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PRE-REG own > Infections- Antibiotics > Flashcards

Infections- Antibiotics Flashcards

1
Q

Which antibiotic is most associated with causing antibiotic associated colitis

A

Clindamycin

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2
Q

What are key side effects of linezolid? (gram positive)

A

Optic neuropathy - visual disorders

blood disorders

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3
Q

What are key interactions of linezolid?

A

SSRI/TCA/MAOI - hypertensive crisis

sympathomimetics, dopaminergics, opioids, 5-HT1 agonists

Tyramine rich foods

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4
Q

Can chloramphenicol be used in pregnancy? why?

A

No - C/I - causes grey baby syndrome, 3rd trimester

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5
Q

What is metronidazole active against and what does it treat

A

Anaerobic and protozoa
- anaerobics e.g. dental, Abx associated colitis, BV, H.pylori, rosacea
Protozoa - vaginal trichomoniasis, giardiasis

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6
Q

What are common side effects of metronidazole?

A

Furred tongue
Oral mucositis
taste disturbance
GI disturbance

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7
Q

What colour can nitrofurantoin turn urine?

A

Yellow/brown

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8
Q

2 counselling points for nitrofurantoin

A

With food

Colours urine yellow/brown

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9
Q

what is the renal cut off for nitrofurantoin?

A

<45

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10
Q

what are aminoglycosides active against

A

Gram -ve

P. aureiginosa

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11
Q

What route are aminoglycosides given?

A

IV in systemic infections-not absorbed by gut

Also have tobramycin via inhaler (pseudomonal in CF)

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12
Q

When would you avoid a once daily dosing regimen for gentamicin?

A

Renal impairment <20
HACEK or gram positive endocarditis
burns

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13
Q

When would you monitor plasma levels of gent on a multiple daily dose regimen?

A

After 3-4 doses

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14
Q

For general multiple daily dose use - what are plasma targets for gent?

A

Post dose peak = 5-10mg/mL

Pre dose trough = <2mg/mL

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15
Q

For endocarditis, what are gentamicin target levels

A

post dose peak 3-5mg/mL

pre dose trough <1mg/mL

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16
Q

In renal impairment - what adjustment is made for gentamicin

A 
Increased interval 
(in severe e.g. <30 - reduce dose, avoid once daily regimens in <20)
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17
Q

What is an MHRA warning for gentamicin

A

Risks histamine related adverse reactions with some batches - monitor for histamine reactions

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18
Q

In what situation is oral vancomycin favoured over IV?

A

C.diff - want it to stay in the intestine/bowel

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19
Q

what are target levels for vancomycin

A

Pre dose trough 10-20

15-20 in endocarditis

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20
Q

What are common side effects of vancomycin

A 
Red man syndrome if IV too quick 
Nephrotoxicity 
Blood dysgrasias
skin and SJS 
Ototoxicity 
Thromboplebitis - pain/inflammation at site
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21
Q

what is an important side effect of tetracyclines

A

benign intracranial hypertension - stop if headache/visual disturbances

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22
Q

What are contraindications of tetacyclines

A

children <12

Pregnancy ^ BF

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23
Q

What are the 3 key areas of tetracyclines counselling

A

Photosensitivity
decreased absorption
oesophageal iritation

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24
Q

Which tetracyclines cause photosensitivity?

A

DD

  • doxyclcine
  • demeclocycline
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25
Q

Which tetracyclines have decreased absorption when given with antacids containing al/ca/mg/zinc and also must avoid milk? what is the cautionary label?

A

DOT

  • demeclocycline
  • oxytetracycline
  • tetracycline

Label: do not take indigestion remedies/antacids containing aluminium, magnesium, calcium or zinc 2 hours before or after taking abx

chelates with the calcium/milks so no absorption

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26
Q

Which tetracyclines cause oesophageal irritation? and what is the counsselling point?

A

DMT:

  • doxycycline
  • minocycline
  • tetracycline

Swallow whole with plenty of fluid during meals whilst sitting or standing

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27
Q

What are key side effects of quinolone abx?

A
  • seizures
  • tendon damage
  • QT prolongation
  • joint diseases/arthritis-avoided in preg/child
  • psychiatric reactions
  • hypersensitivity e.g. SJs
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28
Q

Are quinolones active against MRSA?

