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Y3 DRUGS PROFILES > ANTIBIOTICS > Flashcards

ANTIBIOTICS Flashcards

1
Q

what two types of antibiotics inhibit cell wall synthesis?

A

beta lactams= penicillin, cephalosporin, carbapenams and monobactams
glycopeptides= vancomycin and teicolpanin

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2
Q

what 4 types of antibiotics are protein synthesis inhibitors?

A

aminoglycosides= gentamicin
macrolides= erythromycin, clarithromycin and azithromycin
tetracyclines= doxy
oxazolidinones

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3
Q

what 3 types of antibiotic are DNA synthesis inhibitors?

A

trimethoprim/sulphonamides
quinolone= nalidixic acid
fluroquinolones= ciprofloxacin, levofloxcain

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4
Q

what type of antibiotic is an RNA synthesis inhibitor?

A

rifampicin

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5
Q

give 2 types of antibiotics that are plasma membrane agents

A

daptomycin

polymycin

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6
Q

give 2 other types of antibiotics

A

nitrofurantoin

metronidazole (anaerobic)

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7
Q

what antibiotic group are penicillins?

A

beta lactams that contain B lactam ring= gives antimicrobial properties

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8
Q

are penicillins broad or narrow spectrum?

A

broad

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9
Q

how do penicillins work?

A

It inhibits enzyme cell wall synthesis by - preventing cross linking between peptidoglycan chains. Causing uncontrolled entry of water into bacteria causes cell swelling, lysis and death

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10
Q

what type of bacteria are targeted by penicillins?

A

gram +ve and -ve

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11
Q

when is the only instance that penicillins are taken well into the CNS?

A

inflammation of meninges

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12
Q

what other drugs should be used in caution if there is hypersensitivity to penicillin?

A

cephalosporins

other b lactams

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13
Q

how can bacteria inactive penicillins?

A

produce beta lactamases

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14
Q

name a serious GI side effect of penicillins

A

antibiotic associated colitis

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15
Q

how can penicillins interact with the COCP?

A

reduce effectveness

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16
Q

how can probenecid interact with penicillins?

A

reduce excretion - anti gout drug

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17
Q

give an example of a first generation cephalosporin

A

cephradine

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18
Q

give an example of a second generation cephalosporin

A

cefuroxime

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19
Q

give an example of a 3rd generation cephalosporin

A

cefotaxime
ceftazidime
ceftiaxone

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20
Q

how do cephalosporins work?

A

same as penicillin

cell wall synthesis inhibitor (prevent peptidoglycan cross linking)

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21
Q

which type of bacteria are second generation cephalosporins more active against?

A

They are less susceptible to B lactamase and effective against gram +ve

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22
Q

which type of bacteria are third generation cephalosporins more active against?

A

gram -ve

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23
Q

what cephalosporin is used in pneumocci and H.infleunzae meningitis?

A

cefotaxime

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24
Q

what kind of spectrum do cephalosporins have? What type of infections it is used for?

A

very broad

Second and third line treatment for urinary tract infection and respiratory tract infections

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25
Q

what respiratory condition can reduce the effectiveness of cephalosporins?

A

COPD

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26
Q

what drug can reduce excretion of cephalosporins?

A

probenecid

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27
Q

how do cephalosporins interact with warfarin?

A

increase anticoagulant effect

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28
Q

give an example of a glycopeptide

A

vancomycin

teicoplanin

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29
Q

how do glycopeptides work?

A

cell wall synthesis inhibitors

bind to cell wall and competitively inhibit cross linking

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30
Q

what types of bacteria are glycopeptides effective against?

A

gram +ve as they cannot degrade the cell wall of grame -ve
aerobic &anaerobic
MRSA TOO!

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31
Q

which glycopeptides would be used in endocarditis and c.diff, and the other in endocarditis, cellulitis peritonitis and diabetic foot infection?

a) vancomycin
b) teicoplanin

A

a) endocarditis, c. diff = vancomycin

b) endocarditis peritonitis, cellulitis and diabetic foot infection = teicoplanin

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32
Q

why should glycopeptides be used IV in systemic infections?

