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PathoPharm I NUR 326 > ABX And Antivirals > Flashcards

ABX And Antivirals Flashcards

1
Q

Classes of ABX that attack cell wall

A

Penicillin
Chephalosporins
Carbapenems
Vancomycin

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2
Q

Penicillins

A

Natural Penicillin - PCN G, PCN V
Penicillinase-Resistant Penicillin - nafcillin
Aminopenicillin - amoxicillin, ampicillin
Extended-Spectrum Penicillin - piperacillin, ticarillin

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3
Q

Chephalosporins

A

1st gen - cefazolin, cephalexin
2nd gen - cefuroxime, cefotetan
3rd gen - ceftriaxone, ceftazidime, cefotaxine
4th gen - cefepime
5th gen - ceftaroline

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4
Q

Carbapenems

A

Imipenem/cilastin
Meropenem

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5
Q

Penicillin in general

A

MOA - Inhibit Cell Wall Synthesis (ICWS)
Suffix - cillin
Indications - Gram +, UTI, Perionitis, Gonorrhea, PNA, respiratory infections, Septicemia, Meningitis
SE - Urticaria, pruritis, angioedema, GI distress, oral & vaginal candidiasis, generalized rash, anaphylaxis

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6
Q

Natural PCN
PCN G
PCN V

A

MOA - Cell Wall - can be used w aminoglycosides - gets into the cell & disrupts protein synthesis
Indications - Gram +, Gram -, cocci, anaerobic bacteria, spirochetes, IM for STDs
SE - rash to anaphylaxis, an allergy to one PCN is an allergy to all PCN
Route - IV/IM (P.O. forms are available)
NC - least toxic, 1/2 life of 30 min unless kidney dysfunction, interacts w/NSAIDS, oral contraceptives, and warfarin.

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7
Q

nafcillin

A

MO - Cell Wall
MOA - resists breakdown by the penicillinase enzyme
Indications - good for treating staph infections
Route - IV only
NC - oral forms are called cloxacillin & oxacillin

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8
Q

ampicillin

A

MO - Cell Wall
Type - Aminopenicillin
1st broad spectrum ABX
Use is decreasing because of resistance
Indications - works on Gram -
SE - diarrhea and rash
Route - P.O. or IV
NC - renal sensitive

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9
Q

amoxicillin

A

MO - Cell Wall
Type - Aminopenicillin
Indications- ear, nose, throat, GU and skin infections, very commonly given to pediatric pts Works better on Gram -
SE - less than ampicillin
Route - only given PO
NC - higher doses may be necessary r/t strep resistant organisms

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10
Q

piperacillin

A

MO - Cell Wall
Type - extended-spectrum PCN
MOA - wider spectrum than other PCNs, always given w/ a beta lactamase inhibitor
Indication - very good for pseudomonas
SE - interferes w platelet function
NC - watch for pts w/ renal dysfunction

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11
Q

Cephalosporins in general

A

MO - Cell Wall
Indications - same as PCN such as UTIs, STIs, PNAs
SE - RASH, mild diarrhea, abdominal cramps, pruritis, redness, edema
NC - pregnancy category B (safe), poor oral absorption, if pt has anaphylaxis to PCN then don’t use Cephs

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12
Q

cefazolin

A

MO - Cell Wall
Type - 1st generation Cephalosporin
Indications - Staph and non-enterococcus strep infections
NC - Works well for Gram +
No CNS coverage

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13
Q

Cefazolin

A

MO - Cell Wall
Type - 1st generation Cephalosporin
Indication - Common surgical prophylaxis
Route - IV only

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14
Q

Cephalexin (Keflex)

A

MO - Cell Wall
Type - 1st Generation Cephalosporin
Indication - Skin infections and UTIs, staph & non-enterococcus strep infections
Route - PO or IV
NC - Works well for Gram +, No CNS coverage

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15
Q

Cefuroxime

A

MO - Cell Wall
Type - 2nd Generation cephalosporin
Indication - intestinal infections, No CNS Coverage, More Gram - coverage and retains the Gram + coverage
Route - IV and PO forms
NC - Does NOT kill anaerobic bacteria

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16
Q

Cefotetan

A

MO - Cell Wall
Type - 2nd Generation Cephalosporin
Indication - No CNS Coverage, More Gram - coverage and retains the Gram + coverage
Route - IV and PO forms

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17
Q

Ceftriaxone

A

MO - Cell Wall
Type - 3rd Generation Cephalosporin
Indication - Most potent against Gram - but much LESS effective against Gram +, Able to cross the BBB, effective in treating meningitis and other CNS infections
Route - IV/IM only
NC - extremely long acting (once per day dosing) DO NOT GIVE to Pts with liver failure

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18
Q

Ceftazidime

A

MO - Cell Wall
Type - 3rd Generation Cephalosporin
Indication - Most potent against Gram - but much less against Gram +. Works well for pseudomonas.

