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PRE-REG-Thuri > INFECTIONS- AMINOGLYCOSIDES + GLYCOPEPTIDES > Flashcards

INFECTIONS- AMINOGLYCOSIDES + GLYCOPEPTIDES Flashcards

1
Q

What is MOA of amino-glycosides?

A

Active against many gram
-ve and some gram +ve.

Binds irreversibly to bacterial ribosomes

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2
Q

What is spectrum of amino-glycosides?

A

Broad

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3
Q

Are amino-glycosides bactericidal or bacteriostatic?

A

bactericidal

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4
Q

What are 5 drugs within amino-glycosides class?

A
  1. Amikacin
  2. gentamicin
  3. neomycin
  4. streptomycin
  5. tobramycin
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5
Q

What pathogen is amikacin used for?

A

Gentamicin resistant Gram -ve bacilli.

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6
Q

What is the choice drug within amino-glycosides ?

A

Gentamicin

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7
Q

What route is toxic in neomycin administration?

A

Parenteral

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8
Q

What is neomycin used in?

A

Bowel sterilisation

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9
Q

What is streptomycin used for?

A

TB

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10
Q

What is tobramycin used for when inhaled

A

Pseudomonal infection in cystic fibrosis

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11
Q

What do amino-glycosides have a risk of in patients with mitochondrial mutations?

A

Ototoxicity - deafness

monitor renal + auditory function

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12
Q

What condition is injectable amino-glycosides contra-indicated in?

A

Myasthenia gravis

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13
Q

What are amino-glycosides used in?

A

Serious infections

e.g. pseudomonas aeruginosa infection

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14
Q

What is typical route of amino-glycosides?

A

Parenteral

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15
Q

What is therapeutic index of gentamicin POST- DOSE (peak)?

A

5-10mg/L

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16
Q

What is therapeutic index of gentamicin PRE-DOSE (trough)?

A

< 2mg/L

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17
Q

What are pre and post dose levels of gentamicin in endocarditis like?

A

lower

3-5 mg/l post dose (peak)

<1 mg/l pre dose (trough)

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18
Q

How often should gentamicin dose be monitored?

A

After 3-4 doses

then every 3 days + after dose change.

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19
Q

What is target trough amino-glycoside dose level in endocarditis?

A

<1 mg/l pre dose

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20
Q

What to do if peak levels raised in aminoglycosides?

A

decrease dose

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21
Q

What to do if trough levels raised in aminoglycosides?

A

increase dosing interval

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22
Q

What to do with aminoglycosides monitoring if renally impaired?

A

increase interval

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23
Q

What to do with aminoglycosides monitoring if severely renally impaired?

A

decrease dose

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24
Q

Which 6 types of patient groups need therapeutic drug monitoring for amino-glycosides?

A

Elderly*

Renal impairment

Obesity*

Cystic fibrosis*

High doses

Pregnancy

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25
In amino-glycosides, what 2 factors determine dose?
Weight Renal function
26
If post dose peak level of amino-glycosides are too high, what to do?
reduce dose
27
If pre-dose (trough) levels of amino-glycosides too high what to do?
Increase interval
28
what to do if patient has renal impairment and is on amino-glycosides?
Increase interval of dosing
29
what to do if patient has SEVERE renal impairment and is on amino-glycosides?
increase interval + reduce dose
30
What 2 types of dosing regimens exist in amino-glycosides?
Once daily Multiple daily
31
What to do if patient has severe renal impairment <20ml/min + on amino-glycosides once daily regimen?
not give amino-glycosides
32
What to do if patient has severe renal impairment <20ml/min + on amino-glycosides once daily regimen?
Monitor RI frequent + earlier monitor after 3-4 doses (change dose)
33
When is monitoring done for gentamicin and amikacin multiple daily dose regimen?
Done after 3-4 doses 1 hour after dose + just before next dose
34
Can amino-glycosides be used in pregnancy?
generally NO- risk of auditory or vestibular nerve damage in 2nd/3rd trimester.
35
Which amino-glycoside has the highest risk in pregnancy if it needed to be given?
streptomycin
36
What is an MRHA warning related to gentamicin from 2017?
histamine related adverse reactions with some batches monitor
37
What are 4 SEs of aminoglycosides? (ONNN)
Ototoxicity Nephrotoxicity Neuromuscular Neuropathy
38
What patient counselling points can be given for patients on aminoglycosides?
report hearing loss, dizziness, tinnitus.
39
What main drug class can interact with aminoglycosides to increase ototoxicity?
Loop diuretic- separate dose by long period
40
What 6 classes of drugs can interact with aminoglycosides to increase nephrotoxicity?
Ciclosporin , tacrolimus, NSAID, MTX, Vancomycin, platins
41
What 2 other chemo drugs can increase ototoxicity by interacting with aminoglycosides?
Platins Vinca alkaloids (vancomycin)
42
What is MOA of glycopeptides?
active ONLY in gram +ve e.g. MRSA Blocks cell wall synthesis by preventing cross linking of peptidoglycan chains
43
Is glycopeptides bactericidal or static?
bactericidal
44
What are 4 glycopeptides?
1. dalbavancin 2 oritavancin 3 teicoplanin 4. vancomycin
45
What is Dalbavancin used for?
Skin infections
46
What is oritavancin used for?
Skin infections
47
What is vancomycin similar to?
Teicoplanin
48
What glycopeptide has long half life?
Teicoplanin
49
What is the 4 uses of glycopeptide abx?
Used in C. diff, MRSA - complicated skin + soft tissue, endocarditis
50
What is route of glycopeptide?
Parenteral
51
What is therapeutic index of glycopeptides?
10-20mg/L (pre dose)
52
What patient groups are glycopeptide monitored in?
RI High dose + long term Impaired hearing patients on other ototoxic/ nephrotoxic drugs
53
Can glycopeptides be used in pregnancy?
NO
54
What are 4 SEs of glycopeptide? (ROBN)
Red-man syndromme Ototoxicity Blood dyscrasias Nephrotoxicity
55
What happens upon rapid IV injection of glycopeptides?
cardiogenic shock anaphylaxis maybe
56
What is max infusion rate for glycopeptides?
10 mg/mL in fluid restriction but increased risk of infusion-related effects
57
What 3 things to monitor in patient taking glycopeptide?
Auditory function, renal, FBC
58
What are 2 interactions that can happen in patient taking glycopeptide?
Ototoxicity + nephrotoxicity
59
What is spectrum of glycopeptides?
Narrow
60
How to monitor glycopeptides?
trough concentration initial doses- body weight
61
What is optimum trough level of glycopeptides?
15-20mg/L
62
What is the max cerebrospinal fluid concentration for gentamicin IV/intrathecal injection?
10mg/ L
63
parenteral treatment of amino-glycosides should NOT exceed ------ days?
7 days
64
What amount should amikacin trough dose not exceed in multiple dosing regime?
pre-dose (‘trough’) concentration should be less than 10 mg/litre.
65
What amount should amikacin trough dose not exceed in OD dosing regime?
pre-dose (‘trough’) concentration should be less than 5 mg/litre.

PRE-REG-Thuri (44 decks)

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