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LPN Pharm 2012


Anti-infectives began in 1936 with the use of which drug? Sulfonamides
what started being commercially introduced in 1941? Penicillin
Name four sources of infection 1. Bacteria 2. Fungi 3. Viruses 4. Protazoans
How are Bacteria classified? 1. Ability to take a gram stain 2. Shape 3. Aerobic or Anaerobic
What is a simple definition of Bacteria? One celled organisms and are the most common infectious agents.
Fungi are slow growing organisms that can cause systemic infections. In what ways are they more difficult to treat than bacterial infections? 1. Poor blood supply to areas of the body. (outer layers of skin, hair and nails). 2. Hindered by granulomatous tissue response which is when the body encapsulates the fungi infected tissue.
Viruses are among the simplest of living organisms. What are they composed of? Nucleic Acids that consist of either RNA or DNA but never both.
What does bacteriostatic mean? Slows or prevents the growth of bacteria.
What does bacteriocidal mean? Kills or destroys bacteria.
What does Culture and Sensitivity mean? To culture and grow bacteria, identify the infecting organism and determine which antimicrobial drug it is sensitive to.
Sensitivity involves dropping discs impregnated with various antimicrobials on the plate. If the area around a specific antimicrobial has no bacteria growth, what can be determined? The organism has a sensitivity to that antimicrobial.
Name five factors that determine antibiotic selection. 1. Location of infecting organism. 2. Status of host organ function. 3. Age of host. 4. Pregnancy or lactation. 5. Potential for the development of other organisms that are resistant to the antimicrobial agent.
Name three common micro organisms that are resistant to a particular antibiotic. 1. MRSA 2. VRE 3. ORSA
What does MRSA stand for? Methcillin Resistant Staphylococcus Aureus
To date (March 2012), what 2 meds have successfully treated MRSA? Vancomycin and Linezolid (new synthetic antibacterial agent). Very expensive!
What does VRE stand for? Vancomycin Resistant Enterococcus.
What is the common name for the drug Linezolid that has successfully treated MRSA and VRE? Zyvox a new and very expensive synthetic antibacterial agnt.
What does ORSA stand for? Oxacillin Resistant Staphylococcus Aureus.
What are four actions of antimicrobial drugs? 1. Inhibit cell wall synthesis 2. Inhibit protein synthesis 3. Interfere with the permeability of bacterial cell wall membrane. 4. Interfere with cell metabolism...(antimetabolites).
When are narrow spectrum antibiotics most effective? When the infections are caused by a relatively limited # of organisms. Only gram +
When are extended or broad spectrum antibiotics used? When the identity or susceptibility to antimicrobial treatment of the infecting organisms have not been established.
Are Sulfa drugs primarily bacteriostatic or bacteriocidal? Bacteriostatic. They slow down the growth of bacteria so that the body can fight the infection.
In addition to common bacterial infections, what are four other common uses for Sulfa drugs? To treat: 1. UTI's 2. Burns -secondary infections 3. Otis Media (middle ear infection) 4. Bronchitis
What would we use to treat a UTI that was caused by e-coli, staphylococcus aureus? A Sulfa drug: Bactrim a combination antibacterial class drug, also known as co-trimoxazole.
What would we use to treat secondary infections that are a result of a burn injury? A Sulfa drug: Silvadene or silver sulfadiazine a topical burn treatment.
What would we use to treat "otis media" a middle ear infection? A Sulfa drug: Bactrim (again, a combination antibacterial class drug, also known as co-trimoxazole).
What would we use to treat Bronchitis? A Sulfa drug: Septra, a combination drug also known as co-trimoxazole. (same info as Bactrim)
What are five common adverse GI reactions of sulfanomides? 1. Anorexia, 2. N&V, 3. diarrhea and abd. pain, 4. fever and chills, 5. stomatitis (inflammation of the mm's of mouth)
Name three other adverse reactions of sulfonamides. 1. Urinary and skin discolouration (both take on an orange-yellow colour. 2. crystalluria or increased fluid intake. 3. Photosensitivity
What is pancytopenia and what three adverse sulfonamides reactions can also occur with this? Pancytopenia: abnormal deficiency in both RBC's and WBC's and is associated with bone marrow damage normally caused by chemotherapy. 1. thrombocytopenia (low platelets in blood), 2. aplastic anemia (low platelets in blood)3. leukopenia (low WBC count)
What four reactions are indicative to a hypersensitive reaction to sulfanomides? 1. Pruritus (itching) 2. Uticaria (hives) 3. Skin breakouts or eruptions. 4. Severe: Toxic epidermal necrolysis (TEN or Lyell's syndrome)epidermis separates from dermis. Steven's Johnson Syndrome:epidermis separates from dermis,affects MM's-rash on bod
Name one side effect of Sulfasalazine? Discolouration of skin and urine. Can turn yellow orange colour
How should a sulfonamide be administered? On an empty stomach with lots of water, up to 8 glasses of water daily while on this drug.
