prescribing antimicrobials

Question 1

first line for skin / soft tissue

Answer 1

empirical usually flucloxacillin
good oral absorption

not suitable if MRSA
not suitable if penicillin allergy

Question 2

UTI

Answer 2

trimethoprim
nitrofurantoin

most commonly E.coli, proteus , klebsiella

septrin= cotrimoxazole = trimethorpim + sulfamethaxozole

co amoxcilav= amoxicillin + clavulanic acid

Question 3

antibiotic for CAP pneumonia

Answer 3

amoxicillin / co-amoxiclav in combination with macrolide or doxycyline

causative- strep pneumonia or h influenza

macrolide / doxycyline cover vs atypical organisms

Question 4

antibiotic for CAP pneumonia

Answer 4

amoxicillin / co-amoxiclav in combination with macrolide or doxycyline

causative- strep pneumonia or h influenza

macrolide / doxycyline cover vs atypical organisms

Question 5

common errors

contraindications

Answer 5

allergy
- penicillin (and other beta lactams e.g. carbapenems, cephalosporins)

tetracycline in pregnancy (stains bones and teeth)

Question 6

common adverse reactions
co-amoxiclav
doxycyline

Answer 6

co-amoxcilav: painless jaudince

doxycycline: phototoxicity

Question 7

IV to oral switch

Answer 7

high oral bioavailability
quinolone, triazoles, fusicidic acid, clindamycin, metronidazole, rifamipicin

negabile oral bioavailabilty
vancomycin, ahminoglycosides, amphotericin, nystatin

Question 8

adverse drug reaction and monitoring

Answer 8

hepatotoxicity:
paracetamol
rifampicin
co-amoxiclav
voriconazole

myotoxicity: daptomycin
myelotoxicity: linezolid, chloramphenicol

nephrotoxicity:
ahminoglycosides, vancomycin

ototoxicity:
ahminoglycosides

phototoxicity:
doxycycline

red man syndrome: vancomycin
tendinopathy: fluroquinolones

Question 9

monitoring

Answer 9

gentamicin
before and 1 hour after third dose (8hrs)

peak and troph
troph= adequate clearing. dropping to a low enough level to prevent excessive toxicity. take troph before giving the next dose.

Question 10

peak and trough

Answer 10

peak level correlates with dose

trough level correlates with dose interval

Question 11

enzyme inhibitors

Answer 11

macroldies
quinolones
triazole antifungals- fluclonazole, voriconazole

Question 12

enzyme inducers

Answer 12

rifamycin- rifampicin, rifabutin.

Question 13

chelating properties of quinolone and tetracycline

Answer 13

interact with oral irons, antacids, zinc, oral calcium/milk, oral magnesium

important to allow at least 2 hours between each other so they don’t chalate.