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Pre-reg Exam 2021 > Antibiotics > Flashcards

Antibiotics Flashcards

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1
Q

Which antibiotics are contraindicated in children?

A

Tetracyclines - not for < 12 years

Quinolones - cause arthropathy

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2
Q

Which antibiotics are contraindicated /cautioned in the elderly?

A

Clindamycin - highest risk of C. Diff

Careful in renal/liver impairment

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3
Q

Which antibiotics commonly cause allergic reactions?

A

Penicillins - also cross-sensitivity with cephalosporins and other B-lactam antibiotics

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4
Q

Which antibiotics can be used as alternatives in penicillin allergic patients?

A

Macrolides

Metronidazole (dental infections)

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5
Q

Which antibiotics cause nephrotoxicity?

A

Aminoglycosides

Glycopeptides

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6
Q

Which antibiotics should be avoided in renal impairment?

A

Tetracyclines - except minocycline/doxycycline

Nitrofurantoin - eGFR < 45

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7
Q

Which antibiotics cause hepatotoxicity?

A

Rifampicin
Tetracyclines
Reduce metronidazole dose if liver severely impaired

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8
Q

Which antibiotics cause cholestatic jaundice?

A

Co-amoxiclav

Flucloxacillin

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9
Q

Which antibiotics are contraindicated in pregnancy?

A

Tetracyclines
Trimethoprim
Nitrofurantoin - avoid at term as causes nausea

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10
Q

Which antibiotics should be avoided in pregnancy?

A

MCAT
Metronidazole, chloramphenicol, aminoglycosides, tetracyclines
Quinolones
Sulphonamides

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11
Q

Which antibiotics are safest in pregnancy?

A

Penicillins

Cephalosporins

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12
Q

What are the most common side effects of antibiotics?

A

GI

Nausea, vomiting, diarrhoea, abdominal pain

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13
Q

Which antibiotics can cause superinfection e.g. antibiotic associated colitis and thrush?

A

Clindamycin and broad spectrum antibiotics

C. Diff - antibiotics beginning with C most likely to cause, highest likelihood is clindamycin

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14
Q

Which of the following is most likely to be used in staphylococci infections?

A) Flucloxacillin
B) Vancomycin
C) Phenoxymethylpenicillin
D) Metronidazole
E) Gentamicin
A

A) Flucloxacillin

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15
Q

Which of the following is most likely to be used in MRSA infection?

A) Flucloxacillin
B) Penicillin V
C) Metronidazole
D) Tazosin
E) vancomycin
A

E) Vancomycin

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16
Q

Which of the following is most likely to be used in streptococci infection?

A) Phenoxymethylpenicillin
B) Erythromycin 
C) Metronidazole
D) Gentamicin
E) Flucloxacillin
A

A) Phenoxymethylpenicillin

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17
Q

Which of the following is most likely to be used in anaerobic infection?

A) Gentamicin 
B) Metronidazole 
C) Cefalexin
D) Flucloxacillin
E) Benzylpenicillin
A

B) Metronidazole

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18
Q

Which of the following is most likely to be used in pseudomonas aeruginosa infection?

A) Flucloxacillin 
B) Vancomycin
C) Metronidazole
D) Gentamicin
E) Trimethoprim
A

D) Gentamicin

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19
Q

What is the mechanism of action for clindamycin?

A

Inhibits protein synthesis

Narrow spectrum

Bacteriostatic

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20
Q

What are the most common side effects of clindamycin?

A

Antibiotic associated colitis

Most common in middle aged, elderly women, especially after operations

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21
Q

What is the patient counselling needed for clindamycin?

A

If diarrhoea develops stop and see GP

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22
Q

Which antibiotics reduce the efficacy of COCs?

Impairs bacterial flora responsible for recycling ethinylestradiol

A

Ampicillin
Amoxicillin
Doxycycline

Additional precautions required for duration of treatment and 7 days after stopping

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23
Q

What is the mechanism of action of linezolid?

A

Inhibits protein synthesis

Only active against gram positive bacteria e.g. MRSA and anaerobes

Narrow spectrum
Bacteriostatic

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24
Q

What is an alternative to vancomycin when used for MRSA infection?

