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Flashcards in Antibiotics COPY Deck (107)
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1
Q

What antibiotics are suitable in pregnancy?

A

Penicillins and Cephalosporins

2
Q

What are the indications for aminoglycosides?

A

Used for serious infections
CNS infections e.g meningitis
TB (streptomycin)
Pyelonephritis, pneumonia, endocarditis

3
Q

What is the therapeutic range for gentamicin?

A

5-10mg/L

4
Q

Which aminoglycoside is given orally? and why?

A

Neomycin- too toxic for IV use

5
Q

What are the side effects of aminoglycosides? (3)

A

1) Nephrotoxicity
2) Ototoxicity
3) Peripheral neuropathy

6
Q

Aminoglycosides shouldn’t be used in…? (2)

A

1) Myasthenia gravis (impairs neuromuscular transmission)

2) Pregnancy (ear damage)

7
Q

Aminoglycosides interact with what drugs?

A

1) Loop diuretics and Vancomycin (ototoxicity)

2) Cisplatin, Ciclosporin and vancomycin (nephrotoxicity)

8
Q

IV treatment with aminoglycosides should not exceed how many days?

A

7 days

9
Q

Monitoring requirements for aminoglycosides? (3)

A

1) Plasma concentration (18-24 hours after dose)
2) Renal function (especially during periods of dehydration)
3) Auditory and vestibular function

10
Q

Common bacteria in meningitis? (3)

A

1) Neisseria meningitidis
2) Streptococcus pneumoniae
3) Haemophilius influenza

11
Q

Antibiotics used in meningitis?

A

Benzylpenicillin, cefotaxime, chloramphenicol

12
Q

Name 8 cephalosporins?

A

1) Cefalexin
2) Cetrotide
3) Cefaclor
4) Cefuroxime
5) Cefixime
6) Ceftriaxone
7) Ceftaroline
8) Fosamil

13
Q

Are cephalosporins broad spectrum?

A

Yes

14
Q

Indications for cephalosporins?

A

2nd or 3rd line treatment for UTI and RTI
IV for severe resistant organisms
Pneumonia, meningitis, gonorrhoea

15
Q

Side effects of cephalosporins? (2)

A

1) GI effects

2) Penicillin hypersensitivity (avoid in known allergy)

16
Q

Do IV cephalosporins require approval by a microbiologist?

A

YES and are now mainly restricted to antibiotic associated colitis

17
Q

Does warfarin interact with cephalosporins? if so, how?

A

YES, cephalosporins kill the gut flora responsible for synthesizing vitamin K this results in a reduction in the production of vitamin K dependent blood clotting factors-results in increased anticoagulant effect of warfarin.

18
Q

What is the first line antibiotic group for MRSA?

A

Glycopeptides e.g vancomycin, Teicloplanin etc

19
Q

What indications are glycopeptides generally used for?

A

MRSA
C.diff
endocarditis
surgical prophylaxis (MRSA risk)

20
Q

What are the main side effects of glycopeptides? (5)

A

1) Nephrotoxicity
2) Blood disorders
3) Ototoxicity
4) ‘Red man syndrome’
5) Thrombophlebitis (IV)

21
Q

When would you avoid using glycopeptides?

A

elderly, history of deafness, renal impairment, pregnancy (ear damage)

22
Q

What are the monitoring requirements for glycopeptides? (5)

A

1) FBC
2) WCC
3) Hepatic and renal function
4) Urinalysis
5) Auditory function in elderly

23
Q

What drugs do glycopeptides interact with?

A

Ciclosporin, cisplatin, aminoglycosides, loop diuretics

Suxamethonium- (Increases vancomycin conc)

24
Q

What are the indications for clindamycin (lincosamide)? (3)

A

1) Staphylococcal joint and bone infections
2) Intra abdominal sepsis
3) Cellulitis and skin and soft tissue infections (effective against penicillin resistant streptococci)

25
Q

Important side effects of clindamycin? (4)

A

1) Antibiotic associated colitis-REPORT diarrhoea
2) Esophageal disorders
3) Jaundice
4) SJS, rash

26
Q

In what patient groups is clindamycin CI?

A

Existing diarrhoea

Caution in middle aged/ elderly women after an operation

27
Q

What are the indications for macrolides?

