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//Gpe21// > //Infections// > Flashcards

//Infections// Flashcards

1
Q

Name the 1st gen cephalosporins

A

Cefalexin, cefadroxil, cefradine

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2
Q

Name the 2nd gen cephalosporins

A

Cefuroxime, cefaclor

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3
Q

Name the 3rd gen cephalosporins

A

Cefixime, ceftriaxone, cefotaxime, ceftazidime

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4
Q

Name the 5th gen cephalosporins

A

Ceftaroline, cefepime

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5
Q

What is the MOA of penicillins ?

A

they competitively inhibit PBP (penicillin binding proteins) i.e. DD-transpeptidase
beta-lactam ring binds PBP —> this inhibits cross-linking of peptidoglycans in bacterial cell walls —> weakens the cell walls —> influx of water into the cells —> cell swelling —> lysis

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6
Q

Name examples of penicillins

A

Benzylpenicillin, phenoxymethylpenicillin (pen V)
Amoxicillin, co-amoxiclav (clauvanic acid)
Flucloxacillin
Tazocin

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7
Q

What side effects can penicillins cause?

A

GI upset
Abx associated colitis —> c. difficile infection
Pen allergy - affects 10% of the population

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8
Q

What is the MOA of cephalosporins and carbapenems?

A

> > > Like penicillins«<

they competitively inhibit PBP (penicillin binding proteins) i.e. DD-transpeptidase
beta-lactam ring binds PBP —> this inhibits cross-linking of peptidoglycans in bacterial cell walls —> weakens the cell walls —> influx of water into the cells —> cell swelling —> lysis

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9
Q

What side effects can cephalosporins and carbapenems cause?

A

GI upset
Abx associated colitis
Potential cross sensitivity with penicillins (due to similar structure) - 10% cross sensitivity in earlier cephalosporins vs. 2-3% in third-gen cephalosporins

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10
Q

What is the MOA of glycopeptides?

A

Bind to proteins in the cell wall to prevent PBP (DD-transpeptidase) from binding —> prevents formation of cross links in the peptidoglycan cell wall

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11
Q

Name examples of glycopeptide Abx

A

Vancomycin

Teicoplanin

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12
Q

What is vancomycin used for?

A

Po - severe c dificile infections
IV - severe soft tissue/ bone/ joint infections - also CAP/ HAP/ endocarditis/ meningitis —> provides gram POSITIVE cover

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13
Q

What monitoring is required for IV vancomycin?

A
  • dosing is initially based on pt’s weight and CrCl - then regimen is adjusted based on serum vancomycin levels
  • CrCl - NOT eGFR —> vancomycin accumulates in renal disease
  • pre-dose (trough) levels before the 3rd/ 4th dose
  • LFTs
  • FBC —> can cause agranulocytosis/ neutropenia
  • urinalysis (ACR?)
  • auditory function —> can cause ototoxicity
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14
Q

What is the MOA of aminoglycosides?

A

Inhibit bacterial protein synthesis by binding to the 30S subunit of the ribosome

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15
Q

Name examples of aminoglycosides

A

Gentamicin, neomycin, tobramycin

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16
Q

What are aminoglycosides used for?

A

Severe infections esp those caused by pseudomonas

- often combined with penicillins or metronidazole when the causative organism is unknown

17
Q

What do aminoglycosides interact with

A

Loop diuretics - furosemide - high risk of ototoxicity

Vancomycin - risk of nephrotoxicity + ototoxicity

18
Q

What side effects can vancomycin cause?

A
  • agranulocytosis
  • neutropenia - more common after 1 week or cumulative dose of 25g
  • nephrotoxicity
  • ototoxicity - tinnitus —> discontinue
19
Q

Which of the glycopeptides is associated with a higher incidence of nephrotoxicity?

A

Vancomycin

20
Q

What monitoring is required for aminoglycosides?

A
  • plasma drug concentration 18-24 hours after the first dose
  • renal function
  • auditory function
  • FBC
21
Q

What is the MOA of macrolides?

A

Inhibit bacterial protein synthesis by binding to the 50S subunit of the ribosome —> prevents transloacation —> prevents protein elongation

22
Q

Name examples of macrolides

A

Clarithromycin, erythromycin, azithromycin

23
Q

What are macrolides used for?

A

Respiratory, skin, soft tissue infections in pts with penicillin allergy
H. pylori eradication —> triple therapy with PPI + amoxicillin/ metronidazole

24
Q

What side effects can macrolides cause?

A

Po - gi upset
Prolonged QT interval
Ototoxicity

25
Q

Macrolides are prokinetic - what condition can this help to treat?

A

Gastroparesis

26
Q

Are macrolides CYP450 inhibitors or inducers?

A

Inhibitors

27
Q

What drugs do macrolides interact with? What is the interaction?

A
  • interact with CYP450 substrates - CCCOWPPATTSS
    i. e. ciclosporin, carbamazepine, citalopram, oral contraceptive, warfarin, phenytoin, protease inhibitors i.e. ritonavir, acetylcholinesterase inhibitors i.e. memantine/ donepezil/ rivastigmine, tacrolimus, theophylline, statins, steroids
  • e.g. inhibit enzyme —> increase conc. of warfarin —> increase risk of bleeds —> increase INR
  • do NOT give with drugs that prolong QT interval - i.e. amiodarone, citalopram, ondansentron, domperidone ….

//Gpe21// (8 decks)

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