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Pulmonology > Antibiotic Pharmacotherapy > Flashcards

Antibiotic Pharmacotherapy Flashcards

1
Q

Bactericidal

A

Antibacterial drug that kills microorganisms

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2
Q

Bacterostatic

A

Antibacterial drug that inhibits microorganism growth

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3
Q

Superinfection

A

A new or secondary infection that occurs during antimicrobial therapy of a primary infection
- d/t too large of a dose or inhibition of normal flora within the body

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4
Q

Antibiotic Combination Therapy

A

2+ drugs

  • Synergistic effect
  • Prevent emergence of drug resistant organisms
  • Tx immunosuppressed pts
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5
Q

Empiric Therapy

A

Tx of an infection prior to identification of organisms via culture

  • Broad spectrum antibiotic
  • If necessary, change agent after culture & sensitivity results are obtained
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6
Q

Antibiotic MOA’s

A

Act on any structures unique to bacteria

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7
Q

MOA: Penicillin, Cephalosporin, Vancomycin

A

inhibition of bacterial cell wall synthesis/activation of enzymes that disrupt bacterial cell walls

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8
Q

MOA: Aminoglycocides, Clindamycin, Erythromycin, Tetracyclines

A

Inhibition of protein synthesis by bacterial or production of abnormal bacterial proteins
- Bind irreversibly w/ bacterial ribosomes -> cannot synthesize proteins

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9
Q

MOA: Anti-fungals

A

Disruption of microbial cell membranes

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10
Q

MOA: Fluoroquinolones & Anti-virals (e.g. Rifampin)

A

Inhibition of organism production by interfering with nucleic acid synthesis

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11
Q

MOA: Sulfonamides & Trimethoprim

A

Inhibition of cell metabolism & growth

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12
Q

Indications for Prophylactic Therapy

A
  • Group A strep infections
  • Bacterial endocarditis in pt’s with CVD having dental, surgical, or other invasive procedures
  • TB-INH
  • Peri-operative infections in high-risk pt’s
  • STD’s (gonorrhea, syphilis, chlamydia) after exposure has occurred
  • Recurrent UTI in premenopausal or sexually active women
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13
Q

Antimicrobial Dosing & Administration

A
  • Individualized to each pt*
  • Avg. duration of therapy for acute infections = 7-10 days (48-72 hrs. if febrile and asymptomatic)
  • Schedule dose at even intervals
  • Take most on empty stomach (1 hr. before or 2 hrs. after meal) w/ glass of water
  • Give IM doses into large muscle mass (rotate sites)
  • Give IV doses over 30-60 minutes & flush IV tubing after
  • Always observe for drug interactions
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14
Q

Antimicrobial Pt Education

A
  • Take all prescribed doses; do not stop when symptoms subside
  • Do not take meds left over form previous illness or prescribed to someone else
  • Report all other drugs being taken
  • Some antibiotics decrease effectiveness of estrogens & OCPs (–> Ampicillin, Nitrofurantoin, Penicillin V, Sulfonamides, Tetracyclines)
  • Report all drug allergies
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15
Q

Overall Adverse Effects

A
  • Hypersensitivity (anaphylaxis, serum sickness, acute interstitial nephritis)
  • Superinfection
  • N/V/diarrhea
  • Nephrotoxicity
  • Neurotoxicity (HA, dizziness, confusion, restlessness)
  • Bleeding (platelet dysfunction)
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16
Q

Antibiotic Agents

A
  • Beta Lactams (Penicillins, Cephalosporins)
  • Tetracyclines
  • Aminoglycosides
  • Fluoroquinolones
  • Macrolides
  • Sulfonamides
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17
Q

Beta-Lactams

A

MOA: inhibition of bacterial cell wall synthesis
- USE: Gram - and + bacteria

  • Penicillins: *respiratory, GI, & GU infxns
  • Cephalosporins: *respiratory infxns, surgical prophylaxis, resistant microorganisms, *best for gram - bacteria
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18
Q

B-Lactams & Resistance

A
  • The B-lactam ring is part of the core structure of several antibiotic families
  • Some produce B-lactamases–enzymes capable of destroying penicillins & cephalosporins (resistance)
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19
Q

