Antibiotics Flashcards
Cephalosporins MOA
Target the bacterial cell wall, and are usually bactericidal, have a beta lactam ring
Cephalosporins first generation ex
Cephalexin, cefazolin
Cephalosporins penicillin cross sensitivity
For people with moderate penicillin allergies
If they went into anaphylactic shock with penicillin, DONT GIVE.
Flouroquinolones ex.
-floxacin
Ciprofloxacin (most common), levofloxacin, moxifloxacin, ofloxacin, gemifloxacin
Flouroquinolones side effects
Achilles’ tendon rupture, photosensitivity, nausea, diarrhea, headache, abdominal pain or discomfort, dizzines, superinfections
Flouroquinolones DON’Ts
Children younger than 18, pregnancy (cat C), patients whose lifestyles don’t allow for adherence to precautions regarding photosensitivity
Lincosamides ex
-mycin: lincomycin, clindamycin, pirlimycin
Lincosamides use
Serious infections where penicillin and erythromycin don’t work, gram positive and negative
Lincosamides MOA
Inhibit protein synthesis by disrupting functional ability of ribosomes
Lincosamides reactions
Abdominal pain, esophagitis, blood dyscrasias, skin rash, pseudomembranous colitis
Lincosamides DON’Ts
Infants younger than 1 month, taking cisapride or pimozide, with minor bacterial or viral infections
Tetracyclines ex
-cycline: tetracycline and doxycycline
Tetracyclines MOA + fact
Block protein synthesis, and really bad if expired, bacteriostatic, resistance is an issue
Tetracyclines side effects
epigastric distress, stomatitis, sore throat, skin rashes, photosensitivity
Tetracyclines DON’Ts
give to kids under 9, give to pregnant women (cat D), lactating, yellow-gray-brown teeth
Penicillin and aminopenicillins ex
-illin: penicillin, ampicillin, amoxicillin
Penicillins and aminopenicillins facts
Allergy is common, susceptible to resistance, works with gram + only
Penicillins and aminopenicillins MOA
Disrupting cell wall
Aminoglycosides ex
-micin/-mycin: Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin (GNATS) + kanamycin+ paromycin
Aminoglycosides MOA
Block protein synthesis by blocking the ribosome from reading the mRNA
Aminoglycosides fact
Very toxic and potent
Aminoglycosides serious adverse effects
Renal toxicity, ototoxicity, tinnitus, must monitor peak and trough, neurotoxicity
Macrolides ex
-thromycin: azithromycin, clarithromycin, erythromycin, (ACE), +telithromycin
Macrolides MOA
Change protein synthesis, can be bacteriostatic or bactericidal
Macrolides side effects
abdominal pain and cramping, GI distress (ex. C. Diff. Colitis)
Sulfonamides MOA
Stops bacteria from reproducing, inhibit the activity of folic acid in bacterial cell metabolism
Sulfonamides ex
Sulf-
Oral: sulfisoxazole, sulfamethizole, sulfasalazine
Topical: silver sulfadiazine, mafenide, sulfanilamide, sulfacetamide
Sulfonamides indications
UTIs, acute otitis media, ulcerative colitis
Sulfonamides aren’t effective on
Don’t kill group A strep
Sulfonamides DON’Ts
Lactation, children younger than 2, not near end of term pregnancy (cat D)
Sulfonamides side effects
anorexia, abdominal pain, stomatitis, chills, fever, crystalluria, photosensitivity
Aplastic anemia
Blood disorder caused by the damage to the bone marrow resulting in a marked reduction in the number of red blood cells and some white blood cells
Bactericidal
Drug or agent that kills or destroys bacteria
Bacteriostatic
Drug or agent that slows or retards the multiplication of bacteria
Crystalluria
Formation of crystals in the urine
Leukopenia
Decrease in the number of leukocytes (white blood cells)
Pruritus
Itching
Stevens-Johnson syndrome (SJS)
Fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes and ayes, the lesions appear as red wheals or blisters, often starting on the face, in the mouth, or on the lips, neck and extremities
Thrombocytopenia
Decreased number of platelets in the blood
Toxic epidermal necrolysis (TEN)
Toxic skin reaction with sloughing of skin and mucous membranes
Urticaria
Hives, itchy wheals on the skin resulting from contact with or ingestion of an allergenic substance or food
Mafenide indications
2nd and 3rd degree burn
Silver sulfadiazine indications
2nd and 3rd degree burns
Signs of an allergic reaction to sulfonamides
Urticaria, pruritus, generalized skin eruption, TEN, or SJS
Topical sulfonamides side effects
Burning, rash, itching, edema, urticaria
Silver sulfadiazine side effects
Burning, rash, itching
Hematologic side effects with prolonged sulfonamide therapy
Leukopenia, thrombocytopenia, aplastic anemia
What can occur if sulfonamides are given near the end of pregnancy
Significantly high blood drug levels, it can cause jaundice or hemolytic anemia in the infant
Sulfonamides precautions
Renal impairment, hepatic impairment or bronchial asthma, pregnancy cat C, except at end of term (cat D)
Sulfonamide interactions
Increased action of oral anticoagulants, methotrexate increased bone marrow suppression, and increase serum level of hydantoins
What to do if diabetic patients are given sulfonamides
Asses fro a possible hypoglycemic reaction
How to prevent crystalluria with sulfonamides
Increase fluid intake to over 2000 mL per day
Sulfasalazine side effects
May cause skin and urine to turn orange-yellow
Sulfadiazine sudeeffects
Chills, fever, anorexia, crystaluria, stomatitis, urticaria, pruritus, SJS
Beta lactam ring
Portion of the penicillin drug molecule that can break a bacterial cell wall
Cross sensitivity
Allergy to drugs in the same or related groups
Culture and sensitivity test
Culture if bacteria to determine to which antibiotic the microorganism is sensitive
Glossitis
Inflammation of the tongue
Malaise
Discomfort, uneasiness
Methicillin resistant staphylococcus aureus (MRSA)
Bacterium that is resistant to methicillin
Nephrotoxicity
Damage to the kidneys by a toxic substance
Otitis media
Infection of the middle ear
Pathogens
Disease producing microorganisms
Penicillinase
Enzyme produced by bacteria that deactivates penicillin
Perioperative
Pertaining to the preoperative, intraoperative, or postoperative period
Phlebitis
Inflammation of a vein
Prophylaxis
Prevention
Pseudomembranous colitis
Sever, life threatening form of diarrhea that occurs when normal flora of the bowel is eliminated and replaced with Clostridium difficile (C. diff) bacteria
Thrombophlebitis
Inflammation of a vein with clot formations
4 groups of penicillins
Natural penicillins, penicillinase resistant penicillins, aminopenicillins, and extended spectrum penicillins
Beta lactamase inhibitors ex
Clavulanic acid, sulbactam, and tazobactam
Beta lactamase inhibitors MOA
Bind with the penicillin and protect it from destruction
Penicillins beta lactamase inhibitors combinations
Augmenting, unasyn, zosyn
Augmentin Combo
Amoxicillin and clavulanic acid
Unasyn combo
Combination of ampicillin and sulbactam
Zosyn combo
Combo of piperacillin and tazobactam
Penicillins infectious disease use
UTIs, septicemia, meningitis, intra-abdominal infections, STIs (syphilis), pneumonia and other respiratory infections, prophylaxis in patients with viral infections
What is used as initial therapy for any suspected staphylococcal infection
Penicillinase resistant penicillins
Penicillin side effects general
Glossitis, stomatitis, gastritis, nausea, vomiting, diarrhea, abdominal pain, furry tongue
Penicillin side effects IM
Pain at injection site
Penicillin side effects IV
Vein irritation and phlebitis
Penicillin allergic reactions
Skin rash, urticaria, sneezing, wheezing, pruritus, bronchospasm, laryngospasm, angioedema, hypotension, signs and symptoms resembling serum sickness (chills, fever, edema, joint and muscle pain, malaise)
Penicillin severe adverse reactions
Anemia, thrombocytopenia, leukopenia, bone marrow depression
Penicillin contraindications
History of allergy to penicillin or cephalosporins
