Infection

Name the different classes of antibiotics using the following mnemonic:
Antibiotics
Can
Terminate
Protein
Synthesis
For
Microbial
Cells
Like
Germs

A - Aminoglycosides
C - Cephalosporins
T - Tetracyclines
P - Penicillins
S - Sulfonamides
F - Fluoroquinolones
M - Macrolides
C - Carbapenems
L - Lincosamides
G - Glycopeptides

1 of 96

Name 2 examples of aminoglycosides

Streptamycin
Gentamicin

2 of 96

Name 2 side effects of this class of drugs

Ototoxicity
Nephrotoxicity

3 of 96

Aminoglycosides bind to the 40s subunit of bacterial ribosomes to inhibit protein synthesis. T/F?

False - they bind to 30s subunit

4 of 96

How do they target bacteria and not have an effect on human cells?

Humans have 40s and 60s subunits whereas bacterial cells have 30s and 50s subunits so these are targeted specifically

5 of 96

Which 4 antibacterials inhibit protein synthesis

(MALT - in protein shakes)
M - Macrolides
A - Aminoglycosides
L - Lincosamides
T - Tetracyclines

6 of 96

What is mechanism of action of sulfonamides?

sul(FO)namides
- Inhibit folate synthesis

7 of 96

What is the mechanism of action of fluoroquinolones?

fluoro(QUIN)olones = QUINtuplets
- Inhibit DNA replication

8 of 96

Which 4 drug classes inhibit cell wall synthesis?

Cephalosporins
Carbapenems
Penicillins
Glycoproteins

9 of 96

All classes have gram positive and gram negative coverage except 4 classes - Name these 4 classes and their main coverage.

Hint - GLAM
G - Glycoproteins - Gram positive
L - Lincosamides - Gram positive
A - Ami(NO)glycosides - Gram negative
M - Macrolides - Gram positive

10 of 96

What other class inhibits protein synthesis at the 30s subunit?

Tetracyclines

11 of 96

Which 2 classes inhibit protein synthesis at 50s subunit?

Macrolides
Lincosamides

12 of 96

Why does vancomycin only work on gram positive bacteria?

It is too big to get into the pores of gram negative bacteria

13 of 96

Glycopeptides can also commonly cause nephrotoxicity and ototoxicity.
T/F?

False - Rare in glycopeptides and more common in aminoglycosides

14 of 96

Which syndrome can occur if vancomycin is infused too quickly?

Red man syndrome

15 of 96

Red man syndrome can occur due to flushing from _________ release when vancomycin is infused too quickly.

histamine

16 of 96

Tetracyclines are contraindicated in which group of patients:
A. Patients >80 years of age
B. Patients under 8 years of age
C. Pregnant women
D. Diabetic patients

B and C
B - can cause staining of teeth in kids
C - Can impair fetal bone growth

17 of 96

What class of antibiotics can have a side effect of increased tendon rupture (esp. Achilles tendon)?

Fluoroquinolones - ciprofloxacin, ofloxacin etc.

18 of 96

Which class of antibiotics can increase risk of QT prolongation?

Macrolides

19 of 96

Which macrolide in particular can give rise to cholestatic jaundice?

Erythromycin

20 of 96

Which class of antibiotics does trimethoprim fall into?

Sulfonamides

21 of 96

What are the 4Cs antibiotics that can give rise to Clostridium Difficile infection?

Co-amoxiclav
Clindamycin
Cephalosporins
Fluoroquinolones (ciprofloxacin)

22 of 96

Why does this happen?

These antibiotics kill bad bacteria but also the good germs that protect the body from harmful infections like c.diff

23 of 96

What is the most common sign of C.diff?

Diarrhoea

24 of 96

Penicillins are bacteriostatic.
T/F?

False - they are bactericidal

25 of 96

What can bacteria express that stops penicillins from killing the bacteria?

Beta-lactamases

26 of 96

What other class of antibiotics should a patient not receive if they develop serious immediate hypersensitivity to penicillins?

Cephalosporins

27 of 96

What are signs of a true penicillin allergy?