B-Lactamase Enzyme Inhibitors

A
  • Clavulanic acid
  • Tazobactum
  • Sulbactam
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20
Q

Penicillin/B-Lactamase Enzyme Inhibitor Combinations

A
  • Ampicillin/Sulbactam (Unasyn)
  • Amoxicillin clavulanate (Augmentin)
  • Piperacillin/Tazobactam (Zosyn)
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21
Q

Penicillins

A
  • Natural Penicillins (narrow-spectrum)- (Penicillin G, Penicillin V)
  • Penicillinase-resistant penicillins (narrow)-(Cloxacillin, Dicloxacillin, Methicillin, Nafcillin, Oxacillin)
  • Aminopenicillins (broad-spectrum)-(Amoxicillin, Ampicillin, Bacampicillin)
  • Extended-spectrum penicillins-(Piperacillim, Carbenicillin, Mezlocillin)
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22
Q

Penicillins: Narrow-Spectrum

A
  • Penicillin G (B-lactamase sensitive)
    • Parenterally
    • Most potent penicillin
  • Penicillin V (given for minor infxns)
    • Orally

Covers–Strep pyogenes, S. pneumoniae, Neisseria meningitis, N. gonorrhoeae, treponemes, Listeria, Actinomycetes, Clostridia

23
Q

Penicillins: Broad-Spectrum

A

Ampicillin or Amoxycillin

  • B-lactamase sensitive
  • PO or parenterally (amoxycyillin better PO)
  • Less active than Penicillin G against Gram + bacteria
  • Covers narrow spectrum + Klebsiella & Proteus strains
24
Q

Cephalosporins

A
  • Broad spectrum
  • Divided into generations based on antimicrobial activity
  • Structurally & pharmacologically similar to penicillins
25
Q

Cephalosporins: 1st Generation

A
  • Cephalexin (PO, Keflex)
  • Cefazolin (IV/PO)
  • Cephapirin
26
Q

Cephalosporins: 2nd Generation

A
  • Cefaclor (PO)

- Cefoxitin (IV/IM)

27
Q

Cephalosporins: 3rd Generation

A
  • Cefixime (PO)

- Ceftiaxone (IV/IM, Rocephin)

28
Q

Cephalosporins: 4th Generation

A
  • Cefepime (IV/IM)
29
Q

B-Lactams Adverse Effects

A

Penicillins: Hypersensitivity/allergy, superinfections, N/V, diarrhea, AP

Cephalosporins: Nephrotoxicity, HA, dizziness, weakness, fever, bleeding

30
Q

B-Lactams Contraindications

A
  • Cross-sensitivity w/ Penicillin –> If allergic to Penicillin, do not take/cautiously take Cephalosporins
  • Use may decrease effectiveness of OCPs by diminishing enterohepatic circulation
31
Q

Penicillin: Pt Education

A
  • Take w/ full glass of water on empty stomach

- Use different form of birth control while taking these

32
Q

Cephalosporin: Pt Education

A
  • Take w/ food if gastric upset occurs
  • Do not consume alcohol while on these antibiotics
  • Caution w/ taking ASA or NSAIDs or anticoagulants as bleeding tendencies intensify
33
Q

Tetracycline

A
  • MOA: penetrates microbial cells & binds to 30S ribosomes -> inhibit microbial protein synthesis (bacterostatic & bactericidal)
  • *Broad spectrum

USE: Gram + and - organisms plus, rickettsia, mycoplasmas, some protozoa, spirochetes, & others

34
Q

Tetracyclines: Indications

A

1st line therapy w/:
- Cholera, granuloma, inguinale, chancroid, RMSF, psittacosis, typhus, trachoma

Penicillin substitute if allergic for STDs, long term tx of acne, & prevention of traveler’s diarrhea

35
Q

Tetracycline Drugs

A
  • Tetracycline
  • Demeclocycline
  • Doxycycline
  • Minocycline
36
Q

Tetracycline: Pt Education

A
  • Tetracyclines bind to Ca, Mg, & Al
  • Do not take w/ dairy products, antacids, iron supplements, or magnesium laxatives -> reduce their absorption (within 2 hours)
37
Q

