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nurs 306 > Antibiotics Part 1 > Flashcards

Antibiotics Part 1 Flashcards

1
Q

Sulfonamides include

A 
Sulfamethoxazole-trimethoprim 
Others: 
Sulfamethoxazole
Sulfisoxazole
Sulfadiazine
Sulfamethiozole
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2
Q

Mechanism of Action and Drug Effects: Sulfonamides

A
  • Bacteriostatic (inhibits growth of bacteria)
  • Inhibits folic acid synthesis (folic acid is required for proper synthesis of purines, a chemical component of nuclei can acids)
  • Competitive inhibition (competes with PABA for bacterial enzyme tetrahydropteroic acid synthetase, which incorporates PABA into the folic acid molecule)
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3
Q

Indications for Sulfonamides

A

Broad spectrum: act against gram (+) and (-)
UTI’s
Respiratory Tract Infections
Pneumocystis Jerovecii (HIV associated pneumonia)
Skin and soft tissue infections
Infections due to Staph or MRSA

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4
Q

Contraindications to Sulfonamides

A

Allergy to sulfa
Cyclooxyrgenase-2 inhibitor (Celebrex)
Pregnant women at term and infants younger than 2 months
Sulfite so: preservatives in food, wine, injectable drugs.

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5
Q

Chemical components of folic acid

A

PABA

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6
Q

Adverse Effects of Sulfonamides

A

Allergic Reaction
Stevens Johnson Syndrome, Renal Damage from crystalluria, Kernicterus (bilirubin deposited in infants)
Delay cutaneous reactions, fever followed by rash
Photosensitive try reaction: skin reaction induced by exposure to sunlight, sunburn
Other: mucocutaneous, GI, hepatic, renal and hematologist complications
Immune mediated: involve production of reactive drug metabolites in the body

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7
Q

Interactions of Sulfonamides

A

Sulfonylureas, hypoglycemic effects in diabetes treatment
Phenytoin toxic effects
Warfarin anticoagulant effects hemorrhage
(Increased?) likelihood of cyclosporine-induced nephrotoxicity
(Decreased?)efficacy of oral contraceptives

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8
Q

Assessment of Sulfonamides

A

Drug allergies to sulfa type drugs or sulfites (oral sulfonylureas, thiazides diuretics)
Skin assessment during therapy d/t Stevens-Johnson syndrome
RBC count before therapy d/t possibility of drug related anemias
Renal function d/t potential for drug related crystalluria
Meds and med he for any manifestations of GSPD and slow acetylation.

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9
Q

Implementation of Sulfonamides

A

Avoid in pts w/ G6PD and slow acetylation
Fluids: 2000-3000 mL/24 hrs to prevent crytalluria
Take w/ food to minimize GI upset
Report: worsening abdominal cramps, stomach pain, diarrhea, blood in urine, severe or worsening rash, SOB, fever

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10
Q

Penicillins (PCNs) are divided into 4 subgroups

A
  1. Natural PCNs
  2. Aminopenicillins
  3. Penicillinase-resistant PCNs
  4. Extended spectrum PCNs
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11
Q

Natural PCNs include

A

Penicillin G and V

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12
Q

Aminopenicillins include

A

Amoxicillin

Ampicillin

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13
Q

Penicillinase-resistant PCNs include

A

Nafcillin
Dicloxacillin
Oxacillin
Cloacal lion

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14
Q

Extended spectrum PCNs include

A

Amoxicillin/clavulanic acid
Ampicillin/sulbactam
Ticarcillin/clavulanic acid
Piperacillin/tazobactam

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15
Q

Mechanism of Action and Drug Effects of PCNs

A

Bactericidal (kills a wide variety of gram (+) and some (-)
Inhibits cell wall synthesis -> formation of defective cells walls = cell death from lysis
Doesn’t affect human cells

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16
Q

Beta-Lactam Antibiotics have four major subclasses

A
  1. Penicillins
  2. Cephalosporins
  3. Carbapenems
  4. Monobactams
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17
Q

Beta-Lactam Antibiotics structure and MOA

A

Share a common structure and MOA

Inhibits synthesis of bacterial peptidoglycan cell wall.

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18
Q

Beta Lactamase inhibitors are added to

A

Penicillin AB. Makes drug more powerful against beta Lactamase bacterial strains. (Some bacterial strains produce enzyme: beta lactamase)

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19
Q

Beta Lactamase

A

Resists these antibiotics by breaking the chemical bond of C and N atoms in structure of beta-lactam ring loss of antibacterial efficacy.

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20
Q

Penicillins were first derived from a

A

mold (fungus) seen on bread or fruit

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21
Q

Penicillinases

A

Beta lactamase that inactivates penicillin molecules

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22
Q

Three beta lactamase inhibitors

A

Cleveland acid
Tazobatam
Sulbactam

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23
Q

Natural Penicillin

A

Only 2 in clinical use
Pen G: injectable or IV/IM use
Pen V: PO (tablet & liquid)

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24
Q

Penicillinase-resistant drugs

A

Stable against hydrolysis of staphylococcal Penicillinases

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25
Q

Aminopenicillins

A

has amino group attached

? activity against gram (-) bacteria compared with natural penicillins

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26
Q

Extended spectrum drugs

A

Wider spectra of activity compared to all other penicillins

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27
Q

Combos of Penicillin + Beta-lactamase inhibitors

A

ampi + sulbactam
amoxi + clavulanic acid
ticar + clavulanic acid
pipera + tazobactam

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28
Q

Indications for Penicillins

A
  • to prevent and treat infections caused by gram (+) bacteria (strepto, entero, and staphylo -end coccus
  • for prophylaxis (i.e amoxicillin)
  • extended spectrum penicillins have gram + and - and anaerobic coverage: used in HAI (pneumonia, intraabdominal infections and sepsis)
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29
Q

Contraindications for Penicillins

A

drug allergy: very common, incidence (0.7% - 4%)

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30
Q

Adverse Effects of Penicillin

A

Related to drug allergies/Type 1 hypersensitivity reactions

mostly GI effects such as diarrhea, N/V, taste alterations, oral candidiasis

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31
Q

How does penicillin affect the CNS?

A

causes lethargy, anxiety, depressions and seizures.

32
Q

How does penicillin affect hematologic functions?

A

causes anemia, bone marrow depression and granulocytopenia

33
Q

How does penicillin affect metabolic functions?

A

causes hyperkalemia and hypernatremia

alkalosis

34
Q

How does penicillin affect the skin?

A

causes pruritus, hives and rash.

35
Q

What drugs interact w/ penicillins?

A 
Aminoglycosides (IV) and Clavulanic Acid
Methotextrate
NSAIDs
Oral Contraceptives
Probenecid
Rifampin
Warfarin
36
Q

How does Aminoglycosides and Clavulanic Acid interact with penicillin?

A

Mechanism: Additive
Result: More effective killing of bacteria

37
Q

How does Methotrexate interact with penicillins?

A

Mechanism: ? renal elimination of methotrexate.
Result: ? methotrexate levels

38
Q

How do NSAIDs interact with penicillins?

A

Mechanism: Compete for protein binding
Result: More free and active penicillin

39
Q

How do oral contraceptives interact with penicillins?

A

Mechanism: uncertain
Result: May ? efficacy of contraceptive

40
Q

How does probenecid interact with penicillins?

A

Mechanism: competes for elimination
Result: prolongs effects of penicillins

41
Q

How does rifampin interact with penicillins?

A

Mechanism: inhibition
Result: may inhibit the killing activity of penicillins

42
Q

How does warfarin interact with penicillins?

A

Mechanism: ? vitamin K from gut flora
Result: enhanced anticoagulant effect of warfarin

43
Q

Assessment for Penicillin Administration

A

Determine drug allergies and potential drug interactions
Hx: asthma, allergens, aspirin allergy and sensitivity to cephalosporins
Neuro, abdominal and bowel assessment (electrolyte disturbed, cardiac and renal disease pts.)
Serum Na+ and K+ levels: an ? in levels can exacerbate a patient w/ HF, fluid overload or cardiac dysrhythmias
Don’t always end in cillin; zosyn and augmentin

44
Q

Implementation of penicillin

A

Consumption of probiotics: lactobacillus or dairy products (yogurt, buttermilk, kefir)
Oral: 6oz of water, NOT juices
Penicillin V, amoxicillin and amoxicillin-clavulanate: given w/ water 1 hour before or 2 hours after meals
Procaine and Benzathine salt penicillins (thick): give as ordered IM, 21 gauge
Reconstitute IM imipenem/cilastatin in sterile saline w/ plain lidocaine
Anaphylactic Reaction: give epinephrine or other emergency drugs w/ supportive treatment @ all times(O2)

45
Q

Cephalosporins: First-Generation

A

cefadroxil
cefazolin
cephalexin
cephradine

46
Q

Cephalosporins: Second-Generation

A 
cefactor
ceforetan
cefoxitin
cefprozil
cefuroxime
47
Q

Cephalosporins: Third-Generation

A 
cefdinir
cefditoren
cefixime
cefoperazone
cefotaxime
cefpodoxime
ceftazidime
ceftibuten
ceftizoxime
ceftriaxone
48
Q

Cephalosporins: Fourth-Generation

A

cefepime

49
Q

First Generation Cephalosporin drugs

A

have the most gram (+) coverage, later generations have more gram (-) coverage

50
Q

Anaerobic coverage is found only in

A

second generation drugs

51
Q

Ceftaroline

A

newest cephalosporin
5th generation
broad spectrum and covers gram + and MRSA

52
Q

Cephalosporins are NOT active against

A

fungi and viruses.

53
Q

Mechanism of Action: Cephalosporin

A

Bactericidal
Disrupt bacterial cell wall = lysis and death
Depends on generation, level of coverage increases as generation increases.

54
Q

Cephalosporin Indications

A

moderate to severe infections and choice of drug depends on pathogens and generation

55
Q

Contraindications for Cephalosporins

A

Allergy to cephalosporins and PCNs, renal disease

56
Q

Adverse Effects of Cephalosporins

A

similar to PCNs

57
Q

What drugs interact with cephalosporins?

A

ethanol
antacids, iron
probenecid
oral contraceptives

58
Q

How do cephalosporins interact with ethanol?

A

accumulation of acetaldehyde metabolite ethanol = acute alcohol intolerances after drinking ale, beverage w/in 24 hours of taking cefotetan
symptoms: stomach cramps, N/V diaphoresis, pruritus, headache and hypotension

59
Q

How do cephalosporins interact with antacids and iron?

A

? absorption of certain oral cephalosporins (cefdinir, cefditoren) = ? effectiveness of drug

60
Q

How do cephalosporins interact with probenecid?

A

? renal excretion = ? cephalosporin levels

61
Q

How do cephalosporins interact with oral contraceptives?

A

enhanced OC metabolism = ? risk for unintended pregnancy

62
Q

First Generation cephalosporins

A

Active against gram + and limited activity to gram -.
Parenteral and Oral forms
Cefazolin: for surgical prophylaxis and susceptible staphylococcal infections: (P) form
Cephalexin: (O) form

63
Q

Second Generation Cephalosporins

A

Active against gram + and enhanced activity of gram -.

P/O forms

64
Q

Second Generation Cephalosporin: Cefoxitin

A

-(P) form, used as prophylactic AB in pts undergoing abdominal surgery because it can effectively kill intestinal bacteria

65
Q

Second Generation Cephalosporin: Cephamycins

A

coverage of anaerobic bacteria (cefoxitin and cefotetan)

66
Q

Second Generation Cephalosporin: Cefuroxime

A

prodrug, doesn’t kill anaerobes, little antibacterial activity until hydrolyzed in liver to its active form. (O) form

67
Q

Third Generation Cephalosporins

A

The most potent of the 1st three generations in killing gram - but less active against gram +.
Kills pseudomonas

68
Q

Third Generation Cephalosporin: Ceftriaxone

A

-long acting, once a day, treats most infections
-able to pass through blood brain barrier treating meningitis
-(IV/IM) form
NOT given to hyperbilirubinemic neonates or liver dysfunction pts.

69
Q

Third Generation Cephalosporin: Ceftazidime

A

difficult to treat infections like pseudomonas.

70
Q

Fourth Generation Cephalosporins

A

? activity against enterobacter gram negative and gram positive organisms

71
Q

Fourth Generation Cephalosporins: Cefepime

A

treats complicated/uncomplicated UTIs, uncomp. Skin and skin structure infections and pneumonia

72
Q

Fifth Generation Cephalosporins

A

newest
adjust dose for ? renal function
injectable form

73
Q

Fifth Generation Cephalosporin: Ceftaroline

A

S. aureus MRSA, acute skin and skin structure infections and CAP

74
Q

Cephalosporin Assessment

A

Allergies, allergy to penicillin d/t cross sensitivity

Note generation of cephalosporins; different effects

75
Q

Implementation of Cephalosporins

A

give w/ food to avoid GI upset

avoid alcohol and alcohol containing products - potential disulfiram like reaction (acute alcohol intolerance)

nurs 306 (26 decks)

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