Are Penicillins bacteriostatic or bacteriocidal? Bacteriocidal
Penicillins are among the most widely used antibiotics today, name two ways in which they work? 1. Inhibit synthesis of the bacterial cell wall. 2. Destruction of the organism.
What does a stable or unstable penicillin mean? Stable means the penicillin is acid stable and can be given orally. Unstable means it is rapidly destroyed by stomach acids and cannot be given orally.
Give an example of a stable penicillin. Amoxicillin. Is semisynthetic and can be given orally.
What are the common routes for administering penicillin? PO, topically, I.M. and IV.
Name two NATURAL penicillins. 1. Penicillin G (HAY Groovy, it's natural!) 2. Penicillin V (My middle name is Virginia)kewl. I'm pretty natural.
Name two SEMIsynthetic penicillins. Natural plus synthetic to make them more useful. 1. Amoxicillin (Add More Oxen In Case It Leaves) 2. Ampicillin (Amp it up) Get it? It's semisynthetic
Name two EXTENDED spectrum penicillins. 1. Ticarcillin (Tipperary is a way far away) 2. Pipercillin (Pipers have to hold their breath for a long time)
Name seven uses for penicillin. 1. Initially for suspected staph infections 2. UTI's 3. Septicemia (bacteria in blood) 4. Meningitis 5. Pneumonia (tonsilitis and other UTI's) 6. Intra abd infections 7. STI's (gon. and syph)
How or why would penicillin be prescribed as a prophylaxis? 1. For potential secondary bacterial infection 2. Potential infection in high risk pts. 3. Continually for chronic ear infections
Name four adverse reactions for penicillin. 1. GI reactions 2. Hematopoietic changes (blood or blood cell changes) 3. Hypersensitivity (anaphylactic shock) 4. Superinfections
What type of bacteria do penicillins kill? Harmful or pathogenic bacteria as well as helpful bacteria or normal flora.
What are superinfections? Or Superbacteria? Diseases or infections caused by organisms that are not sensitive to the penicillin and proliferate because they are not kept in check by normal flora.
Are superinfections bacterial or fungal? They are usually both bacterial and fungal.
Name a bacterial superinfection. Pseudomembranous colitis also known as C.Diff colitis.
What are the s/s of C. Diff colitis or pseudomembranous colitis? Diarhhea, can be bloody. fever, and abd cramping.
Name a fungal superinfection. What is it and what are the s/s? Candidiasis. Oral(thrush) or vaginal and anal. S/S are white lesions in mouth and anal and vaginal itching.
As a nurse, how would you advise your pt to take penicillins? 1. Take with a full glass of water 2. Take as prescribed until completed. 3. Take on empty stomach 1 h ac, 2 h pc (with few exceptions)
What dairy products reduce the risk of a superinfection? Yogurt, buttermilk and acidophilus caps.
what would you advise a woman to do while on penicillin? If on oral contraceptives use alternative method for duration of antibiotic regimen.
Should you refrigerate any oral suspensions? Yes
How are Cephalosporins related to penicillins? Structurally and chemically.
Why do we use cephalosporins? Effective in treatment of all strains of bacteria affected by penicillins and also some strains that are resistant to penicillins.
With respect to cephalosporins generation activity, what is the difference between gen 1 to gen 4? Gen 1 shows increased sensitivity to gram- microorganisms and a decreased sensitivity of gram+ microorganisms.
Would 1st gen gram- cephalosporins be more or less effective against gram+ than 3rd gen? First gen cephalosporins would be less effective against gram+ than 3rd gen cepahlosporins.
Are 4th spectrum cephalosporins longer acting than the rest? Yes plus they are broadest spectrum against gram-
Give two examples of gen 1 cephalosporins. 1. Cefazolin sodium (Ancef) 2. Cephalexin (Keflex) both have gram+ and some gram-
Give two examples of gen 2 cephalosporins. 1. Cefaclor (Ceclor) 2. Cefoxitin (Mefoxin) both have more gram- and less gram+
Give an example of a gen 3 cephalosporin. 1. Ceftriaxone (Rocephin) exhibits more gram- and even less gram+
Give an example of a gen 4 cephalosporin. Maxipime: broadest action for gram- organisms and less for gram+
What is the action of a cephalosporin? Is it bacteriostatic or bactericidal? They are bactericidal. They target the cell wall making it defective and unstable.
