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BNF Infections > Antibiotics > Flashcards

Antibiotics Flashcards

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1
Q

what is the mode of action for tetracyclines?

A

Inhibit bacterial protein synthesis, binds to ribosomal 30s subunit

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2
Q

what is the spectrum of activity for tetracyclines?

A

Broad spectrum and bacteriostatic

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3
Q

what are tetracyclines used for?

A

Lower RTI, acne, rosacea, malaria and Chlamydia

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4
Q 
what are the following tetracyclines used for: 
Democlocyline
Doxycycline
Lymecycline
monocycline
oxytetracycline
tetracycline
tiegracycline
A

Democlocyline :
Doxycycline: used in malaria and chlamydia:OD
Lymecycline: acne
monocycline: broader spectrum, rarely used
oxytetracycline
tetracycline
tiegracycline: antibiotic structually related

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5
Q

what are side effects of tetracylines?

A

benign intercranial hypertension

Photosentisation particularly with demclocycline and doxycycline

Discolour teeth under 12

Angioedema
• Headache
• Nausea, Diarrhoea & vomiting
• Hypersensitivity
• Photosensitivity reaction
• Skin reactions
• Systemic Lupus Erythematosus
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6
Q

name 2 patient groups for which tetracyclines are contraindicated

A

children under 12

Pregnant and breastfeeding - deposits in growing teeth and bones - discolours enamel

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7
Q

how are tetracyclines used in renal impairement?

how are tetracyclines used in hepatic impairement?

A

renal: avoid all execept doxycline and minocycline

Hepatic : avoid or use with caution

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8
Q

what counselling points must be given when providing tetracyclines

A

avoid exposure to sunlight/sunlamps, (doxycycline, demecycline )

decreased absorption of : Al, Ca2I,Mg2+ and zinc sales
DOT- democycline,

oespahageal irritation - DMT - doxycycline
minocycline, tetracycline

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9
Q

Give examples of aminoglycosides

A

Amokacin gentamicin, tobramycin, neomycin,streptomycin

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10
Q

What are common indications of aminoglycosides

A

Sepsis, meningitis, endocarditis, pneumonia and surgical prophylaxis

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11
Q

Common side effects of aminoglycosides

A

Nephrotoxicity and ototoxicity

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12
Q

What is a key consideration when prescribing aminoglycosides

A

Can the patient monitor changes in hearing?

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13
Q

What needs to be monitored for a patient taking an aminoglycosides

A

Before and during Renal function -caution in renal failure
During Auditory and vestibular function
Serum concentration- monitor to avoid excessive and sub therapeutic levels and prevent toxicity
Must be monitored in parental admin and determined in elderly obese in CF, high doses of renal impairment

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14
Q

Administration of aminoglycosides

A

Once daily has superseded multiple daily dose

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15
Q

When should concentration be measured

A

After 3 of 4 doses of a multiple daily dose regimen or after a dose change

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16
Q

How are aminoglycosides excreted

A

Primarily Renally

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17
Q

When should bloods be taken for aminoglycosides for multiple daily dose regimens

A

1 hour after IV or IM admin (peak conc )
Just before next dose (trough)
If trough is high then the interval between doses must be increased
If peak is high the dose must be decreased

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18
Q

Mhra aminoglycosides info

A

Rare cases of ototoxicity- increased risk of deafness in patients with mitochondrial mutations - even for patients where concentration was in range

Must consider the need for aminoglycosides in patients at risk

Genetic testing needed but treatment shouldn’t be delayed

Those with mitochondrial mutations or family history Of ototoxicity should inform doctor or pharmacist before use
Continuous monitoring of auditory and renal function required

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19
Q

Dosing of gentamicin

A

Loading dose based of patient weight and renal function
Multiple daily dose regimen :

One hour peak conc : 5-10 mg/L
Pre dose trough conc: less than 2mg/l
Endocarditis peak conc: 3-5 mg/l
Endocarditis trough less than 1mg/L

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20
Q

Describe aminoglycosides spectrum of activity

A

Broad spectrum bacteriacidal

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21
Q

Describe carbapenams spectrum of activity

A

Broad spectrum
Beta lactase
Many gram positive and gram negative bacteria and anaerobes

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22
Q

carbapenams side effects

A 
Antibiotic associated colitis 
CNS toxicity (renal impairment)
Diarrhoea 
Rash
Injection site reactions
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23
Q

