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4- Foundation Year- Infectious disease > Antibiotics > Flashcards

Antibiotics Flashcards

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1
Q

what are some examples of aminoglycosides? main one

A

gentamicin

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2
Q

what needs to be measured when treating with aminoglycosides?

A

serum aminoglycoside conc
-for parenteral (IV)
-Obese, high doses, cystic fibrosis, elderly

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3
Q

when should levels be monitored?days wise

A

after 3/4 doses measure serum aminoglycoside levels, then every 3 days after or dos change (more frequent in renal levels)

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4
Q

if needing to measure levels when would you do it if a dose needs to be given? peak and trough

A

-measure 1 hour after dose (peak) and just before next dose (trough)

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5
Q

what are the levels wanted for multiple daily dosing regimen for peak levels?

A

5-10mg/L but for endocarditis you want 3-5mg/L because you co-prescribe with other antibiotics

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6
Q

what are the levels wanted for multiple daily dosing regimen for trough levels?

A

<2mg/L but for endocarditis you want <1mg/L

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7
Q

what are the dose adjustments for aminoglycosides?trough too high, peak too high

A

-trough too high: increase dose interval
-peak too high: decrease dose

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8
Q

what is the dose adjustment for renal impairment?

A

-renal impairment: increase dose interval
-severe impairment: reduce dose as well

should avoid with other nephrotoxic drugs

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9
Q

what are some MHRA alerts regarding aminoglycosides?

A

-the use is associated with ototoxicity

-interactions with ototoxicity:
cisplatin
loop diuretics
vancomyocin
vinca alkaloids (vinblastine, vincristine, vindesine, vinflunine)
-further interactions: drugs that cause renal impairment

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10
Q

what patients should avoid aminoglycosides?

A

-in pregnancy- risk of auditory or vestibular nerve damage. If must be given monitor serum conc
-contraindicated in myasthenia gravis
-obese patients, use Ideal body weight based on height to prevent overdose

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11
Q

what are different groups of cephalosporins?

A

first gen
second gen
third and fifth gen

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12
Q

what are the first gen cephalosporins?

A

cefadroxil, cefalexin, cefradine

FAD, FAL, FRAD

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13
Q

what are the 2nd gen cephalosporin?

A

cefuroxime, cefoxitin, cefaclor

-furry, fox, face

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14
Q

third and fifth gen are all parental apart from which one?

A

oral cefixime

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15
Q

patients with hypersensitivity to what drug shouldn’t receive a cephalosporin due to cross-sensitivity?

A

penicillin, and other beta-lactams

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16
Q

what is chloramphenicol? avoided in who? OTC guidance

A

mostly used in eye infections
-should be avoided in pregnancy due to risk of neonatal “grey baby syndrome” if used in third trimester
-OTC guidance can be used on children aged 2 years +

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17
Q

what can clindamycin cause that can be fatal?

A

associated with antibiotics-associated colitis -which is really badly infected diarrhoea - most common in elderly and would discontinue antibiotics.
-if severe or prolonged contact doctor bloody

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18
Q

what do you do if Clostridium difficile is suspected when someone is taking clindamycin?

A

-seek specialist advice when antibiotics cant be stopped and patient is experiencing severe diarrhoea

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19
Q

what are some glycopeptides? main one? avoid in who? dose? measuring levels?

A

teicoplanin and vancomycin

-vancomycin only given parenterally for systemic infections due to reduced absorption orally
-should be avoided in pregnancy useless benefit outweighs risk
- initial dose based on body weight, then dose adjustment based on serum-vancomycin conc
-only trough levels measured should be between 15-20mg/L

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20
Q

WHAT ARE SOME SIDE EFFECTS OF GLYCOPEPTIDES?

A

-ototoxicity and nephrotoxicity
-red man syndrome
-severe cutaneous adverse reaction
-blood dyscrasias: arganulocytosis, eosinophilia, neutropenia
-cardiogenic shock on rapid IV injection if given too fast, given at a set rate
-risk of anaphylactoid reactions at infusion sites avoid rapid infusion and rotate site

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21
Q

what is linezolid? what are the risks of it?

A

-optic neuropathy- report visual impairment, therefore monitor regularly if treatment more than 28days
-risk of blood disorders, while on treatment need weekly full blood counts, monitor regularly if treatment more than 10-14 days

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22
Q

what does linezolid interact with to cause serotonin syndrone?

A

tyramine-rich food
such as :
-mature cheese
-marmite
-yeast extract
-fermented soya bean extract
-some beer and wines

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23
Q

what drugs can cause serotonin syndromes?

A

SSRIs
dopaminergic
5-HT1 agonists
TCA
Lithium
other MAOIs

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24
Q

what is serotonin syndrome is?

A

-build up of serotonin altered cognitive state and have too much serotonin in their body can end up in coma

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25
what are examples of macrolides?
azithromycin (once daily clarithromycin (twice daily) Erythromycin
26
when do you see azithromycin given like 3 times a week?
-prophylaxis for COPD exacerbation normally given in winter
27
what patients should be cautioned when using macroclides?
patients with myasthenia gravis erythromycin preferred in pregnancy over clarithromycin. Shoudk avoid clarithromycin in first trimester of pregnancy
28
what are some side effects of macroclides?
-can cause heptotxocity -can cause ototoxicity (hearing loss in large doses) -high levels of gastrointestinal disturbances ( N+V+D) -QT prolongation
29
what drug interactions occur with macroclides?
-due to being a CYP enzyme inducer: therefore increases the body level of CYP enzyme substrates like statins and warfarin increased risk of myopathy and bleeding -cause hypokalaemia, like loops, thiazides diuretics, steroids, salbutamol, theophylline -macrolides increase QT prolongation so shouldn't be given with amiodarone, domperidone, fluconazole, lithium, methadone, ondasetron, quinolones, sotalol, SSRIs
30
what type of drug is a macrolide? CYP?
-CYP enzyme inducer
31
what type of side effects do you get from metronidazole?
-taste disturbance=metallic taste furred tongue -N+V so take with or after food -must not drink alcohol whist in this, will cause disulfiram like side effects N+V+flushing , avoid alcohol during 48 hrs after treatment
32
when should nitrofurantoin be avoided and any colour changes to urine and counselling?
-avoid in pregnancy -take with food or after -can cause yellow or brown urine -renal impairment avoid if eGFR less than 45ml/min/1.73m2
33
what breaks down narrow spectrum penicillins?
-beta lactamase
34
what are some examples of narrow spectrum penicillins?
-penicillin G: benzylpenicillin ~not gastric acid stable can only use parenteral -penicillin V: phenoxymethylpenicillin it is gastric acid stable suitable for oral use
35
what are examples of broad spectrum penicillins that are beta lactamase sensitive and what does that mean? side effects?
-means if faced with beta lactamase they won't cure the illness -e.g. ampicillin, amoxicillin -co-amoxiclav is beta lactamase resistant -can cause antibiotic associated colitis -diarrhoea -if someone was to come in with a sore throat ensure its not glandular fever as it can cause maculopapular rashes
36
what side effects can flucloxacillin cause? how to take? type of penicillin
-penicillinase-resistant penicillin cholestatic jaundice and hepatitis may occur rarely, unto 2 months after treatment ended. -should be taken on empty stomach one hour before food or 2 hours after
37
what are antipseudomonal penicillins?
-piperacillin only available in combination with beta-lactamase inhibitor tazobactam --ticarcillin only avauvle in combination with beta-lactamase clavulanic acid
38
what are some side effects of penicillins?
-don't give intrathecally can cause encephalopathy which can be fatal -PENICILLIN ALLERGY: rash or anaphylaxis. True allergy : immediate rash or anaphylaxis -cross sensitivity: cephalosporin in history of immediate penicillin. hypersensitivity
