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Respiratory > PPT 3 > Flashcards

PPT 3 Flashcards

1
Q

Amoxicillin

A

Penicillins kill susceptible bacteria by specifically inhibiting the transpeptidase that catalyses the final step in cell wall biosynthesis, the cross-linking of peptidoglycan

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2
Q

Benzylpenicillin

A

Natural penicillin antibiotic that is administered intravenously or intramuscularly due to poor oral absorption

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3
Q

Co-amoxiclav

A

AKA augmentin

Amoxicillin + clavulanate

Clavulanic acid is a beta-lactamase inhibitor - prevents bacteria from inactivating certain beta lactam antibiotics

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4
Q

Flucloxacillin

A

A penicillin beta-lactam antibiotic used in the treatment of bacterial infections caused by susceptible, usually gram-positive, organisms

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5
Q

Piperacillin-tazobactam

A

Piperacillin = penicillin beta-lactam antibiotic used in the treatment of bacterial infections caused by susceptible, usually gram-positive, organisms

Tazobactam = beta-lactamase inhibitor

Used to treat hospital acquired pneumonia

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6
Q

Cefotaxime

A

Third-generation cephalosporin antibiotic

Broad spectrum activity against Gram positive and Gram negative bacteria

Inhibits bacterial cell wall synthesis

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7
Q

Cefaclor

A

2nd generation cephalosporin

Beta lactam antibiotic - prevents bacterial cell wall synthesis

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8
Q

Ceftriaxone

A

Cephalosporin antibiotic

Works by inhibiting the mucopeptide synthesis in the bacterial cell wall - attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.

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9
Q

Azithromycin

A

Broad-spectrum macrolide antibiotic - 50s inhibitor

Primarily used for the treatment of respiratory, enteric and genitourinary infection

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10
Q

Clarithromycin

A

Semisynthetic macrolide antibiotic derived from erythromycin, inhibits bacterial protein synthesis by binding to the bacterial 50S ribosomal subuni

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11
Q

Erythromycin

A

Belongs to the macrolide group of antibiotics - 50s inhibitor

Stops bacterial protein synthesis by inhibiting the transpeptidation/translocation step of protein synthesis and by inhibiting the assembly of the 50S ribosomal subuni

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12
Q

Gentamicin

A

30s inhibitor

Aminoglycosides are useful primarily in infections involving aerobic, Gram-negative bacteria, such as Pseudomonas, Acinetobacter, and Enterobacter

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13
Q

Streptomycin (TB)

A

30s inhibitor

Given via deep IM for drug resistant TB (in combination with other drugs)

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14
Q

Tobramycin

A

30s inhibitor

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15
Q

Doxycycline

A

Mainly bacteriostatic and are thought to exert antimicrobial effects by the inhibition of protein synthesis

30s inhibitor

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16
Q

Tetracycline

A
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17
Q

Minocycline (acne)

A
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18
Q

Lymecycline (acne)

A

30s inhibitor

19
Q

Moxifloxacin

A

Synthetic fluoroquinolone antibiotic agent

DNA inhibitor

Inhibition of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV. DNA gyrase is an essential enzyme that is involved in the replication, transcription and repair of bacterial DNA

20
Q

Rifampicin

A

Inhibits DNA-dependent RNA polymerase activity by forming a stable complex with the enzyme. It thus suppresses the initiation of RNA synthesis

Blocks RNA synthesis

1st line for TB

21
Q

Isoniazid

A

Antibacterial agent used primarily as a tuberculostatic - highly specific agent against mycobacterium, ineffective against other microorganisms

22
Q

Pyrazinamide

A

Highly specific agent and is active only against Mycobacterium tuberculosis

23
Q

Ethambutol

A

Ethambutol is an oral chemotherapeutic agent which is specifically effective against actively growing microorganisms of the genus Mycobacterium, including M. tuberculosis. Ethambutol inhibits RNA synthesis and decreases tubercle bacilli replication

24
Q

What does a CURB 65 score of 3 or more mean?

A

Patient is at high risk of death and should be reviewed by senior at the earliest opportunity

25
Q

If a patient has a CURB 65 score of 4 or 5, what should be done?

A

Assess the patient with specific consideration to the need for transfer to critical care

26
Q

If a patient has a CURB score of 0 or 1, what does this mean?

