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Pharmacology
ANTI INFECTIVE AGENTS Antibiotics and Antimicrobial Agents
| Question | Answer |
|---|---|
| What are the four types of classifications for microbes? | Gram positive/Gram negative Anaerobic/ Aerobic |
| Gram negative microbes | gram negative narrow spectrum drugs; Broad spectrums have a lot of kill; Narrow spectrums are preferred drugs; most antibiotics are resistatnt to them |
| Which type of microbe ( Anaerobic or aerobic) is harder to kill? | Anaerobics are harder to kill |
| How many days of medicine do you get to treat gram negative/anaerobic microbes? | + 10 days |
| What are the selective toxicity options? | 1.Disruptions of bacterial cell wall 2.Inhibition of enzyme unique to bacteria 3.Disruption of bacterial protein synthesis |
| Selective toxicity: MOA of inhibition of cell wall | ( weaken cell) synthesis or activate enzymes that disrupt cell wall: penicillins, cephalosporins |
| What drugs weaken the cell wall | Penicilins and Cephalosporins |
| Selective Toxicity: MOA what increases cell membrane permeability? | Increase cell membrane permeability ( cell develops a leak problem) antifungals |
| Selective Toxicity: What causes lethal inhibition of bacterial protein synthesis: | aminoglycosides |
| What drugs do Nonlethal inhibitions of bacterial protein synthesis | tetracyclines ( bacteriostatic; slows down growth which makes the body get its defenses up) |
| What Inhibit bacterial synthesis of nucelic acids? | 1.: fluoroquinolones 2. rifampin |
| What are Antimetabolites and what is a fact abuout them? | Sulfonamides ( a lot of people are allergic) |
| What are Inhibitors of viral enzymes? | 1. Protease inhibitors 2. nucleosides analogs |
| Do viruses reproduce differently than bacteria? | Yes |
| Antibiotics: Factors affecting outcome of therapy: Resistance | Resistance to antibiotics: Examples. MRSA and E.Coli |
| Antibiotics: Factors affecting outcome of therapy: Swab test to know what is making you sick | Important to know what is making you sick. Do a swab to determine what is making one sick. |
| Antibiotics: Factors affecting outcome of therapy: Location | Know the location of infection. |
| Antibiotics: Factors affecting outcome of therapy: Clinical Status | If immune system is compromised; Examples :kidney damage; hepatic ; genetic traits; pregnancy |
| What are the 4 factors that affect the outcome of antibiotic therapy? | 1. Resistance 2. Identification of microbe 3. Location of infection 4. Clinical status of patient |
| What are common problems with antibiotic therapy? | 1. Direct toxicity 2. Allergic reactions 3. Superinfections and supra infections 4. Viral infections 5. Early discontinuation- 6.Instability of stored antibiotics 7. Potential dangers to children |
| What is the difference between Superinfections and supra infections? | Superinfections- Is what you are treating Supra infrections- new infection appears when you are trying to treat another. |
| What is supra infection? | A new infection that appears during the course of treatment for a primary infection. |
| What do we do before we give antibiotics | Culture and sensitivity (blood, urine, feces, emesis) |
| What is the specific mechanism of action of penicillin's? | They weaken the cell wall causing bacteria to take up excessive water and rupture. Penicillin's are only active in bacteria that are undergoing growth and division. |
| Can you kill viral infections? | No. |
| Beta-Lactam antibiotics are effective for? | Against most commonly encountered pathogens |
| What drugs inhibit bacteria cell wall? | Penicillins, carbapenems, monobactams & cephalosporins |
| Do Penicillins, carbapenems, monobactams & cephalosporins cross the blood brain barrier? | No |
| Do Penicillins, carbapenems, monobactams & cephalosporins cross into the placenta? | Yes |
| Bactericidal drugs are most effective against what? | Actively multiplying bacteria |
| What are Beta-lactamases? | Beta-lactamases are enzymes produced by some bacteria that provide resistance to beta-lactam antibiotics like penicillins, cephamycins, and carbapenems, |
| What do Beta-lactamaes promote? | MRSA- |
| How are Beta-Lactam antibiotics excreted? | Renally |
| Do Penicillin G & Penicillin V cross the blood brain barrier? | No |
| When do Penicillin G and Penicillin V cross the blood brain barrier? | Only when there is inflammation because the pores are open. |
| Penicllin G and Penicillin V are active against what? | gram + & gram - bacteria |
