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Advanced Pharmacology Nrsg 107 > Ch. 29 Penicillins > Flashcards

Ch. 29 Penicillins Flashcards

1
Q

What determines the shape of bacteria?

A

The structure of the cell wall

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2
Q

Which organism is elongated or rod-shaped?

A

Bacilli

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3
Q

Which organism is spherical?

A

Cocci

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4
Q

What are cocci that appear in clusters called?

A

Staphylococci

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5
Q

What are cocci that are arranged in chains called?

A

Streptococci

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6
Q

What are bacteria classified as if they retain a purple stain?

A

Gram-positive microorganisms

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7
Q

What are the bacteria that are not stained called?

A

Gram-negative microorganisms

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8
Q

List some examples of gram-positive bacteria.

A

Staphylococcus aureus, streptococcus pneumoniae, group B streptococcus, and clostridium perfringens

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9
Q

List some examples of gram-negative bacteria.

A

Neisseria meningitides, E. coli, and Haemophilus influenzae

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10
Q

What causes cell lysis (cell death)?

A

Toxins produced by bacteria

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11
Q

What enzyme is produced by many bacteria?

A

Beta-lactamase

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12
Q

What is the function of the enzyme beta-lactamase?

A

Destroys beta-lactam antibiotics

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13
Q

List the beta-lactam antibiotics.

A

Penicillins and cephalosporins

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14
Q

What is the function of bacteriostatic drugs?

A

Inhibit growth of bacteria

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15
Q

What is the function of bactericidal drugs?

A

Kill bacteria

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16
Q

What are the 5 mechanisms of antibacterial action are responsible for the inhibition of growth or destruction of microorganisms?

A

(1) Inhibition of cell wall synthesis, (2) Alteration in membrane permeability, (3) Inhibition of protein synthesis, (4) Inhibition of synthesis of bacterial RNA & DNA, & (5) Interference with cellular metabolism

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17
Q

What may be depleted in individuals with poor nutritional status that’s needed to combat infections?

A

Immunoglobulins (antibody proteins such as IgG & IgM) and WBCs

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18
Q

What occurs if bacteria are resistant to an antibacterial?

A

The pathogen continues to grow, despite administration of that antibacterial drug

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19
Q

List the 4 types of resistance to antibacterials.

A

Natural or inherent resistance, acquired resistance, nosocomial infections, and cross- resistance

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20
Q

Define natural or inherent resistance.

A

Occurs without previous exposure to the antibacterial drug

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21
Q

Define an acquired resistance

A

Caused by prior exposure to the antibacterial

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22
Q

Explain how an antibiotic resistance occurs.

A

As bacteria reproduce, some mutation occurs, and eventually the mutant bacteria survive the effects of the drug

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23
Q

What is one explanation as to why an organism becomes resistant to antibiotics?

A

The mutant bacteria strain may have grown a thicker cell wall

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24
Q

Define a nosocomial infection.

A

Infections acquired while clients are hospitalized

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25
Q

Define cross-resistance.

A

Occurs between antibacterial drugs that have similar actions, such as the penicillins and cephalosporins

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26
Q

What can be done to ascertain the effect antibacterial drugs have on a specific microorganism?

A

Culture and sensitivity (C&S) or antibiotic susceptibility testing is performed

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27
Q

Why would a C&S be done?

A

It can detect the infective microorganism present in the sample and what drug can kill it

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28
Q

Why would an antibiotic susceptibility test be done?

A

The susceptibility or resistance of one microorganism to several antibacterials can be determined.

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29
Q

What can delay the development of microorganism resistance?

A

Multiantibiotic therapy (daily use of several antibacterials)

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30
Q

What are 3 results when 2 antibiotics are combined?

A

Additive, potentiative, and antagonistic

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31
Q

When might a combination of 2 or 3 antibiotics be suggested?

A

When there is a severe infection that persists and is of unknown origin or has been unsuccessfully treated with several single antibiotics

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32
Q

Describe the additive effect of combination antibiotics.

A

The antibiotic effect is doubled.

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33
Q

Describe the potentiative effect of combination antibiotics.

A

One antibiotic potentiates (enhances or increases) the effect of the other, increases effectiveness

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34
Q

Describe the antagonistic effect of combination antibiotics.

A

If the combination of antibiotics is one bactericidal and one is bacteriostatic, then the desired effect is diminished

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35
Q

What are the 3 major adverse reactions associated with the admin of antibacterial drugs?

A

Allergy or hypersensitivity, superinfection, and organ toxicity

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36
Q

What are some mild allergic reactions to antibacterials?

A

Rash, pruritus, hives (may be a delayed reaction)

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37
Q

What does a severe allergy to an antibacterial result in?

A

Anaphylactic shock

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38
Q

What are the s/s of anaphylactic shock?

A

SOB, bronchospasm, laryngeal edema, vascular collapse, and cardiac arrest

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39
Q

Which symptom of anaphylactic shock is frequently the first symptom?

A

SOB

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40
Q

What is the treatment for a mild allergic reaction to an antibiotic?

A

An antihistamine

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41
Q

What are the treatments for a severe allergic reactions (anaphylactic shock) to an antibiotic?

