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Pharmacology test 1 > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

Antimicrobial rules 4

A
  1. inhibit microorganisms at [ ]s that are tolerable by host–lowest possible dose
  2. Immunocompromised–BacterialCidal
  3. Narrow spectrum first or combination therapy to preserve normal flora
  4. Prophylactic given no more than 1 hr before incision
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2
Q

Prophylactic abs given in OR…how often?

A

single dose or up to 48hrs

-no proof that this results in emergence of resistant organisms

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3
Q

Abx selection

A
  • *identify organism–essential
  • efficacy depends on drug delivery to site (ex does it cross bbb)
  • usually tx with single drug (but! is pt already on abx?)
  • Route, Duration, Cost
  • hardware
  • Co-morbities (DM, immunosuppressed)
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4
Q

Hypersensitivity

A

independent of dose

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5
Q

Direct drug toxicity

A

dose related

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6
Q

Parturient

A

pregers

  • most abs cross placenta and enter maternal milk
  • Teratogenecity–concern with any drug
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7
Q

Elderly

A

renal impairment

decreased: plasma protein, gastric motility and acidity, liver function/mass
increase: body fat

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8
Q

Penicillin and (gm what and their names)

A 
Bactericidal
gram +  pneumo, meningo, streptococcal
Renal excretion 
*most common for hypersensitivity--anaphylactic, rash/fever
-Ampicillin, Amoxicillin
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9
Q

Ampicillin

A

wider range of activity
Gm neg bacilli–H Flu and E coli
highest incidence of skin rash

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10
Q

Amoxicillin

A

more efficiently absorbed from the GI tract than ampicillin

PO–ear infection

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11
Q

Cephalosporin

A 
Batericidal
Broad spectrum
Renal excretion 
Adverse reaction: allergic--rash 
--anaphylactic reaction 0.02% 
cross sensitivity btwn cephalosporins and PCN but only 8%
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12
Q

Cephalosporin classification

A

increased activity against bacteria as generation increase

1st: cefazolin
2nd: cefoxitin
3rd: cefotaxime

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13
Q

Aminoglycosides

A 
Bactericidal
gram neg
Extensive renal excretion 
--2-3hr elimnation half time Increased 20-40 fold in RENAL FAILURE
adverse reactions:
-ototoxicity
-nephrotoxicity
-skeletal muscle weakness
-prolongs neuromuscular blockade
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14
Q

Aminoglycosides Ototoxicity

A

Vestibular/auditory dysfunction

  • destruction of cochlear sensory hairs
  • does dependent– usually occurs with chronic therapy
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15
Q

Aminoglycosides Nephrotoxicity

A

accumulate in renal cortex-tubular necrosis

  • inability to concentrate urine, proteinuria and RBC casts
  • Reversible–when drug stopped
  • Most nephrotoxic: NEOMYCIN– monitor BUN and creatin
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16
Q

Aminoglycosides Skeletal muscle weakness

A
  • can inhibit PRE junctional release of ACH
  • decreased POST synaptic sensitivity to neurotransmitter
  • Myasthenia graves–uniquely sensitive to weakness
  • *single dose in healthy pt not a problem
  • can give Ca to help
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17
Q

Aminoglycosides Potentiation of neuromuscular (NM) blockade

A
  • high plasma [ ] when given IV
  • systemic absorption from lg volumes of irrigation
  • Reappearance of NM blockage in PACU
  • NM blocking properties of lidocaine are enhanced
  • *neostigmine or Ca induced antagonism may be imcomplete or transient— monitor and use nerve stimulator
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18
Q

Aminoglycosides types 4

A
  • Streptomycin & Kanamycin
  • Limited uses
  • Frequent occurrence of vestibular damage
  • Gentamicin
  • Broader spectrum
  • Toxic level – (> 9mcg/ml)
  • Amikacin
  • Derivative of kanamycin
  • Neomycin
  • Adjunct therapy to hepatic coma
19
Q

Tetracycline

A 
bacteriostatic
Tx-acne
Excreted in urine and bile
Side effects: 
-permanent discoloration of the teeth--not given to parturients or children
-phototoxicity
20
Q

Tetracycline types

A

tetracycline-PO only

Doxycyline- IV or PO, long acting preparation

21
Q

Macrolides

A 
Erythromycin
bacteriostatic or -cidal
-Narrow spectrum-- mostly gram +
metabolized by C-450-excreted mostly in bile
-no altered dose in renal disease
22
Q

Erythromycin adverse reactions

A

GI intolerance, sever N/V with IV infusion*most common
-Gastric emptying
QT effects-prolongs cardiac repolarization and report of torsades
-Thrombophlebitis– with prolonged IV use

23
Q

Clindamycin

A

class: lincosamides
bacteriostatic
-similar to erythromycin, more active on anaerobes
Tx-serious infection in GI tract and female genital tract
-decrease with sever liver disease

24
Q

Clindamycin side effects

A
  • Pseudomembranous colitis– severe diarrhea
  • Pre and post junctional effects at the neuromuscular junction
  • -Not antagonized with anticholinesterases or calcium
  • -Large doses can produce long lasting, profound neuromuscular blockade
25
Q

