Antimicrobials. Flashcards

Question

Carbapenem | Contraindications

Answer 1

``` • Allergy to cabapenems • Allergy to PCN • Allergy to cephalosporins • Seizures and other CNS disorders • Renal impairment ***Monobactam, penicillin and cephalosporins may decrease the effects*** ```

Answer 2

``` -mycin Cell wall synthesis • Reserved for Severe infections ▫ MRSA ▫ Pseudomembranous colitis that has caused C. diff ▫ Infections in patients with PCN allergy • Weakens and destroys cell wall • Bactericidal • PO form for C. Diff • IV forms for other infections ```

Answer 3

• Hypotension/Red person syndrome with rapid IV infusion ▫ Rapid release of histamine when infused too quickly. ▫ Infuse over at least an hour. ▫ Not an allergy • Ototoxicity ▫ Hearing loss ▫ Baseline—do they have hearing loss already • Nephrotoxicity ▫ Monitor BUN, creatinine (memorize these) ▫ Watch for other meds that are hard on kidneys • Thrombophlebitis ▫ Redness, tenderness to IV site • Draw a trough immediately before next dose! ▫ Fairly narrow therapeutic range ▫ Too high, damage to kidneys and ears ▫ Trough—10-20 mcg/L • PO form does not absorb in GI but lines the walls.

Answer 4

``` • Allergy to vancomycin • Allergy to corn products ▫ Contain dextrose • Renal insufficiency • Hearing impairment • Colitis/inflammatory disorders of the colon ```

Answer 5

• Metformin may increase risk lactic acidosis • Other drugs that are also nephrotoxic or ototoxic • Incompatible with multiple IV medications ▫ Must look up to make sure before administering with other meds.

Answer 6

``` -cyclines Protein synthesis • First choice for ▫ Chlamydia ▫ Mycoplasma ▫ Rickettsia infections (Rocky Mountain Fever) ▫ Syphilis ▫ Gram positive infections  Cholera  Anthrax ▫ Acne vulgaris • Broad spectrum • Inhibit protein synthesis • Bacteriostatic – blocks bacterial reproduction ▫ Can give large doses ▫ Can give to resistant bacteria ```

Answer 7

▫ Nausea, vomiting, diarrhea, abdominal pain ▫ Work best on empty stomach  1hour before or 2 hours after meals  Do not give right before bedtime • Can cause esophageal irritation  Don’t give with dairy (calcium absorption) and antacids • Prohibit absorption of drug ``` • Liver toxicity ▫ LFT’s, • Suprainfections • Photosensitivity ▫ Severe sun burn reactions ▫ Avoid tanning bed ▫ Wear UV protections • Teeth ▫ Avoid in infants and children less than 8 ▫ Report pregnancy IV doxycycline v irritating to veins ```

Answer 8

* Women who are pregnant * Children less than 8 * Allergy * Exposure to ultraviolet light * Serious renal or liver failure * History of allergies/hay fever * History of liver or kidney disorder * Myasthenia gravis

Answer 9

* Calcium containing foods * Antacids containing calcium * Should be given an hour before any meds are given because of how they react in the body. * Kaolin containing antidiarrheals decrease tetracycline absorption * Oral contraceptive effects are decreased

Answer 10

-thromycin protein synthesis • First choice for ▫ Legionnaires’ disease ▫ Whooping cough ▫ Acute diphtheria ▫ Some Chlamydia infections ▫ Certain Pneumonias • Option for patients with penicillin allergy • Used in neonates to prevent eye infections • Azithromycin and clarithromycin have longer duration of action than erythromycin, so can be dosed less often • Erythromycin PO, IV, topical, eye ointment • Inhibits protein synthesis • Bacteriostatic *Clarithromycin has been approved in combo with omeprazole and amoxicillin for H. pylori

Answer 11

• GI ▫ Nausea, vomiting, abdominal pain, diarrhea (off label use for patients with decreased GI motility) ▫ Give on empty stomach but can be given with meals with GI upset • Cardiac (esp. with clarithromycin) *** ▫ Ventricular dysrhythmias – prolonged QT interval = ventricular fibrillation ▫ “question patient about a history of a prolonged QT interval” • Not good drug of choice • Ototoxicity • Suprainfection ▫ Candida infection

Answer 12

* Allergy to erythromycin * History of prolonged QT interval * GI disorders * Liver disorders * Seizure disorders

Answer 13

* Decreases clindamycin antibx * Increases digoxin, warfarin, theophylline * Increased effects with grapefruit juice * “-azole” Antifungals, verapamil, HIV meds, diltiazem increase EES levels

Answer 14

-cin Protein synthesis Narrow spectrum ▫ Aerobic gram negative bacilli and specific gram negative cocci • Inhibit protein synthesis ▫ Often in combo with beta-lactams because of synergistic effect • Bactericidal • Use topically for skin and eye infections

Answer 15

• Ototoxicity ▫ Early signs: tinnitus, headache, vertigo • Nephrotoxicity ▫ Polyuria, dilute urine, protein and casts in urine ▫ Elevated BUN/creatinine • Monitor labs ▫ Peak/trough levels ▫ BUN/Creatinine/u/a • Avoid topical form in large areas (toxicity) ▫ Wear gloves during administration

Answer 16

* Allergy to aminoglycoside * Pregnancy category D and lactation * Damage to acoustic nerve (hearing loss * Presence of tinnitus/vertigo * Renal disorders * Chronic neuromuscular disorders * Dehydration * Hypocalcemia

Answer 17

* Vancomycin, ethacrynic acid, furosemide (ototoxicity * Amphotericin, NSAID (nephrotoxicity) * Cephalosporins, vancomycin, PCN increase gentamicin * Avoid mixing in same IV solution with PCN, cephalosporins, heparin * Prolongs muscle paralysis in combination with neuromuscular blocking agents

Answer 18

• Indicated for VRE (Vancomycin resistant enterococcus faecium), a healthcare associated infection ▫ health care–associated pneumonia ▫ complicated skin and skin structure infections, including cases caused by MRSA ▫ gram-positive infections in infants and children ▫ community-associated pneumonia and uncomplicated skin and skin structure infections. • Inhibits protein synthesis

Answer 19

* Headache, nausea, vomiting, diarrhea * Thrombocytopenia * Available PO or injectable * Contraindicated in allergy * Interactions with vasopressive drugs (increase vasopressive effects) * SSRIs – increased risk Serotonin Syndrome * Tyramine containing foods – increase blood pressure

Answer 20

cipro- DNA replication Treats wide range of bacterial infections ▫ UTIs ▫ Prevention of Anthrax if exposed ▫ Cystic fibrosis • Inhibit DNA replication and cell division • Bactericidal • PO, IV should be given over 1 to 1.5 hours

Answer 21

• • Mild CNS symptoms ▫ Dizziness, headache, confusion in older adults (can also present with UTI) • GI ▫ Nausea vomiting and diarrhea ▫ Liver injury in older adults • Achilles tendon rupture (rare) ▫ Children, older adults and patients taking glucocorticoids • Photosensitivity • Take antacids, iron, calcium diary products, sucralfate 2 hours after or 6 hours before oral Cipro. Lose efficacy of AB if taken with. • Cipro and class Ia and III antidysrhythmics  dysrthymias

Answer 22

* Allergy to Fluoroquinolone * Tendon pain * Serious CNS/seizure disorders * Cardiac history * GI disorders * Renal impairment * Warfarin * Children under 18—due to risk of interaction with growth.

Answer 23

* Antacids, iron, calcium, sucralfate decrease oral absorption * Increases theophylline levels * Increases warfarin levels

Answer 24

Inhibit Folic Acid synthesis

Answer 25

``` • GI ▫ Nausea, vomiting and anorexia • Allergic skin reactions • Blood cell deficiencies (long-term use) ▫ Thrombocytopenia ▫ Leukopenia ▫ Anemia • Suprainfection ▫ Pseudomembranous colitis/Candida • Severe rash ▫ Stevens-Johnson syndrome (rare fatal skin disorder) ``` *With long term use, assess kidney function 2/2 risk of drug-related crystalluria • Drink at least 2500-3000 ml of water per day during therapy • Use alternate form of contraception

Answer 26

``` • Pregnant, near term or nursing • Allergy to sulfonamides, trimethoprim • Megaloblastic anemia from folic-acid deficiency • Children less than 2 months • Pharyngitis ▫ Group B beta hemolytic streptococci • Hyperkalemia ▫ Creatinine clearance • Decreased kidney/liver function • Hypersensitivity to sulfites (wine, food) • Bone marrow suppression • Patients at risk for megaloblastic anemia ▫ Pregnant women ▫ Alcoholics ▫ Patients with debilitation ```

Answer 27

* Alcohol may cause reaction * Increased effects of warfarin, phenytoin, tolbutamide and sulfonylurea oral antidiabetic drugs * With methotrexate = increased immunosuppression * Reduce effectiveness of oral contraceptives

Answer 28

• Kill Mycobacterium Tuberculosis Bacteria ▫ Cell walls are waxy ▫ Require a combination of drugs to fully eradicate and avoid resistance

Answer 29

PPD test only tells if we have been exposed to Tb ``` • Treats active and latent TB ▫ Interferes with lipid, RNA and DNA ▫ Bactericidal  Specifically to tubercle bacilli  Disrupts cell wall synthesis and essential cellular functions • Single drug for prevention • Combination for treatment of active TB ```

Answer 30

• GI ▫ Ideally take on empty stomach, but can be taken with food ▫ Increase fiber/fluids to prevent constipation • ADHERENCE TO REGIMEN FOR FULL COURSE (MONTHS) • LIVER DAMAGE ▫ Liver enzymes (LFT’s), elevates LFT’s ▫ Jaundice, abdominal pain, fatigue • Peripheral neuropathy ▫ Can give vitamin B6 for neuropathy • Given with other drugs to prevent resistance • Given alone to treat latent TB (6-9 months) • Consistent use and dosing critical to maintain steady blood levels and decrease resistance • Cultural considerations

Answer 31

* Allergy to isoniazid * History of liver damage * Chronic liver disease * HIV infection * >50 years old * Seizure disorders * Renal disorders * Alcoholism * Increases toxicity

Answer 32

* Disulfiram (Antabuse) = psychosis/ataxia * Phenytoin = phenytoin toxicity * Antacids = decrease absorption

Answer 33

• ADJUNCT (combo) therapy Mycobacterium Tuberculosis Bacteria ▫ Not specific to TB  Preventative  Neisseria meningtides (meningococcal meningitis)  Haemophilus influenza  Treat leprosy • Suppresses protein synthesis • Bactericidal *May turn urine, saliva, tears, and sweat red-brown color

Answer 34

``` • Liver toxicity ▫ Monitor liver enzymes ▫ Report symptoms of hepatitis (abdominal pain, nausea, fatigue, jaundice) • Red/orange color to body fluids ▫ Urine, saliva, tears, sweat ▫ Avoid contact lenses (staining) • GI ▫ N, V, D, abdominal pain ▫ Give on empty stomach • Oral contraceptive ```

Answer 35

* Allergy to rifampin * Obstructive gallbladder disease * Current meningococcal disease * History of liver disease * History of alcoholism

Answer 36

* ORAL CONTRACEPTIVES = decreases levels * Warfarin = decreases levels * HIV drugs = decreases levels

Answer 37

``` ▫ Invades host cells (parasite) ▫ Reproduces inside that cell ▫ Treatment tends to kill host cells  New drugs are becoming more specific  Antibiotics are ineffective ```

Answer 38

``` (-vir) ▫ Herpes simplex (genital herpes) ▫ Herpes zoster/varicella (Shingles)  Infection of the peripheral nerve by the varicella virus when the patient is immunocompromised due to age/co-morbidities ▫ Herpes labialis (cold sore) • Inhibits viral replication of DNA • Bacteriostatic ▫ Herpes simplex ▫ Herpes zoster ```

Answer 39

• **Dependent on the route of administration** • Topical—cold sore, genital herpes outbreak, should wear gloves to administer ▫ Burning, itching at application site • Oral—genital herpes, shingles ▫ GI ▫ Headache ▫ Vertigo ▫ Monitor BUN and creatinine • IV form ▫ Renal toxicity ▫ CNS toxicity (RARE)  Restlessness, tremors, psychosis, seizures ▫ Thrombophlebitis (infiltration causes tissue damage) ▫ Infuse slowly ▫ Hydrate patient during and 2 hours after infusion

Answer 40

* Allergy to acyclovir/valacyclovir * Renal insufficiency * Neurologic disorders * Dehydration

Answer 41

* Probenecid (gout med) increases acyclovir levels * Also sometimes given with penicillin for synergy * Zidovudine increases CNS effects * Other nephrotoxic drugs increases nephrotoxicity

Answer 42

``` ▫ Superficial/systemic fungal infections ▫ Candida/yeast infections ▫ Very toxic—usually given IV  Topical/oral to treat Candida of skin and mucous membranes  Urinary irrigation ```

Answer 43

```  Skin stuff, diaper rash 1. Topical  PO 1. Prophylaxis against candida for the immunosuppressed. 2. Oral and vaginal candidiasis ```

Answer 44

systemic fungal infections | fewer side effects

Answer 45

``` ▫ Interrupts integrity of cell walls of fungi ▫ Fungistatic AND fungicidal (dose-related) ▫ Many indications:  Aspergillosis  Candidiasis  Histoplamosis  Fungal septicemia  Nystatin is a polyene as well ```

Answer 46

▫ Common reactions (p. 659)  Chills, fever, tachycardia, hypotension, headache, nausea  Starts 1-2 hours after infusion begins and subsides within 4 hours  Reactions decrease over course of therapy (weeks)  May give diphenhydramine (Benadryl) and acetaminophen (Tylenol) before infusion ▫ Red blood cell suppression = anemia ▫ Thrombophlebitis ▫ Renal toxicity

Answer 47

* Vital signs and symptoms during infusion * Kidney function tests * Weight, I/O * Hematocrit, CBC * Stop infusion and contact provider immediately if severe reaction occurs including a decline in VS * Contraindication: Bone marrow suppression – Risk versus benefit * Pulmonary infiltrate—stuff in lungs, may hear crackles, see SOB

Answer 48

``` ▫ Lives in blood cells, organs, structures ▫ Malaria  Travels to the liver and proliferates ▫ Helminths  Worms in intestines ▫ Trichomonas  Reproductive tracts ```

Answer 49

``` • Broad spectrum ▫ Damages DNA in anaerobic organism • Bactericidal • Treats bacterial infections ▫ Pseudomembranous colitis (secondary to antibiotic use) ▫ Bacterial vaginal infections • Treats protozoal infections ▫ Intestinal and systemic amebiasis ▫ Giardiasis ▫ Trichomoniasis (males/females) • IV form = prevention of bacterial infections during colorectal, abdominal and vaginal surgeries • Given with tetracycline/bismuth subsalicylate to treat h. pylori ▫ Lot of indications. ```

Answer 50

``` • GI ▫ Best absorption on empty stomach ▫ Nausea, vomiting, diarrhea ▫ Metallic taste • CNS ▫ Headache, vertigo, ataxia ▫ Seizures, peripheral neuropathy (rare, but need to stop drug) • Darkening of urine (harmless) • Suprainfection with Candida ```

Answer 51

* Active CNS disease * Severe blood disorders * Existing Candida infection * Heart failure * Liver/renal failure * Seizure disorders

Answer 52

Citalopram (Celexa), ritonavir (Norvir), IV nitroglycerin, sulfamethoxazole, trimethoprim Disulfiram (Antabuse), Alcohol = psychotic reactions Phenobarbital = decreases flagyl levels Lithium = increases levels Fluorouracil/azathioprine = temporary neutropenia MULTIPLE IV INCOMPATIBILITIES