Exam 2 Review Flashcards
What are the key considerations when approaching treatment for infections?
- Is this an infection?
- What is the site of infection?
- What are the most likely pathogens?
- What are the options for treatment?
- What makes the patient unique?
Patient uniqueness includes factors like age, co-morbidities, pregnancy, etc.
What is an antibiogram?
A report that shows the susceptibility of bacteria to various antibiotics
It is used to guide appropriate antibiotic selection.
Which antibiotics inhibit cell wall synthesis?
- Beta-lactams
- Vancomycin
These antibiotics target the bacterial cell wall, disrupting its synthesis.
What are the types of beta-lactam antibiotics?
- Penicillins
- Cephalosporins
- Carbapenems
- Monobactams
These groups of antibiotics share a common beta-lactam structure.
What is the mechanism of action of clavulanic acid?
Inhibits beta-lactamases, broadening spectrum of coverage and reducing resistance
Clavulanic acid is often combined with penicillin to enhance effectiveness against resistant bacteria.
What is the mechanism of action of penicillin?
Bactericidal; inhibits cell wall synthesis
This mechanism is crucial for its effectiveness against bacterial infections.
Name a few drugs that are important to know for penicillin.
- Amoxicillin
- Penicillin VK
- Amoxicillin-clavulanate (Augmentin)
What is the safest antibiotic in pregnancy?
Penicillin, if appropriate for the type of infection and the patient is not allergic
It is considered the best choice for treating infections in pregnant patients.
What should be done if a patient develops a rash to penicillins?
Examine to ensure it’s an allergic reaction; rash could be due to other causes
Many viruses can cause rashes, so it’s important to differentiate between an allergic rash and other types.
If a patient is allergic to penicillins, what can they take?
Cephalosporins, unless they have anaphylaxis from a -cillin
Anaphylaxis indicates that cephalosporins should also be avoided.
Which first generation cephalosporins provide the best gram-positive coverage?
Cephalexin and cephazolin
These drugs are effective against staphylococci and streptococci.
What happens to gram-negative coverage as you increase from one generation of cephalosporins to the next?
You gain gram-negative coverage but lose gram-positive coverage
This shift is important for understanding the appropriateness of cephalosporins for various infections.
What is the route for many of the fourth-generation cephalosporins?
IV only and are given in the hospital
Their administration route reflects the severity of infections they treat.
What type of antibiotic is vancomycin?
Glycopeptide antibiotic with wide spectrum of gram-positive coverage
It is particularly important for treating serious infections like MRSA.
How is vancomycin administered for C. diff infections?
Orally
Despite being poorly absorbed, oral administration is effective for this specific indication.
How is vancomycin administered for serious staph infections?
IV
This method is used for treating life-threatening infections caused by resistant staphylococci.
Which antibiotics block protein production?
Macrolides, tetracyclines, clindamycin
Name three macrolide antibiotics.
Erythromycin, azithromycin, clarithromycin
What is a common brand name for azithromycin?
Z pack
What is the spectrum of coverage for macrolides?
Gram positive (pneumococci, strep, staph)
Gram negative (H. Influenzae)
atypical bacteria (M. Pneumoniae)
What are some adverse effects of macrolides?
Cardiac arrhythmias
What is a significant risk associated with macrolides?
QT prolongation
What are the risk factors for QT prolongation? (6)
Electrolyte imbalances
Meds
Female
Heart conditions
Age (older people)
Genetics
Why is erythromycin rarely used?
Frequently causes diarrhea and cramping
What gastrointestinal effects are associated with erythromycin?
Diarrhea and cramping
What are the names of the drugs listed in the review for tetracyclines?
Tetracycline, doxycycline, minocycline
What is the spectrum of coverage for tetracyclines?
Gram positive, gram negative, atypical bacteria, rickettsiae
Which disease is treated with tetracyclines in addition to those listed in the exam review?
Lyme disease
Which patients cannot take tetracyclines and why?
- Pregnant women
- Children under 8
- Can affect tooth enamel or impair bone growth
What is a common adverse effect of tetracyclines?
Photosensitivity
What should patients be educated about regarding photosensitivity when using tetracyclines?
To avoid sun exposure
Why should tetracyclines not be given within two hours of antacids?
Due to calcium content
What is the most important adverse effect associated with clindamycin?
Clostridium difficile colitis
What is the mechanism of action (MOA) of clindamycin?
Similar to macrolides due to overlapping receptors
What percentage of patients may develop C. diff when taking clindamycin according to a 2023 study?
