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Diseases > Antimicrobial Chemotherapy, Diseases, Yr 3, Wk 1 > Flashcards

Antimicrobial Chemotherapy, Diseases, Yr 3, Wk 1 Flashcards

1
Q

Principles of Prescribing: 1. Indications for antimicrobials:
Give the 2 types of therapy and describe them:

A

Therapy:
-Empiric: without microbiology results

-Directed: based on microbiology results

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2
Q

Name the 2 types of Prophylaxis and describe them:

A

Prophylaxis:
Primary:
-Anti-malarial; immunosuppressed patients

  • pre-operative surgical
  • post-exposure e.g. HIV, meningitis

Secondary:
-to prevent a second episode e.g. PJP

(An antibiotic can be used in 2 ways : therapy – to treat: empiric- clinical hunch but no microbiology to support that

Primary prophylaxis e.g. when a family member gets meningitis, the rest of the family are given antibiotics to prevent them from developing it)

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3
Q

PoP: What are the different types of Diagnosis of Infection:

A
  • Clinical
  • Laboratory
  • None (no treatment)

(PoP = principles of prescribing)

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4
Q

PoP: Name some severity assessments:

A

? Sepsis (qSOFA: syst BP <100, altered mental, RR >22)

? Septic shock (need for vasopressors, lactate >2)

(qSOFA= quick sofa assessment)

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5
Q

PoP: List some patient characteristics:

A
  • age
  • renal function
  • liver function
  • immunocompromised
  • pregnancy
  • known allergies
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6
Q

PoP: List some things you need to consider when selecting an antimicrobial:

A
  • Guideline or “individualised” therapy
  • ? likely organism(s)
  • empirical therapy or result-based therapy
  • bactericidal vs. bacteriostatic drug
  • single agent or combination
  • potential adverse effects
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7
Q

What should antibiotic selection be based on?

A

Antibiotic selection should be based on the known (or likely) causative organism(s)

(Picture showing triangle with bacteria, disease, antibiotics(s) )

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8
Q

What are some causative bacteria in soft tissue infections

A
  • Streptococcus pyogenes
  • SA
  • Streptococcus group C or G
  • E. coli
  • Pseudomonas aeruginosa
  • Clostridium species

(Bottom 3 are gram negative bacteria- more common in diabetes)

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9
Q

What are some causative bacteria in pneumonia?

A
  • Streptococcus pneumonia (commonest)
  • Haemophilus influenzae
  • Staphylococcus aureus
  • Klebsiella pneumonia
  • Moraxella catarrhalis
  • Mycoplasma pneumonia
  • Legionella pneumonia
  • Chlamydia pneumonia
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10
Q

Bactericidal vs. Bacteriostatic:

-Discuss Cidal

(kill the bacteria = cidal)
(inhibit the proliferation of the bacteria = static)

A

Cidal:

  • e.g. beta-lactams
  • act on cell wall
  • kill organisms
  • indications include neutropenia, meningitis and endocarditis

(cidal- wall falls apart and kills the organism)

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11
Q

Discuss Static:

A
  • e.g. macrolides
  • inhibit protein synthesis
  • prevent colony growth
  • require host immune system to “mop up” residual infection
  • useful in toxin-mediated illness
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12
Q

Give reasons why single therapy should be used as opposed to combination therapy?

A

Single:
-Simpler

  • Fewer side effects
  • Fewer drug interactions
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13
Q

Give reasons why combination therapy should be used as opposed to combination therapy?

A

Combination:
-HIV and TB

  • severe sepsis (febrile neutropenia)
  • mixed organisms (faecal peritonitis)

(one agent or combination of agents)

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14
Q

PoP: Give some things to consider when doing REGIMEN SELECTION:

A
  • Route of administration
  • Dose
  • Adverse effects (side effects/toxicity)
  • Duration
  • Intravenous to oral SWITCH therapy
  • Inpatient or Outpatient therapy (outpatient parenteral antimicrobial therapy (OPAT)
  • Therapeutic drug monitoring
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15
Q

When should the oral route of drug administration be given?

A
  • If not vomiting
  • Normal GI function
  • No shock
  • No organ dysfunction

(Wherever possible, the drug should be given orally)

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16
Q

When should the IV route of drug administration be given?

A
  • For severe or deep-seated infection

- And when oral route is not reliable

17
Q

Describe oral bio-availability:

A

-Ratio of drug level when given orally compared with level when given IV

(Varies widely:

  • Flucloxacillin 50-70%
  • Linezolid 100%)

(Oral bioavailability (F%) is the fraction of an oral administered drug that reaches systemic circulation. After intravenous administration, a drug is directly and fully available in the bloodstream and can be distributed via systemic circulation to the point where a pharmacological effect takes place.)

