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N929 Pharmacology II > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

Goals & general rules of antimicrobial therapy include:

A

Inhibit microorganisms at concentrations that are tolerated by the host
Seriously ill/immunocompromised select bactericidal
Narrow spectrum before broad spectrum or combination therapy to preserve normal flora (target organism)

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2
Q

Adverse reactions with antimicrobial therapy includes:

A

hypersensitivity reaction (dose independent), direct organ toxicity (dose related), potential for superinfections, identify patients at risk for complications (elderly or parturients)

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3
Q

Another concern when incorporating antimicrobials into our care plan includes

A

cross-reactions with other medications given

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4
Q

Providing prophylaxis before surgery is important

A

because it keeps patients safe and allows for reimbursement for quality care

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5
Q

Surgical site infections are defined as

A

an infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure

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6
Q

It is considered a surgical site infection when

A

purulent exudate drains from a surgical site, a positive culture obtained from a surgical site that was closed initially, a surgeon’s diagnosis of infection, a surgical site that requires reopening due to a least one of the following signs or symptoms: tenderness, swelling, redness, or heat

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7
Q

SSI are the second most common

A

healthcare associated infection

they develop in 2-5% of 30 million surgical patients

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8
Q

The cost of SSIs per year equates to

A

1 billion dollars/year

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9
Q

SSIs account for 3% of surgical mortality and lead to

A

increased re-admissions, increased length of stay (7-10 days), and increased hospital costs (additional $3,000-29,000/per SSI diagnosis)

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10
Q

What are the two types of risk for development of SSIs?

A

Surgical Risk

Patient risks

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11
Q

Surgical risks for SSIs include

A

procedure type, skill of surgeon, use of foreign material or implantable device, degree of tissue trauma

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12
Q

Patient risks for SSIs include

A

diabetes, smoking use, obesity, malnutrition, systemic steroid use, immunosuppressive therapy, intraoperative hypothermia, trauma, prosthetic heart valves

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13
Q

Anesthesia providers can make an impact on prevention through:

A

timely and appropriate use of antibiotics, maintenance of normothermia, and proper syringe/med administration practices

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14
Q

SCIP measures related to antibiotics include:

A

prophylactic antibiotic received within one hour prior to surgical incision, prophylactic antibiotic selection for surgical patients, prophylactic antibiotics discontinued within 24 hours after surgery end time

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15
Q

SCIP measures include

A

controlled blood glucose in cardiac patients, appropriate hair removal, urinary catheter removal on postop day 1 or 2, periop temperature management, patients receiving beta-blocker dose, patients with DVT prophylaxis

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16
Q

The timing of antibiotics for surgery is

A

1 hour before incision; 30-60 minutes before incision is the ideal window for drug administration

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17
Q

Hypothermia is associated with adverse outcomes which include:

A

increased blood loss, increased transfusion requirements, prolonged PACU stay, post-op pain, impaired immune function (compromised neutrophil function–> vasoconstriction–> tissue hypoxia and increased incidence of SSI)

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18
Q

What drug is given most frequently preoperatively?

A

cefazolin

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19
Q

The standard general prophylaxis for SBE is:

A

amoxicillin 2 gms PO

IV- Ampicillin 2 gms IV

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20
Q

SBE prophylaxis for an individual with a penicillin allergy is:

A

clindamycin 600 mg IV

cefazolin 1 gm IV

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21
Q

Antibiotics are classified as

A

bactericidal or bacteriostatic

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22
Q

Bactericidial means

A

they kill the susceptible bacteria

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23
Q

Bacteriostatic means

A

if they reversibly inhibit the growth of bacteria

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24
Q

When a bacteriostatic antibiotic is used, the duration of therapy must be sufficient to allow

A

cellular and humoral defense mechanisms to eradicate the bacteria

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25
Q

Bactericidal drugs include

A

penicillins, cephalosporins, isoniazid, metronidazole, polymyxins, rifampin, vancomycin, aminoglycosides, bacitracin, quinolones

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26
Q

Bacteriostatic drugs include

A

chloramphenicol, clindamycin, macrolides, sulfonamides, tetracyclines, trimethoprim

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27
Q

Penicillin is considered a

A

bactericidal drug that interferes with the synthesis of peptidoglycan which is an essential component to cell walls of susceptible bacteria

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28
Q

Penicillin target organisms include

A

pneumococcal, meningococcal, streptococcal, and actinomycosis

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29
Q

Penicillin structure is

A

basic structure is a dicylic nucleus that consists of a thiazolidine ring connected to a beta-lactam ring

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30
Q

Penicillin is excreted by

A

renal excretion

anuria increases elimination half-time by 10 fold

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31
Q

This drug can be administered with penicillin to reduce renal excretion and prolong action