carbapenams indications

A

Severe or complicated resistant organisms

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24
Q

Which carbapemens are active against a significant organism

A

Imapenam and meropenem active against pseudamonas aurigonosa

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25
carbapenams are not active against which serious infection
MRSA
26
Renal and hepatic impairment: carbapenams
Ertapenam- risk of seizures in renal impatient - dose limited to 500mg if eGFR is <30 ml/min Imipenam - risk of CNS side effects dose reduced if CrCl <90ml/min Meropenem-dose adjustments in renal impairment
27
When should carbapenams be avoided
When there is an immediate history of hypersensitivity to beta lactams
28
Cephalosporins spectrum of activity
Broad spectrum
29
first gen Cephalosporins indications
Septacemia, UTI ,Skin reactions ,respiratory tract infections (pneumonia and meningitis)
30
First gen
Gram positive Staphylococci Streptococci
31
First gen Cephalosporins
Cefalexin Cefradine Cefadroxil
32
Side effects of Cephalosporins
Diarrhoea and hypersensitivity
33
Cross sensitivity
10% in first gen cephlasporins 3-5 % in fourth gen Patients wit history of immediate hypersensitivity to penicillin and other beta lactams should not receive a cephalosporins
34
Indications of second gen Cephalosporins
Meningitis UTI RESPIRIATIORY SKIN
35
Activity of second gen
More gram negative than 1st gen and less gram positive
36
Examples of second gen Cephalosporins
Cefaclor Cefoxotin Cefuroxime
37
Side effects of second gen Cephalosporins
Antibiotic associated colitis | Hypersensitivity
38
How to advice someone experience
Severe diarrhoea or longer than 24 hours of contains blood seek medical attention
39
Examples of third gen Cephalosporins
cefixime, cefotaxime, ceftazidime, ceftriaxone
40
Side effects of Side effects of second gen Cephalosporins
antibiotic associate colitis, hypersensitivity
41
indications : third gen Cephalosporins
meningitis, GI infections, UTI, respiratory and skin infection
42
third gen cephlasporins spectrum of activity
enhanced activity against gram negative bacteria
43
glycopepticdes spectrum of activity
bactericidal activity against aerobic and aerobic gram positive bacteria including MRSA no activity against gram negate bacteria
44
glycopeptides indications
endocarditis, pneumonia, meningitis, skin infections, MRSA and antibiotic associated colitis
45
glycopeptides side effects
Nephrotoxicity blood disorders red man syndrome ototoxicity
46
glycopeptides monitoring
auditory function and plasma concentrations
47
vancomycin dosing based on what initially and following this
initial dosing based on bodyweight following does adjusted based on serum concentration
48
duration of action :glycopeptides
teicoplanin is similer but has significantly longer duration of action vancomycin, so can be dosed once daily
49
vancomycin dosing and monitoring Trough target
initial dosing based on bodyweight following does adjusted based on serum concentration all patients require serum levels measured on second day of treatment before the next dose if renal function is normal and earlier if there is renal impairment pre dose conc : 10-20 mg/l IV monitoring : periodic testing of auditory function blood counts, urinalysis, hepatic and renal functions periodically monitor leukocyte cont regularly esp with other drugs causing neutropenia or agrunulocytosis monitor vestibular and auditory function during and after in elderly - avoid concomitant use with other ototoxic drugs oral monitoring serial testing of auditory function to minimise risk of ototoxicity esp in patients with underlying hearing loss
50
What are the main indications for quinolones
UTI Respiratory Eye infections GI INFECTION
51
What are the main side effects of quinolones
``` Nausea and vomiting Diahorrea Hypersensitivity Psychiatric Inc risk of convulsions with NSAIDs Tendonitis - tendon rupture - corticosteroids ``` small increased risk of aortic aneurysm and dissection small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk
52
Quinalone cautions
``` Seizures G6pd deficiency Qt prolongation exposure to excessive sunlight and UV radiation should be avoided during treatment and for 48 hours after stopping treatment; Myasthenia gravis Diabetes ```
53
Common interactions with quinolones
Milk or antacids or vitamin supplements containing iron or zinc Avoid NSAIDS
54
Which antibiotic is most associated with antibiotic associated colitis What other groups can cause it
``` Clindamycin Broad spectrum (penicillins ,cephalosporin, fluoroquinalones ) ```
55
Warning sign for antibiotic associated colitis
If diahorrea develops stops
56
Who are most likely to develop antibiotic associated colitis
Women elderly and those who have just had surgery
57
Antibiotics used against MRSA
Vancomycin and linezolid
58
Linezolid side effects
Blood disorders Optic neuropathy if used greater than 28 days Possible hypertensive crisis
59
Antibiotic for CDIFF infection
Vancomycin 125 mg every 6 hours for 10 days; increased if necessary to 500 mg every 6 hours for 10 days, increased dose if life-threatening or refractory infection. Fidoxomicin
60
contraindications with aminoglycosides
myasthenia gravis
61
interactions with ahminoglycosides
cisplatin and furosemide
62
monitoring aminoglycosides
renall function auditory and vestibular function - serum concentration
63
examples of glycopeptides
vancomycin, teicoplanin , telavancin
64
mode of action of glycopeptide
bacteriacidal inhibit cell wall synthesis
65
spectrum of coverage for glycopeptides
gram positive( aerobic and anaerobic ) enterococci, staphylococci, streptococci
66
patient groups that should avoid use of aminoglycosides
elderly and those with history of auditory problems
67
how are aminoglycosides and glycopeptides used together in treatment of infective endocarditis
aminoglycosides have mainly gram negative coverage and so cover those organisms and glycopeptides cover gram positive broadly
68
drugs to avoid using with
ototoxic drugs- furosemide | ciclosporin, ahminoglycosides, polymixin antifungals

BNF Infections (4 decks)

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