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Pharm Final > Antibiotics and Antifungal > Flashcards

Antibiotics and Antifungal Flashcards

1
Q

Gram positive

A

stain purple; thick cell wall and thick outer capsule

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2
Q

Gram negative

A

stain red; more complex cell wall with a small capsule
with two cell membranes; an outer and inner membrane
- more difficult to treat because drug molecules have
a harder time penetrating the more complex cell wall of gram negative organisms.

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3
Q

Empiric therapy

A

treatment of an infection before
specific culture information has been reported or
obtained

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3
Q

Antibiotics

A

used to treat bacterial infections

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4
Q

Definitive therapy

A

antibiotic therapy tailored to treat
organism identified with cultures

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5
Q

Prophylactic therapy

A

treatment with antibiotics to
prevent an infection, as in intra-abdominal surgery or
after trauma

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6
Q

Subtherapeutic response

A

Signs and symptoms of infection do not improve.

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7
Q

Superinfection

A

can occur when antibiotics reduce or completely eliminate the normal bacterial and fungal flora that are needed to maintain normal function in various organs
i.e. vaginal or pharyngeal
Candida albicans yeast infections or antibiotics acquired diarrhea
becomes a serious superinfection when it causes antibiotic-acquired
colitis, pseudomembranous colitis or C. difficile infection; most common signs are odorous watery diarrhea, abdominal pain and fever.

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8
Q

Secondary infection

A

when another type of
superinfection occurs when a second infection closely follows the initial infection and comes from an external source (as opposed to normal body flora). Example: cough, colds and sore throat are usually viral; if
fever develops suspect bacterial secondary infection i.e viral pneumonia becomes bacterial pneumonia.

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9
Q

Most common severe reactions from antibiotic allergy

A

difficulty breathing; flushing, tachycardia, itching, anxiety
significant rash, hives, or other skin reaction; and
severe gastrointestinal (GI) intolerance

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10
Q

Bactericidal

A

kill bacteria

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11
Q

Bacteriostatic

A

inhibit growth of susceptible
bacteria rather than killing them immediately;
eventually leads to bacterial death

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12
Q

B- lactamase enzyme

A
  • B-lactamase is one way a bacteria can fend off the effects
    of antibiotic
  • can inactivate the antibiotic molecules by opening
    the B-lactam ring (a structural component of the pcn molecule)
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13
Q

Sulfonamides

A
  • One of the first groups of antibiotics
  • Often combined with another antibiotic
  • Combination of 2 drugs i.e. Sulfa combined with trimethoprim causes a
    synergetic effect (stronger effect).
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14
Q

Sulfonamides:
Mechanism of Action

A
  • Bacteriostatic (inhibits the growth of bacteria: does not destroy
    the bacteria but inhibits their growth)
  • Prevent bacterial synthesis of folic acid (B-complex vitamin) required for synthesis of purines and nucleic acid (DNA & RNA)
  • Only affect organisms that synthesize their own folic
    acid
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15
Q

Sulfonamides: Indications

A

-Gram-positive and negative bacteria;

  • Treatment of urinary tract infections; pneumonia; URI
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16
Q

Sulfonamides:
Adverse Effects

A

Common allergic reactions including photophobia and skin rash;

Hemolytic and aplastic
anemia, agranulocytosis,
thrombocytopenia

Superinfection

Convulsions, crystalluria
toxic nephrosis, headache,
neuritis, urticaria, cough

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17
Q

ß- Lactam

A
  • Penicillins
  • Cephalosporins
  • Carbapenems
  • Monobactams
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18
Q

Penicillin

A

B-Lactams
penicillin V or G cloxacillin
amoxicillin
ampicillin
piperacillin/
tazobactam

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19
Q

Penicillins: Mechanism of Action

A

Bactericidal
Enter the bacteria via the cell wall then bind to penicillin-binding protein.
Broad spectrum
* Penicillins do not kill other cells in the body.

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20
Q

Penicillins: Indications

A

Gram-positive and negative; Health care-acquired infections, including pneumonias, intra-abdominal infections and sepsis.

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21
Q

Penicillins: Contraindications and
Concerns

A
  • Usually safe and well-tolerated medications
  • Contraindications
  • Known medication allergy (An allergic reaction to penicillin may also have an allergic reaction to other B- Lactam antibiotics.)
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22
Q

Penicillins: Adverse Effects

A

Nausea, vomiting, diarrhea, abdominal pain

Superinfection

IV penicillin’s are irritating to the veins and contain high amounts of
sodium or potassium. High doses may cause seizures.

