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clinical pharm y5 > antibiotics > Flashcards

antibiotics Flashcards

1
Q

list the beta lactams

A

penicillin
cephalosporins
carbapenems
monobactams

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2
Q

types of penicillin

A

narrow and broad spec

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3
Q

broad spec penicillins

A

Carboxypenicillin
Aminopenicillin
Ureidopenicillin

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4
Q

groups of antibiotics

A
  1. B lactams
  2. Glycopeptides
  3. Aminoglycosides
  4. Tetracycline
  5. Macrolides
  6. Amphenicols
  7. Lincosomide
  8. Fluoroquinolones
  9. Sulphonamides
  10. Nitroimidiazole
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5
Q

examples od nitromidazo;es

A

Metromidazol

b. Timidazol

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6
Q

principle for prescribing antibiotics

A
  1. MUST HAVE A BACTERIAL INFECTION (duh)
  2. Better to know type of MO
  3. character of the disease
  4. the patient
  5. pharmacological characteristics of the drug
  6. localization
  7. clinical manifestations
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7
Q

what type of antibiotic is given to immunosupressed patients

A

bacteriacidal

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8
Q

which factors infulence the efffective therapeutic concenctration at the site of infection

A 
Cmax - max [serum] that a drug
achieves in a specified compartment
of a test area of the body before the
2nd dose.
2. Tmax – amount of time a drug is
present at Cmsx
3. AUC – ‘area under the curve’ àtotal
drug exposure across time. The
curve represents total amount of
drug absorbed by the body
4. T ½
5. MIC – [lowest] of a drug which
prevents visible growth of
bacterium.
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9
Q

what is the Cmax

A

max [serum] that a drug
achieves in a specified compartment
of a test area of the body before the
2nd dose.

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10
Q

what is the t max

A

Tmax – amount of time a drug is

present at Cmsx

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11
Q

what is the AUC

A

area under the curve’ àtotal
drug exposure across time. The
curve represents total amount of
drug absorbed by the body

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12
Q

what is MIC (minimal inhibitory concentration)

A

[lowest] of a drug which
prevents visible growth of
bacterium.

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13
Q

how many types of antibiotics are there according to their absorption

A

type 1: aminoglycosides and fluroquinilones

type 2: b lactam

type 3: tetracycline and azithromycin

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14
Q

type 1: aminoglycosides and fluroquinilones absorption

A 
Fast and powerful
antibacterial effects
- Less ADRs when peak
conc achieved
- Conc dependant effect!*]
- ideal dose MUST ensure
maximal high plasma
conc
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15
Q

type 2 b lactams

A 
highest bacterial efficacy
when [serum] are 2-4 >
MIC
- ideal dose regimen is
maximal duration of
effect between 2 doses.
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16
Q

type 3 tetracylcines and azithromycin

A

Possess mixed type
pharmacokinetic and pharmaco
dynamics

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17
Q

application of aminoglycosides

A

single daily
dose application.
Ratio of Cmax/ MIC > 10
determines antibacterial effect.

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18
Q

flouroquinolones

A

à AUC/MIC
ratio
Gram +ve = 25-30
Gram -ve = 100-125

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19
Q

when should the antibiotic theraapy be changed

A

after 48-72 hours

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20
Q

Concentration dependent antibiotics: Aminoglycosides and flouroquinolones

A

ntibiotics which eradicate pathogenic bacteria by achieving high concentration at the site of binding

ntibiotics which eradicate pathogenic bacteria by achieving high concentration at the site of binding

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21
Q

Time dependent antibiotics: penicillins, cephalosporins, carbapenems, monobactams), clindamycin, macrolides (erythromycin, clarithromycin), oxazolidinones (linezolid).

A

he time that serum concentrations remain above the MIC during the dosing interval (t>MIC)”.They show optimum killing response when the time that the drug remains above the MIC is either equal or greater than 50% of the dosing interval.

22
Q

when is combination therapy indicated

A 
Avoid drug resistance especially in
diseases like TB
2. Immunocompromised patients
3. Prophylaxis in heavy operations – i.e
intraabdominal ops
4. Widening antimicrobial spectrum in
critical cases i.e septicaemia
5. Rx of mixed infections (aerobes and
anaerobes )
23
Q

types of antibiotics based on mechanism of action

A
  1. Bactericidal effect on fast divided microbes + microbe spores – aminoglycosides, flouroquinolones
  2. Bactericidal effect on fast divided microbes – B lactams + vancomycin
  3. Bacteriostatic effect – Tertacycline , macrolides chloramphenicol, lincozamides morning
24
Q

which combinations are profitable

A

group 1 and 2
group 1 and 3
group 2 and 2
group 3 and 3

25
Q

which drug combinations are contraindicated

A

group 2 and 3 decrease effect( except B lactams, sulphonamides + metronidazole)
group 1 and 1 is irrational

26
Q

which operations are require prophylactic antibiotic coverage

A 
o Cardiovascular ops
o Neurosurgery
o Abdominal operations
o Appendectomy (
o Application of prophylactic Abs

