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Year 3 Drug > antibiotics 1 > Flashcards

antibiotics 1 Flashcards

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1
Q

what is the classname of nitrofurantoin

A

nitrofurantoin

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2
Q

indiction for nitrofurantoin

A

1st line treat for uncomplicated UTI

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3
Q

MOA for nitrofurantoin

A

it is metabolised in bacterial cells by nitrofuran reductase and its active metabolite damages bacterial DNA and causes cell death

Nitrofurantoin is active against the G-ve (eg E.coli) and G+ve ( Staph sap) that commonly cause UTI

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4
Q

contraindication for nitrofurantoin

A

should not be use in pregnant women or for bodies tin the first 3 months of life

renal impairment - impaired excretion inc toxicity and reduces efficacy due to lower urinary drug conc

caution for chronic use for long term prevention - inc risk of side-effect esp in elderly pts

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5
Q

side effect for nitrofurantoin

A

GI upset (N+v)

can cause delayed
hypersensitivity

turn urine yellow or dark

can cause chronic pulmonary reactions (inc inflammation and fibrosis)

hepatitis

peripheral neuropathy

in neonates - haemolytic anaemia - RBC can not mop up nitrofurantoin-stimulated superoxides

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6
Q

interaction of nitrofurantoin

A

N/A

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7
Q

typical dose of nitrofurantoin

A

50-100mg 6 hourly

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8
Q

what is the class name for trimethoprim

A

trimethoprim

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9
Q

what are 2 examples of trimethorim

A

trimethoprim and co-trimoxazole (trimethoprim and sulfamethoxazole)

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10
Q

main indication for trimethoprim

A

first choice for uncomplicated UTI

co-trimoxazole is used to treat and prevent pneumocystis pneumonia in people with immunosuppression

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11
Q

MOA for trimethorpim

A

trimethoprim - inhibits bacteria folate synthesis (as bacteria are unable to use folate present in human body) and so it is bacteriostatic

sulfonamides also inhibit bacterial folate synthesis but slightly different pathway to trimethoprim, but together with trimethoprim, a complete bactericidal action

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12
Q

contra-indication for trimethoprim

A

first trimester of pregnancy (folate antagonist)

avoid use in ppl with folate deficiency

a reduced dose should be used in ppl with renal impairment

cautious use in neonate, elderly and ppl with HIV

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13
Q

side effect of trimethoprim

A 
GI upset (N+V) 
skin rash (rare) 
can impair haematopoiesis causing haematological disorder such as megaloblastic anaemia, leucopenia, thrombocytopenia 
can also cause hyperkalaemia
elevation of plasma creatinine conc
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14
Q

interaction of trimethoprim

A

use with potassium-elevating drugs eg (aldosteron antagonist, ACEi, angiotensin receptor blockers) - predisposes to hyperkalaemia

use with other folate antagonist eg methotrexate and drugs that inc folate metabolism - inc risk of adverse haematological effects

can also enhance the anticoagulant effect of warfarin by killing normal gut flora that synthesise vit K

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15
Q

what is the doses of trimethoprim

A

200mg 12 hourly

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16
Q

what are the different examples of penicillin

A

benzylpenicillin, phenoxymethylpenicillin

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17
Q

what are some examples of broad spectrum penicillin

A

amoxicillin and co-amoxiclav

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18
Q

MOA for broad spectrum penicillin

A

Beta lactam

amoxicillin - beta-lactam has side chain attached to the beta lactam ring and this side chain can modified to increase antibacterial ability. amoxicillin has additional amino acids group for inc ability

co-amoxiclav - addition of beta-lactamase inhibitor, clavulanic acid, inc the spectrum of antimicrobial activity to include beta-lactamase-producing bacteria eg staph aureus, gram -ve anaerobes)

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19
Q

main indication for broad spectrum penicillin

A
  • empirial treatment for pneumonia (can be due to both gram +ve and gram -ve pathogens
  • empirial treatment for UTI (most common caused by E.coli)
  • part of combined treatment for H.pylori-associated peptic ulcers
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20
Q

main contra-indications for broad spectrum penicillin

A

pt at inc risk of C.Diff infection

allergy dose should be reduced in those with severe renal impairment

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21
Q

adverse effect of broad spectrum penicillin

A

GI upset eg N+V
antibiotic colitis- normal flora got killed
allergy
cholestatic jaundice - co-amoxiclav

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22
Q

interaction of broad spectrum penicillin

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A

reduce renal excretion of methotrexate - inc risk of toxicity

can enhance the anti-coagulant ability of warfarin by killing gut flora which produce Vita K

