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PHARM 2 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

What is MIC?

A

Minimum Inhibitory Concentration

lowest concentration of antibiotic required to prevent growth

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2
Q

What is MBC?

A

Minimum Bactericidal Concentration

Lowest concentration required to kill bacteria

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3
Q

What meds are bacteriostatic?

A 
Tetracyclines
Chloramphenicol
Erythromycin
Sulfonamides
Trimethmprim
  • others are bactericidal.
  • bactericidal not better than bacteriostatic
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4
Q

What are 3 narrow spectrum meds?

A

PCN G
Erythromycin
Clindamycin

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5
Q

Name some broad spectrum meds?

A 
Ampicillin
Cephalosporins
aminoglycosides
tetracyclines
chloramphenicol
quinolones
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6
Q

Time-dependent killing

A

clinical efficacy is related to the duration for which these levels are maintained

*continuous infusion has not shown to be more effective than intermittent boluses

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7
Q

Concentration dependent killing

A

some meds increase the rate and extent of bacterial killing with increasing concentrations

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8
Q

What is post-antibiotic effect (PAE)?

A

some antibiotics continue to suppress growth of bacteria even after antibiotic is no longer detectable.

demonstrated for virtually all antimicrobials
decreased in acidic (infected) media

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9
Q

This is the judicious use of antibiotics to reduce resistance development

A

antimicrobial stewardship

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10
Q

What med is frequently used for UTIs that contributes to resistance

A

Cipro –> broad spectrum, not necessary

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11
Q

What is intrinsic resistance

A

natural resistance to antimicrobial

ex: vanco only kills gram positive bacteria

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12
Q

What is acquired resistance?

A

a genetic alteration in the bacteria that renders a once effective antimicrobial ineffective

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13
Q

What are 4 mechanisms of acquired resistance?

A

decreased permeability
increased efflux pumps
inactivation
modification of the antimicrobial target

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14
Q

What is a polymicrobial infection?

A

more than 1 drug may be needed to treat infection with more than 1 organism

*Broad spectrum may be able to cover multiple organism infection with a single agent

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15
Q

Why might you use 2 antibiotics with different mechanisms of action?

A

To inhibit emergence of resistant strains of an organism

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16
Q

T/F: there is evidence showing benefit to using “double coverage” to treat infection

A

FALSE

no proven benefit to giving 2 susceptible antibodies as opposed to just one

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17
Q

Name the different types of synergy;

a. 1+1 = 0.5
b. 1+1 = 1
c. 1+1 = 1.5
d. 1+1 = 2
e. 1+1 = 3

A

a. antagonism
b. indifferent
c. in between
d. additive
e. synergistic

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18
Q

What are 5 instances when bactericidal therapy may be necessary for clinical cure

A
  • CV infection - endocarditis
  • Meningitis and cerebral abscess
  • Invasive bacterial infection in severely neutropenic pt
  • Osteomyelitis
  • Attempted treatment of prosthesis or vascular access related infections w/o removing the device
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19
Q

What can increase a pt’s risk for a specific type of infection?

A 
neutropenia
asplenia
malignancy
HIV
immunosuppressant therapy
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20
Q

What 2 things increase a pt’s risk for complications from an infection?

A
  • Prosthesis or foreign body; heart valves, prosthetic joints, vascular grafts *form a biofilm
  • Pregnant pts: pharmacokinetics are altered - increased volume of distribution and GFR
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21
Q

What antibiotics are ok to give to pregnant pts?

A

PCNs - study said to avoid 1st trimester
Cephalosporins
Erythromycin

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22
Q

What antibiotics should you avoid in pregnancy bc will cause injury to fetus?

A

metronidazole, ticarcillin, rifampin, trimethoprim, fluoroquinolones, and tetracyclines

*tetracycline associated with acute fatty necrosis of the liver, pancreatitis, and possible renal injury - it also discolor teeth

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23
Q

what percentage of pts with PCN allergy will have a reaction to cephalosporins?

A

< 2-5%

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24
Q

What 3 devices are highly associated with nosocomial infections?

A

ventilator
vascular access catheter
urethral catheter

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25
Q

Highest rate of central line infection to lowest rate

A

femoral > IJ > subclavian

26
Q

T/F: Antibiotic impregnated caths may decrease bactemia

A

FALSE

not shown to be true in all studies

27
Q

What percentage of people are natural carriers of c-diff

A

10%

28
Q

What antibiotic is the #1 cause for c-diff development?

A

clindamycin

Ancef is #2

29
Q

What % of patients relapse after being successfully treated for c diff?