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23
Q

Penicillins: Interactions

A
  • Nonsteroidal anti-inflammatory drugs
  • Oral contraceptives
  • warfarin
  • Others/MANY
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24
Q

Cephalosporin

A

B-Lactams
* Semisynthetic antibiotics
* Structurally and pharmacologically related
to penicillins
* Bactericidal action
* Broad spectrum
* Divided into groups according to their antimicrobial activity
- Depending on generation, these drugs may be active against gram-
positive, gram-negative or anaerobic bacteria. They are not active against fungi and viruses.

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25
Q

Cephalosporins:
First Generation used for

A

surgical prophylaxis and for susceptible staphylococcal infections - such as staph infection of the skin

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26
Q

Cephalosporins:
Second Generation

A

 Better gram-negative coverage than first- generation
cephalosporins

cefoxitin:
* Used prophylactically for abdominal or colorectal surgeries
* Also kills anaerobes

cefuroxime:
* Surgical prophylaxis
* Does not kill anaerobes

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27
Q

Cephalosporins:
Third Generation

A

 Most potent group against gram-negative bacteria
 Less active against gram-positive bacteria
 Examples
* cefotaxime sodium
* cefixime
* cefpodoxime proxetil
* ceftizoxime
* ceftazidime
* ceftriaxone

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28
Q

Cephalosporins: 3rd Gen
ceftriaxone sodium

A

IV and IM, long half-life, once-a-day dosing
* Elimination is primarily hepatic
* Easily passes meninges and diffused into cerebrospinal fluid
to treat central nervous system infections

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29
Q

Cephalosporins:
Third Generation

ceftazidime

A
  • IV and IM forms
  • Excellent gram-negative coverage
  • Used for difficult-to-treat organisms such as Pseudomonas
    spp.
  • Excellent spectrum of coverage
  • Resistance is limiting usefulness.
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30
Q

Cephalosporins:
Fourth Generation

A
  • Broader spectrum of antibacterial activity than third-
    generation cephalosporins, especially against gram-
    positive bacteria
  • Uncomplicated and complicated urinary tract
    infection
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31
Q

Cephalosporins:
Adverse Effects

A

Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema

Superinfection

Penicillin cross- sensitivity; Incidence between 1 and 4%.

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32
Q

Carbapenem

A

B-Lactams
* Broadest antibacterial action of any antibiotics to
date

Cross sensitivity to PCN; Must be infused over 60 minutes

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33
Q

Carbapenem Action

A

Bactericidal ( gram + and gram-)
Binds to penicillin-binding proteins inside bacteria, which in turn inhibits bacterial cell wall synthesis.

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34
Q

Carbapenem Uses

A

Reserved for complicated body infections; treatment of severe or high-risk bacterial infections such as multidrug-resistant (MDR) bacterial infections i.e. MRSA

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35
Q

Carbapenem

imipenem/cilastatin (Primaxin®)

A
  • Used for treatment of bone, joint, skin, and soft tissue
    infections; many other uses
  • Cilastatin inhibits an enzyme that breaks down imipenem.
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36
Q

Carbapenem Adverse effects

A

most serious adverse effect is seizures; 1.5% for <500mg q 6hrs and 10% > 500mg q 6hrs

Superinfection

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37
Q

Monobactams

A

4th category of B-lactams
* Primarily active against aerobic gram-negative bacteria (E.
coli, Klebsiella spp., Pseudomonas spp.)
* Bactericidal
* Used for management of cystic fibrosis patients with
chronic pulmonary Pseudomonas aeruginosa infections

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38
Q

Macrolides

A
  • erythromycin (E-Mycin®, many others)
  • azithromycin (Zithromax®)
  • clarithromycin (Biaxin®)
  • fidaxomicin (Dificid®)
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39
Q

most widely used
macrolides

A

Azithromycin and clarithromycin

  • they have longer duration of action, which allows them to
    be given less often.
  • They also produce fewer and milder GI tract side effects than erythromycin.
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40
Q

Fidaxomicin (Dificid)

A
  • the newest macrolide antibiotic.
  • It is indicated only for the treatment of diarrhea associated with Clostridium difficile.
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41
Q

Macrolides:
Mechanism of Action

A

Bacteriostatic
Prevent protein synthesis within bacterial cells
* Bacteria will eventually die
* In high enough concentrations, may also be
bactericidal

42
Q

Macrolides: Indications

A

“Strep” infections

Mild to moderate resp infections
Haemophilus influenza;
Spirochetal infections- Syphilis and Lyme disease;
Gonorrhea; Chlamydia.

