W8 Overview of Antibiotics Flashcards

Question

Penicillins What are some examples?

Answer 1

- Beta-lactamase sensitive: benzylpenicillin (penicillin G- injectable) - phenoxymethylpenicillin (penicillin V- oral) - Broad-spectrum (but inactivated by beta-lactamases): amoxicillin and ampicillin - Penicillinase-resistant penicillin:

Answer 2

Hypersensitivity, diarrhoea, antibiotic-associated colitis, encephalopathy, thrombocytopenia * Hypersensitivity (1-10%) and anaphylaxis (<0.05%). A minor rash that occurs after 72hrs is not a true allergy. * Maculopapular rashes common with ampicillin and amoxicillin (in renal impairment). * Flucloxacillin: hepatic disorder, cholestatic jaundice and hepatitis may occur even up to 2 months after treatment (more prevalent in men over 65 and patients who have recieved long courses =2 weeks+) * Co-amoxiclav contra-indicated in penicillin-associated jaundice or hepatic disfunction

Answer 3

Amoxicillin + Clauvulanic acid- stops bacteria from breaking down clauvanic acid, allowing the abx to work better.

Answer 4

Flucloxacillin, Penicillin V: to be taken on an empty stomach, an hour before food or 2 hours after food. Maintain adequate hydration.

Answer 5

1, 2, 3, 5 1st Generation * Cefalexin * Cefradine * Cefadroxil 2nd/3rd generation cephalosporins) * Cefaclor * Cefuroxime * Cefixime - orally active * Ceftriaxone * Cefotaxime * Ceftazidine * Ceftaroline Side-effects: Antibiotic-associated colitis (mostly with

Answer 6

Cross sensitivity with other beta-lactam antibacterials: Patients with history of immediate hypersensitivity to penicillin and other beta-lactams should not receive cephalosporins. 1st Generation Side-effects: Antibiotic-associated colitis (mostly with 2nd/3rd generation cephalosporins) * Cefalexin * Cefradine * Cefadroxil * Cefaclor * Cefuroxime * Cefixime - orally active * Ceftriaxone * Cefotaxime * Ceftazidine * Ceftaroline If no suitable alternative is available, then cefixime, cefotaxime, ceftazidime, ceftriaxone, or cefuroxime can be used in caution. 2nd Generation 3rd Generation 5th Generation

Answer 7

Amikacin, Gentamicin, Neomycin, Streptomycin, Tobramycin

Answer 8

Gentamicin serum concentration: * 1 hour Peak concentration: 5-10 mg/L (3-5 in endocarditis) * Pre-dose trough concentration: <2 mg/L (<1 in endocarditis) (narrow therapeutic index) Once-daily dose should be avoided in CrCl <20 mL/min Dose adjustment: interval between doses must be increased, if renal impairment is severe, the dose itself should be reduced as well.

Answer 9

Cautions & contraindications: **Auditory disorders: (ototoxicity)** **Nephrotoxicity** Muscular weakness (Myasthenia gravis) Dehydration corrected prior to administration Side-effects: may impair neuromuscular transmission, irreversible ototoxicity, nephrotoxicity, N+V, antibiotic-associated colitis, peripheral neuropathy MHRA/CHM advice: Aminoglycosides (gentamicin, amikacin, tobramycin, and neomycin): increased risk of deafness in patients with mitochondrial mutations.