39
what are quinolones? examples,
ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin
40
what patient groups should use quinolones with caution?
-lowers the seizure threshold-avoid in epilepsy -psychiatric disorders -tendon disorders -hypersensitivity
41
what other drugs lower seizure threshold?
-tramadol -ibuprofen -sertraline
42
what can occur regarding sunlight and driving?
-reduce sunlight and UV radiation exposure can cause sensitivity reaction -may impair driving
43
what are some MHRA alerts regarding quinolones?
-can cause tendinitis but more common in over 60s, if its suspected should stop and seek medical help -small risk of aortic aneurysm and dissection, seek medical help if sudden onset severe abdominal chest or back pain. -heart valve regurgitation= experiencing shortness of breath, peripheral, new heart palpitations, oedema
44
what are some cautions with quinolones?
-QT prolongations -myasthenia graves -arthropathy in children or alolescents -perforated tympanic membrane (when used by ear)
45
what care some interactions with quinolones?
-avoid dairy products and mineral-fortified drinks reduce absorption -drugs that cause QT prolongation -reduces seizure thresholds =quinolones+NSAIDs NO
46
WHAT ARE SOME EXAMPLES OF TETRACYCLINES?
-doxcylines, tetracyclin etc
47
what is a common warning for tetracyclines?
-dont take milk, indigestion remedies or medicines containing zinc or iron , 2 hours before or after you take this drug but excludes: -doxycycline -Lymecycline -Minocycline DOES LIKE MILK
48
WHAT ARE SOME SIDE EFFECTS OF TETRACYCLIENS?
-benign intracranial hypertension- stop and report on beaches and visual disturbances -lupus-erythematosus-like syndrome and irreversible pigmentation=high risk with minocycline -teeth discolouration and bone deposit = not for under 12 and preganant women
49
what are some counselling points for tetracylines?
-hepatoticity- avoid in liver failure -photosensitivity-avoid sunlight -can cause dysphagia-swallow with whole glass of water standing or sitting caution in myasthenia gravis
50
what can trimethoprim cause? side effects?
-blood dyscrasia- presented as rash, sore throat, mouth ulcers, bruising or bleeding development, fever -its an anifolate=dont givene in pregnancy, other antifolates are methotrexate and phenytoin -caution in renal impairment -causes hyperkalamia
51
what are the narrow spectrum antibiotics?
PG TLC- less stomach effects penicillin (V+G) glycopeptides trimethoprim linezolid clindamycin
52
what are the broad spectrum antibiotics?
(so many of them they need a leader) CAPTN MCQ chloramphenicol aminoglycosides penilcillins (amoxicillin+ampilicillin) tetracycline nitrofurantoin macrolides cephalosporin quinolones
53
what is the anaerobic antibiotics?
metronidazole
54
what antibiotics are bacteriostatic (prevents growth)?
chloramphenicol linezolid tetracycline macrolide clindamycin
55
what antibiotics are bactericidal? (kills bacteria)
Cephalosporin aminoglycosides nitrofurantoin trimethoprim quinolones metronidazole glycopeptdies penicillin
56
which antibiotics should be taken with food?
metronidazole nitrofurantoin clarithromycin MR Pivmecillinam
57
which antibiotics can be taken on an empty stomach? 30-60mins before a meal or snack or at least 2 hrs after?
flucloxacillin phenoxymethylpenicillin azithromycin capsules tetracycline + oxytetracyline
58
what antibiotics shouldn't be used with patients who have myasthenia gravis?
Quinolones aminoglycosides macrolides tetracycline
59
what antibiotics are nephrotoxic ?
nitrofurantoin aminoglycosides glycopeptides tetracyclines trimethoprim
60
what antibiotics cause hepatotoxicity ?
macrolide flucloxacillin co-amoxiclav chloramphenicol nitrofurantoin tetracylines rifampicin+isoniazid+ pyrazinamide (which are 3 of the 4 TB meds)

4- Foundation Year- Infectious disease (6 decks)

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