pneumonia

Question 1

name antipseudomonal penicillins

Answer 1

tazocin/ piperacillin with tazobactam

Question 2

indications for tazocin

Answer 2

• severe infections esp where broad spectrum needed or where abx resistance likely. Or patients immunocompromised
• LRTI, URI, Intrabdo sepsis, skin and soft tissue infection

Question 3

SE tazocin

Answer 3

• GI upset
• c diff colitis
• hypersensitvity

Question 4

lower dose of tazocin in which patient

Answer 4

moderate to severe renal impairment

Question 5

interactions of tazocin

Answer 5

• methotrexate; increased risk of toxicity

- enhance warfarin effect by killing vit k synthesising gut flora

Question 6

how is tazocin given

Answer 6

IV infusion

Question 7

normal dose of tazocin

Answer 7

4.5g pip and 500mg taz. every 6-8hrs

Question 8

how dose tazocin come to administer

Answer 8

powder to be reconstituted in 10ml sterile water or nacl. this is diluted further in 50-150ml of nacl or 5% glucose for infusion.

Question 9

what should you be mindful of when give tazocin

Answer 9

• it contains 11mol na+ so think about other electrolytes being given

Question 10

name quinolones

Answer 10

ciprofloxacin
moxifloxacin
levofloxacin

Question 11

quinolone indications

Answer 11

2nd/3rd line due to c diff chance

1. UTI
2. severe gastroenteritis
3. LRTI

Question 12

quinolone spectrum of activity

Answer 12

broad spectrum esp gram -ve

Question 13

cipro is good for which organism

Answer 13

pseudomonas

Question 14

what are the advantages of newer quinolones e.g. moxiflox/ levoflox

Answer 14

• more gram +ve activity

Question 15

MOA quinolonea

Answer 15

• inhibit DNA synythesis = bactericidal .

- bacteria become resistant

Question 16

SE quinolones

Answer 16

• GI upset
• immediate/ delayed hypersensitivity
• neurological; lowers seizure threshold and hallucinations
• infla and rupture of muscle tendons
• esp moxi but all = prolonged QTi
• c diff

Question 17

Use quinolones with caution in which patients

Answer 17

• risk of seizures
• kids and young adults still gorwing -= risk of arthropathy
• QT prolonged patients

Question 18

interactions of quinolones

Answer 18

• drugs with divalent cations e.g. ca and antacids reduce absorption and efficacy
• cipro inhibits cyp 450 so increased toxicity if some drugs esp theophylline
• co prescription with NSAIDS= increased risk seizure
• with prednislone = increased tendon rupture
• careful with arrhythmia inducing drugs

Question 19

typical dose cipro

Answer 19

250-750mg PO 12-hrly

400mg IV 12hrly

Question 20

typical dose moxi

Answer 20

400mg PO/IV dialy

Question 21

Typical dose levo

Answer 21

• 500mg PO/IV

Question 22

how do IV quinolones come pre packed

Answer 22

• in solution for infusion over 60mins

Question 23

what travellers diarrhoea is cipro good for

Answer 23

• shigella, salmonella, campylobacter

Question 24

what abx is used for pneumocyatis jiroveci pneumonia

Answer 24

trimethoprim combined with sulfamethoxazole as co-trimoxazole

Question 25

trimethoprim indications

Answer 25

• acute lower UTI
• Propyhlaxis of recurrent UTI
  Alternatives include nitro, amoxi and cefalexin.
  also used for acne, resp infections and prostatis

co-trimoxi for prevention of pneumocystis pneumonia in immunosuppresion

Question 26

Trimethoprim spectrum

Answer 26

broad spec, gram pos and -ve. but high resistance. combo with sulfonamide as co trimoxi is what extends the spectrum

Question 27

trimethoprim MOA

Answer 27

• inhibits bacterial folate synthesis - slows bacterial growth; bacteriostasis.
• but widespread bacterial resistance
• sulfa also onhibits bacterial folate synthesis but at different steps in the pathway

Question 28

trimethoprim SE

Answer 28

• GI uupset
• skin rash
• severe hypersensitivity inc anaphylaxis, drug fever and erythema multiforme - more common with sulfonamides
• impair haematopoeoises causing haematological disorder sich as megaloblastic anaemia, leucopenia and thrombocytopenia
• hyperkalaemia and elevation of plasma creatinine concentrations

Question 29

CI to trimethoprim

Answer 29

• first trimester of pregnancy ; NTDs
• relatice CI;folate deficiency who are more susceptible to adverse haematological effects

relative CI; Renal impariment - dose reduce
- neonates, elderly and HIV patients are susceptible so reduce dose or avoid

Question 30

trimethoprim interactions

Answer 30

• potassium elevating drugs
• folate antagonists - be careful combining use
• drugs that increase folate metabolism e.g. phenytoin , increase risk of adverse haematological effects
• can enhance the anticoagulant effect of warfarin by killing normal gut flora that synthesis vit k

Question 31

usual dose of trimethoprim for UTI

Answer 31

200mg 12hrly

Question 32

how can you give co-trimoxazole

Answer 32

• oral or IV;
  weight based dose 120mg.kg.day.

or IV in 2-4 divided doses.

• 14-21 days to treat pneumocystis
  lower dose for pneumocystis prohphylaxis

Question 33

what does trimethoprim do to creatinine

Answer 33

• inhibits creatinine secretion by tubules. so small reversible rise in serum creatinine on bloods.