A

Poorly absorbed orally in systemic infections

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33
Q

glycopeptide should be avoided in the elderly in which circumstance?

A

history of deafness

Renal impairment

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34
Q

IV Glycopeptides can lead to which blood disorder?

A

neutropenia and thrombocytopenia

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35
Q

Name a serious side effect of giving infusing IV glycopeptide rapidly

A

Red man syndrome = generalised erythema +/- hypotension and bronchospasm

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36
Q

Name an ENT side effect of IV glycopeptides?

A

Ototoxicity leading to tinnitus and deafness

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37
Q

give an example of a tetracycline

A

doxycycline

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38
Q

how do tetracyclines work

A

Bacterial protein synthesis inhibitors

Binds to ribosome 30s sub unit specific to bacteria and prevents RNA translation

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39
Q

what is the spectrum of tetracyclines?

A

broad spectrum

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40
Q

Are tetracyclines bactericidal or bacteriostatic?

A

bacteriostatic

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41
Q

name 2 systems that tetracyclines are used to treat infections in

A 
Respiratory= LRTI including infective exacerbation of COPD (h.influenzae), pneumonia and atypical pneumonia 
Genital= chlamydia and pelvic inflammatory disorders
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42
Q

name 2 skin conditions that tetracyclines are used in

A

acne rosacea

acne vulgaris

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43
Q

Name an infectious disease that tetracyclines are used to treat

A

Typhoid, anthrax, malaria and lyme

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44
Q

why shouldn’t tetracyclines be used in myasthenia gravis patients?

A

can increase muscle weakness

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45
Q

why shouldn’t tetracyclines be used in patients with SLE?

A

can exacerbate

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46
Q

why shouldn’t tetracyclines be used in children under 12?

A

deposits in growing bone and teeth - staining and hypoplasia

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47
Q

why shouldn’t tetracyclines be used in pregnancy and breastfeeding?

A

deposits in growing bone and teeth - staining and hypoplasia

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48
Q

what severe acute disease can be triggered by tetracyclines?

A

acute porphyria

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49
Q

name 2 neurological side effects of tetracyclines

A

photosensitivity

benign intracranial hypertension causing headache and blurred vision

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50
Q

how do tetracyclines interact with anticonvulsants?

A

increase doxycycline metabolism

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51
Q

how do tetracycline interact with methotrexate?

A

increase risk of toxicity

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52
Q

give an example of an aminoglycoside

A

gentamicin
streptomycin
amikacin
Tobramycin

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53
Q

how do aminoglycosides work?

A

protein synthesis inhibitors
They bind to ribosomal 30s subunit
They are bactericidal

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54
Q

What is infections are aminoglycosides generally used against?

A

1) Severe sepsis even when organism is unknown
2) pyelonephritis and complicated urinary tract infections
3) Biliary and other intra abdominal sepsis infections

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55
Q

why are aminoglycosides often used with beta lactams or metronidazole?

A

Lack activity against streptococci or anaerobes and therefore used in combination when the organism is unknown

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56
Q

what kind of bacteria are aminoglycosides effective against?

A

Mainly gram negative aerobic bacteria
Also pseudomonas aeruginosa
Some gram +ve (e.g staph)

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57
Q

which of these aminoglycosides would you use against p aeruginosa, then m tuberculosis

a) gentamicin
b) streptomycin

A

a) gent = p aeruginosa

b) strep = m tuberculosis

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58
Q

why should’t aminoglycosides be used in myasthenia gravis?

A

impair neuromuscular junction transmission

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59
Q

why shouldn’t aminoglycosides be used in 2nd or 3rd trimester of pregnancy?

A

Cross the placenta causing damage to the auditory and vestibular nerve
Streptomycin greatest risk

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60
Q

What renal side effect can you get with aminoglycosides?

