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Chap - 17
PharmacologyHSC1149
| Question | Answer |
|---|---|
| prevent infection, diagnose and treat infection effectively, use antimicrobials wisely, prevent transmission | four strategies to prevent antimicrobial resistance |
| preventing antimicrobial resistance in healthcare settings, four strategies that clinicians can use to prevent antimicrobial resistance, tools for preventing antimicrobial resistance, action steps to prevent antimicrobial resistance, & implementation | CDC's Campaign to Prevent Antimicrobial Resistance |
| vaccinate, catheters out, target pathogen, access experts, practice antimicrobal control, use local data, treat infection not contamination/colonization, say “no” to vanco, stop antimicrobial treatment, isolate pathogen, break chain contagion | 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults |
| Give influenza/pneumococcal vaccine to at-risk patients before discharge Get influenza vaccine annually | Step 1. Vaccinate |
| Use catheters only when essential; Use the correct catheter; Use proper insertion and catheter-care protocols; Remove catheters when they are no longer essential | Step 2. Get the Catheters out |
| Culture the patient; Target empiric therapy to likely pathogens and local antibiogram; Target definitive therapy to known pathogens and antimicrobial susceptibility test results | Step 3. Target the pathogen |
| Consult infectious diseases experts for patients with serious infections | Step 4. Access the experts |
| Engage in local antimicrobial control efforts | Step 5. Practice antimicrobial control |
| Know your antibiogram; Know your patient population | Step 6. Use local data |
| Use proper antisepsis for blood and other cultures; Culture the blood, not the skin or catheter hub; Use proper methods to obtain and process all cultures | Step 7. Treat infection, not contamination |
| Treat pneumonia, not the tracheal aspirate; Treat bacteremia, not the catheter tip or hub; Treat urinary tract infection, not the indwelling catheter | Step 8. Treat infection, not colonization |
| Treat infection, not contaminants or colonization; Fever in a patient with an intravenous catheter is not a routine indication for vancomycin | Step 9. Know when to say “no” to vanco |
| When infection is cured; When cultures are negative and infection is unlikely; When infection is not diagnosed | Step 10. Stop antimicrobial treatment |
| Use standard infection control precautions; Contain infectious body fluids (Follow airborne, droplet, and contact precautions); When in doubt, consult infection control experts | Step 11. Isolate the pathogen |
| Stay home when you are sick; Keep your hands clean; Set an example | Step 12. Break the chain of contagion |
| Hospitalized adults, Dialysis patients, Surgical patients, Hospitalized children, & Long-term care patients | 5 specific specific patient populations CDC campaign |
| serious bacterial illness, leading cause of bacterial meningitis in children 2-18, also causes blood infections, 1,000-2,600 get each yr-10-15% die & 11-19% lose arms/legs, deaf, problems with nervous systems, mental retardation/suffer seizures/strokes | meningococcal disease |
| meningococcal disease is most common in infants __ __ one year & people w/medical conditions such as lack of __ | less than; spleen |
| meningococcal infections can be treated with drugs such as | penicillin |
| licensed in 2005; preferred vaccine for people 2-55 years of age; expected to give better, longer-lasting protection; better at preventing the disease from spreading from person to person | meningococcal conjugate vaccine (MCV4) |
| available since the 1970s; only vaccine licensed for people older than 55 | meningococcal polysaccharide vaccine (MPSV4) |
| recommended for children & adolescents 11-18 years of age; given during the routine preadolescent immunization visit (at 11-12 years) | dose of MCV4 |
| College freshmen living in dorms, microbiologists who are routinely exposed, U.S. military, traveling to, or living in, a part of the world where disease is common, damaged/removed spleen, immune system disorder, exposed to meningitis during an outbreak | recommended to get meningococcal vaccine |
| people 2 years of age and older should get __ __ of MCV4 | one dose |
| may be recommended for children 3 months to 2 years of age under special circumstances; should get 2 doses, 3 months apart | MPSV4 |
| those with allergic reaction to a previous dose, allergy to any vaccine component, moderately or severely ill, Guillain-Barré Syndrome, & pregnant women only if clearly needed | should not get meningococcal vaccine |
| redness or pain where the shot was given usually last for 1 or 2 days; small percentage of people who receive the vaccine develop a fever | mild side effects |