A

10%

Flagyl is no longer recommended due to high reoccurrence rates

30
Q

What is treatment for c diff?

A

10-14 days oral vanco

99% cure rate with fecal transplants

31
Q

What are 3 risk factors for c diff?

A

antimicrobial use
acid suppressant therapy
inappropriate handwashing techniques

32
Q

How many SSIs are preventable using evidence based strategies?

A

estimated that half are preventable

33
Q

The need for surgical prophylaxis depends on what 5 things?

A 
risk of infection (wound classification)
pt-related factors (ie immunocompetence)
bacterial milieu (potential bacteria)
hospital infection rate for various procedures
factors relating to the wound itself
34
Q

What med is usually used for surgical prophylaxis?

A

1st generation cephalosporin - cefazolin

low cost
broad spectrum
low incidence of allergic reactions

35
Q

What are the 4 wound classes?

A
  1. clean: atraumatic, no break in sterile technique, respiratory, GI and GU tracts not entered
  2. Clean-contaminated: surgery in areas known to harbor bacteria, no spillage of contents
  3. contaminated: major break in sterile technique, surgery on traumatic wounds, gross GI spillage, entrance into an infected biliary or GU tract
  4. dirty-infected: infection exists before surgery
36
Q

What is most common species in clean wounds?

A

Staphylococcal

no need for prophylaxis for some clean procedures

37
Q

Antibiotics are redosed after _______ half-lives

A

2

Ancef: 4 hrs
clindamycin: 6hrs
Vanco: don’t redose

38
Q

Beta Lactams are ______ _______ synthesis inhibitors

A

Cell wall

39
Q

what breaks the bon of the beta lactam ring to disable the molecule - making it resistant to the effects of PCN and other beta lactam antibiotics?

A

Beta lactamase

40
Q

Sulbactam
tazobactam
Clavulanic acid

all are:

A

beta lactamase inhibitors

there to trick the enzyme –> get broken apart so hopefully the true antibiotic will remain intact

41
Q

Are cephalosporins bactericidal or bacteriostatic?

A

Bactericidal

have same MOA as PCNs

42
Q

Cephalosporins gram ____ to gram ____ with each generation

A

positive

negative

43
Q

Do 1st generation cephalosporins like ancef and Keflex cover MRSA?

A

NO

44
Q

Carbapenems are the DOC for what?

A

ESBL

broad spectrum, should be used as last resort

45
Q

There is a high risk of _________ with carbapenems

A

seizures

pts with seizure disorder or head injury have a great increase risk of seizure development

46
Q

Is vanco bactericidal or bacteriostatic?

A

bactericidal

47
Q

Vanco covers gram _____ only

A

positive

48
Q

What is the vanco dose?

A

15mgkg

concentration dependent

49
Q

What is a vanco alternative and covers MRSA and VRE

A

Linezolid (Zyvox)

50
Q

Linezolid (Zyvox) has drug interactions with what?

A

MAO –> potential for serotonin syndrome

hold MAOIs and SSRIs

51
Q

Macrolides are bactericidal or bacteriostatic

A

bacteriostatic

52
Q

What are some fun facts about macrolides like azithromycin (Zithromax), biaxin, and erythromycin

A

Can treat a lot of respiratory infections
May prolong QT interval
Lots of drug interactions

53
Q

What antibiotic should be avoided in the elderly?

A

Fluoroquinolones (Ciprofloxacin, Levofloxacin)

May increase morbidity and mortality in elderly pts.

54
Q

what antibiotics permanently deposit in bone and yellows teeth in children?

A

tetracyclines

55
Q

What antibiotics can contribute to neuromuscular blockade?

A

aminoglycosides

neomycin and streptomycin have higher rates of this

56
Q

T/F: 2 bacteriostatic = bactericidal

A

TRUE

Trimethoprim/Suflamethoxazole
Bactrim/septra

57
Q

T/F: Pts with a sulfa allergy can take bactrim

A

FALSE

58
Q

What antibiotic can also prolong neuromuscular blockade?

A

clindamycin (cleocin)

59
Q

This med is used in GI and GU surgeries

A

Metronidazole (Flagyl)

concentration dependent
disulfuram like reactions with ETOH
coumadin interaction

60
Q

These meds are used for biofilms

A

rifampin and rifabutin

*used mostly for TB and prostheitcs

61
Q

Acyclovir (zovirax) and valacyclovir (Valtrex) are:

A

Antivirals

Used for Herpes simplex 1 &2, varicella zoster, Epstein-Barr, CMV

PHARM 2 (7 decks)

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