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Antibiotics Flashcards

1
Q

What was the first Abx introduced for clinical use?

A

Penicillins

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2
Q

How do penicillins work?

A

-inhibit bacterial wall synthesis
-stops the enzyme needed for cell division

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3
Q

Penicillins are _____ _____ antibiotics

A

Beta lactam
Group of drugs that contain beta-lactam ring & are used to Tx bacterial infections by binding to enzyme essential for building bacterial cell walls

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4
Q

Are penicillins bactericidal or bacteriostatic?

A

Bactericidal → kill off bacteria

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5
Q

Do penicillins work against gram pos or gram neg bacteria?

A

Both gram positive & gram negative bacterias

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6
Q

List the bacterias penicillins are effective against

A

streptococcal, staphylococcal, pneumococcal infections

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7
Q

List the different versions of penicillins

A

Penicillin G
Penicillin K
Penicillin V
Amoxicillin (prototype)
Ampicillin

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8
Q

Give examples of penicillinase-resistant Abx

A

nafcillin
oxacillin

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9
Q

What is the suffix for penicillin drugs?

A

“cillin”

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10
Q

Types of penicillin:

Penicillin VK

A

2/3 of the dose is absorbed orally
Less potent than PCN G
Most used in oral form

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11
Q

Common infections penicillin VK is used to Tx?

A

strep throat
oral infections

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12
Q

Types of penicillin:

Penicillin G Benzathine

A

Can be given PO or parenteral
only 1/3 of oral dose absorbed (usually given as injection)
short acting
injection is very painful

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13
Q

Types of penicillin:

Procaine penicillin G

A

Has an anesthetic to decrease pain

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14
Q

When/ why are beta lactamase inhibitors added?

A

When taking broad spectrum Abx; adding beta lactamase inhibitor makes Abx more effective against the beta lactamase producing bacteria

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15
Q

Correlation between PCN use & beta lactamase inhibitors

A

used when there is concern for beta lactamase resistant in organisms usually sensitive to PCN
used to enhance what the penicillins do

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16
Q

Give examples of bacterias treated by PCN that would have a beta lactamase added

A

streptococcus pneumoniae
staphylococcus aureus

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17
Q

Give 3 examples of medications that combine a beta lactam Abx with a beta lactamase inhibitor

A

Augmentin = Amoxicillin + Clavulanic acid
Zosyn = Piperacillin + Tazobactam
Unasyn = Ampicillin + sulbactam

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18
Q

List 6 beta lactamase inhibitors

A

Clavulanate
Sulbactam
Tazobactam
Avibactam
Vaborbactam
Relebactam

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19
Q

Contraindications of taking PCN?

A

If person is allergic to PCN or cephalosporins
Use with caution in patients w/ renal impairment

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20
Q

Is PCN safe to use during pregnancy or breastfeeding?

A

yes

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21
Q

What should a pt taking PCN & oral contraceptive do to prevent pregnancy?

A

Take a second form of contraception

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22
Q

List adverse effects of PCN use

A

GI tract → N/V & stomatitis
Superinfection
Pain & inflammation @ injection site
Hypersensitivity

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23
Q

Drug-drug interactions of PCN

A

tetracyclines
aminoglycosides

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24
Q

What is penicillin cross reactivity?

A

Those who are allergic to PCN can have cross reactivity allergic reactions w/ cephalosporins

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25
Q

PCN cross reactivity is typically seen with what generation cephalosporins?

A

1st generation (cephalexin) & % is low
-rarely seen in 3rd-5th generations

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26
Q

What patients might you see penicillin cross reactivity?

A

those who experience anaphylactic reactions to PCN

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27
Q

What type of bacteria are aminoglycosides effective against?

A

gram negative bacteria

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28
Q

Aminoglycosides are very strong Abx for serious infections such as?

A

bacteremia
abdominal infections

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29
Q

List some contraindications of aminoglycosides

A

known allergies
renal/ hepatic disease
pre-existing hearing loss
active herpes/ mycobacterial infection
myasthenia gravis
parkinson’s
lactation

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30
Q

What kind of disease is myasthenia gravis

A

autoimmune disease → a lot of diff drugs people Dx cannot take b/c it makes Sx worse
-Hard to treat

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31
Q

What formulation of aminoglycosides requires drug monitoring?

A

IV administration

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32
Q

List examples of aminoglycosides

A

Gentamycin (IV, IM, topical → prototype)
Tobramycin (IV, IM, topical, nebulizer)
Neomycin (PO, topical)
Amikacin
Streptomycin (IM)

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33
Q

List some adverse effects of aminoglycosides

A

Nephrotoxicity
Ototoxicity
CNS
GI tract
Cardiotoxicity

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34
Q

What are important labs to monitor to prevent nephrotoxicity when using aminoglycosides?

A

BUN/ Creatinine
LFTs

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35
Q

List drug-drug interactions of aminoglycosides

A

Penicillins & Cephalosporins
Diuretics
Anesthetics

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36
Q

What is the the suffix for aminoglycosides?

A

“mycin”

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37
Q

Cephalosporins are ____ ____ Abx

A

beta lactam

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38
Q

What Abx are cephalosporins similar to?

A

Penicillins

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39
Q

Cephalosporins are both ____ & ____ depending on dose & specific drug

A

bactericidal & bacteriostatic
kill of bacteria or stop microorganism from dividing

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40
Q

What spectrum Abx are cephalosporins?

A

broad spectrum

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41
Q

Cephalosporins are used for Tx of what kind of infections?

A

Skin; urinary; respiratory infections

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42
Q

Contraindications of Cephalosporins

A

Known allergies
An allergy to PCN
Hepatic / Renal impairment
Pregnant or lactating patients

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43
Q

First generation cephalosporins

A

Oldest
effective against gram (+) bacteria → i.e. staph aureus & streptococcus
can treat some gram (-) bacteria → i.e. E. coli & klebsiella
Used for skin infections, UTI, strep throat

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44
Q

List examples of first generation cephalosporin drugs

A

Cefadroxil
Cephalexin (Keflex)

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45
Q

Second generation Cephalosporins

A

Work on same bacteria as 1st generation as well as H. influenzae (gram (-))
Issues with resistance in URIs

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46
Q

List examples of 2nd generation Cephalosporin drugs

A

Cefaclor (prototype)
Cefoxitin
Cefprozil
Cefuroxime

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47
Q

Third generation Cephalosporins

A

Effective against previously mentioned gram (+) but MORE effective against gram (-)

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48
Q

List 3rd generation Cephalosporin drugs

A

Cefdinir (oral)
Cefotaxime (IV)
Cefpodoxime (oral)
Ceftazidime (IV)
Ceftriaxone (IV, IM)

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49
Q

What generations of cephalosporins are more likely to cross through CSF & BBB to Tx infection?

A

Fourth & fifth generation

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50
Q

Fourth generation Cephalosporins

A

Active against both gram (+) & gram (-) organisms
Only available for IV admin

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51
Q

Fourth generation cephalosporins are saved to Tx what kind of infections?

A

Hard to treat infection → i.e. MRSA

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52
Q

List an example of 4th generation Cephalosporin

A

Cefepime (maxipime)

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53
Q

Fifth generation Cephalosporins

A

Has broad spectrum activity against many resistant bacteria → i.e. MRSA & VRSA)

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54
Q

List an example of a 5th generation Cephalosporin

A

Ceftaroline

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55
Q

What is the prefix for Cephalosporins?

A

“cef”

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56
Q

What is the most common adverse effect of Cephalosporins?

A

GI tract → from superinfection can cause C. diff

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57
Q

Can Cephalosporins treat C. diff?

A

NO → cephalosporins can cause C. diff but not treat it

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58
Q

List some other adverse effects of Cephalosporins

A

CNS
Nephrotoxicity
Superinfections

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59
Q

What are some superinfections caused by Cephalosporins?

A

C. diff
Vanco resistant enterococci (VRE)
Klebsiella pneumoniae
β-lactam resistant acinetobacter species

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60
Q

Patients prescribed cephalosporins IV or IM are at increased risk for…

A

Phlebitis at IV site
Abscess at IM site

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61
Q

What should be done to decrease risk of phlebitis & abscesses when giving cephalosporins IV or IM?

A

Make sure IV site does NOT infiltrate
Use Z track method if giving IM

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62
Q

What location should be used when giving cephalosporins IM?

A

deep gluteal (ventrogluteal)

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63
Q

List drug-drug interactions of Cephalosporins

A

Aminoglycosides
Anticoagulants
Alcohol (ETOH)

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64
Q

Carbapenems are _____ _____ Abx

A

broad spectrum

65
Q

What type of bacteria are Carbapenems effective against?

A

Both gram (+) & gram (-) bacteria

66
Q

Are Carbapenems bactericidal or bacteriostatic?

A

Bactericidal → kills off bacteria

67
Q

Carbapenems are reserved for what type of patients?

A

Patients with highly resistant bacteria such as:
-Complicated UTIs
-Pneumonia
-Certain forms of sepsis

68
Q

List the contraindications of Carbapenem use

A

Known allergies
Seizure disorders
Meningitis
Lactating clients
Renal impairment

69
Q

What should be monitored in patients with renal impairment taking Carbapenems?

A

BUN & creatinine

70
Q

List the routes of administration of Carbapenems

71
Q

List the medications considered to be carbapenems

A

Ertapenem (prototype)
Doripenem
Imipenem-cilastin
meropenem

72
Q

List adverse effects of Carbapenems

A

GI tract
Superinfections → causes C. diff
CNS

73
Q

List drug-drug interactions of Carbapenems

A

Valproic acid
Ganciclovir

74
Q

What can happen to a patient on anti-seizure medication if they take a Carbapenem?

A

It can contraindicate & actually cause seizures

75
Q

Fluoroquinolones are ___ ___ Abx

A

Broad spectrum

76
Q

What do Fluoroquinolones interfere with?

A

DNA synthesis

77
Q

What type of bacteria do Fluoroquinolones treat?

A

Used in gram (-) bacteria; but can also be used for gram (+) bacteria

78
Q

What type of infections are Fluoroquinolones used to treat?

A

Urinary & respiratory infections → i.e. E. coli UTI
Anthrax
Typhoid fever

79
Q

List Fluoroquinolone drugs

A

Cirpofloxacin (PO, IV, topical → prototype)
Gemifloxacin (PO)
Moxifloxacin (PO)
Levofloxacin (PO, IV → common)
Ofloxacin (topical, PO)
Finafloxacin (ear)

80
Q

What fluoroquinolone is the drug of choice if exposed to anthrax?

A

Ciprofloxacin

81
Q

What is anthrax?

A

A rare but serious infection; typically found in animals (such as livestock); soil; & contaminated meat

82
Q

What is the suffix for Fluoroquinolones?

A

“floxacin”

83
Q

What are the black box warnings of fluoroquinolones?

A

Tendonitis & achilles tendon rupture
CNS effects
Peripheral neuropathy
Make Myasthenia Gravis worse
Possible Increased risk for AAA

84
Q

Fluoroquinolone black box warning:

Tendonitis & achilles tendon rupture risk in increased when…

A

increased with steroid use
Occurs more in older adult population

85
Q

List adverse effects of Fluoroquinolones

A

QT prolongation (cardiac effects)
Hypoglycemia in DM
Photosensitivty
GI effects
Immunologic effects

86
Q

How can you monitor for cardiac effects in patients taking Fluoroquinolones?

A

Look for EKG changes

87
Q

Cardiac effects from use of Fluoroquinolones could lead to…

A

Cardiac arrest or death

88
Q

Why is it important to keep a really close eye on DM patients taking Fluoroquinolones?

A

Risk for hypoglycemia → blood glucose levels can drop fast

89
Q

Contraindications of Fluoroquinolones

A

Pregnant & lactating patients
Children under 18 → possible cartilage damage

90
Q

What do Macrolides interfere with?

A

Protein synthesis

91
Q

Macrolides are ____ ____ Abx

A

Broad spectrum

92
Q

Are Macrolides bactericidal or bacteriostatic?