A

Nephrotoxicity= reduced urine output and increase serum creatinine levels

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61
Q

Give a ENT side effect of aminoglycosides

A

ototoxicity= tinnitus and deafness

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62
Q

Aminoglycoside in combination with what drugs can potentiate nephrotoxicity?

A 
Platinum
Chemotherapy
Cyclosporine
Vancomycin
Cephalosporin
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63
Q

Aminoglycoside in combination with what drugs can potentiate ototoxicity?

A

Loop diuretics and vancomycin

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64
Q

why shouldn’t aminoglycosides be used for more than 7 days?

A

toxicity risk

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65
Q

How is the dose of aminoglycoside calculated and how is it administrated?

A

Based on weight and renal function

IV

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66
Q

give an example of a macrolid

A

erythromycin
clarithromycin
azithromycin

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67
Q

Are macrolides bactericidal or bacteriostatic?

A

bacteriostatic

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68
Q

how do macrolides work?

A

protein synthesis inhibitors
They bind to ribosomal 50s subunit preventing translocation occurring
Inhibit protein elongation by blocking exit tunnel of ribosome

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69
Q

when are macrolides used?

A

Alternative to penicillin
Respiratory infection
Skin and soft tissue infection

Serious pneumonia with penicillin and atypical pneumonia (Legionella pneumophila and Mycoplasma pneumoniae)

Non-gonococcal urethritis= erythromycin

Uncomplicated chlamydia infection

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70
Q

Macrolides should be used with caution for patients with what ECG abnormality?

A

prolonged QT interval and arrhythmias

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71
Q

how should dosing change for a patient with a reduced eGFR?

A

half dose

72
Q

What are the common abdominal side effects of oral macrolides?

A

Nausea and vomiting
Abdominal pain
Diarrohea

73
Q

What is a cardiac side effect of macrolides?

A

QT interval prolonged which can lead to arrhythmias

74
Q

What action does clarithromycin and erythromycin have on cytochrome p450?

A

Inhibit cytochrome p450

75
Q

give an example of a fluoroquinolone

A

ciprofloxacin
Levofloxacin
Mexifloxacin

76
Q

What type of organisms are quinolones most effective against?

A

Aerobic gram -ve bacteria

77
Q

are fluoroquinolones bactericidal or bacteriostatic?

A

bactericidal

78
Q

Are quinolones effective against gram +ve?

A

Ciprofloxacin has limited effect against +ve

Levofloxacin and mexifloxacin increased activity against +ve and therefore can be used in LRTI

79
Q

what antibiotic might you use to treat campylobacter and neusseria?

A

fluroquinolones

80
Q

how do fluoroquinolones work?

A

Inhibit DNA replication by interacting with bacteria specific enzyme that is invovled with DNA replication

81
Q

which type of fluoroquinolone would be better to treat CAP and why?

a) levofloxacin
b) ciprofloxacin

A

a) levofloxacin (greater against pneumococcal activity)

82
Q

What is quinolones used to treat?

A 
UTI and acute pyelenophritis (cipro)
Severe GI tract infections= e.g. shigella and campylobacter 
LRTI= Levofloxacin and mexifloxacin
Joint and bone infection
Gonorrhea and septicaemia
83
Q

what systemic infection are fluoroquinolones used to treat?

A

septicaemia

84
Q

why shouldn’t fluoroquinolones be taken by patients with epilepsy or previous history of seizures?

A

lowers seizure threshold

85
Q

why shouldn’t fluoroquinolones be used with cyclosporin?

A

increases nephrotoxicity

86
Q

What is the effect of quinolones on cytochrome p450?

A

Inhibit the enzyme

87
Q

why shouldn’t fluoroquinolones be used with

a) warfarin
b) theophylline?

A

a) increases anticoagulation

b) increase risk of convulsion and toxicity

88
Q

What organisms are trimethoprim active against?

A

Broad spectrum Gram +ve and Gram -ve particullarly enterobacteria

89
Q

how does trimethoprim work?

A

inhibit DNA synthesis by inhibiting folate synthesis (folic acid essential for making purines).
Leads to bacteriostatic

90
Q

How is Co-trimoxazole made and what is it used for?

