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Pharmacotherapeutics with Sepik > Antibiotics! > Flashcards

Antibiotics! Flashcards

1
Q

What is selective toxicity?

A

Antibiotics are harmful to the microbe but harmless to the human host.

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2
Q

Antibiotic categories work by different ___________.

A

Mechanisms

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3
Q

What is bacteriocidal?

A

Drugs are directly lethal to bacteria at clinically achievable concentrations

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4
Q

What is bacteriostatic?

A

• Drugs can slow bacterial growth but do not cause cell death. Compromises the bacteria enough so the immune system can sweep in and save the day.

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5
Q

Name two kinds of antiobiotic use?

A

Prophylaxis and treatment

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6
Q

Name some examples of using antibiotics prophylactically:

A 
THIS IS NOT ROUTINE!
◦ Used to prevent infection
◦ Pre-surgery
◦ Special populations:  heart valves, rheumatic
fever 
◦ Immunosuppressed
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7
Q

Name examples of using antibiotics as treatment:

A

◦ Empiric therapy

◦ Based on identification of organism

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8
Q

When might using a bacteriostatic antibiotic not be helpful?

A

If someone is immunocompromised – HIV, organ transplant, chemo drugs. Immune system can’t kick in to kill the microorgs like it should.

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9
Q

When does the WHO say it is ok to use abx prophylactically with surgery?

A

Abx should be used to prevent infection before and during surgery but NOT after.

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10
Q

We should be giving _____________ abx ___ hours before incision, per the WHO.

A

Broad spectrum, 2

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11
Q

Some example of when we would use abx before and during sx?

A

Bowel sx, c-section, abdominal sx. Not minor surgeries.

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12
Q

If you see someone on abx post-sx, what is likely going on?

A

We are actively treating an infection.

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13
Q

What does empiric therapy mean?

A

Treating someone based on experience. Based on our best guess of what is causing the infection (ex: e coli causes most UTIs, will treat for it before getting culture).

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14
Q

What are three main ways we want to identify bacteria?

A

◦ Gram positive vs. gram negative
◦ Shape: bacilli, cocci, spirilla
◦ Ability to grow in relation to oxygen: aerobic vs. anaerobic

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15
Q

Ideally when should a C&S be taken?

A

BEFORE anti-infectives are started

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16
Q

What is the first action we would take in a lab to ID bacteria?

A

Gram stain

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17
Q

After we have done a gram stain, what will happen in the lab?

A

We will begin to grow it out on a petri dish (takes up to 48 hours).

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18
Q

What is it called when you are growing out the bacteria?

A

A culture

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19
Q

Why is it the best practice to get a sample of the bacteria before starting anti-infectives?

A

You risk killing off some of the microorgs, thus making it harder to ID what the problem bacteria might be.

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20
Q

What does PCR stand for?

A

Polymerase Chain Reaction

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21
Q

What is the benefit of a PCR test?

A

We can detect bacteria and viruses and very low titers

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22
Q

Name some gram + organisms:

A

Staphylococcus, streptococus, enterococus

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23
Q

Name some bad things caused by gram + bacteria:

A

carbuncles, furuncles, impetigo, group A hemolytic strep, necrotizing fascitis, MRSA, skin, pneumonia,
catheter infections

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24
Q

Name some gram - organisms:

A

GI tract: E.coli, Shigella, Salmonella, Klebsiella, Enterobacter, Serratia, Proteus, etc.

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25
Q

Name some bad things caused by gram - bacteria:

A

H. influenza, Neisseria (meningitis & gonorrhea), pseudomonas

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26
Q

Where would you find anaerobic bacteria and what is probably happening/what are you seeing when you find it?

A

Deep wounds, tissues, and internal organs

Abscess formation, tissue destruction, foul smelling pus

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27
Q

Name 3 examples of anaerobic bacteria:

A

C.diff, clostridium botulinum, MRSA, e. coli, clostridum tetani

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28
Q

Are anaerobic organisms are harder or easier to treat?

A

Harder. These are the bad guys!

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29
Q

Are anaerobic organisms more often:

Gram +
Gram -
Can be both

A

Can be both

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30
Q

Name two common treatments for anaerobic microorganisms.

A

Flagyl, Clindamycin

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31
Q

We have taken our sample to send out for C&S, what kind of antibiotics do we generally start with now?

A

Broad spectrum (effective against a wide variety of different microorganisms)

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32
Q

After we get our C&S back, what kid of antibiotic do we switch to?

A 
Narrow spectrum (effective against only one or
restricted group of microorganisms)
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33
Q

What is an example of a broad spectrum antibiotic?

A

Ciprofloxacin, Levofloxacin, Penicillin

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34
Q

What is an example of a narrow spectrum antibiotic?

A

Azithromycin, Clindamycin, Vancomycin

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35
Q

Why do we change from broad to narrow spectrum medications?

A

Decreases the risk of superinfections and antibiotic resistance.

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36
Q

What does MIC stand for?

A

Minimal Inhibitory Concentration

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37
Q

What does MIC mean?

A

Minimum Inhibitory Concentration. It is the lowest concentration of antibiotic that causes inhibition of bacteria growth.

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38
Q

Name 6 host considerations in antibiotic selection:

A 
Allergy
Ability to penetrate the site
Immunocompromised patient
Foreign hardware within the body
Age
Genetic Factors
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39
Q

What is something we need to look into when we are examining an allergy to a drug?

A

Is it really an allergy or a SE?

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40
Q

Name two issues that would cause a difficult in a drug penetrating the site?

A

Mengitis (need a drug that will cross the BBB), abscess (is walled off, need to be drained first often)

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41
Q

Some drugs that have a high rate of allergic rxns?

A

Sulfa drugs, penicillin, cephalosporins, erythromycin

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42
Q

What are some example of foreign hardware within the body and how it affects which antibiotic we choose:

A

Hip replacement, pacemakers.

Body attacks the foreign material – the phagocytes are busy fighting this

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43
Q

What do we think about when dosing infants?

A

They have a high level of toxicity

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44
Q

What do we think about when dosing children adolescents?

A

Certain drugs should not be used

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45
Q

What do we think about when dosing pregnant/lactating people?

A

Risk to mom and fetus

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46
Q

What are some drugs to avoid giving during pregnancy/lactation?

A

Gentamicin causes hearing loss; sulfonamides causes kernicterus in nursing newborns

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47
Q

What do we think about when dosing older people?

A

Heightened sensitivity to medications

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48
Q

What is a genetic factor we need to consider when dosing abx?

A

G6PD deficiency with the use of sulfonamides (more common in African American, Middle Eastern, and male patients)

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49
Q

How do we know the antibiotic is working?

A

Clinical/lab Response
◦ Reduction in signs/symptoms and fever
◦ Reduction in WBC
◦ Peak/trough levels–checking for toxicity

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50
Q

Why wouldn’t we recheck the C&S while the patient is still on antibiotics?

A

We could get a negative culture reading, which may or may not be a true reading.

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51
Q

With antibiotic resistance, it is the __________ that becomes resistant, not the _________.

A

Microbe, patient

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52
Q

Name some things abx DON’T work for:

A

Flu, colds, vomiting, MOST coughs, MOST ear infections, MOST sore throats, MOST diarrhea, MOST cystitis

53
Q

Name some things abx DO work for:

A

Serious bacterial infections including: Pneumonia, UTIs, STIs like gonorrhea, sepsis, meningococcal meningitis

54
Q

Name 4 resistant organisms:

A

◦ MDRO
◦ MRSA
◦ VRE
◦ ESBL

55
Q

What dies MDRO stand for?

A

Multi Drug Resistant Orgs

56
Q

What dies MRSA stand for?

A

Methicillin-resistant Staphylococcus aureus

57
Q

What dies VRE stand for?

A

Vancomycin resistant enterococcus

58
Q

What dies ESBL stand for?

A

Extended spectrum beta-lactamase

59
Q

Name some ways we can help stop the spread of drug resistant orgs?

A

◦ Using PPE – isolation procautions
◦ Identifying patients with these resistant orgs
◦ Putting patients on the appropriate meds

60
Q

What are some common SEs with antibiotics?

A

Superinfection (host flora killed off by antibiotic, strong bacteria takes over), nausea/vomiting/ diarrhea (GI distress)

61
Q

Name a common antibiotic related super- / supra-infection SE?

A

Candidiasis in mouth, yeast infection

probiotics can help!

62
Q

Name a common antibiotic related GI SE?

A

C diff (this is also a superinfection)

63
Q

Name some common antibiotic related allergic reactions?

A

Rash, hives, difficulty breathing

64
Q

What to do if suspect of allergy?

A

Assess before and monitor after administration
• If suspected-> STOP medication immediately, think about airway (secure airway)
• Call Rapid Response/ Code Cart

65
Q

What is the most common antibiotic to result in Cdiff?

A

Clindamycin

66
Q

If a patient is going to have an allergic rxn, when it the most likely time it will occur?

A

Within 30 minutes of administration or second + administration (although can happen with first administration – could have been exposed to abx through food sources)

67
Q

How do tetracyclines work?

A

Inhibition of protein synthesis

68
Q

What is the tetracycline prototype?

A

Tetracycline!

69
Q

Name 3 other tetracyclines:

A
  • demeclocycline
  • doxycycline
  • minocycline
70
Q

What is a unique characteristic of tetracyclines?

A

Yellow-brown discoloration of teeth (do not rx children under 8 and during pregnancy)

71
Q

Why is there a lot of resistance to tetracyclines?

A

Overuse in the 1950-60s. Now we just use for weird things (RMSF, typhus, cholera, Lyme disease, H.pylori, chlamydia, acne).

72
Q

What happens if you tell someone to take tetracyclines with food to help their GI issues?

A

It will actually decrease absorption

73
Q

What are some other SE of tetracyclines?

A

GI issues (n/v/d), superinfections (Cdiff, candidiasis), photosensitivity

74
Q

How do tetracyclines interact with food?

A

DO NOT TAKE WITH Calcium, Iron, Mg, Al – they bind to the drug and decrease drug absorption by 50%.

75
Q

What should we tell people taking tetracyclines to avoid?

A

Avoid antacids, anti-diarrheal, dairy products

76
Q

When is the best time to take the tetracyclines re: drug-drug or drug-food interactions?

A

1 hour before or 2 hours after contraindicated food/drugs

77
Q

How do macrolides work?

A

Inhibition of Protein Synthesis

78
Q

What is the prototype for macrolides?

A

erythromycin (E-mycin)

79
Q

What are some other examples of macrolides?

A

Clarithromycin (Biaxin)

Azithromycin (Z-pack)

80
Q

What is a unique trait of erythromycin?

A

Affects the motility of the GI tract (motilin)- this can used to HELP pts with diabetic gastroparesis and also with passing feeding tubes

81
Q

What is a cardiac-related SE of erythromycin?

A

QT prolongation and cardiac death!

82
Q

What are some drug-drug interactions with erythromycin?

A

Any drug that works through CYP3A4 pathway should be avoided. (CCB, antifungals, HIV protease inhibitors)

83
Q

Why is azithromycin/Z-pack unique and why is this good?

A

It has a long duration of action (long 1/2 life), so it is given in a short course. Rx for 3-4 days, works in body for a week. This helps with compliance.

84
Q

Some other SE of erythromycin?

A

GI upset, superinfections

85
Q

Toxic levels with erythromycin (ASK KNOWLTON)

A

theophylline, carbamazepine, warfarin

86
Q

How is administration preferred?

A

Continuous infusions rather that intermittent dosing (this is unusual).

87
Q

How does clindamycin work?

A

Inhibition of protein synthesis

88
Q

What is the biggest risk with using clindamycin?

A

C diff-associated diarrhea. Can be fatal. Stop immediately if concern for this, put on contact precautions. No alcohol-based hand sani.

89
Q

What are the symptoms of C diff-associated diarrhea?

A

Profuse, watery diarrhea, abdominal pain, fever, leukocytosis.

90
Q

If you give clindamycin rapidly IV, what can happen?

A

Risk for cardiac arrest. Give slow.

91
Q

How do aminoglycosides work?

A

By inhibiting protein synthesis, but specifically by producing abnormal proteins – are bacterialcidal. STRONGER.

92
Q

What is our aminoglycoside prototype?

A

Gentamicin

93
Q

Name 6 other aminoglycosides.

A

Tobramycin, Amikacin, Kanamycin, Neomycin, Paromycin, Steptomycin,

94
Q

What are the two unusual adverse effects?

A

Ototoxicity and nephrotoxicity (just like vancomycin!)

Related to trough levels

95
Q

What is often the first sign of vestibular toxicity/effects?

A

Headache

96
Q

How common is nephrotoxicity with aminoglycosides? How should we monitor for this?

A

5-25%! Usually reversible though.

Monitor BUN & creatinine

97
Q

What can ototoxicity with aminiglycosides affect?

A

Cochlea (tinnitus) and vestibular area

98
Q

How do sulfonamides work?

A

Inhibition of folate synthesis

99
Q

What is the sulfonamide prototype?

A

Trimethoprim/Sulfamethoxazole

100
Q

What are some other names for Trimethoprim/Sulfamethoxazole?