Name five diseases we would treat with cephalosporins. 1. Streptococci:anaerobic, gram+ 2. staphylococci:gram+ 3. Gonococci:gram- STI-gonorrhea 4. Shigella:gram-rod shaped bacteria:Digestive tract bacteria infection 5. Clostridia:anaerobic,gram+ 5. Clostridia
Name two infections associated with cold virus' we would use cephalosporins for? 1. Respiratory infections 2. Middle ear infs., inflammations of middle ear.
Name two other infections that cephalosporins are effective against. 1. Bone or joint infections 2. Gentourinary infections (reproductive and urinary systems)
What is another use for cephalosporins? Perioperatively:the time period during a surgical procedures.
Give two adverse reactions to cephalosporins? 1. Common GI: N/V, diarrhea 2. Administration route reactions: I.M. and IV
What are the other 7 common body system reactions? 1. Headache, dizziness and fever 2. Maliase (out of sorts) 3. Heartburn 4. Nephrotoxicity (kidney poisoning) 5. Hypersensitivity 6. Aplastic anemia-insufficient new blood cell production by bone marrow. 7. TEN or Toxic epidermal necrolysis:skin rea
What percentage of the population that are allergic to penicillin is also allergic to cephalosporins? About 10 percent
Who would cephalosporins be contraindicated to? Those folks who are allergic to cephalosporins and penicillins
What 5 conditions would indicate cautious use of cephalosporins? 1. Renal Disease 2. Hepatic Impairment 3. Bleeding disorders 4. Pregnancy 5. Penicillin allergies
What would you advise a pt taking cephalosporins? Take as ordered to maintain therapeutic level and complete the course of therapy.
What would you tell a pt if they experienced GI upset while taking this medication? Take with food or milk.
What might happen if cephalosporins are combined with alcohol? This could result in a disulfiram-like reaction. (flushing, N&V, headache, tachycardia)
Should you keep oral suspensions refrigerated? Yes
What other medication should you refrigerate? Penicillins
What other common drug produces a Disulfiram-like reaction? Antabuse
What are Tetracyclines? A group of broad spectrum bacteriostatic antibiotics
What are tetracyclines composed of? They are made up of natural and semisynthetic compounds.
Name two tetracyclines. 1. Doxycycline (Vibramycin) (Mice are VERY vibrant to me even tho they are drab in colour) 2. Tetracycline (Sumycin) Think of Sue! Maybe her last name should be Mycin?
Why would we prescribe tetracycline meds? When penicillin is contraindicated.
Why are tetracyclines of limited use now? Because of such extensive use in the 1960's and 1970's.
What four diseases would tetracycline be useful for? 1. Rocky Mountain Spotted Fever 2. Typhus 3. Skin infections particularly acne 4. Peptic Ulcer with H Pylori Bacteria
What STI is commonly prescribed tetracycline? Chlamydia trachomatis
What other issues can stem from Chlamydia Trachomatis? Urethral, endocervical or rectal infections
What are seven common adverse reactions to tetracycline? 1. N&V 2. Diarrhea 3. Epigastric Disease 4. Stomatitis 5. Sore throat 6. Skin rash 7. photosensitivity
What is photosensitivity? Exaggerated sunburn reaction when skin is exposed to sunlight or ultraviolet light. Very common.
What other unpleasant and ugly side effect happens when you take tetracycline? Causes permanent yellow-grey-brown discolouration in teeth.
What two groups of people are tetracyclines contraindicated in? Pregnant women and children under 9 years of age.
What would you advise your pt if you were administering tetracyclines? Take on an empty stomach with a full glass of water 1 h ac or 2 h pc. Avoid dairy products, laxatives, antacids, or iron (interferes with absorption)
What are aminoglycosides used on? To treat infections caused by gram- microorganisms.
Are aminoglycosides bactericidal or bacteristatic? bactericidal
Are aminoglycosides broad spectrum or narrow spectrum? They are broad spectrum.
Name two other uses for aminoglycosides? 1. To reduce bacteria in the bowel. (pts having abd. surgery or hepatic coma's) 2. Oral aminoglycosides are also useful in supressing GI bacteria.
