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Chapter 5 Infections > Antibiotics administration/counselling/ side effects > Flashcards

Antibiotics administration/counselling/ side effects Flashcards

1
Q

What are the s/e associated with Clindamycin

A

Antibiotic-associated colitis ​
Most frequently with clindamycin – can be fatal​
Most common in middle-aged, elderly women, especially after operations.

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2
Q

What is one of the counselling points for Clindamycin

A

If pt experiences diarrhoea it must be stopped immediately and they should see a GP. Could be a sign of Pseudomembranous colitis which refers to swelling or inflammation of the large intestine (colon) due to an overgrowth of (C difficile) bacteria

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3
Q

What are the pt counselling points associated with Linezolid

A

report visual symptoms: blurred vision, visual field defects and changes in visual acuity and colour vision.
Report any signs of bruising or bleeding

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4
Q

what are the s/e associated with Linezolid

A

Blood disorders​: leukopenia and thrombocytopenia

Optic neuropathy if >28 days use

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5
Q

What are the contra-indications and interactions associated with Linezolid

A

It is a maoi so pt can go into a hypertensive crisis if they consume Tyramine rich foods such as cheese, soya beans or given at the same time as other drugs that increase blood pressure e.g SSRI, Other MAOI (wait two weeks before giving another), sympathomimetics, TCA, Opioids, dopaminergic drugs, 5HT1 agonists, buspirone and pethidine.

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6
Q

When should Linezolid be stopped

A

If bone suppression occurs

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7
Q

How are aminoglycosides administered and why

A

parenteral injection because it is not absorbed by the gut

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8
Q

what is the typical dose for trimethoprim

A

200mg BD

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9
Q

S/e for trimethoprim

A

anti-folate: teratogenic in 1st trimester
blood dyscrasias
hyperkalaemia

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10
Q

does trimethoprim cause hyper or hypokaleamia

A

hyperkalaemia

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11
Q

counselling points for trimethoprim

A

report fever, sore throat, rash, mouth ulcers, purpura, bruising and bleeding

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12
Q

why should chloramphenicol be avoided in pregnancy

A

grey baby syndrome if used in the third trimester

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13
Q

Why is chloramphenicol reserved for life-threatening infections when given systemically

A

causes blood dyscrasias- a lot of haematological s/e

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14
Q

common s/e associated with metronidazole

A

GI, disturbances, taste disturbances, oral mucositis, furred tongue

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15
Q

pt counselling associated with metronidazole

A

take with or after food
avoid alcohol due to to disulfiram like reactions: flushing of face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulties and anxiety
avoid for 48 hours
Darkens urine

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16
Q

what the side effects associated with nitrofurantoin

A

nausea, risk of peripheral neuropathy in renal impairment

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17
Q

pt counselling assocaited with nitrofurantoin

A

take with or after food

colours urine yellow or brown

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18
Q

what age is nitrofurantoin contra-indicated in

A

3 months and under

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19
Q

At which point in pregnancy should nitrofurantoin be avoided and why

A

term due to it causing neonatal haemolysis

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20
Q

should vancomycin be used in preganancy

A

avoid unless essential

must monitor serum conc

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21
Q

what are the plasma monitoring requirements for vancomycin

A

pre- dose trough level = 10-15mg/ml. 15-20 for endocarditis, less sensitive strains of MRSA or a complicated S. aureus infection
monitor after 3-4 doses and after a dose change
renal impairment more regular monitoring

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22
Q

patient counselling for ethambutol

A

visual changes- report immediately

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23
Q

pt counselling for Isoniazid

A

report signs of hepatoxicity: n&v, rash, jaundice, loss of appetite, fever

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24
Q

what are the pt counselling points for pyrazinamide

A

Look out for signs of hepatoxicity: n&v, rash, jaundice, loss of appetite, fever

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25
Q

Is Isoniazid an enzyme inhibitor or inducer

A

inhibitor

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26
Q

How is peripheral neuropathy when using Isoniazid over come

A

concomitant pyridoxine

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27
Q

what are the patient counselling points for using rifampicin

A

report signs of hepatotoxicity: n&v, rash, jaundice, loss of appetite, fever
colours soft contact lenses and urine red/orange

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28
Q

Mrs T is looking for a suitable contraceptive. She also currently taking medications for her Tuberculosis. Which contraception should she go for and why

A

She is receiving treatment for her TB which includes rifampicin. Rifampicin is an enzyme inducer meaning it cant be use d with oral contraceptives.
The best option is the IUD

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29
Q

What are the side effects associated with Itraconazole

A

Heart failure and hepatoxicity

30
Q

which OTC medication is Contra-indicated in Itraconazole and why

A

Antacids because it needs an acidic environment for absorption

31
Q

what is the MHRA alert associated with ketoconazole

A

risk of fatal hepatoxicity is greater than benefit of suing for fungal infections
This does not apply to using it for Cushings syndrome of topical infections

32
Q

what is the max dose of cobicistat that can be used concomitantly with ketoconazole

A

200mg

33
Q

what are the s/e associated with voriconazole

A

phototoxicity and hepatoxicity

34
Q

what are the s/e associated with voriconazole

A

phototoxicity and hepatoxicity

35
Q

pt counselling for Voriconazole

A

Causes pre-malignant lesions or skin cancer- avoid direct sunlight or sunlamps. Use high factor SPF and carry alert card

36
Q

what are the s/e associated with Amphoteracin B

A

Nephrotoxicity
Anaphylaxis with IV preps so do a test dose and monitor for 30 minutes
specific brand and not interchangeable

