Antibiotic part 2

Question 1

Multi-drug resistant organisms

Answer 1

Resistant to one or more classes of antimicrobial

Question 2

Examples of multidrug resistant organisms

Answer 2

MRSA (Methicillin-resistant Staphylococcus aureus)
VRE (Vancomycin-resistant Enterococcus)
(ESBLs) Organisms producing extended-spectrum B-lactamses
Organsisms producing Klebsiella pneumoniae carbapenemase (KPC)

Question 3

Aminoglycosides

Answer 3

A potent antibiotic with serious toxicities that kill mostly gram negative bacteria and some gram positive (Bactericidal)

Question 4

Examples of Aminoglycosides

Answer 4

Gentamicin sulphate
Tobramycin sulphate
Neomycin sulphate

Question 5

Indications of aminoglycosides

Answer 5

used to kill gram negative bacteria and some gram positive infections. also used with other antibiotics for synergist effects

Question 6

Route of most amnioglycosides

Answer 6

Most often given parenterally

Question 7

Neomycin sulphate route

Answer 7

Topical antibacterial

Question 8

Gentamicin route

Answer 8

Injections, topical, ophthalmic drops and ointments

Question 9

Aminoglycosides adverse effects

Answer 9

Main

Nephrotoxicity (kidney damage)
Ototoxicity (auditory impairment and vestibular impairment)
Less common

Headache
Paresthesia
Fever
Vertigo
Skin rash
Overgrowth of nonsusceptible organisms
Neuromuscular paralysis (very rare and reversible)

Question 10

Why are serum levels measured and what level should they be at

Answer 10

to prevent toxicity and should be higher than the minimum concentration to kill the bacteria

Question 11

Time dependent killing

Answer 11

The time it takes for a pathogen to be killed

Question 12

Concentration dependent killing

Answer 12

The concentration it takes to kill a pathogen

Question 13

What should be monitored when monitoring aminoglycosides

Answer 13

Serum levels, time dependent killing, concentration dependent killing, the peak (the highest level for the day), trough (the lowest to ensure adequate renal clearance of the drug to avoid toxicity), resistance, interactions and any postantibiotic effect

Question 14

Interactionsof aminoglycoside

Answer 14

Concurrent use of nephrotoxic drugs that may increase nephrotoxicity (vancomycin, cylcosporine, amphotericin B), loop diuretics that may increase risk for ototoxicity, Warfarin as it may increase the effect (toxicity)

Question 15

Should have_____ when taking aminoglycosides

Answer 15

• Up to 3000ml/day
• Consumption of probiotic type foods
• Monitor peak and trough levels

Question 16

Peak for gentamicin and tobramycin

Answer 16

5-10 mcg/ml

Question 17

Trough for gentamicin and tobramycin

Answer 17

Less than 2 mcg/mL

Question 18

What is Quinolones(fluoroquinolones)

Answer 18

An antibiotic that has good oral absorption and effective against gram negative and some gram positive organisms

Question 19

Examples of quinolones

Answer 19

Ciprofloxacin, levofloxacin

Question 20

Quinolones MOA

Answer 20

Alters the DNA of the bacteria (bactericidal), does not affect human DNA. Bacteria resistant to the e.coli family

Question 21

Quinolones indications

Answer 21

Gram negative and some gram positive bacteria, Complicated UTI, respiratory, bone/joint, GI and skin infections

Question 22

Ciprofloxacin and levofloxacin routes

Answer 22

oral and injections

Question 23

Norfloxacin hydrochloride route and use

Answer 23

Limited oral absorption but available only in oral form so it is limited to Gu infections

Question 24

Quinolones: interaction

Answer 24

oral- antacids, Ca, Mg Fe, zinc
- take other meds 1 hr before or after
- dairy, enteral feeding, probenecid, nitrofurantoin, warfarin

Question 25

Ciprofloxacin, levofloxacin not recommended with ___ and under because

Answer 25

18 and under as it will affect the MSK development

Question 26

Quinolones: interactions

Answer 26

Absorption reduced when taken with antacids, calcium, magnesium, iron, zinc preparations,sucralfate, enteral tube feedings, oral anticoagulants, nitrofurantoin

Question 27

Quinolones: Adverse Effects CNS

Answer 27

Headache, dizziness, insomnia, depression, restlessness, convulsion

Question 28

Quinolones: Adverse Effects GI

Answer 28

nausea, vomiting, diarrhea, constipation, oral candidiasis, dysphagia, increase liver function

Question 29

Quinolones: Adverse Effects ingumentary

Answer 29

Rash, pruritus, flushing

Question 30

Quinolones: Adverse Effects other

Answer 30

Raptured tendon, tendonitis, fever, chills, blurred vision, tinnitus

Question 31

Clindamycin Interaction, indication

Answer 31

Used for chronic bone, GU, intra-abdominal infections. Interaction wit vecuronium bromide

Question 32

Metronidazole Indication

Answer 32

For anaerobic organism, intra-abdominal and gynecological infections, protozoal infection

Question 33

Vancomycin Hydrochloride indication

Answer 33

Treatment of choice for MRSA and other gram positive, antibiotic induced colitis (c difficile and S. enterocolitis)

Question 34

Vancomycin Hydrochloride adverse effects

Answer 34

May cause ototoxicity and nephrotoxicity and red man syndrome may occur( flushing/itching of head, neck, face, upper trunk)

Question 35

What to monitor when on Vancomycin Hydrochloride

Answer 35

Blood levels to ensure therapeutic levels and to prevent toxicity

Question 36

Vancomycin Hydrochloride interaction

Answer 36

increases neuromuscular blockers effects when taken with Vancomycin Hydrochloride

Question 37

Vancomycin Hydrochloride route

Answer 37

Should be taken IV and over 60min but rapid infusions may cause hypotension

Question 38

When to obtain cultures

Answer 38

Should obtain cultures before the beginning of antibiotic therapy

Question 39

What to assess when looking for a superinfection

Answer 39

Fever, perineal itching, coughing, lethargy, unusual discharge