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Pharm II Final > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

What is anesthesia’s role in antibiotic therapy?

A

The anesthetic provider plays an important role in timely administration of antibiotics
Contributes to our reimbursement for quality care

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2
Q

What are potential adverse reactions from antibiotic therapy?

A

Hypersensitivity reaction
Direct organ toxicity
Potential for superinfection

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3
Q

What is a common misconception regarding hypersensitivity reactions with antibiotics?

A

They are dose independent meaning you can give any amount (test dose or not) and still have a reaction

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4
Q

Why do we give antibiotics prophylactically?

A

The surgeon exposes and transects parts of the body that have bacteria all the time
Exposing certain parts of the body to flora that is not normal in that area

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5
Q

What antibiotic covers majority of the organisms we expose the body to?

A

Cefazolin

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6
Q

What antibiotics should be used with caution in pregnancy?

A

Aminoglycosides (ototoxicity) and Clindamycin (colitis)

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7
Q

What antibiotics are contraindicated in pregnancy?

A

Tetracyclines –> tooth discoloration in babies

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8
Q

How are antibiotics categorized?

A

Bactericidal

Bacteriostatic

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9
Q

What does it mean if an antibiotic is considered to have bactericidal properties?

A

It can kill the susceptible bacteria

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10
Q

What does it mean if an antibiotic is considered to have bacteriostatic properties?

A

It reversibly inhibits growth of the bacteria

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11
Q

If bacteriostatic drugs cannot kill bacteria how do they get rid of a bacterial infection?

A

They allow cellular and humoral defense mechanisms to eradicate the bacteria

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12
Q

What type of antibiotics are penicillins?

A

Bactericidal

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13
Q

What is the mechanism of action of penicillins?

A

They interfere with synthesis of peptidoglycans, which are components of bacterial cell wall

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14
Q

What type of antibiotics are cephalosporins?

A

Bactericidal

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15
Q

What is the mechanism of action of cephalosporins?

A

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins

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16
Q

What class of antibiotics have the highest reported rate of allergy?

A

Penicillins (up to 10%)

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17
Q

What two types of reactions are associated with penicillin allergy?

A 
Delayed = maculopapular rash
Immediate = anaphylaxis
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18
Q

Why is there a high likelihood of cross sensitivity between penicillins and cephalosporins?

A

They share a common beta-lactam ring

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19
Q

What is a side effect of high dose penicillins?

A

Affect platelet aggregation

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20
Q

What superinfections can result with cephalosporin use?

A

Enterococci
Enterobacter
Candida

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21
Q

How many generations of cephalosporin drugs are there?

A

Four

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22
Q

What type of antibiotic is Vancomycin?

A

Bactericidal for most gram positive bacteria

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23
Q

What is the mechanism of action of Vancomycin?

A

Inhibits cell wall synthesis by inhibiting peptidoglycan synthetase

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24
Q

What infections is Vancomycin typically reserved to treat?

A

MRSA
Endocarditis due to strep, viridans or enterococci
Patients allergic to beta lactams

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25
Q

Why is it important to administer Vancomycin slowly?

A

To prevent a massive histamine leading to Red Man’s Syndrome

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26
Q

Why is it important to check the IV site prior to administering Vancomycin?

A

It is phlebosclerotic causing damage to the tissues if infiltration occurs

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27
Q

What organ systems can Vancomycin affect?

A

Kidneys, nephrotoxicity when given with other nephrotoxic drugs
Ototoxicity increased risk if giving with aminoglycosides

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28
Q

What symptoms usually accompany Red Man Syndrome?

A

Profound hypotension

Flushing

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29
Q

Why have aminoglycosides lost favor in patient administration?

A

It has an extensive list of significant side effects

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30
Q

What kind of antibiotic is Gentamicin?

A

Bactericidal Aminoglycoside

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31
Q

What side effects are typically seen with aminoglycoside use?

A

Ototoxicity
Nephrotoxicity
Muscular Weakness

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32
Q

What drugs used in combination with aminoglycosides can increase the risk of ototoxicity?

A

Lasix

Mannitol

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33
Q

What renal impairment are aminoglycosides known to cause?

A

Acute tubular necrosis

34
Q

What mechanism causes muscle weakness in aminoglycoside use?

A

Aminoglycosides inhibit the prejunctional release of Ach and decreases post-synaptic sensitivity
Pre-exisitng musculoskeletal diseases may be potentiated by these efects

35
Q

How would aminoglycoside use impact administration of neuromuscular blockade?

A

Aminoglycosides are associated with potentiation of Non depolarizing NMBA
Not effectively reversed by neostigmine

36
Q

What other anesthetic drug is affected by aminoglycosides?

A

Lidocaine, it enhances the neuromuscular blocking activities

37
Q

How would dose of NMBA be adjusted if the patient is currently taking aminoglycosides?

A

Decrease the amount given

38
Q

What class of antibiotics are useful in patients with allergies to PCN and cephalosporins?

A

Macrolides

39
Q

What two Macrolide antibiotics are commonly used?

A

Erythromycin

Azithromycin

40
Q

What is the most common complaint with Macrolide use?

A

GI intolerance

41
Q

How do Macrolides affect the GI tract?

