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pharm 140 > abx / anti-infectives > Flashcards

abx / anti-infectives Flashcards

1
Q

bactericidal

A

kill the cell

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2
Q

bacteriostatic

A

prevent reproduction of the cell

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3
Q

narrow spectrum

A

specific metabolic pathway or enzyme

effective against only a few microorganisms

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4
Q

broad spectrum

A

useful in treating a wide variety of infection

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5
Q

drugs that inhibit cell wall synthesis

A

cephalosporins
depatomycin
penicillins
vancomycin

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6
Q

drugs that inhibit protein synthesis

A 
aminoglycosides
chloramphenicol
clindamycin
erythromycin
tetracyclines
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7
Q

drugs that inhibit nucleic acid synthesis

A

fluoroquinolones

rifampin

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8
Q

drugs that disrupt cell membrane permeability

A

polymyxins
polyene antimicrobials
imidazole antifungal agents

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9
Q

drugs that work as an anti-metabolite

A

sulfonamides

trimethoprim

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10
Q

drugs that inhibit viral enzymes

A

acyclovir

saquinavir

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11
Q

inhibition of bacterial cell wall synthesis

A

antimicrobial drugs bind to the cell wall allowing the cell to absorb water
results in cell lysis and cell death
prevents bacteria from building cells during cell division

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12
Q

inhibition of nucleic acid synthesis

A

many bacteria use enzymes for replication that do not exist in human cells
drugs can act as anti-metabolites and inhibit synthesis of these enzymes

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13
Q

disruption of cell wall permeability

A

drugs can disrupt the integrity of the bacterial cell wall and cause the cell to leak components that are vital to its survival

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14
Q

selective toxicity

A

ability of a drug to suppress or kill infecting microbes without injury to the host

drugs accumulate in microbe at a higher level than in human cells or affects cellular structures specific to the microbe

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15
Q

most common location of resistant bacteria

A

hospitals

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16
Q

antimicrobial resistance

A

resistance of microbe to drug

may be caused by production of enzymes that deactivate the drug, changes in receptor structure, development of alternate metabolic pathways, spontaneous mutation, conjugation

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17
Q

factors contributing to microbial resistance

A

minimum inhibitory concentration (MIC) of a drug must be present to stop/slow replication
inadequate tissue concentrations 2/2 incorrect dosage
insufficient duration of therapy (pts stop drug when symptoms improve)
prophylactic use of abx

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18
Q

MRSA

A

resistant to all antistaphylococcic penicillins
some strains resistant to protein-synthesis inhibition drugs
MRSE (r/t MRSA; occurs in HCW nasal passages)

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19
Q

MRSA treatment

A

vancomycin

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20
Q

to decrease penicillin resistance among streptococcus pneumoniae, CDC suggests:

A

clinicians stop using drugs as prophylaxis for otitis media

patients at increased risk of infections be immunized

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21
Q

some strains of vancomycin-resistant enterococcus (VRE) are resistant to

A

penicillin
gentamycin
vancomycin

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22
Q

treatment for VRE

A

combination of abx:

aminoglycoside and cephalosporin or penicillin

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23
Q

MDR-TB

A

caused by inadequate drug therapy

multiple drug therapy is implemented at the onset of treatment to decrease the incidence of MDR-TB

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24
Q

nosocomial infections occur because hospital has:

A

high prevalence of pathogens
high prevalence of compromised hosts
an efficient mechanism of transmission from patient to patient