Penicillin precautions
Renal disease, asthma, bleeding disorders, GI disease, pregnancy (cat C), lactation (may cause diarrhea or candidiasis in infant)
Penicillin interactions
Decreased effectiveness of oral contraceptives with ampicillin or penicillin V, tetracyclines decrease effectiveness of penicillins, anticoagulants increase risk of bleeding with large doses of penicillins, beta blockers increase risk for an anaphylactic reaction
First vs 4th generation cephalosporins
Progression form 1st to 4th shows an increase in sensitivity to gram negative and a decrease in sensitivity to gram positive
Cephalosporins 2nd generation ex
Cefaclor, cefoxitin, cefuroxime, cefotetan, cefprozil
Cephalosporins 3rd generation ex
Cefoperazone, cefotaxime, ceftriaxone, cefdinir, cefditoren, ceflixime, cefpodoxime, ceftazidine, ceftibuten
Cephalosporins 4th generation ex
Cefepime
Cephalosporins fifth generation ex
Ceftaroline, ceftobiprole
Cephalosporins uses
Respiratory infections, otitis media, bone and joint infections, complicated interabdominal or genitourinary tract infections, primary drug in post sexual assault medication protocols
Cephalosporins GI adverse reactions
Nausea, vomiting diarrhea
Cephalosporins general reactions
Headache, dizziness, malaise, heartburn, fever, nephrotoxicity, aplastic anemia, toxic epidermal necrolysis, bacterial or fungal superinfection (pseudomembranous colitis)
Cephalosporins hypersensitivity signs
Pruritus, urticaria, skin rashes, SJS, hepatic and renal dysfunction
Cephalosporins side effects IM
Pain, tenderness and inflammation at the injection site
Cephalosporins IV reactions
Phlebitis or thrombophlebitis along the vein
Cephalosporins precautions
Renal disease, hepatic impairment, bleeding disorder, pregnancy (cat B), and known penicillin allergy
Cephalosporins interactions
Aminoglycosides increase risk for nephrotoxicity, oral anticoagulants increase risk for bleeding, loop diuretics increase cephalosporins blood level, alcohol
Carbapenems MOA
Inhibit synth is of the bacterial cell wall and cause the death of susceptible cells
Vancomycin synthetic derivative drugs
Televancin, and oritavancin
Vancomycin MOA
Act against gram positive bacteria, and inhibit bacterial cell wall synthesis, and increase cell wall permeability
Monobactams MOA
Inhibit cell wall synthesis
Monobactam ex
Aztreonam
Meropenem use
Intro abdominal infections and bacterial meningitis
Imipenem-cilastatin use
Serious infections, endocarditis, and septicemia
Doripenem use
Intra-abdominal and complicated UTIs cause ny bacteria
Televancin use
Complicated skin and skin structure infections
Oritavancin use
Complicated skin and skin structure infections
Vancomycin use
Treatment of serious gram positive infections that don’t respond to treatment with other anti invectives, treating anti infective associated pseudomembranous colitis
Monobactams use
Gram negative bacteria
Carbapenems side effects
Access or phlebitis at the injection site
Vancomycin side effects
Nephrotoxicity and ototoxicity (especially in patients with pre-existing kidney disease), chills, fever, urticaria, sudden fall in blood pressure with parenteral administration
Carbapenems contraindications
Allergy to cephalosporins and penicillin, and renal failure
Aztreonam contraindications
Allergy to cephalosporins and penicillins, and renal failure
Televancin contraindications
Allergy to cephalosporins, and penicillins, and renal failure
Carbapenems precautions
Children under 3 months, pregnancy (cat B), lactation, CNS disorders, seizure disorders, hepatic failure
Carbapenems interactions
Carbapenems excretion inhibited with use of probenecid
Televancin precautions
Children younger than 3 months, pregnancy (cat B), lactation
Aztreonam precautions
Children younger than 3 months, pregnancy (cat B), lactation, hepatic and renal impairment
Vancomycin precautions
