Loads and loads and loads of drugs (GI sold separately) Flashcards
2 main classes of gram positive cocci
Staphyloccocus and streptococcus
How are streptococci differentiated
Haemolysis
How are staphylococcus differentiated
Coagulase test
Commonest cause of pneumonia
Streptococcus pneumoniae
Treatment for strep pneumoniae
Penicillin
2 main groups of alpha haemolytic streptococcus
Strep pneumoniae and Strep viridans
Common cause of endocarditis
Strep viridans
2 main groups of beta haemolytic streptococcus
Group A Strep and Group B strep
Most pathogenic strep
Group A strep (strep pyogenes)
Treatment for beta-haemolytic strep
Penicillin/amoxicillin
Examples of non-haemolytic strep
Enterococcus (faecalis and faecium)
Common cause of UTI’s
Enterococcus faecalis
Catalase positive cocci
Staphylococcus
Catalase negative cocci
Streptococcus
Coagulase positive organisms
Staph aureus
Coagulase negative organisms
All staph apart from staph aureus
Common cause of infected prosthetic heart valves and joints
Staph epidermidis (coagulase negative staph)
Treatment for coagulase negative staph
Vancomycin
Common cause of skin infections, abscesses, resp infections and food poisoning
Staph aureus
The most common cause of bacteraemia
Staph aureus
Treatment for staph aureus
Flucloxacillin
Treatment for MRSA
Co-trimoxazole and clindamycin
Gram negative cocci that causes bacterial meningitis
Neisseria meningitis
Gram negative cocci that causes gonorrhoea
Neisseria gonorrhoea
Gram negative cocci that look like E.coli when cultured
Coliforms
Common gut commensals
E.coli, klebsiella and enterococcus
Common gut pathogens
Verotoxin producing E.coli (E.coli 1057), shigella and salmonella
Treatment for coliform infection
Gentamycin
Examples of gram negative bacilli that are strict aerobes
Legionella (gram- bacilli)
pseudomonas (gram- bacilli)
Spiral/curved aerobic gram negative bacilli
Vibro cholera, campylobacter and H. pylori
Gram negative organism that commonly causes chest infections (esp in COPD)
Haemophilus influenza
Gram positive organism that commonly causes C. diff
Clostridium
Treatment for strict aerobes
Metronidazole
Treatment for TB
Rifampicin, isonazide, pyrazinamide and ethambutol
Causative organism of syphilis
Treponema pallidum
Cause of Lyme disease
Borrelia burgdorferi
Class of organisms that do not stain
Spirochaetes
Enzyme that is resistant to the early penicillins (like amoxicillin)
Beta-lactamase
Enzyme that is resistant to all penicillin, cephalosporins and carbapenems
Carbapenemase
Staph aureus that is resistant to flucloxacillin
MRSA
Antibiotics that work on the cell wall
Penicillin, cephalosporins and glycopeptides
Penicillin that is used for gram positive organisms
Flucloxacillin
Penicillin that is used for gram positive and gram negative organisms
Amoxicillin, co-amoxiclav, tazocin
Used first line for staph aureus
Flucloxacillin
Basically treats everything apart from pseudomonas and MRSA
Co-amoxiclav
Reserved for intensive care but can basically treat everything apart from MRSA
Tazocin
Only active against coliforms (gram negative organisms)
Temocillin
Broad spectrum antibiotics that are avoided in hospitals as they can cause C. diff
Cephalosporins
Examples of glycopeptides
Vancomycin and teicoplanin
Antibiotics that inhibit protein synthesis
Macrolides, tetracyclines and aminoglycosides
The only group of protein synthesis inhibiting antibiotics which are bacteriocidal
Aminoglycosides
Examples of macrolides
Erythromycin, clarithromycin and azithromycin
How are macrolides excreted
By the liver NOT the urine
Example of an aminoglycoside
Gentamicin
How must gentamicin be given
IV
Side effects of gentamycin
Kidney/renal damage, damage to CN VII causing deafness and dizziness
Antibiotics that work on bacterial DNA
Metronidazole, trimethoprim and fluoroquinolones
Used for pneumocystis jirovecii
Co-trimoxazole
Examples of fluoroquinolones. Note these are severely restricted in Tayside due to risk of C. diff
Ciprofloxacin and levofloxacin
