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NUR 622: Adv. Pharmacology Lectures > Exam 1B: Dr. Wright > Flashcards

Exam 1B: Dr. Wright Flashcards

1
Q

This drug reacts with almost every drug.

A

Coumadin

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2
Q

If a patient is allergic to PCN, you need to perform ___ prior to administering cephalosporins.

A

skin test (give 1/10th of a cc)

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2
Q

Allergic reactions to cephalosporins has a majority consists of cutaneous manifestations that occur ____h after exposure.

A

24H

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2
Q

This drug was largely replaced by gentamicin and other amino glycosides; less ototoxic.

A

Kanamycin

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2
Q

Aminoglycosides accumulate in the renal cortex and can produce _______ that initially manifests as an inability to concentrate urine, presence of protein and RBC casts

A

acute tubular necrosis

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2
Q

This is considered as the ideal Vancomycin plasma levels in patients with renal dysfunction.

A

20-30 mg/ml

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2
Q

Sulfonamides: Acetyl metabolites are often less soluble increasing the likelihood of ____.

A

crystalluria

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3
Q

Anuria increases PCN elimination half life approximately ___fold

A

10

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3
Q

This is the continued use of antibiotics after the operative procedure based upon the intraoperative findings.

A

Empiric Therapy

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3
Q

During prolonged procedures, antibiotic prophylaxis should be read ministered every

A

3 hours

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4
Q

PCN’s true hypersensitivity is mediated by

A

Ig E Ab

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5
Q

This is the drug of choice for antimicrobial prophylaxis in the preoperative period (well tolerated IM/ IV).

A

Cefazolin

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5
Q

This amino glycoside is given to patients who are allergic to PCN.

A

Gentamicin

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6
Q

Complication of clindamycin therapy.

A

Severe pseudomembranous colitis. Note: should be used only to treat infections that cannot be adequately treated by less toxic antimicrobials.

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7
Q

High doses of PCN G IV to patients with renal dysfunction may result in (2)

A

neurotoxicity and hyperkalemia

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7
Q

JC and CMS mandated reporting of the following performance measures on a monthly basis. They are (2)

A
  1. Prophylactic antibiotics must be administered to a patient within 1 hour prior to surgical incision 2. Prophylactic antibiotics must be discontinued with 24 hours from the end of surgery.
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8
Q

The neuromuscular blocking effects of this drug can also enhance the potentiation of NMB effects seen early postop if given to patient that received amino glycoside and NMB

A

Lidocaine

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9
Q

These are bactericidal antimicrobial that inhibit bacterial cell wall synthesis with LOW intrinsic toxicity.

A

Cephalosporins

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9
Q

Aminoglycosides: Rapid systemic absorption occurs after ____ injection with peak plasma concentration occurring 30-90 minutes.

A

IM injection

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9
Q

This drug is expensive and offer few advantages over gentamicin.

A

Tobramycin

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10
Q

Renal excretion of PCN is rapid. _____% of IM dose is excreted in the first hour.

A

60 - 90%

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11
Q

This drug is given to increase plasma concentration of PCN and prolong its effects.

A

Probenecid Note: It inhibits renal excretion

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11
Q

Resistance to cephalosporins may be due to ___

A

inability of the drug to penetrate to its site of action

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12
Q

The presence of pus, which contains _____ that may bind to or inhibit the drug, makes therapy less effective. Also, areas of infection have less blood supply so penetration of the drug is reduced. If a foreign body such as prosthesis is involved, the foreign body may beed to be removed for antibiotic therapy.

A

phagocytes and proteins

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12
Q

Intrathecal (Spinal cord) use of PCN is prohibited because it can cause (3)

A
  1. Convulsion 2. Arachnoiditis 3. Encephalopathy
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12
Q

______ occur in about 100% of patient treated with clindamycin.

A

Skin rashes

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13
Q

Erythromycin is extensively metabolized by ______. Therefore, meds that inhibit effects of these enzymes may increase plasma erythromycin concentration increasing risk of _____________ (2)

A

Cytochrome P450 (CYP3A) ……. Vtach and sudden death.

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14
Q

Tetracycline is used as an adjuvant therapy with ___

A

severe cystic acne

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16
Q

The IM injection of this drug delays PCN absorption and prolongs duration of action.

A

Procaine

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16
Q

This drug has broader range of activity than PCN G. It is well absorbed after oral administration.

A

Ampicillin.

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16
Q

2nd and 3rd generation cephalosporins have extended activity against ___.