A

NO - resistance

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29
Q

What medications would you avoid with quinolone abx? (interaction)

A
  • other drugs that prolong QT e.g. SSRIs, amiodarone, macrolides, antipsychotics
  • Theophylline - risk of theophylline toxicity, seizures S/E of both
  • Drugs lowering seizure threshold e.g. NSAIDS
  • also note that quinolones (ciprofloxacin) is an enzyme inhibitor
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30
Q

What are 3 counselling points for quinolone abx

A
  • driving - impaired performance/drowsy
  • protect skin from sunlight for ofloxacin
  • leave a 2 hour gap before or after taking quinolone for antacids containing zinc/iron
  • avoid milk/dairy for cipro/nor
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31
Q

Which macrolide has more GI effects, clari or ery?

A

Erythromycin

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32
Q

What is the dose of azithromycin OTC for chlamydia?

A

1g single dose

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33
Q

What are key side effects of macrolides

A 
GI effects (esp Ery)
QT prolongation
Hepatotoxicity
Ototoxicity at high dose

Clari: - taste disturbance, tooth and tongue discolouration

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34
Q

What are counselling points for macrolides

A

take with/after food

Clari: taste disturbance/tooth/tongue discolouration

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35
Q

What is the interaction of macrolides and statins and how to overcome?

A

Macrolids enzyme inhibitors, (ery/clari) - increeased myopathy risk - hold statin during abx coursee

36
Q

What is a counselling point for clarithromycin

A

May cause taste disturbance, toothe and tongue discoloration

37
Q

What antibiotics have cross sensitivity with penicillin allergy

A

Carbapenems
cephalosporins
monobactams

38
Q

What penicillins are narrow spectrum

A 
Pen G (benzyl)
Pen V (phenoxy)
39
Q

Can penicillins be used in CNS infections? what is an exception?

A

No because they poorly penetrate cerebospinal fluid. Only exception is use in meningitis because meninges are inflamed so can pass through

40
Q

What pencillins have anti-pseudomonal activity

A

Tazozin - piperacillin

Ticaricillin (with clauvulanic acid)

41
Q

what penicillin is penicillinase resistant

A

Flucloxacillin

42
Q

What is a ‘true’ penicillin allergy?

A

Immediate rash
Anaphylaxis
hives

43
Q

What is considered mild allergy/may not be allergic? can penicillins be used?

A

Minor rash/small/not itchy/non confluent, rash develops after 72hrs
Do not withhold penciillin for serious infections

44
Q

can penicillins be given intrathecally?

A

No - can cause encephalopathy /cerebral irritation

45
Q

what penicillins are broad spectrum

A

Amoxicillin

ampicillin

46
Q

What is a common issue/SE with broad spectrum abx

A

abx associated colitis

47
Q

Why would you not give broad spectrum abx blindly for sore throats?

A

Can cause maculopapular rash if use in glandular fever (epstein barr)

48
Q

Why is ampicillin not used as much

A

high resistance

49
Q

Uses of ampicillin?

A

UTI, otitis media, acute COPD

50
Q

What is a counselling point for ampicillin

A

Before food because absorption reduced by food

51
Q

What is a side effect of amoxicillin? What is the max treatment duration because of this?

A

Cholestatic jaundice - treatment shouldn’t really exceed 14days

52
Q

What is a main use of benzylpenicillin pen G? and what route is it used?

A

Meningitis

IV /parenteral only - not gastric acid stable and no gut absorption

53
Q

What is phenoxymethylpenicillin used for

A

Resp tract infections in children e.g. strep throat, tonsillitis, sinusitis

oral

54
Q

What indications does flucloxacillin have

A

Penicillin resistant staphycloccoi but NOT MRSA

  • skin infections
  • impetigo
  • cellulitis
  • diabetic foot/ulcers
55
Q

name key side effects of flucloxacillin and when they present

A

Cholestatic jaundice and hepatitis = presenting up to 2 months after treatment

56
Q

What are risk factors for developing cholestatic jaundice and hepatitis with use of flucloxacillin?