| What is the most common adverse effect for Penicillin G and Penicillin V? | Allergic reactions |
| What is the second most common adverse effect for Penicillin G and Penicillin V? | GI distress |
| what is the key go to drug to treat strep throat? | Penicillin G & Penicillin V |
| Penicllin G and Penicillin V cause sensitivty to what? | Cross sensitivity to cephalosporins |
| Is the drug toxicity high or low for Penicillin G and Penicillin V? | Low |
| What does Probenecid treat? | Treats gout, gouty arthritis, and other problems caused by too much uric acid in your body. Also helps some antibiotics work better. |
| What helps some antibiotics work better? | Probenecid |
| What effect does Probenecid have? | Increase effective duration of action; increases activity and effectiveness of original drug |
| What is Procaine Penicillin G designed for? | For slow absorption from IM sites |
| What is the best route for Procaine Penicillin G administration? | Must be given deep IM |
| What spectrum does Procaine Penicillin G have? | Narrow Spectrum |
| What drug treats STD's? | Procain Penicilling G |
| When do you use Procain Penicillin G? | Used for mild/medium serious infections. Also used prophylactically |
| How are the adverse drug reactions for Procain Penicillin G | Usually transient |
| What are the adverse effects for Procain Penicillin G? | Headache and dizziness |
| What is the route of administration for Penicillin V? | PO |
| Do you administer Penicillin V with or without food? | No food. Should be on an empty stomach. |
| What are the two Aminopenicillins? | Ampicillin and amoxicillin |
| Do Aminopenicillins have a narrow or broad spectrum? | Broader spectrum than natural & penicillinase-resistant |
| Are Aminopenicillins ( ampicillin and amoxicillin effective against staph infection? | No |
| What are Aminopenicillins used to treat? | Used to Rx gonococcal infection, URI,UTI, & otitis media, gram negative |
| What is the pregnancy drug categofry for aminopenicillins? | Pregnancy Drug B |
| If you are administering Aminopenicillins to a pregannat woman what do you do before administering? | Ask patient if she has had any allergic reactions to penicillins in the past? |
| Where do you notice the first allergic reactions on the body? | The skin. Reactions usually show up on the skin first to indicate a reaction. |
| What are Extended- spectrum PCN used for? | treat serious infections caused by gram negative organisms |
| What can happen when extended spectrum PCN are used? | Hypersensitivity |
| How are Carbenicillin & ticarcillin administered | By IV |
| What effects do Carbenicillin & ticarcillin have in the body | Increase potassium |
| What do Carbenicillin and ticarcillin inhibit? | Inhibit platelet aggregation |
| What is likely to happen to a patient who is taking carbenicillin and ticarcillin? | More likely to bleed or bruise |
| What pregnancy category are Carbenicillin & ticarcillin? | Pregnancy B drugs. |
| Do Carbenicillin & ticarcillin cross the placenta? | Yes |
| How are Carbenicillin & ticarcillin excreted? | Breast milk |
| What are the nursing implications for Carbenicillin & ticarcillin? | 1. Take samples for culture before initiation of treatment 2. Identify high-risk clients 3. Take 1 hour ac or 2 hr pc- by mouth empty stomach 4. Monitor kidney function – teach them to have a med alert bracelet 5. Minimize adverse effects |
| What are Carbapenems? | Bactericidal. Broadest antibacterial. |
| What do Carbapenems do? | inhibits cell wall synthesis |
| What are Carbapenems reservered for? | 1. Complicated body cavity 2. Connective tissue infections. |
| What are the small riskf of Carbapenems? | 1. cross allergenicity 2. seizures |
| How do you give Carbapenems? | Run it for an hour. Must be slow |
| What are examples of Carbapenems? | 1. Primaxin 2. imipenem |
| What do monobactams do? | Preserve normal gram positive and anaerobic flora. |
| What do monobactams lack? | It lacks cross-allergenicity with PCN |
| What are monobactams similar to? | aminoglycosides |
| What are examples of monobactems? | 1. aztreonan 2. Azactam |
| What are Cephalosporins? | Are a class of β-lactam antibiotics. It is bactericidal. |
| What are β-Lactam antibiotics (beta-lactam antibiotics) | are a broad class of antibiotics, consisting of als that contains a β-lactam ring in their molecular structures. |
