Antibiotic Meds

Question 1

List some signs of infection

Answer 1

Fever, chills, sweats, redness, pain & swelling at the site, fatigue, weight loss, elevated WBC

Question 2

Classify bacteria into 3 categories according to their shape

Answer 2

Coccus, Bacillus, and Spirochete

Question 3

Describe culture reports and sensitivity reports

Answer 3

Culture: gram + or - , shape, and name of bacteria

Sensitivity: R (resistant) or S (sensitive)

Question 4

List the 4 most common mechanisms of action of antibiotics

Answer 4

1. Inhibit bacterial cell wall synthesis
2. Lethal/non-lethal inhibition of bacterial protein
3. inhibition of DNA synthesis
4. anti-metabolites

Question 5

Compare prophylactic therapy with empiric therapy

Answer 5

prophylactic: prevention of infection (before procedure)

empiric: infection present

Question 6

List the 4 major subclasses of beta-lactam antibiotics

Answer 6

1. Penicillin
2. Cephalosporins
3. Carbapenems
4. Monobactams

These subclasses may give cross-allergy!

Question 7

Classify penicillin into 4 groups with examples of each

Answer 7

1. narrow-spectrum + penicillinase sensitive (penicillin G and V)
2. narrow-spectrum + penicillinase resistant (Nafcillin, Oxacillin, etc.)
3. broad-spectrum (ampicillin, amoxicillin)
4. extended -spectrum (piperacillin)

Question 8

Describe the mechanism of action of penicillin

Answer 8

P: penetrate cell wall & bind to protein
C: cell wall becomes weak and leaky
L: lysis

Question 9

Define the role of the beta-lactamases

Answer 9

enzymes produced by bacteria that inactivate penicillin

Question 10

List 3 drugs that inhibit the beta-lactamases

Answer 10

• clavulanic acid
• sulbactam
• tazobactam

Question 11

Name 4 examples of drugs that are combinations of penicillins and beta-lactamase inhibitors

Answer 11

Amoxicillin + CA
Ticarcillin + CA
Ampicillin + sulbactam = Unasyn
Piperacillin + tazobactam

Question 12

Specify the therapeutic indication of penicillin

Answer 12

treat gram-positive bacteria

Question 13

Identify 5 symptoms of allergic reaction with penicillin

Answer 13

hives, rash, itching, angioedema, and sometimes anaphylaxis

Question 14

List 3 alternative antibiotics for patients with penicillin allergy

Answer 14

Vancomycin, erythromycin, and clindamycin

Question 15

Compare 5 generations of cephalosporins

Answer 15

1-2: not effective in CSF
3-5: effective!

1. gram positive only
2. gram negative too!
3. first choice for meningitis
4. hospital-associated pneumonias
5. MRSA

Question 16

List an example of 5 generations of cephalosporins

Answer 16

1. cephalexin
2. cefoxitin
3. cefotaxime
4. cefepime
5. ceftaroline

Question 17

Specify 4 adverse effects of cephalosporin

Answer 17

1. allergic reactions
2. bleeding (cefotetan& ceftriaxon can interfere with VK metabolism)
3. thrombophlebitis
4. hemolytic anemia

Question 18

Describe the interaction of cephalosporin & alcohol

Answer 18

Disulfiram-like effect (severe flushing, tachycardia, hypotension)

Do not mix with alcohol!

Question 19

List 4 example of carbapenems

Answer 19

end in “-penem”
Imipenem, meropenem, ertapenem, doripenem

very broad spectrum!

Question 20

Describe monobactams and identify the adverse effects

Answer 20

narrow-spectrum (only gram negative)
must be given IV –> risk of thrombophlebitis

Question 21

Describe the indications of vancomycin

Answer 21

• used for treating C. diff and MRSA
• alternative for penicillin allergy

Question 22

List 3 adverse effects of vancomycin

Answer 22

allergic reaction, red man syndrome, renal toxicity

Question 23

Identify 5 signs of red man syndrome

Answer 23

flushing, rash, severe itching, tachycardia, hypotension

Question 24

Specify the measure to prevent red man syndrome

Answer 24

infuse slowly, pre-medicate with Tylenol and diphenhydramine

Question 25

Describe tetracyclines and specify 3 uses

Answer 25

Bacteriostatic inhibitor of protein synthesis Used to treat acne, peptic ulcer disease, periodontal disease

Question 26

List some adverse effects of tetracycline

Answer 26

- esophageal erosion - superinfection - calcium deposit on teeth - suppress long bone growth in premature infants - hepato, nephrotoxicity - photosensitivity!!!

Question 27

List 3 examples of macrolides

Answer 27

Azithromycin (Z-pack) Clarithromycin Erythromycin

Question 28

Specify the indications of erythromycin

Answer 28

It mostly hits gram-positive bacteria (whooping cough, chlamydia) Alternative to penicillin

Question 29

2 adverse effects of erythromycin

Answer 29

- GI distress - risk of cardiac QT prolongation

Question 30

Specify the indications of clindamycin

Answer 30

Active against gram + and - - serious anaerobic infections outside CNS - severe group A streptococcus - alternative to penicillin

Question 31

2 adverse effects of clindamycin

Answer 31

- C. diff (4-6 weeks after you stopped) - erosive esophagitis

Question 32

Specify 4 therapeutic indications of linezolid

Answer 32

Keep it for severe infection! - VRE, MRSA - strep community-acquired pneumonia (CAP) - strep aureus infection

Question 33

List 3 adverse effects of linezolid

Answer 33

- GI distress - myelosuppression --> pancytopenia! - rare peripheral neuropathy

Question 34

Describe therapeutic use and adverse effect of Dalfopristin/quinupristin

Answer 34

- used for VRE - hepatotoxicity --> watch for ALT (more specific for liver enzymes!)

Question 35

List 3 examples of aminoglycosides

Answer 35

Gentamicin, Tobramycin, Amikacin

Question 36

Describe aminoglycosides

Answer 36

- bactericidal inhibitor of bacterial protein - must be given IV or IM - serum levels should be monitored (peak & trough)

Question 37

Specify 2 adverse effects of aminoglycosides

Answer 37

Ototoxicity Nephrotoxicity

Question 38

Describe sulfonamides

Answer 38

- bacteriostatic - widespread resistance to sulfonamides - primarily used for UTI

Question 39

Explain the reason sulfonamides are not given to infants less than 2 months age

Answer 39

Due to risk of kernicterus (elevated bilirubin causing brain damage)

Question 40

Explain the importance for patients on sulfonamides to drink enough fluids

Answer 40

Sulfonamides may cause crystalline aggregates in renal system

Question 41

3 adverse reactions of sulfonamides

Answer 41

- hypersensitivity reactions - Stevens-Johnson Syndrome - hematologic effects (anemia, leukopenia, thrombocytopenia)

Question 42

List 2 uses of trimethoprim/sulfamethoxazole

Answer 42

- UTI - Pneumocystis Pneumonia (PCP)

Question 43

Specify 2 adverse effects of trimethoprim

Answer 43

- hyperkalemia - birth defects