Up to 6.6%
What symptoms should patients be monitored for when prescribed clindamycin?
Loose, watery stool
What do all antibiotics that target DNA and replication generally do?
Inhibit enzymes involved in DNA synthesis
Important to know mechanisms for quinolones and sulfa drugs
What are the three main categories of antibiotics that target DNA and replication?
- Sulfa drugs
- Fluoroquinolones
- Metronidazole
What is the common use of Trimethoprim-sulfamethoxazole (TMP-SMX)?
Often used for UTI and skin infection
TMP-SMX is not really used individually
What spectrum of coverage does Bactrim provide?
- Gram positive
- Gram negative
- MRSA
What should you remember about Bactrim’s coverage?
Covers MRSA
Important for understanding its clinical use
What is the mechanism of action for sulfa drugs?
Inhibits folic acid synthesis → essential for bacterial DNA replication
Name the most common fluoroquinolones.
- Levofloxacin (Levaquin)
- Ciprofloxacin (Cipro)
- Ofloxacin (Floxin)
What is the spectrum of coverage for fluoroquinolones?
Excellent gram-negative coverage, moderate gram-positive coverage, and atypical bacteria
Which fluoroquinolone is more effective against gram positive bacteria?
Levofloxacin
Which fluoroquinolone is more effective against gram negative bacteria?
Ciprofloxacin
What should you focus on while studying fluoroquinolones?
- Mechanism of action
- Adverse effects
What is a high risk associated with fluoroquinolones?
Tendon rupture
In which patients is the risk of tendon rupture from use of fluoroquinolones more common? (3)
- Elderly patients
- Patients on prednisone
- Young runners
Other than tendon rupture, what is another potential adverse effect of fluoroquinolones?
QT prolongation
In which populations should fluoroquinolones not be used?
- Children
- Pregnant women
When should fluoroquinolones be used?
In resistant situations when other drugs have been tried or when the patient is allergic to other antibiotics
Why should fluoroquinolones be used sparingly?
Due to their adverse effects
What organisms are fluoroquinolones effective against?
- Multi-drug resistant organisms
- Pseudomonas (gram-)
- Enterobacter (gram-)
When should fluoroquinolones be reserved?
For serious infections or when other more suitable antibiotics cannot be used
What are the basic principles for treating tuberculosis?
Must use multiple drugs to which Mycobacterium tuberculosis is susceptible, drugs must be taken regularly (every day), drugs must be taken long enough to resolve the illness (9 months)
Name one antitubercular drug.
Isoniazid (INH)
What is the mechanism of action of Isoniazid?
Inhibits bacterial cell wall synthesis
What are the adverse effects of Isoniazid?
Liver toxicity, peripheral neuropathy
What can patients take to help avoid peripheral neuropathy with Isoniazid?
Vitamin B6
What is the mechanism of action of Ethambutol?
Inhibits bacterial cell wall synthesis
What is an adverse effect of Ethambutol?
Optic neuritis
What are the symptoms of optic neuritis? (3)
Blurred vision, decreased peripheral vision, color blindness
What should patients be taught to do if they experience symptoms of optic neuritis?
Report these symptoms immediately
What is the mechanism of action of Rifampin?
Blocks bacterial protein production
What is a notable characteristic of Rifampin regarding drug interactions?
Multiple drug-drug interactions
What are some adverse effects of Rifampin?
Nausea/vomiting, red-orange discoloration of urine, saliva, tears
What should patients who wear contact lenses know about Rifampin?
It will permanently stain their contacts; they will need to wear glasses
What is a key factor that increases the risk for microbial resistance?
Overuse of antibiotics
Overuse of antibiotics can lead to the development of resistant strains of bacteria.
What is another factor that contributes to microbial resistance?
Inappropriate prescription of antibiotics
Prescribing antibiotics when they are not needed or using the wrong type can promote resistance.
What is a risk factor for microbial resistance related to medication levels?
Low dose and inadequate levels leading to sub-inhibitory exposure
Inadequate dosing can allow bacteria to survive and develop resistance.
What living conditions can increase the risk of microbial resistance?
Day care and crowded living
Crowded environments can facilitate the spread of resistant bacteria.
What is the first mechanism of microbial resistance?
Decreased permeability/Limiting drug uptake
Bacteria can limit the entry of antibiotics through porin channels.
What is the second mechanism of microbial resistance?
Antibiotic efflux pump
Active pumps can expel antibiotics from bacterial cells, reducing their effectiveness.
What is the third mechanism of microbial resistance?
Drug inactivation
Enzymes may destroy antibiotics or prevent them from binding to their target sites.
What is the fourth mechanism of microbial resistance?
Altered target site
Changes in binding proteins on bacterial surfaces can prevent antibiotics from binding effectively.
What are the two classes of antiviral drugs discussed?
Neuraminidase inhibitors and Nucleoside Analogs
What are the names of the neuraminidase inhibitors?
Oseltamivir (Tamiflu) and Zanamivir (Relenza)
How is Oseltamivir administered?
Well absorbed orally
How is Zanamivir administered?
Via inhalation
What is the mechanism of action for neuraminidase inhibitors?
Act by breaking the bond that attaches the viral particles to the host cell
What are the indications for using neuraminidase inhibitors?
Prophylaxis and treatment for influenza A and B
Who are the ideal candidates for neuraminidase inhibitors?
People with comorbidities
What are common adverse effects of neuraminidase inhibitors?
Headache (HA), Nausea/Vomiting (N/V), CNS effects
When should neuraminidase inhibitors be started for maximum effectiveness?
Within 72 hours of symptom onset
What is a current concern regarding Tamiflu?
A lot of Tamiflu resistance right now
What are the names of the nucleoside analogs?
Acyclovir (Zovirax), Valacyclovir (Valtrex), Famciclovir (Famvir)
How often must Acyclovir be taken?
5 times a day
Which nucleoside analog is the most effective?
Valacyclovir (Valtrex)
What advantage does Valacyclovir have over Acyclovir?
Achieves higher serum levels and penetration
What is the mechanism of action for nucleoside analogs?
Blocks an enzyme essential for viral replication
What are common adverse effects of nucleoside analogs?
Headache (HA), Nausea/Vomiting (N/V)
What are the indications for using nucleoside analogs?
Herpes simplex (genitals or mouth) and varicella zoster (Shingles)
When should nucleoside analogs be started for maximum effectiveness?
Within 72 hours of onset of symptoms
What is a special consideration for prescribing nucleoside analogs for shingles in elderly patients?
Higher risk of developing postherpetic neuralgia after rash goes away
True or False: Nucleoside analogs are effective after 72 hours of symptom onset.
False
What is a key characteristic of antifungal drugs when given orally?
Highly protein bound
This characteristic leads to interactions with many drugs.
What should be monitored during long-term use of antifungal drugs?
Liver function tests (LFTs)
Long-term use is associated with hepatotoxicity.
For how long are antifungals often taken?
3-6 months
What is the primary focus when studying antihelmintic drugs?
Treat parasitic infections caused by worms
What is a common treatment for pinworms in pediatric patients?
Mebendazole or Pyrantel (OTC)
What are some adverse effects of antihelmintic drugs?
- Nausea
- Diarrhea
- Stomach pain
True or False: Antifungal drugs have multiple drug-drug interactions.
True
What are anxiolytics?
Medications used to reduce anxiety
Includes drugs like benzodiazepines and Buspar.
What is the mechanism of action (MOA) of benzodiazepines?
Act at GABA receptors to increase GABA action
This decreases neuronal excitation and firing.
List four common benzodiazepines.
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Temazepam (Restoril)
- Clonazepam (Klonopin)
What are the indications for benzodiazepines?
- Reduction in anxiety
- Muscle relaxation
- Ataxia
- Anticonvulsant activity
True or False: Benzodiazepines are usually used alone for anticonvulsant activity.
False
They are usually used in combination with another anticonvulsant.
What is Buspar commonly used for?
Treatment of Generalized Anxiety Disorder (GAD)
Sometimes referred to as an atypical anxiolytic.
What type of receptor does Buspar primarily act on?
Serotonin-1A (5-HT1A) receptor
It is a full agonist at this receptor.
Fill in the blank: Buspar also has action at the _______ receptor.
dopamine
How should Buspar be taken to decrease the first-pass effect?
With food
What is the half-life and onset of action of Buspar?
Short half-life; slow onset of action
What are antidepressants?
Medications used to treat depression and other mental health disorders
Antidepressants can include various classes such as SSRIs and SNRIs.
What are SSRIs and their mechanism of action?
Selective Serotonin Reuptake Inhibitors; they act at the Serotonin receptor
SSRIs increase serotonin availability in the synaptic cleft.
What should you focus on as you study SSRIs?
Know indication, MOA, side effects, patient education
Indications include major depressive disorder, generalized anxiety disorder, etc.
Name a few SSRIs.
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Citalopram (Celexa)
- Escitalopram
What are common adverse effects of SSRIs?