Name four aminoglycosides. 1. Gentamicin 2. Neomycin 3. Streptomycin 4. Tobramycin
What are some general body adverse effects to aminoglycosides? 1. N&V 2. Anorexia 3. Rash 4. Uticaria (hives)
Name four serious adverse effects to aminoglycosides. 1. Nephrotoxicity(kidney poisoning) 2. Ototoxicity (ear poisoning! :)) 3. Neurotoxicity (Nervous system poisoning) 4. Mild to severe hypersensitivity
What does peak and trough plasma concentrations mean? Lab test to determine the level of drug in your system. The Trough is done a half hour prior to admin of next dose. This shows the lowest level of the drug in your system. The peak is a half hour after dose (if on IV) and one-two hours after for PO.
What is another name for maintenance of a med within therapuetic levels? Gent levels
What are three SERIOUS adverse reactions to aminocyclosides? 1. Nephrotoxicity: Damage to kidneys 2. Ototoxicity: Damage to hearing organs 3. Neurotoxicity: Damage to Nervous System
what is nephrotoxicity? Damage to the kidneys- 1.Proteinuria:abnormal quantities of protein in kidneys. 2. Hematuria-Blood in urine. 3. Increased BUN and creatinine levels 4. Decreased urine output.
What is Ototoxicity? Damage to the hearing organs. Includes tinnitus, dizziness, roaring in the ears and vertigo.
What is Neurotoxicity? Damage to the nervous system. Includes numbness, skin tingling, circumoral paresthesia (around the mouth numbness)
How does Myasthenia Gravis affect us? It is an autoimmune disease that affects the neuromuscular junction, which is the contact point between the nerves and muscles.
What specifically happens to the acetylcholine receptors in MG? )
Are Macrolides broad spectrum or narrow spectrum? They are broad spectrum.
Are Macrolides bacteriostatic or bacteriocidal? Macrolides are bacteriocidal.
What pathogenics are Macrolides particularly effective against? The respiratory and genital tract kind.
Name two Macrolides. 1. Azithromycin (zithromax)1st and last letter of the alphabet 2. Clarithromycin (Biaxin)(My pal Claire
In what way can you use Macrolides at the dentist? As a prophylaxis in dental procedures or other procedures for patients allergic to penicillin.
What other infections are treated with Macrolides? 1. A wide range of gram-/+ infections. 2. Acne vu3lgaris and other skin infections. 3. Upper respiratory infections caused by Hemophilus influenza.
What are five adverse reactions to Macrolides? 1. N&V 2. Diarrhea 3. abd. pain and cramping 4. Pseudomembranous colitus 5. Visual disturbances
Do you have to administer Macrolides around food or drink? No. Administer without regard to meals and with milk.
What specific Macrolides are the exception to this rule? Azithromycin, Dirithromycin and Erythromycin
Under what three situations should Macrolides be used cautiously? 1. Liver dysfunction 2. Myasthenia Gravis 3. During pregnancy or lactation
How do Macrolides work? They inhibit protein synthesis in susceptible bacteria and cause cell death.
Can you use Macrolides with other antibiotics? Yes
Give an example of another Macrolide. Clindamycin
What are Lincosamides effective against? Many gram+ organisms like streptoccoci and staphylococcus.
When do you use Lincosamides? In serious infections where penicillin or erythromycin is not effective. (risk of toxicity)
What seven adverse reactions can occur with Lincosamides? 1. N&V 2. Abdominal pain and diarrhea 3. Esophagitis 4. skin rash 5. Pseudomembranous colitis 6. Hypersensitivity 7. Blood Dyscrasias (blood disease)
What is the only Lincosamides that you can administer with food? Clindamycin. The rest should be administered on a full stomach. 1 h ac or 2 h after.
If you have MG, are you ok taking Lincosamides? No. Avoid this drug if you have MG.
Lincosamides have a high potential for what? Toxicity
Are Fluoroquinolones broad spectrum or narrow spectrum? Broad spectrum.
Are Fluoroquinolones bacteriocidal or bacteriostatic? Bacteriocidal
Why were they evolved? To combat antibiotic resistant bacteria
How do Fluoroquinolones act? They interfere with cell reproduction, resulting in cellular death.