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19
Q

Cefotaxine

A

MO - Cell Wall
Type - 3rd Generation Cephalosporin
Indication - Most potent against Gram - but much less against Gram +
Route - IV/IM only

20
Q

Cefepime

A

MO - Cell Wall
Type - 4th Generation Cephalosporin
Indication - uncomplicated and complicated UTIs, skin infections, and PNAs, it is very broad spectrum, Works against Gram - & +. It is very broad spectrum. Crosses the BBB - works in the CNS. Works against pseudomonas.

21
Q

Ceftaroline

A

MO - Cell Wall
Type - 5th Generation Cephalosporin
Indication - treats MRSA & MSSA, works against some VRSA/VISA. No coverage against Enterobacter, Pseudomonas, ESBL, or Klebsiella.
Route - Only in IV form
NC - Very hard on the kidneys and you must monitor BUN, Creatinine, etc.

Note - ceftolozane/tazobactam is the newest, it treats complicated infections

22
Q

Imipenem/cilastin (Primaxin)

A

MO - Cell Wall
Type - Carbapenem
MOA - binds to PCN-binding proteins -> inhibiting cell wall synthesis. Combo of a carbapenem with inhibitor of enzyme that breaks down Imipenem.
Indication - Broadest spectrum of all antibiotics, very resistant to beta-lactamase. Used for complicated infections. Penetrates the BBB and meninges.
SE - Seizure
Route - IV infused over 60 minutes
NC - Watch for seizures -> especially in elderly and w/other meds that can induce seizures. This is a last resort medication.

23
Q

Meropenem

A

MO - Cell Wall - bactericidal
Type - Carbapenem
Indication - little less coverage than Imipenem but still Gram - and +, aerobes and anaerobes. Broadest spectrum of all antibiotics.
SE - less seizure activity, Rash and diarrhea

24
Q

Vancomycin

A

MO - Cell Wall
Type - Glycopeptide antibiotic
Indication - Gram + infections including MRSA and PCN resistant pneumococcus
SE - Toxic SE
- Ototoxicity - hearing loss, usually temporary.
- Immune-mediated thrombocytopenia
- Nephrotoxic - very hard on kidneys, watch when using w/other drugs that are hard on kidneys such as IV contrast.
- Watch w/neuromuscular blockades (paralyzers).
Non Toxic
- REDMAN Syndrome - usually related to rapid infusion. Flushing, rash, pruritus, urticaria, tachycardia, hypotension. Infuse slowly over longer time period. Usually not harmful. Can pretreat with Benadryl.
Routes -
Oral - given to treat CDiff and pseudomembraneous colitis.
IV - all others
NC - Doesn’t cross BBB so no CNS coverage. Very hard on the kidneys so monitor BUN, Creatinine, etc. this is especially important in those receiving by IV.
Monitor therapeutic levels by drawing peak and trough blood levels.
Peak - 30 min after dosing
Trough - 30 min before next dose

