Antimicrobials Antiseptics Chemotherapeutic Agents Flashcards
Allergic reaction to Cephalosporins include?
Allergic reaction SE =Uticaria =Bronchospasm =Hemodynamic collapse =Substitute W/ Clindamycin or Vancomycin
Which antimicrobial agents need to be changed in dosing, as well as monitor renal function for the elderly population?**
PCN, cephalosporin, Vanco and Aminoglycosides may need change in dosing schedule and regimen as well as monitor renal function**
How does PCN G effect the cell wall?
Interfere with synthesis of peptidoglycon which is an essential component of cell wall
How much is PCN G excreted from the kidneys?*
90% Renal Excreted**
Intrathecal not recommended with with antimicrobials?***
PCN G Intrathecal administration is not recommended***
Which penicillianse-resistant penicillins causes SE, if given IV,
Hemorrhagic cystitis and Allergic interstitial nephritis
Methicillin
Renal excretion
SE if given IV
Hemorrhagic cystitis
Allergic interstitial nephritis
Which penicillianse-resistant penicillins is excreted in the bile?
Nafcillin
TX Staphylococcal meningitis
80% Excreted in bile**(this is different from the others )
Which penicillianse-resistant penicillins causes hepatitis?
Oxacillin
Hepatitis with high dose
What does Ampicillin cover?
Broader activity than PCN G
Covers Gram- Neg bacilli
Ecoli and Haemophilus influenzae
What is the SE of Ampicillin?
SE
High incidence of Skin Rash
What determines the duration of action for Ampicillin?
Renal function influences duration of action
What generation is Ampicillin?
Penicillinase-Susceptible Broad-Spectrum Penicillins 2nd Generation
What is drug is chemically identical to ampicillin?
Chemically identical to ampicillin
Which 2nd generation spectrum penicillin is more efficiently absorbed the GI tract?
Amoxicillin
Effective concentrations are in circulation 2x as long
What is a Extended-Spectrum Carboxypenicillins 3rd Generation
Carbenicillin
What is Carbenicillin
used to treat?
TX Pseudomonas aeruginosa & Proteus resistant to ampicillin
Carbenicillin is ineffective against what bacteria?
Ineffective against S. Aureus
Whit antibiotic is not absorbed in GI tract and must be given IV?
(Hint: Its a derivative of Ampicillin)
Carbenicillin
What are examples of Extended-Spectrum Acylaminopenicillins 4th Generation?
Mezlocillin
Piperacillin
Azlocillin
What are the roadest activity of all PCN?
Mezlocillin
Piperacillin
Azlocillin
- Derivative of Ampicillin
- Do not work against S. Aureus
What is the MOA of Penicillinβ-Lactamase Inhibitor Combinations ?
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
What are examples of Penicillinβ-Lactamase Inhibitor Combinations ?
Clavulanic Acid
Sulbactam
Tazobactam
Cephalosporins MOA?
MOA
Bactericidal antimicrobials that inhibit bacterial cell wall synthesis and have a low intrinsic toxicity
What are the SE of Cephalosporins?
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%
What is the major antigenic determinant for Cephalosporins and allergy to PCN?**
Approximately 95% of patients allergic to penicillin form this penicilloyl-protein conjugate (the major antigenic determinant)***
What is the minor antigenic determinant for cephalosporins and allergy to PCN?
The remaining allergic patients form 6-aminopenicillic acid & benzylpenamaldic acid (minor antigenic determinants)
what are the Manifestations of allergic reaction: (to cephalosporins)?
- Laryngeal edema
- Bronchospasm
- Cardiovascular collapse
What should you do with dose cephalothin and patients with renal dysfunction?
Cephalothin
Excreted by the kidneys
Decrease dose with renal dysfunction**
Cefoxitin - Extends activity against (what kind of) bacteria
Cefoxitin - Extends activity against (GRAM NEGATIVE) bacteria
Which Cephalosprorin 2nd generation drug, poses a risk of bleeding and disulfiram-like reactions with concurrent use of alcohol??
Cefamandole
Which drug is the drug of choicefor H. Influenza?
Hint: The only second-generation cephalosporin effective in the treatment of meningitis
Cefuroxime
Cefuroxime
Cefamandole
Cefoxitin
How are these drugs eliminated?
All excreted by kidneys**
Which drug is used to Tx Meningitis caused by Gram negative other than Pseudomonas
Cefotaxime First 3rd Generation
Which drug has the ongest ½ life and is used to treat Neisseria and Haemophilus
Cetriaxone Rocephin
Which 3rd generation cephalosporin is PO and used to treat URI?
Cefixime
Which drugs can achieve levels is CSF therefore can Tx Meningitis?
Cephalosporins 3rd Generation
Which β-Lactam Antimicrobial is not absorbed in the GI tract and does not enter the CSF?
Aztreonam
What does Aztreonam
treat?
Tx Gram-negative bacteria
What is a SE of Azteronam?
SE enterococcal superinfection
Which β-Lactam Antimicrobial has NO cross reactivity between PCN or cephalosporin?
Aztreonam
what do the Aminoglycoside Antimicrobials treat?
Rapidly antibacterial aerobic gram-negative bacteria*
How are the Aminoglycoside Antimicrobials eliminated from the body??
Renal excretion*
Decrease dose with renal dysfunction*
What are the SE of the Aminoglycoside Antimicrobials?
Side Effects
==Ototoxicity**
=Vestibular and auditory
=Nephrotoxicity
=Skeletal muscle weakness
=Contraindicated in Myasthenia Gravis patients
==Potentiation of non-depolarizing neuromuscular blocking drugs*
Which aminoglycoside TX P. aeruginosa and gram Negative Bacilli?
Gentamicin
Monitor toxic levels (>9ug/mL)
Which drug is 1st to TX Mycobacterium tuberculosis
Streptomycin
Which drug is used to TX Gentamicin or tobramycin resistant infections
Amikacin
Which Aminoglycoside should you not administer with PCN*?
Amikacin
Do not administer with PCN* (can get a bad rash)
Which aminoglycoside is used as a Topical to TX infections of skin mucous membranes and cornea?
Neomycin
6-8% allergic reaction
What does Erythromycin treat?*
Gram positive *
Alt to other ABX for TX Strep, bronchitis, & pneumonia
What are the SE of Erythromycin?
SE
- GI intolerance
- Thrombophlebitis
- Tinnitus
- Hearing loss
- Torsade’s des pointes
- Ventricular arrhythmia
- Death
Which macrolide has a Prolonged elimination time and is dosed QD ?
Azithromycin
Which macrolide is used for severe infection of the GI tract and female genital tract?
Clindamycin
What is the SE of clindamycin?
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
Which macrolide is the drug of choice for MRSA?
Vancomycin
Vancomycin can be used for what heart procedure and/or condition?
Vanco also used for prosthetic heart valve and endocarditis
Why isn’t vanco used routinely as a prophylaxis?
Routine prophylaxis with Vanco not recommended due to concerns of resistant organisms
Red Man Syndrome is related to which antibiotic?
Vancomycin
How does Red Man Syndrome occur?
Vancomycin directly activates mast cells to release histamine
This is not a true allergic reaction
How do you manage Red Man Syndrome?
Stop Infusion, Administer antihistamine,
Can restart vanco at a slower rate once symptoms resolve
What are the clinical manifestations of Red Man Syndrome?
Flushing, Erythema, Pruritus, Maylgia, Dyspnea, hypotension
Dose of Vancomycin?
Vancomycin
IV dose 10-15mg/kg over 60 min to minimize histamine release
How is Vancomycin eliminated?
Excreted by kidneys
Plasma levels need to be monitored
What are the SE of Vancomycin?
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?)
What does Ciprofloxacin
treat?
- GI & GU infections
- Systemic concentrations
- M. tuberculosis susceptible
What does Moxifloxacin treat?
-TX acute bacterial sinusitis
What are the SE of Moxifloxacin?
- -peripheral neuropathy
- -SIADH
- -Tendonitis
- -Acute liver failure
- -QTc prolongation
- -Toxic epidermal necrolysis
- -Psychotic reactions
- -Stevens-Johnson syndrome
MOA for Alkylating Agents?
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
Which Nitrogen mustard is used to Tx wide variety of CA, RA, Wegner granulomatosis?
Cyclophosphamide
Which nitrogen mustard is often used when lymph node involvement Breast CA?
Cyclophosphamide
Which drug should you D/C w/ dysuria and hematuria?
Hint: It has less thrombocytopenia and more alopecia
Cyclophosphamide
Which drug is associated with Hodgkin’s regimen?
Mechlorethamine
Most effective when injected into blood supply of tumor
Limited by leukopenia, thrombocytopenia
Which nitrogen mustard is used to treat multiple myeloma, Ovarian epithelial CA, Hodgkin lymphoma, Amyloidosis?
Melphalan
Bone marrow suppression necessary for therapeutic effect
Which Nitrogen mustard treats
Chronic lymphocytic leukemia, Macroglobulinemia, Polycythemia vera?
Chlorambucil
Which chemo drugs should you be cautious about because of herpes zoster and thrombophlebitis??
All NMs: herpes zoster, thrombophlebitis
Handle with care
Which alkyl sulfonates is used to treat chronic myelogenous leukemia?
Bisulfan
Cell-cycle non-specific antineoplastic agent
Pulmonary fibrosis
Prognosis poor
Which nitrosoureas is used for gastric adenocarcinoma?
Mitomycin
70% pts experience renal or hepatic toxicity and hyperglycemia with which nitrosourea?
Streptozocin
Interstitial pneumonitis, fibrosis, 20-30% pulmonary toxicity, can be delayed weeks, high mortality occurs with which nitrosourea?
Carmustine
Which platinating drug causes Ototoxicity, emetogenic, myelosuppression, peripheral sensory neuropathies, paresthesia, hyperuricemia, seizures, dysrhythmias, allergic reactions?
Cisplatin
Which drug treats Non-hematologic cancers- lung, bladder, testicular, ovarian
Cisplatin
Which drug is used for Palliative for carcinoma of breast, GI tract
Fluorouracil
Which antimetabolite is used to treat Mesothelioma and lung CA?
Pemetrexed
Which antimetabolite is used for Non-hematologic CAs, Solid organ CA, pancreas, breast, lung?
Gemcitabine
Which medication is considered a folic acid inhibitor?
Methotrexate
Which drug is used for Wilms tumor in children, inhibit immunologic response w/ organ transplant?
Dactinomycin
Which two drugs are natural products of soil fungi, contain tetracycline ring, (anthracycline antibiotics), leukemia?
Doxorubicin & Daunorubicin
which topoisomerase inhibitor causes Cardiomyopathy- dose related increased plasma concentrations of troponin T (late), CHF, LV dysfunction?
Doxorubicin
Which Topoisomerase inhibitor causes Pulmonary toxicity?
Bleomycin
Pulmonary toxicity- dose related 4% patients*****
Cough, dyspnea, rales, fibrosis, infiltrates
Which tubulin-binding drugs cause severe neurotoxicity?
Paclitaxel, Docetaxel
Extract from pacific Yew tree
Breast, lung, ovarian, bladder CA
Severe neurotoxicity*** precludes use