A

Increased age

>14 days use

57
Q

cautionary label for flucloxacillin

A

Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food

58
Q

What are 1st generation cephalosporins

A

CEFA

  • cefalexin
  • cefadroxil
  • cefradine
59
Q

What are 2nd generation cephalosporins

A

cefuroxime

cefaclor d

60
Q

What are 3rd generation cephalosporins

A

Contains T except cefixime

  • Cefixime
  • ceftriaxone
  • ceftotaxime
  • ceftazidine
61
Q

What is the activity of 3rd gen cephalosporins

A

Greater activity against gram negative

less active against positive e.g. s.aureus

62
Q

Which cephaloxposin is active against pseudomonas

A

Ceftazidine

and 4th generatiton Cefepimee

63
Q

What is the dosing for ceftriaxone and what does it treat

A

OD (long half life)

  • gonorohoea
  • meningitis
  • sepsis
64
Q

which cephalosporin is active against MRSA

A

5th generation Ceftaroline

65
Q

which cephalosporins is abx associated colitis more common with?

A

2nd and 3rd gen

66
Q

What situations can cephalosporins be used in UTI?

A

pregnancy

2nd line

67
Q

Are carbapenems active against pseudomonas?

A

Yes - imipenem and meropenem

not active against MRSA or enterococcus

68
Q

What are carbopenems used for?

A

Severe hospital acquired infections and polymicrobial infections e.g. sepsis, HAP, intra-abdominal infections, skin and soft tissue, complicated UTI

69
Q

What is ertapenem used for?

A

Abdominal and gynaecological infections
CAP (but not against atypical resp pathogeens or penicillin resistant pneumoccoci)
(no pseudomonas)

70
Q

What is the issue with imipenem

A

Partially inactivated in kidney by enzymatic activity - must be administered in combination with cilastatin (enzyme inhibitor to block renal metabolism)

71
Q

Does meropenem have less seizure inducing potential?

A

yes

72
Q

which antimalarials are OTC

A

malarone -atovaquone and proguanil
chloroquine and proguanil
mefloquine
doxycycline

73
Q

What are the effects of mefloquine

A

neuropsychiatric reactions - psychosis, suicidal ideation and suicide
also insomnia, anxiety, confusion
- need to stop and seek immediate medical attention
Contraindicated in history of depression or convulsions

Also causes dizziness/balance off-caution in driving

74
Q

if a journey requires 2 regimens for malaria prophylaxis what regimen is chosen

A

the one with the highest risk for whole journey

75
Q

What is the length of time before travel when need to start chloroquine and proguanil

A

1 week before

76
Q

what is the length of time before travel do treat with mefloquine for malaria prophylaxis and why

A

mefloquine stat 2-3 weeks before because of the risk of s/e e.g. neuropsychiatric - want to establish whether pt can tolerate

77
Q

What is the length of time the patient starts taking doxycycline for malaria prophylaxis before travel

A

2-3 days - good for urgent/last min

78
Q

What is the general length of time needed to take malaria prophylaxis after arriving home? what is the exception?

A

4 weeks after

Except for malarone which is 1 week after

79
Q

which patient groups would you advise against going to malaria countries

A

asplenic

pregnant

80
Q

Which antimalarials are avoided in epilepsy and what can be used

A

chloroquine
mefloquine
reduce seizures threshold

Use: doxycycline or malarone

81
Q

If a pregnant pt needs to go to malarial area what is used

A

Chloroquine and proguanil

plus 5mg folic acid with proguanil

82
Q

What are the antimalarial options in renal impairment

A

doxycycline or mefloquine

NOT proguanil, or malarone/chloro in <30

83
Q

If a patient is on warfarin but needs malaria prophylaxis what is the protocol

A

starting on it 2-3 weeks before to establish INR changes and ensue INR is stable before departure
Monitor INR before initiation, 7 days after and after completion

84
Q

What is a significant side effect of chloroquine

A

Ocular toxicity and eye problems

85
Q

If a patient presents with illness within 3months-1year of travel to malarial country, what is the most appt action?
Illness=fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness

A

Refer- potential malaria

86
Q

What is the standby emergency treatment of malaria e.g. if suspect that pt wont access medical care in 24hrs of fever onset?

A

Quinine-only if cannot access medical carer with written instructions
(note that a drug used for chemoprophylaxis should not be used for standby treatment for the same traveller)

PRE-REG own (35 decks)

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