A

Linezolid

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25
What are the side effects of linezolid?
Blood disorders | Optic neuropathy if > 28 days use
26
What is the patient counselling needed for linezolid?
Report visual symptoms Blurred vision, visual field defects, changes in visual acuity and colour vision
27
What are the important interactions for linezolid?
Hypertensive crises - SSRI, TCA, MAOI (wait 2 weeks after stopping), opioids, 5HT agonists, buspirone, pethidine Linezolid is a reversible MAOI Avoid consuming large amounts of tyramine rich foods e.g. cheese, cured meats
28
What is the mechanism of action for trimethoprim?
Inhibits DNA synthesis Narrow spectrum Bactericidal
29
What is trimethoprim used for and what dose?
UTI 200mg BD
30
What are the important side effects of trimethoprim?
Anti-folate - teratogenic in first trimester Blood dyscrasias - with long term use Hyperkalaemia
31
Most important interaction for trimethoprim?
Methotrexate - DO NOT USE
32
What is co-trimoxazole used for? | Trimethoprim/sulfamthoxazole
Prophylaxis and treatment of pneumocystis jirovecii pneumonia
33
What are the side effects for co-trimoxazole?
Rashes, necrolysis, photosensitivity
34
What are the counselling points for trimethoprim?
Blood dyscrasias - report fever, sore throat, rash, mouth ulcers, purpura, bruising, bleeding
35
What is the mechanism of action for chloramphenicol?
Inhibits protein synthesis Broad spectrum Bacteriostatic
36
When is chloramphenicol used?
Bacterial conjunctivitis OTC Life-threatening conditions
37
What are the side effects of chloramphenicol?
Blood dyscrasias Grey baby syndrome - avoid in pregnant women Unlikely to occur with eye drops but eye drops unlicensed for use in pregnant women OTC
38
What is the dosing regime for chloramphenicol eye drops for bacterial conjunctivitis OTC?
5 day course, if no improvement within 48 hours discontinue and seek medical advice Optrex - one drop every 2 hours for the first 48 hours and 4 hourly thereafter. Use for 5 days even if symptoms improve
39
What age can chloramphenicol eye drops be used OTC?
Over the age of 2 as it contains boron which may impair fertility in the future
40
What is the dosing regimen for chloramphenicol ointment OTC?
Apply approximately 1 cm of ointment between the lower eyelid and the eye 3-4 times a day
41
What time of day chloramphenicol eye drops and eye ointment be used if using together?
Drops used during the day | Ointment used at night
42
Does chloramphenicol ointment need to be stored in the fridge?
No
43
Do chloramphenicol eye drops need to be stored in the fridge?
Yes
44
What is the mechanism of action for metronidazole?
Inhibits DNA synthesis High activity against anaerobic bacteria and protozoa Narrow spectrum and bactericidal
45
What is metronidazole used for?
Anaerobic infections e.g. dental, antibiotic associated colitis, h. Pylori, rosacea, bacterial vaginosis Protozoal infections e.g. vagina, trichomoniasis, giardiasis
46
What are the common side effects of metronidazole?
GI disturbances, taste disturbances, oral mucositis, furred tongue
47
What are the counselling points for metronidazole?
Take with or after food | AVOID alcohol as it causes a disulfiram-like reaction
48
What is the mechanism of action for nitrofurantoin?
Damages bacterial DNA Only active against urinary pathogens Narrow spectrum Bactericidal
49
What are the uses of nitrofurantoin?
UTIs
50
What are the side effects of nitrofurantoin?
Nausea | Peripheral neuropathy in renal impairment
51
Can nitrofurantoin be used in pregnancy?
Yes, but avoid at term as causes neonatal haemolysis
52
What are the contraindications for nitrofurantoin?
Infants less than 3 months
53
What are the counselling points for nitrofurantoin?
Take with or after food | Colours urine YELLOW or BROWN
54
What are the aminoglycosides?
``` Gentamicin Tobramycin Streptomycin Neomycin Amikacin ```
55
What is the mechanism of action of aminoglycosides?
Bind irreversibly to bacterial ribosomes Active against gram negative aerobe pseudomonas aeruginosa Broad spectrum Bactericidal
56
What are the aminoglycosides used for?
Severe sepsis Pyelonephritis Complicated UTI Endocarditis
57
Why are aminoglycosides given parenterally?
They are not absorbed by the gut
58
Which of the following aminoglycosides is most likely to be used for pseudomonas aeruginosa infection? ``` A) Amikacin B) Neomycin C) Gentamicin D) Streptomycin E) Tobramycin ```
C) Gentamicin
59
Which of the following aminoglycosides is most likely to be used via an inhaler for pseudomonal infection in cystic fibrosis? ``` A) Amikacin B) Neomycin C) Gentamicin D) Streptomycin E) Tobramycin ```
