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Pharm 2 > Class 13 Deck 1 > Flashcards

Class 13 Deck 1 Flashcards

(62 cards)

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1
Q

What is the difference between bacteriocidal and bacteriostatic?

A
  • Bacteriosidal = Kill bacteria

- Bacteriostatic = Inhibit bacteria growth

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2
Q

What is the Minimum Inhibitory Concentration (MIC)?

A

-Lowest concentration of antibiotic required to inhibit growth

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3
Q

What is the Maximum Bactericidal Concentration (MBC)?

A

-Concentration required to kill 99.99% of the inoculum

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4
Q

What is concentration dependent killing?

A

-Antibiotics that increase extent of killing with increased concentrations (aminoglycosides)

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5
Q

What is time dependent killing?

A

-Clinical effectiveness is related to duration of exposure not greater concentrations.

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6
Q

What is the post antibiotic effect?

A

-Antibiotics continue to suppress bacteria growth after drug is no longer detectable

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7
Q

Post antibiotic effect (PAE) can be decreased in what type of environment?

A

-Acidic (infected)

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8
Q

During the PAE phase, bacteria are more susceptible to killing by ______.

A

Leukocytes (body doing the work)

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9
Q

Antibiotics with concentration-dependent killing and significant PAEs, it is more important to have very _____ _____ and allow the ______ to decrease to less than MIC (Let PAE do the work) this is the basis daily dosing of what drug?

A
  • High Peak
  • Trough
  • Amoniglycosides
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10
Q

Sometimes the presence of an ______ may allow a drug to ______ when it otherwise wouldn’t. What is an example?

A
  • Infection, penetrate

- Meningitis

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11
Q

What local factors may modify the efficacy of the drug?

A
  • Poorly drained infection (Low ph/O2 tension/ pus)
  • Mixed infection
  • Infected hematoma
  • Foreign body
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12
Q

Food or substances containing what can alter GI absorption?

A

-Divalent metal ions

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13
Q

What are the mechanisms for acquired resistance?

A
  • Decreased permeability
  • Increased effux pumps
  • Inactivation
  • Modification of antimicrobial target
  • Development of pathways that bypass target
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14
Q

What is increased effux?

A

-Drug gets into cell but bacteria pumps it out.

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15
Q

What drugs are effected by effux?

A
  • Macrolides
  • Fluroquinolones
  • Beta Lactams
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16
Q

What is the predominant mechanism of acquired resistance of antimicrobials?

A

-Inactivation

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17
Q

Beta lactams are inactivated by what?

A

-Beta lactamases

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18
Q

Modification in the penicillin binding proteins account for methicillin resistance in _______ and penicillin resistance in _______ and _______

A
  • staphylococcus

- pneumococci and enterococci

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19
Q

What are the three reasons to use multidrug therapy?

A
  • Polymicrobial infections
  • Emergence of resistance
  • Synergy
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20
Q

What broad spectrum antibiotics can cover multiple organism infections?

A
  • Ampicillin-sublactam

- Imipenen-cilastin

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21
Q

How should resistance be inhibited? What is an example of this?

A
  • Administration of 2 antibiotics w/ different MOAs

- TB

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22
Q

What are the synergy combination responses?

A
  • Antagonism (1+1=0.5)
  • Indifferent (1+1=1)
  • Inbetween (1+1=1.5)
  • Additive (1+1=2)
  • Synergistic (1+1=3)
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23
Q

Treatment of infection with antimicrobial use can be narrowed down to what three things?

A
  • Delivery of drug to infection
  • High enough concentration
  • Sufficient time to inhibit/kill bacteria
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24
Q

What 5 infections require bactericidial therapy?

A
  • CV infection (endocarditis)
  • Meningitis/Cerebral abscess
  • Neutropenic patients
  • Osteomylitis
  • Prothesis/vascular access infection w/o removing device
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25
What 3 things should be known to make proper therapy choices?
- Patient - Invading microbe - Antimicrobial agents
26
What information should be known about the patient?
- Where exposed | - Previous antibiotic treatments
27
What are some examples of impaired host defenses against SPECIFIC INFECTION types?
- Anatomical (ulcerations) | - Secondary (Neutropenia, aspleenia, Malignancy, HIV, immunosupressant therapy)
28
What can increase a patients risk for infection complications? and what should you consider?
- Prothesis or foreign bodies (Heart valves, grafts) | - front loading antibiotic therapy
29
How are preggos at risk for infection complications?
- Pharmacokinetics are altered - Increased VD and GFR - Little or not safety data on ABX
30
What ABX is OK for preggos?
- PCN, Cephalosporins and erythomycin | - except ticarcillin
31
What ABX should be used only if necessary in preggos?
- Aminoglycosides (cranial nerve dysfunction) | - Isoniazid (Retardation, myoclonus, seizures)
32
What 6 drugs should be avoided in preggos?
- Metranidazol - Ticarcillin - Tetracyclines - Trimethoporin - Rifampin - Fluroquinolones
33
What does tetracyclines do to fetus?
- Fatty necrosis of liver - Panreatitis - renal innjury
34
What can increase risk of taking a specific ABX drugs?
- Previous reaction to the ABX | - Decreased renal/hepatic function
35
Decreased renal function can have what effect with aminoglycosides? PCN/Imipenem? Ticarcillin/Mezlocillin/Pipercillin?
- 8th cranial nerve (ototoxicity) - Seizures - Bleeding (platelet dysfunction)
36
80% of all nosocomial infections occur where?
- Resp system (24%) from vents - Blood (17%) from IV catheters - Urniary tract (36%) From foleys
37
IV catheters are a common cause of what?
- Bactermia | - Fungemia
38
How is catheter infection defined?
- 1 positive blood culture from cath and perpherial site - Clinical manifestation of infection - No other apparent source
39
What central line sites are at greatest risk for infection?
Femoral > I.J. > Subclavian
40
What is the initial therapy for catheter related infections? and why?
- Vancomycin | - High prevalence of MRSA and staph epidermidis in noscomial infections
41
When would gram negative rod coverage w/ catheter related infections be appropriate?
- infection at other body site | - CV instability
42
How should staph epidermidisa and enterocococcus be treated?
Remove catheter and short course of ABX
43
Staph aureus often disseminates and can cause what destructive infections?
- Osteomylitis | - Endocarditis
44
How should staph aureus be treated?
- Prolonged ABX therapy | - Look for metaststic lesions
45
Candida fungemia requires what?
- Looking for metastatic infections | - If non found remove cath and use fluconazole
46
What drug is usually used for surgical prophylaxis? and why?
-1st gen cephalosporin (cefazolin)
47
What are the 4 would classes?
- Class I: Clean - Class II: Clean-Contaminated (surgery in area known to have bacteria) - Class III: Contaminated (Break in sterile technique) - Class IV: Dirty-Infected (infection before surgery)
48
What is the most common infection from clean wounds? and what should be administered?
- Staphylococcal | - Some do not require prophalyxis
49
Clean-Contaminated and contaminated requires what? (including hyst and urinary tract procedures)
Prophylactic ABX
50
Patients w/ UTI's should have what ABX?
-ABX against gram negative bacilli (Fluorquinolones, aminoglycosides, 3rd gen cephlasporins)
51
Biliary tract and urinary tract should have what type of ABX?
- Ampicillin-sublactam | - Piperacillin-tazobactam
52
What is the SCIP mandate for prophylactic ABX?
-All patients 18 and up have parenteral ABX -Must be administered w/i one hour prior to incision (fluroquinolone & Vanco w/i 2 hours)
53
Bacteremia resulting from ______ is much more likely to cause IE than from bacteremia associated with a dental, GI, or GU procedure.
-Daily activities
54
What are the new guidelines for infective endocarditis?
-ABX Prophylaxis for those with the highest risk of adverse outcomes should they develop IE, rather than those at highest risk of developing IE.
55
What 4 cardiac conditions are at greatest risk for adverse outcomes with IE?
- Prosthetic cardiac valve - Previous IE - Congentital heart disease - Cardiac transplant who develop valvulopathy
56
What procedures have increased risk for developing bacteremia subsequent IE?
- Dental | - Respiratory tract procedures
57
What bacteria is the most common cause of endocarditis?
-Streptococcus viridans
58
What is the preferred prophylaxis for dental or respiratory procedures?
- PO amoxicillin - IV ampicillin/cefazolin in unable to take PO - PO cephalexin/Clindamycin/Azithromycin if allergic to PCN
59
Post op pneumonia is NOT community acquired and usually needs what ABX?
-Clindamycin (similar to erythromycin but more active against anaerobes)
60
What is the leading cause of noscomial GI infection?
-C-Diff
61
What causes C-Diff?
- ABX by altering normal bowel flora | - Enterotoxin A and Cytotoxin B
62
What is the ABX of choice in C-Diff?
- Metronidazole | - Vanc if not responsive to metronidazole

Pharm 2 (23 decks)

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