(WASHD)
Wheezing
Anaphylaxis
Swelling in mouth/throat
Hives
Difficulty breathing/swallowing

28 of 96

Why must benzylpenicillin (Pen G) be given by injection?

Inactivation by gastric acid so cant be given orally

29 of 96

Phenoxymethylpenicillin (Pen V) is commonly used for which type of infection?

Oral infections

30 of 96

Pen V is used for treatment of streptococcal infections following rheumatic fever and pneumococcal infections following splectenomy or in sickle-cell disease.
T/F?

False - prophylaxis not treatment

31 of 96

Which penicillin is not inactivated by beta-lactamases?

Flucloxacillin

32 of 96

Which penicillin is reserved for the treatment of infections of beta-lactamase producing strains of gram negative bacteria?

Temocillin

33 of 96

Ampicillin and its derivative amoxicillin are both broad-spectrum antibiotics.
T/F?

True

34 of 96

What is the purpose of clavulanic acid in the combination co-amoxiclav?

Inhibits beta-lactamase

35 of 96

What other penicillin does clavulanic acid combine with?

Ticarcillin

36 of 96

What does Tazocin consist of?

Piperacillin and Tazobactam

37 of 96

Piperacillin/Tazobactam and Ticarcillin/Clavulanic acid both have narrow/broad spectrum activity against a range of gram positive and negative bacteria.

Broad

38 of 96

Both are also active against MRSA.
T/F?

False - They are both not active against MRSA

39 of 96

Tazocin is active against Pseudomonas Auroginosa. What would be used in addition to Tazocin for severe Pseudomonas infections due to their synergistic effects?

Aminoglycoside e.g. gentamicin

40 of 96

What class of antibiotic is pivmecillinam?

Penicillin

41 of 96

Pivmecillinam is a pro-drug. What is the name of the active metabolite?

Mecillinam

42 of 96

It has significant activity against gram positive bacteria such as klebseilla, salmonella, E.Coli and enterobacter.
T/F?

False - Gram negative (all of listed bacteria are gram negative)

43 of 96

Tetracyclines can cause photosensitivity.
T/F?

True

44 of 96

Which STI can be treated using doxycycline?

Chlamydia

45 of 96

Doxycycline is commonly used to treat __________ infections.

Respiratory

46 of 96

Tetracyclines are bacteriostatic.
T/F?

True

47 of 96

What should be taken 2 hours apart from doxycycline and why?

Iron, magnesium and calcium supplements due to reduced absorption of doxycycline

48 of 96

Which class of antibiotic is known to reduce seizure threshold and so is cautioned in patients with a history of seizures?

Fluoroquinolones

49 of 96

Ciprofloxacin would provide inadequate pathogen cover if used alone empirically for mild community acquired pneumonia.
T/F?

True

50 of 96

What is the only indication for use of vancomycin capsules?

C. Diff Infection

51 of 96

Why is this?

Because vancomycin is not absorbed very well systemically so when taken orally, it will reach the intestines and kill the bacteria locally.

52 of 96

If a patient has diarrhoea associated with C.Diff, they should be prescribed loperamide to alleviate the symptoms.
T/F?

False - This will slow GI tract and retain infection for longer so should not be recommended

53 of 96

C.diff is anaerobic and can form spores.
T/F?

True

54 of 96

How long can use of antibiotics disrupt the normal human microbial flora for?

over 6 months

55 of 96

Smoking is a risk factor community acquired pneumonia.
T/F?

True

56 of 96

What is the most common pathogen to cause community acquired pneumonia?

Streptococcus Pneumonia

57 of 96

What is the most common organism to cause UTIs?

E.Coli

58 of 96

Doxycycline can cause oesophageal irritation and so should be swallowed whole while upright or standing.
T/F?

True

59 of 96

Which drug used to treat UTIs can cause brown discolouration of urine?

Nitrofurantoin

60 of 96

Ciprofloxacin may impair the performance of skilled tasks.
T/F?

True

61 of 96

There is a risk of hepatotoxicity with amoxicillin with a 6x greater risk than using co-amoxiclav.
T/F?

False - risk 6x greater with co-amoxiclav

62 of 96

Doxycycline and trimethoprim can also rarely cause hepatotoxicity.
T/F?

True

63 of 96

What specific liver disorder can occur using co-amoxiclav?

Cholestatic jaundice

64 of 96

A 23 year old woman returns from a beach holiday in Greece with a widespread, painful rash. Which of the following is most likely to have been a significant factor?
A. Co-amoxiclav
B. Amoxicillin
C. Trimethoprim
D. Doxycycline

D - Doxycycline

65 of 96

What OTC preparation should be avoided while taking nitrofurantoin?

Potassium citrate sachets

66 of 96

Nitrofurantoin should be stopped if ____ function deteriorates.

Lung

67 of 96

Rifampicin can _________ warfarin concentrations and ________ warfarin.

Decrease
Increase

68 of 96

Metronidazole increases lithium concentrations.
T/F?

True

69 of 96

Metronidazole and lithium should not be taken together!
T/F?

False - Can be taken together but need to monitor

70 of 96

What colour can rifampicin turn tears/contact lenses?

Red/orange

71 of 96

Why are metronidazole tabs taken after food?

Can cause GI upset

72 of 96

When should flucloxacillin should be taken?

1 hr before or 2 hours after food

73 of 96

Why?

Allows better absorption of drug

74 of 96

Which childhood disease should be avoided by pregnant women due to the risk of congenital abnormalities?

German measles (Rubella)

75 of 96

Which childhood disease produces characteristic white spots surrounded by a red ring (Koplik spots) on the inner cheek and gums ?

Measles

76 of 96

Which conditions
should the whole household be treated?
Threadworm
Ringworm
Chickenpox
Cold sores

Threadworm

77 of 96

Match the infection to most likely causative organism.
Osteomyelitis
Pyelonephritis
Meningitis in an immunocompromised patient

Staphylococcus Aureus - Osteomeylitis
Listeria Monocytogenes - Meningitis in an immunocompromised patient
Proteus Mirabilis - Pyelonephritis

78 of 96

What is a common side effect of the TB drug ethambutol?

Vision impairment

79 of 96

What are the 2 phases of TB treatment called?

Initial phase and continuation phase

80 of 96

The initial phase of treatment consists of 4 drugs. Name these.

(RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

81 of 96

Some patients require pyridoxine for isoniazide-induced _________.

Neuropathy

82 of 96

In practice, pyridoxine is given to all patients on TB therapy with isoniazid.
T/F?

True

83 of 96

Which 2 of these drugs are used in continuation phase of treatment?

Rifampicin and isoniazid

84 of 96

How long are these treatments given for?

Initial phase - 2 months
Continuation phase - 4 months

85 of 96

What if the patient had active TB of the CNS

Initial phase - 2 months
Continuation phase - 10 months

86 of 96

Which of the following poses the least risk during the first trimester of pregnancy?
Doxycycline
Ciprofloxacin
Trimethoprim
Clindamycin

Clindamycin

87 of 96

Which of the following offers cover against Pseudomonas aeruginosa?
Doxycycline
Ciprofloxacin
Trimethoprim
Clindamycin

Ciprofloxacin

88 of 96

Which of the following is bacteriostatic?
Amoxicillin
Ciprofloxacin
Clarithromycin
Metronidazole

Clarithromycin

89 of 96

Which of the following would be most likely to have activity against MRSA?
Phenoxymethylpenicillin
Doxycycline
Flucloxacillin
Metronidazole

Doxycycline

90 of 96

Children with which condition can clear aminoglycosides at a faster rate than children their same age without the condition?

Cystic fibrosis

91 of 96

What is common causative organism of cystic fibrosis?

Pseudomonas Aeruginosa

92 of 96

Tendonitis is a side effect that can be associated with which antibiotic class?

Fluoroquinolones e.g. ciprofloxacin

93 of 96

Clarithromycin and fluoroquinolones can have an adverse effect on the heart. What is this?

Prolonged QT interval

94 of 96

What can prolonged QT interval increase risk of?

Torsades de pointes

95 of 96

Gentamicin should be avoided in decompensated _____ disease and ___________ _____ (MG).

Liver
Myasthenia Gravis

96 of 96

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Infection

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