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Thompson class fall 2015 > Exam 2: Week 8 Wednesday- Antibacterials > Flashcards

Exam 2: Week 8 Wednesday- Antibacterials Flashcards

1
Q

What are two ways nitroglycerin might be used?

A

Acute: for acute angina

Slow Release or Extended Release: long term lower dose to prevent Angina (prophetically)

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2
Q

In diabetic neuropathy: even if it is not specifically painful neuropathy, can a medication for neuralgia help?

A

Yes.

They are being increasingly used because they help some people with sensory issues.

For example, Gabapentin.

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3
Q

what is a good question to ask someone when you get their medication list?

A

Are you currently taking all of these medications?

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4
Q

What are some good goals for someone with a wound?

A
  1. reduce swelling
  2. decrease the size of the wound
  3. Eliminate infection
  4. Patient education (big!)
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5
Q

INR stands for

A

International Normalized Ratio From

WIkipedia: The INR is typically used to monitor patients on warfarin or related oral anticoagulant therapy. The normal range for a healthy person not using warfarin is 0.8–1.2, and for people on warfarin therapy an INR of 2.0–3.0 is usually targeted, although the target INR may be higher in particular situations, such as for those with a mechanical heart valve. If the INR is outside the target range, a high INR indicates a higher risk of bleeding, while a low INR suggests a higher risk of developing a clot. (https://en.wikipedia.org/wiki/Prothrombin_time#International_normalized_ratio)

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6
Q

How long do you have to communicate with an MD when you have a concern?

A

About 30 seconds

Give them concrete information (vitals and numbers around concern)

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7
Q

Precautions for someone whose blood is thin.

A

Be careful not to hurt yourself

Maybe just stay here until we find out what the MD wants you to do.

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8
Q

What is Selective Toxicity?

A

Selective toxicity – kill or attenuate the growth of the pathogen without excessive damage to the host

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9
Q

True/False: Bacteria are incapable of independent life. They must take over a cell structure to reproduce.

A

False

  • ~Bacteria are structurally capable of independent life, but need a nourishing host
  • ~Viruses must take over a cell for reproduction
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10
Q

What does broad spectrum refer to in antibiotics

A

Broad spectrum – how many different bacteria will the drug affect (broad spectrum would be many different bacteria)

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11
Q

What is the difference between the terms “Bactericidal” and “Bacteriostatic”?

A

Bactericidal – kills

bacteriostatic – limits growth and proliferation

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12
Q

What are the most common adverse effects of antibiotics?

A

Most common adverse effects of antibiotics – GI upsets (Nausea, Vomiting, Diarrhea)

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13
Q

Explain some points about human exposure to disease

A
  • Humans are continually exposed to disease
  • Infections are common and always evolving (Ebola)
    • There is a continual struggle to keep antibiotics ahead of microbe mutations
  • Some are becoming more common nosocomial (originatinating in the hospital) as well as community
  • MRSA, VRE, multidrug resistant TB, Clostridium difficile (C-diff)
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14
Q

What were some of the first drugs to limit damage from bacterial infections in 1950s-1980s?

A

Sulfa drugs, penicillins, and antibiotics- 1950’s to 1980’s limited damage from bacterial infections

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15
Q

What are three diseases that were limited or eliminated by vaccinations?

A

Immunizations- limited or eliminated measles, mumps, rubella, poliomyelitis

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16
Q

What were some new infectious agengents that developed in the 1970s and 1980s?

A

New infectious agents- 1970’s and 1980’s- legionella, HIV, antibiotic-resistant organisms, Avian flu, Ebola

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17
Q

What are some microbes suspected as predisposing individuals to?

A

Some microbes are suspected as predisposing individuals to chronic disorders like heart disease, mental illness (Dementia, Alzheimer’s disease), autoimmune disorders

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18
Q

what are 4 resistant nosocromial infections?

A
  1. •MRSA,
  2. VRE,
  3. multidrug resistant TB,
  4. Clostridium difficile (C-diff)
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19
Q

What is an infection?

A

•Infection- Process in which an organism establishes a parasitic relationship with the host

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20
Q

What produces an immune response?

A

•Immune response- Produced by invasion and multiplication of an organism

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21
Q

what are three factors that must be present for the developement of an infection?

