Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Pharm > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Penicillin MOA and uses

A

bactericidal - messes with cell walls - peptidoglycan

broad spectrum - good for a lot of things - gram positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how is PCN excreted

A

renal
plasma concentration decreases by half in first hour
anuria increases elimination half time by 10x
if you’re giving a probenecid, excretion is reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PCN big problem

A

beta-lactam ring = hypersensitivy in up to 10% of people

cross-sensitivity 3% of the time with cephalosporins because they share the ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

second generation penicillins?

A

amoxicillin and ampicillin - wider range of activity including gram neg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is a good abx substitue for patients with documented IgE mediated anaphylactic reaction to B-lactum abx?

A

clindamycin or vanc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cephalosporins MOA and use

A

cefazolin (ancef)
bactericidal, broad spectrum, but more widely used because low toxicity
higher generations = more reactive to gram neg

*also renal excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the macrolides, MOA, and use

A

Erythromycin, azithromycin
bacteriostatic or bactericidal - dose-dependent
block protein synthesis
broad spectrum - respiratory probs, STIs - chlamydia, gram positives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

macrolides metabolism and excretion

A

CYP450 metabolism (can act like an inducer and increase serum concentraion of theophylline, warfarin, cyclosporine, methylprednisone, digoxin)

excreted in bile

good for renal patients**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

macrolides side effects

A

INCREASED PERISTALSIS - gi upset
qt prolongation = torsades

thrombophlebitis so give in a good IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clindamycin (linomycins) - MOA, use

A

bacteriostatic
ACTIVE WITH ANAEROBES
commonly used for GU females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

clindamycin probs

A

CAN CAUSE C DIFF
bad for liver disease

POTENTIATE BLOCKADE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Vancomycin MOA and use

A

bactericidal - impairs cell wall synthesis
gram positives!!!
Drug of choice for MRSA
used in combo with aminoglycosides for endocarditis
used for cardiac/ortho procedures with implants
CROSSES BBB (slowly unless meningeal inflammation)
used for bacteria resistant to other abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

vanc PK

A

renal excretion - half time is up to 6 hours and can be prolonged up to 9 days with renal failure patients (give them half the dose once a week)

poor PO absorption - give IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Vanc dosing and adminstration

A

10-15mg/kg
give IV SLOW over 60 minutes
1 gram mixed in 250 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

vanc side effects

A

rapid administration = profound hypotension
red man syndrome from histamine release
ototoxicity (with concentration >30mcg/ml) and nephrotoxicity (rare except when in combo with aminoglycosides)
give in big IV - phlebosclerotic

RETURN OF neuromuscular blockade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what can you administer with vanc to decrease histamine effects

A

give within 1 hr of induction:

1mgkg benadryl
4mg/kg cimetidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Aminoglycosides what are they/uses. MOA

A

Bactericidal, inhibits protein synthesis good for TB and aerobic gram neg and pos

streptomycin - we don’t use
kanamycin - we don’t use
gentamicin - broad spectrum
amikacin - pseudomonas, infections caused by a gentamicin or tobramycin resistant gram neg bacilli
neomycin - skin, eye, mucous membrane (think neosporin), decrease bacteria in intestine before GI surgery

usually given in combo with a beta lactam for gram neg therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

aminoglycoside excretion

A

renal - glom filtration

2-3 hour elimination half time increased 20-40x with renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

aminoglycoside SE

A

ototoxicity, nephrotoxicity, skeletal muscle weakness

POTENTIATES NDMR BLOCKADE - reversal may not be sustained with calcium or neostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

fluroquinolones (ciprofloxacin and moxifloxacin) use and MOA

A

Bactericidal, broad spectrum
good for gram neg and mycobac
complicated GI/GU infection

cipro - resp infections, TB, anthrax, bone/soft tissue infection

moxi - sinusitis, bronchitis, abd infection

21
Q

fluroquinolones PK

A

rapid GI absorption
penetration to body fluid and tissue = excellent
renal excretion - required renal dosing
CYP450 inhibitor