Tetracycline: Adverse Effects

A
  • Permanent stains in developing teeth of fetus & children
  • Photosensitivity
  • Superinfection
  • Diarrhea, GI upset
38
Q

Tetracycline: Contraindications

A
  • Pregnancy (retards fetal skeletal development)

- Children up to 8 years of age

39
Q

Aminoglycoside

A
  • MOA: Penetrates cell walls of susceptible bacteria, binds irreversibly to 30S ribosomes, & inhibits protein synthesis (bactericidal)
    • Narrow spectrum (VERY POTENT)
  • USE: Gram - (aerobic) organisms
    • Reserved for serious/life threatening infxns
    • Ex: respiratory, resistant TB
40
Q

Aminoglycoside Drugs

A
  • Gentamicin
  • Amikacin
  • Neomycin
  • Streptomycin
  • Kenamycin
  • Tobramycin
  • POOR ORAL ABSORPTION*
41
Q

Aminoglycoside: Adverse Effects/CI

A 
AE:
- Nephrotoxicity
- N/V/diarrhea
- Ototoxicity (auditory impairment)
CI:
- Renal disease (do not combine w/ loop diuretics)
- MUST MONITOR DRUG LEVELS
42
Q

Flouroquinolones

A
  • Broad spectrum*
  • MOA: (Bactericidal)-interfere w/ DNA gyrase-enzyme needed for bacterial synthesis
  • USE: Gram - and + bacteria
    • respiratory infections
43
Q

Fluoroquinolone Drugs

A
  • Ciprofloxacin*–(Cipro)
  • Levofloxacin (Levaquin)
  • Many more…

Excellent oral absorption-reduced w/ antacids

44
Q

Fluoroquinolone: Adverse Effects/CI

A

AE:

  • Allergy/rashes
  • N/V/diarrhea
  • HA, dizziness, drowsiness, restlessness
  • Photosensitivity (ciprofloxacin)

CI:
- Children, infants, pregnant, or lactating

45
Q

Fluoroquinolone: Drug Interactions

A
  • Increases the effects of anticoagulants & caffeine

- DO NOT TAKE w/ antacids, milk, iron supplements, or magnesium laxatives

46
Q

Macrolides

A
  • Broad Spectrum*
  • MOA: Attach to 50S ribosomes -> inhibit microbial protein synthesis (bacterostatic & bactericidal in large doses)
  • USE: Gram +, some anaerobic & atypical mycobacterium
  • respiratory tract infxns, penicillin substitute if allergic, prophylaxis for rheumatic fever, & STDs, tx of Legionnaire’s DZ
47
Q

Macrolide Drugs

A
  • Erythromycin
  • Azithromycin (Zithromax)
  • Clarithromycin
  • Dirithromycin
48
Q

Macrolide: Pt Education

A
  • Effective on empty stomach, but may give w/ food if GI upset occurs
49
Q

Macrolide: Adverse Effects/CI

A 
AE:
- N/V/diarrhea
- Hepatoxicity
- HA, dizziness
- GI upset (erythromycin)
CI:
- Pre-existing liver disease
50
Q

Sulfonamide

A
  • MOA: (bacterostatic)-inhibits multiplication
  • USE: wide range
    • Primary use in UTI tx
51
Q

Sulfonamide Drugs

A
  • Single Agents: Sulfamethoxazole, Sulfisoxazole
  • Combination Agents: Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
  • Topical Agents: Silver Sulfadiazine (Silvadene)–burns
52
Q

Sulfonamide: Adverse Effects/CI

A 
AE:
- Kidney damage
- Photosensitivity
- GI upset
CI:
- Renal failure
- Late pregnancy, lactation & children
53
Q

Sulfonamide: Pt Education

A
  • Take w/ water on empty stomach
  • Drink 8-10 glasses of water to prevent crystallization of sulfa in the kidneys
  • Wear protective clothing & sunscreen
  • Urine should be acidic for sulfonamides to work
  • Avoid carbonated beverages
54
Q

Antimicrobials & Nursing

A

Before initiation, assess for –> drug allergies, hepatic liver & cardiac functions, potential drug interactions
*Must obtain cultures before initiation

After initiation –> watch for signs of superinfection (e.g. fever, cough, lethargy, perineal itching)

Pulmonology (8 decks)

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