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4- Foundation Year- Infectious disease > Antibiotics > Flashcards

Antibiotics Flashcards

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
Q

what are examples of macrolides?

A

azithromycin (once daily
clarithromycin (twice daily)
Erythromycin

26
Q

when do you see azithromycin given like 3 times a week?

A

-prophylaxis for COPD exacerbation normally given in winter

27
Q

what patients should be cautioned when using macroclides?

A

patients with myasthenia gravis
erythromycin preferred in pregnancy over clarithromycin. Shoudk avoid clarithromycin in first trimester of pregnancy

28
Q

what are some side effects of macroclides?

A

-can cause heptotxocity
-can cause ototoxicity (hearing loss in large doses)
-high levels of gastrointestinal disturbances ( N+V+D)
-QT prolongation

29
Q

what drug interactions occur with macroclides?

A

-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
Q

what type of drug is a macrolide? CYP?

A

-CYP enzyme inducer

31
Q

what type of side effects do you get from metronidazole?

A

-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
Q

when should nitrofurantoin be avoided and any colour changes to urine and counselling?

A

-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
Q

what breaks down narrow spectrum penicillins?

A

-beta lactamase

34
Q

what are some examples of narrow spectrum penicillins?

A

-penicillin G: benzylpenicillin
~not gastric acid stable can only use parenteral
-penicillin V: phenoxymethylpenicillin it is gastric acid stable suitable for oral use

35
Q

what are examples of broad spectrum penicillins that are beta lactamase sensitive and what does that mean? side effects?

A

-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
Q

what side effects can flucloxacillin cause? how to take? type of penicillin

A

-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
Q

what are antipseudomonal penicillins?

A

-piperacillin only available in combination with beta-lactamase inhibitor tazobactam
–ticarcillin only avauvle in combination with beta-lactamase clavulanic acid

38
Q

what are some side effects of penicillins?

A

-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
Q

what are quinolones? examples,

A

ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin

40
Q

what patient groups should use quinolones with caution?

A

-lowers the seizure threshold-avoid in epilepsy
-psychiatric disorders
-tendon disorders
-hypersensitivity

41
Q

what other drugs lower seizure threshold?

A

-tramadol
-ibuprofen
-sertraline

42
Q

what can occur regarding sunlight and driving?

A

-reduce sunlight and UV radiation exposure can cause sensitivity reaction
-may impair driving

43
Q

what are some MHRA alerts regarding quinolones?

A

-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
Q

what are some cautions with quinolones?

A

-QT prolongations
-myasthenia graves
-arthropathy in children or alolescents
-perforated tympanic membrane (when used by ear)

45
Q

what care some interactions with quinolones?

A

-avoid dairy products and mineral-fortified drinks reduce absorption
-drugs that cause QT prolongation
-reduces seizure thresholds =quinolones+NSAIDs NO

46
Q

WHAT ARE SOME EXAMPLES OF TETRACYCLINES?

A

-doxcylines, tetracyclin etc

47
Q

what is a common warning for tetracyclines?

A

-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
Q

WHAT ARE SOME SIDE EFFECTS OF TETRACYCLIENS?

A

-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
Q

what are some counselling points for tetracylines?

A

-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
Q

what can trimethoprim cause? side effects?

A

-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
Q

what are the narrow spectrum antibiotics?

A

PG TLC- less stomach effects

penicillin (V+G)
glycopeptides
trimethoprim
linezolid
clindamycin

52
Q

what are the broad spectrum antibiotics?

A

(so many of them they need a leader)

CAPTN MCQ

chloramphenicol
aminoglycosides
penilcillins (amoxicillin+ampilicillin)
tetracycline
nitrofurantoin
macrolides
cephalosporin
quinolones

53
Q

what is the anaerobic antibiotics?

A

metronidazole

54
Q

what antibiotics are bacteriostatic (prevents growth)?

A

chloramphenicol
linezolid
tetracycline
macrolide
clindamycin

55
Q

what antibiotics are bactericidal? (kills bacteria)

A

Cephalosporin
aminoglycosides
nitrofurantoin
trimethoprim
quinolones
metronidazole
glycopeptdies
penicillin

56
Q

which antibiotics should be taken with food?

A

metronidazole
nitrofurantoin
clarithromycin MR
Pivmecillinam

57
Q

which antibiotics can be taken on an empty stomach? 30-60mins before a meal or snack or at least 2 hrs after?

A

flucloxacillin
phenoxymethylpenicillin
azithromycin capsules
tetracycline + oxytetracyline

58
Q

what antibiotics shouldn’t be used with patients who have myasthenia gravis?

A

Quinolones
aminoglycosides
macrolides
tetracycline

59
Q

what antibiotics are nephrotoxic ?

A

nitrofurantoin
aminoglycosides
glycopeptides
tetracyclines
trimethoprim

60
Q

what antibiotics cause hepatotoxicity ?

A

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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