Can cause tendonitis
Ciprofloxacin
Interacts with alcohol
Metronidazole
Antibiotics to avoid (the 4 C’s)
Ciprofloxacin, co-amoxiclav, cephalosporins and clindamycin
Treatment for mild/moderate CAP
IV/PO Amoxicillin (PO doxycycline if allergic)
Treatment for severe CAP
IV Co-amoxiclav + clarithromycin OR doxycycline PO
IV levofloxacin if allergic
Treatment for non-severe HAP
PO Amoxycillin and metronidazole
If penicillin allergic PO Co-trimoxazole + Metronidazole
Treatment for severe HAP
IV Amoxicillin + Metronidazole + Gentamicin
If penicillin allergic: IV Co-trimoxazole + Metronidazole +/- Gentamicin
Specific treatment for Staphylococcal Pneumonia
Flucloxicillin
If MRSA suspected add vancomycin
Specific treatment for Klebsiella Pneumonia
Cefotaxime or Imipenem
Specific treatment for Pseudomonas Pneumonia
Anti-pseudomonal penicillin, cerftazidime, meropenum, or ciprofloxacin + aminoglycoside
Specific treatment for Mycoplasma Pneumonia
Clarithromycin or Tetracycline or Fluroquinolone (e.g. ciprofloxacin or norfloxacin)
Specific treatment for Legionella Pneumonia
Clarithromycin + rifampicin OR
Fluoroquinolone (e.g. cirporfloxin) for 2-3 weeks
Specific treatment for Chlamydophilia Psittaci Pneumonia
Tetracycline or Clarithromycin
Specific treatment for Viral Pneumonia
Ciprofloxacin and Co-Amoxiclav.
Prophylactically oseltamivir is given
Specific treatment for Pneumocystis Pneumonia (PCP)
High dose co-trimoxazole or pentamidine.
Steroids are beneficial if severe hypoxaemia. Prophylaxis often used.
Treatment for Native valve (Subacute) Endocarditis (enterococcus)
IV Amoxicillin + Gentamicin, b.d.
Treatment for Native valve severe sepsis (Acute) Endocarditis (staph aureus)
IV Flucloxacillin
Native valve severe sepsis + risk factors for resistant pathogens Endocarditis
Vancomycin IV + Meropenem IV
Explain CURB 65 Score
Confusion Urea >7 mmol/L Resp. Rate ≥ 30/min Bp <90mmHg (systolic) or ≤60mmHg (diastolic) 65 Age ≥65 1 point for each criteria 0-2 = Mild/Moderate CAP 3-5 = Severe CAP
Mechanism of Penicillins, Glycopeptides and Cephalosporins
Inhibit cell wall formation
Mechanism of Macrolides (e.g. erythromycin), Aminoglycosides and Tetracyclines
Inhibit protein synthesis
Mechanism of Rifampicin
Inhibit RNA synthesis
Gram+ organisms stain…
Purple
Stain well due to thick peptidoglycan layer
Gram- organisms stain…
Pink
Thinner peptidoglycan layer doesn’t retain stain well
Endotoxin is produced by…
Gram-
Part of cell wall
Exotoxin is produced by…
Gram+
Exported from cell
Gram+ cocci in chains are?
Strep
The 5 methods of spread of infection are…
Inhalation, Ingestion, Inoculation, mother to Infant, Intercourse
Viruses contain RNA or DNA, never both. True/False?
True
Size of their capsid (protein coat) limits space
Bactericidal antibiotics inhibit cell growth. True/False?
False
Kill bacteria directly - bacteriostatic inhibits cell growth
Vancomycin is part of which family of antibiotics?
Glycopeptides
Penicillins are bactericidal/bacteriostatic, safe/not safe in pregnancy, excreted via kidneys/urine/liver
Bactericidal, safe in pregnancy, kidneys
Cephalosporins are bactericidal/bacteriostatic, safe/not safe in pregnancy, excreted via kidneys/urine/liver
Bactericidal, safe in pregnancy, kidneys + urine
Gentamicin [aminoglycoside] is bactericidal/bacteriostatic, safe/not safe in pregnancy, excreted via kidneys/urine/liver
Both bacteriostatic + bactericidal, not safe in pregnancy, urine
Metronidazole is bactericidal/bacteriostatic, safe/not safe in pregnancy, treats aerobes/anaerobes
Bactericidal, safe in pregnancy, anaerobes (Clostridium and Bacteroides)
Treatment of non-severe C.Difficile
Metronidazole PO 10days
Treatment of severe C.Difficile
Vancomycin PO/NG (10 days)
+/- IV Metronidazole
What is the main treatment for CF?
if Staph. aureus - flucloxacillin (PO) and septrin (PO)
if pseudomonas - azithromycin (PO), nebuliser colomycin and nebuliser tobramycin
Creon for pancreas
laxido/ gastrogaffin if constipation
What is the side effect of Ivacaftor?