A

probenecid

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32
Q

Adverse reactions from penicillins include

A

hypersensitivity- most allergenic of all the antimicrobials (up to 10%): rash, fever, hemolytic anemia, maculopapular rash, immediate sensitivity: anaphylaxis

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33
Q

Penicillin has cross-sensitivity with

A

all penicillin drugs and cephalosporins (3%) due to the common beta-lactam ring

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34
Q

Routes of penicillin include

A

PO & IV

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35
Q

Mechanism of action of penicillin includes

A

inhibits transpeptidation of cell wall

bactericidal

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36
Q

Penicillin can be used to treat

A

otitis media, meningitis, sore throat, pneumonia and respiratory infections, septicemia, peritonitis, gonorrhea, UTIs

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37
Q

Known issues of penicillin include:

A

resistance, allergic reactions, and cross hypersensitivity

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38
Q

Second generation penicillins target these organisms

A

pneumococcal, meningococcal, streptococcal, actinomycosis, Wider range of activity (e coli, gram negative bacilli–> haemophilus influenze)

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39
Q

Second generation penicillins include

A

amoxicillin & ampicillin

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40
Q

For patients with documented IgE mediated anaphylactic reactions with B-lactum antibiotics

A

clindamycin or vancomycin can be substituted

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41
Q

Cephalosporin antibiotics include

A

cefazolin

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42
Q

Cephalosporin antibiotics are

A

bactericidal antimicrobials that inhibit bacterial cell wall synthesis and have low toxicity

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43
Q

Cephalosporin antibiotics are excreted

A

renally

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44
Q

Cephalosporin is what kind of spectrum of antibiotic?

A

broad spectrum activity

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45
Q

Cephalosporin has cross reactivity

A

with other cephalosporins, anaphylaxis is 0.02%, and penicillin and cephalosporin allergy is 1-3% (don’t give it if it was an anaphylaxis reaction)

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46
Q

Cephalosporins can penetrate

A

the joints and cross the placenta

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47
Q

Cephalosporins are more effective as

A

you go up in generation

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48
Q

Examples of macrolides include

A

erythromycin & azithromycin

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49
Q

Macrolides are particularly useful for patients with

A

sensitivities to penicillins and cephalosporin drugs

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50
Q

The chemical structure of macrolides is

A

a macrolytic lactone ring containing 14-16 atoms with a deoxy sugar attached

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51
Q

Macrolides are effective against

A

gram positive bacilli, pneumoccoci, streptococci, staphylococci, mycoplasma, chlamydia

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52
Q

Routes of macrolides include

A

oral and IV

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53
Q

Macrolide uses include

A

URI (pharyngitis, tonsillitis, sore throat), otitis media, uncomplicated skin infections (staph), ulcers (h. pylori), STDs (chlamydia, gonorrhea), lower respiratory tract infections (MAC, pneumonia, Legionnaire’s, anthrax)

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54
Q

The mechanism of action of macrolides

A

bind to 50 S and block translocation step in protein synthesis

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55
Q

Macrolides are considered to be

A

bacteriostatic

56
Q

The half life of azithromycin is

A

3 days

57
Q

Erythromycin is considered to be

A

bacteriostatic or bactericidial

58
Q

Erythromycin works by

A

inhibiting bacterial protein synthesis

59
Q

Erythromycin is excreted in

A

bile

60
Q

Erythromycin is metabolized by

A

cytochrome P-450 system and thus increase serum concentration of theophylline, warfarin, cyclosporine, methylprednisone, and digoxin

61
Q

The dose in renal disease for erythromycin

A

does not need to be altered

62
Q

Side effects of erythromycin include

A

GI intolerance, severe N/V with IV infusion, gastric emptying with increased peristalsis, cholestasic hepatitis, thrombophlebitis, QT effects (prolongs cardiac repolarization & torsades de pointes)

63
Q

Clindamycin is (class & type)

A 
linomycins- class
bacteriostatic
64
Q

Complications of clindamycin include

A

pseudomembranous colitis–>severe diarrhea should indicate discontinuation of therapy
Severe GI complications limit its use to infections that are difficult to treat

65
Q

Clindamycin is most commonly used in

A

female GU surgeries

66
Q

The mechanism of action of clindamycin is

A

similar to emycin in antimicrobial activity

67
Q

When administering clindamycin, the dose

A

needs to be decreased with severe liver disease

68
Q

Side effects of clindamycin include

A

skin rash, prolonged pre & post junctional effects at NMJ in the absences of NMDR

69
Q

Clindamycin is not antagonized with

A

anticholinesterases or calcium- concurrent administration with NMDR can produce long lasting, profound neuromuscular blockade

70
Q

Routes of clindamycin include

A

PO & IV

71
Q

The mechanism of clindamycin is

A

Binds to 50S & inhibits peptidyl transferase and transduction

72
Q

Vancomycin (class & type)

A

glycopeptide derivative

bacteriocidal- impairs cell wall synthesis

73
Q

Vancomycin is excreted

A

renally & can be prolonged (up to 9 days) with renal failure patients

74
Q

Vancomycin is effective for

A

gram positive bacteria, severe staph infections, streptococcal, enterococcal, endocarditis, drug of choice for MRS, penicillin/cephalosporin allergy, administered with aminoglycoside for endocarditis

75
Q

Rapid infusion of vancomycin can cause

A

profound hypotension

76
Q

Side effects of vancomycin include

A

red man syndrome- intense facial & truncal erythema from histamine release; ototoxicity/nephrotoxicity, return of NMJ blockade

77
Q

Vancomycin is used for

A

CSF & shunt related infections, cardiac/orthopedic procedures using prosthetic devices

78
Q

The use of vancomycin is typically reserved for

A

Rx of bacterial infections resistant to other antibiotics, or patients with severe hypersensitivity to other indicated antibiotics; if bacteria become resistant to vancomycin, there are only a few other drugs that may be effective in treating the patient

79
Q

Administration of vancomycin consists of

A

IV slowly over 1 hour

80
Q

Vancomycin has synergistic actions with

A

aminoglycosides against susceptible gram positives

81
Q

Indications of vancomycin include

A

MRSA, endocarditis due to strep or enterococci, patients allergic to Beta lactams

82
Q

Side effects of vancomycin include

A

phlebosclerotic (vanc is irritating to tissue), nephrotoxicity rare unless concomitant tx with other nephrotoxic drugs such as aminoglycosides, ototoxicity when concentrations are >30 mcg/ml, hypersensitivity (maculopapular skin rash), hypotension & red man syndrome if given IV in less than 30 minutes, administration of benadryl 1 hour before induction limits histamine related effects

83
Q

Aminoglycosides include

A

streptomycin, kanamycin, gentamicin, amikacin, neomycin

84
Q

The most nephrotoxic aminoglycoside is

A

neomycin

85
Q

Neomycin can be used to treat

A

skin, eye and mucous membrane infections
adjunct therapy to hepatic coma
administered to decrease bacteria in intestine before GI surgery

86
Q

Amikacin is used to treat

A

infections caused by gentamicin or tobramycin resistant gram negative bacilli
it is a derivative of kanamycin

87
Q

Vestibular damage can occur with use of these aminoglycosides

A

streptomycin & kanamycin

also has limited uses

88
Q

Routes for aminoglycosides include

A

IM, IV or topical

89
Q

Mechanism of action for aminoglycosides include

A

irreversible inhibition of protein synthesis

90
Q

Adverse effects of aminoglycosides include

A

ototoxicity (rev vestibular & irreversible auditory), nephrotoxicity (reversible), NMJ blockade (high dose), pregnancy category C

91
Q

Adverse side effects of antiretroviral drugs include

A

liver toxicity, peripheral neuropathy, nephro-toxicity, neuromuscular weakness

92
Q

Antiretroviral drugs have interactions with

A

proton-pump inhibitors, cimetidine, NDMR, opioids, benzos

93
Q

Treatments for HIV typically consist of

A

“triple therapy” and include nucleosides/non nucleotide reverse transcriptase inhibitors, protease inhibitors, fusion inhibitors, CCR5 receptors antagonists, integrase inhibitors

94
Q

Side effects of antivirals include

A

flu like symptoms, hematologic toxicity, depression, irritability, decreased mental concentration, development of autoimmune conditions, rashes, alopecia, changes in CV, thyroid, hepatic function

95
Q

Interferons definition

A

term used to designate glycoproteins produced in response to viral infections

96
Q

Antivirals work by

A

binding to receptors on host cell membranes and induce the production of enzymes that inhibit viral replication– degradation of viral mRNA
-enhance tumoricidal activities of macrophages

97
Q

Antivirals are used for the treatment of

A

chronic hepatitis B & C

98
Q

Acyclovir can be used

A

to treat herpes, may cause renal damage if infused rapidly, thrombophlebitis, patients may complain of HA during IV infusion

99
Q

Viruses are obligate

A

intracellular parasites & it is difficult to kill virus and not host cell
some cell surface receptors are unique for viruses and this gives a location for potential drug therapy

100
Q

Example of antifungals include

A

amphotericin B

101
Q

Amphotericin B is given for

A

yeasts and fungi

102
Q

Amphotericin is given via

A

IV as it has poor PO absorption

103
Q

Amphotericin is excreted by

A

renal excretion & renal function is impaired in 80% of patients treated with this drug (most recover but it could be lasting)

104
Q

Side effects of antifungals include

A

fever, chills, dyspnea, hypotension (can occur during infusion), impaired hepatic function, hypokalemia, allergic reactions, seizure, anemia, thrombocytopenia

105
Q

Antimyobacterial agents are distributed through

A

tissues, CSF

106
Q

Which antimycobacterial agents are bacteriostatic?

