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Patient PCP > Infection/Antibiotics > Flashcards

Infection/Antibiotics Flashcards

1
Q

What are the safest classes of antibiotics to use in pregnancy?

A

Penicillins

and

Cephalosporins (cefalexin, ceftriaxone, cefadroxil)- all but Cefopime a 4th generation cephalosporin

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2
Q

What antibiotic treatment is indicated for septicaemia (community or hospital acquired)?

A

BROAD SPEC antibiotics: e.g. Piptaz (pipericillin and tazobactam)
If MRSA suspected: add Vancomycin

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3
Q

What antibiotic Is very good against anaerobic bacteria so usually infections of the colon?

A

Metronidazole
V high anaerobic activity, narrow spectrum

Used for bacteria growing where there isn’t much oxygen:
Gut (H pylori, Chron’s)
Bacterial vaginosis
Leg ulcers

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4
Q

How is bacterial meningitis empirically treated?

A

1) BENZYPENICILLIN- can be given before transfer to hospital,
2) If penicillin allergy- CEFOTAXIME (a cephalosporin)
3) If hypersensitivity to penicillin & cephalosporins: CHLORAMPHENICOL
4) Can consider addition of Dexamethasone
5) Consider Vancomycin if multiple use of antibiotics in previous 3 months

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5
Q

What is the treatment for meningococcal meningitis?

A

Benzylpenicillin or cefotaxime
2nd line: Chloramphenicol
For 7 days

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6
Q

What is the treatment for pneumococcal meningitis?

A

Cefotaxime (OR ceftriaxone)
(or if bacteria is penicillin sensitive: Benzylpenicillin)
For 14 days
Consider adding dexamethasone

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7
Q

What is the treatment for meningitis caused by haemophilus influenza?

A

What is the treatment for meningitis caused by haemophilus influenza?

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8
Q

What antibiotics are used in endocarditis (infection of the heart)?

A

Usually Amoxicillin or Flucloxicillin or benzylpenicillin

PLUS LOW DOSE gentamicin- hence the lower target level range for gentamicin in endocarditis!

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9
Q

What antibiotic is indicated for gastro-enteritis?

A

This is usually self-limiting and an antibiotic not indicated

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10
Q

What is the antibiotic indicated for C. diff?

A

First episode: oral Metronidazole (high anaerobic activity)
Second episode/ 2nd line: oral Vancomycin
Use together
If combo not worked:
oral Fidaxomicin
ALL FOR 10-14 DAYS DURATION

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11
Q

Which antibiotics are commonly used for GU infections?

A

Azithromycin- used in chlamydia, gonorrhoea

Doxycycline- alternative in chlamydia, pelvic inflammatory disease, syphilis

Metronidazole- used for bacterial vaginosis, pelvic inflammatory disease

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12
Q

What class of AB’s is Amikacin? When is amikacin usually indicated?

A

An aminoglycoside

Usually indicated for gentamicin resistant infections as amikacin is more stable than gentamicin to enzyme inactivation.

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13
Q

What is the target One hour peak concentration of gentamicin? (multiple daily dosing)

A

5 - 10 mg/L

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14
Q

What is the target pre-dose trough concentration of gentamicin? (multiple daily dosing)

A

under 2 mg / L

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15
Q

What is the target One hour peak conc of gentamicin in treatment of ENDOCARDITIS? and target trough level?

A

Peak: 3 - 5 mg/L
Trough:

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16
Q

Which aminoglycoside is too toxic to be administered parenterally, therefore is taken by mouth?

A

NEOMYCIN

used for bowel sterilisation before surgery as its so strong it will wipe the bowel clean of bacteria

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17
Q

Etrapenem
Imipenem
Meropenem
Are all examples of what kind of antibiotics?

A

The carbapenems
These are beta-lactam antibacterials

NB: imipenem is administered with cilastatin which is a specific enzyme inhibitor that stops it being renally metabolised

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18
Q

Which two cephalosporins are suitable for infections of the CNS?

A

Cefotaxime
Ceftriaxone
(Hint: these are the two we see used in meningitis, a CNS infection!)

