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Antibiotics And Antivirals Flashcards

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1
Q

Unknown cause sepsis

A

Flucoxacillin, metronidazole, gentimycin UHL

Meropenem KETS

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2
Q

Resp infections - generalised unknown source how would you manage

A

Give amoxicillin or co amoxicillin
This targets:
Gram positive bacteria e.g. Strep,staph
Gram negative bacteria: haemophillus, moxarella,

Allergic- give doxycycline or meropenem

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3
Q

Which microbes is amoxicillin effective against

A

This targets:
Gram positive bacteria e.g. Strep,staph
Gram negative bacteria: haemophillus, moxarella,
Also: helicobacter pylori, escheridia coli, proteus mirabilis, so use in GI inf.
Not effective : klebsilla, pseudomonas, serration, citrobacter, some gram negative aerobes

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4
Q

Mechanism of action of amoxicillin

A

Penicillin so beta lactam antibiotic
Disrupts cell wall synthesis in peptidoglycan cell walls so mostly effective against gram positive bacteria as rely more on their peptidoglycan cell wall.

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5
Q

Name other beta lactam antibiotics

A

Cephalosporins
Carbapenem- meropenem, eropenem.
Penicillins

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6
Q

Common causative organisms CAP. And their classification

A

Streptococcus pneumonia- gram positive cocci
Moxeralla catarhalis - gram neg, cocci
Haemophillus influenzae- gram negative bacilli

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7
Q

Curb 65

A 
CURB
C- confused? Ab. Mental state score <8
Urea >7
RR >30
BP <90 or <60 diastolic
65 > age

0-1 low risk manage at home
2 hospital general wards
3+ consider ITU

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8
Q

Management of CAP

A

Antibiotics - amoxicillin or doxycycline. PO
If 2+score then: add doxycline po and then change to co-amox IV
If 2+ allergic: add meropenem IV and can change doxy to clarithromycin IV

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9
Q

HAP common organisms

A

Psumodmonas aerunginosa

Kelbsiella pneumoniae

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10
Q

HAP antibiotics

A

(Co- amoxiclav) not pseudo

Tazocin - pipereracillin with taxobactam

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11
Q

Co- amoxiclav uses against which microorganism

A

Same as amoxicillin but also for resistant microorgnansims, klebsiella
NOT PSEUDOMONAS
Gram positive aerobes- staph, strep, enterococcus
Gram negatives - haemophillus, e.coli. Moxarella, klebsiella, helicobacter pylori . Also: neisseria gonorrhoea,
Also: anaerobic - bacterioides, fusobacterium, peptostreptococcus.

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12
Q

Mechanism of co- amoxiclav

A 
Amoxicillin- b lactamase inhibitor. Inhibit the binding oriteins that do cross linking in bacterial cell walls
Clavurinic acid- b lactamase inhibitor : class 2-5 -can really target gram negatives. But not pseudomonas 
Irreversible inhibitor of thenlactamases
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13
Q

CI in using co amoxiclav

A

Penicillin allergy,
Cholestatic jaundice or liver dysfunction
hepatic toxicity is usually reversible but still have caution - don’t use over 14 days

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14
Q

CI amoxicillin

A

Penicillinin celhalosporin allergy
C diff associated diarrhoea can occur

Can interact with methotrexate
Other antibiotics can interfere with amoxicillin (tetracyclines, macrolides)
Cna reduced effectiveness of OCP and oral antocoagulants

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15
Q

Antibiotics in aspiration pneumonia

A

Co amoxiclav Po or iv

Or meropenem

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16
Q

Antibiotics for acute COPD with acute lrti

A

Amoxicillin or co amox

Or doxyclijne

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17
Q

Doxycycline- class and mechanism of action

A

Broad spectrum tetracycline

Reversible inhibitor of 30s bacterial ribosome . Stops binding of tRNA to ribosome.

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18
Q

Name other classes of antimicrobials targeting ribosomes and which classes they treat

A

Tetracyclines- doxycycline - stop tRNA binding, work with gram positive, and negative and anaerobes
Aminoglycosides- gentimycin, streptomycin - gram neg. read mRNA abnormally .
Macrolides - erythromycin azithromycin. Gram positive and atypical pneumoniae . Stop mRNA translocation

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19
Q

Doxycline - uses, administration

A
  • LRTI if penicillin allergic, milder skin infections if penicillin allergic,
    Drugs of choice for intracellular organisms e.g. chlamydia trachomatus ,Lyme disease, mycoplasma, anthrax, rickettsia - all parasitic and penetrate well,

Administration: oral or iv

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20
Q

Tetracyclines
CI
SE

A

Bind to calcium e.g. Bones and teeth - so CI in young <8yrs, pregnant and lactating women. –> discoloured teeth

SE: N&V, C. difficile, thrush,idiopathic intercranial hypertension

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21
Q

New tetracycline - tigecycline - use and SE CI

A

Use: gram +ve -ve inc resistant strains. - skin soft tissue GI
CI - caution in liver
SE: inc LFTs, N&V, potosensitivity

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22
Q

Name some aminoglycosides, Their. Mechanisms of action. And overall sensitivity

A

Gentimycin, streptomycin, tobramycin, amikacin
Mechanisms: bactericidal antibiotics - strong ones, must give IV,
Bind to 30s ribosome and inhibit tRNA binding and ALSO promote misreading of mRNA
USe: gram negatives and gent/Tobramycin - can target pseudomonas.

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23
Q

Amino glycosides CI and SE

A

Ottotoxicity - damage 5th cranial nerve
Nephrotoxic - CI in renal failure. - Monitor aminoglycosides levels and serum creatinine
CI myasthenia gravis as impairs NM transmission