E) Tobramycin
60
Which of the following aminoglycosides is most likely to be used in TB? ``` A) Amikacin B) Neomycin C) Gentamicin D) Streptomycin E) Tobramycin ```
D) Streptomycin
61
Which of the following aminoglycosides is most likely to be used in bowel sterilisation? ``` A) Amikacin B) Neomycin C) Gentamicin D) Streptomycin E) Tobramycin ```
B) Neomycin Neomycin is parenterally toxic
62
Which of the following aminoglycosides is most likely to be used for gentamicin-resistant gram-negative bacilli? ``` A) Amikacin B) Neomycin C) Gentamicin D) Streptomycin E) Tobramycin ```
A) Amikacin
63
What is gentamicin used for?
Active against pseudomonas aeruginosa | Blind therapy in serious infection - with metronidazole/penicillin
64
What are the monitoring requirements for gentamicin?
Plasma concentrations - narrow therapeutic index ``` Serum concentration in: Elderly Obesity Cystic fibrosis High doses Renal impairment ```
65
When do you avoid a once daily dosing of gentamicin?
Avoid in renal impairment < 20ml/min, HACEK or gram positive endocarditis, burns covering > 20% of body
66
When do you monitor serum concentration for gentamicin multiple dose regimens?
Monitor after 3 or 4 doses and after a dose change In renal impairment requires more frequent and earlier monitoring
67
When do you reduce the dose of gentamicin?
When the post-dose peak level after 1 hour is too high - 5-10mg/ml, (3-5mg/ml for endocarditis) In severe renal impairment (<30 ml/min)
68
When do you increase the interval with gentamicin dosing?
Pre-dose trough level before next dose is too high Needs to be less than 2mg/ml (< 1mg/ml for endocarditis) In renal impairment
69
Is gentamicin dosing based on body weight or ideal body weight?
Ideal body weight
70
Can you give gentamicin in pregnancy?
Yes but avoid unless essential | Monitor serum concentrations
71
What are the side effects of gentamicin?
``` Dose related - do not exceed 7 days Commonly occur in elderly and renal failure Nephrotoxicity Ototoxicity Peripheral neuropathy Impaired neuromuscular transmission Hypokalaemia Hypocalcaemia Hypomagnesaemia ```
72
What are the signs of nephrotoxicity?
Low urine output Creatinine clearance High serum creatinine High urea
73
The concomitant use of gentamicin with these drugs causes nephrotoxicity. Which drugs are these?
Ciclosporin Tacrolimus Vancomycin
74
What are the counselling points for gentamicin?
Report hearing loss, tinnitus or vertigo - irreversible ototoxicity
75
What interaction causes an increased risk of ototoxicity when used with gentamicin?
Loop diuretics - separate by as long a period as possible | Cisplatin
76
What is the 2017 MHRA warning for gentamicin?
Potential for histamine related adverse reactions with some batches
77
What are the glycopeptides?
Vancomycin Teicoplanin Televancin
78
What is the mechanism of action for glycopeptides?
Inhibits cell wall synthesis Only active against gram positive bacteria including MRSA Narrow spectrum Bactericidal
79
Which glycopeptides cannot be given by mouth for systemic infections?
Vancomycin | Teicoplanin
80
Which glycopeptide is most likely to be used in HAP?
Televancin but only when other antibiotics are unsuitable
81
Which glycopeptide is more likely to be used for MRSA?
Vancomycin
82
What is vancomycin used for?
Antibiotic associated colitis, MRSA infections Given parenterally for serious infections
83
What are the monitoring requirements for the plasma concentrations of vancomycin?
Plasma concentrations: All patients After 3-4 doses and after a dose change Renal impairment- earlier and regular monitoring = reduce dose Pre-dose trough level = 10-15 mg/mL 15-20 mg/mL for endocarditis, less sensitive MRSA strains or complicated S. aureus infections
84
Can vancomycin be used in pregnancy?
Avoid unless essential
85
What are the parenteral side effects of vancomycin?
``` Nephrotoxicity Ototoxicity Red man syndrome Blood dyscrasias Skin disorders Thrombophlebitis ```
86
What needs to be monitored for vancomycin?
Renal function Auditory function FBC - neutropenia
87
What are the counselling points for vancomycin?
Report tinnitus, hearing loss, vertigo, dizziness Discontinue if tinnitus occurs
88
The concomitant use of vancomycin with which drugs causes nephrotoxicity?
Ciclosporin
89
The concomitant use of vancomycin with which drugs causes ototoxicity?
Loop diuretics
90
What is the mechanism of action for tetracyclines?
Inhibits bacterial protein synthesis Binds to ribosomal 30S subunit Broad spectrum, bacteriostatic
91
What are tetracyclines used for?