A
  1. Transmission
  2. Proper environment
  3. Susceptibility of the host
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22
Q

What is the 102 degree F Rule?

A
  • Someone who has infection with fever below 102 will look quite different from those with fever above 102
    • Older people may be an exception

Some Details and rationale:

Some people with serious infection may not develop fever initially, but may become tachypneic, confused, or hypotensive

In aging adults – impaired thermoregulatory system may mask fever; temp or 99-100°F may be sufficient to cause alarm

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23
Q

True or False: microorganisms colonization is present in many people’s tissue but it does not create necessarily have signs and symptoms of systemic disease

A

True

Person is therefore carrier and transmitter

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24
Q

True or False: Colonization and infection are the same thing

A

False.

They are very different.

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25
Q

Time frames for Infection (3)

A
  1. Incubation period- time from invasion to signs and symptoms (Ebola 2 to 21 days)
  2. Latent period- microorganism has replicated but lay dormant (TB, herpes zoster)
  3. Period of communicability- time after latency when symptoms or transmission can occur (Ebola after symptoms occur in humans)
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26
Q

What is communicable disease?

A

any disease where the causative agent can be passed directly or indirectly

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27
Q

Signs/Symptoms of Infectious Disease (6)

A
  • Abscess – leukocytes wall off the invader – if necrosis progresses, abscess deepens (we may not be able to see or palpate it)
  • If not obvious (i.e., internal), may present as pain, limp, lump – abdominal abscess, pelvic inflammatory disease, tuberculosis of the spine may form abscess between posterior peritoneum and psoas/iliac fascia, presenting as hip pain
  • Rash, macropapuler eruptions (measles, mumps), vesicubullous eruptions (herpes zoster p. 405), petechial or purpuric eruptions (Epstein-Barr)
  • Red streaks (blood poisoning)- person may be marked up to see if line is moving n positive or negative direction
  • Inflamed lymph nodes
  • Joint effusion
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28
Q

Most common early symptoms of infectious disease

A
  • fever
  • chills
  • malaise
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29
Q

Symptoms of infectious disease in integumentary system

A
  • purulent drainage from abscess, wound, or lesion
  • skin, rash, red streaks
  • bleeding from gums or into joints; joint effusion or erythema
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30
Q

Symptoms of infectious disease in cardiovascular system

A
  • petechial lesions
  • tachycardia
  • hypotension
  • change in pulse rate
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31
Q

Symptoms of infectious disease in CNS

A
  • altered level of consciousness, confusion, and seizures
  • headache
  • photophobia
  • memory loss
  • stiff neck, myalgia
32
Q

Symptoms of infectious disease in GI system

A
  • nausea
  • vomitting
  • diarrhea
33
Q

Symptoms of infectious disease in Genitourinary system

A
  • dysuria or flank pain
  • hematuria
  • oliguria
  • urgency, frequency
34
Q

Symptoms of infectious disease in upper respiratory system

A
  • tachypnea
  • cough
  • dyspnea
  • hoarseness
  • sore throat
  • nasal drainage
  • sputum production
  • oxygen desaturation
  • decreased exercise tolerance
  • prolonged ventilatory support
35
Q

The Anatomy Lesson of Dr. Nicolaes Tulp

Rembrandt

1632

A
36
Q

Common lymph node sites

A
  • left and right supraclavicular nodes
  • left and right axillary nodes
  • left and right inguinal nodes
  • retroperitoneal nodes
37
Q

Types of organisms that can invade our bodies and make us feel like crap (8)

A
  1. Viruses
  2. Mycoplasmas
  3. Bacteria
  4. Rickettsiae
  5. Chlamydia
  6. Protozoa
  7. Fungi
  8. Prions
38
Q

Points to note about bacteria

A
  • do not require host
  • single-cell microorganism of many variations - rod, spherical, spiral, gram positive/negative (staining)
  • motility
  • tendency toward capsulation
  • capacity to form spores
  • aerobic, anaerobic
  • specific antibiotic for type
39
Q

Modes and causes of nosocomial infections

A

Modes

  • UTI- catheter
  • Bloodstream infection- IV, wounds
  • Pneumonia- intubation, lack of mobility
  • GI and genitourinary- lack of motility