Can’t eat grapefruit
What is the treatment for the flu?
oseltamivir/zanamivir
What vaccine for the flu is given to which group of people (live/killed)?
Killed - adults that need it (e.g. health care workers and elderly/ asthmatics
Live - for children aged 2-5 and NOW all primary school children are offered
What treatment is given to those with CAP caused by an atypical bacteria?
Tetracycline and Macrolides
What drugs do you NOT give to people with bronchiolitis?
salbutamol, adrenaline, antibiotics, ipratropium, corticosteroids, montelukast or saline
What treatment do you give to those with bronchiolitis?
O2 (if below 92%), consider CPAP
What treatment should be given to those having an exacerbation of COPD?
amoxicillin 500mg (5 days), doxycycline if allergic to penicillin 200mg
What is the treatment for whooping cough?
less than a month - clarythromycin
more than a month - clarythromycin and azithromycin
if pregnant - erythromycin
What treatment should be given to those with Legionnaires disease?
clarythromycin, erythromycin and quinolones (levofloxacin)
What is the treatment for aspergilloma?
Amphoteric B, Voriconazole and surgery
What is the treatment for TB?
Two months of Rifampicin, isoniazid, pyrazinamide and ethambutol
A further 4 months of rifampicin and isoniazid
“ 2RIPE 4RI”
What are the side effects of the treatments for TB?
rifampicin - orange tears n urine
isoniazid - peripheral neuropathy
pyrazinamide - joint pain, gout
ethambutol - optic neuritis
What is the initial treatment for those diagnosed with asthma?
SABA (IH) PRN
If the initial treatment for asthma isn’t working, what the treatment can be given?
ICS - beclometasone
LABA - only used in combination with ICS - salmeterol
CystLT receptor antagonist - montelukast
cromone - sodium cromoglicate
xanthine - used in combination with SABA/LABA and ICS - theophylline
What is ivabradine?
A selective HCN channel blocker that slows HR in angina
When is dobutamine used as a treatment?
During acute but possibly reversible heart failure
What do B-blockers do?
Propanolol, atenolol, bisoprolol - reduce HR and force - can cause bradycardia or bronchospasms( yeh even cardio selective ones according to passtest)
When are B-blockers used?
to decrease tachycardia, AF, treat angina, heart failure and hypertension
What are the side effects of B-blockers?
bronchospasm bradycardia (heart block in those with coronary disease) masks a hypo fatigue cold extremities
What is atropine?
Muscarinic receptor antagonist - increases HR
Why is atropine used clinically?
For patients with SEVERE bradycardia
What should you be careful of when using atropine?
Always give in 600mg or more doses because if given in lower doses, can cause more bradycardia (lol how unlucky could you get)
What is digoxin used for?
Heart failure
What are the side effects of digoxin?
Can cause tachycardia, an ectopic beat, hypokalemia, heart block, nausea, vomiting, diarrhoea, disturbances of colour vision, tender breasts
Basically, it’s a riot
What is levosimendan?
A calcium- sensitiser - causes vasodilation
When are diuretics used?
Hypertension (mild - thiazide) Heart failure (strong - Loop)
Loop diuretics side effects include
HYPO - everything basically
What is an example of a non selective b blocker and what is it used for?
propanolol
thyrotoxicosis
When are anti platelets used?
angina
acute MI
CVA/TIA
What is an example of an antiplatelet?
aspirin
clopidogrel
What are the side effects of anti platelets?
haemorrhage
peptic ulcer
aspirin sensitivity
What are examples of anticoagulants?
Heparin IV Warfarin IV (blocks clotting factors 2,7,9,10)
What is the treatment for an acute MI?
MONAC moprhine = anti emetic oxygen nitrates (GTN) aspirin clopidogrel
What is used for an acute phase SVT?
vagal manoeuvres
IV adenosine
IV verapamil
What drug can control rhythm in AF?
K+ channel blockers
amiodarone, soltalol
What is the treatment for post MI?
SABA statin (simvastatin) ACEI/ARB (lisinopril/losasartan) B blocker (atenolol) Aspirin
What drug can control AF rate?
b blocker - NOT sotalol
Rate limiting channel blockers - verapamil, diltiazem
digoxin for those that don’t got off their arse (that was flannigan not me, i’m not a dick to ppl with AF)
What is the treatment for chronic SVT?