- Nausea
- Dry mouth
- Headache
- Sexual side effects
What patient education is important when prescribing SSRIs?
- Nausea improves over time; try to tolerate it
- Take medication at the same time every day
- Inform about possible adverse effects
- Expect symptom improvement in about 2 weeks
What are symptoms of serotonin syndrome?
Symptoms can include confusion, rapid heart rate, and high blood pressure
Serotonin syndrome can be life-threatening and requires immediate medical attention.
What is a drug-drug interaction concern with SSRIs?
Interaction with linezolid (Zyvox)
Linezolid is an antibiotic that can cause serotonin syndrome when combined with SSRIs.
What are the indications for SSRIs? (5)
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Panic disorder
What is the mechanism of action of SNRIs?
They block serotonin and norepinephrine transporters, inhibiting reuptake
SNRIs increase the levels of both serotonin and norepinephrine in the brain.
Name a few SNRIs.
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
How does venlafaxine primarily affect neurotransmitter reuptake at lower doses?
It predominantly affects serotonin reuptake
At higher doses, venlafaxine also affects norepinephrine reuptake.
Which patients should avoid taking SNRIs?
Patients with uncontrolled hypertension or those who are sensitive to serotonin and norepinephrine levels
Caution is advised in patients with a history of cardiovascular issues.
What are tricyclic antidepressants primarily used for?
They are used to treat depression but are not prescribed as much.
What is the mechanism of action for tricyclic antidepressants?
They inhibit the reuptake of serotonin and norepinephrine at the presynaptic neuron and also act on histamine and acetylcholine.
List contraindications for prescribing tricyclic antidepressants.
- Patients with CV disease
- Uncontrolled epilepsy
- Urinary retention
- Angle-closure glaucoma
True or False: Patients can overdose on tricyclic antidepressants.
True
What should you avoid when prescribing tricyclic antidepressants?
Do not give anyone at risk for suicide a TCA.
What is the mechanism of action for bupropion (Wellbutrin)?
It is a norepinephrine-dopamine reuptake inhibitor.
What are the contraindications for bupropion?
- Patients with seizure disorders or conditions that increase the risk of seizures
- Angle-closure glaucoma
What additional benefit does bupropion provide?
Can help people stop smoking.
What is a key characteristic of carbamazepine (Tegretol) regarding its metabolism?
It is completely metabolized and induces its own metabolism, leading to increased clearance and shortened half-life.
What effect does carbamazepine have on neuronal firing? Which type of channel is affected?
It inhibits neuronal firing by blocking sodium channels.
What types of seizures is carbamazepine most effective against?
Partial seizures.
What is the binding characteristic of carbamazepine in the body?
It is highly bound to plasma proteins.
List common side effects of carbamazepine.
- Drowsiness
- Headaches
- GI distress
What are less common side effects of carbamazepine?
- Cardiac arrhythmias
- Blurred or double vision
- Decreased blood cells or platelets
- Aplastic anemia (rare)
Fill in the blank: Bupropion weakly inhibits the uptake of _______ and _______.
[Norepinephrine] and [Dopamine]
What is the primary action of Gabapentin (Neurontin)?
Inhibits the release of excitatory neurotransmitters in the presynaptic area to decrease seizure activity
Gabapentin is primarily used in the treatment of seizures.
List the medical conditions Gabapentin is used to treat.
- Seizures
- Restless legs syndrome
- Postherpetic neuralgia
- Neuropathic pain
- Off-label uses (mostly pain)
Gabapentin has various applications beyond its primary indications.
What should be monitored in patients taking seizure medications like Gabapentin?
Monitor patients for psychiatric side effects
Patients on any seizure medications must be monitored for potential psychiatric effects.
What are some adverse effects of Gabapentin?
- Depression
- Suicidal thoughts/behaviors
- Nausea/Vomiting
- Somnolence
- Dizziness
- Dry mouth
Adverse effects can be significant and require monitoring.
What is a key focus area for patient education regarding Levetiracetam (Keppra)?
Understanding the medication and its effects is crucial for patient compliance.
What should be a focus area regarding side effects of Levetiracetam (Keppra)?
Side effects
Awareness of side effects can help in managing patient care.
What are the symptoms of toxicity associated with Lithium?
Coarse tremors of the hands that impair function
N/V
Diarrhea
Confusion
Stupor
Polydipsia/Polyuria
Muscle weakness
Ataxia
What happens if a Lithium patient gets out in the sun, sweats, and loses sodium?
Increased risk of toxicity
Sodium loss can lead to elevated Lithium levels, increasing toxicity risk.