| What are included in the b-Lactam antibiotics? | This includes penicillin derivatives (penams), cephalosporins (cephems), monobactams, and carbapenems.[ |
| How do B-Lactam antibiotics work? | Most β-lactam antibiotics work by inhibiting cell wall biosynthesis in the bacterial organism and are the most widely used group of antibiotics. |
| What are cephalosporins most active against? | Active against most gram positive cocci & many gram negative bacilli. |
| What is the cross sensitivity to PNC? | 10% |
| The higher the generationf or Cephalosporins the... | (1)the better they treat gram negative bacteria & anaerobes, (2) increasing resistance to destruction by beta-lactamases, gram negative actions (3) decrease Rx gram positive bacteria, increase gram negative (4) increasing ability to reach CSF. |
| What are 1st generation of Cephalosporins? | 1st generation: cefazolin/ancef, cephalexin/keflex |
| What are the 1nd generation of Cephalosporins? | 2nd: cefoxitin/mefoxin- for h influenza; causes meningitis;; only in IV form |
| What is the 3rd generation of Cephalosporins? | ceftazidime/fortaz, ceftriaxone/rocephin; starts entering CNS; not that toxic |
| What is the 4th generation of Cephalosporins? | 4th:cefepime/maxipime- MAXI- highly resistant |
| What is the drug interaction of Cephalosporins? | Drug interactions: Probenecid, alcohol, aminoglycosides ; if take alcohol will have anabuse reaction; they will have a violent GI response |
| What are the precautions of Cephalosporins? | Precautions; false reading on blood glucose for diabetics ; esp urine test |
| What is a major care implication for Cephalosporins? | Identify high risk factors |
| Advise patient to take Cephalosporins with? | Food if gastric is upset |
| How should you store cephalosporins? | Must be refrigerated. |
| Regarding giving Cephalosporins what would you want to minimize? | Minimize adverse effects, adverse interactions |
| Who will need a lower dose of Cephalosporins? | Patients with renal problems |
| Macrolides: Bacteriostatic has a ____concentration? | Low concentration |
| Macrolides: Bactericidal has a +______ concentration? | Higher concentration |
| Macrolides are __ bound? | Protein Bound. |
| How are Macrolides eliminated | Hepatic elimination |
| What are examples of Macrolides? | 1. Erythromycin 2. Clarithromycin 3. Dirithromycin 4. Azithromycin |
| Which of the Macrolides antibiotics is the most safe? | Erythromycin one of safest antibiotics |
| What is the alternative drug for those that are allergic PCN's? | Penicillin G |
| When is Erythromycin given? | Before dental procedures |
| Does Erythomycin cross placenta? | Yes, crosses placenta but adverse effects in fetus not observed. |
| What are the side effects of Erythomycin? | GI tract complaints; superinfection of bowel; thrombophlebitis |
| What is thrombophlebitis? | Inflammation of blood vessel that can promote clot formation) if given IV |
| What are the effects of high dosage of Erythomycin? | transiet effects; hearing impairment |
| Are allergic reactions rare re: Erythomycin? | Yes |
| What are examples of erythromycin? | Azithromycin & Clarithromycin |
| Azithromycin drug is called? | Zithromax- zpac |
| Facts about Zithromax-zpac | Excellent tissue penetration Long duration of action=dosing qd Food decreases rate and extent of GI absorption Used in MAC |
| Clarithromycin drug is called? | Biaxin |
| Facts about Biaxin | PO bid Can be given with or without food Used in MAC- bacteiral infections from birds; found in individuals that have HIV Used in combination to treat Heliocobacter pylori- cause for pelvic ulser |
| What do Tetracyclines treat? | rickettsial diseases chlamydial infections peptic ulcer disease, acne |
| Do not give the following along with Tetracyclines | Should not be given with calcium supplements, milk products, iron supplements, Mg laxatives, and most antacid; |
| Does tetracyclines enter the placenta & fetal circulation | Yes |
| What are the adverse effects of Tetracyclines? | GI irritation, discolors permanent teeth, superinfection, hepatoxicity, renal toxicity |
| What are examples of tetracylines? | Doxycycline/Vibramycin: |
| What does Doxycycline/Vibramycin treat? | Travelers Diarrhea |
| What are the major care implications of tetracycline? | Advise client to take on an empty stomach and full glass of water Minimize adverse effects Minimize adverse interactions |
| Aminogylcosides are used against? | Aerobic gram negative bacilli |
| Are aminoglycosides absorbed in the GI tract? | NO |