37
Q

what are the s/e associated with doxycyline

A

photosensitivity and oesophageal irritation

38
Q

what are the contra-indications for doxycyline

A

pregnancy, breastfeeding and under 12 year olds

39
Q

in what condition are Mefloquine, Chloroquine and Chloroquine with Proguanil contraindicated in

A

epilepsy

40
Q

what are the s/e associated with Mefloquine (Lariam)

A

Neuro-psychiatric reactions

41
Q

Which anti-malarial tablets are contra-indicated in renal impairment

A

Malarone
Proguanil
Chloroquine
Chloroquine with Proguanil

42
Q

when should a once daily regimen of gentamicin be avoided

A

renal impairement <20ml/min
HACEK or gram +ve endocarditis
burns cob=ver >20% of body

43
Q

what is the MHRA alert associated with using aminoglycosides e.g gentamicin, neomycin, tobracycin, amikacin

A

increased risk of deafness (ototoxicity) in patients with mitochondrial mutations-particularly the m.1555A>G mutation- risk and benefit should be weighed up. Genetic testing considered in those that need long term treatment.
monitor auditory and hepatic markers

44
Q

what is the max length of treatment aminoglycosides should be given for

A

7 days

45
Q

for multiple daily dosing in endocarditis what is the plasma monitoring required

A

3-5mg/L for the peak level taken 1 hr in
1mg/L for the pre dose trough level
Plasma conc should be taken after every 3-4 doses then every 3 days

46
Q

what are the two major interactions associated with macrolides erythromycin and clarithromycin as enzyme inhibitors

A

warfarin= increased risk of bleeding

statins: increased risk of myopathy

47
Q

should azithromycin be taken before or after food

And what is is the dosing

A

before food OD

48
Q

With which antibiotics should a 2 hur gap be left for indigestion remedies

A

erythromycin

azithromycin

49
Q

which macrolide can cause taste disturbance and is given twice a day

A

clarithromycin

50
Q

what is the toxic effect spiramycin has

A

toxoplamosis

51
Q

which macrolide causes visual disturbances, hepatoxicity and transient loss of consciousness

A

telithromycin

51
Q

which macrolide causes visual disturbances, hepatoxicity and transient loss of consciousness

A

telithromycin

52
Q

What are the patient counselling points for quinolones

A

can impair performance of skilled tasks: it’s effects is enhanced by alcohol
antacid and zinc/iron: leave 2 hours before or after taking a quinolone
avoid milk with ciprofloxacin and norfloxacin
With oral ciprofloxacin avoid concurrent consumption of dairy and mineral fortified drinks due to reduced exposure
With Ofloxacin protect from sunlight and avoid sunbeds

53
Q

which drug class has an increased risk of tendon damage when used with steroids in over 60 year olds

A

quinolones

54
Q

what is the age range that fluconazole is indicated in

A

16-60 years

55
Q

List the interactions associated with quinolones

A

increased risk of QT Prolongation (avoid when taking SSRI, Quinine, amiodarone, macrolide and antipsychotics), ventricular arrhythmias and heart regurgitation
increased risk of seizures : ciprofloxacin and theophylline- cipro is an enzyme inhibitor so causes theophylline toxicity and a side effect of theophylline is convulsions
NSAIDS can also increase the risk of convulsions
arthopathy: avoid in pregnancy, children and adolescent

56
Q

What are the CI for using moxifloxacin

A

QT prolongation: electrolyte disturbances, heart failure with reduced LVEF, bradycardia, congenital QT syndrome, other QT prolonging drugs

57
Q

when should quinolones be discontinued

A

psychiatric, neurological and hypersensitivity reactions occur

58
Q

which of the tetracycline antibiotics should you avoid milk

DOT

A

demeclocycline
Oxytetracycline
Tetracycline

59
Q

Which of the tetracycline should you avoid using sunlight’s/ lamps
DD

A

demeclocycline

doxycycline

60
Q

Which tetracyclines is there decreased absorption when taking antacids, iron or zinc salts 2 hrs before or after taking

A

all tetracyclines

61
Q

which tetracyclines are associated with oesophageal irritation DMT

A

Doxycycline
Minocycline
Tetracycline

62
Q

What eGFR is CI in nitrofurantoin

A

45 and under

63
Q

Which tetracyclines can be used in renal impairement

A

doxycycline and minocycline

64
Q

Are tetracycline hepatoxic

A

yes- avoid and or use with caution especially in those already using hepatoxic drugs

65
Q

What are the s/e associated with tetracyclines

A

benign intracranial hypertension
minocycline cn cause vertigo, dizziness, irreversible pigmentation, lups-erythrateaosus syndrome
deposit in growing bone and teeth and causes teeth discolouration and dental (enamel) hypoplasia

66
Q

pt counselling associated with tetracyclines

A

stop if headache and visual disturbances

67
Q

When tetracyclines are contra-indicated

A

children under 12
pregnancy and breast feeding- deposit in growing bone and teeth and causes teeth discolouration and dental (enamel) hypoplasia

68
Q

what are the plasma monitoring requirements for gentamicin in adults (not endocarditis)

A

for multiple daily dosing regimens
peak serum conc should be taken an hour in and should be 5-10mg/L
trough (pre-dose) should be less than 2mg/L
monitor trough after 3-4 doses and a dose change at least every 3 days
more frequently and earlier in renal impairment

69
Q

What affect does amoxicillin have on methotrexate

A

Increases the clearance of methotrexate

Chapter 5 Infections (3 decks)

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