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Microbiology and ID > Tetracyclines > Flashcards

Tetracyclines Flashcards

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Biology 101 flashcards
1
Q

What is the general action of tetracyclines?

A

Bacteriostatic

Binds to 30S ribosomes (and 50S to a lesser extent)

Inhibits bacterial protein synthesis

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2
Q

Name some common tetracyclines?

A

Tetracycline

Lymecycline

Doxycycline

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3
Q

What is the pharmacokinetic of doxycycline?

A

Oral bioavailability = 73-95%

Protein binding = plasma proteins (limited info available)

Half-life = limited info available

Metabolism = limited info available

Excretion = concentrated in bile by the liver, excreted in urine and faeces

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4
Q

Which bacteria is doxycycline effective against?

A

Gram +ve cocci = Streptococci

Gram -ve bacilli = E. coli

Gram -ve cocci = N. meningitis

Atypicals

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5
Q

What are the indications for doxycycline?

A

Susceptible infection e.g., chlamydia, rickettsia and mycoplasma

Severe infections (including refractory UTIs)

Acute sinusitis

Acute cough (if systemically very unwell or at higher risk of complications)

CAP

HAP

Acute exacerbation of bronchiectasis

Acute exacerbation of COPD

Mild diabetic foot infection

Cellulitis, erysipelas

Leg ulcer infection

Prophylaxis/treatment of infection from human or animal bites

Acne vulgaris

Rosacea

Papulopustular facial rosacea

Early syphilis

Late latent syphilis

Neurosyphilis

Uncomplicated genital chlamydia, non gonococcal urethritis

PID

Lyme disease

Anthrax

Malaria prophylaxis

Adjunct to quinine in Tx of Plasmodium falciparum malaria

Periodontitis

Tx of recurrent aphthous ulceration

Rocky mountain spotted fever

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6
Q

What is the typical dosing of doxycycline?

A

200mg daily for 1 dose

Then maintenance 100mg PO OD (length of days vary according to indication)

OR

just 100mg PO, OD/BD

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7
Q

What are the common side effects of tetracyclines in general?

A

Diarrhoea

N+V

Angioedema

Headache

HSP

Pericarditis

Hypersensitivity

SLE exacerbation

Skin reactions

Photosensitivity reaction

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8
Q

What are the uncommon side effects of tetracyclines in general?

A

Dizziness

Pancreatitis

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9
Q

What are the rare side effects of tetracyclines in general?

A

Decreased appetite

Thyroid gland discolouration

Dysphagia

Eosinophilia

Bulging fontanelle (in infants)

GI disorders

Glossitis

Haemolytic anaemia

Hepatic disorders

Idiopathic intercranial HTN

Increased infection risk

Neutropenia

Pseudomembranous enterocolitis

SJS

Thrombocytopenia

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10
Q

What is the frequency side effects of tetracyclines in general?

A

Tooth discolouration

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11
Q

If a patient on a tetracycline develops a headache or visual disturbance what should you do?

A

Headache and visual disturbances may indicated a benign intercranial hypertension

Stop treatment if raised intercranial pressure develops

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12
Q

What are the common side effects of doxycycline?

A

Dyspnoea

Hypotension

Peripheral oedema

Tachycardia

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13
Q

What are the uncommon side effects of doxycycline?

A

GI discomfort

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14
Q

What are the rare/very rare side effects of doxycycline?

A

Abx associated colitis

Anxiety

Arthralgia

Flushing

Raised ICP with papilloedema

Jarisch-Herxheimer reaction

Myalgia

Severe cutaneous adverse reactions (SCARs)

Skin hyperpigmentation (with long term use)

Stomatitis

Tinnitus

Vision disorders

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15
Q

Can tetracyclines be given to pregnant or breastfeeding women?

A

NO

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16
Q

What advise should you give people on how to take doxycycline capsules/tablets?

A

Drink with plenty of water

Whilst sitting or standing

Avoid lying down for at least 30 mins after taking doxycycline

Space the doses evenly throughout the day

Keep taking the medication until the course is finished, unless you are told to stop

It should not be taken together with dairy products, or calcium rich products as it can stop the body from absorbing the drug

17
Q

What should patients not take with doxycycline?

A

Ingestion tablets

Medicines containing iron or zinc

2 hours before or after they take doxycycline

18
Q

TRUE OR FALSE

Patients on doxycycline should protect their skin from sunlight

A

TRUE

Even on a bright but cloudy day

19
Q

What are the significant drug interactions for doxycycline?

