antimicrobials (against cell wall) PHARM

Question 1

MOA of antimicrobials

Answer 1

inhibit cell wall synthesis of bacteria
weaken cell wall

influx of fluid into cell –> cell swells and bursts –> cell destroyed and dies

Question 2

antimicrobials: classes

Answer 2

penicillins
cephalosporins
carbapenems
vancomycin

Question 3

beta lactam ATB are made up of

Answer 3

penicillins & cephalosporins, carbapenems and monobactams

Question 4

if a bacteria produces beta-lactamase…

Answer 4

beta lactam ATB will NOT kill the bacteria

must be combined with another ATB to kill bacteria
(sulfabactam, clavulanic acid, tazobactam, avibactam)

Question 5

penicillin: side effects

Answer 5

low toxicity - relatively controllable

urticaria (rash), pruritus (itchy), angioedema (swelling)

GI distress, oral/vaginal candidiasis, anaphylaxis

Question 6

penicillin: indications

Answer 6

UTI, gonorrhea, peritonitis (abd swelling/inflammation), PNA + resp conditions, meningitis, sepsis

Question 7

different types of penicillins

Answer 7

*natural: G + V
*penicillinase-resistant: nafcillin
*aminopenicillins: amoxicillin & ampicillin
*extended-spectrum: piperacillin

Question 8

penicillin drug-interactions

Answer 8

warfarin
NSAIDS
oral contraceptives

Question 9

penicillin G & V

Answer 9

natural, least toxic
IV/IM

works on: gram +, gram -, anaerobic bacteria and spirochetes

1/2 life: 30 min

can be used with aminoglycosides (disrupts protein synthesis)

Question 10

what should you be aware of if a patient is allergic to 1 type of penicillin?

Answer 10

likely allergic to ALL penicillins and cephalosporins

Question 11

nafcillin

Answer 11

penicillanse resistant –> resist the breakdown by penicillanse enzyme
*IV only
*drug of choice

Question 12

ampicillin

Answer 12

aminopenicillin

effective against a ton of organisms

SE: diarrhea, rash
route: PO, IV

sensitive to kidneys

combo: ampicillin+sulbactam (beta-lactamase inhibitor)

Question 13

amoxicillin

Answer 13

aminopenicillin

*less SE
*common in pediatrics
*ONLY PO

*common use: ENT, genitourinary and skin infections

Question 14

piperacillin

Answer 14

extended spectrum
*works against the most
*ALWAYS given with beta-lacatamase inhibitor

*good for pseudomonal infections
*affects platelet fxn
*watch for pt with renal dysfunction

Question 15

how many generations of cephalosporins are there?

Answer 15

5 generations
increase the spectrum, activity, and ability to penetrate CSF

Question 16

cephalosporins

Answer 16

*resistant to beta-lactamase (cephalosprinase)
*low toxicity
*avoid if had rxn to penicillin

Question 17

cephalosporins: SE + considerations

Answer 17

most common - rash
mild diarrhea, abd cramps, pruritus, redness, edema

pregnancy safe (cat B)

poor oral absorption

Question 18

cephalosporins: indications

Answer 18

same as penicillin
UTI, peritonitis (abd swelling/inflammation), PNA + resp conditions, meningitis, etc.

Question 19

1st generation cephalosporin

Answer 19

cefazolin & cephalexin

works well: gram +, staph & nonenteroccal strep
^does NOT cross CSF

*cephalexin: PO or IV
*cefazolin: IV - common for surgical prophylaxis

Question 20

2nd generation cephalosporin

Answer 20

cefuroxime & cefotetan
gram - & +
IV and PO

does NOT kill anaerobic bacteria

*common treatment for abd infection

Question 21

3rd generation: cephalopsorin

Answer 21

ceftriaxone & ceftazidime & cefotaxine
gram - & less against +

IV/IM

ceftriaxone: extremely long acting (1x/day) + can cross BBB
^can treat CNS infections

NOT GIVEN TO PT W LIVER FAILURE

ceftazidime: good for pseudomonas

Question 22

4th generation cephalosporin

Answer 22

cefepime
very broad spectrum

UTIs, skin infections, and PNA

crosses BBB

Question 23

5th generation cephalosporin

Answer 23

ceftaroline
ONLY IV
gram - & +
treats MRSA and MSSA (resistant v. sensitive) + some VRSA/VISA

*NO enterobacter, pseudomonas, ESBL, klebsiella coverage

*renally dosed –> monitor BUN, Cr

Question 24

carbapenems

Answer 24

imipenem/cilastin & meropenem

broadest of ALL ATBs
“last resort” med

can cause drug-induced seizure –> ALL IV, infused over 60 MIN

Question 25

imipenem/cilastin

Answer 25

*binds to penicillin-binding proteins
*very resistant to beta-lactamase
*IV
*penetrates BBB + meninges
*watch for seizures (elders + other meds that lower threshold)

used for complicated infections

Question 26

meropenem

Answer 26

less coverage than imipenem
doesn’t degrade in kidneys
less seizure activity

gram + and -
most common SE: rash and diarrhea

Question 27

carnapenem-resistant enterobacteriaceae (CRE)

Answer 27

PUBLIC HEALTH EMERGENCY - HAI that kills 50%

*infection prevention problem
*carbapenem do not work (which is broadest spectrum) - very few drugs to work

Question 28

vancomycin

Answer 28

glycopeptide ATB (classification)

MRSA + PCN resistant pneumococcus

oral: C. diff and pseudomembranous colitis

NOT for CNS infections

kidneys eliminate drug –> decrease doses for renal dysfunction

Question 29

toxic side effects of vancomycin

Answer 29

*ototoxicity (reversible)
*immune system damages platelets
*nephrotoxic (watch with aminoglucsides, cyclosporine, IV contrast)
*watch with paralyzers

RED MAN SYNDROME: r/t rapid infusion
*flushing, rash, itchy, hives, high HR, low BP
^infuse slowly over longer periods

Question 30

peak vs. trough

Answer 30

peak: highest level (30 min after dose given)

trough: lowest level (30 min before next dose)

Question 31

purpose of measure peak and trough

Answer 31

to ensure med is in therapeutic level