B blockers
Calcium channel antagonist
Ablation
What is the treatment of sinus bradycardia?
Atropine
Pacing if haemodynamic compromise
What is the treatment pathway for angina?
- B blocker/ calcium channel blocker
- Can add long acting nitrate, ivabradine, nicorandil
then ACEI
statins
What is the treatment for Ventricular fibrillation?
CRP
Defib
after 3rd shock - IV adrenaline
-IV amiodarone
What is the treatment of Ventricular tachycardia?
DCCV catheterisation electrolyte correction amiodarone lidocaine
B blockers are initial therapy
What are the side effects of heparin?
osteoporosis
haemorrhage
hypoaldosteronism
What do aldosterone antagonists do and give an example?
gets rid of excess water and Na retention (RAAS inhibitor), increases potassium levels, lowers high BP, treats heart failure
- spironolactone
What are side effects of spironolactone?
gynecomastia (lol)
hyperkalaemia
What does ezetimibe do?
reduces the absorption of cholesterol to decrease LDL
Who can ezetimibe not be given to?
breast feeding females (females who are breast feeding their kids not ones who are feeding off breasts)
Name the 4 classes of Anti-Hypertensive drugs
Diuretics, Beta-blockers, Ca2+ Channel Antagonists and Vasodilators
Name the two types of Diuretics and their relative strength
Thiazide mild
Loop strong
Name the two types of Beta Blockers and the difference between them
Cardioselective - Only block B1 receptors
Non -selective - Block B1 and B2 receptors
Name the 3 types of Vasodilators
Alpha-Blockers a1 adrenoreceptor antagonists
ACE inhibitors
Angiotensin receptor blockers
Give an example of a Loop diuretic
Furosemide
Give an example of a Cardioselective beta blocker
Atenolol
Give an example of a Non-selective beta blocker
propanolol
Give an example of a Dihydropyridine Ca2+ Channel antagonist
Amlodipine
Give examples of Rate limiting calcium antagonists (Ca2+ channel antagonists)
Verapamil
Diltiazem
Give examples of Alpha Blocker vasodilators
Prazosin
Doxazosin
Give an example of an ACE inhibitor vasodilator
Ramipril
Give an example of an Angiotensin receptor blocker vasodilator
Losartan
Name the monoclonal antibody against IgE?
olamizumab (yeh that weird one that you can’t pronounce)
What is the monoclonal antibody against IL-5?
mepolizumab
What treatment is used for those who present with an acute asthma attack?
O2 (high flow) Salbutamol nebulised Hydrocortisol (or prednisolone) Ipratropium Magnesium sulphate Theophylline Anaesthetist
What is the treatment for those suffering an acute exacerbation of COPD?
What is the treatment for those suffering an acute exacerbation of COPD?
What is the recommended treatment for COPD?
A LABA/LAMA combination inhaler
and stop smoking so you dont die as soon
What is an example of an Ultra - LABA?
Indacaterol (cos it’s shorter acting than salmeterol)
What other drugs can be used in the treatment for COPD?
Rofumilast - PDE4 inhibitor
What is the main drug given to those diagnosed with rhinitis?
Glucocorticoids - beclometasone, prednisolone
What other treatments can be given to those with rhinitis?
Anti-histamines - Loratadine, Fexofenadine, Cetirizine
SAMA - Ipratropium
Cromones - sodium cromoglicate
CystLT - montelukast
Vasoconstrictors - oxymetazoline
(if ur keen, take a look at rebecca’s Resp cards she loves rhinitis)
Mechanism of diuretics
Promote Na+ and water excretion from the kidneys by inhibiting reabsorption in the loop of Henle or distal tubule
What is the mechanism of cardioselective beta blockers
Only block β1 receptors – β1 adrenoceptors stimulate Gs - ↑ cAMP, ↑PKa - ↑CICR VIA RyR2, ↑Contractility
What is the mechanism of non-selective beta blockers
Block β1 & β2 receptors – β2 adrenoceptors cause vasodilation of the coronary arteries and ↑ HR
What is the mechanism of Alpha Blocker vasodilators
Block vascular α1-adrenoceptors - ↓ TPR and MABP
What is the mechanism of Ace inhibitors
Block the conversion of angiotensin I – angiotensin II
What is the mechanism of Angiotensin Receptor Blockers
AT1 receptor antagonist – competitively blocks the agonist action of angiotensin II at AT1 receptors – Venous dilatation (↓ preload) and arteriolar dilatation (↓ afterload and ↓TPR), ↓ MABP
Name the 4 types of Anti- Anginal drugs
Beta Blockers Ca2+ Channel Antagonists Nitrates Potassium channel openers
Give 2 examples of Nitrates
Glyceryl trinitrate Spray (GTN Spray) Isosorbide mononitrate
Give 2 examples of Potassium channel openers
Nicorandil Ivabradine
What is the mechanism of Nitrates
Relax all types of smooth muscle, via their metabolism to nitric oxide. Small doses – vasorelaxation - ↓ CVP (preload) reduces SV Higher doses - ↓ MAP - ↓ afterload ↑ Coronary blood flow. In angina, there is no overall increase, but blood is directed towards the ischaemic zone – collateral arterioles dilated»_space; ↓myocardial O₂ req., ↓ afterload, ↑Ischaemic perfusion
How you doing?