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25
how many patients per year in the US acquire a nosocomial infection?
2 million
26
best way to prevent nosocomial infection
frequent hand hygiene
27
how to treat severe infection in which pathogen is unknown
combination therapy | broad spectrum drugs
28
duration of antimicrobial treatment
typically 7-10 days may be extended 30+ days for infections such as prostatitis
29
infection in meninges
difficult to achieve MIC because many drugs do not cross the blood-brain barrier
30
abscess
difficult to achieve MIC because abscesses are poorly vascularized and presence of pus may impede drug concentration
31
infections in foreign objects
pacemakers, prosthetic joints difficult to treat
32
empiric theory
prescribing antibiotics before identification of the pathogen when multiple microbes may be the causative agent, empiric therapy is started and a culture is taken to identify pathogen
33
penicillin types
amoxicillin penicillin G, penicillin V ampicillin nafcillin, oxacillin
34
cephalosporin types
generations 1-4 | cefaclor (2nd gen)
35
lipoglycopeptide type
vancomycin
36
B-lactam antibacterials
penicillins (PCN) cephalosporins lipoglycopeptides affect cell wall contain a B-lactam ring that is essential for antibacterial activity
37
penicillin is a ____ spectrum antibiotic
narrow
38
penicillin indications
gram-positive cocci and bacilli some gram-negative bacilli streptococcal pharyngitis, pneumococcal pneumonia, endocarditis, meningitis, otitis media, sinusitis, syphilis, gonorrhea
39
amoxicillin indications
penicillin prototype treatment of infection postexposure prophylaxis for anthrax treatment of helicobacter infections as part of combination therapy
40
amoxicillin action
inhibits synthesis of cell wall in susceptible bacteria, causing cell death
41
amoxicillin pharmacokinetics
PO or oral suspension or IV excreted in urine
42
amoxicillin adverse effects
``` seizures, insomnia, behavioral changes n/v/d psuedomembranous colitis nephropathy agranulocytosis, thrombocytopenia anaphylaxis superinfections ```
43
amoxicillin contraindications
allergy/sensitivity to penicillins or cephalosporins
44
amoxicillin cautions
patients with renal disease | pregnant patients
45
amoxicillin interactions
tetracyclines - amx effects are decreased aminoglycoside action can be deactivated allopurinol - rash
46
amoxicillin interventions
review culture to ensure amoxicillin is indicated report bloody stools, long term diarrhea report candida infections of mouth/vagina
47
amoxicillin pt teaching
take exactly as ordered for as long as ordered report s/s of yeast infection report s/s hypersensitivity and d/c immediately
48
ampicillin
broad spectrum penicillin
49
pipercillin, carbenecillin
extended spectrum penicilin
50
augmentin
amoxicillin + clavulanic acid | combination
51
methicillin, nafcillin
penicillinase-resistant penicillins
52
unasyn
ampicillin-sulbactam
53
zosyn
piperacillin-tazobactam
54
cephalosporins
B-lactam antibiotics that affect bacterial cell wall synthesis/integrity 4-5 generations
55
differences between cephalosporin generations
activity against gram-negative bacteria resistance to B-lactamases ability to distribute into CSF
56
cephalosporin indications
``` UTI gram-negative bacterial meningitis MDR gram-negative infections abdominal/pelvic infections (peritonitis) surgical prophylaxis ```
57
which is more active against gram-positive organisms? A. penicillins B. cephalosporins
A penicillins are more active against gram-positive bacteria cephalosporins are more active against gram-negative bacteria
58
first gen cephalosporins
cefazolin (Ancef) - IM/IV | cephalexin (Keflex) - PO
59
second gen cephalosporins
cefoxitin (Mefoxin) - IM/IV cefaclor (Ceclor) - PO cefuroxime (Zinacef) - PO, IM or IV
60
third gen cephalosporins
only drugs that are able to penetrate blood-brain barrier sufficiently to treat CNS infections ``` ceftriaxone sodium (Rocephin) - IM/IV cefotaxime (Claforan) - IM or IV ```
61
fourth gen cephalosporins
more stable than earlier generations and effective for gram positive AND gram negative bacteria cefepime (Maxipime) - IM, IV push, IV piggyback
62
fifth gen cephalosporins
effective with some methicillin resistant organisms used for community acquired pneumonia infection (CAP) ceftaroline (Teflaro) - IV
63
cefaclor
second gen cephalosporin | cephalosporin prototype
64
cefaclor indications
many kinds of infections | lower resp tract, pneumonia
65
cefaclor pharmacokinetics
given PO | excreted unchanged in urine
66
ceflacor action
inhibits bacterial cell wall synthesis | causes cell death (bactericidal)
67
ceflacor contraindications
allergy/hypersensitivity to PCN or cephalosporins
68
ceflacor cautions
colitis | renal insufficiency
69
ceflacor side effects
``` headache, dizziness oral/vaginal candidiasis pseudomembranous colitis thrombocytopenia, transient leukopenia rash anaphylaxis, serum sickness ```
70
ceflacor interactions
aminoglycosides: nephrotoxicity antacids: may decrease absorption; separate doses by 1 hr anticoagulant effects may be increased ALCOHOL: risk of disulfiram-like reaction; may lead to CV collapse, convulsions, death
71
ceflacor interventions
monitor for s/s of allergy, superinfection, chronic diarrhea, phlebitis at IV site keep oral suspensions in fridge monitor BUN, Cr, PT/INR take with food to decrease GI distress
72
ceflacor pt teaching
take drug as prescribed as long as prescribed shake suspension well do not consume alcohol notify dr if s/s superinfection
73
are first gen cephalosporins effective at treating gram-negative bacteria
NO
74
vancomycin (vancocin)
tricyclic glycopeptide antibiotic (only one) limited use 2/2 side effects only used when other abx have failed effective against gram-positive pathogens
75
vancomycin indications
``` bacterial septicemia endocarditis bone/joint infections MRSA, C. diff pneumonia staph infections ```
76
vancomycin pharmacokinetics
given PO or IV | excreted kidneys/feces
77
vancomycin action
hinders bacterial cell wall synthesis, damaging bacterial plasma membrane and making cell more vulnerable to osmotic pressure also interferes with RNA synthesis
78
vancomycin contraindications
hypersensitivity
79
vancomycin cautions
other neurotoxic, nephrotoxic or ototoxic drugs pts >60 y/o colitis
80
vancomycin adverse effects
renal failure hypotension, tachycardia, flushing; rapid IV infusion may cause cardiac arrest ototoxicity (usually reversible) thrombophlebitis at IV site, tissue damage with IV infiltration n/v hypokalemia headache
81
vancomycin interactions
aminoglycosides, amphotericin B, bacitracin, piperacillin, polymyxin B: increased risk of nephrotoxicity, ototoxicity muscle relaxants: may enhance neuromuscular blockade NSAIDs: may increase serum vanco concentration
82
vancomycin interventions
administer 60-90 min by infusion checking vitals monitor trough levels, BUN, Cr levels monitor for s/s red man syndrome, superinfection, allergy check for blood return in both central and peripheral lines prior to administration
83
vancomycin pt teaching
take drug as prescribed for as long as prescribed report flushing, faintness, vertigo during IV infusion report tinnitus, hearing loss report increase or decrease in urine output report IV site issues immediately
84
oral vancomycin is used to treat
pseudomembranous colitis

pharm 140 (18 decks)

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