23
Q

typical dose for amoxicillin

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A

severe infection - 1g 8-hrly then switch to oral

mild-moderate - 250-500mg 8 hrly

24
Q

what are the group name for benzypenicillin, phenoxymethypenicillin

25
MOA for benzypenicillin and phenoxymethypencillin
Beta lactam the side chain to the beta lactam ring is the characteristic for the medicine
26
main indication for benzypenicillin and phenoxymethypenicillin
- strep infection - incl tonsillitis, pneumonia (combine with macrolide if severe), endocarditis and skin and soft tissue infections (added to fluxcloxacilline if severe) Costridial infection eg tetanus meningococcal infection eg meningitis, septicaemia (blood poisoning)
27
contra-indication for benzypenicillin and phenoxymethypenicillin
pt with renal impairment | allergy
28
side effect for benzypenicillin and phenoxymethypenicillin
allergy CNS toxicity - can occur with high dose of penicillin
29
interaction of benzypenicillin and phenoxymethypenicillin
methotrexate - pencillin reduce renal exercretion - inc conc
30
what is penicillin V
phenoxymethypenicillin
31
what is an example of penicillin with antipseudomonal
piperacillin with tazobactam (Tazocin)
32
MOA for Tazocin
beta lactam for piperacillin, side chain = a form of urea which improve affinity to penicillin binding proteins - inc spectrum of antimicrobialactivity to include pseudomonas aeruginosa tazobactam - confers antimicrobial activity against beta lactamase producing bacteria eg staphy aureus, gram -ve anaerobes
33
main indication for Tazocin
reserved for severe infections - where broad spectrum of potential pathogens (incl pseudomonas aeruginosa) and antibiotic resistance is likely or pts who are immunocompromised lowere Resp tract inf UTI Intra-abdominal sepsis skin and soft tissue infection
34
contra-indication for Tazocin
caution in pt at risk of C.diff allergy renal impairment
35
side effect of Tazocin
GI upset antibiotic associated colitis - killing of normal gut flora allergy
36
interaction of Tazocin
methotrexate | inc risk of warfarin toxicity - killing of normal gut flora which produce vita K
37
which of the penicillin medication should be used with a pathogen which is penicillinase-resistant
Flucloxacillin
38
MOA for flucoxacillin
an acyl side chain protects the beta lactam from beta lactamases makes flucloxacillin effective against beta lactamase producing staphylococci MRSA resist the flucloxacillin by reducing penicillin binding affinity
39
contra-indication for flucloxacillin
renal impairment | allergy
40
side effect of flucloxacillin
GI upset allergy CNS toxicity - when high dose
41
interaction of flucloxacillin
methotrexate
42
what are some examples of cephalosporins and carbapenem
cefalexin and cefotaxime meropenem ertapenem
43
MOA of ceflaxin and cefotaxime and meopenem and ertapenem
beta lactam ring but inhibit enzymes responsible for cross-linking peptidoglycanrs in the bacterail cell wall during cell growth broad spectrum both are more resistant to beta-lactamases than pencillin due to fusion of the β-lactam ring with a dihydrothiazine ring (cephalosporins) or a unique hydroxyethyl side chain (carbapenems).
44
main indication for cephalosporins and carbapenems
- oral cephalosporins - 2nd or 3rd line treatment options for UTI and resp tract infection - IV injections of both types are reserved for severe or complicated infection - cAN BE USED FOR MOST INFECTION DUE TO BROAD SPECTrum
45
contra-indication for cephalosporin and carbapenems
pt at risk of C.diff allergy carbapenems - caution in pt with epilepsy renal impairment in both
46
side effect for cephalosporin and carbapenems
``` GI upset antibiotic associated collitis allergy CNS system toxicity - when high doses renal impairment ```
47
interaction of cephalosporins and carbapenems
warfarin cephalosporins - inc nephrotoxicity of aminoglycosides carbapenems - reduce plasma conc of valproate
48
examples for tetracyclines
doxycycline, lymecycline
49
MOA for doxycycline and lymecycline
inhibit bacterial protein synthesis binds to ribosomal 30s subunit found specifically in bacteria - bacteriostatic broad spectrum
50
indication for tetracyclines
acne vulgaris lower RTI incl infective exacerbation of COPD, pneumonia and atypical pneumonia chlamydial infection incl pelvic inflammatory disease typhoid, anthrax, malaria and Lyme disease
51
contra-indication for tetracyline
oesophageal and bone - teeth deformity - avoid in infant as they are still growing, pregnancy, breast feeding renal impairment
52
side effect of tetracycline
GI upset ulceration and dysphagia photosensitivity discolour and hypoplasia of tooth enamel intracranial hypertension - rare
53
interaction of tetracycline
They shouldn’t be given within 2 hours of calcium, antacids or iron Enhance warfarin
54
indication for flucloxaillin
skin and soft tissue - eg cellulitis (with benzypenicillin) Osteomyelitis and septic arthritis endocarditis

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