; DO NOT USE BROAD-SPEC BLINDLY FOR ‘SORE THROAT’
65
PENICILLINASE-RESISTANT PENICILLIN
EXAMPLE?
Flucloxacillin
66
PENICILLINASE-RESISTANT PENICILLIN
FLUCLOXACILLIN
Take on empty stomach when..?
1hr before food/2hrs after
67
PENICILLINASE-RESISTANT PENICILLIN
FLUCLOXACILLIN
Safety information?
Cholestatic jaundice+hepatitis can occur, up to 2 months after treatment has ben stopped. Risk factors: >2 weeks use+elderly
68
PENICILLINASE-RESISTANT PENICILLIN
FLUCLOXACILLIN
Cautioned in?
Hepatic impairment
69
ANTIPSEUDOMONAL PENICILLINS? name 2 and how they are available as
Piperacillin- only available in combo w/ beta-lactamase inhibitor Tazobactam
Ticarcillin- only available in combo w/ beta-lactamase Clavulanic Acid
70
the antipseudomonal penicillins are available wih a b lactamase inhibitor (tazobactam/ clavulanic acid) only used in hospitals meaning theyre what?
resistant to b lactamase
71
why should you not give penicillins intrathecally? spine
can cause encephalopathy (same with Vincristine sulfate/vinca alkaloids!)
72
PENICILLIN ALLERGY?
True allergy
immediate rash, anaphylaxis
Maybe not? minor rash, small, not itchy/confluent >72hrs after
73
CROSS-SENSITIVITY of penicillins
DO NOT GIVE X in history of immediate penicillin hypersensitivity
CEPHALOSPORINS
same structure so cross sensitivity
74
examples of quinolones
CIPROFLOXACIN
DELAFLOXACIN
LEVOFLOXACIN
MOXIFLOXACIN
OFLOXACIN
75
QUINOLONES- SIDE-EFFECTS
MAY CAUSE?
- LOWERS SEIZURE THRESHOLD- avoid in epilepsy (+tramadol, sertraline, ibuprofen)
- PSYCHIATRIC DISORDERS
- TENDON DISORDERS
- PHOTOSENSITIVITY
- HYPERSENSITIVITY DISORDERS
76
advice/ counselling point with quinolones
Advice? Reduce sunlight+UV radiation exposure+can impair driving ability
77
QUINOLONES- IMPORTANT SAFETY INFORMATION?
- TENDINITIS
- AORTIC ANEURYSM+DISSECTION
- HEART VALVE REGURGITATION- seek help asap if SOB/peripheral neuropathy/new heart palpitations
FLUOROQUINOLONES ARE VERY VERY BAD
78
tendinitis is a SE of quinolones.
more common in what age and if its suspected, what to do?
common in >60years, STOP!
79
what is aortic aneurysm (SE of quinolones)? symptoms?
bulge in main BV running from heart -> stomach
sudden onset severe abdominal chest back pain
seek help ASAP
80
QUINOLONES- CAUTIONS?
MAP-QT
MYASTHENIA GRAVIS
ARTROPATHY (arthritis joint disease)
PERFORATED TYMPANIC MEMBRANCE (when used by ear)
QT INTERVAL PROLONGATION
81
myasthenia gravis a caution with what 3 drug classes
aminoglycosides
macrolides
quinolones
82
QUINOLONES
interact with which FOOD & DRINKS?
dairy products and mineral fortified drinks - reduces absorption
83
QUINOLONES- INTERACTIONS
3 main interactions
food drinks
drugs that cause QT prolongation
reduce seizure threshold
84
which drugs cause QT prolongation thus interact with quinolones
amiodarone, SSRIs, haloperidol, chlorpromazine
85
quinolones interact with what drug to reduce seizure threshold (ie. increasing risk of seizures)
NSAIDs
eg if pt taking ciprofloxacin asks to buy OTC ibuprofen, NO!
86
TETRACYCLINES- EXAMPLES?
DOXYCYCLINE
TETRACYCLINE
MINOCYCLINE
87
TETRACYCLINES
LABEL?
LABEL exception? DLM
LABEL? Do not take w/ milk, indigestion remedies, or medicines containing iron/zinc, 2hrs before/after you take this medicine
LABEL exception? DLM- DOES LIKE MILK
Doxycycline
Lymecycline
Minocycline
88
examples of tetracyclins
doxycycline
lymecycline
tigecycline
89
TETRACYCLINES- 3 main SEs?