Vancomycin

A 
Glycopeptide derivative
-bactericidal 
for Gram pos: -severe staph infection
-streptococcal, enterococcal endocarditis
-methicillin resistant staph aureus 
-PCN/Cephalosporin allergy 
Renal excretion: elimination 1/2 life is 6hrs **can be up to 9 days with renal failure puts
**monitor renal--Renal dosing
26
Q

Vanco tx

A

Cardiac procedures
Ortho with prosthetic devices
CSF and shunt related infections

27
Q

Vanco dosing and adverse effects

A 
10-15mg/kg over 60 min---1gm in 250ml
Adverse effects: 
-rapid infusion--profound HypOtension
-red man--facial and truncal erythema form histamine release
-Ototoxicity/Nephrotoxicity
-return of neuromuscular blockade?
28
Q

Sulfonamides

A 
bacteriostatic
*inhibit microbial synthesis of folic acid
Tx- UTIs
hepatic metabolism with renal excretion
Adverse effects:
-skin rash to anaphylaxis
**increase effect of PO anticoagulants
29
Q

Polymycxin B and Colistimethate

A

bactericidal
gram neg
Tx- UTI, infections of skin, mucous membranes, eyes and ears
Eliminated by kidneys–accumulate in renal failure

30
Q

Polymycxin B and Colistimethate Side Effects

A

*most potent of all antimicrobials in their action at NM junction
*predominantly PRE junctional
-can produce skeletal muscle weakness resembling nondepolarizing NM blockade
-Marked potentiation of nondepolarizing neuromuscular blocking drugs
-Neostigmine or calcium do not reliably antagonize this drug induced effect at the NM junction
HIGHLY nephrotoxic

31
Q

Metronidazole

A

Bactericidal

  • Anaerobic Gm (-) bacilli
  • Tx:
  • CNS infections
  • Abdominal and pelvic sepsis
  • Pseudomembranous colitis
32
Q

Fluoroquinolone

A 
BacteriCidal
broad spectrum
Enteric gm neg
-elimination 1.2 time 3-8hrs
-can inhibit P450 enzymes
-mostly renal excretion
--decrease dose in renal dysfunction 
Tx-complicated GI and GU
**Ciprofloxacin-tx of systemic infection-bone, soft tissue and resp tract
33
Q

Fluoroquinolone side effects

A

minimal

mild GI disturbances

34
Q

Rifampin

A 
for TB
bactericidal for mycovateria
inhibits most Gm+ and many gm-
-fat soluble--penetration of tissue including CNS
-oral or IV
-excreted in blie and urine
35
Q

Rifampin side effects

A

usually infrequent

  • High doses- thrombocytopenia, anemia, hepatitis, fatigue, numbness, skeletal muscle weakness
  • potent inducer of C P450 system- accelerate metabolism of opioids, NM blocking agents, warfarin
36
Q

Amphotericin B

A

antifungal
tx-yeast and fungi
Slow renal excretion
–renal function is impaired in 80% of pt treated with this drug
–most recover, some result in permanent decrease in glomerular filtration rate
–monitor plama creatinine levels

37
Q

Amphotericin B side effects

A
  • fever, chills, dyspnes, hypotension-can occur during infusion
  • impaired hepatic function
  • allergic reaction
  • seizure
  • anemia
  • thrombocytopenia
38
Q

Viruses

A

-intracellur parasites, can’t reproduce outside of host cell
-composed of a nucleic acid core surrounded by a protein containing outer coat
-genome either DNA or RNA, never both-classified on this basis-use many biochemical mechanisms of host cell
*development of antiviral is difficult
Vaccines are the alternative
-hep A and B
-HPV
-herpes zoster

39
Q

Antivirals (6)

A
  • *Acyclovir and Valacyclovir
  • limited to Tx of herpes viruses
  • excreted by kidney
  • *Vidarabine
  • cytomegalic inclusion disease
  • herpes simplex encephalitis
  • mutagenic and carcinogenic
  • Famciclovir
  • acute herpes zoster
  • Ganciclovir
  • Cytomegalovirus disease
  • hematologic toxicity
  • Amantadine
  • influenza A virus/ parkinsons
  • renal excretion
40
Q

interferons

A
  • glycoproteins produced in response to viral infections
  • bind to receptors on host cell membranes and induce the production of enzymes that inhibit viral replication
  • -degradation of viral mRNA
  • enhances tumoricidal activities of macrophages
  • Chronic hep B
  • hepatitis C
  • Nasal sprays
41
Q

interferons side effects

A 
flu like symptoms
hematologic toxicity
depression, irritability
decreased mental concentration
development of autoummune conitions
rashes, slopecia
changes in CV, thyroid, hepatic functions
42
Q

Antivirals for AIDS

A

NUcleoside reverse transcriptase inhibitors (NRTI)
–imposter
Nonnucleoside revers transcriptase inhibitors (NNRTI)
–inhibit function of enzyme used by virus
Protease inhibitors
–Bind to HIV protease
*combination therapy

43
Q

Antivirals for AIDS side effects

A

Many and varied:

  • Pancreatitis, hepatotoxicity , lactic acidosis, fat redistribution, increases in serum cholesterol and triglycerides, hypersensitivity
  • *Proteaseinhibitor
  • Most all inhibit CP450 system
  • Ritonavir most potent inhibitor
  • Large plasma increases of many drugs including analgesics, lidocaine, antimicrobials, anticonvulsants, anticoagulants, antiemetics, calcium channel

Pharmacology test 1 (4 decks)

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