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N3540 Pharmacology > Exam 2 - Antibiotics > Flashcards

Exam 2 - Antibiotics Flashcards

1
Q

**-cillin **

Drug Classification?

Example?

A

Penicillin antibiotic

EX: Amoxicillin

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1
Q

cef-, ceph-

Drug Classification?

Example?

A

Cephalosporin antibiotic

Ex: Cefazolin

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1
Q

-cycline

Drug Classification?

Example?

A

Tetracycline antibiotic

EX: Tetracycline

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1
Q

-floxacin

Drug Classification?

Example?

A

Fluoroquinolone antibiotic

EX: Levofloxacin

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1
Q

-thromycin

Drug Classification?

Example?

A

Macrolide antibiotic

EX: Azithromycin

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1
Q

-micin, -mycin

Drug Classification?

Example?

A

Aminoglycoside antibiotic

EX: Gentamicin

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1
Q

-azole

Drug Classification?

Example?

A

Antifungal

EX: Itraconazole

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1
Q

Describe some characteristics of the narrow spectrum antibiotic Penicillin G:

A
  • Routes: IM, IV
  • 3 different salts – potassium Pen G, Procaine Pen G, Benzathine Pen G
  • Distributes well to most tissues and body fluids except the meninges and into fluids of joints and the eye. With inflammation, entry into the CSF, joints and eyes are enhanced.
  • Effective against gas gangrene, tetanus, anthrax, syphillis, pneumonia, meningitis, strep throat, infective carditis
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1
Q
A
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3
Q

Describe some characteristics of the narrow spectrum antibiotic Penicillin V:

A
  • Route: PO
  • Stable in stomach acid
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3
Q

Describe the 1st generation of Cephalosporins

A
  • destroyed by beta-lactamases
    Cefazolin (Ancef)
  • rarely used for active infection
  • As Effective as newer drugs
  • Less expensive
  • Have narrow antimicrobial spectrum
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3
Q

Describe the 2nd generation of Cephalosporins

A
  • rarely used for active infection
  • less sensitive to destruction Cefaclor (Ceclor)
  • most effective against pneumonia caused by h. influenzae, Klebsiella, pneumococci & staphylococci
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4
Q

Describe the 3rd generation of Cephalosporins

A
  • highly resistant to destruction Cefoperazone (Cefobid)
  • Preferred therapy for several infections
  • Highly active against gram-negative organisms
  • Able to penetrate to cerebrospinal fluid (CSF)
  • most effective against meningitis
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6
Q

Describe the 4th generation of Cephalosporins

A
  • most highly resistant to destruction Cefepime (Maxipime)
  • Broad spectrum
  • Penetration to CSF is good
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8
Q

Describe the pharmacokinetics of tetracyclines

A
  • Absorption – short acting, reduced by food, long acting (minocycline) not affected by food.

3 tetracyclines are affected by food:

  • Chelation – tetracyclines form insoluble chelates with Ca++
  • Avoid calcium supplements, milk products, iron supplements, magnesium-containing laxatives & antacids, zinc
  • Should be taken on empty stomach: Give 2 h before or 2 h after chelating agents
  • Elimination - by kidneys & liver; tetracycline & demeclocycline by kidneys*
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9
Q

Erythromycin is used as a durg of choice for what type of infections?

A
  • Upper & lower respiratory tract infections
  • Acute otitis media (AOM)
  • GI infections
  • Mycobacterium avium complex (MAC) infections in pts. with advanced HIV infection
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11
Q

How do microbes become resistant to Tetracyclines?

A

They become resistant from increased drug inactivation, decreased access to ribosomes (d/t presence of ribosome protection proteins), & reduced intracellular accumulation (d/t decreased uptake & increased export)

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12
Q

How must procaine and benzathine Penicillin G salts be administered to a patient?

A

intramuscularly

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13
Q

How would you give Ampicillin or Amoxicillin, broad spectrum penicillins, and what are some of their effects on the body?

A

Delivery:

  • Ampicillin – IV, PO
    • Ampicillin/sulbactam (Unasyn)
  • Amoxicillin – PO
    • Amoxicillin/clavulanic acid (Augmentin)

Side effects:

  • Rash and diarrhea (most with ampicillin)
  • Nursing teaching: Refrigerate oral suspensions
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15
Q

If a patient is allergic to Penicillin, why would the nurse be uneasy about administering cephalosporin’s or carbapenems to this patient?