Renal or hearing impairment, pregnancy (cat C), lactation
Vancomycin interactions
Additive effects with other ototoxic and nephrotoxic Drugs, anticoagulants increase risk of bleeding
1st generation cephalosporins side effects
Superinfection, nephrotoxicity, Headache, SJS, pseudomembranous colitis
2nd generation cephalosporins side effects
Nephrotoxicity, headache, hematologic reactions
3rd generation cephalosporins side effects
Same as 2nd generation
4th generation cephalosporins side effects
Same as 2nd generations
Carbapenems ex
Doripenem, ertapenem, imipenem-cilastatin, meropenem
Ceftobiprole side effects
Taste changes
Blood dyscrasias
Abnormality if blood cell structure
Enteric coated
Special coating on the drug that prevents absorption until drug reaches small bowel
Helicobacter pylori
Stomach bacterium that causes peptic ulcer
Hematuria
Blood in urine
Hepatic coma
Coma induced by liver disease
Neuromuscular blockade
Acute muscle paralysis and apnea
Apnea
Absence of breathing
Neurotoxicity
Damage to the nervous system by a toxic substance
Ototoxicity
Damage to the organs of hearing by a toxic substance
Proteinuria
Protein in the urine
Vancomycin resistant enterococcus faecium (VREF)
Bacteria resistant to the drug vancomycin
Tetracyclines uses
When penicillin is contraindicated, Rocky Mountain spotted fever, typhus fever, tick fever, intestinal amebiasis, some skin and soft tissue infections, uncomplicated urethral, endocervical, or rectal infections caused by chlamydia trachomatis, severe acne
How to treat helicobacter pylori
Tetracyclines with metronidazole, and bismuth salicylate
Tetracyclines precautions
Impaired renal function, liver impairment
Tetracyclines interactions
Antacids decrease tetracycline effectiveness, oral anticoagulants increase risk of bleeding, decreased effectiveness of oral contraceptives (breakthrough bleeding or pregnancy), increased risk for digitalis toxicity with digoxin
Aminoglycosides uses
Gram negative, reduce bacteria in the bowel during abdominal surgery or hepatic coma (bowel prep)
What aminoglycosides are used in the management of a hepatic coma
Kanamycin, neomycin, and paromycin
Aminoglycosides side effects
Nausea, vomiting, anorexia, rash, urticaria
Nephrotoxicity signs
Proteinuria, hematuria, increase in blood urea nitrogen level, decrease in urine output, increase in serum creatinine levels
Ototoxicity signs
Tinnitus, roaring in ears, vertigo, mild to severe loss of hearing
Neurotoxicity signs
Numbness, skin tingling, circumoral paresthesia, tremors, muscle twitching, convulsions, muscle weakness, and neuromuscular blockade
Aminoglycosides contraindications
Pre-existing hearing loss, myasthenia gravis, Parkinson’s disease, lactation or pregnancy (cat C, except gentamicin, amikacin, neomycin, tobramycin, and kanamycin which are cat D), and long term therapy
Aminoglycosides precautions
Elderly, renal failure, neuromuscular disorders
Aminoglycosides interactions
Cephalosporins increase risk for nephrotoxicity, loop diuretics increase risk for ototoxicity, and pavulon or anectine (general anesthetics) increase risk of neuromuscular blockade
Macrolides uses
Prophylaxis before dental and other procedures in high risk patients allergic to penicillin, gram negative and gram positive, acne vulgaris and skin infections, upper respiratory infections caused by haemophilus influenzae along with sulfonamides
Macrolides contraindications
Pre existing liver disease
Telithromycin side effects
Visual disturbance
Telithromycin contraindications
Taking cisapride or pimozide
Macrolides precautions
Liver dysfunctions, myasthenia gravis,
Azithromycin side effects
QT prolongation
Azithromycin pregnancy cat
B
Erythromycin pregnancy cat
B
Clarithromycin pregnancy cat
C
Telithromycin pregnancy cat
C
Macrolides interactions
Antacids decrease absorption and effectiveness of macrolides, increased serum levels of digoxin, increased risk of bleeding with anticoagulants, increased theophylline serum levels, clindamycin, lincomycin, and chloramphenicol decrease therapeutic activity of macrolides
Lincosamides precautions
History of GI disorders, renal disease, liver impairment, myasthenia gravis
Lincosamides interactions
Antacids decrease lincosamides absorption, and increased action of neuromuscular blocking drugs, possible leading to severe respiratory depression
Daptomycin MOA
Interfere with protein synthesis
Linezolid MOA
Interfere with protein synthesis
Daptomycin use
Complicated skin and skin structure infections and staph aureus infections of the blood
Linezolid use
Skin and skin structure infections caused by MSRA, and treatment of VREF, and healthcare acquired and community acquired pneumonia
Quinupristin/dalfopristin MOA
Interfere with protege synthesis, bacteriostatic
Quinupristin/dalfopristin use
VREF
Quinupristin/dalfoprisitin side effect
Vein irritations
Linezolid contraindications
Pregnancy (cat C), lactating, PKU
Daptomycin contraindications
Pregnancy (cat B), lactation
Quinupristin/dalfopristin contraindications
Pregnancy (cat B), lactation
Linezolid precautions
Bone marrow depression, hepatic dysfunction, renal impairment, hypertension, and hyperthyroidism
Linezolid interactions
Antiplatelet drugs cause increased risk of bleeding and thrombocytopenia, decreased effectiveness of MAOIs, large amounts of food containing tyramine comes with risk of severe hypertension
Daptomycin interactions
Statins cause myopathy with elevated creative phosphokinase levels (CPK)
Daptomycin precautions
Warfarin
Quinupristin/dalfopristin interactions
Increased serum levels of antiretrovirals, antineoplastics, and immunosuppressants, CCBs, benzodiazepines, and cisapride
Tetracyclines administration
Empty stomach
Erythromycin administrations
Empty stomach
Azithromycin administration
Empty stomach
Lincosamides administrations
Empty stomach
Daptomycin side effects
Vein irritation
Linezolid side effects
Headache, insomnia, pseudomembranous colitis
Quinupristin/dalfopristin side effects
Vein inflammation
Extended release
Formulation in which drug is released over time
Superinfections
Overgrowth of bacterial or fungal microorganisms not affected by the antibiotic being administered
Flouroquinolones MOA
Interfering with synthesis of bacterial DNA, bactericidal
Flouroquinolones sues
Gram positive and gram negative, lower respiratory infections, bone and joint infections, urinary tract infections, skin infections, STIs
Who is most likely to develop a super infection while taking antibiotics
Elderly, debilitated, chronically ill, and taking antibiotics for an extended period of time
Symptoms of bacterial superinfections of the bowel
Diarrhea, bloody diarrhea, rectal bleeding, fever, abdominal cramping
Symptoms of fungal superinfections
Lesions of the mouth and tongue, vaginal discharge, or anal or vaginal itching
Who is at the highest risk for tendinitis and tendon rupture when taking flouroquinolones
Older than 60 taking corticosteroids
Flouroquinolones precautions
Diabetes, renal impairment, history of seizures, older patients, patients on dialysis
Flouroquinolones interactions
Increase serum levels of theophylline, cimetidine interferes with elimination of antibiotics, oral anticoagulants increase risk of bleeding, antacids decrease absorption of antibiotics, and NSAIDs increase risk of seizure activity, risk of cardiac arrhythmia when given with drugs increase QT interval
Gemifloxacin side effects
Restlessness, dizziness, confusion, taste changes, sleep disturbances
Metronidazole use
Anaerobic microorganism in bone, skin, CNS, internal body cavity, respiratory system
Metronidazole side effects
Peripheral neuropathy, alcohol interactions
Rifaximin use
Hepatic encephalopathy, irritable bowel syndrome, C. diff infection
Rifaximin side effects
Gas pains