A

Respiratory infections (in addition to penicillin), Lyme disease, severe pneumonia (added to penicillin), skin and soft tissue infections (alternative to penicillin)

28
Q

Important side effects of macrolides? (4)

A

1) Antibiotic associated colitis
2) QT prolongation
3) Ototoxicity
4) Cholestatic jaundice

29
Q

Why would you avoid using macrolides in myasthenia gravis?

A

Macrolides cause electrolyte abnormalities which can aggravate myasthenia gravis

30
Q

Main CI for macrolides?

A

1) Hepatic impairment (cholestatic jaundice)

2) Arrhythmia (QT prolongation)

31
Q

What drugs interact with macrolides?

A

1) CYP450 substrates

2) Drugs that prolong QT interval

32
Q

What are the main indications of metronidazole? and appropriate doses? (3)

A

1) Antibiotic associated colitis (400mg TD 5 days)
2) Oral infections (200mg TD 3 days for gingivitis)
3) Gynecological infections e.g trichomonas vaginal infection

33
Q

Main side effects associated with metronidazole? (3)

A

1) Neurological effects e.g peripheral and optic neuropathy
2) Mouth-Taste disturbance, furred tongue and mucositis
3) Hearing loss

34
Q

Is metronidazole a CYP450 inhibitor?

A

NO, it is a substrate of CYP450

35
Q

What happens if you drink alcohol while taking metronidazole?

A

‘di-sulfram like’ reaction will occur. Metronidazole inhibits the clearing of acetylaldehyde (intermediary metabolite)- this causes flushing, headache, tachycardia

36
Q

How long after stopping metronidazole should you avoid alcohol?

A

2 days

37
Q

What drugs does metronidazole interact with? (4)

A

1) CYP450 inhibitors
2) CYP450 inducers
3) CYP450 substrates
4) Lithium (reduces clearance of lithium resulting in toxicity)

38
Q

What effect will ketoconazole have on metronidazole?

A

Ketoconazole is a CYP450 inhibitor, metronidazole is a substrate of CYP450 therefore ketoconazole will reduce the metabolism of metronidazole. Metronidazole is a pro-drug so this will reduce the efficacy of metronidazole.

39
Q

What duration of treatment with metronidazole requires FBC and hepatic monitoring?

A

10 days

40
Q

Are penicillins broad spectrum?

A

Yes

41
Q

What are the main indications for penicillins? (7)

A

1) Tonsillitis (streptococcal)
2) Otitis media
3) Cellulitis
4) RTI
5) Meningitis
6) Tetanus (C.diff)
7) Skin and soft tissue infections

42
Q

Main side effects of penicillin’s? (2)

A

1) Penicillin allergy

2) CNS toxicity (convulsions, coma)-do not give intrathecal injection

43
Q

Main drug interaction of penicillin’s?

A

Methotrexate- reduced renal excretion and increased toxicity

44
Q

What are the main indications for co-amoxiclav? (3)

Main side effect of co-amoxiclav?

A

1) Pneumonia
2) UTI (250-500mg 8hrly)
3) H.pylori (combo therapy)

Same as penicillin’s + Cholestatic jaundice (no more than 14 days treatment)

45
Q

What are the main indications for flucloxacillin? (3)

Main side effect of flucloxacillin?

A

1) Skin and soft tissue infections e.g cellulitis
2) Osteomyelitis/septic arthritis
3) Endocarditis

Same as penicillin’s +Cholestatic jaundice

46
Q

Name two diaminopyrimidine antibiotics

A

1) Trimethoprim

2) Co-trimoxazole

47
Q

How do diaminopyrimidines work?

A

Bacteriostatic-inhibit folate synthesis

48
Q

Main indications of diaminopyrimidines?

A
Uncomplicated UTI (200mg 12 hourly)
RTI, pneumocystis pneumonia (co-trimoxazole)
49
Q

What are the main side effects associated with diaminopyrimidines? (2)

A

1) Blood disorders (look out for bruising, bleeding, ulcers etc)
2) SJS

50
Q

What are the main CI for diaminopyrimidines? (2)

A

1) Pregnancy (Teratogenic-especially in first trimester)

2) Caution in folate deficiency

51
Q

Drugs that interact with diaminopyrimidines?

A

K+ elevating drugs e.g ACE inhibitors, ARB’s
Folate antagonists e.g methotrexate
Phenytoin, warfarin (reduced clearance)

52
Q

Name five Quinolone antibiotics?

A

1) Ciproflaxacin
2) Monoflaxacin
3) Levofloxacin
4) Ofloxacin
5) Norfloxacin

53
Q

Why are quinolones typically 2nd and 3rd line drugs?

A

Rapid resistance developing

54
Q

Main indications that quinolones are used for? (4)

A

1) UTI
2) severe GI infections including travelers diarrhoea
3) LRTI
4) Gonorrhoea

55
Q

What are the main side effects associated with quinolones? (5)

A

1) C. diff
2) Neurological-seizures and hallucinations
3) Inflammation and rupture of tendons-STOP
4) Prolong QT interval-arrhythmia
5) Photosensitivity

56
Q

What is an important side effect of monoflaxacin?

A

Life threatening hepatotoxicity

57
Q

In what conditions should quinolones be use with caution?

A

1) Epilepsy
2) GPD6 deficiency
3) Joint disorders e.g myasthenia gravis
4) Children and adolescents (disease of joints)

58
Q

What drugs do quinolones interact with?

A

1) Calcium and antacids (reduce absorption)
2) Theophylline (quinolones inhibit CYP450)
3) NSAIDS
4) Prednisolone (tendon rupture)
5) QT prolonging drugs e.g amiodarone, antipsychotics etc

59
Q

What is the last resort antibiotic for MRSA?

A

Linezolid (vancomycin resistant cocci)

60
Q

What types of infections is Linezolid used for?

A

Complicated skin and soft tissue infections and pneumonia

61
Q

What type of drug is linezolid (HINT-psychiatric effects)

A

MAOI

62
Q

What are the main side effects associated with Linezolid?

A

1) Bipolar and confusional states
2) History of seizures
3) Uncontrolled hypertension
4) Elderly (increased risk of eosinophilia)

63
Q

What foods should be avoided while taking linezolid?

A

Tyramine rich foods

64
Q

What monitoring is required for Linezolid if the treatment exceeds 14 days?

A

FBC monitoring unless patient has existing myelosuppression, taking blood drugs and renal impairment (check for eosinophilia)

65
Q

What monitoring is required for Linezolid if treatment exceeds 28 days?

A

Check for optic neuropathy

66
Q

What drugs does Linezolid interact with and why?

A

SSRIs, triptans, tricylic antidepressants, sympathomimetics, buspirone, opioids, pethidine, antipsychotics (MAOI inhibitor)

67
Q

Which TWO drugs cause peripheral neuropathy?

A

Metronidazole and nitrofurantoin

68
Q

What type of infection is nitrofurantoin used for and what are the typical doses?

A

1st line for UTI (100mcg m/r BD for 3 days) and as prophylaxis for UTI (50-100mg nightly for max 6 months)

69
Q

What are the main side effects associated with nitrofurantoin? (4)

A

1) Dark yellow/ brown urine
2) Pulmonary reactions
3) Peripheral neuropathy
4) Hepatitis

70
Q

In what patient groups would nitrofurantoin be an inappropriate choice? (2)

A

1) Pregnancy

2) CI in renal impairment

71
Q

What are the TWO monitoring requirements for LT nitrofurantoin use?

A

Hepatic and pulmonary function

72
Q

In what patient groups would a specimen and culture be collected before treatment for UTI?

A

Men, pregnant women, children <3, Upper UTI, resistant organism suspected e.g Klebsiella suspected

73
Q

What are the treatment options for an uncomplicated UTI in a child >3mo?

A

Trimethoprim, Nitrofurantoin, Cefalexin, amoxicillin

74
Q

What are the treatment options for an uncomplicated UTI in a child <3mo?

A

IV ampicillin with gentamicin or cefotaxime in hospital, then oral treatment

75
Q

What are the antibiotic treatment options for recurrent UTI’s in children?

A

Trimethoprim or nitrofurantoin

76
Q

Name FIVE tetracyclines?

A

Tetracyline, doxycycline, minocycline, lymecyline, oxytetracyline

77
Q

What are the main indications for tetracylines? (4)

A

1) Chlamydia and PID
2) Acne
3) LRTI (including COPD)
4) Malaria, lyme disease, rickettsia

78
Q

Main side effects associated with tetracylines? (5)

A

1) Photosensitivity
2) Esophageal irritation
3) Hepatotoxicity
4) benign intracranial pressure- headache and visual disturbances-STOP
5) Discoloration of tooth enamel

79
Q

In what patient groups would you want to avoid tetracylines?

A

1) Children <12 (binds to teeth)

2) Pregnancy and breastfeeding

80
Q

Name TWO conditions that require prolonged courses of antibiotics?

A

TB and osteomyelitis

81
Q

Antibiotic used to prevent pneumococcal infection in sickle cell disease?

A

Phenoxymethylpenicillin, if CI then erythromycin

82
Q

Antibiotic used as prevention for early onset neonatal infection?

A

Benzylpenicillin (IV)

83
Q

Name FOUR beta lactam antibiotics?

A

1) Penicillins
2) Cephalosporins
3) Carbapenems
4) Monobactams

84
Q

What is the main use for fusidic acid?

A

narrow spectrum for staph infections, topically on the skin or eye or IV/oral for osteomyelitis and endocarditis

85
Q

What is the first line treatment for C.diff?

A

Metronidazole

or vancomycin or fidoxamicin

86
Q

What can a tobramycin dry powder inhaler be used for?

A

Pseudomonas lung infection in CF

87
Q

Name TWO carbapenems?

A

Imipenem and Meropenem

88
Q

Name TWO cephalosporins that can be used for CNS infections?

A

1) Cefotaxime

2) Ceftriaxone

89
Q

Which cephalosporin has good activity against haemophillus influenza?

A

Cefaclor

90
Q

Which cephalosporin should be used in history of hypercalciuria (history of renal stones)?

A

Ceftriaxone

91
Q

What is the maximum duration of treatment for fusidic acid?

A

10 days

92
Q

What are the specific monitoring requirements for minocycline if the treatment is longer than 6 months?

A

Monitor every 3 months for hepatotoxicity, pigmentation of the skin and systemic lupus erythromtosus

93
Q

Name TWO antimycobacterials?

A

Clofazimine and Dapsone (both used for leprosy)

94
Q

Name the FOUR antibiotic groups that can be used in lyme disease?

A

1) Macrolides
2) Amoxicillin
3) Macrolides

95
Q

Name SEVEN bacteria that can cause UTI?

A

1) E coli
2) Staph saprophyticus
3) Proteus
4) Klebsiella
5) Pseudomonas aeruginosa
6) Staph epidermidus
7) Enterococcus Faecalis

96
Q

What is the antibacterial prophylaxis and treatment of choice for animal bites?

A

Co-amoxiclav (if penicillin allergic- doxycyline + metronidazole for up to 5 days) and give the tetanus jab

97
Q

What is the treatment for a >50 year old with meningitis?

A

Cefotaxime or ceftriaxone
AND Amoxicillin or Ampicillin
Consider adding vancomycin (10 days)

98
Q

How long is the initial phase of TB treatment?

A

2 months

99
Q

How long is the second phase of TB treatment?

A

4 months

100
Q

What drugs are used in the initial phase of treatment for TB?

A

Isonazid (300mg OD)
Rifampicin (<50kg=450mg OD, >50kg=600mg OD)
Pyrazinamide (<50kg=1.5g, >50kg=2g OD)
Ethambutol (15mg/kg OD)

101
Q

What drugs are used in the second phase of treatment for TB?

A

Isonazid (300mg OD)

Rifampicin (same as initial)

102
Q

Which TB drugs cause liver toxicity?

A

Isonazid
Rifampacin
Pyrazinamide

103
Q

Which TB drugs cause peripheral neuropathy?

A

Isonazid

104
Q

Which TB drugs cause occular toxicity?

A

Ethambutol

105
Q

What are the monitoring requirements for TB treatment?

A
Plasma levels e.g ethambutol
Urinalysis
Visual acuity testing
Blood counts
Liver and hepatic function
Auditory function in the elderly
106
Q

What is the duration of treatment for extrapulmonary TB?

A

10 months

107
Q

What is a specific CI of pyrazinamide?

A

Acute attack of gout

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