| Serious allergic reactions, within a few minutes to a few hours of the shot, Guillain- Barré Syndrome (or GBS) | severe side effects |
| federal program to help pay for the care of anyone who has had a rare serious reaction to a vaccine | National Vaccine Injury Compensation Program |
| treatment of infection depends on the medications mode of action, __ vs. __ | bacteriostatic; bacteriocidal |
| 1st step of treatment is ordering | C&S |
| test to identify causative infectious organism & specific medicine to which it is sensitive; results available 24-48hres | culture & sensitivity (C&S) test |
| symptoms on which C&S test is based | wound, throat, urine, or blood |
| antibiotic effective against a large variety of organisms | broad spectrum |
| when drugs are used too frequently & those drugs are no longer effective | resistance |
| antibiotics should not be used for common colds because they are caused by | viruses |
| organisms can also become resistant if infections have been treated | incompletely |
| more than 70% of bacteria that cause __ infections are resistant to at least one of drugs most commonly used to treat those infections according to the CDC | nosocomial |
| antimicrobial resistance is rising in __ and across all spectrum of antibiotics | prevalence |
| organism resistant to most antibiotics is | methicillin-resistant Staphylococcus aureus (MRSA) |
| one of the very few drugs effective against MRSA | Vancomycin IV |
| Vancomycin IV can cause serious side effects, including | ototoxicity & nephrotoxicity |
| some strains of __ have become resistance to most of the antibiotics, incl. vancomycin | enterococci |
| infections such as bacteremia, endocarditis, or urinary tract infections (UTIs) are caused by | vancomycin-resistant enterococci |
| effective strategies to combat __ __ incl. better patient/physician education on appropriate antibiotic use, accurate diagnosis, & targeted treatment of bacterial infections | antimicrobial resistance |
| lower doses or alternative anti-infective drugs may be indicated w/this impairment | status of hepatic &/or renal function |
| anti-infectives may be more toxic in | children or elderly |
| tetracycline & streptomycin are 2 anti-infective agent capable of | crossing placenta |
| sometimes a combination of anti-infective agents is used to decrease the chance of developing resistance | to a single drug |
| sulfamethoxazole & trimethoprim are combined to treat | UTIs |
| treatment consists of combination of 3/more anti-infective agents | tuberculosis |
| an alternative anti-infective agent should always be used in cases of | allergies |
| allergic hypersensitivity, direct toxicity, & indirect toxicity/superinfection are the 3 categories of __ __ to anti-infective agents | adverse reactions |
| overresponse of body to a specific substance | hypersensitivity |
| rash, uticaria, or mild fever; usually able to treat w/ corticosteroids/antihistamines | mild hypersensitivity reaction to anti-infective agents |
| in the case of a mild hypersensitivity reaction to anti-infective agents the agent is | discontinued |
| may be manifested as anaphylaxis, sudden onset of dyspnea, chest constriction, shock & collapse | severe hypersensitivity reaction to anti-infective agents |
| severe hypersensitivity reaction to anti-infective agents must be treated promptly w/__, __, & __ or death may result | epinephrine, corticosteroids, & CPR |
| severe hypersensitivity reactions to anti-infective agents may occur with __ administration of a specific medication | first |
| severe hypersensitivity reaction to anti-infective agents may occur following a(n) | mild hypersensitivity reaction |
| often severe and sometimes fatal systemic reaction upon 2nd exposure to specific antigen after prior sensitization; characterized by resp. symptoms, fainting, itching, & hives | anaphylactic shock |
| hypersensitivity to foreign proteins/drugs, resulting from prior sensitization to causative agent | anaphylaxis |
| results in tissue damage, ototoxicity, nephrotoxicity, hepatotoxicity, blood dyscrasias, phlebitis, or phototoxicity | direct toxicity |
| direct toxicity damage can be | permanent |
| direct toxicity can be reversible if medication | is discontinued |
| health care worker's responsibilities involve assessment of physical condition & lab reports, and discontinuance of medication at | first sign of toxicity |
| manifests as a new infection with different resistant bacteria or fungi as result of killing normal flora in intestines or mucous membranes, especially w/broad-spectrum antibiotics | indirect toxicity, or superinfection |
| symptoms can incl. diarrhea, vaginitis, stomatitis, or glossitis | super infection |
| consists of antifungal medications & incl. buttermilk or yogurt in diet, or administering Lactinex to help restore normal intestinal flora | treatment of super infection |
