N-T abx Flashcards
What are the MHRA warnings for nitrofurantoin?
risks of pulmonary and hepatic adverse drug reactions
- monitor for respiratory symptoms
- monitor for hepatic dysfunction/injury symptoms
When is nitrofurantoin contraindicated?
acute porphyrias
G6PD deficiency
infants less than 3 months old
Can nitrofurantoin be used in pregnancy and breastfeeding?
Pregnancy
- avoid at term: may produce neonatal haemolysis.
Breastfeeding
- avoid: only small amounts in milk but enough to produce haemolysis in G6PD-deficient infants.
Can nitrofurantoin be used in renal impairment?
avoid if eGFR less than 45 mL/ minute/1.73 m2
may be used with caution if eGFR 30–44 mL/ minute/1.73 m2 as a SHORT-course only (3 to 7 days)
What should be monitored for nitrofurantoin?
on long-term therapy, monitor
- liver function
- pulmonary symptoms,
especially in the elderly (discontinue if deterioration in lung function).
What is the most common side effect associated with penicillins?
diarrhoea
- most common with broad spectrum penicillins
- can cause antibiotic associated colitis
What side effect is common to ampicillin and amoxicillin?
maculopapular rashes
- flat and raised lesions on skin
occur commonly in patients with glandular fever
- avoid using for sore throat
What is the MHRA warning for flucloxacillin?
cholestatic jaundice and hepatitis may occur
- risk increased is treatment duration is > 2 weeks and with older age
What is counselling for flucloxacillin?
take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
How does allergy work with penicillin?
rash that occurs more than 72 hours after penicillin administration are most likely not allergic to penicillin
- penicillin should not be withheld
immediate rash
- allergy
What are quinolones?
ciprofloxacin, levofloxacin moxifloxacin
What are the MHRA warnings for quinolones?
can induce convulsion
- avoid in epilepsy
- NSAIDs can increase risk
tendon damage
- occur within 48 hours of starting treatment or after stopping
- increased risk with corticosteroid use
- DISCONTINUE
small increased risk of aortic aneurysm and dissection
- seek help if sudden-onset severe abdominal, chest, or back pain develops
disabling and potentially long-lasting or irreversible side effects
- stop treatment at the first signs of a serious adverse reaction: tendinitis, joint pain, peripheral neuropathy
small risk of heart valve regurgitation
- seek help if rapid onset of SOB (especially when lying down flat in bed), swelling of the ankles, feet, or abdomen, or new-onset heart palpitations develops
psychiatric side-effects
- suicidal thoughts and behaviour
- DISCONTINUE
only prescribe as LAST resort
Can quinolones be used in pregnancy or breastfeeding?
avoid in pregnancy
- arthropathy risk
caution in breastfeeding
What counselling should be given for quinolones?
avoid excessive sunlight and UV radiation exposure
- during and 48 hours post treatment
may impair driving ability
- effects enhanced by alcohol
What are cautions for quinolones?
QT prolongation
myasthenia gravis
arthropathy
What are the interactions for quinolones?
ciprofloxacin
- dairy products and mineral-fortified drinks
- reduces ciprofloxacin absorption
QT prolongation
- lithium, azoles, SSRIs, ondanstron, amiodarone
drugs that reduce seizure threshold
- antipsychotics, NSAIDs, TCAs, tramadol, mefloquine
What are tetracyclines?
doxycycline, lymecycline, minocycline, tetracycline
What counselling is there for tetracyclines? What are the exceptions?
Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
exceptions: does like milk
- doxycycline
- lymecycline
- minocycline
What are the contraindications for tetracyclines?
children under 12 years
- deposition in growing bone and teeth
- by binding to calcium, causes staining and occasionally dental hypoplasia
What is a red flag for tetracyclines?
headache and visual disturbances may indicate benign intracranial hypertension
- DISCONTINUE treatment if raised intracranial pressure develops
What are side effects of tetracyclines?
systemic lupus erythematosus exacerbated
- minocycline: highest risk
photosensitivity reaction
- irreversible pigmentation when exposed to sunlight
Can tetracyclines be used in pregnancy?
avoid
- effects on skeletal development have been documented in the first trimester
- discoloration of the child’s teeth in the second or third trimester
- maternal hepatotoxicity in parenteral high doses
How should tetracyclines be taken?
tablets should be swallowed whole with plenty of fluid while sitting or standing
- can cause dysphagia
What counselling is needed for trimethoprim?
recognise signs of blood disorders and seek help if
- symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop
