Antibiotics

Question 1

What medications inhibit cell wall synthesis?

Answer 1

Penicillin, Cephalosporins, Carbapenems, and Vancomycin

Question 2

What happens when cell wall synthesis is inhibited?

Answer 2

Weaking of the cell wall, influx of fluid into the cell, cell swells and bursts, cell lysis and death

Question 3

What are the beta lactam antibiotics?

Answer 3

Sulfabactam, Clavulanic acid, tazobactam, and avibactam. Can be added with other medications to target bacteria that secrete beta lactamase that normally wouldn’t be killed.

Question 4

What are common combinations for beta-lactamase inhibitors?

Answer 4

Ampicillin-Sulbacam, Amoxicillin-Clavulanic acid, Ticarillin-Clavulanic acid, Pipracillin-Tazobactam, and Ceftazidime-Avidbactam

Question 5

Penicillin class MOA

Answer 5

Disrupts synthesis of the cell wall by inhibiting the transpeptidases essential for synthesis. Activates autolysis. Bacteria must be growing and dividing

Question 6

Adverse effects of penicillin class

Answer 6

Urticaria, pruritis, angioedema, GI distress, rash

Question 7

Indications for penicllins

Answer 7

Gonorrhea, UTI, Peritonitis, Pneumonia and respiratory infections, Septicemia, Meningitis

Question 8

Different types of penicillin

Answer 8

Natural Penicillins (PCN G and V), Penicillinase-resistant penicillins (nafcillin), Aminopenicillins (amoxicillin and ampicillin), extended-spectrum penicillins (piperacillin)

Question 9

Natural Penicillin med

Answer 9

PCN G and PCN V

Question 10

Penicillinase-resistant penicillin med

Answer 10

nafcillin

Question 11

Aminopenicillin meds

Answer 11

amoxicillin and ampicillin

Question 12

Extended-spectrum penicillin meds

Answer 12

piperacillin

Question 13

Penicillin G and V (Natural)

Answer 13

-Given IV/Im
-Works on gram positive and negative
-Half life 30 minutes
-Can be used with aminoglycosides

Question 14

Nafcillin (Penicillinase resistant PCNs)

Answer 14

-Drug of choice for PCNs
-IV ONLY
-Resistant breakdown by penicillinase enzyme

Question 15

Ampicillin (Aminopenicillin)

Answer 15

-Diarrhea and rash common SE
-Given PO or IV (if oral amoxicillin is better option)
-Renal sensitive
-Commonly given with sulbactam

Question 16

Amoxicillin (Aminopenicillin)

Answer 16

-Common for peds pts
-Only given PO
-Common for ear, nose, throat, GI and skin infections

Question 17

Piperacillin (Extended spectrum)

Answer 17

-ALWAYS given with a beta lactamase inhibitor
-Anti-pseudomonal
-Affects platelet function
-Good for pseudomonas infections
-Monitor renal dysfunction pts

Question 18

Cephalosporins class MOA

Answer 18

Inhibits cell wall synthesis through same binding proteins as penicillin –> activates autolysis

Question 19

Generations of cephalosporins

Answer 19

5 generations. Increase the spectrum, activity, and ability to penetrate CNS the higher the number

Question 20

Cross sensitivity

Answer 20

If you are allergic to one thing, you’re more likely to be allergic to another. PENICILLIN AND CEPHALOSPORINS

Question 21

Common adverse effects for all cephalosporins

Answer 21

mild diarrhea, abdominal cramps, rash, pruritis, redness, edema

Question 22

1st generation cephalosporins

Answer 22

Cefazolin and cephalexin

Question 23

Cefazolin

Answer 23

-Works well for gram +
-Staph and non enterococcal strep infections
-Given IV only
-Common for surgical prophylaxis

Question 24

Cephalexin

Answer 24

-Works well for gram +
-Staph and non enterococcal strep infections
-PO or IV

Question 25

2nd generation cephalosporins

Answer 25

Cefuroxime and Cefotetan

Question 26

Cefuroxime

Answer 26

-Gram + and - coverage -IV and PO -Does not kill anerobic bacteria

Question 27

Cefotetan

Answer 27

-Gram + and - -IV and PO

Question 28

3rd generation cephalosporins

Answer 28

Ceftriaxone, ceftazidime, and cefotaxine

Question 29

Ceftriaxone

Answer 29

-most potent fighting against gram - but still works on + -IV and IM injection only -EXTREMELY long-acting (once per day dosing) -Able to cross blood brain barrier (treat meningitis) -DO NOT GIVE TO PT WITH LIVER FAILURE

Question 30

Ceftazidime

Answer 30

-More potent on - but still works on + -IV and IM injection only -Works well for pseudomonas

Question 31

4th generation cephalosporins

Answer 31

Cefepime

Question 32

Cefepime

Answer 32

-Works against - and + -Crosses BBB

Question 33

5th generation cephalosporin

Answer 33

Ceftaroline

Question 34

Ceftaroline

Answer 34

-Treats MRSA and MSSA, works against some VRSA/VISA -Needs to be renally dosed -IV ONLY

Question 35

Carbapenems MOA

Answer 35

Bactericidal and cell wall inhibitor

Question 36

Carbapenem meds

Answer 36

imipenem/cilastin and meropenem

Question 37

What is the broadest spectrum of antibiotics?

Answer 37

Carbapenems

Question 38

Carbapenem AE

Answer 38

drug-induced seizures

Question 39

Carbapenem route

Answer 39

IV. MUST BE INFUSED OVER 60 MIN

Question 40

Imipenem/Cilastin

Answer 40

MOA- binds to penicillin-binding proteins --> inhibits the cell wall synthesis (VERY resistant to beta-lactamas) -IV only -Can penetrate BBB -Used for complicated infections -MOST broad spectrum -Cilastin is an inhibitor enzyme that breaks down imipenem

Question 41

Meropenem

Answer 41

-Less coverage than imipenem -Gram - and + -Doesn't degrade in the kidneys -less seizure activity -Rash and diarrhea common SE

Question 42

CRE

Answer 42

Carbapenem resistant Enterobacteriaceae

Question 43

Vancomycin MOA

Answer 43

-Destroys by binding to bacterial cell wall, producing immediate inhibition of cell wall synthesis and death

Question 44

What is vancomycin?

Answer 44

glycopeptide antibiotic

Question 45

Vancomycin

Answer 45

-Works on gram + (MRSA and PCN resistant pneumococcus) -Oral is given to treat C.diff --> may still need IV antibiotic -Doesn't work on CNS infections -Decrease doses for renal dysfunction (eliminated in kidneys)

Question 46

Toxic side effects of Vancomycin

Answer 46

Ototoxicity, immune-mediated thrombocytopenia, nephrotoxic, red-man syndrome

Question 47

Red man syndrome S/S

Answer 47

Flushing, rash, pruritis, urticaria, tachycardia, hypotension

Question 48

What to do if someone develops red man syndrome

Answer 48

Infuse vancomycin slowly and over longer time periods

Question 49

When do you draw a peak?

Answer 49

30 minutes after medication administered, or when it theoretically should be the highest concentraion

Question 50

When do you draw a trough?

Answer 50

Right before administering another dose of meds

Question 51

What meds cross the BBB?

Answer 51

Ceftriaxone (3rd), Cefepime (4th) and Ceftaroline (3rd) <-- cephalosporins, imioenem/cilastin <-- carbapenem

Question 52

What med works best for gram - bacteria?

Answer 52

cefuroxime, cefotetan, ceftriaxone, ceftazidime, cefotaxine

Question 53

Works well for gram +

Answer 53

cefazolin, cephalexin

Question 54

Antimicrobial classes

Answer 54

aminoglycosides, lincosamides: clindamycin, macrolides, tetracyclines, fluoroquinolones, sulfonamides, metronidazole

Question 55

Antimicrobials work by...

Answer 55

inhibiting or altering protein synthesis in transcription or translation

Question 56

Aminoglycoside meds

Answer 56

gentamycin, amikacin, tobramycin

Question 57

Aminoglycosides (gentamycin, amikacin, and tobramycin)

Answer 57

-Works well on gram - -Can work on gram + but needs another antibiotic for synergistic effect -Used for UTIs, pyelonephritis, gynecological infections, peritonitis, endocarditis, PNA, osteomyelitis -SE: nephrotoxicity and ototoxicity -Monitor therapeutic levels -Start 3x a day dosing and transition to 1x a day