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ARCHIVED: Pharmacology for Nurse Anesthesia > Exam 1: Antimicrobials and Antibiotics > Flashcards

Exam 1: Antimicrobials and Antibiotics Flashcards

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1
Q

Class of antibiotic to use in immunocompromised patients:

A

Bactericidal

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2
Q

Reason for preserving normal/GI flora if possible:

A

Normal flora have antixenobiological action

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3
Q

Type of abx usually used in OR:

A

Cheap, broad spectrum

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4
Q

Are abx always necessary in OR?

A

No; pts with allergies and superficial surgeries may not need

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5
Q

SCIP guidelines for abx:

A

Single dose within 1 hr of incision

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6
Q

Considerations for selection of abx:

A

ID of causative organism
Drug delivery to site
Single drug if possible
Route, duration, cost

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7
Q

Pts who particularly need prophylactic abx:

A

Bowel/appy
Hardware
Diabetics
Extended surgical time

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8
Q

Relationship between hypersensitivity reaction and dose:

A

Independent

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9
Q

Relationship between drug toxicity and dose:

A

Dose related

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10
Q

Abx concerns with parturients:

A

Most abx cross the placenta and enter milk

Possible teratogenicity

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11
Q

Abx concerns with elderly:

A

Renal impairment
Decreased plasma protein
Reduced GI mobility, acidity
Increased body fat = more drug in tissues

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12
Q

Penicillin structure and mechanism of action:

A

Bactericidal beta-lactam

Interferes with bacterial cell wall

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13
Q

Organisms susceptible to penicillin:

A

-coccals

Pneumococcal
Meningococcal
Streptococcal

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14
Q

Penicillin elimination:

A

Renal

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15
Q

Ampicillin organisms:

A

Gram(-)

H. influenza, e. coli

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16
Q

Notable ampicillin adverse effect:

A

Skin rash

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17
Q

Amoxicillin advantage over ampicillin:

A

More efficiently absorbed from GI tract

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18
Q

Most allergenic antimicrobial:

A

Penicillins

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19
Q

Most common adverse reaction to PCNs:

A

Allergy/hypersensitivity

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20
Q

Signs of PCN allergy:

A

Rash and/or fever
Anaphylaxis
Hemolytic anemia

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21
Q

Classes of abx with cross-sensitivity and % chance:

A

PCNs and cephalosporins

8% chance

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22
Q

Cephalosporin mechanism of action:

A

Bactericidal

Inhibits bacterial cell wall synthesis

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23
Q

Cephalosporin elimination route:

A

40% bile

60% renal

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24
Q

Cephalosporin organisms:

A

Broad spectrum

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25
Q

Primary s/s of cephalosporin allergy:

A

Rash

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26
Q

% incidence of anaphylactic rxn to cephalosporin:

A

0.02%

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27
Q

First, second, and third generation cephalosporins:

A

1st: cefazolin
2nd: cefoxitin
3rd: cefotaxime

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28
Q

Type of surgery that often uses cephalosporins and why:

A

Ortho - cephalosporins penetrate into joints

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29
Q

Differences in cephalosporin generations:

A

Better anti-Gm(-) activity in later generations

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30
Q

Aminoglycoside mechanism of action:

A

Bactericidal

Inhibits cellular activity inside microbe

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31
Q

Aminoglycoside organisms:

A

Aerobic Gm(-)

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32
Q

Aminoglycoside elimination & elimination half-time

A

Extensively renal
2-3hr elimination half-time in healthy pt
20-40x increase in renal failure

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33
Q

Aminoglycoside adverse effects:

A

Ototoxicity
Nephrotoxicity
Skeletal muscle weakness
Prolongs NMB

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34
Q

Mechanism of aminoglycoside ototoxicity:

A

Irreversible damage to vestibular/cochlear hairs

Dose dependent

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35
Q

Mechanism of aminoglycoside nephrotoxicity:

A

Accumulation in renal cortex –> tubular necrosis –> proteinuria, dilute urine, RBC casts
Reversible!