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24
Q

Resistance in aminoglycosides

A

Enzymes produced by the bacteria can inactivate the aminoglycosides

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25
Use of aminoglycosides
Gentimycin - unknown sepsis. - acute life threatening infection inc. pseudomonas. So use until sensitivities known. - streptococcal endocarditis with penicillin and vancomycin Amikacin - newest and has least resistance
26
Name some macrolides, their main use and mechanisms
Erythromycin, clarithromycin, Gram positive - like penicillin - use in allergies Mechansim: taken up by gram positive more than negatives - they bind to 50s sub unit and inhibit translocation
27
Erythromycin and clarithromycin uses, CI andSE
Oral or IV Sim to penicillin - Gram positive cocci inc. MRSA, and B lactam resistant strains - so use in penicillin allergies!! Also used in: mycoplasma pneumoniae and legionnaires CI - not really SE/interactions: liver metabolism and p450 inhibitors = accumulation of warfarin and inc. conc of statins (rhabdomyelosis) and calcineurin inhibitors etc. SE: GI, Choletasis, inc. QT
28
Skin and bone infections/
Flucoxacillin Or vancomycin if allergic
29
SE of penicillins
Rashallergy NV C diff Cholestasis
30
First. Line antibiotic for c.difficile
Metronidazole oral
31
Name some anaerobes , and what you could use to treat
C.difficile Bacterial vaginosis Intra-abdominal, pelvic oral soft tissue. --- enclosed environments E.coli, staphylococcus, clostridium - use metronidazole Gram negatives:intra abdo infections , frusobacteroium (abscesses wounds), others causin aspiration pneumonia and soft tissue Gram positives: clostridium, peptostreptococcus, other types causing pelvic neck and head. Infections.
32
Side effects and CI f metronidazole
Caution withliver problems Inhibits warfarin metabolism - p450 inhibitor Can cause disulfuram like reaction with alcohol
33
First line therapy UTI
Uncomplicated trimethoprim 3 days
34
Complicated uti
Trimethoprim (women) Or Co-amoxiclav - recommended more in men 7 days
35
Pyelonephritis
Co-amoxiclav pO or IV if NBM Allergic - ciprofloxacin or meropenem
36
Use of cephalosporins and name example
Alternatives to penicillins when allergies or resistance Cefriaxone - meningococcus Ceftazidime - neutropenic sepsis (broad spec)
37
Diabetic foot ulcers
Superficial flucoxacillin Deep metronidazole - anaerobic Allergic - doxycycline
38
Use of vancomycin and teicoplanin - mechanism
Complicated gram positives including MRSA Inhibits peptidoglycan formation - from positive Use septicaemia or endocarditis with MRSA. Or psydomenranous colitis (c.diff)
39
SE of teicoplanin and vancomycin
Nephrotoxic - monitor creatinine Ototoxic Platelet deficiency Only IV - not oral
40
Use and mechansim of carbapenems
B lactam inhibitors but very rewesistant to most b lactamases. Wide spec. Acts against gram negatives and gram positives inc. pseudomonas and MRSA IV Meropenem Ertapenem (not for pseudomonas)
41
Menigitis
Gram -ve cocci | Give cefriaxone
42
Use of rifamycin
Mycobacterium Legionella Meningococcal prophylaxis
43
Se and CI with rifamycin
``` Epatitis Gi Cna effects Myelosu[rssion Red secretions- urine sweat s alive tears ```
44
Mechansim or tripmthroprim and co-trimoxazole
Folate synthesis inhibitors
45
Tb treatment
Rifamycin 4 mths Isoniazid 4 mths Pyrazinamide 2 mths Ethambutol 2 mths
46
SE of ethambutol
CI optic neuritis - ocular toxicity and colour blindness | Don't use in young. Kids
47
Cholecytisis infection, peritonitis, or hepatobilary
Treat like sepsis IV - amoxicillin metronidazole gentimycin (or meropenem if allergic)
48
Abdominal gastroenteritis or other complaint - not as severe
Ciprofloxacin or cefriaxone
49
Use of gentimycin
Aminoglycosides | Gram negatives inc. pseudomonas
50
SE of pyramizadole
CI in gout, Caution in DM Hepatotoxic, photosensitivity
51
Se or isoniazid
Caution in liver disease Peripheral neuropathy - caution in DM - common Rare - psychotic episode
52
Name some cutenous fungal infections
Dermatophytosis Candidiasis Malassezia
53
What is dermatopytosis
Ringworm Scale and pruitis - itchy Can be circular Also skin and blisters between toes
54
Malassezia
Greasy skin - hypo or hyperpigmented ras - sebrharrhoeic dermatitis (scaling and danddruff)] RF acne
55
RF Diagnosis and treatment of superficial fungal infections
Immmunocop. Moist environments. Antibiotics Diagnsis - clinical.skin scrapings Treatment: topical -azole e.g. Imisazoles or triadazoles . Or terbinafine 1-4wks Topical nystatin (candidiasis )
56
Name a common anti-fungal for superficial infections
Triazoles | - fluconazole
57
Candiasis infections - superficial
Nystatin or amphotericin | Polyenes - antifungals
58
Invasive fungal infections - name som organisms
Candidiasis-- immunocomp Cryptococcosis --> menigitis or pneumonia Histoplasmosis --> from soil with bat or birt faeces Blastomycosis
59
RF for invasive fungal.
RF- infection malignancycritical illness e.g. ITU, transplant surgical - GI perforation, burns immunosuppressed
60
Investigating serious infections - especially suspected fungal and those with RF
3 blood culture samples 3 different sites, same time/ Microscopy and immunohistocemistry - consider antigen antibody testing
61
Managing invasive candidiasis
Repeated tissue cultures Remove potential source- catheter and sample Give cocktail of antifungals: triazole e.g. Fluconazole. Ecinocandins (terbinafine) and others
62
7 types of antiviral s
Think 7 steps 1) inhibit penetration - palivzumab (RSV propylaxis in infants at risk) 2) Inhibit uncoatting' - rare 3) Integrase inhibitors - prevent integrating into nucleus 3) Replication - inhibit viral DNA polymerase- aciclovir, galciclovir. - herpes. - antiretrovirals - NRTIs 4) inhibit exit - neuramindase inhbitors - oseltamavir, zanamivir 5) prevent maturation/bodies response - protease inhibitors - prevent maturation of virus - - immunomodulators - interferon alpha
63
Treatment complicated influenza
Oseltamivir
64
Treating HIV - pharm
``` 2x NRTI backbone - combo of 2 NRTIs e.g. Tenofovir emtricitabine Plus. 1 of: - Protease inhibitor- atazanavir - NNRTI - Integrase inhibitor ``` Also monitor adherence, LFTs glucose, viral load,
65
Managing HIV
Pharm Counselling - Screen forinfectins and malignancy - co-trimoxaloe prophylaxis Base lines - CD4 viralload LFTelectrolytes pregnancy resistance Review medications
66
Antivirals in hepatitis - hep C
Interferons -modulate hosts response - old and now phased out for Hep C with serotype specific treatments
67
Hepatitis B treatment
Generally upportive - avoid alcoholimmunise contacts Antivirals with interferon if. High risk of liver disease
68
Hepatitis A treatment
Supportive avoid alcohol

infection antimicrobials (3 decks)

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