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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
Q

In amino-glycosides, what 2 factors determine dose?

A

Weight

Renal function

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26
Q

If post dose peak level of amino-glycosides are too high, what to do?

A

reduce dose

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27
Q

If pre-dose (trough) levels of amino-glycosides too high what to do?

A

Increase interval

28
Q

what to do if patient has renal impairment and is on amino-glycosides?

A

Increase interval of dosing

29
Q

what to do if patient has SEVERE renal impairment and is on amino-glycosides?

A

increase interval + reduce dose

30
Q

What 2 types of dosing regimens exist in amino-glycosides?

A

Once daily

Multiple daily

31
Q

What to do if patient has severe renal impairment <20ml/min + on amino-glycosides once daily regimen?

A

not give amino-glycosides

32
Q

What to do if patient has severe renal impairment <20ml/min + on amino-glycosides once daily regimen?

A

Monitor RI frequent + earlier

monitor after 3-4 doses (change dose)

33
Q

When is monitoring done for gentamicin and amikacin multiple daily dose regimen?

A

Done after 3-4 doses

1 hour after dose + just before next dose

34
Q

Can amino-glycosides be used in pregnancy?

A

generally NO- risk of auditory or vestibular nerve damage in 2nd/3rd trimester.

35
Q

Which amino-glycoside has the highest risk in pregnancy if it needed to be given?

A

streptomycin

36
Q

What is an MRHA warning related to gentamicin from 2017?

A

histamine related adverse reactions with some batches

monitor

37
Q

What are 4 SEs of aminoglycosides? (ONNN)

A

Ototoxicity

Nephrotoxicity

Neuromuscular

Neuropathy

38
Q

What patient counselling points can be given for patients on aminoglycosides?

A

report hearing loss, dizziness, tinnitus.

39
Q

What main drug class can interact with aminoglycosides to increase ototoxicity?

A

Loop diuretic- separate dose by long period

40
Q

What 6 classes of drugs can interact with aminoglycosides to increase nephrotoxicity?

A

Ciclosporin , tacrolimus, NSAID, MTX, Vancomycin, platins

41
Q

What 2 other chemo drugs can increase ototoxicity by interacting with aminoglycosides?

A

Platins

Vinca alkaloids

(vancomycin)

42
Q

What is MOA of glycopeptides?

A

active ONLY in gram +ve e.g. MRSA

Blocks cell wall synthesis by preventing cross linking of peptidoglycan chains

43
Q

Is glycopeptides bactericidal or static?

A

bactericidal

44
Q

What are 4 glycopeptides?

A
  1. dalbavancin

2 oritavancin

3 teicoplanin
4. vancomycin

45
Q

What is Dalbavancin used for?

A

Skin infections

46
Q

What is oritavancin used for?

A

Skin infections

47
Q

What is vancomycin similar to?

A

Teicoplanin

48
Q

What glycopeptide has long half life?

A

Teicoplanin

49
Q

What is the 4 uses of glycopeptide abx?

A

Used in C. diff, MRSA - complicated skin + soft tissue, endocarditis

50
Q

What is route of glycopeptide?

A

Parenteral

51
Q

What is therapeutic index of glycopeptides?

A

10-20mg/L (pre dose)

52
Q

What patient groups are glycopeptide monitored in?

A

RI

High dose + long term

Impaired hearing

patients on other ototoxic/ nephrotoxic drugs

53
Q

Can glycopeptides be used in pregnancy?

A

NO

54
Q

What are 4 SEs of glycopeptide? (ROBN)

A

Red-man syndromme

Ototoxicity

Blood dyscrasias

Nephrotoxicity

55
Q

What happens upon rapid IV injection of glycopeptides?

A

cardiogenic shock

anaphylaxis maybe

56
Q

What is max infusion rate for glycopeptides?

A

10 mg/mL in fluid restriction but increased risk of infusion-related effects

57
Q

What 3 things to monitor in patient taking glycopeptide?

A

Auditory function, renal, FBC

58
Q

What are 2 interactions that can happen in patient taking glycopeptide?

A

Ototoxicity + nephrotoxicity

59
Q

What is spectrum of glycopeptides?

A

Narrow

60
Q

How to monitor glycopeptides?

A

trough concentration

initial doses- body weight

61
Q

What is optimum trough level of glycopeptides?

A

15-20mg/L

62
Q

What is the max cerebrospinal fluid concentration for gentamicin IV/intrathecal injection?

A

10mg/ L

63
Q

parenteral treatment of amino-glycosides should NOT exceed —— days?

A

7 days

64
Q

What amount should amikacin trough dose not exceed in multiple dosing regime?

A

pre-dose (‘trough’) concentration should be less than 10 mg/litre.

65
Q

What amount should amikacin trough dose not exceed in OD dosing regime?

A

pre-dose (‘trough’) concentration should be less than 5 mg/litre.

PRE-REG-Thuri (44 decks)

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