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Year 2: Pharmacology for nursing practice > Antimicrobials > Flashcards

Antimicrobials Flashcards

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1
Q

Define a microbe

A

a microscopic organism which could have the potential to cause harm

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2
Q

Why do we use antimicrobial chemotherapy?

A

sytemic

loca infections

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3
Q

What are the other reasons for administering antimicrobals

A

Prophylaxis

Surgery / travel

Gut motility

Farming

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4
Q

How can you tell between gram+ and gram- bacteria in a laboratory?

A

gram- stain violet/purple

gram+ stain red

this is because gram+ have a thinner wall

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5
Q

Structure wise what is the difference between gram+ and gram- bacteria?

A

gram + bacteria have a thinner wall

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6
Q

Which type of bacteria is ore harmful and why?

A

Gram- bacteria are more pathogenic than gram+ because they produce harmful endotoxins.

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7
Q

What type of antibiotics are there?

A

bacteriostatic

bacteriocidal

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8
Q

How do bacteriocidal antibiotics work?

A

They kill bacteria by destroying the cell wall structure, allowig water to enter and causing the cell to lyse

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9
Q

How do bacteriostatic antibiotics work?

A

stop cell replication by inhibiting protein and nucleic acid synthesis.

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10
Q

What type of antibiotic kills bacteria?

A

bacteriocidal

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11
Q

What type of antibiotic stops baterial cell replication?

A

bacteriostatic

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12
Q

What general considerations should be taken into account prior to a prescribing antibiotics?

A 
Know the patient:-
Sensitivities / Allergies
Renal / hepatic function
Resistance to infection
Severity of illness
Ethnicity
Tolerance of oral dosage
Pregnancy / breast feeding
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13
Q

Why should ethnicity be taken into account prior to prescribing an antibiotic

A

some ethnic backgrounds may be more resitant toa particular antibiotic

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14
Q

What is inherent resistance?

A

particular gram stains are resistance to antibiotics due to there cell wall structure

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15
Q

What is acquired resistance?

A

induced resistance of a bacteria to an antibiotic it was originally sensitive to, (i.e. concentration need would have to be toxic)

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16
Q

What type of antibiotic resistance is a result of the wall structure of the bacteria?

A

inherent resistance

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17
Q

What type of antibiotic resistance is a result of continuous use of antibiotics causing mutations in bacteria?

A

acquired resistance

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18
Q

Which is better: amoxicillin or augmentin?

in the eyes of Dr Ehsan

A

Augmentin

19
Q

Why is MRSA resistant to penecillin?

A

MRSA possess enzyme known as beta-lactamase that destroys the compound

20
Q

What factors are considered when choosing an antibiotic for a patient?

A

Patient

  • Allergies
  • renal & hepatic function
  • susceptibility
  • age
  • severity of illness
  • pregnancy
  • breastfeeding
  • tolerate oral drugs?

Organism

  • Local bugs
  • multi-drug resistance (MDR)

Culture and sensitivity when possible – why?

PO or IV

21
Q

Why might a patient be prescribed multiple antibiotics?

A

To prevent the emergence of resistant strains

To treat mixed infections

To treat emergency / life threatening cases before a firm diagnosis

To take advantage of antibiotic synergism

To use lower doses of a toxic drug

22
Q

What are some o the general side effects of antibiotics?

A

Elimination of commensals

Continuous Antibiotic use destroys gut flora
 - Diarrhoea
 - Reduced absorption 
 - of nutrients
 - Anaemia due to 
   abnormal absorption 
   of vitamin B12

Allergic reactions / Anaphylaxis

Toxicity

renal / hepatic

23
Q

What nursing responsibilities to the patient who is taking antibiotics?

A

Inappropriate dosage or incomplete courses lead to antibiotic resistance.

Patients frequently feel better after 2-3 days of antibiotics and stop taking them, especially if GI tract disturbance occurs

!!!Ensure that patient takes complete course of antibiotic

If antibiotic is causing considerable distress to the patient then it needs to be changed for another antibiotic

24
Q

Why is it important to take bloods prior and throughout the administration of antibiotcs?

A

narrow therapeutic index

Peak / trough level of antibiotic (therapeutic drug monitoring: TDM).
Efficacy of antibiotic may be time dependent, concentration dependent and T&C dependent

Minimum inhibitory concentration (MIC) affected by many things:
Renal function
Hepatic function
Changes in compartment volumes

25
Q

what drug interactions must be considered prior to antibiotic administration?

A

Addition of an antibiotic may influence other drug levels

Antacids and laxatives contain metals like
aluminium, calcium and magnesium which
tend to bind (chelate) antibiotics in the GI
tract.

This reduces absorption of many
antibiotics, eg Ciprofloxacin, Tetracyclines

26
Q

How can microbial resistance have global effects?

A

Giving antibiotics to an individual can affect more than just that individual

One bacterium that develops resistance can pass the genes for this into many others, and other species

The total antibiotic resistance gene pool for all bacteria world wide can be viewed as the ‘resistome’

27
Q

What is Teixobactic?

A

an antibiotic Identified 2015
•Effective against gram positive microbes

  • Inhibits formation of type II lipids involved in the petidoglycan production
  • More resistant to mutation as it acts on lipids rather than proteins.

•4-5 years until introduction into clinical practice?
Currently effective against MRSA, VRE and TB (in the lab

28
Q

What factors promote the transmission of MDR bacteria?

A

Patient transfer
Internal and external (notes, bedding)

Open Nursing
cross contamination of neighbouring pt

Non-compliance to staff hygiene protocols:
 - Inadequate washing 
   of hands
 - Inadequate apron 
   and glove usage
   White coats , Ties
29
Q

Define adverse reactions

A

Unwanted effects sometimes occur unrelated to the basic pharmacological action of a drug but rather as a result of its direct action: .g. – gastric bleeding from aspirin.

Adverse reactions unrelated to the main action of a drug are often caused by:- reactive metabolites and/or immunological reactions.

Usually such unwanted effects are reversible by reducing the dose or changing the prescription.

30
Q

Define side effects

A

‘Those responses not required clinically which occur at doses of the drug within the therapeutic range’

31
Q

What are the main risk factors of adverses drug effects?

A

Older age

Polypharmacy

comorbidities

Female gender

Poor literacy

32
Q

What are the types of adverse drug reactions you need to know for the exam?

A

Type A and Type B

33
Q

What is a Type A reaction?

A

Adverse reactions included in this category are usually dose dependent

An example of a Type A response is the respiratory depression that occurs with the administration of fentanyl - this may be viewed as a predictable and dose dependent reaction

34
Q

What is a type b reaction?

A

They cannot be predicted from the known pharmacology of the drug

Dose dependency is usually not a feature

These reactions often have uncertain mechanisms

These are common and mortality is often high

Examples include hepatotoxiticity, blood dyscrasias

35
Q

How does the kidney function of neonates affeect the half life of a drug

A

prolongs drug half-life

36
Q

What is a compliment cascade?

A

complement cascade, is a part of the immune system that enhances (complements) the ability of antibodies and phagocytic cells to clear microbes and damaged cells from an organism, promote inflammation, and attack the pathogen’s cell membrane.

37
Q

How does ageing affect absorption

A

Decreased gastric acid secretion

Altered gastrointestinal peristalsis

Reduces oral drug absorption

38
Q

How does ageing affect distribultio of drugs in the body?

A

Total body water decrease and total body fat increase.

Distribution of fat-soluble drugs e.g. diazepam and water-soluble drugs such as digoxin, changes

39
Q

How does ageing affect plasma protein binding in the body?

A

Decreased plasma albumin restricts drug binding,

Produces higher free concentrations of albumin bound drugs (e.g. warfarin).

40
Q

How does ageing affect metabolism of drugs?

A

Reduced hepatic blood flow; slower metabolism

Alters half life, may result in increased absorption, e.g. barbiturates such as thiopentone sodium.

Less first pass effect

41
Q

How does ageing affect renal excretion of drugs?

A

Glomerular filtration rate is decreased by 30% by the age of 65.

The lower filtration rate, reduces excretion

Increasing half life e.g. digoxin

42
Q

What two levels are indication of kidney funcion in blood test?

A

craetinine and urea

43
Q

How does ageing affect creatinine?

A

older people have less muscle mass

Older people have lower normal creatinine levels, thus they may have renal impairment even with ‘normal creatinine levels

Year 2: Pharmacology for nursing practice (13 decks)

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