25
Classes of ABX that attack bacterial internally (DNA/RNA)
Aminoflycosides Lincosamides: clindamycin Macrolides Tetracyclines Fluoroquinolones Sulfonamides Metronidazole
26
Aminoglycosides
Gentamycin Amikacin Tobramycin
27
Lincosamides
Clindamycin
28
Macrolides
Erythromycin Azithromycin
29
Tetracyclines
Tetracycline Doxycycline Minocycline
30
Fluoroquinolones
Ciprofloxacin Levofloxacin
31
Sulfonamides
Sulfamethoxale + trimethoprim (Bactrum) Metronidazole (Flagyl)
32
Gentamycin, amikacin, tobramycin
MOA - DNA/RNA - Usually given with betalactam or vancomycin to create a synergistic effect. The beta or vanc is given first to break down the bacteria’s defenses so the aminoglycoside can gain entry into the cell and destroy it. Type - aminoglycoside Indication - Complicated infections - UTIs, pyelonephritis, gyno infections, endocarditis, PNA, osteomyelitis (DM related infections) SE - Nephrotoxicity in 5-25%, usually reversible. Ototoxicity in 3-14%, usually permanent. CNS - confusion, depression, disorientation, numbness, and tingling. Cochlear damage - Ototoxicity, high frequency hearing loss, high pitched tinnitus NC - if given w/a neuromuscular blockade (paralytic) - be careful, can cause PROFOUND respiratory distress (myasthenia gravis)
33
Clindamycin
MOA - DNA/RNA - binds to ribosomes and inhibits protein synthesis Type - Lincosamide Indications - chronic bone infections, GU tract infections, Intra-abdominal infections, anaerobic PNA, septicemia, serious skin infections, prophylaxis for endocarditis. Route - PO & IV SE - Very toxic - monitor peak/trough, can cause pseudomembranous colitis by causing extreme diarrhea, leading to CDiff, leading to the pseudo colitis which can lead to death. Notify HCP and pharmacy if signs of this are developing. NOTE - all enteriobactic bacteria (VRE/CRE) are resistant to clindamycin. NC - Monitor use with neuromuscular blockade meds because of respiratory distress
34
Erythromycin
MOA - DNA/RNA - inhibit protein synthesis by binding to ribosomes Bacteria static in general but can be bactericidal in high enough concentrations. Works on bacteria that invade host cells Type - Macrolide Indication - infections of upper & lower respiratory tract, skin infections, soft tissue infections, STI (gonorrhea especially), legionnaires, listeria, mycoplasma PNA. It is also used to help DM pts w/slow gastric motility and emptying. It speeds it up. SE - YUCK Drugs!!!! Extreme GI side effects, upset stomach, lack of appetite and diarrhea. Route - PO & IV note that the IV route is painful and oral absorption is not great. Comes in topical and ophthalmic versions. NC - Do not take on an empty stomach. Lots of drug/drug interactions.
35
Azithromycin (Z-pack)
MOA - DNA/RNA - bacteriostatic in general but bactericidal in high enough concentrations. Works on bacteria that invade host cells Type - macrolide Indications - infections of upper and lower respiratory tract, skin infections, soft tissue infections, STI (gonorrhea especially), legionnaires, listeria, mycoplasma PNA SE - some GI upset NC - very good tissue penetration with long duration of action. Do NOT take with food.
36
Tetracycline
MOA - DNA/RNA Type - Tetracycline Indications - Broad spectrum but major resistance is developing. Treats Rickettsia (Rocky Mtn Spotted Fever), Chlamydia, trichomonas, Lyme, cholera, pelvic inflammatory disease (PID), Mycoplasma PNA, and acne SE - Enamel hypo plasma - thins enamel on teeth. DO NOT Give to children under 8 or a fetus. Photosensitivity - must wear sunscreen or get sunburnt Diarrhea, yeast infection, and thrombocytopenia Rare - anaphylaxis and angioedema NC - DO NOT GIVE TO PREGNANT WOMEN OR TO THOSE BREASTFEEDING, or to kids under 8. Give on an empty stomach as it is a slow absorber. Concentrates in bones, teeth, liver, spleen and in tumors. Route - PO only
37
Doxycycline
MOA - DNA/RNA Type - Tetracycline Indications - Broad spectrum but major resistance is developing. Treats Rickettsia (Rocky Mtn Spotted Fever), Chlamydia, trichomonas, Lyme, cholera, pelvic inflammatory disease (PID), Mycoplasma PNA, and acne, other skin infections, and prophylaxis for STIs. SE - Enamel hypo plasma - thins enamel on teeth. DO NOT Give to children under 8 or a fetus. Photosensitivity - must wear sunscreen or get sunburnt Diarrhea, yeast infection, and thrombocytopenia NC - DO NOT GIVE TO pregnant women or those breastfeeding or children under 8 Find out why a pt is taking, there are so many treatment reasons.
38
Minocycline
MOA - DNA/RNA Type - Tetracycline Indications - Broad spectrum but major resistance is developing. Treats Rickettsia (Rocky Mtn Spotted Fever), Chlamydia, trichomonas, Lyme, cholera, pelvic inflammatory disease (PID), Mycoplasma PNA, acne, neisseria meningitis, decreases symptoms of rheumatoid arthritis, Solodyn is an extended release form for acne and rosacea. SE - Enamel hypo plasma - thins enamel on teeth. DO NOT Give to children under 8 or a fetus. Photosensitivity - must wear sunscreen or get sunburnt Diarrhea, yeast infection, and thrombocytopenia NC - DO NOT GIVE TO pregnant women or those breastfeeding or children under 8 Find out why a pt is taking, there are so many treatment reasons.
39
Ciprofloxacin
MOA - DNA/RNA - destroys by altering bacterial (not human) DNA - works well on rapid and slow growing organisms, mostly Gram - and some Gram +. Minimal BBB penetration. Type - Fluoroquinolones Indications - very broad spectrum - UTIs, STIs, upper & lower respiratory infections, gonorrhea, and others such as anthrax SE - Prolonged post ABX effect concentrated in neutrophils (good) but sometimes concentrated in joints (arthropathy) which is bad. It is irreversible. Route - PO, IV and Topical NC - very good oral absorption. avoid giving to pts under 18 and over 60. Stop giving if pt complains of bone/joint pain. Not a primary drug, it is used if a primary drug fails.
40
Levofloxacin
MOA - DNA/RNA - destroys by altering bacterial (not human) DNA - mostly Gram - and some Gram +. Type - Fluoroquinolones Indications - very broad spectrum - UTIs, STIs, upper & lower respiratory infections, gonorrhea, and others such as anthrax, sinus infections or bronchitis and community acquired PNA. SE - CNS disorders - lead to seizures, kidney failure, can cause prolongation of QT interval, and photosensitivity. Route - PO or IV NC - very good oral absorption. Monitor kidney function (BUN, creatinine, etc) Once daily dosing.
41
Sulfamethoxale + trimethoprim (Bactrum)
MOA - DNA/RNA - doesn’t destroy it just slows down growth by preventing synthesis of folic acid Type - sulfonamides Indications - Uncomplicated UTIs, respiratory infections, salmonella, shigellosis, may be given to HIV pts. SE - Sulfa allergies - start with fever and progress to skin rashes, Photosensitivity.
42
Metronidazole
MOA - DNA/RNA - inhibits DNA synthesis like Fluoroquinolones Type - Sulfonamides SE - N/V, xerostomia (dry mouth), vaginal candidiasis (yeast infection). NC - lots of drug/drug interaction DO NOT TAKE W/ALCOHOL. No alcohol for 24 hours prior and 36 hours post med admin. If alcohol used it creates an alcohol metabolite that is toxic.
43
Acyclovir
Type - NON HIV Antiviral MOA - interferes with viral nucleic acid synthesis, reg of DNA/RNA. Prevents virus from binding to cells so it can’t enter the cell. Stimulates the body’s immune system to kill the virus. Indications - Used to suppress replication of: HSV 1 - oral HSV 2 - genital VZV - herpes zoster, varicella and chicken pox SE - GI Distress, renal impairment, seizures, ITP (idiopathic thrombocytopenia), IV form may have tissue necrosis if IV no patent, may need a central line. ROUTE/SE - IV, Oral, tablet, liquid, topical cream, and ointment. Educate - it is not a cure, it reduces symptom severity, duration and frequency of outbreaks. May require multiple treatments.
44
Oseltamivir (Tamiflu)
Type - NON HIV Antiviral MOA - inhibits neuraminidase in influenza viruses. Indications - Used for prophylaxis & to treat active disease (within 48 hours of symptom onset). Most often given to elderly and immunocompromised after known exposure to influenza A and B. Also a treatment for H1N1 (Swine Flu). SE - Nausea, Vomiting, Seizures, and renal impairment. Route - PO Only
45
Ganciclovir (Zirgan)
Type - NON HIV Antiviral MOA - Inhibits viral DNA polymerases resulting in chain termination. Indications - Cytomegalovirus (CMV) - immunocompromised pts, (AIDS, immunosuppressed, transplants). - controls but doesn’t cure - CMV usually in respiratory system - If CMV retinitis, the med is injected directly into the eye. SE - Hematologic toxicity (low platelet count, pancytopenia), fertility impairment (male and females), fetal toxicity (brain defects) and carcinogenesis. Route - IV and PO, Usually start IV and switch to PO after a few weeks. NC - DO NOT CRUSH OR BREAK PILLS! WASH HANDS IMMEDIATELY if exposed. It can be very irritating. Do not give Imipenem-cilastin combo as it will raise risk of seizures Monitor kidney function if given with other nephrotoxic drugs

PathoPharm I NUR 326 (1 decks)

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