43
Q

Fidaxomicin (Dificid) adverse effects

A
  • The most common adverse effects are nausea, vomiting,
    and GI bleed
44
Q

Macrolides: Adverse Effects

A
  • GI effects, primarily with erythromycin
  • Nausea, vomiting, diarrhea, hepatotoxicity, flatulence,
    anorexia, heartburn, abnormal taste.
    • Report immediately, chest pain, palpitations,
      dizziness, jaundice or hearing loss
45
Q

Tetracyclines examples

A
  • doxycycline hyclate (Doxycin®, Vibramycin®, others)
  • minocycline hydrochloride (Minocin®)
  • tigecycline (Tygacil®)
46
Q

tigecycline (Tygacil®)

A
  • Tetracycline
  • indicated for complicated infections, intra- abdominal
    infections, and community acquired pneumonia; the drug should be used only when other treatments are not available.
47
Q

Tetracyclines action

A

Bacteriostatic
inhibit bacterial growth
Inhibit protein synthesis; Bind (chelate) to Ca, Mg and Al ions to form insoluble complexes

48
Q

Tetracyclines nursing considerations

A

Dairy products, antacids, and iron
salts reduce oral absorption of tetracycline; discolors of teeth

  • Strong affinity for calcium precludes use in:
  • Children younger than 8 years of age
  • Results in discoloration/ mottling of permanent teeth
  • Pregnant women and nursing mothers
  • can be another route of exposure leading to tooth discoloration in
    nursing children
  • May stunt fetal skeletal development if taken during
    pregnancy
49
Q

Tetracyclines Uses

A

wide spectrum Gram-negative and gram-positive organisms; acne in adults and adolescents; chlamydia, mycoplasma pneumonia; h.pylori; syphilis; resistant to gonorrhea.

50
Q

Tetracyclines: Adverse Effects

A
  • Alteration of the intestinal flora
  • May also cause:
  • Diarrhea
  • Vaginal candidiasis
  • Gastric upset
  • Enterocolitis
  • Maculopapular rash
  • Other effects photosensitivity, coagulation irregularities and
    hemolytic anemia
51
Q

antibiotic Nursing Interventions

A
  • obtain cultures from appropriate
    sites before beginning antibiotic therapy ( including
    bloodwork- blood cultures).
  • Instruct patients to take antibiotics exactly as
    prescribed and for the length of time prescribed;
    they should not stop taking the medication early
    when they feel better.
  • Watch for for signs and symptoms of superinfection
    or secondary infections: fever, perineal itching,
    cough, lethargy, or any unusual discharge.
  • All oral antibiotics are absorbed better if taken with
    at least 180 mL of water.

Avoid simultaneous use of antacids, antidiarrheal drugs, dairy products, calcium, iron preparations which may reduce the absorption of tetracycline. Consume drug 2 hour before or 3 hour after these.

52
Q

Sulfonamides pt teaching

A
  • Take with 2 000 to 3 000 mL of fluid per 24 hours.
  • Take oral doses with food.
  • Encourage patients to immediately report worsening
    abdominal cramps, stomach pain, diarrhea, hematuria,
    severe or worsening rash, shortness of breath, and fever.
  • Taking 2-3 L. in 24 hrs will prevent drug related crystalluria
53
Q

B- Lactams - Penicillins pt teaching

A
  • Take oral doses with water (not juices) because acidic fluids
    may nullify the drug’s antibacterial action.
  • consumption of probiotics such as lactobacillus supplements or cultured dairy products like yogurt or buttermilk or kefir to prevent normal GI flora killed off causing c-diff
54
Q

B-Lactams- Cephalosporins pt teaching

A
  • give PO with food to decrease GI
    upset even though this will delay absorption.
  • Some of these drugs may cause a disulfiram (acute alcohol
    intolerance)
55
Q

Signs and symptoms of disulfiram (acute alcohol intolerance)

A

stomach cramping, nausea,
vomiting, headache, diaphoresis, pruritus, hypotension

56
Q

Macrolides drug-drug interaction

A
  • will cause severe
    interactions with other protein-bound drugs i.e.
    carbamazepine, cyclosporine, theophyline, warfarin
    sodium.
  • can reduce the efficacy of oral contraceptives.
57
Q

Organisms that produce ESBL

A

are resistant to all B-lactam antibiotics and can be
treated only with carbapenems or sometimes quinolones

58
Q

Aminoglycosides

A

gentamicin
streptomycin
tobramycin
amikacin
paromomycin
neomycin

59
Q

Aminoglycoside action

A
  • Very potent antibiotics with serious toxicities
  • Bactericidal; prevent protein synthesis
  • Kill mostly gram-negative some
    gram-positive bacteria
  • Bactericidal
  • Prevent protein synthesis; Often used in combination with other antibiotics for synergistic effects.
60
Q

Aminoglycoside Uses

A
  • Drug of choice for virulent infections
  • Kill mostly gram-negative bacteria, some
    gram-positive bacteria; Used for certain gram-positive infections that are resistant to other antibiotics such as Enterococcus spp., S. aureus. MRSA, ESBL
61
Q

Aminoglycosides: Adverse
Effects

A
  • drug monitoring required to prevent toxicities
  • Nephrotoxicity; occurs in 5-25% patients and usually reversible.
  • Ototoxicity affects hearing and balance functions (vestibular
    impairment) in 3-14% of patients. Often not reversible such as hearing loss from damage to 8th cranial nerve.

Superinfection

62
Q

Postantibiotic effect (PAE)

A

a period of continued bacterial growth suppression that occurs after short term antibiotic exposure, as in once- daily aminoglycoside dosing. The PAE is enhanced with higher peak drug concentrations and concurrent use of B-lactam antibiotics.

63
Q

Aminoglycosides: Drug toxicity

A

increased when used with other drugs with nephrotoxic
properties such as vancomycin. And the concurrent use of loop diuretics
increases the risk for otoxicity. They reduce GI flora and thus reduce
vitamin K produces. Can potentiate warfarin.

64
Q

Quinolones
(referred to as fluoroquinolones)
Action

A
  • A potent bactericidal broad spectrum antibiotic
  • Bactericidal
  • Alter deoxyribonucleic acid (DNA) of bacteria, causing death
  • do not affect human DNA
65
Q

Quinolones Uses

A
  • S. aureus
  • Effective against gram-negative organisms and some gram-positive organisms;
  • Potent and broad-spectrum for complicated urinary tract, respiratory, bone and joint, gastrointestinal, and skin infections.
  • Serratia marcescens, and Mycobacterium fortuitum
66
Q

Quinolones: Interactions

A
  • Oral quinolones: antacids, calcium,
    magnesium, iron, zinc preparations, or
    sucralfate reduce absorption
    -Patients need to take the interacting drugs at least 1 hour before or after
  • dairy
  • En tube
  • probenecid
  • oral anticoagulants
  • Nitrofurantoin
67
Q

Quinolones: adverse effects

A
  • CNS depression
  • Nausea, vomiting, diarrhea, constipation,
  • oral candidiasis,
  • dysphagia,
  • increased liver function
  • Superinfection
  • rash
  • ruptured tendons
68
Q

Clindamycin Action

A

Bactericidal or bacteriostatic depending on the concentration of the drug at the site of infection and on the infecting bacteria.
It inhibits protein synthesis in bacteria

69
Q

Clindamycin uses

A

Chronic bone infections, genitourinary infections, intra-abdominal infections, other serious infections

70
Q

Clindamycin adverse effects

A

GI including nausea, vomiting, abdominal pain, diarrhea, anorexia

Superinfection i.e.
C. difficile infection-

71
Q

linezolid (Zyvoxam)

A
  • bactericidal
  • inhibits bacterial synthesis
  • new class; used for VRE, MRSA and other Hospital Acquired Infections
72
Q

linezolid contraindications

A

avoid tyramine containing foods; avoid concurrent use with SSRI due to Serotonin Syndrome

73
Q

Metronidazole

A
  • bactericidal
  • interferes with microbial DNA synthesis; similar to quinolones
  • given for C. difficile
  • treatment of choice for protozoal infections such as amebiasis and trichomoniasis
  • Metronidazole- do not chew extended release capsule; avoid alcohol 24hrs before treatment and 36 hrs after last dose
74
Q

Nitrofurantioin action

A

Bactericidal
Interferes with the activity of enzymes that regulate bacterial carbohydrate metabolism and disrupting bacterial cell wall formation

75
Q

Nitrofurantioin uses

A

UTIs

76
Q

Nitrofurantioin Adverse effects/considerations

A

Watch kidney function; drug concentrates in the kidney

Superinfection

Give with fluids, food or milk to reduce GI upset; to prevent tooth staining do not crush tablets

77
Q

Vancomycin

A

Bactericidal antibiotic that is structurally unrelated to any other
commercially available antibiotic
Antibiotic of choice for MRSA infection
Not active against gram-negative bacteria, fungi or yeast.