22
Q

fluroquinolone SE

A

TENDON RUPTURE
muscle weakness in MG
dizzy, insomnia, N/V

moxi = qt prolongation and SJS

23
Q

Sulfonamides (sulfamethoxazole and trimethoprim) MOA/use

A

bacteriostatic - prevent bacteria from being able to synthesize folic acid

good for UTIs, IBS, Burns

24
Q

sulfonamides PK and SE

A

liver acetylated and renal excretion - needs renal dosing

skin rash to anaphylaxis
hepatotoxicity - thrombocytopenia, increase coagulant effects, hemolytic anemia
allergic nephritis
photosensitivity
drug fever
25
Q

Metronidazole - MOA/use

A

bactericidal

good fore anaerobic gram neg
CNS - crosses BBB
c-diff
endocarditis
abd sepsis
preop prophylaxis for colorectal
26
Q

metronidazole side effects

A

dry mouth
metallic taste
nausea
avoid alcohol

27
Q

antimycobacterial first line agents

A

CSF penetration!! - used in combo therapy

Rifampin - bactericidal
Isoniazid - bacteriostatic (cidal with cell dividing)
Pyrazinamide - bateriostatic
Ethambutol - bacteriostatic

used in combo therapy for 2 months of 3-4 agents and then a minimum of 4 more months with 2 of them

28
Q

name the statics

A 
sulfonamides
clindamycin
macrolides (dose dependent)
isonazid (non-rapid dividing)
pyrazidimide
ethambutol
29
Q

abx that cross BBB

A

Vancomycin
Metronidazole
Antimycobacterials

30
Q

Non-renal excretions abx

A 
clinda = liver
sulfonamides = liver and renal
macrolides = excreted in bile
31
Q

abx that effect NDMR

A 
aminoglycosides = potentiate blockade
clindamycin = potentiate blockade
vancomycin = return of blockade
32
Q

ABX that act like cyp450 inhibitors

A

macrolides

fluroquinolones

33
Q

Antifungals - Amphotericin B

A

given for yeast/fungi
poor PO absorption
slow renal excretion - impairs renal function in 80% of patients on the drug (monitor plasma creatinine levels)
Side effects - fever, chills, hypotension with infusion, hypokalemia, allergic reactions, seizure, anemia, thrombocytopenia

not compatible with saline

34
Q

how do antivirals work

A

there are some cell surface receptors unique to viruses and this gives a location for potential drug therapies

it is difficult to kill virus and not host

35
Q

acyclovir

A

used to treat herpes
may cause renal damage
thrombophlebitis
patients may complain of headaches during IV infusion

36
Q

interferons

A

bind to receptors on host cell membranes and induce the production of enzymes that inhibit viral replication - degrade viral mrna

treatment for hep b/c

side effects: flu like symptoms, autoimmune conditions, changes in CV, thyroid, and hepatic functions, alopecia, decreased mental concentration, depression, irritability

37
Q

antiretroviral drugs

A

TRIPLE THERAPY chosen from 6 classes

  • nucleoside/non-nucleotide reverse transcriptase inhibitors
  • protease inhibitors
  • fusion inhibitors
  • CCR5 receptor antagonists
  • integrase inhibitors

CRNAs should note that there are adverse effects with these drugs = liver toxicity, peripheral neuropathy, nephro-toxicity, neuromuscular weakness

inhibit cyp450

38
Q

goals of antimicrobial therapy

A
  • inhibit microorganisms at concentrations that are tolerated by the host
  • seriously ill/immunocompromised select bacteriocidal
  • narrow spectrum before broad spectrum or combo therapy to preserve normal flora
39
Q

surgical site infections outcomes

A

SSIs develop in 2-5% or 30million surgical patients that cost 1 billion dollars/year

cause increased re-admissions, increased length of stay, and increased hospital cost

40
Q

SSI definition

A

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

purulent drainage from site
positive culture obtained from surgical site that was closed initially
surgeon’s diagnosis of infection
surgical site that requires reopening due to tenderness, swelling, redness, or heat

41
Q

surgical risks for ssi

A

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

42
Q

patient risks for ssi

A

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

43
Q

anesthesia impact on SSI

A

timely and appropriate use of abx
maintain normothermia
proper med admin

44
Q

SCIP goals

A 
give abx one hour prior to incision
discontinue within 24 hours after surgery end time
glucose control
periop temp management
VTE prophylaxis
45
Q

dose of amoxicillin

A

2 gram po

46
Q

dose of ampicillin

A

2 gram IV

47
Q

clindamycin dose

A

600 mg IV

48
Q

cefazolin dose

A

1 gm IV

Advanced Pharm (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions