A 11-page concise summary of the cardiovascular system intended to facilitate preparation for the GPhC registration exam. These notes can also be used as a quick reference guide or a resource to refresh general clinical pharmacy knowledge, perfect for pre-registration pharmacists, medical students,...
, Drug Summaries – Humza Ibrahim
contents. Active against some gram +ve bust mostly
Chapter 5 gram -ve.
Infection Indications
Endocarditis, septicaemia, meningitis and other CNS
infections, biliary-tract infection, prostitis, and
1 ANTIBACTERIAL DRUGS pneumonia. Amikacin, tobramycin and gentamicin are
active against P. aeruginosa, streptomycin is active
against M. tuberculosis.
1.1 BEFORE STARTING THERAPY
Side-effects
The follow must be considered:
May impair neuromuscular transmission, irreversible
• Viral infections should not be treated with ototoxicity, nephrotoxicity. Nausea, vomiting,
antibacterials antibiotic associated colitis, peripheral neuropathy,
• Samples should be taken for culture and electrolyte disturbances.
sensitivity testing
Contraindications and cautions
• Narrow-spectrum antibacterials are preferred
Caution in patients with clinical muscular weakness
to broad-spectrum antibacterials unless there is
e.g. myasthenia gravis; avoid concomitant use with
a clear clinical indication, hence the need to
ototoxic drugs e.g. cisplatin and furosemide, and
test for the prevalent organism
nephrotoxic drugs e.g. vancomycin and ciclosporin
• The dose varies according to factors including
age, weight, hepatic function, renal function, Other points
and severity of infection Aminoglycosides are not absorbed from the gut and
• Route of administration of an antibacterial therefore are given parenterally for systemic
often depends on the severity of the infection, infections, however neomycin can be given orally for
usually IV for life-threatening bowel sterilisation prior to surgery or in hepatic
• Duration of therapy depends on the nature of failure. Once daily doses preferred over multiple daily
the infection and the response to treatment, doses, need to consult local guidelines.
undue prolonged courses encourage resistance,
may lead to side-effects and are costly 1.2.1 Gentamicin
Gentamicin is the aminoglycoside of choice in the UK.
1.1.1 Pregnancy Therapy may require loading doses, and it has a
Penicillins and cephalosporins are suitable for use narrow therapeutic Range:
during pregnancy. Nitrofurantoin may also be used • multiple daily dose regimens
but it should be avoided at term. Diaminopyrimidines one-hour (peak) serum concentration should be 5
and quinolones should be avoided during pregnancy; to 10mg/L (3 to 5 mg/L for endocarditis);
trimethoprim should also preferably be avoided pre-dose (trough) concentration should be
particularly in the first trimester. < 2mg/L (< 1mg/L for endocarditis);
• once daily doses
1.1.2 Renal impairment
consult local guidelines
Antibacterials normally excreted by the kidney
accumulate with resultant toxicity unless the dose is 1.2.1.1 Monitoring (all aminoglycosides)
reduced; especially aminoglycosides; tetracyclines, Renal function (nephrotoxicity); auditory and
and nitrofurantoin should be avoided altogether. vestibular function (ototoxicity which is irreversible);
serum-aminoglycoside concentration must be
determined in the elderly, all patients receiving
1.2 AMINOGLYCOSIDES parenteral treatment, those with renal impairment, in
Amikacin, Gentamicin, Neomycin, Streptomycin, obesity and cystic fibrosis, and if high doses given.
Tobramycin
Mechanism of action
Bactericidal by irreversibly binding to ribosomes
inhibiting protein synthesis; fissure result which
enhances antibiotic uptake as well as leakage of cell
Chapter 5 – Pg 2
Compiled using the British National Formulary
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