Causes: Surgical procedures, immunosuppressed, antibiotics, sicker/older patient, caregivers hygiene and amount of exposure, displacement of normal flor

40
Q

Types of Precautions for infection control

A
  • Standard Precautions (All patients)- Bloodborne Pathogen, Gloves and hand washing with body fluid contact, alcohol based products if hands are not visibly soiled
  • Airborne Precautions (TB)- Private negative airflow room, Door to room closed, Respiratory precautions (respirator mask fit tested), Restrict entry to most susceptible, Limit transport and use surgical mask for patient when transport is necessary
  • Droplet precautions (Influenza)- Private room or with like infection, Door can be open, Mask within 3 feet, Limit transport and use surgical mask for patient when transport is necessary
  • Contact precautions (C-diff, MRSA, VRE)- Private room, gown and gloves, dedicate equipment to patient for full stay (single use stethoscope/BP cuff, limit patient transport)
41
Q

Points to note about Clostridium difficile AKA C-diff (5)

A
  • becoming more prevalent due to high rate of antibiotic use in hospitals, est. 228/100,000 persons
  • Fecal-oral transmission, contaminated environment (alcohol-based hand sanitizers not effective)
  • Age and use of H2 reception blockers and proton-pump inhibitors for GERD may increase risk
  • Overgrowth of C. diff occurs when other intestinal flora are destroyed (such as by Clindimycin)
  • Fecal transplants showing great promise; Flagyl (effective against anaerobic bacteria)
42
Q

Staphylococcal Infections (S. aureus, S. epidermis)- 6 points to know

A
  • Hygiene issue
  • Spread by direct contact, multiple predisposing factors (Table 8-6, p. 317in Goodman and Fuller)
  • Infection, suppuration, abscess, infective syndromes
  • Antibiotic effectiveness is problematic
  • Vancomycin for MRSA, VISA (vancomycin intermediate S. aureus), VRSA
  • Daptomycin, Linezolid- new meds for VRSA
43
Q

Group A Streptococci (GAS, S. pyogenes)

A
  • Spread by direct contact or droplets (Table 8-67 p. 319)
  • Includes multiple common diseases- Scarlet fever, some neonatal infections, and necrotizing fascitis
44
Q

Group B Strep (S. agalactiae)

A
  • leading cause of neonatal pneumonia, meningitis, sepsis
  • group B strep is part of normal vaginal flora, found in 30% of women.
  • Pregnant women are checked to see if they are Step B positive.
45
Q

3 treatment options for Gas gangrene (Clostridial Myonecrosis)

A
  1. Debridement and excision of necrotic tissue
  2. IV antibiotics
  3. possible hyperbaric oxygen (HBO) therapy
46
Q

Pseudomonas aeruginosa

A
  • One of the most common hospital and nursing home-acquired pathogens
  • Pathogens found in moist areas, like sinks – also in healthcare workers’ hands, nails (a reason why artificial nails are prohibited)
  • Seen in pneumonias, wounds, UTI, sepsis, chronic lung diseases
  • Contact spread
  • Local infections managed fairly easily; septicemia has a high mortality rate
  • grayish green and smells like dirty gym socks
47
Q

2 specialty MDs who may work together and have advanced training with infectious diseases

A

an infectious disease physician

immunologist/allergist physcian

48
Q

A common side effect of penicilln

A

skin reactions, including Steven Johnson syndrome where skin sloughs off

49
Q

Most Common Causes of Prolnged Fever (Goodman & Snyder Table 8-1; pg 300):

14 Examples of Conditions in which fever generally does not exceed 102* F

(Dr. T did not say to memorize these, I just found this chart that helped me understand the 102* F rule that she mentioned)

A
  1. Catheter-accociated Bacteriuria
  2. Atelectasis
  3. Phlebitis
  4. Pulmonary emboli
  5. Deyhydration
  6. Pancriatitis
  7. Myocardial infarction
  8. Uncoplicated wound infections
  9. Any malignancy
  10. CMV infection (cytomegalovirus)
  11. Hepetitis
  12. EBV infection (Epstein-Barr Virus)
  13. Subacute bacterial endocarditis
  14. Tuberculosis
50
Q

What are Cephalosporins?

What are they used for?