| probiotics (available OTC in capsule form) are used __ to prevent super infections, especially severe colitis | prophylactically |
| incl. aminoglycosides, cephalosporins, macrolides, penicillins, quinolones, & tetracyclines | therapuetic categories of antibiotics |
| used to treat many infections caused by gram-positive/negative bacteria | aminoglycosides |
| aminoglycosides are used in short-term treatment of many serious infections, only when less toxic anti-infectives are __ or __ | ineffective; contraindicated |
| enterococci are generally __ to aminoglycosides | resistant |
| due to poor absorption from the GI tract aminoglycosides are usually administered | parenterally |
| often drawn to determine optimal dosing & lessen risk of side effects w/aminoglycosides | serum levels |
| serum levels measure the amount of drug in the blood at different times, allowing for adjustment of __ doses &/or __ between doses | subsequent; frequency |
| drawn 1h after start of aminoglycoside infusion, or IM injection of 3rd dose of aminoglycoside | peak serum level |
| drawn 30min. before next schedule dose of aminoglycosides | trough serum level |
| occur especially in older adults, dehydrated patients, or those w/renal or hearing impairment | serious side effects from aminoglycosides |
| incl. nephrotoxicity, ototoxicity, neuromuscular blocking, & CNS symptoms | aminoglycosides serious side effects |
| incl. pathological kidney condition that can be revered upon DC of medication | nephrotoxicity from aminoglycosides |
| causes both auditory & vestibular and it/they may be permanent | ototoxicity from aminoglycosides |
| incl. respiratory paralysis | neuromuscular blocking from aminoglycosides |
| incl. headache, tremor, lethargy, numbness, seizures, blurred vision, rash & uticaria | CNS symptoms from aminoglycosides |
| applies to patients w/tinnitus, vertigo, & high-frequency hearing loss; reduced renal function; dehydration; pregnancy/nursing; infants & older adults | contraindications for aminoglycosides |
| aminoglycosides may have an interaction w/amphotericin B, cephalosporins, polymixin B, bacitracin, & vancomycin because | they are also ototoxic drugs |
| general anesthetics or neuromuscular blocking agents, such as succinylcholine/curare, can interact w/aminoglycosides because they can | cause respiratory paralysis |
| aminoglycosides can cause interactions w/antiemetics because they may | mask symptoms of vestibular ototoxicity |
| semisynthetic antibiotic derivatives produced by a fungus; broad-spectrum, active against infections of resp. tract, UT, bones/joints, septicemias, some STDs, & endocarditis | cephalosporins |
| cephalosporins are related to | the penicillins |
| cephalosporins vary widely in their activity against __ bacteria | specific |
| cephalosporins are classified as 1st, 2nd, 3rd, & 4th-generation according to the organisms __ to their activity | susceptible |
| 1st-generation cephalosporin, usually effective against gram-positive organisms (i.e. causing some pneumonias or UTIs) | cephalexin |
| 2nd-generation cephalosporin, usually effective against many gram-positive/negative organisms (i.e. many strains causing bacterial influenza)c | cefaclor |
| 3rd-generation cephalosporin; usually effective against more gram-negative bacteria than others & sometimes used for STDs (i.e. chancroid or gonorrhea) | ceftriaxone |
| 4th-generation, parenteral cephalosporin; excellent activity against gram-positive/negative bacteria | cefepime (Maxipime) |
| is essential to determine which cephalosporin is appropriate | C&S test |
| cephalosporins are used prophylactically, especially in __ __, for many types of surgery | high-risk patients |
| can incl. hypersensitivity, renal toxicity, mild hepatic dysfunction, nausea, vomiting, diarrhea, resp. distress & seizures | side effects of cephalosporins |
| blood dyscrasias is a side effect of cephalosporins, which will increase bleeding time or | transient leukopenia |
| renal toxicity is a side effect from cephalosporins, especially in | older patients |
| a side effect from cephalosporins can incl. __ w/IV administration & pain at site of IM injections | phlebitis |
| cephalosporins are __ for patients w/renal impairment, known allergies (esp. penicillin w/3-6% cross-sensitivity) pregnant/nursing, & children | contraindicated |
| prolonged use of cephalosporins is contraindicated because it can possibly lead to | super infections or severe colitis |
| interactions of cephalosporins w/Probenecid can increase | effectiveness |
| interactions of cephalosporins w/alcohol ingestion can lead to | disulfiram-like reactions |
| flushing, tachycardia, & shock are __reactions | disulfiram |
| aminoglycosides or loop diuretics taken w/cephalosporins can __ __ of nephrotoxicity | increase risk |
| patients taking cephalosporins should be instructed to pay attention to signs of abnormal bleeding, such as | checking stools & urine for blood |