Answer 10

Vancomycin, teicoplanin, telavancin

Answer 11

Cautions & contraindications: Avoid in history of deafness, elderly caution: systemic absorption enhanced in patients with inflammatory disorders of the intestinal mucosa or with C.difficile Agranulocytosis, neutropenia, nephrotoxicity, ototoxicity, blood disorders, fever, rashes, SCAR reaction, photosensitivity, 'red-man- syndrome' flushing, thrombophlebitis, tinnitus (discontinue)

Answer 12

Monitoring: TROUGH LEVEL 10-20 mg/L (LEARN) - All patients require monitoring of serum vancomycin, more regularly if renally impaired. - Monitor auditory function, blood counts, urinalysis, hepatic + renal function, monitor leucocyte count Avoid with ototoxic drugs: ciclosporins aminoglycosides, loop diuretics

Answer 13

Peak and trough levels indicate drug levels in an individual's body. A peak is the highest level of a medication in the blood, while a trough level indicates the lowest concentration. Troughs of medication concentration occur after the drug has been broken down and metabolized by the body

Answer 14

Azithromycin - once daily dose Clarithromycin - BD (avoid in pregnancy) Erythromycin - BD/QDS (used in pregnancy) Side-effects: GI side-effects (mostly with erythromycin), hepatotoxicity, rash, ototoxicity (with high doses), skin reactions, vision issues.

Answer 15

Take with or just after food. Label 5 - do not take indigestion remedies 2 hours before or after you take this medicine: Azithromycin + Erythromycin Azithromycin can be sold to the public for treatment of confirmed asymptomatic chlamydia in those over 16 years of age, and for the treatment of their partners - max 1g

Answer 16

Patients with a predisposition to QT interval prolongation. May aggravate myasthenia gravis Warning: * Patients should not be given erythromycin with a history of QT interval prolongation or ventricular arrhythmia, or those with electrolyte disturbances. * 2-3-fold increase in the risk of infantile hypertonic pyloric stenosis during infancy monitor for vomiting or irritability with feeding. A potential drug interaction between rivaroxaban and erythromycin resulting in an increased risk of bleeding

Answer 17

Ciprofloxacin, Levofloxacin, Moxifloxacin, Norfloxacin, Olfoxacin prolongs QT interval, seizures, GI side-effects, dizziness, headache, eye disorders, decreased appetite

Answer 18

If they experience a rapid onset of SOB especially when lying down flat in bed, swelling of ankles, feet, or abdomen or new onset heart palpitations. * Avoid administration of dairy products due to reduced exposure. Do not take milk, indigestion remedies, iron or zinc 2 hours before or after taking this medicine. * Discontinue if psychiatric, neurological and hypersensitivity reactions occur.

Answer 19

Cautions & contraindications: * CSM: may induce convulsions (e.g. when taking with NSAIDs) * Tendon damage: within 48 hours, some cases several months after stopping, do not give to patients with a history of tendon disorders or those taking corticosteroids (increases risk of tendinitis) -discontinue if tendon damage is suspected. * Small risk of aortic aneurysm and heart valve regurgitation: sudden onset severe abdominal, chest, or back pain develops * Caution: exposure to sunlight and UV radiations should be avoided up to 48 hours after treatment stopped. G6PD deficiency, history of epilepsy, myasthenia gravis, psychiatric disorders, children or adolescents (Arthropathy)

Answer 20

Tetracycline, Doxycycline, Minocycline

Answer 21

N+V, diarrhoea, antibiotic- associated colitis, dysphagia, oesophageal irritation, hepatotoxicity, blood disorders, photosensitivity, hypersensitivity, hepatotoxicity Cautions & contraindications: * Headache and visual disturbances indicate benign intracranial hypertension (discontinue) * Contra-indicated in children <12 years old (deposition in growing bone and teeth, by binding to calcium causing staining and occasionally dental hypoplasia) Should not be given to pregnant or breast-feeding women, effects on skeletal development, may cause discolouration of child's teeth, and maternal hepatotoxicity has been reported. * Myasthenia gravis, systemic lupus erythematosus

Answer 22

Tetracyclines should not be given within 2 hours of calcium, antacids or iron, which will prevent antibiotic absorption. Tablets should be swallowed whole with plenty of fluid while sitting or standing. Patients should be advised to avoid exposure to sunlight or sun lamps.

