INFECTIONS - MACROLIDES, PENICILLINS + CEPHALOSPORINS, CARBAPENEMS + MONOBACTAMS

Question 1

MOA of Macrolides?

Answer 1

Similar to penicillins

Prevent protein synthesis by binding to 50s subunit of ribosome (bacteriostatic)

Question 2

Spectrum of Macrolides?

Answer 2

Broad

Question 3

List 3 drugs within macrolide class?

Answer 3

Azithromycin

Clarithromycin

Erythromycin

Question 4

What are 5 cases/conditions macrolides can be used for?

Answer 4

RIT

Chlamydia

If patient has penicillin allergy

H pylori

Skin + soft tissue infections

Question 5

What Macrolide is given ONCE DAILY?

Answer 5

Azithromycin

Question 6

What Macrolide is given twice daily?

Answer 6

Clarithromycin

Question 7

What macrolide is safe in pregnancy?

Answer 7

Erythromycin

Question 8

What are 4 SEs of macrolides?

Answer 8

GI disturbances

Taste disturbances + tongue discolouration

QT prolongation

hepatotoxicity

Question 9

What SE happens in large doses of macrolide uses?

Answer 9

Ototoxicity

Question 10

What is an MHRA warning linked to erythromycin risk?

Answer 10

Risk of QT prolongation + Cardiotoxicity.

Report any signs of fainting, dizziness, dyspnoea, heart palpitations.

Question 11

What macrolide is taken before food?

Answer 11

Azithromycin

Question 12

What macrolide is taken after food?

Answer 12

Clarithromycin

Question 13

What 2 macrolides cannot be taken with indigestion meds?

Answer 13

Azithromycin + erythromycin

Question 14

Are erythromycin + clarithromycin enzyme inhibitors or inducers?

Answer 14

Inhibitors

Question 15

What is a caution of macrolides?

Answer 15

Myasthenia gravis

Question 16

What is the interaction between macrolides + statins?

Answer 16

Myopathy - stop course duration of statin then continue.

Question 17

What is the interaction between warfarin + macrolides?

Answer 17

Bleeding risk

Question 18

What is an MHRA warning linked to erythromycin + rivaroxaban?

Answer 18

Increased risk of bleeding

Question 19

What 9 drugs interact with macrolides to increase QT prolongation?

Answer 19

Antipsychotics

Anti-arrhythmics e.g. amiodarone, sotalol

SSRIs

TCA

domperidone

Lithium

Methadone

Quinolone

5HT3 antagonists

Question 20

What 4 drugs can interact with macrolides, cause hypokalaemia + increase risk of torsade de pointes?

Answer 20

B2 agonist,

Corticosteroids

Loop + thiazide diuretics

Theophylline

Question 21

MOA of penicillins?

Answer 21

Prevent peptidoglycan cross-linking in bacterial cell walls

Bactericidal

Question 22

Are penicillins broad or narrow?

Answer 22

Both

Question 23

What are 2 broad spectrum penicillins?

Answer 23

Amoxicillin

Ampicillin

Question 24

How many times is amoxicillin given in a day?

Answer 24

TDS

Question 25

How is amipicillin given?

Answer 25

Before food Taken QDS- high resistance

Question 26

Which broad spectrum penicillin has high resistance?

Answer 26

amipicillin

Question 27

List 2 narrow spectrum penicillin abxs?

Answer 27

Benzylpenicillin (G) Phenoxymethypenicillin (V)

Question 28

Which penicillin is given parenterally only?

Answer 28

Benzylpenicillin (G) - not GI acid stable

Question 29

What are 2 penicillins that are antipseudomonal + for serious infections?

Answer 29

Piperacillin (parenteral) Ticarcillin (parenteral)

Question 30

What is flucloxacillin used for?

Answer 30

Staph infections

Question 31

How to take flucloxacillin?

Answer 31

Before food on empty stomach or 2 hours after food QDS

Question 32

What is a rare SE of flucloxacillin?

Answer 32

Cholestatic jaundice - hepatic disorders

Question 33

What condition can penicillins not treat?

Answer 33

CNS infections -penetration into the cerebrospinal fluid is poor except when the meninges are inflamed

Question 34

What CNS condition can penicillins treat?

Answer 34

Meningitis

Question 35

What are 5 indications of penicillins?

Answer 35

RTI H. pylori Otitis Media Oral infection UTI

Question 36

Why are sore throats not treated with penicillin?

Answer 36

Bacteria produces beta-lactamases which inactivate antibiotic?

Question 37

What is co-amoxiclav?

Answer 37

Amoxicillin + clavulanic acid

Question 38

What SE does co-amoxiclav cause?

Answer 38

Cholestatic jaundice - if treatment over 14 days especially.

Question 39

What is penicillin dose in 1-11 months?