A

TMP/SMX AKA: Bactrim, Cotrim, Septra, Co-trimoxazole

101
Q

What is the TMP/SMX ratio?

A

Ratio 1:5. FIXED DOSE PRODUCT

102
Q

When put together, Trimethoprim and Sulfamethoxazole have a/an _________________ effect.

A

Synergistic

103
Q

SEs of TMP/SMX?

A

GI (N/V)
Rash (CONCERN FOR SJS, stop medication immediately)
Blood dyscrasias (abnormal or disordered, more common with DS)
Crystalluria- Pts should increase hydration
Photophobia – Pts need sun protection, will easily get burned
CNS effects

104
Q

What are some blood dyscrasias that are seen as SEs of TMP/SMX?

A
  • Hemolytic anemia (with G6PD deficiency)

- Bone marrow suppression (folks with alcohol use disorder and pregnant people more at risk for this)

105
Q

Refresher: Who is more likely to have a G6PD deficiency?

A

More common in AA and ME males

106
Q

TMP/SMX is taken in what population to treat ________________ prophylactically?

A

HIV positive patients, PCP pneumonia

107
Q

Whra CNS effects can TMP/SMX have?

A

Headaches, depression, hallucinations

108
Q

If we give TMP/SMX to a pregnant woman, what can happen to the baby?

A

Kernicterus risk (bilirubin build up, nephrotoxic) & birth defects.

Should not be used in pregnancy, breast-feeding or in children under the age of 2months (this is used for UTI tx – should get a preg test first?).

109
Q

What are some drug-drug interactions with TMP/SMX?

A

Warfarin, Dilantin

is 68% protein bound

110
Q

If patients say they have a sulfa allergy what else should they not take?

A

Thiazide diuretics, loop diuretics, sulfa-DM meds

other drugs in same category

111
Q

TMP/SMX can also cause _________kalemia.

A

Hyper

112
Q

Tell me a little bit about SJS?

A

Symptoms: Widespread lesions, fever, malaise
Mortality rate 25%
Often treated in burn unit

113
Q

How do fluroquinolones work?

A

Disrupt DNA Replication/cell division

114
Q

What is our fluroquinolone prototype?

A

Ciprofloxacin (Cipro)

115
Q

Name some other fluroquinolones:

A

ofloxacin
moxifloxacin
levofloxacin
gemifloxacin

116
Q

How are fluroquinolone given?

A

Oral or IV. BOTH ARE EQUAL IN BIOAVAILABILITY!

117
Q

If giving cipro via IV how should it be pushed?

A

Over 60 minutes (SAME AS VANCOMYCIN)

118
Q

What is a unique side effect of ciprofloxacin?

A

Tendon rupture!
High risk with elderly & people on steroids (Think: COPD patients with exasperation)
Watch for heel pain
Avoid in kids under 18

119
Q

Name other SEs of ciprofloxacin:

A

CNS issues in elderly
Photosensitivity
Dysrhythmias if on anti-dysrhythmia agent
Superinfections (Candida & Cdiff)

120
Q

What is the main drug-food interaction with cipro?

A

Interacts with Al, Mg, iron, zinc, Ca
Milk/dairy products
Give drug 6 hours after or 2 hours before these food/supplements.

121
Q

What happens when cipro is taken with milk/dairy products?

A

Medication binds to Al, Mg, iron, zinc, Ca, reduces absorption by 90%!!!!

122
Q

Name some drug-drug interactions with cipro

A

Sucralfate, theophylline, warfarin, tinidazole

123
Q

How does metronidazole (Flagyl) work?

A

Inhibition of nucleic acid synthesis

124
Q

What does metronidazole work best against?

A

Protozoa and anaerobic bacteria. Has NO action against aerobic bacteria.

125
Q

How does metronidazole work against these anaerobic bacteria?

A

Is only taken up by anerobic orgs and then converted into an active form, then causes death.

126
Q

When is metronidazole often prescribed?

A

C.difficile (PO)

GI and Pelvic surgery

127
Q

How do you give vancomycin for treatment of c diff?

A

ONLY IN ORAL FORM. IV will not work.

128
Q

How do you administer metronidazole via IV?

A

Infuse over 1 hour (Same as vanco, cipro)

129
Q

What are some unusual SEs of metronidazole?

A
  • NO alcohol (3 days) due to Disulfiram (antabuse )-like reaction ALTHOUGH THIS IS BEING DEBATED, research not supporting this.
  • Urine may turn dark reddish-brown
  • Metallic taste in mouth

Pharmacotherapeutics with Sepik (7 decks)

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