Answer 23

Antifolate antibiotic. - when fetus is forming Cautions & contraindications: Blood dyscrasias acute prophylaxis, elderly, neonates, those at risk of folate deficiency Avoid in first-trimester of pregnancy due to antifolate effect Side-effects: allergic reactions, anaphylaxis, drug fever, electrolyte imbalances, GI disturbances, photosensitivity, fungal overgrowth

Answer 24

Monitoring: Hyperkalaemia, increased creatinine concentration, renal function, plasma-trimethoprim if used for long- term treatment. Monitor and advise patients to look out for blood dyscrasias symptoms: sore throat, rash, mouth ulcers, bruising, bleeding, purpura, fever. Interactions: - Not to be used with potassium-elevating drugs (aldosterone antagonist, ACEI, ARBs) - Not to be used with other folate antagonists (methotrexate) or drugs that increase folate metabolism (phenytoin)

Answer 25

Don't give in 3rd trimester Dont give in first trimester

Answer 26

Cautions & contraindications: * Acute porphyrias, G6PD deficiency , infants less than 3 months old. * Caution in anaemia, diabetes, electrolyte imbalances, folate deficiency, susceptibility to peripheral neuropathy, Vit B deficiency * Pregnancy: avoid at term - may produce haemolysis * BF: avoid, small amounts enough to produce haemolysis in G6PD - deficient infants. Side-effects: pulmonary reactions, nausea and anorexia, hypersensitivity reactions, peripheral neuropathy, blood disorders. Taken with or just after food, may discolour urine but this is harmless Monitoring: * Renal function: avoid if eGFR <45 mL/ min; may be used in caution if eGFR 30-44 mL/min as a short course of 3-7 days to treat lower UTI * On long-term therapy, monitor liver function and monitor for pulmonary symptoms, especially in the elderly (discontinue if deterioration in lung function)

Answer 27

Clindamycin Cautions & contraindications: Should not be used with existing diarrhoea (colitis more common in middle-aged and elderly women especially after an operation) Avoid injections containing benzyl alcohol in neonates Avoid in acute prophyrias Monitoring: - Monitor liver and renal function if treatment exceeds 10 days and in infants - Not harmful in 2nd and 3rd trimester - Present in breast milk and so child needs to be monitored for side-effects and diarrhoea. Side-effects: antibiotic-associated colitis, GI side-effects, oesophageal disorders, taste disturbances, jaundice, blood disorders, rash, Steven-Johnson syndrome, skin reactions. Counselling: Patients should be advised to discontinue immediately and contact a doctor if diarrhoea develops. - Dalacin 2% cream can damage latex condoms and diaphragms - Advise patients to take with a full glass of water

Answer 28

Metronidazole Cautions & contraindications: Clinical and laboratory monitoring if treatment > 10 days Vaginal gel is not licensed for use in children under 18 years With topical use: avoid exposure to strong sunlight or UV light With vaginal use: avoid intravaginal preparations in young girls who are not sexually active, unless there is no alternative; not recommended during menstruation; some systemic absorption may occur with vaginal gel. P+BF: avoid high-dose regimens, use only if potential benefit outweighs risk. Side-effects: gastro-intestinal side- effects, taste disturbances, furred tongue, oral mucositis, anorexia, vulvovaginal candidiasis, pelvic discomfort (with vaginal use) Do not drink alcohol or use any alcohol hand sanitisers, avoid it!- disulfiram-like reaction Take with or just after food, or a meal Swallow whole do not chew or crush Take with full glass of water Interactions: Interactions: - Metronidazole is an enzyme inhibitor, so may enhance the effect of warfarin, and phenytoin - CYP450 inducers can also decrease the function of metronidazole

Answer 29

Cautions & contraindications: CHM advice: optic neuropathy; if used for >28 days Patients advised to report symptoms of visual impairment or new visual symptoms even if not given for long-term Blood disorders: thrombocytopenia, anaemia, leucopoenia – it’s recommended that patients receive a full blood count weekly. P+BF: not recommended unless necessary with close monitoring Side-effects: anaemia, constipation, diarrhoea, eosinophilia, headache, nausea, vomiting, taste disturbances, severe optic neuropathy, blood disorders. Avoid consuming large amounts of tyramine-rich foods (mature cheese, salami, marmite, oxo, Bovril, pickled herring, or any similar meat or yeast extract or fermented soya bean extract and some beers, lagers or wines) and other MAOIs Caution: unless close observation and BP monitoring possible, linezolid should be avoided in uncontrolled hypertension, pheochromocytoma, carcinoid tumour, thyrotoxicosis, bipolar depression, schizophrenia or acute confusional states.