``` Lower RTIs Acne Rosacea Malaria Chlamydia ```
92
What are the tetracyclines?
``` Demeclocyline Doxycycline Lymecycline Minocycline Oxytetracycline Tetracycline Tigecycline ```
93
Which tetracycline is most likely to be used in malaria?
Doxycycline OD
94
Which tetracycline is most likely to be used in chlamydia?
Doxycycline
95
Which tetracycline has the broadest spectrum?
Minocycline
96
What are the side effects of tetracyclines?
``` Benign intracranial hypertension Teeth discolouration Dental hypoplasia Photosensitivity Decreased absorption of salts and iron Oesophageal irritation ```
97
What are the side effects of minocycline?
Vertigo Dizziness Irreversible pigmentation Lupus erythymatosus like syndrome
98
What are the contraindications of tetracyclines?
Children under 12 | Pregnancy and breastfeeding
99
What happens when you use tetracyclines in pregnancy and breastfeeding?
Deposit in growing bone and teeth causing discolouration and dental hypoplasia
100
Which tetracyclines can you use in renal impairment?
Doxycycline | Minocycline
101
Can you use tetracyclines in hepatic impairment?
Avoid or use with caution as tetracyclines are hepatotoxic
102
What are the counselling points for tetracyclines?
Avoid exposure to sunlight - demeclocycline, doxycycline Do not take antacids (Al, Mg2+, Ca2+, Iron, Zinc salts), leave gap of 2 hours before/after taking Avoid milk - demeclocycline, oxytetracycline, tetracycline Swallow whole with plenty of fluid during meals while sitting or standing - doxycycline, minocycline, tetracycline
103
What is the mechanism of action for quinolones?
Inhibits DNA synthesis Broad spectrum Bactericidal
104
What are quinolones used for?
Lower RTIs, UTIs | Avoid in MRSA
105
What are the quinolones?
``` Ciprofloxacin Levofloxacin Moxifloxacin Nalidixic Acid Norfloxacin Ofloxacin ```
106
Which quinolone is the most likely to cause QT prolongation?
Moxifloxacin
107
Which quinolone is most likely to cause life threatening hepatotoxicity?
Moxifloxacin
108
Which quinolone is most likely to be avoided if the eGFR < 20ml/min?
Nalidixic acid
109
What are the side effects of quinolones?
Seizures - with or without previous history Tendon damage - stop if tendinitis suspected QT prolongation - leads to ventricular arrhythmias Arthropathy - avoid in pregnancy, children, adolescent
110
When should quinolones be discontinued?
Psychiatric, neurological or hypersensitivity reactions occur
111
Which of the following is most likely to cause convulsions if used concomitantly with quinolones? ``` A) Fluoxetine B) Amiodarone C) Clarithromycin D) Naproxen E) Aripiprazole ```
D) Naproxen - NSAIDs induce convulsions The others cause an increased risk of QT prolongation
112
Which medications cause an increased risk of QT prolongation when used with quinolones?
``` SSRIs Quinine Amiodarone Macrolides Antipsychotics ```
113
Which medication causes an increased risk of seizures when used with ciprofloxacin? ``` A) Salbutamol B) Ramipril C) Theophylline D) Amiodarone E) Quinine ```
C) Theophylline - pharmacokinetic and pharmacodynamic interaction - ciprofloxacin is an enzyme inhibitor and causes theophylline toxicity. Theophylline side effect is convulsions
114
What are the counselling points for quinolones?
Take care when driving as impairs performance of skilled tasks Antacids, zinc/iron - leave 2 hours before/after taking a quinolone Avoid milk with ciprofloxacin and norfloxacin Protect skin from sunlight. Avoid sunbeds- ofloxacin
115
What is the mechanism of action for macrolides?
Inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome Broad spectrum Bacteriostatic
116
What are macrolides used for?
Penicillin alternative H. Pylori RTIs Skin and soft tissue infections
117
Which of the following macrolides is most likely to be taken once daily? A) Azithromycin B) Clarithromycin C) Erythromycin
A) Azithromycin Take before food/indigestion remedies - leave a 2 hour gap
118
What side effect is common in clarithromycin?
Taste disturbance
119
How often is clarithromycin taken?
BD
120
How often is erythromycin taken?
QDS/BD Before indigestion remedies - 2 hour gap
121
What is telithromycin used for?
B-lactam resistant infections
122
What are the common side effects of telithromycin?
Visual disturbances Hepatotoxicity Loss of consciousness
123
What is an unlicensed use for spiramycin?
Toxoplasmosis in pregnancy
124
What are the common side effects of macrolides?
GI effects QT interval prolongation Hepatotoxicity Ototoxicity at high doses
125