A

doxy + warfarin/acenocoumarol = increases anticoagulant effect - monitor INR

doxy + acitretin/alitretinoin/isotretinoin/tretinoin = increased risk of benign intercranial hypertension

doxy + ciclosporin = increased [ciclosporin]

doxy + lithium = increased risk of lithium toxicity

doxy + phenindione = increases anticoagulant effect of phenindione - monitor INR

20
Q

Which group of people should you apply caution too when prescribing tetracyclines?

A

Myasthenia gravis - muscle weakness may be increased

SLE - can be exacerbated

21
Q

Which group of people may doxycycline not be suitable for?

A

allergic reaction to doxycycline or any other medicine

kidney or liver problems

oesophagitis

SLE

myasthenia gravis

pregnant or breastfeeding

22
Q

What are the common indications of lymecycline?

A

Acne (mainly)

Chest infections

Sinusitis

STIs

Infections in, or around, the mouth

23
Q

What is the typical dosage of lymecycline for acne Tx?

A

1 capsule 408 mg OD

24
Q

What advise should you give people on how to take lymecycline capsules?

A

Drink with plenty of water

Whilst sitting or standing (important the capsule is not stuck in throat as it could cause irritation)

Do not take the capsule just before bed

It can be taken with or without food - but less likely to feel sick if taken with food

25
Q

What should patients do if they miss a dose of their doxycycline?

A

Take it as soon as remembered

BUT do not take 2 doses at the same time

Never take an extra dose to make up for a forgotten one

May help to set an alarm to remind you

26
Q

What are the common side effects of lymecycline?

A

N + V

Stomach pain

Diarrhoea

Headaches

27
Q

What serious side effects of lymecycline should you safety-net for and advice patients to call 111?

A

Dark urine

Whites of eyes turn yellow

Skin turns yellow

Skin becomes very sensitive to the sun

28
Q

When should a patient on any tetracycline call 999?

A

Anaphylactic reaction

29
Q

What serious side effects of doxycycline should you safety-net for and advice patients to call 111?

A

Signs of blood problems
- unexplained bruising or bleeding (inc. nosebleeds)
- sore throat, high temperature, and feeling tired or generally unwell

Diarrhoea that contains blood or mucus (also severe diarrhoea that lasts > 4 days)

Ringing or buzzing in ears

Signs of liver problem
- pale poo or dark poo
- whites of eyes turning yellow / skin turning yellow

Joint or muscle pain since starting doxycycline

Severe headaches, vomiting and vision problems - could be signs of intercranial HTN

Fingernail that starts coming away from its base ; could be reaction to sunlight - photo-onycholysis

Sore or swollen mouth, lips or tongue

Severe pain in stomach with or without bloody diarrhoea, nausea and vomiting - could be signs of pancreatitis

Difficulty or pain when swallowing, sore throat, acid reflux, a smaller appetite or chest pain that worsens when eating - could be signs of oesophagitis or oesophageal ulcer

30
Q

For which medications should patients inform their doctor they are taking before starting on lymecycline?

A

Ingestion remedies

Medicines that contain aluminium, bismuth, calcium, iron, kaolin, magnesium or zinc

Other Abx

Quinapril - a med for high BP or HF

Acne meds containing vitamin A e.g., isotretinoin

Warfarin

Diuretics

Epileptic meds e.g., phenytoin, carbamazepine

31
Q

What are the significant drug interactions for lymecycline?

A

lyme + warfarin/acenocoumarol = increases anticoagulant effect - monitor INR

lyme + acitretin/alitretinoin/isotretinoin/tretinoin = increased risk of benign intercranial hypertension

lyme + ciclosporin = increased [ciclosporin]

lyme + lithium = increased risk of lithium toxicity

lyme + phenindione = increases anticoagulant effect of phenindione - monitor INR

32
Q

Sources

A

https://go.drugbank.com/drugs/DB00759

https://bnf.nice.org.uk/drugs/doxycycline/#indications-and-dose

https://go.drugbank.com/drugs/DB00254

https://bnf.nice.org.uk/drugs/doxycycline/medicinal-forms/#capsule

https://www.nhs.uk/medicines/doxycycline/how-and-when-to-take-doxycycline/

https://www.nhs.uk/medicines/lymecycline/who-can-and-cannot-take-lymecycline/

https://bnf.nice.org.uk/drugs/lymecycline/

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