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Pharm Exam 4 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

SCIP 1

A

Prophylactic abx received within 1 hr prior to surgical incision

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2
Q

SCIP 2

A

Prophylactic antibiotic selection for surgical patients - choose abx appropriate for patient and surgery

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3
Q

SCIP 3

A

discontinue prophylactic abx within 24 hours after surgery (48 hours for cardiac patient)

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4
Q

SCIP 4

A

cardiac surgery patient w/ controlled 6am post-op glucose (<200)

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5
Q

SCIP 5

A

post-op wound infection diagnosed during index hospitalization

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6
Q

SCIP 6

A

surgical patients with appropriate hair removal

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7
Q

SCIP 7

A

colorectal patients with immediate postoperative normothermia

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8
Q

hypothermia results in:

A

peripheral vasoconstriction, decreased wound oxygen tension and recruitment of leukocytes, favoring infection and impaired healing

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9
Q

How are PCN classified into subgroups?

A

B-lactamase susceptibility, structure, and spectrum of activity

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10
Q

Penicillins interfere with synthesis of _______

A

peptidoglycan

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11
Q

What is peptidoglycan?

A

essential component of cell walls in bacterias

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12
Q

Penicillins decrease the availability of an ______ of murien hydrolase

A

inhibitor

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13
Q

When murien hydrolase is uninhibited, it:

A

destroys (lyses) the structural integrity of bacterial cell walls

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14
Q

What do resistant gram-negative bacteria have/do that prevents PCN from working?

A

cell membranes that prevent the penicillin from getting to the site of peptidoglycan synthesis; the bacteria could produce B-lactamase enzymes that hydrolyze the B-lactam ring and make the penicillin inactive

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15
Q

T/F: Penicillin is ONLY active against growing bacteria

A

TRUE

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16
Q

High doses of PCN G may result in _____ and ______

A

Hyperkalemia and neurotoxicity

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17
Q

PCN G has ____ meq of K per 10 million U

A

16

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18
Q

PCN G is _____% ______ excreted

A

90% renally

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19
Q

3 drugs that prolong PCN duration of action

A

probenecid
procaine
benzathine

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20
Q

Penicillinase-Resistant PCN (list names of drugs)

A 
Methicillin
Nafcillin (80% bile excreted)
Oxacillin (hepatitis SE)
Cloxacillin (PO)
Dicloxacillin (PO)
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21
Q

Penicillinase-resistant PCN are used to treat what infections?

A

Staphylococci

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22
Q

What makes penicillinase-resistant penicillins resistant?

A

not susceptible to hydrolysis of B-lactam ring by bacteria

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23
Q

What generation are Penicillinase-susceptible broad spectrum penicillins?

A

2nd generation

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24
Q

Penicillinase-susceptible broad spectrum penicillins (list drugs)

A

Ampicillin

Amoxicillin

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25
Q

Does staphylococcus respond to Penicillinase-susceptible broad spectrum penicillins (2nd generation PCN)?

A

No

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26
Q

Of penicillins, which has highest incidence skin rash?

A

Ampicillin

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27
Q

Ampicillin has (broader/narrower) activity then PCN G

A

broader

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28
Q

Amoxicillin or Ampicillin: which is better absorbed from GI tract?

A

Amoxicillin

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29
Q

Amoxicillin or Ampicillin: which has longer effective circulating concentrations?

A

Amoxicillin

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30
Q

Which generation are Extended-Spectrum Carboxypenicillins?

A

third generation

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31
Q

Extended-Spectrum Carboxypenicillins (list the drugs)

A

Carbenicillin

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32
Q

Is Carbenicillin effective against staph aureus?

A

No

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33
Q

Side effects of Carbenicillin:

A

CHF (>10% drug is Na)
hypokalemia
metabolic alkalosis
increased bleeding time with normal platelet count

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34
Q

What generation are extended-spectrum acylaminopenicillins?

A

4th generation

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35
Q

Are extended-spectrum acylaminopenicillins effective against staph aureus?

A

No

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36
Q

Extended-spectrum acylaminopenicillins (list drugs)

A

Mezlocillin
piperacillin
azlocillin

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37
Q

Which subgroup has broadest spectrum of all penicillins?

A

extended-spectrum acylaminopenicillins

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38
Q

Is piperacillin effective against staph aureus and penicillinase-producing bacteria?

A

No

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39
Q

Penicillinase B-lactamase Inhibitors MOA:

A

B-lactam compounds have little intrinsic antimicrobial activity. They bind irreversibly to B-lactamase enzyme so drugs that were inactivated by this enzyme (and breaking of the B-lactam ring) are no longer susceptible, and can work against these bacteria

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40
Q

Penicillinase B-lactamase Inhibitors (list them)

A

Clavulanic acid
Sulbactam
Tazobactam

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41
Q

Penicillinase B-lactamase Inhibitors Combinations (list the pairings)

A

Clavulanic acid + amoxicillin
Sulbactam + ampicillin
Tazobactam + piperacillin

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42
Q

Why do we use cephalosporins?

A

wide therapeutic index
cost effective
low incidence of side effects

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43
Q

What surgery are cephalosporins used in?

A

GI/GU surgery

44
Q

Incidence of allergic reactions in cephalosporins

A

1-10%

45
Q

Side effects cephalosporins:

A 
\+ Coombs reaction (antibodies react against RBCs)
hemolysis
nephrotoxicity
bronchospasm
urticaria
hemodynamic collapse
46
Q

Life threatening anaphylaxis in cephalosporins:

A

0.02%

47
Q

Most common adverse reaction to B-lactam antimicrobials:

A

hypersensitivity (IgE antibodies)

48
Q

Most allergenic of all drugs:

A

Penicillin, 1-10%

49
Q

95% of patients allergic to PCN for ____ metabolite

A

penicilloyl-protein conjugate (major antigenic determinant)

minor antigenic determinant is 6-aminopenicillicacid + benzylpenamaldic

50
Q

T/F: 1st gen cephalosporins are just as good as 2nd and 3rd gen against staphylococci and nonenteral streptococci

A

True

51
Q

allergy to one penicillin increases likelihood of allergy to other penicillins because of ____, which also is a potential for cross reactivity between PCN and cephalosporins

A

a common nucleus (B-lactam ring)

52
Q

Actual cross reactivity between cephalosporins and PCN

A

textbook says rare, in class she said 1-3%

53
Q

First generation cephalosporins (list them)

A

Cephalothin

Cephazolin

54
Q

How are cephalosporins eliminated?

A

kidneys

55
Q

Drug of choice for antimicrobial prophylaxis for many surgeries

A

Cephazolin

56
Q

Second generation cephalosporins (list them)

A

Cefoxitin
Cefamandole
Cefuroxime

57
Q

Which is the only second generation cephalosporin effective in treating meningitis?

A

Cefuroxime

58
Q

Generally, activity against gram ___ cocci decreases and activity against gram ____ cocci increases from the first to the third generation

A

positive; negative

59
Q

Third generation cephalosporin is different from the others… how?

A

enhanced ability to resist hydrolysis by the B-lactamases of many gram negative bacilli and can achieve therapeutic levels in CSF (so used against meningitis)

60
Q

Third generation cephalosporins (list them)

A

Cefotaxime
Ceftriaxone
Cefixime

61
Q

Do you reduce the cephalosporins dose or frequency in ESRD?

A

yes
first generation: decrease dose
second generation: do not give ESRD
third generation: cleared renal and hepatic, still reduce dose in renal patient

62
Q

Aztreonam effective against gram ____ bacteria only

A

negative

63
Q

Does Aztreonam have B-lactam ring?

A

Yes

64
Q

Is Aztreonam cross sensitive with PCN/cephalosporins?

A

No

65
Q

Side effect Aztreonam:

A

enterococcal superinfection

66
Q

Aminoglycosides are excreted:

A

renally

67
Q

Aminoglycoside lipid solubility:

A

poor. less than 1% oral administration is absorbed systemically

68
Q

Aminoglycoside normal half-life 2-3 hours in normal renal function.
half-life in renal failure:

A

20-40x normal

69
Q

Side effects aminoglycosides:

A

ototoxicity (vestibular and auditory)
nephrotoxicity
skeletal muscle weakness (potentiates NMB, do not give in MG)

70
Q

Aminoglycosides (list them)

A

gentamicin
streptomycin
amikacin
neomycin

71
Q

Gentamicin is active against:

A

P. aeruginosa and gram negative bacilli

72
Q

Important to _____ when administering gentamicin

A

monitor plasma concentration

73
Q

What is toxic level of gentamicin?

A

> 9 ug/ml

74
Q

Macrolides are absorbed (well/poorly) from GI tract

A

well

75
Q

Macrolides (list them)

A

Erythromycin
Azithromycin
Clindamycin
Vancomycin

76
Q

Do you need to alter erythromycin dose in renal failure?

A

No, excreted in bile

77
Q

Part of new combo treatment for COVID-19

A

Azithromycin

78
Q

Clindamycin is used for infection of:

A

GI tract and female genital tract

79
Q

Clindamycin is excreted:

A

hepatic ally, decrease dose in liver patients

80
Q

Side effects of clindamycin:

A

pseudomembranous colitis (swelling or inflammation of large intestine due to c. diff)
diarrhea
large dose can induce NMB in absence of non depolarizer
skin rash

81
Q

Clindamycin has (more/less) activity against anaerobes (usually gram negative) than erythromycin

A

More

82
Q

MRSA drug of choice

A

Vancomycin

83
Q

Is routine prophylaxis with vancomycin recommended?

A

No, because concerns of resistant organisms

84
Q

Vancomycin works against gram ____ bacteria

A

positive (impairs cell wall synthesis)

85
Q

Is vancomycin absorbed in GI tract?

A

no, poorly absorbed in GI tract

86
Q

Vancomycin should be infused over ____ minutes to minimize ______

A

60 minutes; occurrence of drug-induced histamine release and hypotension

87
Q

Vancomycin should be started ____ hour(s) before surgery for prophylaxis

A

2 (per stoelting)

88
Q

Vancomycin is excreted by _____

A

kidney

89
Q

Does vancomycin dose have to be adjusted in renal failure?

A

yes

90
Q

Important guide to dosing vancomycin (especially in renal failure):

A

plasma vancomycin levels

91
Q

Side effects vancomycin administration:

A 
Red Man Syndrome
arterial hypoxemia, low SpO2
ototoxicity
nephrotoxicity (with aminoglycoside)
Vanco + succs = NMB
histamine release
bronchospasm
92
Q

Red man syndrome

A

rate dependent infusion reaction- NOT A TRUE ALLERGIC RXN
intense facial and truncal erythema
rapid infusion (<30 min) can cause hypotension and cardiac arrest
pruritus
myalgia, dyspnea
venodilation, decreased ventricular filling

93
Q

Treatment of pseudomembranous colitis

A

Metronidazole

94
Q

Which abx causes pseudomembranous colitis?

A

Clindamycin

95
Q

Fluoroquinolones (list them)

A

Ciprofloxacin (M. tuberculosis)

Moxifloxacin (serious SE, last resort)

96
Q

Vancomycin dose

A

10-15 mg/kg over 60 min

prophylaxis:
<90 kg 1 gm
90-120 kg 1.5 gm
>120 kg 2 gm

97
Q

Silver nitrate is used as a:

A

caustic, antiseptic, astringent

98
Q

Silver nitrate is strong bactericidal, especially for

A

gonococci

99
Q

Silver nitrate is used in prophylaxis for

A

ophthalmia neonatorum

100
Q

Silver nitrate SE

A

hypochloremia
hyponatremia
methemoglobinemia

101
Q

Chlorhexidine MOA

A

disrupts cell membranes of the bacterial cells

102
Q

Chlorhexidine is effective against gram ____

A

positive and negative

103
Q

Chlorhexidine is ____ effective in decreasing number of normal cutaneous bacteria than povidone-iodine and hexachlorophene

A

more- greater initial decrease

104
Q

Chlorhexidine is used for

A

preoperative reduction of cutaneous flora for the surgeon and patient

105
Q

Chlorhexidine solution in alcohol base can cause:

A

deafness and corneal injury (if instilled in middle ear or eye)

106
Q

Chlorhexidine potential for contact sensitivity and photosensitivity is:

A

Low

Pharm Exam 4 (3 decks)

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