TEETH DISCOLOURATION/BONE DEPOSIT
BENIGN INTRACRANIAL HYPERTENSION
LUPUS-ERYTHMEATOSUS-LIKE SYNDROM+IRREVERISBLE PIGMENTATION
90
tetracyclies have a risk of TEETH DISCOLOURATION/BONE DEPOSIT therefore avoid in which pt? ages
avoid in <12 years/pregnant women
91
tetracyclins have a risk of
BENIGN INTRACRANIAL HYPERTENSION
how does this present and what to do?
headache, visual disturbances
just like lithium
STOP and report
92
LUPUS-ERYTHMEATOSUS-LIKE SYNDROME + IRREVERISBLE PIGMENTATION can be a SE of tetracyclins.
risk is highest with which?
highest risk w/ minocycline
93
TETRACYCLINES- COUNSELLING POINTS
HEPATOXIC- avoid in liver failure
PHOTOSENSITIVITY- avoid exposure to sunlight/lamps
DYSPHAGIA- swallow whole with plenty of fluid, sitting/standing
CAUTION IN MYASTHENIA GRAVIS
94
TRIMETHOPRIM- SIDE-EFFECTS?
BLOOD DYSCRASIA
ANTIFOLATE- thus teratogenic risk in first trimester, avoid
interactions w/ other antifolates: methotrexate/phenytoin
HYPERKALAEMIA
95
trimethoprim can cause blood dyscrasia as a SEwith long term tx. what are the symptoms?
look out for signs of blood disorders
fever, sore throat, rash, mouth ulcers, bruising or bleeding
96
risk of hyperkalaemia as a SE with trimethoprim. what drugs also cause this hus interact?
ACEi, ARB, digoxin, K+ sparing/aldosterone
97
use trimethoprim with caution in which pt
renally impaired due to dec clearance of drug thus accumulation
also interacts with warfarin and increases INR!
98
ANTIBIOTICS- NARROW vs BROAD SPECTRUM
NARROW? PG TLC
PENICILLIN (Pen V+Pen G)
GLYCOPEPTIDES
TRIMETHOPRIM
LINEZOLID
CLINDAMYCIN
Anaerobic- METRONIDAZOLE
99
ANTIBIOTICS- NARROW vs BROAD SPECTRUM
BROAD? CAPTN MCQ
CHLORAMPHENICOL
AMINOGLYCOSIDES
PENICILLINS (amoxicillin+ampicillin)
TETRACYCLINES
NITROFURANTOIN
MACORLIDES
CEPHALOSPORINS
QUINOLONES
100
ANTIBIOTICS- BACTERIOSTATIC vs BACTERICIDAL
BACTERIOSTATIC (prevents growth)? CLTMC
CHLORAMPHENICOL
LINEZOLID
TETRACYCLINE
MACROLIDES
CLINDAMYCIN
101
ANTIBIOTICS- BACTERIOSTATIC vs BACTERICIDAL
BACTERICIDAL (kills)?
CEPHALOSPORIN
AMINOGLYCOSIDES
NITROFURANTOIN
TRIMETHOPRIM
QUINOLONES
METRONIDAZOLE
GLYCOPEPTIDES
PENICILLINS
102
ANTIBIOTIC DIRECTIONS
WITH/AFTER FOOD? MNCP
Metronidazole
Nitrofurantoin
Clarithromycin MR
Pivmecillinam
103
ANTIBIOTIC DIRECTIONS
TAKE ON EMPTY STOMACH? (30-60mins before meal/snack OR at least 2hours after)
FLUCLOXACILLIN
PHENOXYMETHYLPENICILLIN
AZITHROMYCIN CAPS (not tabs/liquid)
TETRACYCLINE/OXYTETRACYCLINE
104
ANTIBIOTICS
which abx used with CAUTION IN MYASTHENIA GRAVIS?
MAT-Q
QUINOLONES- Ciprofloxacin
AMINOGLYCOSIDES- Gentamicin, Metronidazole…
MACROLIDES- Clarithromycin…
TETRACYCLINES- Doxycycline…
105
ANTIBIOTICS
NEPHROTOXIC/CAUTION IN KIDNEY FAILURE?
(BIG 3)
-NITROFURANTOIN
-AMINOGLYCOSIDES
-GLYCOPEPTIDES- vancomycin, teicoplanin…
-tetracyclines
-trimethoprim
106
ANTIBIOTICS
HEPATOXIC/CAUTION IN LIVER FAILURE?
MFC-TRIP
MACROLIDES
FLUCLOXACILLIN
CO-AMOXICLAV
chloramphenicol
nitrofurantoin
tetracyclines
3/4 TB meds- rifampicin, isoniazid & pryazinamide (RIPE)
What’s the 4th? ethambutol
107
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