Good shift for making it this far, just checking up on you, click the wee blue comment symbol and lemme know how ur feeling
What conditions can Potassium channel blockers be used for
Nicorandil - Stable Angina Ivabradine - Chronic Heart Failure, Angina Pectoralis
What are the side effects of nitrates
Repeated Administration may be associated with diminished tolerance. Build in ‘nitrate low’ periods. Postural hypotension Headaches leave 8hrs of the day nitrate free
What are the side effects of Potassium channel openers
Hypovolaemia – low systolic BP Palpitations, Weakness
Name 2 statins
Simvastatin
Atorvastatin
Name 2 fibrates
Bezafibrate
Gemfibrozil
Name 3 Bile acid Binding Resins
Colestyramine
Colestipol
Colesevelam
Name an Ezetimibe
Ezetimibe (just making sure ur paying attention and not just boosting ur flashcard number)
What is the mechanism of statins
Block HMG-CoA reductase (competitive inhibitors) – Reduction of LDL production in Liver
Surface expression of the LDL receptors increases → increased clearance of LDL in the liver.
↓ inflammation, reversal of endothelial dysfunction, ↓ thrombosis, stabilisation of atherosclerotic plaques
What conditions are statins used for
Hypercholesterolaemia Diabetes Angina/MI CVA/TIA High risk of MA & CVA
What conditions are fibrates used for
Low HDL cholesterol
Hypertriglyceridaemia – first line treatment
What are the side effects of statins
Myopathy
Rhabdomyolysis
sreenal failure lol
Should not be prescribed to pregnant → cholesterol needed for foetus development
What are the side effects of fibrates
May cause myositis – advised combining with statins.
When can statins not be used
Ineffective in Homozygous familial hypercholesterolaemia, where LDL receptors are lacking
What is the mechanism of bile acid binding resins
Cause the excretion of bile salts resulting in more cholesterol to be converted to bile salts by interrupting enterohepatic recycling
↓ absorption pf triglycerides, ↑ LDL receptor expression
What are the side effects of bile acid binding resins
G.I. tract irritation
Name the 4 types of Anti-Arrhythmic drugs
Class I Class II Class III Class IV
you’ve nailed it, ur basically a doctor now
Name the 3 types of Class I Anti-Arrhythmic drugs
IA IB IC
congrats ur now a consultant
Give an example of a Class IA drug
Disopyramide
Give an example of a Class IB drug
Lignocaine
Give an example of a Class IC drug
Flecainide
Give an example of a Class II drug
Metoprolol
Give an example of a Class III drug
Amiodarone
Give an example of a Class IV drug
Verapamil
How to remember mechanisms of the 4 classes of anti arrhythmic drugs
Seumy Barker Pulls Cammy
Sodium, Beta, Potassium, Calcium
1, 2, 3, 4
Name 3 types of inotropic drugs
Digoxin
Calcium sensitizers
Beta-Adrenoceptor agonists
Name the 2 types of Digoxin
Digoxin I
Digoxin II
mate, ur basically a surgeon now
Name 2 Beta-Adrenoceptors
Adrenaline
Dobutamine - IV
What is the mechanism of Digoxin I
Blocks atrial-ventricular conduction – produces an AV conduction delay. Blocks the Sarcolemma ATPase - Na+/K+ATPase blocked, ↑[Na]I and ↓Vm, ↓Na+/Ca2+ exchange and ↑[Ca2+]I, ↑ storage of Ca2+ in SR, ↑CICR; ↑contractility (Increases contractility of the heart)
What is the mechanism of Digoxin II
Increases ventricular irritability which produces ventricular arrhythmias – always bad, narrow therapeutic index BAD BAD BAD BAD