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Pharm > Antibiotics Affecting Bacterial Cell wall minus Penicillin > Flashcards

Antibiotics Affecting Bacterial Cell wall minus Penicillin Flashcards

1
Q

Monobactams

A 
axetreonam (Azactam)
Given if allergic to PCN
Given IV or IM, check IV site frequently for thrombophlebitis
Eliminated by kidneys
Half-life is prolonged in renal failure
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2
Q

Monobactams/axetreanam (Azactam) MOA

A

Inhibits cell wall synthesis

Works on gram negative bacteria

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3
Q

Cautions with Monobactams/axetreanam (Azactam)

A

Renal infufficiency

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4
Q

Adverse effects with Monobactams/axetreanam (Azactam)

A

Thrombophlebitis - check IV site

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5
Q

Nuring implications/Education for Monobactams/axetreanam (Azactam)

A

If patient is not eating well - find out if taste has changed
Encourage patient to eat
Monitor BUN and creatinine - get baseline before treatment
If patient complains about burning, slow rate by 5 mL/hr or place ice pack over IV site

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6
Q

Carbapenems - drugs ending in “penem”

A

imipenem + cilastatin (Primaxin)
ertapenem (Invanz)
meropenem (Merrem)

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7
Q

imipenem + cilastatin (Primaxin)

A

deactivated by enzyme in kidneys quickly

the cilastatin inhibits the enzyme

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8
Q

ertapenem (Invanz)

A

Highly protein bound
No liver metabolism
Excreted by kidneys

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9
Q

meropenem (Merrem)

A

Little protein binding
No metabolism
Renally excreted

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10
Q

Broad spectrum

A

Gram positive
Gram negative
Anaerobic
Resistant to beta-lactamase

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11
Q

MOA of broad specrtum

A

Inhibits wall synthesis

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12
Q

Adverse effects of broad spectrum

A 
Seizures
Cross reactivity with PCNs - space out when give each
Rash
Seizures
Diarrhea
N/V
Edema
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13
Q

Drug interactions with broad spectrum

A

Cross reactivity with PCN

Works synergistically with aminoglycosides but need to be separated when giving

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14
Q

Cephalosporins - drugs beginning with “Cef”

First generation

A 
cefazolin, cefadroxil, cephalexin
Gram positive
Some gram negative
Some anaerobic
Little resistance to beta lactamase
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15
Q

Second generation Cephalosporins

A

cefaclor, cefuroxime, cefoxitin
Increased gram negative
More beta resistance

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16
Q

Third generation Cephalosporins

A

ceftriaxone, ceflazidime
Extended gram negative
even more beta resistance

17
Q

Fourth generation Cephalosporins

A

cefepime
Most gram negative coverage
Most resistant to beta lactamase

18
Q

Fifth generation Cephalosporins

A

ceftaroline (Teflano), ceftobipole (Zeftera)
Mainly targets resistant bacteria
Mainly MRSA

19
Q

If allergic to PCN, most likely allergic to cephalosporins

A

True “kissing cousins”

20
Q

Kinetics of Cephalosporins

A 
Widely distributed in body water
3rd, 4th, 5th generations have good CSF penetration (good for meningitis)
Most excreted unchanged by kidney
ceftriaxone excreted hepatically
Half-lives are short
21
Q

MOA of Cephalosporins

A

Similar to PCNs in structure
Inhibition of cell wall synthesis, causing weakened wall that will swell and burst
Also beta lactam antibiotics
bactericidal

22
Q

Adverse effects of Cephalosporins

A

Hypersensitivity - cross reactivity with PCN
Thrombocytopenia
Rash
GI upset
Superinfection due to normal flora destroyed
Can alter blood clotting times = increase risk of bleeding especially in high doses

23
Q

Cautions of Cephalosporins

A 
Kidney patients (hard on kidneys)
Look at BUN and Creatinine levels
24
Q

Drug interactions

A

Aminoglycosides - risk for nephrotoxicity
Oral Anticoagulants - increased risk for bleeding
Probenicid - like PCN, may prolong effects
Alcohol - especially in earlier generations
- flushing, SOB, N/V, chest pains confusion, dizziness, seizures, headache
- Read OTC labels

25
Q

Tricyclic Glycopeptides

A 
Pretty toxic, usually given as last resort tx
vancomycin (P)
telavancin (very expensive)
Gram positive
Good for MRSA
26
Q

Kinetics of Tricyclic Glycopeptides/Vancomycin

A

Not absorbed orally well
Renally excreted, but PO excreted in feces
Usually given in central line - hard on veins
Always give on pump
If infiltrated = tissue sloughing
Some protein binding
Half-life 4-6 hours
Elderly/renal impairement - half life can be as long as 146 hours.

27
Q

MOA for Tricyclic Glycopeptides/Vancomycin

A

Inhibits cells wall synthesis

Bactericidal

28
Q

Adverse effects of Tricyclic Glycopeptides/Vancomycin

A

Rash, Nephrotoxicity, BBW: ototoxicity (tinnitus, hearing loss, ataxia, vertigo, n/v)
Red man syndrome (histamine release)
Tissue sloughing with IV infiltration

29
Q

Cautions with Tricyclic Glycopeptides/Vancomycin

A

Renal patients
Patients receiving aminoglycosides in conjunction with vanco - used to treat methicillin resistant organisms
- Due to nephrotoxicity
Inflammatory Bowel disease
- PO only
- increases absorption of vanco and increasing risk of toxicity
- Can cause c-diff
Elderly - decreased renal function may put them at risk for toxicity
Metformin - increase risk for lactic acidosis.

Pharm (11 decks)

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