A

Patient is at low risk of death from pneumonia and may be suitable for home treatment

27
Q

Discuss management of a patient with pneumonia, with reference to CURB scores

A

CURB 65 = 0-1: 1.5% 30 day mortality, low risk patient so consider home treatment

CURB 65 = 2: 9.2% 30 day mortality, will most likely need admitting or managing closely as an outpatient

CURB 65 = 3-5: 22% 30 day mortality, admit the patient and treat as severe pneumonia

28
Q

Your patient has a CURB score of 0-1, which antibitoic are you going to prescribe?

A

Oral amoxicillin if able to tolerate penicillin

Oral doxyclycline if allergic to penicillin

29
Q

Your patient has a CURB score of 2, which antibiotic are you going to prescribe?

A

Oral doxycycline

OR

No penicillin allergy: oral amoxocillin + clarithromycin

Penicillin allergy: clarithromycin

If IV needed:

No penicillin allergy: benzylpenicillin + clarithromycin

Penicillin allergy: clarithromycin

30
Q

Your patient has a CURB score of 3 or more, which antibiotic will be prescribed?

A

Able to tolerate penicillin: IV co-amoxiclav + IV clarithromycin

Allergic to penicillin: IV cefotaxime + IV clarithromycin

31
Q

What is antimicrobial stewardship?

A

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

32
Q

What are the principles of good prescribing when prescribing antibiotics?

A
  1. Prescribe shortest effective course
  2. Prescribe most appropriate dose
  3. Appropriate route of administration
33
Q

BTS recommendations when prescribing in cases of pneumonia

A
  1. Diagnosis and prescription of antibiotics to be reviewed by senior clinician
  2. Indication for antibotics to be written clearly in notes
  3. Need for IV antibitoics to be reviewed daily
  4. De-escalation of therapy to be considered as soon as appropriate
  5. Strongly consider narrowing specturm of antibiotic
34
Q

Principles of antimicrobial prescribing

A

Right antibiotic - what organism? risk factors for resistance? Effective antibiotic?

Right time - have we got culture results?

Right dose

Right route - can this patient have oral antibiotics?

Least harm - most narrow spectrum possible, minimum treatment duration, least amount of side effects

35
Q

Why do we try and avoid using broad spectrum antibiotics in community acquired pneumonia?

A

To reduce the risk of c.diff colonisation

36
Q

What types of healthcare acquired infections does the use of broad specturm antibiotics predispose to?

A

C.diff

MRSA

Extended spectrum beta-lactamases - ezymes that are resistant to most beta-lactam antibiotics **found exclusively in gram negative organisms

37
Q

What is atypical pneumonia?

A

Refers to the radiological pattern associated with patchy inflammatory changes often confined to the pulmonary interstitium most commonly associated with atypical bacterial aetiologies e.g.

  • Mycoplasma pneumoniae
  • Chlyamydia pneumoniae
  • Legionella pneumoniae
38
Q

Discuss the principle of TB drug therapy

A

Regimens generally consist of an intense phase (2mo) followed by a continuous phase (4-7mo)

Intensive phase usually consist of rifampicin, isoniazid, pyrazinamide and ethambutol

Continuation phase usually consists of isoniazid and rifampicin administered for an additional 4 months

39
Q
A
40
Q

Discuss rifamycin drug interactions

A

Reduced plasma concentrations of oestogen in those taking oral contraceptives

Reduces plasma concentration of warfarin, phenytoin (for eplisepsy, blocks sodium channels) and sulphonylureas (T2DM)

41
Q

Isoniazid

A

Pro-drug, activated by catalase peroxidase activity within the mycobacteria

The active product blocks the synthesis of mycolic acids unique to the cell wall of mycobacteria and blocks nucleic acid synthesis

Can cause hepatotoxicity and peripheral neuropathy

42
Q

Pyrazinamide

A

If pyrazinamide us used alone for the treatment of TB resistance develops rapidly

Can cause hepatotoxicity and a rise in plasma bilirubin usually warrant cessation of treatment

Crosses BBB so good for TB meningitis

43
Q

What are the adverse effects of ethambutol?

A
  • Visual disturbances
  • Optic neuritis - produces red green colour blindness
  • Hyperurucaemia and gout
  • Nephrotoxicity

Respiratory (19 decks)

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