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19
Q

What is the treatment of UTI’s in pregnancy?

A

Nitrofurantoin: okay to use but avoid at term

Trimethoprim: Teratogenic risk in first trimester as it is a folate antagonist

Cefalexin: a cephalosporin, these are safe in pregnancy

Cranberry juice or other cranberry products are not recommended as no evidence to support their use

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20
Q

What classes, other than penicillins, do we have to be wary of with penicillin allergic patients?

A

Cephalosporins- cefalexin, cefadroxil, ceftriaxone, cefixime, cefotaxime
All cephalosporins begin with CEF

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21
Q

What is Co-trimoxazole? What is it used for?

A

Contains SULFAMETHOXAZOLE and TRIMETHOPRIM!

Resistance to sulphonamides has increased so there are restrictions on the use of co-trimoxazole.

LIMITED USE:

It IS indicated for: Pneumonia caused by p.jiroveci/ carinii.
Also for toxoplasmosis + nocardiasis

Should only be used in bronchitis exacerbation/ UTI’s/ otitis media in children when culture and sensitivities evident

ONLY use when there is GOOD EVIDENCE to use this COMBO rather than just a single due to resistance!

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22
Q

What antibiotics require reporting on blood disorders/ rash?

A

Co-trimoxazole (contains trimethoprim and sulfamethoxazole)- discontinue immediately if:
signs of blood disorder such as anaemia, thrombocytopenia
or rash: stevens johnsons syndrome, photosensitivity

Trimethoprim: Blood disorders: fever, sore throat, ulcers, bruising, bleeds

Penicillamine: not really an anti-bacterial: used as a disease-modifying anti-rheumatic drug
Same as above: fever, sore throat, ulcers, bruising

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23
Q

What do you see fusidic acid commonly used for?

A

Staphylococcal infection of the SKIN & also EYES

comes as tablet, cream, eye drops

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24
Q

What happens if a patient on clindamycin develops diarrhoea?

A

Antibiotic associated colitis with clindamycin can be fatal- discontinue immediately

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25
Q

What antibiotic has been associated with Myopathy/ Muscle effects?

A

Daptomycin

monitor creatinine kinase every 2 days if muscle effects reported

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26
Q

Which antibiotics can cause cholestatic jaundice?

A

Co-amoxiclav
Nitrofurantoin
Flucloxacillin
Be careful in liver patients

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27
Q

What is the important safety information associated with Flucloxacillin?

A

Hepatic disorders:
Cholestatic Jaundice and HEPATITIS have been reported in patients even up to 2 months after the drug has been stopped.
Use flucloxacillin with caution in patients with liver impairment!!

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28
Q

Which antibiotics have been associated with visual problems?

A

LINEZOLID- optic nephropathy

QUINOLONES (Ciprfloxacin, Levofloxacin)- retinal detachment

Ethambutol (used for TB)- ocular toxicity

Rifampicin- colours tears/ contacts red

Rifabutin- Uveitis (eye inflammation)

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29
Q

What two things need to be looked out for with Linezolid treatment?

A

Optic neuropathy (visual problems)- report any visual disturbance IMMEDIATELY

Blood disorders: Aneamia, thrombocytopenia
FBC monitored WEEKLY, monitor especially for treatment of 10-14 days or more

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30
Q

What are the TWO very important safety warnings with QUINOLONES (ciprofloxacin, levofloxacin)?

A

May induce CONVULSIONS especially if also taking NSAIDS. Caution in EPILEPSY. Caution with THEOPHYLLINE as also causes seizures.

TENDON DAMAGE- Tendonitis, tendon rupture
(NB: this has also been reported with prednislone!)

(also can PROLONG QTc interval- this is a caution)

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31
Q

When should patients discontinue treatment with Quinolones?

A 
If any of the following occur:
Psychiatric reactions (hallucinations, anxiety, depression)

Neurological reactions (tremor, asthenia [abnormal weakness])

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32
Q

What antibiotics can cause QT prolongation?