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36
Q

Most nephrotoxic aminoglycoside:

A

Neomycin (mostly given topical for this reason)

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37
Q

Mechanism of aminoglycoside muscle weakness:

A

Inhibits pre-synaptic ACh release

Decreases post-synaptic sensitivity to ACh

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38
Q

Patient population in whom aminoglycosides should be avoided:

A

Myasthenia gravis

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39
Q

“Sneaky” way aminoglycosides become systemically absorbed:

A

From irrigation fluid

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40
Q

Drug effect enhanced by aminoglycosides:

A

NM blocking properties of lidocaine

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41
Q

Five aminoglycosides:

A 
Streptomycin
Kanamycin
Gentamicin
Amikacin
Neomycin
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42
Q

Toxic level of gentamicin:

A

> 9mcg/ml

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43
Q

Unique use of neomycin:

A

Adjunct therapy to hepatic coma

44
Q

Aminoglycosides with limited use due to ototoxicity:

A

Streptomycin/kanamycin

45
Q

Tetracyclines mechanism of action:

A

Bacteriostatic

Inhibits bacterial protein synthesis

46
Q

Common use of tetracyclines:

A

Treatment of acne via decrease in fatty acid content of sebum

47
Q

Tetracyclines elimination:

A

Excreted in urine and bile

48
Q

Tetracyclines side effects:

A

Discoloration of teeth (in developing fetus/children)
Photosensitivity
Hepatic/renal damage in high doses

49
Q

Administration of tetracycline:

A

PO only

50
Q

Administration of doxycycline:

A

IV or PO

51
Q

Macrolide drugs:

A

Erythromycin, azithromycin

52
Q

Erythromycin mechanism of action:

A

Can be bacteriostatic or bactericidal

Inhibits bacterial protein synthesis

53
Q

Erythromycin organisms:

A

Gm+ bacteria

Narrow spectrum

54
Q

Erythromycin elimination:

A

CYP450 metabolism

Excreted mostly in bile

55
Q

Erythromycin adverse effects:

A

GI (esp. IV)
QT effects
Thrombophlebitis (prolonged IV use)

56
Q

Physiologic alteration that increases erythromycin side effects:

A

CYP450 inhibition

57
Q

Clindamycin class:

A

Linomycins

58
Q

Clindamycin mechanism of action:

A

Bacteriostatic

Inhibits bacterial protein synthesis

59
Q

Clindamycin organisms:

A

Anaerobes

60
Q

Clindamycin uses:

A

Serious GI or female genital tract infections

61
Q

Clindamycin dosing considerations:

A

Decrease dose with severe liver disease

62
Q

Clindamycin adverse effects:

A

Pseudomembranous colitis

Pre- and post-synaptic effects at NMJ - unantagonizable with calcium or anticholinesterases

63
Q

Vancomycin class:

A

Glycopeptide derivative

64
Q

Vancomycin mechanism of action:

A

Bactericidal

Impairs cell wall synthesis

65
Q

Vancomycin organisms:

A

Gm(+) bacteria
Staph
Strepto- and enterococcus
MRSA

66
Q

Vancomycin elimination & elimination half-time:

A

Renal excretion
6 hrs
Up to 9 days in renal patients

67
Q

Vancomycin surgical uses:

A

Cardiac procedures
Ortho procedures with prosthetics
CSF, shunt infections

68
Q

Vancomycin dosing & concentration:

A

10-15 mg/kg over 60 min

1gm/250ml concentration

69
Q

Vancomycin adverse effects:

A

Profound hypotension with rapid infusion
Red man syndrome
Ototoxicity/nephrotoxicity

70
Q

Mechanism of red man syndrome:

A

Facial/truncal erythema from histamine release

71
Q

Sulfonamides mechanism of action:

A

Bacteriostatic

Inhibit bacterial folic acid synthesis

72
Q

Sulfonamide uses:

A

UTIs

73
Q

Sulfonamide elimination:

A

Hepatic metabolism

Renal excretion

74
Q

Sulfonamide side effects:

A 
Skin rash, anaphylaxis
Drug fever
Hepatotoxicity
Acute hemolytic anemia
Increase PO anticoagulant effect
75
Q

Polymixin B/colistimethate mechanism of action:

A

Bactericidal

Affects bacterial cell wall phospholipids

76
Q

Polymixin B/colistimethate organisms:

A

Gm(-) bacteria

77
Q

Polymixin B/colistimethate uses:

A

Severe UTIs
Skin, mucous membrane, eye, ear infections
GI tract sterilization (poop transplant)

78
Q

Polymixin B/colistimethate elimination:

A

Renal elimination

79
Q

Polymixin B/colistimethate side effects:

A

Most potent at NMJ

Very nephrotoxic

80
Q

Metronidazole mechanism of action:

A

Bactericidal

81
Q

Metronidazole organisms:

A

Anaerobic Gm(-) bacteria

82
Q

Metronidazole uses:

A

CNS infections
Abdominal/pelvic sepsis
Pseudomembranous colitis

83
Q

Fluoroquinolones mechanism of action:

A

Bactericidal

84
Q

Fluoroquinolones organisms:

A

Enteric Gm(-) bacilli

85
Q

Fluoroquinolones elimination & elimination half-time:

A

Mostly renal excretion

3-8 hr half-time

86
Q

Fluoroquinolones drug example:

A

Ciprofloxacin

87
Q

Fluoroquinolones adverse effects:

A 
CYP450 inhibition
GI disturbances (mild)
88
Q

Fluoroquinolones uses:

A

Systemic infections, bone, soft tissue, respiratory tract, GI, GU

89
Q

Rifampin mechanism of action:

A

Bactericidal

Inhibits RNA chain in microbe

90
Q

Rifampin organisms:

A

Mycobacteria - tuberculosis
Gm(+) - most
Gm(-) - many

91
Q

Rifampin administration and excretion:

A

Oral or parenteral
Bile and urine excretion
Penetrates into CNS

92
Q

Rifampin side effects:

A 
CYP450 induction
Thrombocytopenia
Anemia
Hepatitis
Fatigue/weakness
Numbness
93
Q

Amphotericin B use:

A

Yeasts and fungi

94
Q

Amphotericin B administration:

A

IV only

95
Q

Amphotericin B elimination:

A

Renal - slowly!

96
Q

Amphotericin B adverse effects

A 
Renal function impairment (80%!!)
Fever, chills, dyspnea, hypotension
Hepatic impairment
Hypokalemia
Allergies
Seizures
Anemia/thrombocytopenia
97
Q

Classification of viruses:

A

DNA or RNA

98
Q

Acyclivir & valacyclovir use and elimination:

A

For the herps

Renal excretion

99
Q

Vidarabine uses and side effects:

A

Cytomegalic inclusion disease
HSV encephalitis
Mutagenic, carcinogenic

100
Q

Famciclovir use:

A

Acute herpes zoster

101
Q

Ganciclovir use and adverse effect:

A

CMV disease

Hematologic toxicity

102
Q

Amantadine use and elimination:

A

Influenza A virus and Parkinson’s

Renal excretion

103
Q

Interferons mechanism of action:

A

Induce enzymes that inhibit viral replication

Enhance anti-tumor activities of macrophages

104
Q

Interferons uses:

A

Hepatitis B (chronic)
Hepatitis C
Nasal sprays

105
Q

Interferons side effects:

A 
Flulike symptoms
Hematologic toxicity
Depression, irritability, decreased concentration
Autoimmune conditions
Rash, alopecia
CV, thyroid, hepatic changes
106
Q

Types of AIDS antivirals:

A

Nucelotide reverse transcriptase inhibitors
NON-nucleotide reverse transcriptase inhibitors
Protease inhibitors

107
Q

AIDS antiviral side effects:

A

Pancreatitis, hepatitis, lactic acidosis, fat changes, increased cholesterol/trigs, hypersensitivity

Protease inhibitors are potent CYP450 inhibitors

ARCHIVED: Pharmacology for Nurse Anesthesia (20 decks)

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