A

Prokinetic effect on GI tract and increases the tone of the LES

42
Q

What effect do Macrolides have on the cardiovascular system?

A

Prolongs cardiac repolarization (prolong QT)

Can cause Torsades and sudden cardiac death

43
Q

What drug is most commonly used in female GU surgeries?

A

Clindamycin

44
Q

Why is Clindamycin’s use so limited?

A

Severe GI complications limit its used to infections that are difficult to treat

45
Q

What other antibiotic has an affect on neuromuscular blockade?

A

Clindamycin, produces pre and post junctional effects at the NMJ that cannot be readily antagonized

46
Q

What ailments are fluoroquinolones useful in treating?

A

Respiratory infections
GI upset
Anthrax

47
Q

What type of antibiotics are sulfonamides?

A

Antimicrobial

48
Q

What is the mechanism of action of sulfonamides?

A

Prevent normal use of PABA by bacteria to synthesize folic acid

49
Q

What antibiotic is used most often in pediatric patients for ear infections?

A

Sulfonamides

50
Q

What is a negative effect of using sulfonamides?

A

High incidences of allergic reactions

51
Q

What is a virus?

A

Obligate intracellular parasites

52
Q

How do we target a virus without killing our own cells?

A

Some host cell surface receptors are unique for viruses and this gives a location for potential drug therapy

53
Q

What is Acyclovir used to treat?

A

Used to treat herpes

54
Q

What side effects can be seen with the use of Acyclovir?

A

May cause renal damage if infused rapidly
Thrombophlebitis
Headache

55
Q

If a patient reports being on triple therapy what disease process are they more than likely fighting?

A

HIV

56
Q

What are the six classes of HIV antiretrovirals?

A 
Nucleoside/nucleotide reverse transcriptase inhibitors
Protease inhibitors
Fusion inhibitors
CCR5 receptor antagonists 
Integrase inhibitors
57
Q

What should the anesthetic provider be assessing in the operative patient on triple therapy?

A

Existence of adverse effects (organ damage, neuropathy, weakness)
Interactions with other medications (PPI and cimetidine) can affect CYP causing increased available medications leading to toxicity

58
Q

If a healthcare worker is exposed to HIV with a high viral load what precautions should be taken?

A

Prophylaxis with three or more antiretroviral drugs (two if the patient had a low viral load)

59
Q

How long should a healthcare provider be followed if exposed to HIV?

A

For at least six months after exposure

60
Q

When does most mother to child transmission of HIV occur?

A

At the time of labor and delivery (both mom and baby should receive AZT every six hours for six weeks after birth)

61
Q

What antiretroviral drug should the HIV positive mother receive after the first trimester of pregnancy?

A

AZT

62
Q

What microbial agents do first generation cephalosporins have the greatest effect on?

A

Strep pneumoniae
Gram positives
(little effect on gram negative)

63
Q

What microbial agents do second generation cephalosporins have the greatest effect on?

A

Equally effective against gram positive, gram negative and strep pneumoniae

64
Q

What microbial agents do third generation cephalosporins have the greatest effect on?

A

Gram negative
Strep pneumoniae
(little effect on gram positive)

65
Q

What microbial agents do fourth generation cephalosporins have the greatest effect on?

A

Gram negative
Strep pneumoniae
(moderate effect on gram positive)

66
Q

What other drug is almost always used in combination with aminoglycosides?

A

Almost always used along with a cell wall synthesis inhibitor

67
Q

What is the mechanism of action of aminoglycosides?

A

Irreversible inhibition of protein synthesis 30s (O2 dependent transport)

68
Q

What pregnancy category are aminoglycosides?

A

C

69
Q

What lab values should you base your dose of aminoglycosides on?

A

Creatinine

Serum concentration

70
Q

What is significant about azithromycins half life?

A

The half life is three days, 1g dose provides 7 days of coverage

71
Q

What is the mechanism of action of macrolides?

A

Bind to 50s and block translocation step in protein synthesis

72
Q

What type of antibiotics are macrolides?

A

Bacteriostatic

73
Q

How can macrolides affect metabolism of other drugs?

A

P450 Inhibitor, increasing the concentration of other drugs

Can also cause liver toxicity

74
Q

What type of antibiotic is Clindamycin?

A

Bacteriostatic

75
Q

If a sulfa allergy is present, what two drugs can be used to treat toxoplasmic encephalitis?

A

Clindamycin and pyrimethomine

76
Q

What two GI disturbances can occur with Clindamycin use?

A

Cdiff

Enterocolitis

77
Q

What is the mechanism of action of fluoroquinolones?

A

Inhibits DNA gyrase and topoisomerase

78
Q

What type of antibiotic are fluoroquinolones?

A

Bacteriocidal

79
Q

What pregnancy category are fluoroquinolones?

A

C

80
Q

What are some adverse effects of fluoroquinolone use?

A 
Tendon rupture
QT prolongation
seizure
Dizziness
Confusion
Photosensitivity
81
Q

Why shouldn’t children under 18 take fluoroquinalones?

A

Interferes with cartilage formation

82
Q

How is cefazolin typically dosed?

A

Usually 1g, but increase to 2g when over 80kg

Pharm II Final (12 decks)

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