A

MACROLIDES:
erythromycin
clarithromycin
azithromycin

QUINOLONES
ciprofloxacin
levofloxacin
moxifloxacin

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33
Q

Linezolid is an antibacterial used in pneumonia. It also has Monoamine oxidase inhibition activity (part of MAOI family). What should patients be advised to avoid?

A

Avoid consuming large amounts of tyramine rich foods

Remember: Linezolid will still have interactions/tyramine effects 2 weeks after discontinuation

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34
Q

What can happen if VANCOMYCIN is infused too rapidly?

A

Flushing of upper body (red man syndrome)

Severe hypotension
wheezing
pruritis
back pain/muscle spasm

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35
Q

After how many doses should Vancomycin plasma levels be measured?

A

After 3 or 4 doses if renal function is normal (earlier if impaired)

36
Q

What side effects do Vancomycin and Gentamicin both have in common? What drugs should be avoided with these?

A

Ototoxicity and nephrotoxicity

Ototoxic drugs: loop diuretics (e.g. furosemide)

Nephrotoxic drugs: ciclosporin, platinum, chemotherapy

37
Q

Treatment with Vancomycin required Full Blood count monitoring. Why is this?

A

Risk of neutropenia - monitor neutrophils and platelets

38
Q

Which antibiotics could cause CHOLESTATIC JAUNDICE (a liver disorder where bile builds up in the blood stream as it gets blocker from being excreted)?

A

Flucloxacillin (may even occur up to 2 months after flucloxacillin is stopped, more likely after 2 weeks of treatment)

Co-fluampicil (contains amoxicillin and flucloxacillin)

Co-amoxiclav

Nitrofurantoin

*use these in caution in liver dysfunction

39
Q

Which antibiotics are commonly used to treat acne??

A

Tetracyclines:
tetracycline
doxycycline
oxytetracycline

Erythromycin (macrolide) sometimes used

40
Q

What conditions can Tetracyclines exacerbate?

A

Systemic lupus
Erythematosus
Myasthenia Gravis (increased muscle weakness)

41
Q

Which antibiotics can cause photosensitivity?

A

Doxycycline

Demeclocycline

42
Q

Which antibiotics are not recommended in children and adolescences under 18 years old? And why?

A

Quinolones:

  • ciprofloxacin
  • levofloxacin
  • moxifloxacin

*because of the risk of tendon damage/joint disease (aropathy)

43
Q

What is an important monitoring parameter with Linezolid?

A

WEEKLY full blood counts due to risk of blood disorder/anaemia

44
Q

Which antibiotics may cause a false positive result on urinary GLUCOSE tests- i.e. be careful when testing for diabetes?

A

CEPHALOSPORINS

cefalexin, ceftriaxone etc

45
Q

Which antibiotic is a FOLATE SYNTHESIS INHIBITORS and is therefore teratogenic?

A

Trimethoprim

Co-trimoxazole (contains sulfamethoxazole and trimethoprim)

(AVOID in pregnancy - especially first trimester when folate is needed)

46
Q

What frequency of administration is Vancomycin given?

A

BD - (12 hourly) due to long half life

Teicoplanin: even longer acting: OD dose after loading dose

47
Q

Name 2 Glycopeptide antibiotics?

A

Vancomycin

Teicoplanin (less nephrotoxic)

48
Q

What are the target pre-dose TROUGH levels for vancomycin?? (only trough levels are used with Vancomycin)

A

10-15mg/L

49
Q

First line antibiotic for Cellulitis?

A

Flucloxacillin (250-500mg QDS)

If allergic to penicillin (clindamycin)

50
Q

Which antibiotics/ antifungals may cause STEVENS JOHNSON SYNDROME (skin rash)?

A

Co-trimoxazole

Clindamycin

Fluconazole

51
Q

What are some of the more common side effects experienced with Metronidazole (its quite an unpleasant antibiotic)?

A

GI disturbance (sick/stomach pain)

Mouth effects (taste disturbance, oral mucositis (ulcers), furry tongue)

Alcohol - disulfiram like reaction

52
Q

What is fusidic acid used for?

A

Narrow spectrum antibiotic used for STAPHYLOCOCCAL SKIN infections

Used for impetigo (topical) fucidin cream
Staph eye infections (topical)

53
Q

Which antibiotic is cautioned in problems to do with:
Lungs
Liver
Neurones

A

Nitrofurantoin:

  • pulmonary fibrosis
  • cholestatic jaundice
  • peripheral neuropathy
  • can also cause Vit B/folate deficiency
54
Q

Which antifungal medication can cause QT prolongation?

A

Fluconazole

55
Q 
What antibiotics/ antifungals should be stopped if signs of
dark urine
vomiting
fatigue
anorexia occur?
A

This indicates LIVER FAILURE

Discontinue drugs that are hepatotoxic:

  • itraconazole
  • fluconazole
  • ketoconazole (no longer available orally)
  • terbinafine
  • rifampicin
  • isoniazid
  • pyrizinamide
56
Q

Which antifungal is cautioned in patients at a high risk of heart failure?

A

ITRACONAZOLE

- can worsen this. more at risk if on negatively ionotropic drug e.g. CCBs

57
Q

What skin condition may Terbinafine (antifungal) exacerbate?

A

Psoriasis

58
Q

Which antifungal can cause renal toxicity?

A

AMPHOTERICIN

*can also cause electrolyte disturbance: hypokalaemia and hypomagnesaemia

59
Q

Which antimalarials are unsuitable in patients with epilepsy/ has a history of epilepsy?

A

Chloroquine and mefloquine

60
Q

A woman, 4 weeks pregnant, comes and asks you what she can do to avoid malaria when she goes to Bolivia next month.
Which antimalarials are ok to use in pregnancy?

A

Chloroquine and Proguanil

  • can both be used at normal doses in pregnancy as benefit of malaria prophylaxis outweighs any risk
  • recommend folic acid 5mg to be taken with proguanil
61
Q

What does the antimalarial malarone contain?

A

Proguanil and Atovaquone

*fine to use in epilepsy; does not contain chloroquine or mefloquine

62
Q

What is the most common causative bacteria of a UTI?

A

E. coli

63
Q

Daktocort cream (containing Miconazole and Hydrocortisone) needs to be stored where? Why?

Where is the ointment stored?

A
  • Daktocort CREAM stored in fridge (creams are more water based so more liable to bacterial growth)
  • Ointment stored on shelf, more stable less liable to bacterial growth
64
Q

What drugs are used to treat Bacterial Vaginosis?

A
  • Metronidazole vaginal gel

- clindamycin cream

65
Q

Which antifungal requires an Alert card as it is so Hepatotoxic?

A

Voriconazole

66
Q

What two toxicities may Voriconazole cause?

A

Hepatoxicity

Phototoxicity (avoid sunlight)

67
Q

When should a penicillin be discontinued? Describe the effects.

A
  • In people with history of anaphylaxis, urticaria (hives like rash) or rash immediately after penicillin should discontinue - risk of hypersensitivity. Rash would wide spread all over body, raised and itchy
  • those with minor history of rash (localised non itchy) that occurred more than 72hrs post penicillin can receive if absolutely necessary
68
Q

What antibiotics are commonly seen prescribed for chest infections?

A

Penicillins: amoxicillin or ampicillin

Or A macrolide: azithromycin, clarithromycin, erythromycin

*Co-amoxiclav used for more severe chest infections as it has a broader action

69
Q

How is oral thrush managed?

A

Initially TOPICAL treatment with miconazole oromucosal gel or nystatin oral suspension (use pipette to hold in mouth, used after food)

If these do not work, or patient has a dry mouth, use oral fluconazole capsule

70
Q

Which anti-epileptic does Meropenem reduce the levels of?

A

Sodium Valproate

71
Q

What is the usual organism (Not atypical) causing Lower respiratory tract infections?

A

Streptococcus pneumoniae (major cause of pneumonia)

S. pneumoniae is also one of the major causes of meningitis (pneumococcal) alongside Neisseria meningitis (meningococcal)

72
Q

What antibiotic should be used for resistant strains of pneumonia?

