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Pharm Spring 2014 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

If a patient is severely immunocompromised, what type of antibiotic should you give them?

A

Bactericidal

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2
Q

Without our normal flora, we can be exposed to

A

Superinfections. Our normal flora competes with pathogens for nutrients and secrete substances that can kill opportunistic bacteria

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3
Q

When might you not want to give antibx?

A

If the person is allergic and the surgery has low risk for infection

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4
Q

The prophylactic antibiotic should be given no earlier than _____

A

1 hour before surgery

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5
Q

Does a brief course of antibiotics result in resistant organisms?

A

There is no evidence of this. Peri-operatively we usually only give 1 dose, but may be continued up to 48 hours post-op

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6
Q

Do we usually give broad or narrow antibx?

A

Anesthesia usually gives broad. The antibx will depend on pt tolerances and location of the surgery

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7
Q

Do antibiotics cross the BBB?

A

Highly variable

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8
Q

When might the surgeon want you to hold off on the antibiotics?

A

If pt is in OR for a wound cleaning (remember that antibiotics are more effective if infected material is removed!)

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9
Q

Are hypersensitivity reactions from antibiotics dependent or independent of dose?

A

Independent

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10
Q

Things to keep in mind with parturients

A

Most antimicrobials cross the placenta and enter breast milk. Also concern for teratogenecity.

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11
Q

Considerations for the elderly

A

Renal and liver impairment
Decreased plasma protein (higher free fraction)
Reduced gastric motility and acidity
Increased body fat

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12
Q

Which is better absorbed from the GI tract, ampicillin or amoxicillin?

A

Amoxicillin! (think of Moxi)

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13
Q

Renal excretion of Penecillin

A

90%

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14
Q

MOA for penicillin?

A

Interferes with cell wall synthesis and stability

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15
Q

These antimicrobials belong to the beta-lactam family

A

Penicillins, cephalosporins,

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16
Q

Only these antimicrobials are bacteriostatic

A

Tetracyclines, macrolides (can be either), lincomycins, and sulfonamides

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17
Q

How are viruses classified?

A

By if they contain DNA or RNA. They never contain both!!

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18
Q

This HIV protease inhibitor is the most potent inhibitor of the cytochrome P-450 system

A

Ritonavir

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19
Q

Acyclovir and Valacyclovir

A

Antivirals for herpes. Excreted by the kidneys.

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20
Q

Vidarabine

A

Antiviral for cytomegalic inclusion disease and HSV encephalitis. This antiviral is mutagenic and carcinogenic.

21
Q

Famciclovir

A

Antiviral for acute herpes zoster (shingles)

22
Q

Ganciclovir

A

Antiviral for CMV. Risk of hematologic toxicity

23
Q

Amantadine

A

Antiviral for Influenza A. Renally excreted.

24
Q

Antibiotic that inhibits the P-450 system

A

Cipro (fluoroquinolone)

25
Q

Antibiotic that induces the P-450 system

A

Rifampin

26
Q

Antibiotic whose MOA is bactericidal by acting on DNA and RNA polymerase

A

Rifampin

27
Q

This antibiotic has the most potent effect at the NMJ

A

Polymyxin B and Colistimethate. These are mostly prejunctional, and potentiate with NDNMBs. Not reliable reversed with neostigmine or calcium.

28
Q

This antibiotic can cause pseudomembranous colitis

A

Clindamycin

29
Q

This antibiotic can treat pseudomembranous colitis

A

Flagyl (even when caused by clinda)

30
Q

Example of an antifungal

A

Amphotericin B.

31
Q

Biggest risk of amphotericin B

A

Renal impairment. 80% of people will experience renal impairment. Most recover, but some have permanent reduction in GFR. Follow plasma creatinine.

Amphotericin B is a terrible bitch to your kidneys

32
Q

Method of action for antivirals (interferons)

A

1) Binds to receptors on host cell membranes, causing production of enzymes that inhibit viral replication and degrade viral RNA
2) Enhances tumoricidal activity of macrophages

33
Q

Biggest symptom of interferons

A

Flu-like symptoms

34
Q

Three different mechanisms of antivirals for AIDS

A

1) Nucleoside reverse transcriptase inhibitors (impostor host cells)
2) Non-nucleoside reverse transcriptase inhibitors (inhibits the function of enzymes used by the virus)
3) Protease inhibitors (binds to HIV protease)

35
Q

Effect of protease inhibitors on the P-450 system

A

Inhibits the P-450 system.

36
Q

Which protease inhibitor is the most potent inhibitor of the P-450 system?

A

Ritonavir

37
Q

MOA of penicillins

A

Interferes with enzymes responsible for cell wall construction and stability

38
Q

Main method of excretion of macrolides

A

Bile

39
Q

How to remember macrolides.

A

Remember the erythromycin is a macrolide. We used this to increase gastric emptying. Therefore, the main SE of this is GI intolerance (Cramping, N/V/D, especially with IV infusion). Also with GI stuff, it is excreted through bile and is metabolized by the P-450 system.

40
Q

SE of erythromycin

A

GI intolerance (cramping, N/V/D) especially with IV infusion, QT prolongation, and thrombophlebitis with prolonged IV use.

41
Q

Ciprofloxacin has a ________ effect on the P-450 system and has an elimination half time of _____

A

Inhibitory

3-8 hours

42
Q

SE of Cipro

A

Minimal SE. Mild GI disturbance

43
Q

All GPCRs will undergo _____

A

Desensitization

44
Q

MOA of ciprofloxacin

A

Interfering with the enzyme responsible for maintaining the helical structure of DNA

45
Q

Adverse effects of sulfonamides

A

Increases the effects of PO anticoagulants, skin rash to anaphylaxis, drug fever, hepatotoxicity, and rare incidence of hemolytic anemia

46
Q

Polymyxin B and Colistimethate have mostly (pre/post) junctional effects on the NMJ

A

Mostly prejunctional (“B”efore the synapse!)

47
Q

With what antibiotic class do you want to measure coags?

A

Sulfonamides

48
Q

Is rifampin able to cross the BBB?

A

Hellz to the yea

Pharm Spring 2014 (13 decks)

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