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Pharmacology 2 > Antimicrobials Antiseptics Chemotherapeutic Agents > Flashcards

Antimicrobials Antiseptics Chemotherapeutic Agents Flashcards

1
Q

Allergic reaction to Cephalosporins include?

A 
Allergic reaction SE
=Uticaria
=Bronchospasm
=Hemodynamic collapse
=Substitute W/ Clindamycin or Vancomycin
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2
Q

Which antimicrobial agents need to be changed in dosing, as well as monitor renal function for the elderly population?**

A

PCN, cephalosporin, Vanco and Aminoglycosides may need change in dosing schedule and regimen as well as monitor renal function**

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3
Q

How does PCN G effect the cell wall?

A

Interfere with synthesis of peptidoglycon which is an essential component of cell wall

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4
Q

How much is PCN G excreted from the kidneys?*

A

90% Renal Excreted**

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5
Q

Intrathecal not recommended with with antimicrobials?***

A

PCN G Intrathecal administration is not recommended***

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6
Q

Which penicillianse-resistant penicillins causes SE, if given IV,
Hemorrhagic cystitis and Allergic interstitial nephritis

A

Methicillin

Renal excretion

SE if given IV
Hemorrhagic cystitis
Allergic interstitial nephritis

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7
Q

Which penicillianse-resistant penicillins is excreted in the bile?

A

Nafcillin

TX Staphylococcal meningitis

80% Excreted in bile**(this is different from the others )

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8
Q

Which penicillianse-resistant penicillins causes hepatitis?

A

Oxacillin

Hepatitis with high dose

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9
Q

What does Ampicillin cover?

A

Broader activity than PCN G

Covers Gram- Neg bacilli
Ecoli and Haemophilus influenzae

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10
Q

What is the SE of Ampicillin?

A

SE

High incidence of Skin Rash

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11
Q

What determines the duration of action for Ampicillin?

A

Renal function influences duration of action

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12
Q

What generation is Ampicillin?

A

Penicillinase-Susceptible Broad-Spectrum Penicillins 2nd Generation

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13
Q

What is drug is chemically identical to ampicillin?

A

Chemically identical to ampicillin

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14
Q

Which 2nd generation spectrum penicillin is more efficiently absorbed the GI tract?

A

Amoxicillin

Effective concentrations are in circulation 2x as long

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15
Q

What is a Extended-Spectrum Carboxypenicillins 3rd Generation

A

Carbenicillin

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16
Q

What is Carbenicillin

used to treat?

A

TX Pseudomonas aeruginosa & Proteus resistant to ampicillin

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17
Q

Carbenicillin is ineffective against what bacteria?

A

Ineffective against S. Aureus

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18
Q

Whit antibiotic is not absorbed in GI tract and must be given IV?
(Hint: Its a derivative of Ampicillin)

A

Carbenicillin

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19
Q

What are examples of Extended-Spectrum Acylaminopenicillins 4th Generation?

A

Mezlocillin
Piperacillin
Azlocillin

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20
Q

What are the roadest activity of all PCN?

A

Mezlocillin
Piperacillin
Azlocillin

  • Derivative of Ampicillin
  • Do not work against S. Aureus
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21
Q

What is the MOA of Penicillinβ-Lactamase Inhibitor Combinations ?

A

Bind irreversibly to the β-lactamase enzymes, which are produced by many bacteria, thus inactivating these enzymes and rendering the organisms sensitive to β-lactamase–susceptible penicillins

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22
Q

What are examples of Penicillinβ-Lactamase Inhibitor Combinations ?

A

Clavulanic Acid
Sulbactam
Tazobactam

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23
Q

Cephalosporins MOA?

A

MOA

Bactericidal antimicrobials that inhibit bacterial cell wall synthesis and have a low intrinsic toxicity

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24
Q

What are the SE of Cephalosporins?

A 
SE
\+ Coombs Reaction with lg doses
--Hemolysis is rare
--Nephrotoxicity
--Incidence of allergic reactions 1-10%
-Usually Cutaneous manifests 24 hours after exposure
-Anaphylaxis 0.02%
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25
Q

What is the major antigenic determinant for Cephalosporins and allergy to PCN?**

A

Approximately 95% of patients allergic to penicillin form this penicilloyl-protein conjugate (the major antigenic determinant)***

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26
Q

What is the minor antigenic determinant for cephalosporins and allergy to PCN?

A

The remaining allergic patients form 6-aminopenicillic acid & benzylpenamaldic acid (minor antigenic determinants)

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27
Q

what are the Manifestations of allergic reaction: (to cephalosporins)?

A
  • Laryngeal edema
  • Bronchospasm
  • Cardiovascular collapse
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28
Q

What should you do with dose cephalothin and patients with renal dysfunction?

A

Cephalothin
Excreted by the kidneys
Decrease dose with renal dysfunction**

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29
Q

Cefoxitin - Extends activity against (what kind of) bacteria

A

Cefoxitin - Extends activity against (GRAM NEGATIVE) bacteria

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30
Q

Which Cephalosprorin 2nd generation drug, poses a risk of bleeding and disulfiram-like reactions with concurrent use of alcohol??

A

Cefamandole

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31
Q

Which drug is the drug of choicefor H. Influenza?

Hint: The only second-generation cephalosporin effective in the treatment of meningitis

A

Cefuroxime

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32
Q

Cefuroxime
Cefamandole
Cefoxitin

How are these drugs eliminated?

A

All excreted by kidneys**

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33
Q

Which drug is used to Tx Meningitis caused by Gram negative other than Pseudomonas

A

Cefotaxime First 3rd Generation

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34
Q

Which drug has the ongest ½ life and is used to treat Neisseria and Haemophilus

A

Cetriaxone Rocephin

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35
Q

Which 3rd generation cephalosporin is PO and used to treat URI?

A

Cefixime

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36
Q

Which drugs can achieve levels is CSF therefore can Tx Meningitis?

A

Cephalosporins 3rd Generation

37
Q

Which β-Lactam Antimicrobial is not absorbed in the GI tract and does not enter the CSF?

A

Aztreonam

38
Q

What does Aztreonam

treat?

A

Tx Gram-negative bacteria

39
Q

What is a SE of Azteronam?

A

SE enterococcal superinfection

40
Q

Which β-Lactam Antimicrobial has NO cross reactivity between PCN or cephalosporin?

A

Aztreonam

41
Q

what do the Aminoglycoside Antimicrobials treat?

A

Rapidly antibacterial aerobic gram-negative bacteria*

42
Q

How are the Aminoglycoside Antimicrobials eliminated from the body??

A

Renal excretion*

Decrease dose with renal dysfunction*

43
Q

What are the SE of the Aminoglycoside Antimicrobials?

A

Side Effects
==Ototoxicity**
=Vestibular and auditory

=Nephrotoxicity

=Skeletal muscle weakness
=Contraindicated in Myasthenia Gravis patients

==Potentiation of non-depolarizing neuromuscular blocking drugs*

44
Q

Which aminoglycoside TX P. aeruginosa and gram Negative Bacilli?

A

Gentamicin

Monitor toxic levels (>9ug/mL)

45
Q

Which drug is 1st to TX Mycobacterium tuberculosis

A

Streptomycin

46
Q

Which drug is used to TX Gentamicin or tobramycin resistant infections

A

Amikacin

47
Q

Which Aminoglycoside should you not administer with PCN*?

A

Amikacin

Do not administer with PCN* (can get a bad rash)

48
Q

Which aminoglycoside is used as a Topical to TX infections of skin mucous membranes and cornea?

A

Neomycin

6-8% allergic reaction

49
Q

What does Erythromycin treat?*

A

Gram positive *

Alt to other ABX for TX Strep, bronchitis, & pneumonia

50
Q

What are the SE of Erythromycin?

A

SE

  • GI intolerance
  • Thrombophlebitis
  • Tinnitus
  • Hearing loss
  • Torsade’s des pointes
  • Ventricular arrhythmia
  • Death
51
Q

Which macrolide has a Prolonged elimination time and is dosed QD ?

A

Azithromycin

52
Q

Which macrolide is used for severe infection of the GI tract and female genital tract?

A

Clindamycin

53
Q

What is the SE of clindamycin?

A

SE

  • pseudomembranous colitis (if you run this in really fast, this is diarrhea)
  • diarrhea
  • Lg doses can induce NMB in the absence of non-depolarizer (patient behaves like you gave them a paralytic)
  • Skin rash
54
Q

Which macrolide is the drug of choice for MRSA?

A

Vancomycin

55
Q

Vancomycin can be used for what heart procedure and/or condition?

A

Vanco also used for prosthetic heart valve and endocarditis

56
Q

Why isn’t vanco used routinely as a prophylaxis?

A

Routine prophylaxis with Vanco not recommended due to concerns of resistant organisms

57
Q

Red Man Syndrome is related to which antibiotic?

A

Vancomycin

58
Q

How does Red Man Syndrome occur?

A

Vancomycin directly activates mast cells to release histamine

This is not a true allergic reaction

59
Q

How do you manage Red Man Syndrome?

A

Stop Infusion, Administer antihistamine,

Can restart vanco at a slower rate once symptoms resolve

60
Q

What are the clinical manifestations of Red Man Syndrome?

A

Flushing, Erythema, Pruritus, Maylgia, Dyspnea, hypotension

61
Q

Dose of Vancomycin?

A

Vancomycin

IV dose 10-15mg/kg over 60 min to minimize histamine release

62
Q

How is Vancomycin eliminated?

A

Excreted by kidneys

Plasma levels need to be monitored

63
Q

What are the SE of Vancomycin?

A

Hypotension

  • Cardiac arrest
  • Histamine release
  • Red Man Syndrome
  • Erythema
  • Bronchospasm
  • Arterial hypoxemia/ low SPO2
  • Ototoxocity and nephrotoxicity with given with aminoglycoside*
  • Vanco and Succs can result in NMB (will behaive like non depolarizer?)
64
Q

What does Ciprofloxacin

treat?

A
  • GI & GU infections
  • Systemic concentrations
  • M. tuberculosis susceptible
65
Q

What does Moxifloxacin treat?

A

-TX acute bacterial sinusitis

66
Q

What are the SE of Moxifloxacin?

A
  • -peripheral neuropathy
  • -SIADH
  • -Tendonitis
  • -Acute liver failure
  • -QTc prolongation
  • -Toxic epidermal necrolysis
  • -Psychotic reactions
  • -Stevens-Johnson syndrome
67
Q

MOA for Alkylating Agents?

A

MOA

  • Form covalent alkyl bonds with nucleic acid bases, resulting in intrastrand or interstrand DNA cross-links which are toxic to cells undergoing division.
  • By altering the structure of DNA, these drugs inhibit DNA replication and transcription.
  • DNA damage produced by alkylating chemotherapeutic drugs is more likely to kill malignant cells than nonmalignant cells because rates of proliferation are greater for the cancer cells
  • Resistance is common
68
Q

Which Nitrogen mustard is used to Tx wide variety of CA, RA, Wegner granulomatosis?

A

Cyclophosphamide

69
Q

Which nitrogen mustard is often used when lymph node involvement Breast CA?

A

Cyclophosphamide

70
Q

Which drug should you D/C w/ dysuria and hematuria?

Hint: It has less thrombocytopenia and more alopecia

A

Cyclophosphamide

71
Q

Which drug is associated with Hodgkin’s regimen?

A

Mechlorethamine

Most effective when injected into blood supply of tumor

Limited by leukopenia, thrombocytopenia

72
Q

Which nitrogen mustard is used to treat multiple myeloma, Ovarian epithelial CA, Hodgkin lymphoma, Amyloidosis?

A

Melphalan

Bone marrow suppression necessary for therapeutic effect

73
Q

Which Nitrogen mustard treats

Chronic lymphocytic leukemia, Macroglobulinemia, Polycythemia vera?

A

Chlorambucil

74
Q

Which chemo drugs should you be cautious about because of herpes zoster and thrombophlebitis??

A

All NMs: herpes zoster, thrombophlebitis

Handle with care

75
Q

Which alkyl sulfonates is used to treat chronic myelogenous leukemia?

A

Bisulfan

Cell-cycle non-specific antineoplastic agent

Pulmonary fibrosis
Prognosis poor

76
Q

Which nitrosoureas is used for gastric adenocarcinoma?

A

Mitomycin

77
Q

70% pts experience renal or hepatic toxicity and hyperglycemia with which nitrosourea?

A

Streptozocin

78
Q

Interstitial pneumonitis, fibrosis, 20-30% pulmonary toxicity, can be delayed weeks, high mortality occurs with which nitrosourea?

A

Carmustine

79
Q

Which platinating drug causes Ototoxicity, emetogenic, myelosuppression, peripheral sensory neuropathies, paresthesia, hyperuricemia, seizures, dysrhythmias, allergic reactions?

A

Cisplatin

80
Q

Which drug treats Non-hematologic cancers- lung, bladder, testicular, ovarian

A

Cisplatin

81
Q

Which drug is used for Palliative for carcinoma of breast, GI tract

A

Fluorouracil

82
Q

Which antimetabolite is used to treat Mesothelioma and lung CA?

A

Pemetrexed

83
Q

Which antimetabolite is used for Non-hematologic CAs, Solid organ CA, pancreas, breast, lung?

A

Gemcitabine

84
Q

Which medication is considered a folic acid inhibitor?

A

Methotrexate

85
Q

Which drug is used for Wilms tumor in children, inhibit immunologic response w/ organ transplant?

A

Dactinomycin

86
Q

Which two drugs are natural products of soil fungi, contain tetracycline ring, (anthracycline antibiotics), leukemia?

A

Doxorubicin & Daunorubicin

87
Q

which topoisomerase inhibitor causes Cardiomyopathy- dose related increased plasma concentrations of troponin T (late), CHF, LV dysfunction?

A

Doxorubicin

88
Q

Which Topoisomerase inhibitor causes Pulmonary toxicity?

A

Bleomycin

Pulmonary toxicity- dose related 4% patients*****
Cough, dyspnea, rales, fibrosis, infiltrates

89
Q

Which tubulin-binding drugs cause severe neurotoxicity?

A

Paclitaxel, Docetaxel
Extract from pacific Yew tree
Breast, lung, ovarian, bladder CA
Severe neurotoxicity*** precludes use

Pharmacology 2 (11 decks)

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