Name three Fluoroquinolones. 1. Ciprofloxacin (Cipro) 2. Levofloxacin (Levaquin) 3. Moxifloxacin (Avelox)
What four conditions do we use Fluoroquinolones? 1. Lower respiratory infections. 2. Skin, bone and joint infections. 3. UTI's 4. STDs
What are the three common adverse effects from Fluoroquinolones? 1. N&V 2. Abd pain and diarrhea 3. headache and dizziness
What are three SERIOUS side effects that can result from fluoroquinolones? 1. Sensitivity X2-Photo and Hyper 2. Pseudomembranous Colitis 3. Superinfections X2-bacterial or fungal
What group of people is fluoroquinolones contraindicated? Children under 18 years
Name two miscellaneous Anti Infective drugs? 1. Linezold 2. Vancomycin
Is Linezold bacteriostatic or bacteriocidal? Both...haha! Trick question. :)
For what three reasons do we use Linezold? 1. VRE-Vancomycin Resistant Enterococcus 2. Health care and community acquired pneumonias 3. Skin and skin structure infections
What five common side effects can result from Linezold? 1. N&V 2. Diarrhea 3. Headache and dizziness 4. Insomnia 5. Rash
What are four less common side effects from Linezold? 1. Fatigue 2. Depression 3. Nervousness 4. Photosensitivity
What are two serious side effects from Linezold? 1. Pseudomembranous Colitis 2. thrombocytopenia (low platelets in blood)
How does Vancomycin act on bacteria? It inhibits bacterial cell wall synthesis and increases cell wall permeability.
Does Vancomycin act against gram- or gram+? It acts against gram+ bacteria
When do we use Vancomycin? We use it against serious gram+ bacteria where no other anti infective will work. Also pseudomembranous colitis caused by Clostridium difficile or C Diff.
Used Vancomycin a common drug to use? NO. It is not a first line drug.
What are two common adverse reactions to Vancomycin? 1. Nephrotoxicity (kidney disease) 2. Ototoxicity (ear damage)
Name three other adverse reactions to Vancomycin. 1. Nausea, chills and fever 2. Urticaria(hives) and skin rash 3. Fall in bp with parenteral admin.
Why do we use Antivirals? To combat viral infections
How do Antivirals work? They interfere with the virus' ability to reproduce in a cell.
Are antivirals toxic to humans? They can be toxic to the human cell
Name two Antiviral meds. Acyclovir and Retrovir
Name six diseases in which we would use antivirals? 1. Herpes Simplex 2. Herpes Zoster 3. HIV 4. CMV (Cytomegalo Virus) 5. Influenza A 6. RSV (Respiratory Syncytial Virus)
Name four adverse reactions to antivirals. 1. N&V 2. Diarrhea 3. Burning and pruritis(itching)
Are antifungal meds fungicidal or fungistatic? They can be both...haha! Got 'cha again! :)
Why do we use antifungals prophylactically? To prevent fungal infections in immunocompromised pts.
Name three situations we would use antifungals? 1. Superficial or deep fungal infections 2. systemic infections 3. Superficial nailbed infections, oral, anal or vaginal infections.
Name four superficial and deep skin fungi. 1. Tinea pedis (athletes foot) 2. tinea cruris (jock itch) 3. tinea capitis (ringworm of the scalp) CAP 4. tinea corpitis (ringworm)
Give three examples of an antifungal administered PO 1. Diflucan 2. Lamisil 3. Mycostatin
Name three topical antifungals. 1. Mycostatin 2. Monistat 3. Tinactin
What is the proper name for a yeast infection? Cutaneous Candidiasis
What do we call nail fungus? Onychomycosis
What is another name for thrush? C. albicans
What are the three main adverse reactions to topical skin and vaginal administration to Antifungals? 1. Burning and irritation 2. Redness and stinging 3. Abdominal pain-vaginal reaction
What are five common systemic reactions to antifungals? 1. N&V 2. Abdominal pain and diarrhea 3. Anorexia and malaise and rash 4, Joint and muscle pain 5. Headache
What is a common amebicide? Metronidazole or (Flagyl)
What is Metronidazole used for? To kill amebas: Intestinal amebiasis and infections caused by susceptible microorganisms
what are three common GI adverse effects of Metronidazole? 1. N&V 2. Abdom.cramps and diarrhea 3. anorexia
What are eight other adverse effects of Metronidazole? 1. Skin eruptions 2. Fever, chills 3. headache and vertigo 4. Hypotension and vertigo 5. ECG changes 6. peripheral neuropathy (numbness in extremities) 7. nephrotoxicity (kidney disease) 8. Ototoxicity (ear disease)
When is metronidazole contraindicated? In the first trimester of pregnancy.
Created by: Sully45