A

Co-amoxiclav - contains amoxicillin and clavulanic acid which is a beta lactamase inhibitor (makes this antibiotic very effective against resistant strains)

73
Q

Aside from antibiotics like clindamycin etc, what can cause C.diff?

A

PPIs

74
Q

What is the difference between the discharge in bacterial vaginosis and Trichomoniasis Vaginalis?

A

BV = thick white and fishy discharge -cottage cheese like appearance

Trichomoniasis Vaginalis = frothy, smell, green/yellow coloured

75
Q

Pink and frothy sputum?

A

Heart failure: the pulmonary oedema (fluid on lungs) can result in coughing up blood and requiring more pillows to sleep on to take weight off chest

76
Q

What are the most common causative organisms of Community Acquired pneumonia? (2)

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae

Atypical (less common):

  • chlamydia pneumoniae
  • mycoplasma pneumoniae
  • legionella
77
Q

Which antibiotics should be taken WITH OR JUST AFTER FOOD

(extra warning label)??

A

Metronidazole

Nitrofurantoin

Clarithromycin MR

78
Q

Which antibiotics should be taken ON AN EMPTY STOMACH i.e. 2 hours before or 2 hours after food

(extra warning label)

A

Penicillin (Penicillin V- Phenoxymethylpenicillin)

Ampicillin

Flucloxacillin

Rifampicin

79
Q

Which antibiotics should MILK be avoided 2 hours before or 2 hours after taking, as MILK DECREASES THEIR ABSORPTION?

A

Ciprofloxacin

Tetracyclines:

Oxytetracycline

Tetracycline

Demeclocycline

As MILK contains CALCIUM- chelate to this forming a complex that cannot be absorbed

80
Q

Which antibiotics SHOULD BE TAKEN WITH A FULL GLASS OF WATER (extra warning label)?

A

Certain Tetracyclines:

Doxycycline

Minocycline

Tetracycline

also

CLINDAMYCIN

METRONIDAZOLE

*To avoid irritation of the oesophagus

81
Q

Antacids contain calcium, magnesium and aluminium metal ions. Medicines containing IRON/ ZINC can also affect absorption. What antibiotics need to be taken 1 hour before or 2 hours after antacids/ iron or zinc products, and why?

NB: There is a cautionary label that incorporates both antacids and iron/zinc products: this is needed

A

Antibiotics can chelate with the metal ions and this will reduce the antibiotics absorption:

Tetracycline, oxytetracycline, doxycycline- remember these are contra-indicated in children under 12 years due to deposition in bones/ teeth (calcium binding- also avoided with milk)

Quinolones: Ciprofloxacin, levofloxacin, moxifloxacin

Nitrofurantoin- Magnesium only

82
Q

What are the counselling points/ extra warning labels with Metronidazole?

A

Take WITH or just after FOOD

WITH A FULL GLASS OF WATER

Do NOT drink ALCOHOL

83
Q

What are the counselling points/ extra warning labels with DOXYCYCLINE?

A

Do not take indigestion remedies (antacids)/ med’s containing iron or zinc 2 hours before/ after

Drink with a full glass of water

Protect skin from sunlight- even on cloudy day

Space evenly throughout day

84
Q

What extra warning label do

Ciprofloxacin

Oxytetracycline

Tetracycline

Demeclocycline

All share?

A

Do not take milk, indigestion remedies or med’s containing iron/ zinc 2 hours before or after

85
Q

What are the extra warning labels for Isoniazid (used in TB)?

A

Take 30 to 60 mins before food

Do not stop taking unless doctor says (as its for TB- needed for long time!)

86
Q

What are the extra warning labels for azithromycin?

A

DO not take indigestion remedies/ antacids at same time

Space doses evenly

NB: here the mention of zinc/iron products not needed

87
Q

What are the extra warning labels for Nitrofurantoin?

A

May colour the urine (yellow/ brown)

Take with or just after food

Space doses evenly, don’t stop taking unless told to

Patient PCP (15 decks)

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