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NURS 1064 - Pharm > Chapter 38, 39, 40 (Learning Outcomes) > Flashcards

Chapter 38, 39, 40 (Learning Outcomes) Flashcards

1
Q

What is a narrow-spectrum antibacterial drug effective against?

A

Effective against only a few specific bacteria

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2
Q

What is a broad-spectrum antibacterial drug effective against?

A

Effective against many types of bacteria

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3
Q

What are three examples of bacteriostatic drugs?

A
  1. Sulfonamides
  2. Erythromycin
  3. Tetracyclines
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4
Q

Define selective toxicity

A

The ability to suppress or kill an infecting microbe without injury to the host

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5
Q

What are the two ways that drug-resistant microbes develop?

A
  1. Spontaneous mutation

2. Conjugation (transfer of genetic material)

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6
Q

What are the classifications by mechanism of action for antimicrobial drugs (6)?

A
  1. Inhibition of bacterial cell wall synthesis
  2. Inhibition of protein synthesis
  3. Inhibition of nucleic acid synthesis
  4. Inhibition of metabolic pathway
  5. Disruption of cell wall permeability
  6. Inhibition of viral enzymes
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7
Q

How do some antimicrobial affect the cell wall synthesis of certain microbes?

A

Drugs weaken the cell wall, allowing the cell to absorb water and rupture
= leads to cell death (lysis)

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8
Q

How do some antimicrobial affect the protein synthesis of certain microbes?

A

Drugs disrupt the bacteria protein synthesis process

- without affecting the protein synthesis in human cells

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9
Q

How do some antimicrobial affect the metabolic pathways of certain microbes?

A

Nucleic acid synthesis requires folic acid

  • microbes must synthesize it
  • drugs can act to inhibit folic acid synthesis
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10
Q

How do some antimicrobial affect the cell wall permeability of certain microbes?

A

Drugs that disrupt the integrity of the bacterial cell wall

- cause the cell to leak the components that are vital to its survival

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11
Q

What is a nosocomial infection?

A

An infection that originates or occurs in a hospital (or hospital like setting)

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12
Q

What are the 7 considerations for selecting antimicrobial therapy?

A
  1. Identification of the pathogen
  2. Drug susceptibility
  3. Drug spectrum
  4. Drug dose
  5. Time to affect the pathogen
  6. Site of infection
  7. Patient assessment
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13
Q

Define empiric therapy

A

Prescribing antibiotic treatment before the pathogen has been definitely indentified

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14
Q

What is the most common test to identify drug susceptibility?

A

Culture and sensitivity

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15
Q

What is the course of action if multiple microbes are though to be the causative agent?

A

A culture specimen of the infected area should be taken BEFORE treatment
- antimicrobials might make identification difficult

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16
Q

What does the culture determine? What does the sensitivity determine?

A 
Culture = determines the identity of the microbe
Sensitivity = determines which antimicrobial agent will be therapeutic
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17
Q

Why is it important to choose a drug with the narrowest possible spectrum?

A

The benefit of a narrow-spectrum antimicrobial agent is that it limits the potential for adverse effects
- such as a superinfection

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18
Q

What is a superinfection?

A

An infection that occurs during the course of treatment for a primary infection
- ex: antibiotics keep in check ALL microbes (even the good ones) - could give an opportunistic resistant microbe the chance to multiply

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19
Q

What are two possible consequences of NOT using narrow-spectrum antibiotics?

A
  1. Secondary infections

2. Development of drug-resistant microbes

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20
Q

When should antibiotics be used prophylactically (5)?

A
  1. Exposure to sexually transmitted diseases
  2. Recurrent UTIs
  3. Neutropenia (low levels of neutrophils)
  4. Surgery (GI)
  5. Bacterial endocarditis (bacteria in the heart)
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21
Q

True or False:

Prophylactic use of antibiotics may contribute to the development of resistant organisms

A

True

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22
Q

Why is it important to educate patients on taking the FULL dose and duration of an antibiotic treatment?

A

Stopping therapy early may result in reinfection with the same pathogen
- pathogen will probably have become more drug resistant as a result of inadequate treatment

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23
Q

True or False:
Immunocompromised patients should receive drugs that are quickly bacteriostatic because of patients’ immune responses are limited

A

False

- they should receive bacterioCIDAL drugs b/c their immune systems are compromised

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24
Q

What body systems must be taken into account when administering antibiotics?

A
  1. Liver
  2. Kidneys
    - patient might have difficulty metabolizing or excreting the drug
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25
Q

What adjustment should be made when prescribing an antibiotic to an elderly patient?

A

Lowering the dose

- minimize the risk for toxicity

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26
Q

Why are nosocomial infections so difficult to treat (3)?

A
  • high prevalence of pathogens
  • high prevalence of compromised hosts
  • efficient mechanism of transmission
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27
Q

What is the minimum inhibitory concentration (MIC)?

A

The minimum concentration of an antibiotic that completely suppresses bacterial growth

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28
Q

What is the minimum bactericidal concentration (MBC)?

A

Concentration of an antibiotic that kills 99.9% of the initial inoculum in a broth dilution

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29
Q

What is the most important element of patient education regarding antibiotics?

A

Take the entire course of therapy

- taking the prescribe dose at the prescribed intervals

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30
Q

What is the prototype drug for the penicillin drugs?

A

Penicillin G

- narrow spectrum

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31
Q

What are the different classifications of penicillin (4)?

A
  1. Narrow-spectrum penicillin
  2. Aminopenicillin
  3. Extended-spectrum penicillin
  4. Penicillinase-resistant penicillian
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32
Q

What do beta-lactamases do?

A

Enzymes that disrupt the beta-lactam ring

- inactivates beta-lactam drugs

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33
Q

What should you recommend to your patient if they are allergic to penicillin?

A

Suggest that they never take an “cillin” drug

- they might be allergic to it as well

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34
Q

What are the two broad-spectrum aminopenicillins?

A
  1. Ampicillin

2. Amoxicillin

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35
Q

What are the two extended-spectrum penicillins?

A
  1. Piperacillin

2. Ticarcillin

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36
Q

How are aminopenicillins different than penicillins?

A

Effective against gram-negative microorganisms

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37
Q

Why can resistance to beta-lactams (such as penicillin) occur?

A

Because of the bacteria’s ability to produce beta-lactamase

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38
Q

Describe the pharmacodynamics of beta-lactamase inhibitors

A

On their own, they exhibit only weak antibacterial effects

  • when combined with other penicillins they are much more effective
  • Beta-lactamase inhibitors bind to the enzymes’ active site allowing the penicillin to reach the target site
39
Q

How many generations of cephalosporins are there?

A

4

40
Q

What is important to know about 1st generation cephalosporins?

A
  • Most active against gram-positive bacteria (esp. staphylococci and nonenterococcal)
  • Most are destroyed by beta-lactamases and minimal ability to concentrate in CSF
41
Q

What is important to know about 2nd generation cephalosporins?

A
  • Less sensitive to destruction by Beta-lactamases than 1st gen
  • Still cannot achieve effective concentration in CSF
  • Has broader coverage against gram-negative bacteria
  • Can penetrate gram(-) cell wall better
42
Q

What is important to know about 3rd generation cephalosporins?

A
  • Drugs are highly resistant to destruction by beta-lactamases
  • highly effective against gram(-) aerobes
  • used for severe infections or in immunocompromised patients
43
Q

What is important to know about 4th generation cephalosporins?

A
  • active against (-) and (+) bacteria
  • Greater spectrum than 3rd generation
  • Highly resistant to destruction by beta-lactamases
44
Q

What is cefazolin (cephalosporin) used to treat?

A

Many kinds of infections:

  • skin
  • bone
  • heart
  • respiratory
  • GI
  • sinus/ear
  • urinary
45
Q

What is important to know about cephalosporins and penicillins?

A

Because of structural similarities …

- patients who are allergic to one, typically are allergic to the other

46
Q

Why should cefazolin be used cautiously in elderly patient?

A

In case they have a renal insufficiency

47
Q

Why is the use of Vancomycin limited?

A

B/c of its ability to produce toxic effects

- therefore, it is only used when other antibiotics fail

48
Q

What is VRE

A

Vancomycin-resistant enterococci (VRE)

49
Q

What is vancomycin used to treat?

A
  • bacterial septicemia
  • endocarditis
  • bone and joint infections
  • pseudomembranous colitic caused by C. difficile
50
Q

What antibiotic can be used if a patient is allergic to penicillin?

A

Vancomycin

- exceptionally effective for treating gram (+)

51
Q

True or False:

Gram-negative bacteria and mycobacteria are resistant to Vancomycin

A

True

52
Q

What are adverse effects of taking Vancomycin (6)?

A
  • Ototoxicity (hearing loss, tinnitus, vertigo, nausea)
  • Nephrotoxicity
  • Anaphylactic reactions (due to histamine release)
  • Phlebitis
  • Leukopenia
  • Thrombocytopenia
53
Q

When can ototoxicity occur with Vancomycin?

A

When it is infused too quickly through IV

- serum concentration > 60 - 80 mcg/mL

54
Q

What are penicillin drugs also known as?

A

Beta-lactam antibiotics

55
Q

How can penicillin be inactivated?

A

By beta-lactamases (an enzyme produced by the bacteria)

56
Q

What are penicillins most effective against?

A

Gram-positive bacteria

- they have difficult penetrating the gram-negative cell envelope

57
Q

Process of protein synthesis is divided into what two sections?

A
  1. Transcription

2. Translation

58
Q

Where does transcription occur?

A

Nucleus

59
Q

Where does translation occur?

A

Cytoplasm

60
Q

What do aminoglycoside agents do?

A

Affect protein synthesis

61
Q

What are serious adverse effects of aminoglycosides (4)?

A
  1. Ototoxicity
  2. Nephrotoxicity
  3. Neurotoxicity
  4. Neuromuscular blockade
62
Q

What is the prototype drug for aminoglycosides?

A

Gentamicin (Garamycin)

63
Q

What is Gentamicin used for?

A

Serious infections:

  • UTIs
  • pyelonephritis
  • gynecologic infections
  • peritonitis
  • endocarditis
  • pneumonia
  • bacteremia
  • sepsis
64
Q

What is Gentamicin effective against?

A

Gram-negative bacilli

65
Q

What is ototoxicity?

A

Being toxic to the ear

66
Q

What is the most common Gentamicin-induced nephrotoxicity?

A

Acute tubular necrosis

67
Q

If using Gentamicin, what can the neuromuscular blockade, result in?

A

Respiratory depression

68
Q

What is monitored throughout the course of Gentamicin therapy? Why?

A

Peak and trough drug levels

- because the therapeutic margin is very narrow

69
Q

For Gentamicin therapy when is blood drawn to measure peak levels?

A

30 minutes after the completion of a 30 minute IV administration
OR
Immediately after a 60 minute IV administration
OR
45 - 60 minutes after an IM injection

70
Q

For Gentamicin therapy, when is blood drawn to measure trough levels?

A

Just before the next dose

71
Q

What are the common adverse effects of Gentamicin?

A
  • nausea
  • vomiting
  • diarrhea
  • weight loss
72
Q

What is the prototype drug for lincosamides?

A

Clindamycin (Cleocin)

73
Q

What is clindamycin active against?

A

A wide range of aerobic gram-positive cocci and several anaerobic gram-negative and gram-positive organisms

74
Q

What is clindamycin used to treat?

A
  • Skin and skin structure infections
  • Respiratory tract infections
  • Septicemia
  • Intra-abdominal infections
  • Osteomyelitis
75
Q

Why are Lincosamides rarely used?

A

They are very toxic drugs

76
Q

What is the most serious adverse effect of Clindamycin?

A

Clostridium difficile colitis (psudomembranous colitis)

- diarrhea, abdominal cramps, abdominal tenderness

77
Q

What are common adverse effects of Clindamycin

A
  • nausea
  • vomiting
  • abdominal pain
  • rash
  • pruitus
78
Q

What is erythromycin used for?

A

Treating Legionnaire’s disease

79
Q

What do tetracyclines affect?

A

Positive and negative bacteria

80
Q

Why is tetracycline not used as frequently as it once was?

A

It has acquired substantial resistance patterns

81
Q

What is the most serious adverse effect of tetracycline?

A 
Azotemia - abnormally high nitrogen levels in the blood
Also:
- anaphylaxis
- angioedema
- blood dyscrasias
- damage to the teeth
- hepatotoxicity
- nephrotoxicity
82
Q

What are common adverse effects of Tetracycline?

A
  • discoloration of teeth
  • nausea
  • vomiting
  • photosensitivity
83
Q

What is tetracycline used for?

A
  • Rickettsia
  • Mycoplasma pneumonia
  • Chlamydia
  • Acne
84
Q

True or False:

Drugs that inhibit protein synthesis may be bactericidal or bacteriostatic

A

True

85
Q

When assessing a patient prior to administering an initial dose of IV penicillin, you should …?

A

Examine the patient’s skin for any rashes or lesions

- to provide a baseline to avoid the misdiagnosis of an allergic reaction

86
Q

Immunocompromised patients should receive antimicrobials that are …?

A

Fact-acting bacteriocidals

87
Q

Prior to the initiation of long-term clindamycin therapy, what would you assess for?

A

A baseline CBC (complete blood count)

88
Q

What are the populations most vulnerable to drug toxicity?

A
  1. Infants

2. Elderly

89
Q

What is the nosocomial transmission of MRSA predominately attributable to?

A

The non-adherence to aspectic guidelines by healthcare providers

90
Q

Vancomycin would be the antimicrobial agent of choice when treating …?

A

Bacterial septicemia

91
Q

What is an adverse effect of aminoglycoside therapy?

A

Neuromuscular blockade

92
Q

True or False:

Tetracyclines are use to treat bacteria that are both gram (-) and gram (+)

A

True

93
Q

Describe the pharmacodynamics of penicillin

A

Changes the osmotic pressure of the bacterial cell

94
Q

What does a hypersenitivity to Cefazolin most frequently present with?

A

A maculopapular rash that develops several days after the onset of therapy

NURS 1064 - Pharm (9 decks)

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