Medicines 9 - Infections Flashcards
What antibiotics can interact with alcohol
completely avoid drinking alcohol when taking:
metronidazole - an antibiotic sometimes used to clear dental, or vaginal, infections, or to clear infected leg ulcers, or pressure sores
tinidazole - an antibiotic sometimes used to treat many of the same infections as metronidazole, as well as to help clear bacteria called Helicobacter pylori (H pylori) from the gut.
co-trimoxazole - drinking alcohol while taking co-trimoxazole can occasionally cause a similar reaction to that of metronidazole or tinidazole, although this is very rare. Drinking alcohol in moderation does not normally cause a problem
linezolid - linezolid can interact with un-distilled (fermented) alcoholic drinks, such as wine, beer, sherry and lager
doxycycline - this is known to interact with alcohol and in people with a history of chronic alcohol consumption the effectiveness of doxyclycline may be reduced. It should not be taken by people with liver problems
erythromycin - there is some evidence or a minor interaction with alcohol that may slightly reduce or delay the effect of erythromycin
What is flucloxacillin used to treat?
FLUCLOXACILLIN - Penicillin-resistant Staphylococcal infections except MRSA
e.g. skin infections: impetigo, cellulitis.
What is a key side effects to note with flucloxacillin
CHOLESTATIC JAUNDICE AND HEPATITIS
Up to two months after treatment.
Increasing age and >14 days treatment increases risk.
What are the different spectrums of penicillins?
NARROW-SPECTRUM (beta-lactamase sensitive)
- BENZYLPENICILLIN “PEN G”
* PHENOXYMETHYLPENICILLIN “PEN V”
BROAD-SPECTRUM (inactivated by beta-lactamases)
* AMPICILLIN
- AMOXICILLIN
PENICILLINASE-RESISTANT
* FLUCLOXACILLIN - Penicillin-resistant Staphylococcal infections except MRSA
What are the different indications for metronidazole?
- Treatment of anaerobic bacteria - e.g. dental infections, antibiotic-associated
- colitis, h.pylori, rosacea, bacterial vaginosis.
- Antibiotic-associated colitis caused by c.difficile – gram positive anaerobe
- Oral infections or aspiration pneumonia = gram negative anaerobes in mouth
- Surgical and gynaecological infections – gram negative anaerobes from colon
- Protozoal infections
What are the key contraindications of metronidazole and SEs?
- Metabolised by CYP450 enzymes
- Severe liver disease – REDUCE total daily dose to 1/3 and give once daily
- Avoid alcohol – disulfiram-like effect = flushing, headache, nausea and vomiting (because metronidazole inhibits the enzyme that breaks down a compound of alcohol) = do not drink during or for 48 hours after treatment.
- topical use: avoid exposure to strong sunlight or UV light
- avoid large doses in pregnancy and breastfeeding
How often is amoxicillin given dosing wise in a H.Pylori infection?
TWICE DAILY instead of common three
1 g twice daily for 7 days for first- and second-line eradication therapy; 10 days for third-line eradication therapy.
What is the usual dosing schedule of clarithromycin
TWICE DAILY!!
Whats the first line treatment for athletes foot?
Terbinafine 1% cream
Clotrimazole 1% cream (2% not licensed)
Miconazole 2% cream
This antibiotic is bactericidal and acts by interfering with bacterial cell wall synthesis. It diffuses well into body tissues and fluids, but penetration into the cerebrospinal fluid is poor except when the meninges are inflamed. It is excreted in the urine in therapeutic concentrations
This describes which antibiotic
NARROW-SPECTRUM (beta-lactamase sensitive) penicillins
- BENZYLPENICILLIN “PEN G”
- PHENOXYMETHYLPENICILLIN “PEN V”
What is a key caution with mefloquine
Neuropsychiatric reactions
Mefloquine is associated with potentially serious neuropsychiatric reactions. Abnormal dreams, insomnia, anxiety, and depression occur commonly. Psychosis, suicidal ideation, and suicide have also been reported. Psychiatric symptoms such as insomnia, nightmares, acute anxiety, depression, restlessness, or confusion should be regarded as potentially prodromal for a more serious event. Adverse reactions may occur and persist up to several months after discontinuation because mefloquine has a long half-life. For a prescribing checklist, and further information on side-effects, particularly neuropsychiatric side-effects, which may be associated with the use of mefloquine for malaria prophylaxis, see the Guide for Healthcare Professionals provided by the manufacturer.
whats the MHRA alerts regarding chloroquine and hydroxychloroquine?
MHRA/CHM advice: Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions (February 2022)
An observational study has shown that co-administration of azithromycin with hydroxychloroquine in patients with rheumatoid arthritis was associated with an increased risk of cardiovascular events (including angina or chest pain and heart failure) and mortality. Healthcare professionals are reminded to consider the benefits and risks of co-prescribing systemic azithromycin, or other systemic macrolides, with hydroxychloroquine. If such use cannot be avoided, caution is recommended in patients with risk factors for cardiac events and they should be advised to seek urgent medical attention if any signs or symptoms develop.
A European safety review has reported that psychiatric reactions associated with hydroxychloroquine (including rare cases of suicidal behaviour) typically occurred within the first month of treatment; events have been reported in patients with no history of psychiatric disorders. Healthcare professionals are reminded to be vigilant for psychiatric reactions, and counsel patients and carers to seek medical advice if any new or worsening mental health symptoms develop.
what is oseltamivir used to treat?
Reduces replication of influenza A and B viruses by inhibiting viral neuraminidase.
which doac does not have a reversible agent?
EDOXABAN
dabigatran etexilate, apixaban, and rivaroxaban do have one.
Idarucizumab is licensed for the rapid reversal of dabigatran etexilate in life-threatening or uncontrolled bleeding, or for emergency surgery or urgent procedures.
Andexanet alfa is licensed for the reversal of apixaban or rivaroxaban in life-threatening or uncontrolled bleeding.