One more thing

A
  • Type of antibiotic (acts on cell membrane synthesis)
  • may be used low dose prophylactically, ex: kids with recurrent ear infections or SCI with recurrent UTIs
  • cross sensitivity with penicillin, but works on same bugs
51
Q

Most Common Causes of Prolnged Fever (Goodman & Snyder Table 8-1; pg 300):

16 Examples of Conditions in which fever regularly exceeds 102* F

(Dr. T did not say to memorize these, I just found this chart that helped me understand the 102* F rule that she mentioned)

A
  1. Malignant hyperthermia (secondary to anestehsia)*
  2. Transfusion reactions
  3. Urosepsis
  4. IV line sepsis
  5. Prosthetic valve endocarditis
  6. Intra-abdominal or pelvic peritonitis or abscess
  7. C. difficile colitis (C-diff)
  8. Procedure-related bacteremia
  9. Nosocomial pneumonia (hospital aquired pneumonia)
  10. Drug fever
  11. HIV infection
  12. Heat stroke
  13. Acute bacerial endocarditis
  14. Tuberculosis (usually disseminated or extrapulmonary)
  15. Lymphoma
  16. Metastasising carcinoma to liver or CNS

*Malignant hyperthermia is disease passed down through families that causes a fast rise in body temperature (fever) and severe muscle contractions when the affected person gets general anesthesia. (Wikipedia)

52
Q

What are Carbapenems?

Negative effects?

A
  • type of antibiotic (act on Cell Membrane Synthesis)
  • CNS abnormalities, especially for patients with pre-existing seizure disorder or if drug dosage is too high
  • can cause dizziness, confusion
53
Q

Antibiotics that work on bactierial cell wall synthesis (2)

Side effects

A
  • topicals- ex: bacitracin. may cause local hypersensitivty
  • Vancomycin- side effects: bitter taste in mouth, hypersensitivity, nephro and ototoxic med (need blood draws to monitor kidney function)
54
Q

What does Nosocomial mean?

A

hospital aquired

55
Q

Points to remember about antibiotics that inhibit bacterial protein synthesis

  • Spectrum?
  • Three negative effects?
  • When is it chosen?
A
  • Very broad spectrum
  • nephrontoxic- liver and kidney failure
  • ototoxic
  • Choice may be chosen due to routine protocol, what is available, cost, physician preference
56
Q

Names of antibiotic that inhibit bacterial protein synthesis and some key points about them.

A
  1. Erythromycin – may be useful in airway infections; must monitor liver function
  2. Tetracycline - good: may have anti-inflammatory, neuroprotective, and immunomodulation effects; bad- photosensitivity, interference with osteoblasts/clasts in bone remodeling, discoloration of teeth, bone, and skin
  3. Chloromycetin – may lead to aplastic anemia, reserved for non-responsive resistant infections
  4. Clindamycin – has a black box warning for C. diff
  5. Ketek – first of new class: ketolide antibacterials – erythromycin derivative. May be useful in bacterial resistance but hepatotoxic
57
Q

drugs in class that inhibit RNA/DNA synthesis include:

A
  • anti-TB
  • anti-leprosy drugs
  • Fluoroquinolones – for resistant strains. Adverse effects: CNS toxicity, photosensitivity, risk of causing tendinopathy, especially for folks who are older or in renal failure – monitor for pain complaints, back off of exercise loading
  • Sulfonamides – photosensitivity
58
Q

Thompson’s wrap up point regarding use of antibiotics

A
  • use judiciously
  • follow the MD directions and follow the whole course when it is prescribed
  • be mindful of effects of poly-pharmacy
59
Q

Erythromycin –

  • What class is it from?
  • What is it useful for?
  • Negative effects?
A

Erythromycin –

  • Antibacterial that inhibits bacterial protein synthesis (erythromycins)
  • may be useful in airway infections;
  • must monitor liver function
60
Q

Tetracycline -

  • What class is it from?
  • Positive effects? (3)
  • Negative effects? (3)
A

Tetracycline -

  • Antibiotic that inhibits bacterial protein synthesis (tetracyclines)
  • Positive effects: may have
    • anti-inflammatory,
    • neuroprotective, and
    • immunomodulation effects;
  • Negative effects:
    • photosensitivity,
    • interference with osteoblasts/clasts in bone remodeling,
    • discoloration of teeth, bone, and skin
61
Q