| used to treat many infections of resp. tract & skin conditions or some STDs when patient is allergic to penicillin | macrolides |
| considered among least toxic antibiotics& preferred for treating susceptible organisms under which more toxic antibiotics may be dangerous | erythromycins |
| gram-negative bacilli and some strains of streptococcus A are __ to macrolides | resistant |
| in combination w/amoxicillin & lansoprazole (Prevpac Kit) is being used to treat Helicobacter pylori in patients w/duodenal ulcer | clarithromycin |
| any of numerous inflammatory diseases of the mouth having various causes (as mechanical trauma, allergy, vitamin deficiency, or infection) | stomatitis |
| inflammation of the tongue | glossitis |
| anorexia, nausea, vomiting, diarrhea, & cramps are | GI side effects from macrolides |
| when erythromycin is mixed w/calcium channel blockers (Verapamil/diltiazem) or antifungal Fluconazole (Diflucan) it can cause | abnormal, potentially fatal cardiac arrhythmias |
| penicillin is the drug of choice for | syphilis |
| penicillin is used prophylactically to prevent recurrences of | rheumatic fever or endocarditis |
| hypersensitivity reactions to penicillin range from | rash to fatal anaphylaxis |
| treatment of hypersensitivity reactions to penicillin incl. the drugs | epinephrine & corticosteroids |
| penicillin V or ampicillin may inhibit the action of | estrogen containing oral contraceptives |
| there are potentially serious side effects from quinolones for | children & elderly |
| quinolones should be reserved for infections that are non-responsive to other antibiotics because of | potentially serious side effects |
| for quinolones, C&S tests should be done | before initiating a quinolone |
| phototoxicity (w/severe sunburn), possible cartilage/tendon damage, & nausea. vomiting, diarrhea, abdominal pain, & colitis are side effects of | quinolones |
| taking antacids while on quinolones causes | decreased absorption |
| taking theophylline while on quinolones can potentiate serious or fatal | CNS effects, cardiac arrest, or respiratory failure |
| tetracycline should be used only when other antibiotics are ineffective or contraindicated because some organisms are | showing increasing resistance |
| tetracycline can cause some super infections, such as | vaginitis & stomatitis |
| photosensitivity, w/severe sunburn & discoloration of teeth in fetus/young children are side effects of | tetracycline |
| antacids, calcium & iron preparations, & dairy product act as __ when taken w/tetracycline, which decreases absorption | antagonist |
| oral contraceptive taken w/tetracycline act as antagonists & may cause | breakthrough bleeding or pregnancy may occur |
| preferable on empty stomach w/full glass of water; 1h before or 2h after meals unless there is gastric distress; do not take at bedtime to prevent irritation from esophageal reflux | tetracycline administration |
| drug of choice for severe fungal infections resulting from immunosuppressive therapy, patient w/AIDS, or for a severe illness such as meningitis | Amphotericin B |
| Amphotericin B is administered | IV w/hospitalization |
| antipyretics, antihistamines, & antiemetics are used to provide symptomatic relief from the __ __ of Amphotericin B | side effects |
| headache, chills, fever, hypotension, & tachypnea are all side effects of Amphotericin B related to | vital signs |
| malaise, muscle & joint pain, & weakness are __ side effects of Amphotericin B | musculoskeletal |
| anorexia, nausea, vomiting, & cramps are __ side effects of Amphotericin B | GI |
| fluconazole is administered | orally |
| limited to severe candidal infections unresponsive to conventional antifungal therapy | fluconazole |
| nystatin can be administered | orally or topically |
| two medications most commonly use for initial or recurrent UTIs | Furadantin & Macrodantin |
| 1st new antibiotic approved to treat MRSA and VRE is | linezolid (Zyvox) |
| erythromycin is the __ __ __ macrolide | most commonly used |
| Kaposi's sarcoma is an example of a(n) | opportunistic infection |
| oseltamivir (Tamiflu) & zanamivir (Relenza) are prescribed to treat | uncomplicated, acute illness due to influenza Type types A & B infections |
| treatment of superinfections involves administration of __ medications | antifungal |
| oseltamivir (Tamiflu) is administered by the __ route | oral |
| antiviral drug effective in treating diabetic foot infections | acyclovir |
| used to treat serious resp. tract infections, Pneumocystis carinii, pneumonia, serious female pelvic infections, osteomyelitis, & septicemia | Clindamycin |
| Staphylococcus aureus is a gram-__ bacteria | positive |
| to treat asymptomatic TB __ is administered daily for 6-12 months | isoniazid |
Created by:
lfrancois
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