ATB Flashcards
Types of PCN
Natural PCN, Penicillinase-resistant PCN, aminoPCNs, extended spectrum PCN
Natural PCN
PCN G, PCN V
Penicillinase-resistant PCN
nafcillin
aminoPCN
amoxicillin, ampicillin
Extended spectrum PCN
piperacillin-tazobactam
MOA PCN
inhibit cell wall synthesis by inhibiting transpeptidase
What do PCN in general treat?
UTI, STI, peritonitis, PNA, sepsis, meningitis
Adverse Reactions PCN
urticaria, itching, angioedema
Adverse Reactions PCN
urticaria, itching, angioedema
What structure do PCN have?
beta lactam structure
What bacteria do PCN work against?
gram +
PCN medication interactions
NSAIDs, oral contraceptives, warfarin
What route are the natural PCNs given?
usually IV or IM (STIs)
Nafcillin indication and route
staph infections
Amoxicillin indications and route
-infections of ears, nose, throat, GU, GI, esp in peds
-given PO
Ampicillin route
IV
Piperacillin indication
antipseudomonal
Piperacillin SE
-PLT interaction
-caution in renal dysfunction
Cephalosporin MOA
inhibit cell wall synthesis by inhibiting transpeptidase
Cephalosporin MOA
inhibit cell wall synthesis by inhibiting transpeptidase
cephalosporin SE
-abd cramps
-mild diarrhea
-rash
-pruritis
-redness
-edema
-pregnancy cat 2
cephalosporin SE
-abd cramps
-mild diarrhea
-rash
-pruritis
-redness
-edema
-pregnancy cat 2
structure of cephalosporins
beta lactam structure
1st Generation Cephalosporins
cefazolin, cephalexin
Cephalexin Route
PO, IV
Cefazolin Route
IV only
1st Gen Cephalosporin Indications
broadspectrum (+/-)
staph
nonenterococcal strep
sx prophylaxis (cefazolin)
Do 1st gen cephalosporins work on the CNS?
NO
2nd Gen Cephalosporins
cefuroxime, cefotetan
2nd Gen Cephalosporin Indications
gram +, some gram -
abd infections (cefuroxime)
2nd Gen Cephalosporin Route
IV, PO
Do 2nd Gen Cephalosporins work on CNS, pseudomonas?
NO
3rd Gen Cephalosporins
ceftriaxone, ceftazidime, cefotaxine
3rd Gen Cephalosporin Indications
gram -, less gram +
pseumomonas (ceftazidime)
3rd Gen Cephalosporin Routes
IV, IM
3 impt things about ceftriaxone
-long acting
-crosses BBB
-cannot give to liver fx patients
4th gen cephalosporin
cefepime
Can cefepime cross the BBB?
YES
4th gen cephalosporin indications
very broad spectrum
skin infections
PNA
UTIs
pseudomonas
CNS
5th gen cephalosporin
ceftaroline
5th gen cephalosporin indications
MRSA
MSSA
some VRSA/VIS
AKA “nasty staph infections”
What does ceftaroline treat?
nasty staph infections
What route is ceftaroline given?
IV only
Carbapenems
imipenem, meropenem
carbapenem MOA
inhibit cell wall synthesis
carbapenem indications
-CNS infections (imipenem)
carbapenem SE
-seizures (esp. imipenem)
-rash, diarrhea (meropenem)
carbapenem structure
beta lactam
carbapenem route
IV (infused over 60 minutes)
glycopepetide
vancomycin
vancomycin MOA
inhibit cell wall synthesis
vancomycin indications
-gram + bacteria, esp. MRSA and PCN resistant pneumococcus
-c. diff
-pseudomembranous colitis
Vancomycin adverse effects
-ototox (reversible)
-immune mediated thrombocytopenia
-nephro toxic (be aware of IV contrast)
-watch with neuromuscular blockages
-red man syndrome
Red Man Syndrome symptoms and nursing actions
itching, rash, tachy, hypotension; half infusion speed and premedicate, slow infusion with next dose
Red Man Syndrome symptoms and nursing actions
itching, rash, tachy, hypotension; half infusion speed and premedicate, slow infusion with next dose
What organ metabolizes vanc?
kidneys => decrease dose for renal dysfunction
How to draw a peak, trough
peak (15-30 min post admin)
trough (30 min before next dose)
Aminoglycosides
gentamycin, amakacin, tobramycin
Aminoglycosides
gentamycin, amakacin, tobramycin
aminoglycoside MOA
binds to bacterial ribosomes and prevents protein synthesis
Aminoglycoside indications
-gram + bacteria
-gram - bacteria with another ATB
-complicated infections (difficult, recurrent), i.e. pyelonephritis, gynecologic, peritonitis, endocarditis, osteomyelitis
Aminoglycoside adverse reactions
-nephrotox (usually reversible, monitor creat, BUN)
-ototox (may not be reversible)
Aminoglycoside adverse reactions
-nephrotox (usually reversible, monitor creat, BUN)
-ototox (may not be reversible)
Major gentamycin nursing considerations
cannot use with neuromuscular blockade -> myasthenia gravis
CNS SE (confusion, depression, numbness, tinging, disorientation)
cochlear damage (permanent)
Do you need peak and trough for aminoglycosides?
YES
Lincosamide
Clindamycin
Clindamcyin MOA
binds to ribosomes and inhibits PRO synthesis
Clindamycin indications
complicated infections, i.e. chronic bone, intraabdominal, GU, septicemia, propx for endocarditis, serious skin infections, anaeorbic PNA
Clindamycin adverse effects
-severe respiratory distress with neuromuscular blockades
-pseudomembranous colitis (severe diarrhea, bloody stool, c. diff)
Clindamycin route
PO, IV
Is peak trough needed with clindamycin?
YES
Is clindamycin effective against enterobacter bacteria?
NO
Macrolides
erythromycin
azithromycin
Macrolides MOA
bind to ribosomes and prevent PRO synthesis
Macrolide indications
-STI, esp gonorrhea
-upper and lower respiratory infections
-skin infections
-soft tissue infections
-LISTERIA
-LEGIONNAIRES
-MYCOPLASMA PNA
What DM dx is erythromycin given for?
gastroparesis
Why are macrolides called the “yuck” drugs?
cause GI upset, n/v/d
macrolide route
usually PO (mx times/day)
IV is very painful
Tetracyclines
tetracycline
Minocycline
Doxycycline
Tetracycline MOA
inhibit PRO synthesis by binding to ribosomes
tetracycline indications
RICKETTSIA (ROCKY MTN SPOTTED FEVER)
chlamydia
trichomonas
LYME DISEASE
CHOLERA
PID
MYCOPLASMA PNA
ACNE
Tetracyline ABT Contraindications
pregnancy, breastfeeding, children <8 yr (enamel hypoplasia)
Tetracyline class SE
tooth discoloration
photosensitivity
diarrhea
yeast infections
thrombocytopenia
Minocycline Indications
Neisseria meningtides
RA
ER for acne (Solodyn)
Flouroquinolones
ciprofloxacin
levofloxacin
fluoroquinolone MOA
alter bacterial DNA enzymes which leads to destruction
Cipro Indications
-complicated UTIs
-STIs, gonorrhea
-upper/lower respiratory. infections
-ANTHRAX
cipro SE
arthropathy (usually irreversible) => avoid in less than 18 yr, greater than 60 yr
Levofloxacin indications
-pneumococcal
-atypical respiratory infections
Levofloxacin SE
-CNS SE, increase RF seizures
-kidney failure
-prologned QT interval
-photosensitivity
Sulfonomides
sulfamexazole-trimethroprim
sulfonomides MOA
prevents synthesis of folic acid to inhibit growth
sulfamexazole-trimethoprim indications
-uncomplicated UTI
-resp infections
-SALMONELLA
-SHIGELLOSIS
Metronidazole MOA
inhibits DNA synthesis
metronidazole indications
-amoebiasis
-giardiasis
-trichomoniasis
-intra abdominal infections
-H. pylori
-crohn’s
-c. diff
Which ABT creates a toxic metabolite with ETOH?
metronidazole; cannot use ETOH for 24 hr before or 36 hr after
metronidazole SE
-n/v
-xerostomia
-vaginal candidiasis
oseltamivir indication
flu a
flu b
swine flu
oseltamivir MOA
inibits neuraminidases in flu virus (prevents replication)
oseltamivir SE
-n/v
-seizures
-renal impairment
When does oseltamivir need to be taken
within 48 of symptom onset
acyclovir, valcyclovir, famcyclovir MOA and indications
interferes w/ viral nucleic acid synthesis; prevents virus from binding with cells; turns on body’s immune virus
given for HSV 1, HSV 2, zoster
acyclovir, valcyclovir, famcyclovir SE
-GI distress
-renal impairement
-seizures
-ITP
-tissue necrosis if IV not patent
ganciclovir MOA
inhibits viral DNA polymerases
ganciclovir indication
CMV (immunosuppressed ie HIV, transplant)
ganciclovir 4 black box warnings
1) hematologic toxin (low PLT, pancytopenia)
2) fertility impairment
3) fetal toxin
4) carcinogenic?
where is ganciclovir metabolized?
kidneys
what should you not give ganciclovir with?
imipenem -> can cause seizures
ganciclovir route
IV