Must monitor blood levels to ensure therapeutic
levels and prevent toxicity

May cause ototoxicity and nephrotoxicity

78
Q

Vancomycin action

A

Bactericidal
Only gram positive bacteria effective
Binds to bacterial wall, producing immediate inhibition of cell wall synthesis and death. This is different than B-lactam

79
Q

Vancomycin uses

A

Antibiotic of choice for MRSA

Because it is poorly absorbed, the oral route is used for its local effects on the surface of the GI tract infection - Oral vancomycin is indicated for the treatment
of antibiotic-induced colitis (C. difficile) and for
the treatment of staphylococcal enterocolitis.

80
Q

Vancomycin adverse effects

A

Red Man Syndrome- flushing, erythema or itching of the head, face, neck and upper trunk.

  • Superinfection
81
Q

vancomycin nursing considerations

A

Infuse IV slowly to reduce incidence of Red Man Syndrome.
Rapid infusion may also cause low B/P, pain in back and chest, dyspnea
Tough levels done

82
Q

Red Man syndrome

A

flushing, erythema or itching of the head, face, neck and upper trunk area. It is most commonly seen when the drug is infused too rapidly. It can usually be alleviated by giving the infusion of the dose over at least one hour. It is bothersome side effect but not
harmful.

83
Q

Colistimethate sodium (Coly-Mycin)

A

used to treat KPC as its often one of the only drugs available.
- Serious adverse effects includes kidney failure, neurotoxic effects such as, paresthesia, numbness, tinging, vertigo, dizziness and impaired
speech.

84
Q

Aminoglycosides and Vancomycin may cause?

A

ototoxicity or nephrotoxicity

85
Q

Linezolid considerations

A

Assess for concurrent use of SSRI because of drug induced
serotonin syndrome.
Assess for tyramine foods (wine, aged cheese, soy sauce,
smoked fish or meat) because of risk of hypertensive crisis.

86
Q

signs and symptoms of
superinfection

A

fever, perineal itching,
cough, lethargy, or any unusual discharge

87
Q

Fungal infections are also known as

A

mycoses

88
Q

Fungi that cause integumentary infections are known as

A

dermatophytes

Dermatomycoses

89
Q

Moulds

A

 Multicellular
 Characterized by long, branching filaments called hyphae

90
Q

Yeasts

A

 Single-cell fungi
 Reproduce by budding

91
Q

Candida albicans

A

 May follow antibiotic therapy, antineoplastics,
or immunosuppressants (corticosteroids)
 May result in overgrowth and systemic infections
 Growth in the mouth is called thrush or oral
candidiasis.
 Common in newborn infants and
immunocompromised patients

92
Q

Vaginal candidiasis

A

 Yeast infection
 Pregnant women, women with diabetes, women
taking oral contraceptives

93
Q

Polyenes

A

Amphotericin B (systemic)
Nystatin (topical)
(also available with metronidazole-topical or vaginal)

94
Q

Polyenes action

A

Binds to sterols on cell membrane lining of fungi; causes fungal cell death

  • Do not bind to human cell membranes or kill
    human cells
95
Q

Polyenes uses

A

Systemic and topical fungal infections
Nystatin- candidal infections
Amphotericin B is drug of choice for the treatment of many severe systemic fungal infections.

96
Q

fluconazole

A

passes into the cerebrospinal
fluid and inhibits the growth of cryptococcal
fungi; effective in the treatment of
cryptococcal meningitis

97
Q

Amphotericin B Adverse
Effects

A

IV infusion syndrome referred to ‘shake and bake’ syndrome including fever, chills, N&V> B/P, > hr, HA, malaise, muscle and joint pain, anorexia

  • dyssrthymias
  • nephrotoxicity
    tinnitus; visual disturbances;
    paresthesias; convulsions
    Pulmonary infiltrates
98
Q

Amphotericin B Adverse
Effects: Prevention

A
  • Prescribers commonly order various premedications: antiemetics, antihistamines,
    antipyretics, and corticosteroids
  • Prevent or minimize infusion-related reactions to
    amphotericin B
99
Q

fluconazole adverse effects

A

 Nausea, vomiting, diarrhea, stomach pain,
 Increased liver enzymes
 Use with caution in patients with kidney or liver dysfunction

100
Q

nystatin (topical) adverse effects

A

 Nausea, vomiting, anorexia, diarrhea, rash,
urticaria

101
Q

nursing considerations: Triazoles and Imidazoles

A
  • Use with caution in patients with kidney or liver dysfunction
  • For IV dose, if itching or a rash occurs, stop the infusion, take vital signs and report
102
Q

Nystatin nursing considerations

A

dropped directly on the tongue using the calibrated dropper and held in the mouth for as long as possible swish & swallowed.

Pharm Final (7 decks)

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