A

Bacteriostatic → stop microorganism from dividing

93
Q

What type of bacteria are Macrolides effective against?

A

Gram (+) bacteria

94
Q

List the gram (+) bacteria Macrolides are effective against

A

Streptococcus pneumoniae
Legionella
Listeria
Lyme’s disease
Sinusitis
STIs

95
Q

What class of Abx has an increasing resistance due to overuse?

A

Macrolides

96
Q

List the drugs classified as Macrolides

A

Azithromycin
Clarithromycin
Erythromycin (prototype)
Fidaxomicin

97
Q

Macrolides should be used with caution in what type of patients?

A

Patients with hepatic dysfunction
important to monitor LFTs

98
Q

Macrolides are often used as an alternative to what Abx?

A

Penicillins → for patients with allergies & can be used to Tx pneumonia

99
Q

List drug-drug interactions of Macrolides

A

Anticoagulants
Antacids
Digoxin toxicity

100
Q

List adverse effects of Macrolides

A

QT interval prolongation
GI tract effects
CNS
Superinfections
Hypersensitivity

101
Q

Prolongation of QT interval from Macrolide use can lead to

A

Life threatening arrhythmias

102
Q

What is important to teach patients about taking Macrolides to prevent GI effects?

A

They need to be taken on an empty stomach (1 hr before eating or 2-3 hrs after)

103
Q

Macrolide use increases the risk of developing what superinfection?

104
Q

Sulfonamides (sulfa drugs) inhibit ____ ____ ____

A

folic acid synthesis

105
Q

Sulfonamides are precursors of ____ & ____

106
Q

Sulfonamides are effective against what type of bacteria?

A

Both gram (+) & gram (-) bacteria

107
Q

Why are sulfonamides no longer used often?

A

Due to resistance

108
Q

Sulfonamides are used to Tx what infections?

A

UTIs
Skin infections
MRSA
STIs

109
Q

List sulfonamide drugs

A

Sulfasalazine
Sulfamethoxazole → trimethoprim (bactrim)
Cotrimoxazole (septra) → prototype

110
Q

Sulfasalazine carried by ____ _____ _____

A

amino salicylic acids

111
Q

Contraindications of sulfonamides

A

Teratogenic → use cautiously in pregnant women
Allergies to sulfa drugs
Use with caution in pts with renal impairment

112
Q

What age group should not use Sulfonamides?

113
Q

Adverse effects of sulfonamides

A

GI tract effects
Renal → monitor BUN/ creatinine
CNS
Hypoglycemia → caution in Diabetics
Bone marrow depression
Skin reactions

114
Q

List some skin reactions caused by sulfonamides

A

Photosensitivity
Rash/ itching (common)
Steven-Johnson’s syndrome

115
Q

List 4 things that are important to monitor for patients taking sulfa drugs

A

I & O
BUN/ Creatinine
Glucose levels

116
Q

What is an important teaching factor for someone taking sulfa drugs?

A

Teach to take medication w/ at least a cup of fluid (8 oz)

117
Q

Lis drug-drug interactions of Sulfonamides

A

Many diabetic meds
Cyclosporine
Warfarin

118
Q

Tetracyclines work by affecting…

A

protein synthesis

119
Q

Tetracyclines are ____ ____ Abx

A

Broad spectrum

120
Q

What type of bacteria are Tetracyclines effective against?

A

Both gram (+) & gram (-) bacteria

121
Q

List some common infections tetracyclines would be prescribed to treat

A

Infections in skin (acne)
Upper respiratory (sinusitis; atypical pneumonia)
STIs
Lyme’s disease
MRSA
Traveler’s diarrhea

122
Q

List drugs in tetracycline class of Abx

A

Demeclocycline (PO)
Doxycycline (IV, PO)
Minocycline (IV, PO)
Tetracycline (PO, topical) → prototype

123
Q

What is the suffix for tetracycline drugs?

A

“Cycline”

124
Q

Contraindications of Tetracyclines

A

Allergies to Tetracycline
Pregnant & lactating clients
Children under 8

125
Q

What is the biggest contraindication of Tetracycline use?

A

Taking in children under 8 → can damage teeth & bones & impact a child’s growth

126
Q

Adverse effects of Tetracyclines

A

GI tract effects
Hepatotoxicity
Skeletal (bone growth & mineralization)
Skin
Superinfections
Hematologic
Local effects
Hypersensitivity

127
Q

List drug-drug interactions of Tetracyclines

A

Penicillins
Digoxin

128
Q

Absorption of Tetracycline is affected when taking

A

Calcium
Magnesium
Zinc
Iron
Bismuth
Food or dairy products

129
Q

What is important teaching of Tetracycline administration?

A

They should be taken on an empty stomach → can block absorption

130
Q

What is the drug class of clindamycin?

A

Lincosamides

131
Q

Clindamycin interferes with _____ _____ _____

A

Bacterial protein synthesis

132
Q

What type of bacteria is Clindamycin effective against?

A

gram (+) bacteria

133
Q

List infections Clindamycin is used to treat

A

Staph infections (MRSA)
Strep infections
Anaerobes
Bacterial Vaginosis

134
Q

Clindamycin is used when there is an allergy to what Abx?

A

Penicillins or Cephalosporins

135
Q

Clindamycin is a ____ ____ Abx

A

Broad spectrum

136
Q

What Abx is saved to use when no other Abx will do the job?

A

Clindamycin

137
Q

Adverse effects of Clindamycin

A

Severe GI effects → fatal pseudomembranous colitis
Increased risk for C. diff

138
Q

What drug class is vancomycin?

A

Glycopeptide Abx

139
Q

Is Vancomycin a Strong or weak Abx?

A

Very very strong

140
Q

What does vancomycin cause?

A

Cell death by disrupting the bacterial membrane

141
Q

Vancomycin is effective against treating…

A

gram (+) bacteria → MRSA
C. diff
Endocarditis

142
Q

How is Vancomycin usually administered?

A

Intravenously

143
Q

What is the one exception where Vancomycin must be given orally?

A

To treat C. diff

144
Q

Contraindications of Vancomycin

A

pregnant or lactating clients

145
Q

Adverse effects of Vancomycin

A

GI tract effects
Nephrotoxicity
Ototoxicity
Phlebitis

146
Q

Why must we monitor drug levels & infuse slowly when giving Vancomycin?

A

To prevent Red Man Syndrome

147
Q

What does Red Man Syndrome have to do with?

A

The release of Histamine → triggered by stimulation of mast cells causing blood vessels to dilate & causing redness

148
Q

Is Red Man Syndrome an allergy?

A

No → not technically an allergic reaction

149
Q

How long should Vancomycin be run for to prevent Red Man syndrome?

A

An hour or more

150
Q

How often is Vancomycin typically given?

A

Every 8-12 hours

151
Q

What drug class is Metronidazole (Flagyl)?

A

Nitroimidazole

152
Q

Is Metronidazole a Broad spectrum Abx?

A

Not necessarily → more specific

153
Q

List a type of infection Metronidazole can be used to treat

A

Lower respiratory infections

154
Q

List some bacterias Metronidazole is effective against

A

Anaerobic bacterial infections
Amebiasis
Protozoal infections
H. Pylori infection
Trichomoniasis
Pseudomembranous colitis (C. diff)

155
Q

Ideally a patient with what type of impairment should not take Metronidazole?

A

Liver impairment → or use with caution

156
Q

List adverse effects of Metronidazole

A

GI effects
Headaches
Dry mouth
Steven Johnsons syndrome
Disulfiram-like reaction

157
Q

Described a Disulfiram-like reaction from taking Metronidazole

A

If someone drinks alcohol while on Flagyl they will have very intense/ very violent vomiting
can least up to 48 hrs after stopping the medication

158
Q

What can a Disulfiram-like reaction from Metronidazole lead to

A

SOB; sweating; Chest pain → which can all lead to dehydration

159
Q

List drug-drug interactions of Metronidazole

A

Warfarin → anticoagulant
NO ALCOHOL!!!

NUR516 (30 decks)

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