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PPT Phase II > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Name the components of the CURB65 score

A 
Confusion - new onset
Urea > 7mmol/L
RR >/= 30
BP - SBP =90 or DBP = 60
65 - age >65

score 0-1 = low risk, consider home treatment
score of 2 - 9.2% 30 day mortality. Admit or monitor as outpatient closerly
score of 3-5 - admit and manage as severe (30-day mortality of 22%)

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2
Q

If a patient is able to take penicillin what would be the antibiotic of choice for someone with pnemonia with a CURB65 score or 1?

A

oral amocicillin 500mg 8-hrly

if IV needed you can give the same IV

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3
Q

what antibiotics could you use for a CURB65 score of 2?

A 
oral doxycycline 100mg 12hrly
or
oral amoxicillin + clarithromycin
or 
IV benzylpenicillin 1.2g 6hrly + IV clarithromycin 500mg 12 hrly
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4
Q

what antibiotics would you use in a patient with a CURB65 score of 3+?

A

IV co-amoxiclav 1.2g 8hrly + IV clarithromycin 500mg 12 hrly

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5
Q

what is the difference between a bacteriocidal and a bacteriostatic antibiotic?

A

bacteriocidal kills bacteria

bacteriostatic prevents growth of bacteria allowing natural immune mechanisms to eliminate the bacteria

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6
Q

what bacteria is the commonest cause of CAP?

A

Streptococcus pneumoniae

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7
Q

what group of patients would you not use doxycycline to treat pneumonia?

A

children - tetracyclines affect bone development

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8
Q

what drug should a patient stop taking if they are on clarithromycin?

A

statins, warfarin etc.
they inhibit CYP enzymes meaning the level of statins and warfarin in the system will increase and patient is at more risk of side effects

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9
Q

If a patient is allergic to penicillin, what would be first line in someone with a CURB65 score of 1?

A

oral doxycycline 100mg 12hrly
or
IV clarithromycin 500mg 12hrly

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10
Q

if a patient is allergic to penicillin, what would you use in a patient with a CURB65 score of 2?

A 
oral doxycycline 100mg 12 hrly
or
oral clarithromycin 500mg 8-hrly
or
IV clarithromycin 500mg 12hrly
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11
Q

If a patient is allergic to penicillin what would be the treatment for a patient with a CURB65 score of >/= 3?

A

IV cefotaxime 1g 8hrly + IV clarithromycin 500mg 12hrly

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12
Q

what is meant by antimicrobial stewardship?

A

an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness

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13
Q

what local or national guidelines should prescribers follow for principles of good prescribing (3 things)

A
  1. prescribing the shortest effective course
  2. the most appropriate dose
  3. route of administration
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14
Q

why are broad spectrum antibiotics avoided where possible in CAP?

A

to reduce likelihood of C.diff colonisation.

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15
Q

what antibiotics are most frequently implicated in predisposition to C.diff acquired diarrhoea?

A

fluoroquinolones, clindamycin, broad-spec penicillins and cephalosporins

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16
Q

what is involved the sepsis 6 pathway?

A
  1. administer O2 (aim to keep sats at >94% or 88-92% for T2RF)
  2. take blood cultures
  3. IV antibiotics
  4. IV fluids
    5 check serial lactates
  5. measure urine output
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17
Q

Name the red flag symptoms for sepsis (10)

A
  • Responds only to voice or pain or is unresponsive
  • Acute confusional state
  • Systolic BP = 90 or a drop of >40 from normal
  • HR >130
  • RR >/= 25
  • Needs O2 to keep SpO2 >92%
  • non-blanching rash, mottled/ashen/cyanotic
  • Not passed urine in last 18hr/UO <0.5ml/kg/hr
  • Lactate >/= 2mmol/l
  • Recent chemotherapy
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18
Q

name 3 common causes of atypical bacteria causes of pneumonia

A
  • Legionella pneumophilia
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
19
Q

what antibiotics could you use to treat pneumonia caused by Legionella spp?

A

fluoroquinolone or clarithromycin

20
Q

what is the MOA of penicillins

A

cell wall damage whcih causes cell swelling, lysis and then cell death

21
Q

what types of bacteria does benzylpenicillin have activity agains?

A

relatively narrow specturm. some activity against some Gr+ organisms (e.g. streptococci, bacillus) and Gr- cocci (e.g. Neisseria spp.) Not active against Gr- bacilli

22
Q

name two broad spectrum penicillins

A

amoxicillin

co-amoxiclav

23
Q

what can be given alongside co-amoxiclav to make it more effective against resistant strains?

A

clavulanic acid (a beta-lactamase inhibitor)

24
Q

what do penicillinase-resistant penicillins have activity against?

A

narrow spectrum of activity against Gr+ staphylococci

25
Q

name a penicillinase-resistant penicillin

A

flucloxacillin

26
Q

what is the spectrum of activity like for cephalosporins and carbapenems?

A

broad

27
Q

what is the MOA of cephalosporins and carbapenems?

A

prevent new bacteria from forming by disrupting cell wall growth due to presence of a beta-lactam ring

28
Q

when might you prescribe cephalosporins or carbapenems?

A

2nd and 3rd-line option for UTI and RTIs.

for very

29
Q

What antibiotics are used to treat TB and how long do you use each of them?

A

for 2 months: rifampicin, isoniazid, ethambutol, pyrazinamide
for a further 4 months continue on: rifampicin and isoniazid

30
Q

what is multi-drug resistant TB classified as?

A

TB caused by M.tuberculosis that is resistant to at least rifampicin and isoniazid

31
Q

what is extensively drug resistant TB defined as in terms of resistnace?

A

resistance to rifampicin, isoniazid, plus any agent of the fluoroquinolone family, plus at least one of the aminoglycosides or polypeptides.

32
Q

rifamycins such as rifampicin induce cytochrome P450 isoenzymes and in doing so can reduce blood plasma concentrations of some drugs - name two important ones?

A

oestrogen - so may reduce effectiveness of the oral contraceptive pill, warfarin, sulphonylureas, phenytoin

33
Q

what is the MoA of tetracyclines?

A

inhibit bacterial protein synthesis - 30S inhibitor

34
Q

what TB drug can cause red-green colourblindness followed by reduced visual acuity? are these effects permanent?

A

ethambutol.

effects are dose-related and usually reversible

35
Q

what are the two main bacterial causes of infective endocarditis?

A 
Staphylococcus aureus (31%)
Viridians group Streptococcus (17%)
36
Q

what antibiotic would you use for initial blind therapy of infective endocarditis in someone with a native valve

A

amoxicillin and consider adding low-dose gentamicin

37
Q

what antibiotic would you use for initial blind therapy of infective endocarditis in someone with a native valve who is allergic to penicillins?

A

vancomycin + gentamicin

38
Q

what antibiotic would you use for initial blind therapy of infective endocarditis in someone with a prosthetic valve

A

vancomycin + rifampicin + low dose gentamicin

39
Q

what antibiotic would you use for Native valve endocarditis caused by staphylococci

A

flucloxacillin

if penicillin allergic - vancomycin + rifampicin

40
Q

what antibiotic would you use for sensitive streptococci?

A

benzylepenicillin

if allergic - vancomycin + gentamicin

41
Q

what gram stain of bacteria is vancomycin active against?

A

Gr+

42
Q

what is the MoA of vancomycin

A

inhibits synthesis of cell walls of Gr+ bacteria

43
Q

name some examples of macrolides and their MOA

A

e.g. clarithromycin, erythromicin, azithromycin,

Inhibit bacterial protein synthesis

44
Q

how do aminoglycosides work? give some examples of drugs

A

they inhibit protein synthesis (30S inhibitors)

e.g. gentamicin, amikacin, neomycin

PPT Phase II (37 decks)

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