§ For 48 hours
§ IM – before op
§ IV – during op

27
Q

which disease inidcate prophylactic antiobiotic coverage

A

Meningococcus induced meningitis
Neutropenia
Animal bites
Acute joint rheumatism

28
Q

which antibiotics induce CYP450A3

A

rifampicin

29
Q

what drugs have their plasma concentration decreased by rifampicin

A

a. Warfarin
b. Cyclosporin
c. Glucocorticoids
d. Ketoconozol
e. Cardiac glycosides
f. Verapamil

30
Q

which drugs inhibit CYP450A3

A

Erythromycin, flouraquinolones and isoniazid

31
Q

which antibiotics cause disulfiram reaction w/ alcohol

A

Metronidazol + tinidazole

32
Q

antacids cause decreased absorption of which drugs

A

macrolides
tetraclyclines
flouroquinolones

33
Q

adr’s of antibiotics

A
  • gastrointestinal disrubances
  • dysbacteriosis
  • allergy
  • hepatotoxicity
  • nephrotoxicity
  • myelotoxicity
  • neurotoxicity
  • bones and teeth
34
Q

GIT disturbance

A

irritation observed especially w/
GIT
tetracyclines + erythromycin.

• Wide spec = alter the intestinal and oral
microflora

• N/V , anorexia abdominal pain , diarrhoea

35
Q

Dysbacterioris

A 
ncomycin/ clindamycin
à development of pseudomembranous
enterocolitis can occur à V DANGEROUS
(swelling and overgrowth of large intestine
d/t growth of C. difficile)
36
Q

Hepatotoxicity

A

Abs that have bile excretion
mainly for eg tetracycline, erythromycin.
And rifampicin

aundice is observed after long term use
with tetra, streptomycin + lincomycin

37
Q

Myelotoxiitiy

A

Heavy BM disturbances seen w/ long term rx

w/ chloramphenicol

38
Q

Neurotoxic effects

A

Aminoglycosides and vancomycin effect the
8th vestibular cochlear nerve!

Optic nerve – streptomycin
chloramphenicol

39
Q

Bone + teeth

A 
Tetracyclines can accumulate in teeth and
bones
• Can destroy their growth and form
• CI in children up to 7 yrs
• Quinolones à damage chondroithal
catrlidge . CI in children upto 12
40
Q

what happens to antibiotics in liver failure

A

Metabolism of Abs may be delayed which leads to the ^ in [plasma] and ^
risk of ADRs
• When clin lab results show liver malfunction ie ^ Br AST + ALT enzyme ^ -
reduce dose

41
Q

which antibiotics have delayed metabolism in liver diseases

A

Erythromycin
Clindamycin
Lincomycin
Chloramphenico

42
Q

how does kidney failure affect antibiotics

A

increased half life excretion time causing increase plasma volume of antibiotics thus increasing the risk od ADRS . the dose should be reduced or the dosing intervals should be increased

43
Q

which antibiotics have increased half life excretion time in kidney failure

A

Aminoglycosides
Floura
Beta lactams
Vanco etc

44
Q

approach to type 1 (conc) antibiotics in kidney failure

A

keep dose unchanged and only ^ dose interval

45
Q

pproach to type 2 (time) antibiotics in kidney failure

A

decrease dose only – ensures optimal t> MIC ratio

46
Q

Which anitibiotics can be applied in pregnancy

A

category b antibiotics e.g.penicillins: amoxicillin, clavulanic acid, cefalosporins, macrolides, aztreonams

category c antibiotics
e.g. imipenems, aminoglycosides, chloramphenicol , flouroquinolones

47
Q

antibiotic approach to community acquired pneumonia

A

Specific Abs not good d/t late and low rate microbial lab results
• EMPIRICAL THERAPY is the way to go!
• Recommended therapy is B lactams w/ wide spec
• In pts w/ heavy infection, combine above w/ macrolides

DO NOT COMBO W/ AMINOGLYCOSIDE

48
Q

antibiotic approach to hospital acquired pneumonia

A

Combo therapy cos mixed infections
• Fluoroquinolones not recommended ads they ^ resistance in ambulatory pts
• Always paraentral BUT when combo – 2nd drug is applied orally
• Duration = paraentral – 5 to 7 days + 5 days oral therapy

49
Q

antibiotic approach to urological infections

A

Causative agent is usually E.coli
Aminoglycosides + B lactams and 3rd gen
• NOT co – trimoxazole and floura d/t developed resistance.

50
Q

antibiotic approach to acute prostatitis

A

causative agents are : strep pne, HI and Moraxella catarhallis.

Use quinolones – 1 month
• They have good penetration In prostate secretes and accumulate in prostate
gland

51
Q

antibiotic approach to Acute and chronic

sinusitis

A

ACUTE: caused by trep pne, HI and Moraxella catarhallis.
• 1st line Rx – amoxicillin (+/- clavulanic acid)
• 2 weeks
• Cefuroxime – also used
• If no imoprovemnt within 72 hrs then proceed with application of
flouraquinalones – levoflaxicin and moxifloxacin
• In cases of B lactam allergy use – clarithromycin azithromycin etc
• Penicillin , erythromycin and 1st gen – not recommended

52
Q

antibiotic approach to Osteomyelitis

A

Use paraentral drugs which penetrate bines and joints à oral therapy
• 4-6 weeks
• PRSPs and 3rd gen

clinical pharm y5 (22 decks)

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