Which of the following macrolide is most likely to cause nausea, vomiting, abdominal discomfort and diarrhoea? ``` A) Clarithromycin B) Azithromycin C) Spiramycin D) Telithromycin E) Erythromycin ```
E) Erythromycin
126
What re the risk factors for QT interval prolongation in macrolides?
``` Bradycardia Heart disease Hypokalaemia Hypomagnesaemia QT prolongation drugs ```
127
Should macrolides be taken on an empty stomach?
Take with or after food, 2 hour gap with indigestion remedies
128
What are the most important interactions for macrolides?
Erythromycin and Clarithromycin are enzyme inhibitors Warfarin - increased risk of bleeding Statins - increased risk of myopathy
129
What is the mechanism of action of penicillins?
Interfere with bacterial cell wall synthesis Not useful in CNS infections except meningitis Broad spectrum Bactericidal
130
Which penicillins are narrow spectrum (beta-lactamase sensitive)?
Benzylpenicillin (PEN G) | Phenoxymethylpenicillin (PEN V)
131
Which penicillins are broad spectrum (inactivated by beta-lactamases)?
Ampicillin | Amoxicillin
132
Which penicillin is penicillinase resistant?
Flucloxacillin
133
Which penicillin is antipsuedominal (extended spectrum)?
Piperacillin (with tazobactam) | Ticaricillin (with clavulanic acid)
134
What are the common side effects of penicillins?
Penicillin allergy - rash or anaphylaxis True allergy - Immediate rash. Anaphylaxis. Hives Do not use any beta-lactam antibiotic - cephalosporins, carbapenems, monibactams May not be allergic - minor rash, rash after 72 hours Do not withhold penicillin for serious infections
135
Can penicillin be given as an intrathecal injection?
No - causes encephalopathy and can be fatal
136
What are the risks associated with broad spectrum penicillins?
Do not give blindly for sore throat - causes maculopapular rash in glandular fever Can cause antibiotic associated colitis
137
Does ampicillin have high or low antibiotic resistance?
High
138
What is ampicillin used for?
UTIs Otitis media Acute COPD exacerbations
139
How do you take ampicillin?
Before food
140
What is amoxicillin active against?
Beta lactamase producing strains
141
What does co-amoxiclav contain?
Amoxicillin and clavulanic acid
142
What is an important side effect of amoxicillin, especially if it is used for more than 14 days?
Cholestatic jaundice
143
What is PEN G uses for?
Meningitis
144
Can benzylpenicillin be taken orally?
No. Parenteral only as not gastric acid stable
145
What is PEN V uses for?
RTIs in children E.g. streptococcal throat, tonsilitis
146
Is PEN V able to be taken orally?
Yes. It is gastric acid stable
147
What is Flucloxacillin used for?
Penicillin resistant staphylococcal infections except MRSA e.g. skin infections, impetigo, cellulitis
148
If an elderly person uses flucloxacillin for more than 14 days, this increases the risk of…?
Cholestatic jaundice and hepatitis This can occur up to two months after treatment
149
How do you take flucloxacillin?
Before food
150
What are piperacillin with tazobactam, and ticaricillin with clavulanic acid used for?
Septicaemia Complicated UTI HAP Effective against pseudomonas aeruginosa
151
What is temocillin used for?
Beta lactamase producing strains of gram negative bacteria
152
What is the mechanism of action of cephalosporins?
Interferes with bacterial cell wall synthesis They have a similar spectrum of activity to penicillins Broad spectrum Bactericidal
153
What are the cephalosporins used for?
UTI (pregnancy or second line) Sinusitis Otitis media
154
What are the first generation cephalosporins?
Cefalexin Cefadroxil Cefradine
155
Which of the following is a BD dose? A) Cefalexin B) Cefadroxil C) Cefradine
B) Cefadroxil
156
What are the second generation cephalosporins?
Cefuroxime | Cefaclor
157
What is a common side effect of cefaclor?
Protracted skin reactions, especially in children
158
What are the third generation cephalosporins?
Cefixime Ceftriaxone Cefotaxime Ceftazidime
159
Which is the only third generation cephalosporin that is orally active?
Cefixime The others are parenteral
160
Which 3rd generation cephalosporin is used OD?
Ceftriaxone
161
Which two cephalosporins are most likely to be used in meningitis?
Ceftriaxone | Cefotaxime
162
When if ceftaroline used? (5th generation cephalosporin)
CAP | Complicated skin and soft tissue infections
163
What are the common side effects of cephalosporins?
Hypersensitivity - do not give in history of immediate penicillin hypersensitivity. If no alternative give 3rd generation or cefuroxime Antibiotic associated colitis- most common in 2nd and 3rd generation

Pre-reg Exam 2021 (79 decks)

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