A

An antihistamine, epinephrine, and a bronchodilator

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42
Q

When does a severe allergic reaction to an antibiotic occur?

A

Generally occurs within 20 minutes

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43
Q

What is a superinfection and when does it occur?

A

A secondary infection that occurs when the normal microbial flora of the body are disturbed during antibiotic therapy

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44
Q

Where can superinfections occur?

A

The mouth, respiratory tract, intestines, genitourinary tract (vagina), or skin

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45
Q

What type of infections frequently result in superinfections, although bacterial organisms may be the offending microorganism?

A

Fungal infections

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46
Q

When would a superinfection occur during antibiotic therapy?

A

Usually occurs when treated with antibiotics for more than 1 week

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47
Q

In which organs can toxicity occur during antibiotic therapy?

A

Ears, liver and kidneys

48
Q

What is a narrow spectrum antibiotic?

A

Primarily effective against one bacterial type

49
Q

List 2 narrow spectrum antibiotics.

A

Penicillin and erythromycin (gram-positive)

50
Q

What is a broad spectrum antibiotics?

A

Effective against gram-positive and gram-negative

51
Q

List 2 broad spectrum antibiotics.

A

Tetracycline and cephalosporins

52
Q

When might a pt receive a broad spectrum antibiotic?

A

Before surgery to prevent post-op infections

53
Q

When is a broad spectrum antibiotic used instead of a narrow spectrum antibiotic?

A

To treat infections when the offending microorganism has not been identified by C&S

54
Q

Describe the structure of penicillins.

A

Beta-lactam structure (beta-lactam ring) interferes with bacterial cell-wall synthesis

55
Q

What is the purpose of the structure of penicillin?

A

Inhibits the bacterial enzyme that is necessary for cell division and cellular synthesis. The bacteria die of cell lysis (cell breakdown)

56
Q

What were basic penicillins introduced to kill?

A

Staphylococcus

57
Q

Is a basic penicillin a narrow-spectrum or a broad-spectrum antibiotic?

A

Narrow-spectrum antibiotic

58
Q

What is the expected pharmacological action of penicillins?

A

To destroy bacteria by weakening the bacterial cell wall

59
Q

List 4 examples of basic penicillins.

A

Penicillin G procaine (Crysticillin, Wycillin), penicillin G benzathine (Bicillin), penicillin G sodium/potassium (Pfizerpen), and penicillin V potassium (Veetids)

60
Q

What is the -suffix associated with penicillins?

A

Suffix -cillin

61
Q

What are penicillins mainly referred to as?

A

Beta-lactam antibiotics

62
Q

What are the beta-lactamases, which attack penicillins called?

A

Penicillinases

63
Q

Name the bacterial enzyme that destroys penicillin.

A

Penicillinase

64
Q

Which penicillins are used to treat both gram-positive and gram-negative bacteria?

A

Broad-spectrum penicillins

65
Q

List some gram-negative bacteria that is treated with broad spectrum antibiotics

A

E. coli, H. influenzae, S. dysenteriae, P. mirabilis, and Salmonella

66
Q

Are broad spectrum antibiotics bacterostatic or bactericidal?

A

Bactericidal

67
Q

What are broad spectrum antibiotics also known as?

A

Aminopenicillins

68
Q

What does it mean that broad spectrum antibiotics are not penicillinase resistant?

A

They are readily inactivated by beta-lactamases, thus ineffective against S. aureus

69
Q

List 2 examples of broad spectrum antibiotics.

A

Amoxicillin (Amoxil) and ampicillin (Omnipen)

70
Q

What are penicillinase-resistant penicillins (antistaphylococcal penicillins) used to treat?

A

Peniscillinase-producing S aureus

71
Q

Which gram stain are penicillinase-resistant penicillins effective at treating?

A

Gram-positive

72
Q

Are penicillinase-resistant penicillins or basic penicillins more effective at treating gram-positive bacteria?

A

Basic penicillins

73
Q

Are penicillinase-resistant penicillins bacterostatic or bactericidal antibiotics?

A

Bactericidal

74
Q

What are penicillinase-resistant penicillin antibiotics also known as?

A

Antistaphylococcal penicillins

75
Q

List 3 examples of penicillinase-resistant penicillins.

A

dicloxacillin sodium (Dynapen), nafcillin (Nallpen), oxacillin sodium (Bactocill)

76
Q

What are extended spectrum penicillins also known as?

A

Antipseudomonal penicillins

77
Q

Antipseudomonal penicillins are a part of what group?

A

Broad spectrum penicillins

78
Q

What are extended spectrum penicillins effective in treating?

A

Gram-negative organisms

79
Q

Which gram-negative organisms does extended spectrum penicillins treat?

A

Pseudomonas aeruginosa, Proteus, Klebsiella pneumoniae

80
Q

Are extended spectrum penicillins bacterostatic or bactericidal?

A

Bactericidal

81
Q

What type of infections do extended spectrum penicillins treat?

A

Bone, joint, skin, soft tissue, respiratory tract and urinary tract infections

82
Q

What are 3 examples of extended spectrum penicillins (antipseudomonal penicillins)?

A

piperacillin (Pipracil), ticarcillin (Ticar), and carbenicillin (Geopen)

83
Q

What are beta-lactamase inhibitors?

A

A broad spectrum antibiotic is combined with a beta-lactamase (enzyme) inhibitor

84
Q

What is the action of a beta-lactamase inhibitor in combination with a broad spectrum antibiotic?

A

The resulting antibiotic inhibits the bacterial beta-lactamases, making the antibiotic effective and extending it antimicrobial effect

85
Q

What are the 3 beta-lactamase inhibitors?

A

clavulanic acid, sulbactam, and tazobactum

86
Q

What are the peniclillinase-sensitive penicillins that are combined with the beta-lactamase inhibitors?

A

amoxicillin, ampicillin, piperacillin, or ticarcillin

87
Q

Name the oral beta-lactamase inhibitor.

A

Amoxicillin-clavulanate (Augmentin)

88
Q

What is the benefit of combining amoxicillin and clavulanate?

A

The combo intensifies the effects of the amoxicillin

89
Q

What are the 3 parenteral beta-lactamase inhibitor antibiotics and what is the benefit of combining them?

A

piperacillin-tazabactam (Zosyn), ticarcillin-clavulanate (Timentin), and ampicillin-sulbactam (Unasyn). The combination extends the spectrum

90
Q

What needs to be monitored in a parenteral beta-lactamase inhibitor antibiotic?

A

Irritation, rashes, red streaks up the arm (phlebitis), and allergic reactions

91
Q

What must be done prior to administering an antibiotic?

A

Check C&S (testing of infective organism)

92
Q

What are the s/s of a superinfection?

A

Stomatitis (mouth ulcer), genital discharge (vaginitis), and anal or genital itching

93
Q

What medications are used to treat a superinfection while on antibiotic therapy?

A

fluconazole (Diflucan) or Nystatin

94
Q

What needs to be monitored for especially after the first and second doses of antibiotics?

A

An allergic reaction to the penicillin product

95
Q

What must you have available to counteract a severe allergic reaction to penicillin antibiotic therapy?

A

Epinephrine

96
Q

Why do you not mix aminoglycosides with a high dose or extended spectrum penicillin G?

A

This combination may inactivate the aminoglycosides

97
Q

Why would you check for bleeding if high doses of penicillin are being given?

A

A decrease in platelet aggregation (clotting) may result

98
Q

Why would you encourage the patient to increase their fluid intake while on penicillins?

A

Fluids aid in decreasing the body temperature and in excreting the drug

99
Q

Should penicillins be taken with or without food?

A

Usually taken on an empty stomach; 1 hr before or 2 hrs after a meal. May be taken with food to avoid gastric irritation

100
Q

What is the first assessment that needs to be done prior to administration of penicillins?

A

Assess for allergy to penicillin or cephalosporins

101
Q

When do you monitor a patient for allergies/anaphylaxis during treatment with parenteral penicillin?

A

30 minutes following administration

102
Q

What do you advise a patient with allergies to PCN to wear?

A

A medication alert (MedicAlert) bracelet or necklace

103
Q

Why is it so important to assess renal function with PCN therapy?

A

Most beta-lactam antibiotics are excreted via the kidneys

104
Q

What labs should be monitored to assess renal function during PCN therapy?

A

Serum BUN and serum creatinine

105
Q

What is done to the PCN antibiotic dose if there is a decrease in renal function?

A

The antibiotic dose should be decreased

106
Q

What else besides labs need to be monitored to assess renal function during PCN therapy?

A

Monitor I&O

107
Q

Which broad spectrum penicillins may decrease the effectiveness of oral contraceptives?

A

Amoxicillin and ampicillin

108
Q

Why would you monitor cardiac status and serum electrolyte levels in patients receiving PCN antibiotics?

A

Hyperkalemia/dysrhythmias are possible with high doses of penicillin and penicillin G

109
Q

Why would you exercise caution with patients who follow a sodium-restricted diet during PCN therapy?

A

Hypernatremia may occur with IV carbenicillin and ticarcillin

110
Q

Why would you administer probenecid (Probalan) during PCN therapy to prolong antibacterial action?

A

Probenecid (Probalan) delays excretion of PCN

111
Q

What are some food interactions with PCN antibiotics?

A

Decrease affect with acidic fruits or juices

112
Q

What changes in lab values might you see during PCN antibiotic therapy?

A

Increases serum AST, ALT, BUN and creatinine

113
Q

How does aspirin effect amoxicillin and dicloxacillin therapy?

A

Increases the effect of the penicillin antibiotics

114
Q

What are common adverse reactions to penicillin administration?

A

Hypersensitivity and superinfection

115
Q

What are some common GI disturbances during PCN administration?

A

N/V and diarrhea

116
Q

What does amoxicillin treat?

A

Respiratory tract infections, UTIs, otitis media, and sinusitis

117
Q

What does dicloxacillin treat?

A

Staphylococcus aureus infections

Advanced Pharmacology Nrsg 107 (5 decks)

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