A

isoniazid, ethambutol, pyrazinamide

107
Q

Which antimycobacterial agents are bacteriocidal?

A

rifampin
side effects: hepato-real toxicity, thrombocytopenia, anemia
causes hepatic enzyme induction

108
Q

Antimycobacterial agents are used in

A

combination therapy (3 or 4 agents) for 2 months, followed by minimum of 4 months of therapy with 2 agents

109
Q

List the side effects of antimycobacterial agents

A

isoniazid-hepato-renal toxicity
ethambutol- optic neuritis
pyrazinamide- liver toxicity

110
Q

Metronidazole is (type)

A

bactericidal- targeting anaerobic gram negative bacilli clostridium

111
Q

Metronidazole is useful for treating

A

CNS infections, abdominal & pelvic sepsis, pseudomembranous colitis (c. diff.), and endocarditis

112
Q

Side effects of metronidazole include

A

dry mouth, metallic taste, nausea, avoid alcohol

113
Q

Metronidazole can be used

A

PO or IV

well absorbed orally and widely distributed in tissue including CNS

114
Q

Metronidazole is recommended for

A

pre-op prophylaxis for colorectal surgery

115
Q

Side effects of sulfonamides include

A

skin rash to anaphylaxis, photosensitivity, allergic nephritis, drug fever, hepatotoxicity, acute hemolytic anemia, thrombocytopenia, increase effect of PO anticoagulant

116
Q

Clinical uses of sulfonamides include

A

urinary tract infections, inflammatory bowel disease, and burns

117
Q

Sulfonamides are excreted

A

via renal & liver

dose is reduced in renal disease

118
Q

Sulfonamide examples include

A

sulfamethoxazole and trimethoprim

119
Q

Sulfonamides work by

A

bacteriostatic
antimicrobial activity is due to the ability of these drugs to prevent normal use of PABA by bacteria to synthesize folic acid
inhibits microbial synthesis of folate production

120
Q

Aminoglycoside side effects include

A

limited by their toxicity, ototoxicity, nephrotoxicity, skeletal muscle weakness, potentiation of NMDR blockade, muscle weakness: inhibit the pre-junctional release of Ach and decreases post-synaptic sensitivity to the neurotransmitter (impact on patients with neuromuscular pathology i.e. myasthenia gravis)

121
Q

Aminoglycosides have increased elimination half-time

A

in the setting of renal failure

extensive renal excretion through glomerular filtration

122
Q

Aminoglycosides are (type)

A

bactericidal and effective for aerobic gram negative and positive bacteria
also used to treat mycobacterium tuberculosis

123
Q

Aminoglycosides are prescribed as

A

combination therapy with beta-lactam antibiotic for gram negative

124
Q

Aminoglycosides & NMDBs

A

have potentiation, paralysis is usally reversible with calcium gluconate or neostigmine, effect may not be sustained

125
Q

Examples of fluroquinolones include

A

ciprofloxacin and moxifloxacin

126
Q

Ciprofloxacin is used to treat

A

respiratory infections, TB & anthrax

127
Q

Moxifloxacin is used to treat

A

acute sinusitis, bronchitis, & complicated abdominal infections

128
Q

Moxifloxacin side effects include

A

QT prolongation, peripheral neuropathy, pscyhosis, Stevens-Johnson syndrome

129
Q

Fluroquinolones work by

A

inhibiting DNRA Gyrase and Toposomerase IV

130
Q

Side effects of fluoroquinolones include

A

mild GI disturbances, N/V, CNS dizziness, insomnia, tendon or achilles rupture, muscle weakness in patients with myasthenia gravis

131
Q

Fluoroquinolones are (type)

A

broad spectrum and bactericidal

132
Q

Fluoroquinolones are excreted via

A

renal excretion- decrease dose in renal dysfunction

133
Q

Fluoroquinolones can inhibit

A

P450 enzymes

134
Q

Fluorquinolones can be used to treat

A

GI & GU infections

ciprofloxacin is useful in treatment of systemic infections including bone, soft tissue, and respiratory tract

135
Q

Fluoroquinolones are effective in (type of bacteria)

A

treating enteric Gram negative bacilli and mycobacterium

N929 Pharmacology II (16 decks)

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