18
Q

(Adverse effects) Give 2 types of Allergic Reactions:

A
  • Immediate Hypersensitivity: anaphylactic shock
  • Delayed Hypersensitivity: rash, drug fever, serum sickness, erythema nodosum, Stevens-Johnson syndrome

Mostly with penicillins and cephalosporins

(-Anaphylactic shock`; swollen lips, swollen tongue, wheeze; uncommon

-Delayed: day 3 or 4 when using penicillin)

19
Q

Give name of a type of rash you can get (picture of the back with a big pink rash) from a drug reaction:

A

Maculopapular drug rash

20
Q

Give some GI system related adverse effects of drugs:

A
  • nausea
  • vomiting
  • diarrhoea
  • Clostridium difficile infection
21
Q

When can Candida (thrush) occur?

A

when using broad spectrum penicillins, cephalosporins

22
Q

When can liver adverse effects occur?

A
  • All drugs, particularly tetracyclines, TB drugs

- More likely if pre-existing liver disease

23
Q

When can renal adverse effects occur?

A
  • When taking gentamicin, vancomycin
  • More likely if pre-existing renal disease or nephrotoxic meds

(Gentamicin- aminoglycoside (gram –ve infectons treatment) and vancomycin (glyocpeptide and used for treatment of gram positive infections such as staph aureus)  these 2 drugs are from different families
Nephrotoxic drugs; NSAIDS)

24
Q

Give some Neurological adverse effects:

A
  • Otoxicity- gentamicin, vancomycin
  • Optic neuropathy- ethambutol (TB)
  • Convulsions, Encephalopathy- penicillins, cephalosporin
  • Peripheral neuropathy- isoniazid (TB), metronidazole
25
Q

Give some Haematological adverse effects:

A
  • Marrow toxicity
  • megaloblastic anaemia (folate metabolism)- co-trimoxazole

(otoxicity- deafness)

26
Q

PoP: Describe some of the liaison with the laboratory:

A
  • Sending appropriate specimens: culture/ direct detection/ serology
  • Receiving results: preliminary culture results, sensitivity results, final results
  • Monitoring: disease activity, therapeutic drug monitoring
27
Q

PoP: Describe antimicrobial stewardship:

A

“making the best use of current antimicrobials”

28
Q

List some of the components of the Antimicrobial Management Team:

A
  • Antibiotic Pharmacists
  • Infectious Diseases
  • Acute Medicine
  • Medical Microbiology
  • Infection Prevention and Control
  • General Practice.
29
Q

List some of the jobs that the antimicrobial Management Team carry out:

A
  • Antimicrobial Guidelines and Policies
  • Audit of quality of antimicrobial prescribing
  • Education
30
Q

Why have there been outbreaks of Clostridium Difficile infection?

A

Due to overuse of broad spectrum antibiotics

31
Q

If we reduce what 4 antibiotics, what will it reduce?

A

If we reduce the 4Cs:
-Ceftriaxone

  • Co-amoxiclav
  • Clindamycin
  • Ciprofloxacin

Then we reduce C Diff

(-We tried to remove the ‘4Cs’ from the Empirical Guidance where possible following the Vale of Leven outbreak.

  • If an outbreak had occurred we actually removed them from the wards involved as an interim measure, as this has been shown to cut the rates of C.diff.
  • e.g.. Woodend, 13/14, 27/28
  • The avoidance of the 4cs at greatest risk of causing c. diff)
32
Q

Name the guideline followed in antibiotic therapy:

A

Infection Management Guidelines: Empirical Antibiotic Therapy

33
Q

Name the 10 Antimicrobial classes:

A
  • Penicillins (β-lactams)
  • Cephalosporins (β-lactams)
  • Aminoglycosides
  • Macrolides
  • Quinolones
  • Glycopeptides
  • Other antibiotics
  • Antifungals
  • Antivirals
  • Immunoglobulin
34
Q

Which antimicrobial classes follow the mechanism of action of INHIBITION OF CELL WALL SYNTHESIS?

A
  • Beta-lactams: penicillins and cephalosporins

- Glycopeptides: vancomycin, teicoplanin

35
Q

Which antimicrobial classes follow the mechanism of action of INHIBITION OF PROTEIN SYNTHESIS?

A
  • Aminoglycosides: gentamicin
  • Macrolides: clarithromycin
  • Tetracyclines: doxycycline
  • Oxazolidinones: linezolid
36
Q

Which antimicrobial classes follow the mechanism of action of INHIBITION OF NUCLEIC ACID SYNTHESIS?

A
  • Trimethoprim
  • Sulphonamides: sulphamethoxazole
  • Quinolones: ciprofloxacin
37
Q

There are a lot of tables from slide 29-38 of this powerpoint:

A

So copy these into a book (its from the Antimicrobial Chemotherapy lecture)

Diseases (9 decks)

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