Antibiotics

Question 1

What is Selective Toxicity?

Answer 1

It kills the bugs without harming the human host

Question 2

Bacteriostatic:

Answer 2

Slows down bacterial growth

Question 3

Bacteriocidal

Answer 3

Kills the bacteria

Question 4

What are the 3 ( and “other”) abx that disrupt the cell wall?

Answer 4

Penicillin (+beta-lactams), Cephalosporin, Carbapenems, (and Vancomycin inhibits cell wall synthesis)

Question 5

When would you use abx prophylactically?

Answer 5

Pre-surgery for serious surgeries like heart valves, rheumatic fever, and immunosuppressed. Broad spectrum, 2 hours pre incision

Question 6

What is empiric theory?

Answer 6

Using best judgement to choose treatment

Question 7

Where would you find anaerobic bacteria?

Answer 7

Deep wounds, tissues, abscess formation

(C. diff, botulism, tetanus). Use Flagyl or Clindamycin

Question 8

Host considerations (age, etc.)

Answer 8

Infants = high risk for toxicity
Penetration = meningitis, abscess, more difficult to treat
Children = don’t give tetracycline
Preg/lactating = Hearing loss (gentamicin), Kernicterus (Sulfas)
Older adults = heightened drug sensitivity
Genetic factors = G6PD deficiency with Sulfas

Question 9

What are 3 signs an abx is working?

Answer 9

Decreased S&S of fever
Decreased WBC
Peak/trough levels for toxicity

Question 10

What is the best way to prevent MDROs (Multi drug resistant organisms)?

Answer 10

Isolation Precautions

Question 11

What abx’s make the bacteria take on H2O?

Answer 11

Penicillin, Carbapenems, Cephalosporins

Question 12

What abx inhibits cell wall synthesis?

Answer 12

Vancomycin

Question 13

What are the admin routes and considerations for PCN?

Answer 13

IV, IM
IM = painful injection site, viscous fluid, large bore needle
K+ PCN = risk for hyperkalemia

Question 14

Beta-Lactamase. Explain.

Answer 14

bacteria enzyme that breaks down beta-lactamase rings in PCN. need drug combo.

Question 15

List the 4 BL drug combos

Answer 15

Amoxicillin + clavulanate = Augmentin
Ticarcillin + clavulanate = Timentin
Ampicillin + sulbactam = Unasyn
Pipercillin + tazobactam = Zosyn

Question 16

What are the admin routes for Cephalosporin?

Answer 16

IV, IM, oral

Question 17

What is so interesting about Cephalosporin? (hint: 1-5)

Answer 17

It has 5 generations. The higher the generation, the more ability it has to fight off gram - anaerobic bacteria, and the more ability it has to reach cerebral spinal fluid

Question 18

What is the relationship between PCN and Cephalosporin?

Answer 18

Cross-Sensitivity. 1% have it.

Question 19

Ceotetan:

Answer 19

increase bleeding risk, intolerance to alcohol

Question 20

Cephatriaxone

Answer 20

Increase bleeding risk, don’t mix with beta-lactamases, eliminated by the liver

Question 21

Cefazoline

Answer 21

Intolerance to alcohol

Question 22

Carbapenem, routes of admin

Answer 22

IV, IM
Combo drug (Imipenem, Cilastatin), second drug prevents Carbapenem from being destroyed by renal enzymes

Question 23

Carbapenem, drug-drug interaction

Answer 23

Carbapenem + Valproate acid = seizures

Question 24

Vancomycin MOA

Answer 24

Inhibits cell wall synthesis

Question 25

Vancomycin, routes of admin

Answer 25

IV, oral (only for c. diff)

Question 26

Use Vancomycin for:

Answer 26

Only Gram + | C. diff, MRSA, serious infections

Question 27

Biggest AE of Vancomycin

Answer 27

Ototoxicity, nephrotoxicity If pushed too quickly = Red Man Syndrome....Infuse SLOWLY, over 60 min Thrombophlebitis, check trough levels

Question 28

Abx that Inhibit Protein Synthesis:

Answer 28

Tetracycline, Macrolides, aminoglycoside (gentamicin) (other: clindamycin)

Question 29

Tetracycline treats:

Answer 29

RMSF, typhus, cholera, Lyme disease, H. Pylori, chlamydia, acne

Question 30

REMEMBER Tetracycline teaching

Answer 30

Photosensitivity, Teeth discoloration (<8 years), Superinfections; No calcium, iron, Mg, Al, ant-acids, anti-diarrheal, dairy products (1 hour before, 2 hours after), best on an empty stomach

Question 31

Macrolides: Erythromycin

Answer 31

Biaxin, Z-pack Fire belly, GI upset! Increase GI motility (sometimes used for this SE) QT prolongation = cardiac death

Question 32

Most important erythromycin teaching:

Answer 32

-Fire belly, QT prolongation

Question 33

Macrolides drug-drug interactions

Answer 33

- CYP3A4 (CCB, antifungals, HIV protease inhibitors) | - Toxicity: theophylline, carbamazepine (Tegretol, anti-seizure adjuvant) Warfarin, Superinfections

Question 34

Clindamycin Biggest Risk:

Answer 34

C. diff. Cease use immediately.

Question 35

Abx inhibition of protein synthesis: Producing Abnormal Proteins

Answer 35

Gentamicin (Aminoglycosides)

Question 36

Gentamicin, Admin routes

Answer 36

IV, IM

Question 37

Considerations for Gentamicin:

Answer 37

Ototoxicity (tinnitus), Nephrotoxicity (usually reversible), monitor peak/trough, BUN, and creatinine

Question 38

Abx Inhibition of Folate Synthesis:

Answer 38

Sulfonamides (TMP/SMX) | Bactrim, Septra, co-trimoxazole

Question 39

Special consideration for TMP/SMX:

Answer 39

Prescribed prophylactically for HIV patients to prevent PCP (Pneumocystis pneumonia), usually high incidence of adverse effects in these patients

Question 40

Specific AE for TMP/SMX

Answer 40

``` Stevens-Johnson Syndrome Blood dyscrasias (hemolytic anemia) G6PD Bone Marrow Suppression (Watch CBC) CRYSTALURIA (Keep pt hydrated) Photophobia CNS problems in older adults Nursing mothers- Kernicterus in nursing infants (<2 months) ```

Question 41

TXP/SMX + _________ = Stevens-Johnson Syndrome

Answer 41

Loop diuretics, thiazide diuretics, sulfa-DM meds

Question 42

TXP/SMX drug-drug interactions

Answer 42

Warfarin, dilantin (68% protein bound), Risk for hyperkalemia

Question 43

Abx Disrupt DNA replication/ cell division

Answer 43

Fluoroquinolones: Ciprofloxacin

Question 44

Fluoroquinolones: Admin routes

Answer 44

Oral, IV (same dosage) | Infuse over 1 hour

Question 45

Special considerations for Cipro

Answer 45

- Tendon rupture, don't give to kids < 18 yo - CNS effects in older adults - Dysrhythmia if taken with dysrhythmia agents

Question 46

Don't take Cipro with:

Answer 46

Ca, Al, Mg, Iron, Zinc, Milk/dairy, | 2 hours before, 6 hours after

Question 47

Drug-drug interactions for cipro

Answer 47

Sucralfate, theophylline, warfarin, tinidazole

Question 48

Abx. Inhibition of Nucleic Acid Synthesis

Answer 48

Metronidazole (Flagyl)

Question 49

Coverage for Flagyl:

Answer 49

Protozoa, Anaerobic | No action against aerobic

Question 50

Use Flagyl for:

Answer 50

C. Diff | GI, Pelvic surgery, infuse over 1 hour

Question 51

Superinfections caused by Flagyl

Answer 51

Candidiasis

Question 52

Unusual SE for Flagyl

Answer 52

Dark red urine, Metallic taste, Alcohol intolerance (3 days)

Question 53

Photosensitivity:

Answer 53

1. Fluoro (Cipro) 2. Tetracycline 3. Sulfa

Question 54

Infuse over 1 hour

Answer 54

1. Fluoro (Cipro) 2. Flagyl 3. Vanco

Question 55

Oto/ Nephrotoxic

Answer 55

1. Vanco | 2. Genta (Tinnitus)

Question 56

Oral Admin

Answer 56

1. Ceph | 2. Vanco

Question 57

CNS Effects

Answer 57

1. Fluoro (Cipro) | 2. Sulfa

Question 58

Anaerobic Killing Machines

Answer 58

1. Metro (Flagyl) 2. Ceph (Gram -) 3. Vanco (Gram +)

Question 59

Alcohol Antabuse

Answer 59

1. Ceotetan, Cefazoline | 2. Flagyl

Question 60

Best for C. Diff

Answer 60

Flagyl

Question 61

Best on an empty stomach

Answer 61

Tetraycycline

Question 62

GI upset

Answer 62

Erythromycin

Question 63

Combo drugs

Answer 63

1. PCN 2. Carbapenems 3. Sulfa

Question 64

QT Prolongation

Answer 64

Erythromycin

Question 65

Allergy and cross-sensitivity

Answer 65

PCN and Cephalosporins

Question 66

Sulfa AE:

Answer 66

``` SJS (loop diuretics, thiazide diuretics, Sulfa DM meds) Blood dyscrasias (hemolytic anemia) Bone marrow suppression Kernicterus Crystaluria ```

Question 67

Cipro AE:

Answer 67

Tendon Rupture, dysrhythmias