Answer 30

Maximum FEVERPAIN score=5 Infection markers: Temp, pus on tonsils, pain, swelling Using NICE CKS Sore throat due to a viral or bacterial cause is a self-limiting condition which generally resolves within two weeks- no treatment First-line- phenoxymethylpenicillin 500mg QDS for 5-10 days OR 1g BD (QDS when severe) Second line (allergic to above)- Clarithromycin 250-500mg BD for 5 days lifestyle advice- paracetamol/ibuprofen. keep hydrated. BUT no NSAIDS in asthma. Salt water gargling to relieve pain. Don't have hot drinks- can exacerbate pain. Children- go back to school after fever.

Answer 31

- Fever - Purulence - Attend rapidly - Severely inflamed tonsils - No cough or coryza (inflammation of mucus membranes in the nose) Each of the FeverPAIN criteria score 1 point (maximum score of 5). Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause. A score of 0 or 1 is thought to be associated with a 13 to 18% likelihood of isolating streptococcus. A score of 2 or 3 is thought to be associated with a 34 to 40% likelihood of isolating streptococcus. A score of 4 or 5 is thought to be associated with a 62 to 65% likelihood of isolating streptococcus

Answer 32

Otitis externa- flucloxacillin/ clarithromycin 1. Manage aggravating factors, cleaning the external auditory canal. Analgesia and counselling on drug administration. 2. Possibly 3. Acetic acid 2% 1 spray TDS or Ear drops for 7 days Topical antibiotics with or without a topical corticosteroids (7-14 days) Lifestyle advice- CKS - Avoid damage to the external ear canal: Troublesome ear wax should be removed safely to avoid damaging the ear canal. Cotton buds or other objects should not be used to clean the ear canal. Keep the ears clean and dry. Avoid swimming and water sports for at least 7–10 days during treatment. Use ear plugs and/or a tight-fighting cap when swimming. Keep shampoo, soap, and water out of the ear when bathing and showering, for example by inserting ear plugs or cotton wool (with petroleum jelly). Consider using a hair dryer (at the lowest heat setting) to dry the ear canal after hair washing, bathing, or swimming

Answer 33

* Initiate antibiotics as soon as possible in severe infection. * A dose and duration of treatment for adults is usually suggested, but adjust for age, weight and renal function. * In severe or recurrent cases, consider a larger dose or longer course. * Confirm dosing and interaction information * Check for allergy. * Consider lower threshold for antibiotics in patients with multiple morbidities; consider culture and seek advice. * Suspect neutropenic sepsis if patients having cancer treatment become unexpectedly or seriously unwell. Refer immediately!! for assessment at their appropriate local hospital. * Prescribe an antibiotic ONLY when there is likely to be a clear clinical benefit. * Consider a no, or delayed, antibiotic strategy for acute self-limiting upper respiratory tract infections. * Use simple generic antibiotics if possible- not brand * Avoid broad-spectrum antibiotics when narrow-spectrum antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant UTIs. * Avoid widespread use of topical antibiotics- small amounts should be used but patients use like creams * Where a ‘best guess’ therapy has failed or special circumstances exist, microbiological advice can be obtained from your local microbiology team. * Monitor renal function, and biochemical results as appropriate. * Monitor response to treatment, safety and adverse reactions. * Counsel patients on administration and the importance of completing the course

W8 Overview of Antibiotics Flashcards

(57 cards)