A

Because 5-10% of people who are allergic to penicillin will also have a cross-sensitivity with cephalosporin’s or carbapenems.

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16
Q

Lab results for Mrs. Smith, the patient, came in and it was found that her urinary tract was infected by a bacteria that produces beta-lactamase. The doctor on staff ordered 500mg of Ampicillin IM every 6 hours to treat the infection. What should the nurse assigned to Mrs. Smith do when she receives this order?

A
  • The nurse should know that Ampicillin & Amoxicillin are both inactivated by beta-
    lactamases, and would thus be non-effective against the bacteria. The nurse should notify the doctor.
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18
Q

Nafcillin, Oxacillin, Dicloxacillin & Methicillin are narrow spectrum PCNase resistance antibiotics from the penicillin class of drugs. What are some characteristics of these antibiotics?

A
  • Highly resistant to beta-lactamases
  • Very narrow spectrum against penicillinase producing staphylococci (s. aureus & s. epidermidis)
  • Methicillin – No longer avail. Causes interstitial nephritis (MSRA use Vancomycin
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19
Q

Resistance to PCN occurs in what 3 ways?

A
  1. Inability of PCN to reach their targets
  2. Inactivation of PCN by bacterial enzymes
  3. Production of penicillin-binding proteins (PBPs) that have a low affinity for penicillins
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20
Q

increThe nurse was given an order to administer 1 unit of Potassium Penicillin G IM to Patient X. Before administering the dose to the patient, the nurse should immediately realize what?

A

The nurse should know that Potassium Penicillin G can only be administered via IV and should not adminster the antibiotic.

21
Q

What are beta-lactamases and what do they do?

A
  • Beta-Lactamases cleave to beta-lactam rings & if specific to PCN’s they are called pencillinases.
    • Gram-neg (Gm -) produce PCNase in small amounts and secrete them into the periplasmic space
    • Gram-pos (Gm+) produce PCNase in large amounts and export it into the surrounding medium
21
Q

What 3 drugs can be used as alternatives to PCN if someone is allergic to PCN?

A
  1. Erythromycin
  2. clindamycin
  3. vancomycin
  • If previous mild allergic reaction to PCN, can be given cephalosporin -preferably oral dosing
  • If past anaphylaxis reaction to PCN- avoid both PCN and cephalosporins
22
Q

What are examples of Macrolides and what are some of their characteristics?

A
  • Examples: Erythromycin, Clarithromycin, Azithromycin (-mycins)
  • Broad-spectrum antibiotic (active against most gram-positive and some gram-negative bacteria)
  • Usually bacteriostatic but can be bactericidal
  • Similar to PCN (kills gm+ & some gm- & mycobacteria)
  • Can use if allergic to PCN
23
Q

What are some adverse effects of Vancomycin?

A
  • Nephrotoxicity – major toxicity is renal failure – risk is dose-related and increased by use of other nephrotoxic drugs (aminoglycosides, cyclosporine, NSAIDs, etc.)
  • Ototoxicity (reversible or permanent [if exceed 30mcg/ml])
  • Red man syndrome — flushing, rash, pruritus, urticaria, tachycardia, hypotension
  • Thrombophlebitis (common)
  • Thrombocytopenia (rare)
  • Allergy
  • Narrow antimicrobial spectrum
24
Q

What are some characteristics of Carbapenems?

A
  • Beta-lactam antibiotic with an extremely broad antimicrobial spectrum & low toxicity
  • Use is generally restricted to severe infections largely in hospitalized patients
  • Not active against methicillin-resistant Staphylococcus aureus (MRSA)
  • this drug is administered IV
26
Q

What are some characteristics of penicillins?

A
  • Active against a variety of bacteria
  • Bactericidal
  • Direct toxicity: low – one of the safest abx
  • Beta-lactam ring in their structure is what causes allergic reactions in people.
  • Beta-lactam family: also includes cephalosporins, aztreonam, imipenem, meropenem, and ertapenem
  • PCN eliminated by kidneys
    • Renal impariment can lead to toxic levels
  • High concentration PCN can inactivate aminoglycosides (example gentamicin)
28
Q

What are some characteristics of the Broad spectrum penicillins (Aminopenicillins)?

A
  • Ampicillin & Amoxicillin – both inactivated by beta-lactamases
  • Same spectrum as Pen G (narrow spectrum) but also active against more gm- (h. influenzae, e. coli, Salmonella & Shigella)
30
Q

What are some characteristics of narrow spectrum Penicillin drugs?

A
  • PCNase sensitive
  • Bactericidal to numerous gram-positive and some gram-negative organisms
31
Q

What are some characteristics of Cephalosporins?

A
  • Most widely used group of antibiotics
  • Are beta-lactam antibiotics – similar to PCNs MOA
  • Similar to penicillin structure
  • Bactericidal
  • Usually given parenterally
  • Toxicity is low
  • 4 generations
  • Susceptible to Beta-lactamases
32
Q

What are some characteristics of Clarithromycin?

A
  • gen’l same as erythromycin
  • Available in tablets, ER tabs (Biaxin XL) & granules)
    ER take with food others with or without
  • USED TO TREAT: Respiratory tract inf., uncomplicated skin inf., H. pylori, Mycobacterium avium in HIV inf.
  • Adverse reactions: Metallic taste, cardiac arrhythmias
33
Q

What are some characteristics of Extended Spectrum PCN’s (Antipseudomonals)?

A
  • susceptible to beta-lactamases and therefore ineffective against S. aureus
  • Used against P. aeruginosa, often occurring in immunocompromised pts
  • both can cause bleeding from disrupting platelet function
  • both can cause sodium overload (more for ticarcillin)
  • do NOT mix PCNs w/ aminoglycosides in the same IV solution b/c PCNs can inactivate aminoglycoside
35
Q

What are some drug interactions with cephalosporins?

A
  • Probenecid – delays renal excretion
  • Alcohol – cephazolin, cefmetazole, cefoperazone & cefotetan
  • Drugs that promote bleeding – cefmetazole, cefoperazone & cefotetan (check prothrombin time)
  • Calcium and ceftriaxone combo
36
Q

List and describe the 2 narrow spectrum Penicillins that are PCNase sensitive?

A
  1. PCN G (IM, IV)
  2. PCN V (PO)
37
Q

What are the 3 mechanisms of bacterial destruction?

A
  1. Cell wall disruption -
  2. Enzymatic inhibition
  3. Protein synthesis disruption
38
Q

What are the 4 members of the tetracycline family?

A
  1. Tetracycline – short-acting
  2. Demeclocycline – intermediate-acting
  3. Doxycycline – long acting
  4. Minocycline – long acting
  • All similar in strux, abx actions, and AEs
  • Different pharmocokinetics
39
Q

What are the 5 narrow spectrum penicillins that are PCNase resistant & antistaphyloccocal?

A
  1. Methicillin
  2. Nafcillin
  3. Oxacillin
  4. cloxacillin
  5. dicloxacillin
40
Q

What are the 6 Extended-spectrum penicillins (antipseudomonal PCN’s)?

A
  1. carbenicillin (PO)
  2. ticarcillin (IV)
  3. mezlocillin
  4. Piperacillin
  5. Ticarcillin/clavulanate (IV)
  6. Piperacillin/tazobactam (IV)
41
Q

What are the adverse affects of tetracyclines?

A
  • Gastrointestinal irritation – burning, cramps, N&V, diarrhea
  • Effects on bone and teeth – bind to Ca++ in developing permanent teeth (4mos – 8 yo) resulting in yellow/brown discoloration
  • Suprainfection – issues with all broad spectrum ab. DIARRHEA*
  • C. difficile a.k.a. antibiotic-associated pseudomembranous colitis Renal toxicity – tetracycline & demeclocycline elim by kidneys
  • Photosensitivity
  • High-dose IV therapy associated w/ severe liver damage esp. pregnant & postpartum women with kidney ds
42
Q

What are the adverse effects of televancin?

A
  • taste disturbance, nausea, vomiting, foamy urine
  • Red man syndrome
  • Kidney damage – measure function at baseline, q 72 hrs during tx, and at end of tx
  • Prolong QT interval
43
Q

What are the adverse effects of Cephalosporins?

A
  • Allergic rxns – hypersensitivity rxns (maculopapular rash, days after onset of tx is most common); severe rxns are rare
  • Bleeding – cefmetazole, cefoperazone, cefotetan, & ceftriazone
  • Thrombophlebitis - phlebitis
  • Hemolytic anemia [antibodies (Abs) mediate destruction of RBCs] - rarely
44
Q

What are the characteristics of Narrow spectrum, PCNase resistant antibiotics.

A

Nafcillin, Oxacillin, Diloxacillin & Methillin

  • Highly resistant to beta-lactamases
  • Very narrow spectrum against penicillinase producing staphylococci.
  • Methicillin is no longer avaliable. Causes interstitial nephritis.
45
Q

What are the four methods microbes use for drug resistance?

A
  1. Decrease the concentration of a drug at its site of action
  2. Alter drug target molecules (receptors)
  3. Produce drug
  4. Drug inactivation
46
Q

What are the mechanisms of action of Carbapenems?

A
  • Binds to 2 PBPs (PBP1 & PBP2) weakening cell wall causing lysis & death
  • Resistant to almost all beta-lactamases & has ability to penetrate gm- microbes
  • Elimination – primarily renal
  • Interaction with Valproate – can reduce blood levels of valproate (used to control seizures)
47
Q

What are the nursing interventions when administering Vancomycin?

A
  • Monitor serum drug levels – check peak and trough levels
  • Dosage should be adjusted to achieve effective TROUGH serum levels
48
Q

What are the pharmacokinetics of Cephalosporins?

A
  • Almost all renally excreted – except ceftriazone (liver)
  • 5-10% cross resistance with PCN
  • Dose usually based on duration of action (DOA)
  • Refrigerate oral suspension
49
Q

What are the uses of Vancomycin?

A
  • Drug of choice for MRSA: Methicillin-resistant Staphylococcus aureus or Staphylococcus epidermidis (most strains are still sensitive to vanc
  • Severe infections only – severe Clostridium difficile (C. diff) infection (CDI) [oral dosing – vanc not absorbed from GI tract*
    • Oral dose used for C. diff if metronidazole was tried and found ineffective
50
Q

What are the 5 broad spectrum pencillins ((aminopenicillins)?

A
  1. ampicillin (PO, IV)
  2. amoxicillin (PO)
  3. bacampicillin
  4. Ampicillin/sublactam
  5. Amoxicillin/clavulanate
51
Q

What are the 7 major specific MOAs for anti-infectives?

A
  1. Disrupt the cell wall or activate enzymes that disrupt the cell wall
  2. Increase cell wall permeability
  3. Lethal inhibition of protein synthesis
  4. nonlethal inhibition of protein synthesis
  5. Inhibit DNA or RNA synthesis or disrupt DNA function
  6. Antimetabolites
  7. suppress viral replication
52
Q

What are Tetracyclines method of action?

A
  • Inhibit bacterial synthesis* which suppresses cell growth & replication but are only bacteriostatic. These are mostly 2nd line agents when infections are resistant to 1st line agents.
  • Selective toxicity to microbes*
53
Q

What does Vancomycin do?

A
  • Inhibits cell wall synthesis by binding to molecules that serve as precursors for cell wall synthesis (not PBPs)
  • ONLY active against gm+ bacteria
  • NO beta-lactam ring – so can use on pts allergic to PCNs*
  • Eliminated by kidney*
55
Q

What is the mechanism of action for Macrolides?

A

inhibition of protein synthesis (50S ribosomal subunit)*

56
Q

What are the mechanism of action for Cephalosporins?

A
  • Bind to penicillin-binding proteins (PBPs), disrupt cell wall synthesis, and cause cell lysis
  • Most effective against cells undergoing active growth and division
57
Q

What is the MOA of penicillin?

A
  • Weaken cell wall which causes cell wall to take up excessive water & rupture through activation of autolysins and inhibition of transpeptidases
    • Only effective against cells that are undergoing growth and division
    • Most effective against gram positive bacteria
58
Q

What problem could a Calcium and ceftriaxone combo cause in a neonate?

A
  • This can form fatal precipitates (solids that fall out in sol’n) in lungs & kidneys
  • Don’t give through the same line OR different lines unless 48 hours between them
  • In pts other than neonates IV cephtriaxone and Ca++ may be administered through the same line sequentially (not at the same time), but must flush between sol’ns
59
Q

With each new generation of Cephalosporins what 3 things are noticed?

A
  1. Increasing activity against gm- bacteria
  2. Increasing resistance to beta-lactamases
  3. Increasing ability to reach the cerebral spinal fluid (CSF)

N3540 Pharmacology (5 decks)

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