| Does the aminoglycosides pass the blood brain barrier? | NO |
| How are aminoglycosides excreted? | Quickly excreted |
| Is neomycin an aminoglycoside | Yes |
| Neomycin is a ___ drug | Topical Drug |
| What are the adverse effects of aminoglycoside? | Ototoxicity, nephrotoxicity, neuromuscular blockade, hypersensitivity |
| What are examples of aminoglycosides? | Gentamicin, tobramycin, amikacin, kanaycin, streptomycin |
| Aminoglycosides are administered parenteral | Serious infections cause by gram negative organisms |
| Aminoglycosides administerd orally do | Suppress bowel flora prior to elective colorectal surgery |
| Topical therapy of aminoglycosides are used for | treating local infections of the eyes, ears, and skin |
| What are the major caring implications for aminoglycosides? | Intravenous infusions should be given slowly (30+ min) Monitor aminoglycoside levels Minimize adverse effects Minimize adverse interactions |
| What are Fluoroquinolones? | Are bactericidals |
| Fluoroguinolone are used to treat against? | For growing bacteria |
| Flyoroguinolones work better | Good for gram negative more than positive |
| What can Fluoroquinolones cause? | Can cause tendon rupture; use with care; if you’re a runner sit home for a while |
| Ciprofloxacin is a ____? | Fluoroquinolones |
| Ciprofloxacin is good against | P. aeruginosa, many anarobic, UTI, bone joint, and skin infections, infectious diarrhea, gonococcal infections |
| Crystalluria occurs at__? | high doses in alkaline pH. |
| Cipro increases ____ levels? | theophylline levels |
| RE: ciprofloxacin what do Antacids & sucralfate do? | Lower Absorption |
| When taking ciproflaxin it increases prothrombin time in patients who are taking which drug? | Warfarin |
| When taking NSAIDS and Ciproflaxin there is a higher risk of what? | Increasing the risk of becoming jittery or having seizures |
| What are Sulfonamides? | Are medicines that prevent the growth of bacteria in the body. |
| Are Sulfonamides bacteriostatic or bacteriocidal? | Bacteriostatic |
| Sulfonamides are ____ absorbed and ___? | Well absorbed and distributed |
| Acute UTI caused by E. coli & chronic upper URI are best treated with? | Sulfonamides |
| Where are Sulfonamides metabolized? | Liver |
| Where are Sulfonamides excreted | Kidneys |
| What are adverse effects for Sulfonamides? | Hypersensitivity reactions, blood dyscrasias, kernicterus, crystalluria, photosensitivity |
| Hypersensitivity reactions, blood dyscrasias, kernicterus, crystalluria, photosensitivity are adverse effects for which drugs? | Sulfonamides |
| Sulfadiazine treat _____? | toxoplamosis |
| Toxoplamosis is treated by which drug? | Sulfadiazine |
| Sulfamethoxazole/bactrim treat___? | UTI,P.carinii, resp infections, gonococcal urethritis |
| What are examples of Sulfadiazin? | Sulfisoxazole/gantrisin |
| What are nursing implications for Sulfanamides? | Identify hi-risk pts Take oral sulfonamides on empty stomach & full glass of water Discont drug @ 1st sign of hypersensitivity Avoid prolonged exposure to sunlight Periodic blood cell counts Do not give to pregnant or infants under age 2 mos |
| Re: sulfanamides you must take on a ____ stomach and a _____ glass water? | Empty Stomach and a full glass of water |
| When taking Sulfadiazine you must avoide prolonged exposure to ___? | Sunlight |
| You must perform periodic ___ cell count when taking Sulfonamides | Blood cell count |
| What are two Miscellaneous antibiotics? | Chloamphenicol: and Vancomycin: |
| What is Chloampenicol used for? | used infections that can’t be treated with other antibiotic. |
| What are adverse effects of Chloamphenicol? | Bone marrow suppression; gray-baby syndrome; otic neuritis |
| What Vancomycin used to treat? | destroys most gram +ive MRSA. Useful in pt allergic PCN and cephalosporins. Not absorbed after PO & not useful for systemic infections. |
| What are adverse effects of Vancomycin? | Red man’s syndrome. Ototoxicity & nephrotoxicity; |
| Clindamycin/cleocin is useful to treat | Useful in anaerobic infections; |
| What is the major adverse effect of Clindamycin/cleocin? | pseudomembrane colitis |
| What is Flagyl/metronidazole? | It is misc. antibiotic used against Effective against protozoal infections |
| Flagyl is effective against? | Against anaerobic organism |
| Flagyl has a cute drug interactions with | alcohol, lithium, benzodiazepams ( or benzodiazepines) |
Created by:
jwhite223
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