A

Gram Negative bacteria

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18
Q

PCN is highly effective against streptococcal infections, accounting for its value in patients with _____.

A

rheumatic fever

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19
Q

These (3) drugs may displace sulfonamides and increase amount of free drug in the plasma.

A

1.Indomethacin 2. probenicid 3. Salicylates

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21
Q

This drug is given for severe staph infections or streptococcal or enterococcal endocarditis in patients allergic to PCN or cephalosporins.

A

IV Vancomycin

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23
Q

______ are susceptible to B lactamases and are ineffective against most S. aureus strains.

A

PCN V&G

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23
Q

Alternative drug to PCN G IV (aqueous PCN G) if K poses a risk to the patient.

A

Na salt of PCN G Na salt of a similar PCN such as AMPICILLIN.

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24
Q

This drug resembles erythromycin, but more active against many anaerobes.

A

Clindamycin

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25
Q

This drug is an effective alternative for patients with pharyngitis, bronchitis, and pan that can’t tolerate PCNs or cephalosporins.

A

Erythromycin

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26
Q

These factors determine the choice of antibiotic and the route it is administered. (2)

A
  1. Location of infection 2. Host factors
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27
Q

CYP 450 inducer will (increase or decrease) metabolism.

A

Increase. Dilantin will eliminate muscle relaxants faster because it is an enzyme inductor.

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28
Q

T/F: Other drugs should not be mixed with PCN as the antimicrobial effects may be inactivated.

A

True

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30
Q

These group of drugs are bactericidal interfering with the ribosomal function and inhibition of protein synthesis.

A

Aminoglycosides

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30
Q

Oral erythromycin has been used by GI docs before endoscopy and in as a prep emergency anesthesia because if its effects on _____.

A

gastric emptying (increases LES tone)

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32
Q

Antibodies to PCN may cause ___.

A

hemolytic anemia

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33
Q

Lab test you need to check in Renal disease patients receiving PCNs.

A

K level **Make sure they excrete K.

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33
Q

These are the most potent of all the antimicrobials in their actions at the NMJ (pre junctional).

A

Polymyxins Polymyxin B can produce skeletal muscle weakness

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35
Q

This is a semisynthetic derivative of kanamycin. Used primarily in treatment of infections caused by gentamicin-or tobramycin-resistant gram Neg bacilli.

A

Amikacin

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35
Q

These antibiotics can be given upon arrival to OR. (3)

A
  1. Ancef 2. Kefurox 3. Zinacef
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36
Q

FYI: Therapy more likely to be effective if the material is removed.

A

e.g. Infections behind obstructing lesions such as pneumonia behind a blocked bronchus will not respond to antimicrobials until the obstruction is removed.

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38
Q

It is chemically identical to ampicillin except for an OH substituent instead of an -H on the side chain.

A

Amoxicillin

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38
Q

Tetracyclines are not given to pregnant and children because it can cause

A

permanent discoloration of teeth

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39
Q

Amoxicillin is associated with the highest incidence of skin rash which typically appears ____ days after beginning of therapy

A

7-10 days

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41
Q

Nearly 80% of nosocomial infections occur in the ___(3)

A

Urinary tract (catherters), respiratory tract (vents), bloodstream (catheters)

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41
Q

Erythromycin is the drug of choice for

A

atypical PNA

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42
Q

A single preoperative dose of antibiotic is as effective as a _______ of postoperative therapy assuming an uncomplicated procedure.

A

5-day course

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43
Q

This drug poses a risk of bleeding with concurrent use of alcohol.

A

Cefamandole

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43
Q

Oral erythromycin prolongs cardiac depolarization and is associated with ______.

A

torsades de pointes

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45
Q

Name 4 beta-lactam compounds

A
  1. PCNs 2. Monobactams 3. Cephalosporins 4. Carbapenems
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45
Q

FYI: All cephalosporins can penetrate into joints and can readily cross the placenta.

A

Used in ortho procedures

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46
Q

Amoxicillin: Aproximately 50% of an oral dose is excreted unchanged by kidneys in the first ____h

A

6 hours

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47
Q

This drug is used for prophylaxis against endocarditis in PCN-allergic patients who have valvular heart disease and are undergoing dental procedures.

A

Vancomycin

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48
Q

Doxycline may be given po or IV. Elimination half-life after an oral dose is ____.

A

11-22 Hrs

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50
Q

What is the goal of prophylactic antibiotics?

A

to reduce the incidence of postop wound infection

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51
Q

When realizing your patient has PCN allergy, ask if they have had a ___ test

A

skin.

51
Q

This amino glycoside is the MOST nephrotoxic and is not given parenterally. (given as cream/ irrigation)

A

NEOMYCIN

52
Q

The synergistic effects of 2 antibiotic agents may be utilized to achieve a greater effect need. Give 2 examples.

A
  1. Ampicillin + gentamicin = for enterococcal endocarditis 2. Ampicillin + Sulbactam = inhibits enzymatic inactivation.
52
Q

Side effects of INH (4)

A
  1. Seizures 2.Optic neuritis 3. Mental changes (euphoria, psychoses) 4. Excessive sedation (pts on dilantin and are slow acetylators)
53
Q

Transient bacteremia may occur in patients undergoing ___ (4)

A
  1. Dental extractions especially in patients with congenital/acquired heart disease 2. Tonsillectomy 3.GI, GU surgeries 4. Vaginal deliveries
54
Q

IV push is contraindicated in this antibiotic.

A

Gentamicin

55
Q

Vestibular toxicity to aminoglycosides manifests as (4).

A
  1. nystagmus 2. Vertigo 3. Nausea 4. Meniere’s syndrome
57
Q

This is an adverse reaction, not considered an allergy nor toxicity.

A

Hypersensitivity

58
Q

This is indicated for procedures associated with high infection rates, those involving implantation of prosthetic material, and those in which the consequences of infection are serious.

A

Prophylaxis

59
Q

Aminoglycosides are highly polar compounds, which means they have _____ penetrating the cells

A

difficulty

60
Q

Erythromycin can be given IV, but only with severe infections due to ______ and development of _______ in some patients.

A

thrombophlebitis …. tinnitus and hearing loss

61
Q

The presence of a common nucleus in the structure of all penicillin means that allergy to one PCN increases the likelihood of an allergic reaction to another penicillin. This is an example of ___.

A

Cross-sensitivity

63
Q

This is a significant risk of using polymyxins.

A

Nephrotoxicity

64
Q

This drug is useful in prophylactic antimicrobial in patients undergoing cardiac and orthopedic surgical procedures that involve placement of prosthetic device.

A

Vancomycin

65
Q

This is an indication to discontinue clindamycin therapy.

A

severe diarrhea

66
Q

These antibiotics all need to be started by CRNA before leaving the preoperative area (4)

A
  1. Ampicillin 2. Gentamicin 3. Unasyn 4. Invanz
67
Q

Aminoglycosides are attenuated by ____

A

Diuretics (Lasix and Mannitol)

69
Q

Vancomycin is used to treat shunt-related infections due to _______

A

coagulase-negative staphylococcus

70
Q

Side effect of Invanz (2)

A

hypotension and flushed skin

71
Q

This is vancomycin-induced histamine release.

A

Redman syndrome

72
Q

This is a quinolone antibiotic used in adults as a lung, sinus, skin, and UTI treatment when such infections are caused by certain bacteria

A

levaquin (GIVE SLOW)

73
Q

Skin rash associated with ampicillin is due to _______. Does not represent true allergy.

A

protein impurities in the commercial preparation of the drug.

74
Q

S/Sx of PCN true hypersensitivity (3)

A

Laryngeal spasm, CV collapse, Bronchospasm

75
Q

Aminoglycosides should not be given too fast secondary to ____

A

ototoxicity

76
Q

For colorectal and abdominal procedures, ___________ may provide a less costly alternative.

A

a bowel prep with oral antimicrobials

77
Q

name 4 Side effects of Aminoglycosides

A
  1. Nephrotoxicity 2. Ototoxicity 3. Skeletal muscle weakness 4. Potentiation of non depolarizing neuromuscular blockers
78
Q

This is considered the primary drug for chemotherapy of TB and the only medication proved effective for prevention of TB.

A

Isoniazid

79
Q

This is the prototype of 1st gen cephalosporins.

A

Cephalothin

80
Q

This is the best approach for recognizing potentially toxic levels of gentamicin.

A

Monitor plasma concentration

82
Q

PCN plasma concentration decreases to 50% of its peak value within ___ Hour(s) after injection

A

1 hour

82
Q

True or False: There are also 3rd and 4th generation PCNs extending their spectrum of activity.

A

True

83
Q

This is the most common cause of bacteremia and fungemia in hospitals.

A

IV catheters. usually comes from the colonized hub/ lumen and reflect skin flora.

84
Q

This is the metabolite of INH. It is a known hepatotoxin.

A

Acetylisoniazid

86
Q

Gentamicin penetrates _____, _____,_____ in the presence of inflammation.

A

pleural, ascitic, and synovial fluids

87
Q

This drug is a bactericidal glycopeptide that impairs cell wall synthesis of Gram + bacteria

A

Vancomycin Note: It has large Volume distribution, including CSF

89
Q

This is the maximum time between start time of antibiotic and incision.

A

Window

91
Q

______ has essentially the same antimicrobial spectrum but has the advantage of achieving higher blood levels, presumably due to slower renal elimination.

A

Cefazolin

92
Q

The use of oral vancomycin is only for

A
  1. staph enterocolitis 2. Antimicrobial-associated pseudomembranous enterocolitis
93
Q

This antibiotic class is stable in the presence of gastric fluid, so well absorbed from the GIT.

A

Macrolides

94
Q

It should not be given with PCN as it may antagonize bactericidal actions of PCN

A

Amikacin

96
Q

Antibiotics need to be given within

A

1 hour prior to surgery

97
Q

These antibiotics will be started by the preop RN (2)

A
  1. Vancomycin 2. Levaquin
98
Q

Skeletal muscle weakness effect of amino glycosides most likely is because of the ability of these drugs to inhibit _____ while also decreasing ______.

A

pre junctional release of ACh…………… postsynaptic sensitivity to ACh. NOTE!!!! IV calcium: to strengthen muscle tone Neostigmine (Acetylcholinesterase inhibitor) : reversal for NMB; overcomes this effect at the NMJ

100
Q

Allergic reactions to _____ noted in 1-10% of patients making these the most allergenic of all drugs.

A

PCNs

102
Q

It is commonly used topically for skin infections (burns), cornea, and mucous membranes.

A

Neomycin

103
Q

Simultaneous use of multiple antibiotics is avoided because of the risk of ___ (3)

A
  1. drug toxicity 2. superinfections 3. antagonism between each drug Note: Initial treatment of life-threatening infections may be initiated with combinations until offending organism can be identified.
104
Q

This side effect can occur with intrapleural or intraperitoneal institution of large doses of amino glycosides.

A

Skeletal muscle weakness

106
Q

This adverse reaction may manifest as damage to virtually any organ.

A

Direct drug toxicity

107
Q

What medication is given in patients who are hypotensive due to rapid infusion of Vancomycin (

A

Neosynephrine, ephedrine, benadryl (H1), Cemetidine (H2)

108
Q

Patients receiving amino glycosides should be checked frequently for ______.

A

Vestibular or auditory dysfunction

109
Q

Gastric emptying secondary to oral erythromycin can be seen when administered ___hr(s) before induction. In contrast, when given ___hr(s) before induction, no significant change in gastric acidity.

A

1 hour…… 3 hours Note: Give 100 mg

110
Q

The National Nosocomial Surveillance System (NNSS) mentioned the factors which increase the risk of infection during surgery. Name 4.

A
  1. ASA: Comorbidities 2. Level of contamination 3. Duration of the procedure 4. Use of Laparoscope
111
Q

10 million units of PCN contains ____ mEq of K.

A

16

112
Q

Cephalosporins have ____% chance of cross-reactivity/sensitivity if they are allergic to PCN.

A

8%

113
Q

This is the most common side effect of erythromycin.

A

GI intolerance

114
Q

IV Vanc infusion dose

A

10-15mg/kg over 1 hour

115
Q

The use of this involves risk-to-benefit evaluation that varies depending on the procedure. (clean vs dirty procedure)

A

Antimicrobial prophylaxis

116
Q

Why are newborns at higher risk of adverse reactions? (2)

A

Poorly developed renal excretion and hepatic biotransformation mechanism

117
Q

Clindamycin is indicated in treatment of anaerobes, particularly originating in the ____(2)

A

GI and female Genital tract

119
Q

A hospital that does not report monthly performance to JC and CMS and has no action plan for improvement will have a _____ % cut in reimbursement.

A

3%

120
Q

Prophylactic antibiotics should be administered within ___

A

1 hour prior to incision.

121
Q

PCN is the drug of choice for ___ (3)

A

pneumococcal, streptococcal, and meningococcal infections

122
Q

Simultaneous administration of amino glycosides and _____ increases risk for toxicity.

A

diuretics

123
Q

This drug is more effective against H. influenza and only 2nd generation effective in MENINGITIS.

A

Cefuroxime

124
Q

This is found in PCNs, Cephalosporins, etc…

A

Beta lactam ring

125
Q

Life-threatening anaphylaxis to cephalosporins is estimated to occur in ______% of patients.

A

0.02%

126
Q

The goal of antibiotic therapy should be to achieve a drug concentration at the site of infection ___________ for the infecting organism. Plus, this concentration must be tolerable by the host. (Host factors –inadequate immune system).

A

equal to or greater than the MIC

127
Q

This is the lowest concentration of a given antimicrobial at which an organism’s growth is inhibited.

A

Minimum inhibitory concentration (MIC)

128
Q

Combination drug in the treatment of otitis media in children.

A

Sulfonamide + erythromycin

129
Q

This generation of cephalosporins is not recommended for treatment of meningitis because it can’t enter CSF in significant amounts

A

1st gen

130
Q

IV administration of any cephalosporins can cause ____.

A

thrombophlebitis

132
Q

Name 3 categories of adverse reactions

A
  1. Hypersensitivity 2. Direct Drug toxicity 3. Microbial superinfection
133
Q

Patients with ______ are susceptible to skeletal muscle weakness if treated with aminoglycoside

A

myasthenia gravis

134
Q

Tetracycline is the drug of choice in treatment of (2)

A

rickettsial diseases and mycoplasma pneumoniae.

135
Q

This is the antibiotic drug of choice for surgical procedures in which skin flora and normal flora of the GI/GUT are the most likely pathogens.

A

cephalosporins (1st generation)

136
Q

Tetracycline is not recommended for topical use because of high incidence of _____.

A

sensitization

137
Q

FYI: Slow acetylators may be susceptible to accumulation of toxic concentrations if renal function is impaired.

A

!

138
Q

Why are the elderly prone to adverse reactions? (4)

A

1.Oral Absorption: Decreased Gi motility and acidity 2. Distribution:Decreased body fat and albumin (more free drug) 3. Metabolism: Decreased hepatic blood flow 4. Excretion: Decreased GFR

139
Q

What is the Mechanism of Action of Beta-Lactam compounds?

A

Inhibits cell wall synthesis.

141
Q

This drug was used for treatment of bubonic plague.

A

streptomycin

142
Q

Sulfonamides increase the effect of these drugs (4)

A
  1. Anticoagulants 2. Methotrexate 3. Sulfonylurea hypoglycemic drugs 4. Thiazide diuretics
144
Q

Ampicillin covers not only what PCN does but also ____.

A

H. influenzae and E.coli

145
Q

General factors associated with risk for infection (7)

A
  1. Age 2. Obesity 3. Tobacco Use 4. Malnutrition 5. DM 6. ISchemia 7. Prolonged surgical procedure
147
Q

FYI: Erythromycin is enteric-coated because gastric acids inactivate it

A

;)

148
Q

Patients with renal failure should have the PCN dose adjusted because high doses may cause ___.

A

seizures

149
Q

PCN Allergy: Fatal reactions have occurred in patients receiving PCN as little as _____ of PCN for skin testing.

A

1 unit

150
Q

Excretion of PCN (2)

A

10% eliminated by GFR 90% of renal tubular secretion

151
Q

Incidence of infection complication.

A

1-5% (Increase hospital stay = $1.6M)

152
Q

Isoniazid is given with ______ to prevent peripheral neuropathy and anemia.

A

Vit B6 (Pyridoxine) INH promotes excretion of Vit B6

153
Q

Auditory dysfunction related to amino glycosides manifests as (2)

A
  1. Tinnitus 2. Sensation of pressure/ fullness in the ears.
154
Q

These are enzymes produced by bacteria that hydrolyze the beta lactam ring, rendering the molecule ineffective.

A

Beta Lactamase

155
Q

The metabolism of sulfonamide is primarily by ______ by pharmacologically inactive compounds.

A

acetylation in the liver

156
Q

This drugs are used principally to treat uncomplicated UTI caused by E.coli

A

Sulfonamides

157
Q

Side effects of Levaquin (fluoroquinolones) (3)

A
  1. Palpitations, Aflutter 2. CNS distrubance 3. Tendon rupture, muscle pain
158
Q

Side effects of Vancomycin (histamine-release)

A
  1. Redman syndrome (facial and truncal erythema) 2. hypotension

NUR 622: Adv. Pharmacology Lectures (7 decks)

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