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550 Pharm > Antimicrobials and Anesthesiology > Flashcards

Antimicrobials and Anesthesiology Flashcards

1
Q

What are some goals and General Rules concerning antimicrobials?

A
  • inhibit microorganism at concentrations that are tolerated by the host.
  • seriously ill/immunocompromised: select bactericidal
  • Narrow spectrum before broad spectrum or combination therapy to perverse normal flora
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2
Q

Antimicrobial surgical prophylaxis

A
  • cost effective, broad spectrum
  • no more than 1hr before incision
  • usually a single dose but may be continue for 48hrs
  • no proof a brief course results in resistant organisms
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3
Q

What are some things to consider when selecting an antimicrobial?

A
  • identification of causative organism
  • efficacy depends on drug site (BBB)
  • single dose
  • route of admin
  • duration of treatment
  • cost
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4
Q

What are some general adverse reactions to antimicrobials?

A
  • hypersensitivity reactions

- direct drug toxicity

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5
Q

T/F: Hypersensitivity is dose related?

A

FALSE - independent of dose

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6
Q

What type of adverse reaction is dose related?

A

Direct drug toxicity

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7
Q

What are two special considerations?

A
  • Parturient

- Elderly

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8
Q

What are some concerns with a parturient patient?

A
  • most antimicrobials cross the placenta and enter maternal milk
  • teratogenecity: concern with any drug
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9
Q

What are some concerns with elderly patients?

A

renal impairment
decreased plasma protein
reduced GI motility and acidity
increased body fat

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10
Q

What class is penicillin? Is it a cidal or static?

A

B-lactin, Bactericidal (interferes with the bacterial cell wall by preventing it from joining properly or interfering with an enzyme that keeps the cell wall stable)

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11
Q

What organism does penicillin kill?

A

pneumococcal, meningococcal, streptococcal

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12
Q

How is penicillin excreted?

A

90% renal

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13
Q

Ampicillin

A

wider range of activity, gm- bacilli, highest incidence of rash

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14
Q

Amoxicillin

A

more efficiently absorbed from the GI tract than ampicillin

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15
Q

What are some adverse reaction of penicillin’s?

A
  • hypersensitivity - most common (rash +/or fever, anaphylactic, hemolytic anemia
  • cross sensitivity (between penicillin and cephalosporins)
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16
Q

Why does cross sensitivity occur between penicillin and cephalosporins?

A

the share a b-lactin ring

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17
Q

What class is cephalosporin? Is it a cidal or static?

A

B-lactin, bactericidal (inhibits cell wall synthesis

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18
Q

Is cephalosporin a broad or narrow spectrum?

A

broad

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19
Q

How is cephalosporin excreted?

A

renal

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20
Q

What are adverse reactions of cephalosporin?

A

allergic reactions - rash
anaphylactic reaction 0.02% of treated patients
cross sensitivity between cephalosporins and penicillin

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21
Q

What are the three classifications of cephalosporins and give an example in each class.

A

FIrst generation - cefazolin
Second generation - cefoxitin
third generation - cefotaxime

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22
Q

What generation of cephalosporin is most commonly used in surgical prophylaxis?

A

first generation - cefazolin

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23
Q

What generation(s) of cephalosporin are more specific for gram - ?

A

second and third

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24
Q

All cephalosporins penetrate into _____.

A

joints

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25
Q

Are aminoglycosides cidal or static?

A

bactericidal

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26
Q

Aminoglycosides are effective for what type of bacteria?

A

gram -

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27
Q

How are aminoglycosides excreted?

A

renal

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28
Q

What is the elimination half time of aminoglycosides?

A

2-3hr

increase 20-40 fold with renal failure

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29
Q

What are some adverse reaction os aminoglycosides?

A

ototoxicity
nephrotoxicity
skeletal muscle weakness
prolongs NMB

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30
Q

Aminoglycosides: Ototoxicity

A
  • irreversible
  • vestibular/auditory dysfunction
  • drug induced destruction of vestibular or cochlear sensory hairs
  • dose dependent - usually occurs with chronic therapy
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31
Q

Aminoglycosides: Nephotoxicity

A
  • accumulate in renal cortex - tubular necrosis
  • inability to concentrate urine, proteinuria, and RBC casts
  • reversible
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32
Q

What aminoglycoside is most nephrotoxic?

A

neomycin

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33
Q

Aminoglycosides: Skeletal weakness

A
  • Can inhibit pre-junctional release of acetylcholine
  • decreases post synaptic sensitivity to the neurotransmitter
  • myasthenia gravis - uniquely sensitive to weakness
  • single dose in healthy patients is no a problem
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34
Q

Aminoglycosides: Potentiation of NMB

A
  • high plasma concentration when given IV
  • systemic absorption from large volumes of irrigation
  • reappearance of NMB in PACU
  • NMB properties of lidocaine are enhanced
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35
Q

Aminoglycosides: Neostigmine or calcium induced antagonism may be ______ or ______.

A

incomplete or transient

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36
Q

What are some example of aminoglycosides?

A

Streptomycin & Kanamycin
Gentamicin
Amikacin
Neomycin

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37
Q

Streptomycin & Kanamycin

A
  • limited uses
  • frequent occurrence of vestibular damage
  • ototoxicity
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38
Q

Is Gentamicin a broad or narrow antimicrobial?

A

-broad spectrum

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39
Q

What is the toxic level of gentamicin?

A

> 9mcg/ml

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40
Q

What aminoglycosides is a derivative of kanamycin?

A

Amikacin

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41
Q

Neomycin is used as an adjunct to what?

A

hepatic coma

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42
Q

Why is neomycin not given IV?

A

d/t toxic effects

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43
Q

Are tetracyclines cidal or static?

A

bacteriostatic - inhibits bacterial protein synthesis

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44
Q

What is the common use of tetracycline?

A

tx of acne - decreases fatty acid content in of sebum

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45
Q

How are tetracyclines excreted?

A

urine and bile

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46
Q

What kind of toxicity can tetracyclines cause?

A

renal

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47
Q

What are some side effects of tetracylines?

A
  • permanent discoloration of teeth

- phototoxicity

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48
Q

How is tetracycline given?

A

PO only

49
Q

What is another example of tetracycline?

A

Doxycycline

50
Q

How is doxycycline given?

A

PO or IV

51
Q

What is the difference in prep between doxycycline and tetracycline?

A

doxycycline is a longer acting preparation

52
Q

Give an example of macrolides.

A

Erythromycin

53
Q

Is erythromycin a cidal or static?

A

its both

54
Q

is erythromycin a broad or narrow spectrum?

A

narrow ( mostly gm +)

55
Q

How is erythromycin excreted?

A

bile

56
Q

How is erythromycin metabolized?

A

cytochrome P-450 system

57
Q

Do you need to alter the does of erythromycin in patients with renal disease?

A

no

58
Q

What are some adverse reactions of erythromycin?

A
  • GI intolerance - most common
  • Delayed gastric emptying
  • QT effects - prolonged - torsades
  • Thrombophlebitis
  • ***check to see if pt is taking a drug that inhibits the P-450 system–if so they will have an increase in free faction of drug
59
Q

What class of drug is clindamycin? cidal or static?

A

Linomycin, bacteriostatic

60
Q

Clindamycin is more active with ________.

A

anaerobes

61
Q

What is clindamycin used for?

A

serious infection in GI tract or female genital tract

62
Q

What disease would you want to decrease the dose w/ clindamycin?

A

liver

63
Q

What are some side effects of clindamycin?

A
  • pseudomembranous colitis (drug stopped immediately)
  • pre and post junctional effects at the NMJ
  • not antagonized with anticholinesterases or calcium
  • large doses can produce long lasting profound NMB
64
Q

Vancomycin is a derivative of _________

A

glycopeptide

65
Q

Is vanco a cidal or static?

A

cidal

66
Q

WHat kind of bacteria is vanco effective?

A 
gm+
severe staph infections
streptococcal, enterococcal endocarditis
MRSA
pencillin/cephalosporin allergy
67
Q

What is vanco excreted?

A

renal

68
Q

What is vanco’s eliminiation half-time?

A

6hrs and can be up to 9 days with renal failure pats

69
Q

During what procedures is vanco usually used?

A

cardiac, orthopedic using prosthetic devices, CSF and shunt related infections

70
Q

What is the dosing for vanco?

A

10-15mg/kg infused for 60mins

1gm mixed in 250ml

71
Q

WHat happens if you infuse vanco too rapidly?

A

PROFOUND HYPOTENSION

72
Q

Red man syndrom

A

inteense facial and truncal erythema from histamine release - can occur with rapid or slow infusion

73
Q

What are some other side effects of vanco?

A

ototoxicity
nephrotoxicity
return of NMB?

74
Q

Are sulfonamides cidal or static?

A

static

75
Q

WHat are sulfonamides used to treat?

A

UTI

76
Q

How are sulfonamides excreted/metabolized?

A

hepatic metabolism with renal excretion

77
Q

What are some sides effects of sulfonamides?

A 
skin rash to anaphylaxis
drug fever
hepatotoxicity 
acute hemolytic anemia
increase effect of PO anticoags
78
Q

Are Polymyxin B and Colistimethate cidal or static?

A

cidal - effect bacterial cell wall membrane phospholipids

79
Q

What bacteria are effected by polymyxin B and colistimethate?

A

gm -
used for severe UTI
infections of skin, mucous membranes, eyes and ears

80
Q

How are polymyxin B and colistimethate excreted?

A

kidneys - can accumulate in renal failure

81
Q

What are some side effects of polymyxin B and colistimethate?

A
  • *Most potent of all antimicrobials in their action at the NMJ
  • predominately pre junctional
  • can produce skeletal muscle weakness resembling non-depolarizing NMB
  • marked potentation of NDNMB
  • Neostigmine or calcium do not reliably antagonize this drug
  • *HIGHLY nephrotoxic
82
Q

Is metronidazole a cidal or static?

A

cidal

83
Q

Metronidazole works best on what type of bacteria?

A

gm - bacilli

84
Q

What kind of infections is metronidazole used for?

A

CNS infections
abdominal and pelvic sepsis
pseudomembranous colitis

85
Q

Are fluoroquinolones cidal or static?

A

bactericidal - inhibits enzyme that maintains helical DNA structure

86
Q

Are fluoroquinolones narrow or broad spectrum?

A

broad

87
Q

What is the elimination half time for fluoroquinolones?

A

3-8hours

88
Q

What can fluoroquinolones inhibit?

A

P-450 enzymes

89
Q

How are fluoroquinolones excreted?

A

renal - through glomerular filtration and renal tubular secretion

90
Q

T/F: When using fluoroquinolones you do not need to decrease the dose in a patient with renal dysfunction.

A

False - decrease the dose

91
Q

What are sine side effects of fluoroquinolones?

A

Minimal side effects : Mild GI

92
Q

What are fluoroquinolones used to treat?

A

useful in the tx of complicated GI and GU infections

93
Q

Give an example of a fluoroquinolone. What is it useful in treating?

A

Ciprofloxacin. useful in tx of a variety of systemic infections including bone, soft tissue and respiratory tract

94
Q

What is a drug used for TB?

A

Rifampin

95
Q

Is Rifampin a cidal or static?

A

bactericidal for myobacteria

96
Q

Rifampin inhibits the growth of what kind of bacteria?

A

most gm+ and many grm-

97
Q

Is rifampin water soluble or fat soluble?

A

Fat soluble - allows penetration of tissues including CNS

98
Q

How is rifampin administered? How is it excreted?

A

Oral or parenteral; excreted in bile and urine

99
Q

T/F: You can develop a resistance to rifampin very quickly.

A

True

100
Q

What are some side effects of rifampin?

A
  • usually infrequent - high doses can see thrombocytopenia, anemia, hepatitis, fatigue, numbness, skeletal weaknes
  • Potent inducer of C P450 system - accelerated metabolism of opioids, NMB agents, warfarin
101
Q

What is an example of an antifungal?

A

Amphotericin B

102
Q

How is amphotericin B administered?

A

IV - poor PO excretion

103
Q

How is amphotericin B excreted?

A
  • slow renal excretion - approx 80% of patients treated with this drug renal function is impaired - most recover
  • monitor plasma cr levels
104
Q

What are some side effects of amphotericin B?

A 
fever, chills, dyspnea, hypotension can occur during infusion
impaired hepatic function
hypokalemia
allergic reactions
seizure
anemia
thrombocytopenia
105
Q

What are alternatives for antivirals?

A

vaccines

106
Q

Viruses

A
  • composed of a nucleic acid core surrounded by a protein containing outer coat
  • genome either contains RNA or DNA but never both - classified on this basis
107
Q

What are some examples of antivirals?

A 
Acyclovir & Valacyclovir
Vidarabine
Famciclovir
Ganciclovir
Amanatadine
108
Q

Acyclovir & Valacyclovir

A
  • antiviral activity limited to herpes viruses

- excreted by the kidneys

109
Q

Vidarabine

A
  • cytomegalic inclusion disease
  • herpes simplex encphalitis
  • mutagenic and carcinogenic
110
Q

Famciclovir

A

acute herpes zoster

111
Q

Ganciclovir

A

cytomegalovirus

hematologic toxicity

112
Q

Amantadine

A

influenza A virus

renal excretion

113
Q

What are interferons?

A
  • term used to designated glycoproteins produced in response to viral infections
  • bind to receptors on host cell membranes and induce the production of enzymes that inhibit viral replication - degradation of viral mRNA
  • enhances tumoricidal activities of macrophages
114
Q

What are interferons used to treat?

A

Chronic hep B

hep C

115
Q

What are side effects of interferons?

A 
flu-like symptoms
hematologic toxicity
depression, irritability
decreased mental concentration
development of autoimmune conditions
rashes, aplopecia
changes in CV, thyroid, hepatic function
116
Q

Antivirals for AIDS

A
  • Nucleoside reverse transcriptase inhibitors (NRTIs): imposter
  • Nonnucleosides reverse transcriptase inhibitors (NNRTIs) : inhibit function of enzymes used by virus
  • Protease inhibitors - binds to HIV protease
  • Combination therapy is used in treatment of HIV
117
Q

What are some side effects of antivirals for AIDS?

A

pancreatitis, hepatotoxicity, lactic acidosis, fat redistribution, increases in serum cholesterol and triglycerides, hpersensitivity

  • protease inhibitors
  • most all inhibit P-450 system
  • ritonavir most potent inhibitor
  • large plasma increases in many drugs
118
Q

What are some drug that plasma concentration increases with antivirals for AIDS?

A

analgesics, lidocaine, antimicrobials, anticonvulsants, anticoagulants, anti emetics, CCB

550 Pharm (6 decks)

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