SESSION 1 Flashcards
According to NICE guidelines, what is the preferred dosing regimen for Gentamicin?
Once daily dosing.
What is the recommended monitoring for patients receiving Gentamicin?
Serum creatinine
Serum aminoglycosides concentrations
Auditory and vestibular function
What is the maximum duration of Gentamicin therapy recommended by NICE?
7 days
Dont give for longer than 5 days without discussion with department of infection
Fill in the blank: Gentamicin should be dosed based on the patient’s _____________.
Ideal body weight (unless they are underweight!)
Which of the following is a potential side effect of Gentamicin therapy? A) Nausea B) Ototoxicity C) Rash D) Headache
B) Ototoxicity
What is the recommended route of administration for Gentamicin according to NICE?
Intravenous/IM or topical
Not absorbed well from the gut as its poorly lipid-soluble!
Fill in the blank: Gentamicin is primarily excreted by the _____________.
Kidneys.
Which of the following is a contraindication for Gentamicin therapy? A) Renal impairment B) Hypertension C) Diabetes D) Asthma
A) Renal impairment
What is the mechanism of action of Gentamicin?
Targets the bacterial 30s ribosomal subunit which inhibits normal ribosomal functioning and blocks bacterial protein synthesis = cell death
What class of antibiotic is gentamicin?
Aminoglycoside.
What is the recommended duration of Gentamicin therapy for serious infections?
7-10 days.
True or False: Gentamicin is safe to use in pregnant women.
False - small risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy
What is the primary concern when prescribing Gentamicin to elderly patients?
Risk of nephrotoxicity and ototoxicity.
Which of the following is a common indication for Gentamicin therapy? A) Urinary tract infections B) Influenza C) Malaria D) Tuberculosis
A) Urinary tract infections
What is the recommended dosing interval for Gentamicin in patients with normal renal function?
Once daily.
Which of the following is a common adverse effect of Gentamicin therapy? A) Diarrhea B) Hypertension C) Tinnitus D) Insomnia
C) Tinnitus
Aminoglycosides are ototoxic and this is usually irreversible - bear in mind its rare if <2 weeks of Tx
True or False: Gentamicin is effective against anaerobic bacteria.
False
This is because aminoglycosides require oxygen-dependant transport to enter the bacterial cell
What is the recommended peak serum level for Gentamicin therapy?
5-10 mg/L.
How does once-daily dosing work for gentamicin?
Gentamicin dose is given according to IBW (unless underweight then 7mg/kg). The serum levels are then monitored 6-14 hours after the start of infusion. The dose interval is then adjusted according to the Hartford nomogram
How does once-daily dosing work for gentamicin?
Gentamicin dose is given according to IBW (unless underweight then 7mg/kg). The serum levels are then monitored 6-14 hours after the start of infusion. The dose interval is then adjusted according to the Hartford nomogram
Dose of gentamicin?
5-7mg/kg if once-daily dosing
3-5mg/kg if multiple daily dose regimen
Absolute contraindication of aminoglycosides?
Myasthenia gravis - can induce a myasthenic crisis
How does gentamicin cause ototoxicity?
Irreversibly damages auditory or vestibular nerve damage
How does gentamicin cause nephrotoxicity?
In renal failure gentamicin accumulates and is preferentially taken up by proximal renal tubular cells where they accumulate to toxic levels and cause ATN
Concominant use of which drugs increases the risk of nephrotoxicity with gentamicin?
Furosemide and NSAIDs
Concominant use of which drugs increases the risk of ototoxicity with gentamicin?
Vancomycin
What happens if you miss taking a gentamicin level for monitoring within the 6-14 hour window?
You cannot interpret the results using the Hartford nomogram
You can only give gentamicin once the serum level falls below 1mg/L and NEVER give gentamicin less than 24 hours after previous dose!
If >1 gentamicin level is missed then discuss with dept of infection
Outline the multiple daily dosing regimen of gentamicin?
3 doses are given in 24 hours i.e. every 8 hours.
Peak levels of gentamicin are taken 1 hour from start of infusion - should be 5-10mg/L and if too high then dose of gentamicin is reduced
Trough levels are taken within 30 minutes before next dose is due to determine how well gentamicin is being cleared from the body. Should be <2mg/L and if too high then dose interval should be extended!!
Note ranges are different in endocarditis
What are schedule 1 drugs?
includes drugs not used medicinally such as hallucinogenic drugs (e.g. LSD), ecstasy-type substances, raw opium, and cannabis
What are schedule 2 drugs?
includes opiates (e.g. diamorphine hydrochloride (heroin), morphine, methadone hydrochloride, oxycodone hydrochloride, pethidine hydrochloride), major stimulants (e.g. amfetamines), quinalbarbitone (secobarbital), cocaine, ketamine, and cannabis-based products for medicinal use in humans
What are schedule 3 drugs?
includes the barbiturates (except secobarbital, now Schedule 2), buprenorphine, gabapentin, mazindol, meprobamate, midazolam, pentazocine, phentermine, pregabalin, temazepam, and tramadol hydrochloride. They are subject to the special prescription requirements
What are schedule 4 drugs?
includes in Part I drugs that are subject to minimal control, such as benzodiazepines (except temazepam and midazolam, which are in Schedule 3), non-benzodiazepine hypnotics (zaleplon, zolpidem tartrate, and zopiclone) and Sativex®. Part II includes androgenic and anabolic steroids, clenbuterol, chorionic gonadotrophin (HCG), non-human chorionic gonadotrophin, somatotropin, somatrem, and somatropin. Controlled drug prescription requirements do not apply and Schedule 4 Controlled Drugs are not subject to safe custody requirements.
What are schedule 5 drugs?
includes preparations of certain Controlled Drugs (such as codeine, pholcodine, or morphine) which due to their low strength, are exempt from virtually all Controlled Drug requirements other than retention of invoices for two years, and nitrous oxide.
What are FP10 forms?
Green forms for prescribing in the community by GPs
What is an FP10MDA form?
A blue form for prescribers to use to manage substance misuse pts i.e. prescription to be given in installments
What are FP10D forms?
Yellow forms for prescribing by dentists
What are FP10SP or FP10PN forms?
lilac prescribing forms for community/independant nurse prescriptions
What are RA and RD FD10 forms?
RA = repeat authorisation forms
RD = repeat dispensing forms
When is writing the DOB on a prescription a legal requirement?
When a child is under the age of 12
How many pt identifiers must be on a prescription?
3
What are P drugs?
a personal or preferred or priority choice drug of a clinician
How to decide if IV antibiotics should be changed to oral?
Use COMS:
Is there…
Clinical improvement
Oral route not compromised
Markers improving
Specific indication
Antibiotic stewardship points?
Appropriateness of antimicrobial prescribing
Prevention of inappropriate antimicrobial use
Prevention of adverse effects of antibiotic therapy
Surveillance of antimicrobial use and AMR trends
Education of healthcare professionals and patients
Development of novel antimicrobials
Which diuretics are most commonly associated with gout in pts with hypertension?
Loop diuretics
??/ ask about this I’m confused as thought it was thiazides
Adverse effects of warfarin?
Haemorrhage
Alopecia
Nausea & vomiting
Skin necrosis
Purple toes
Factors that may potentiate warfarin?
liver disease
P450 enzyme inhibitors, e.g.: amiodarone, antibiotics, Azoles, PPIs, sodium valproate, grapefruit
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs
Factors that may reduce the function of warfarin?
P450 enzyme inducers e.g. alcohol, azathioprine, carbamazepine, griseofulvin, mercaptopurine, phenobarbital, phenytoin, rifampicin, St John’s wort, cigarettes, steroids
Most appropriate monitoring option to assess for adverse effects of morphine?
AVPU
Adverse effects of amiodarone?
thyroid dysfunction: both hypothyroidism and hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval
Monitoring specifically for agranulocytosis for a pt on clozapine?
Differential WBC monitoring weekly for 18 weeks
Then fortnightly for up to 1 year
Then monthly
(Note there’s a lot more monitoring for clozapine this is just for the agranulocytosis)
How common is a dry cough for pts on ACEi? When does it start after Tx start?
15% of pts
Can occur even up to 1 year after starting drug
Analgesia for pt with renal stones?
NSAIDs are first line (IM diclofenac has been used traditionally but consider risk of cardiovascular events)
What does it mean if a pt with hypothyroidism has the following results: TSH is high but free T4 is normal
What should you do?
It could indicate poor compliance or intermittent dosing
Reinforce medication compliance and repeat TFTs in 6-8 weeks
MOA of carbamazepine?
Binds to Na+ channels to increase the refractory period and reduce firing
Tx for trigeminal neuralgia?
Carbamazepine 100mg PO 12-hourly
some patients may require higher initial dose, increase gradually according to response; usual dose 200 mg 3–4 times a day, increased if necessary up to 1.6 g daily
SE of carbamazepine?
Dizziness & drowsiness
Dry mouth
Fatigue
GI discomfort
Ataxia
Headache
Visual disturbances
Steven-Johnson syndrome and other skin reactions
Leukopenia, thrombocytopenia & Agranulocytosis
Hyponatraemia secondary to SIADH
Tx of suspected meningitis in the community prior to urgent transfer to hospital or where pt cannot be transferred to hospital ?
1.2g IM benzylpenicillin for adult
(Children doses different)
Drop rate (drops/min) calculation?
{Drop factor (drops/mL) x volume to be infused (mL)} / {all divided by time of infusion (mins)}
What must all prescriptions contain?
State the name and address of the patient
Be written or printed legibly in ink
Be signed in indelible ink
Have an appropriate date (usually the date of signing)
State the address of the prescriber
State the age of a child under 12
Which units must always be written in full?
Micro grams
Nanograms
International units
At what Cr clearance should you not use the once-daily dosing regimen for gentamicin?
if Cr clearance is <20ml/min
