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afsha - infections > penicillins > Flashcards

penicillins Flashcards

1
Q

PMP 4 interactions - vit K antagonists + methotrexate

A
  • aconocoumarol: PMP potentially alters AC effect, monitor and adjust dose
  • MTX: PMP predicted to increase risk of toxicity. monitor
  • pheninidione: PMP may increase risk of bleeding events
  • warfarin: PMP potentially alters AC effect of warfarin, monitor INR and adjust dose
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2
Q

name the 4 drugs that PMP interacts with

A

vit K antagonists - warfarin, acenocoumarol, pheninidione
MTX

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3
Q

PMP - take with or without food

A

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

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4
Q

MOA Penicillins

A

bactericidal
act by inferring with bacterial cell wall synthesis

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5
Q

can you use penicillin in CNS infections

A

penetration into CSF if poor except with meninges are inflamed

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6
Q

important safety info - fluclox & hepatic disorders

A

cholestatic jaundice and hepatitis may occur rarely up to 2 months after treatment with fluclox has stopped
RF: admin for more than 2 weeks and increasing age
do not use in pt with Hx hepatic dysfunction associated with fluclox
use in caution in HI
careful enquiry should be made about hypersensitivity reactions to Beta lactam abx

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7
Q

can cholestatic jaundice and hepatitis occur even after fluclox has been stopped?

A

can occur up to two months after treatment with fluclox has been stopped

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8
Q

name 2 risk factors for choelstatic jaundice and hepatitis with fluclox

A

taking for more than 2 weeks
increasing age

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9
Q

what is the interaction between paracetamol and fluclox

A

caution
P has been reported to cause high anion gap metabolic acidosis when given with F

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10
Q

what are the 5 severe interactions with fluclox?

A

vit K antagonists - warfarin, pheninidone, acecoumarol (rosa of bleeding events/altered AC effect)
MTX (risk of toxicity, monitor)
paracetamol (caution, high anion gap metabolic acidosis)

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11
Q

the following electrolyte imbalance can occur with fluxloc, esp in high doses

A

potentially life threatening hypokalaemia - can be resistant to potassium supplementation ! hence regular monitoring of serum potassium recommended when using higher doses

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12
Q

diarrhoea frequently occurs during oral penicillin therapy. it is most common with …….

A

most common with BS penicillins, which can cause abx-associated colitis

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13
Q

who is at higher risk of anaphylactic reactions to penicillins

A

history of atopic allergy e.g. asthma, eczema, hay fever

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14
Q

patients with history of anaphylaxis, urticaria, or rash immediately after penicillin administration - should they be given a penicillin

A

no because at risk of immediate hypersensitivity

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15
Q

which characteristics indicate immediate hypersensitivity to penicillin

A

history of anaphylaxis, urticaria or rash immediately after penicillin

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16
Q

individuals with a history of a minor rash (non-confluent, non-pruritic rash restricted to small area of body) or rash that occurs >72h after penicillin administration - should they be given penicillin

A

probably not allergic
do not withhold unnecessarily for serious infections
however bear in mind the possibility of an allergic reaction
other beta-lactam abx including cephalosporins can be used too

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17
Q

dose of pivmecillinam for acute uncomplicated cystitis

A

initially 400mg for 1 dose
then 200mg every 8 hours (TDS) for 8 tablets
total 10 tabs
(for body weight 40kg and above)

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18
Q

when pivmecillinam is used orally, it must only be used in pt with the following body weight

A

40kg and above

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19
Q

what are the 5 interactions of pivmecillinam

A
  • vit k antagonists (warfarin, acecoumarol, phenindione - increased risk bleeding events/increased AC effect, monitor INR)
  • valproate - avoid increased risk of adverse effects
  • MTX - increased toxicity , monitor
20
Q

pivmecillinam - directions for administration

A
  • swallow whole with plenty of water during meals while sitting or standing
21
Q

labels for pivmecillinam

A

take with or just after food, or a meal
take with a full glass of water

22
Q

this route of administration is not recommended for benzylpenicillin sodium

A

intrathecal

23
Q

are benzyl penicillin sodium and benzathine benzylpenicillin the same

A

BS is a short acting form of B and is not interchangeable with BB

24
Q

6 common side effects for all penicillins

A
  • diarrhoea
  • thrombocytopenia
  • hypersensitivity
  • nausea
  • vomiting
  • skin reactions
25
Q

contraindications for coamoxiclav (2)

A
  • hx of co-amoxiclav associated jaundice or hepatic dysfunction
  • hx penicillin-associated jaundice or hepatic dysfunction
26
Q

why does benzylpencillin need to be given by injection

A

inactivated by gastric acid and absorption from the GIT is low

27
Q

what is benzathine benzylpenicillin used for and what route

A

IM injection
early syphillis and late latent syphilis

28
Q

which one is more active - penicillin V or benzylpenicillin sodium

A

penicillin V (phenoxmethylpenicillin)

29
Q

why should penicillin v not be used for serious infections

A

absorption can be unpredictable and plasma concentrations variable

pen V - phenoxy

30
Q

what is used for penicillin resistant staphylococci

A

fluclox , this is because it is not inactivated by penicillinase enzymes

31
Q

what are the antipsuedomonal penicillins

A

piperacillin (only available in combo with beta lactamase inhibitor tazobactam)

ticarcillin (only available with clavulanic acid)

32
Q

are piperacillin + tazobactam and ticaricillin + clavulanic acid active against MRSA

A

no

33
Q

Pivmecillinam hydrochloride is hydrolysed to …….., which is the active drug.

A

mecillinam

34
Q

Maculopapular rashes commonly occur with the following 2 drugs but are not usually related to true penicillin allergy

A

ampicillin
amoxicillin

35
Q

Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in pt with the following symptom………., therefore BS penicillins should not therefore be used for blind treatment of sore throat

A

glandular fever

36
Q

this drug has to be taken on empty stomach because less than half the dose is absorbed when taken orally, and absorption is further decreased by presence of food in gut

A

ampicillin

37
Q

antipseudomonal penicillins spectrum of activity

A

BS activity against gram positive and gram negative and anaerobes
not for MRSA

38
Q

pevmecillinam spectrum of activity

A

many gram negative bacteria
not against P. aeruginosa or enterococci

39
Q

name the broad spectrum penicillins

A

ampicillin
amoxicillin
antipseudomonal penicillins (T+C, P+T)
co-amox
temocillin

40
Q

which one with food and which one on empty stomach

A

food: pivmecillinam
empty: phenoxy

41
Q

what is pen V and pen G

A

pen g = benzylpenicillin
pen v = phenoxy

42
Q

name the narrow spectrum pencillins

A

pen g = benzylpenicillin
pen v = phenoxy
fluclox

43
Q

who is probably not allergic to penicillin, and therefore a penicillin should not be withheld unncesessarily for serious infections.

A

Individuals with a history of a minor rash (i.e. non-confluent, non-pruritic rash restricted to a small area of the body) or a rash that occurs more than 72 hours after penicillin administration are probably not allergic to penicillin

44
Q

this drug is not inactivated by penicillinases (unlike benzylpenicillin) so if effective in infections caused by penicillin resistant staph, which is the sole indication for its use

A

fluclox

45
Q

co amox is CI in the following 2 scenarios

A

History of co-amoxiclav-associated jaundice or hepatic dysfunction; history of penicillin-associated jaundice or hepatic dysfunction

46
Q

Hepatitis is more common with co amox if …

A

male
elderly

afsha - infections (57 decks)

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