A

Trimethoprim and sulfamethoxazole (sulfonamide)
Used to treat pneumocystis pneumonia in immunosuppressed patients.
Also treat acute exacerbations of chronic bronchitis, UTI and otitis media in children = if their is bacterial sensitivity
Travellers diarrohea

91
Q

when is trimethoprim normally used?

A

First line for UTI

Also used for respiratory tract infections, shigellosis, invasive salmonella infection

92
Q

why shouldn’t trimethoprim be used in 1st trimester of pregnancy?

A

teratogenic causing cardiovascular defect and oral cleft due to folate antagonist

93
Q

which blood disorders contraindicate use of trimethoprim?

A

anaemia

thrombocytopenia

94
Q

Name an immunological side effect of trimethoprim

A

bone marrow suppression

95
Q

give a severe two severe derm side effects of trimethoprim and especially co-trimoxazole

A

toxic epidermal necrolysis (TEN) and Steven’s Johnson Syndrome

96
Q

why shouldn’t trimethoprim be used with cyclosporin?

A

increase nephrotoxicity

97
Q

why shouldn’t trimethoprim be used with methotrexate (folate antagonist) and phenytoin (^ folate metabolism)?

A

Increases the risk of adverse haematological effects such as bone marrow suppression

98
Q

give an example of an anaerobic antimicrobial

A

metronidazole and tinidazole

99
Q

how does metronidazole work?

A

Passive diffusion into the anaerobic bacteria where it is reduced into free radical.
It damages the DNA synthesis causing DNA degradation and cell death
Bactericidal

100
Q

What is the spectrum of activity for metronidazole?

A

Anaerobic bacteria and protozoa

101
Q

What infections are metronidazole used to treat?

A

1) Abx assoicated collitis caused by C.diff ( anaerobic)
2) Oral infections including dental abscess and aspirated pneumonia caused by -VE anarebes
3) Surgical and gynaecological infections from -ve anaerobes from the colon
4) H.pylori eradication with PPI and clarithromycin
5) protozoa infections

102
Q

what physiological state is metronidazole contraindicated in?

A

pregnancy, breastfeeding

103
Q

What can high doses of prolonged treatment of metronidazole cause?

A

Peripheral and optic neuropathy, sieuzures and encalopathy

104
Q

why shouldn’t metronidazole be taken with alcohol?

A

It inhibits the excretion of alcohol leading to symptoms of flushing, nausea and vomiting and headache

105
Q

why shouldn’t metronidazole be used with phenytoin?

A

Causes phentyoin toxicity and can cause impaired cerebellar function

106
Q

What effect does metronidazole have on P450?

A

It is metabolised by p450 and inhibits the enzyme

107
Q

How does nitrofurantoin work?

A

It is metabolised and reduced by bacteria using nitrofuran reductase.
Forming the active metabolite that damages the bacterial DNA and causes cell death.

108
Q

What two organisms is nitrofurantoin effective against?

A

Gram -ve E.coli and Gram +ve Staphylococcus saprophyticus. Two most common causes of UTI

109
Q

when is nitrofurantoin mainly used?

A

Lower UTI = acute cystitis

110
Q

What side effect does nitrofurantoin have on urine?

A

Cause it to go dark yellow or brown

111
Q

when in the day should nitrofurantoin be taken?

A

With food or milk

112
Q

what organ impairments contraindicate use of nitrofurantoin?

A

renal

hepatic

113
Q

why is nitrofurantoin contraindicated in pregnancy and neonates?

A

increases risk of haemolytic anaemia

114
Q

why is nitrofurantoin contraindicated for use with magnesium-containing antacids?

A

reduce absorption

115
Q

What is the potential side effect of prolonged used for nitrofurantoin?

A

Chronic pulmonary reaction (fibrosis), hepatitis and peripheral neuropathy

116
Q

What are the 4 different types of penicillin?

Give example for each

A

Broad spectrum penicillin = Co amoxiclav and amoxicillin
Benzylpenicillin
Antipseudomonal penicillin’s= Piperacillin with tazobactam
Penicillinase resistant penicillin = Flucloxacillin

117
Q

Impairment of what organ would be contradictory to give penicillin?

A

Renal impairment

118
Q

What is the side effect of high doses of penicillin or when given to patient with renal impairment ?

A
  • Central nervous system toxicity (including convulsions and coma)
119
Q

what is the interaction between penicillin and methotrexate?

A
  • Penicillins reduce renal excretion of methotrexate, increasing the risk of toxicity.
120
Q

Are cephalosporins and carbapenems more or less resistant to beta lactamase produced by bacteria?

A

More resistant to beta lactemase due to fusion of their beta lactam rings

121
Q

What antibiotics are linked to the development of C.difficile?

A

Cephalosporins
Ciprofloxacin (and other quinolones)
Clindamycin
Co-amoxiclav

122
Q

IV carbapenems and cephalosporins are used in what situations?

A

To tackle very severe and complicated infections caused by antibiotic resistant organisms

123
Q

What effect does cephalosporin have on aminoglycoside?

A

Increase the nephrotoxicity effects of aminoglycoside

124
Q

What is the effect of cephalosporin on valproate?

A

It reduces the plasma level and efficancy of valproate

125
Q

What route is vancomycin given for abx associated colitis caused by c.diff?

A

Oral

126
Q

What renal side effect is caused by IV glycopeptide?

A

Nephrotoxicity ( less in teicoplanin)

127
Q

What is the most common side effect of IV glycopeptide?

A

Thrombophlebitis at sight of IV

128
Q

Vancomycin Interaction with what drugs increases the risk of ototoxicity and/or nephrotoxicity?

A

Aminoglycoside
Cyclosporin
Loop diuretics

129
Q

What are the 2 general uses of penicllin?

A

LRTI

Urinary tract infection

130
Q

What is broad spectrum penicillin used for?

A

Empirical treatment for pneumonia either gram +ve (Pneumoccocus pneumonia) or Gram -ve (H.influenzae)
and Urinary tract infection ( caused by E.coli)
Also in combination therapy for H pyolri peptic ulcer disease

131
Q

What is Co-amoxiclav?

A

Amoxicillin and clavulanic acid

132
Q

What is the benefit or Co-amoxiclav over amoxicillin?

A

Great range of activity

133
Q

What combination therapy is Co-amoxiclav used in?

A

Hospital acquired infections and intra abdominal sepsis

134
Q

What does Strep pneumonia and E.coli produce to be resistant to broad spectrum penicillin?

A

Penicillinase

135
Q

What is the range of use of benzylpenicillin?

A

Streptococcal infections= Tonsillitis, pneumonia and endocarditis
Clostridium infections= tetanus
Meningococcal infections = Meningitis and septicaemia

136
Q

Benzylpenicillin is given for skin and soft tissue infection in what situations and in combination with what drug?

A

In severe infections and combination with flucloxacillin

137
Q

What is benzylpenicillin limitation?

A

It is inactivated by B lactamase

138
Q

What is tazocin?

A

Piperacillin with tazobactam

139
Q

What bacteria is tazocin specifically used against?

A

pseudomonal infections

140
Q

Tazocin are preserved for use in what situations?

A

Severe infection with a range of pathogens
Hospital acquired infection such as HAP
Patient is immunocompromised (neutropenic)

141
Q

What are the infections in which tazocin are used for?

A

HAP
Complicated Urinary tract infection
Intraabdominal sepsis
Complicated Skin and soft tissue infection

142
Q

What is Flucloxacillin specifically used for?

A

Penicillin resistant staphylococci infection

143
Q

Why is Flucloxacillin used for staphylococci infections instead of benzylpenicillin?

A

Staphylococci produce penicillinase which is resistant to benzylpenicillin

144
Q

What infections are flucloxacillin commonly used in?

A

Impetigo and cellulitis
Osteomyelitis and septic arthritis
Endocarditis

145
Q

What % of patients have a penicillin allergy?

A

1-10%

146
Q

What is the common presentation of penicillin allergy?

A

Get a skin rash (urticarial) 7-10 days after treatment
1-3 days after treatment if repeated dose s
(Delayed IgE mediated reaction)

147
Q

What happens in anaphylactic reaction to penicillin?

A

Angioedema
Bronchospasm
Hypotension

148
Q

Which antibiotics increase warfarin’s anticoagulation effects?

A

Tetracycline, Cephalosporin, Broad Penicillin and tazocin

149
Q

Example of 5th generation cephalosporin?

A

Ceftaroline fosamil

150
Q

What bacteria does ceftazidime have good activity against?

A

Pseudomonas

151
Q

What infection is telavancin used for?

A

HAP

152
Q

What is the most common used aminoglycoside?

A

Gentamicin

153
Q

What infections are gentamicin solely used for?

A 
Bacterial endocarditis ( with other abx)
Iisteria Meningitis and other CNS infection
Pseudomonas aeruginosa
154
Q

What is streptomycin used for?

A

Treatment of mycobacterium tuberculosis

155
Q

Why are gram +ve and anaerobics resistant to aminoglycoside

A

Do not contain the oxygen transporting system

156
Q

What effect do macrolides have on

a) warfarin
b) statin

A

a) can lead to bleeding

b) can lead to myopathy

157
Q

What effect do erythromycin and clarithromycin have on drugs that are metabolised by cytochrome p450?

A

Increase their plasma concentration as cytochrome p450 metabolism is being blocked

158
Q

What MSK side effect does clarithromycin have?

A

Myalgia and arthralgia

159
Q

What drugs should macrolides and quinolones not be used with in risk of further prolongation of the QT interval?

A

SSRI’s, antipsychotics, amiodaron, quninine and each other

160
Q

Give example of gram -ve bacteria in which quinolones are effective against?

A 
Campylobacter
Pseudomonas
Shigella
Salmonella
NEISSERIA
161
Q

What is oral ciprofloxacin used for?

A

Pseudomonas aeruginosa

162
Q

What is the interaction of quinolones and NSAIDS?

A

Increase risk of seizures

163
Q

What is the interaction of quinolones and prednisolone?

A

Increase risk of tendon rupture

164
Q

What drugs reduce the absorption of quinolones?

A

Drugs that contain divalent cations such as calcium and antacids

165
Q

Why should quinolones be avoided in children and young adolescents?

A

Causes arthropathy

166
Q

Why is quinolones usually second and third line treatment?

A

Due to the rapid development of resistance to them and their association with C.diff infection

167
Q

What is a MSK side effect of quinolones?

A

Inflammation and rupture of muscle tendons

168
Q

What cardiac side effect of quinolones?

A

Increase QT interval

169
Q

What is a severe side effect of trimethoprim?

A

It can cause haematological disorders= should be avoided in the elderly

170
Q

Trimethoprim can cause hyperkalemia. Therefore what drugs should be avoided?

A

Aldosterone antagonist, ACH inhibitor and angiotensin receptor blocker

171
Q

What is the common side effects of trimethoprim?

A

Nausea and vomiting
Sore throat
Rash

172
Q

What are the three abx of choice for UTI?

A

Trimethoprim
Amoxicillin
Nitrofurantoin

173
Q

What abx are involved in the eradication of H.pylori?

A

PPI + clarithromycin + either amoxicillin or metronidazole

174
Q

Who are particularly susceptible to adverse affects of TRIMETHOPRIM?

A

Neonates, elderly and HIV patients

175
Q

What respiratory tract infections are moxifloxacin and levofloxacin used in? When are they used?

A

CAP
Sinusitis
Chronic bronchitis
2nd or 3rd line treatment

176
Q

What 4 abx are contradictive in patients with myasanthia gravis?

A

Tetracylcine
Aminoglycoside
quinolones
marcolides

Y3 DRUGS PROFILES (9 decks)

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