Answer 39

125mg TDS

Question 40

What is penicillin dose in 1-4 years?

Answer 40

250mg TDS

Question 41

What is penicillin dose in adults?

Answer 41

500- 1000mg TDS

Question 42

What are 2 SEs of penicillins?

Answer 42

Antibiotic associated colitis - broad spectrum Penicillin allergy

Question 43

What are 3 true allergy symtpoms?

Answer 43

Anaphylaxis Urticaria immediate rash

Question 44

What symptoms to abx may mean maybe not allergic?

Answer 44

minor rash after 72 hrs (can use penicillin for serious infections)

Question 45

What route are penicillins NOT given by?

Answer 45

Intrathecally

Question 46

What drug causes bleeding with penicillins?

Answer 46

Warfarin

Question 47

What drug toxicity happens when given with penicillins?

Answer 47

methotrexate toxicity

Question 48

What 2 penicillins are more likely to cause hepatotoxicity?

Answer 48

Co-amoxiclav Flucloxacillin

Question 49

What other drug classes can interact with penicillins to increase risk of hepatotoxicity?

Answer 49

Anti epileptics Anti fungals Methotrexate Statins Sulfasalazine Tetracycline

Question 50

MOA of cephalosporin?

Answer 50

It is also beta lactam group prevent peptidoglycan cross linking in bacterial cell wall bactericidal

Question 51

Spectrum of cephalosporin?

Answer 51

Broad

Question 52

What are 2 indications of cephalosporin?

Answer 52

UTI + RTI - serious infections

Question 53

How many groups of cephalasporin?

Answer 53

1-5 generations

Question 54

List 3 gen 1 cephalasporins? (fal, fad, frad)

Answer 54

Cefalexin Cefadroxil (BD- longest name so more times) Cefradine

Question 55

List 3 2nd gen cephalosporins?

Answer 55

Cefuroxime Cefoxitin Cefaclor

Question 56

What 2nd gen cephalosporins has a SE that is protracted skin reactions?

Answer 56

Cefaclor

Question 57

What 2nd gen cephalosporin is taken after food?

Answer 57

Cefuroxime

Question 58

List 4 3rd gen cephalosporins? (IME)

Answer 58

Cefixime * Cefotaxime Ceftazidime Ceftriaxone

Question 59

Which 3rd gen cephalosporin is the only oral one?

Answer 59

Cefixime

Question 60

List 1 4rd gen cephalosporins? (P)

Answer 60

Cefepime

Question 61

List 2 5rd gen cephalosporins? (O)

Answer 61

Cefatoline Ceftobiprole

Question 62

Which cephalosporin is used for menigitis?

Answer 62

cefotaxime

Question 63

What are 2 SEs of cephalosporins?

Answer 63

Antibiotic associated colitis (3rd + 4th). Cross sensitivity - penicillin allergy

Question 64

What generation cephalosporin to give if patient has penicillin allergy + needs this class?

Answer 64

3rd gen or cefuroxime can be used

Question 65

What 5 cephalosporins to avoid if patient has penicillin allergy + needs this class?

Answer 65

cefaclor cefadroxil cefalexin cefradine, + ceftaroline fosamil

Question 66

What 6 nephrotoxic drugs interact with cephalosporins + increase risk of nephrotoxicity?

Answer 66

Aminoglycosides Ciclosporin Glycopeptides Mtx NSAIDs Tacrolimus

Question 67

What does cephalosporin interact with to cause bleeding?

Answer 67

Warfarin -big

Question 68

What are carbapenams?

Answer 68

beta-lactam antibacterials broad-spectrum activity - gram + ve and -ve and anaerobes

Question 69

What 4 indications are Imipenem and meropenem used for?

Answer 69

HAP intra-abdominal infections, skin soft-tissue infections, UTIs

Question 70

Which Carbapenem is not active against Pseudomonas unlike others?

Answer 70

Ertapenem

Question 71

Why is Imipenem given with cilastatin?

Answer 71

Imipenem is partially inactivated in the kidney by enzymatic activity. Giving it with enzyme blocker stops it from being renally metabolised

Question 72

Which 2 carbapenems are stable against the kidney enzymes + are not broken down?

Answer 72

Meropenem and ertapenem

Question 73

Which Carbapenem has less of a seizure inducing potential?

Answer 73

Meropenem has less seizure-inducing potential and can be used to treat central nervous system infection.

Question 74

Why are broad spectrum abx not given for glandular fever?

Answer 74

Maculopapular rashes

Question 75

Why are penicillins NEVER given intrathecally?

Answer 75

Can cause encephalopathy

Question 76

When to reduce flucloxicillin dose?

Answer 76

Reduce dose or increase dose interval if creatinine clearance less than 10 mL/minute (consult product literature)