Chloromycetin –

  • What class is it from?
  • When is it used?
  • Negative effects?
A

Chloromycetin –

  • Antibiotics that inhibit bacterial protein synthesis (other agents)
  • reserved for non-responsive resistant infections
  • may lead to aplastic anemia
62
Q

Clindamycin –

  • What class is it from?
  • Negative effects? (2)
A

Clindamycin –

  • Antibacterial that inhibits bacterial protein synthesis (other agents)
  • has a black box warning for C. diff
  • Pretty sure it is ototoxic
63
Q

Ketek –

  • What class is it from?
  • What is unique about it?
  • When is it used?
  • Negative effects?
A

Ketek –

  • Antibacterial that inhibits bacterial protein synthesis (other)
  • first of new class: ketolide antibacterials – erythromycin derivative.
  • May be useful in bacterial resistance but
  • hepatotoxic
64
Q

penicillin –

  • What class is it from?
  • Negative effects? (6)
A

penicillin –

  • Antibiotic that acts on Cell Membrane Synthesis
  • Negative effects:
    • Always
      • skin reactions,
        • Stevens - Johnson syndrome (sloughing of the skin),
      • toxic epidermal necrosis;
    • with prolonged use,
      • may cause CNS issues (hallucinations, confusion),
      • hemolytic anemia,
      • thrombocytopenia
65
Q

Cephalosporins –

  • What class is it from?
  • Unique characteristics?
  • Used for? (3)
A

Cephalosporins –

  • Antibiotic that acts on cell mambrane synthesis
  • Unique characteristics: cross-sensitivity with penicillin
  • Best uses:
    • works on the same bugs as penacilin;
    • may be better than penacillin for UTI
    • often used as Low dose, “prophylactic” antibiotics –
      • SCI patient, or ear infection prone
66
Q

Carbapenems -

  • What class are they from?
  • Negative affects?
A

Carbapenems -

  • Antibacterial that acts on bacterial cell membrane synthesis (Meropenem is listed in book as a Carbapenem, but Carbapenem itself is not listed in the chart)
  • Negative affects:
    • CNS abnormalities, especially for patients with pre-existing seizure disorder or if drug dosage is too high
67
Q

Topical Antibacterials

  • What class are they from?
  • Negative effects?
A

Topical Antibacterials

  • Dr. T listed them under Antibacterials that act on bacterial cell membrane synthesis, but others were topicals too I believe. (in the book there is Polymyxin B that is an Antibacterial that acts on bacterial cell mebrane and is so nephrotoxic that it is used almost exclusively in topical-like ways. Maybe she meant that?)
  • Negative effects: local hypersensitivity (true for topicals no matter what class)
68
Q

Vancomycin –

  • What class is it from?
  • Negative effects? (4)
A

Vancomycin –

  • Antibacterial that works on bacterial cell membrane synthesis
  • Negative effects?
    1. hypersensitivity,
    2. bitter taste in mouth,
    3. nephrotoxicity (kidney issues)
    4. ototoxicity (ringing in ears)
69
Q

Drugs that Inhibit bacterial protein syntheis

In General

  • Unique characteristics?
  • Negative effects? (3)
A

Drugs that Inhibit bacterial protein syntheis

In General

  • Unique characteristics: Very broad spectrum
  • Negative effects?
    • problems with toxicity –
      1. nephrotoxicity and kidney failure
      2. ototoxicity,
      3. liver failure
70
Q

Drugs that inhibit DNA/RNA synthesis

  • Four types of drugs in the class
A

Drugs that inhibit DNA/RNA synthesis

  • Types of drugs in the class
    1. anti-TB
    2. anti-leporosy
    3. Fluoroquinolones
    4. Sulfonamides
71
Q

Fluoroquinolones –

  • What class are they in?
  • Negative effects? (3)
A

Fluoroquinolones –

  • Antibacterial that inhibits DNA/RNA synthesis
  • Negative effects?
    1. CNS toxicity,
    2. photosensitivity,
    3. tendinopathy,
      • especially for folks who are older or in renal failure – monitor for pain complaints, back off on exercise loading
72
Q

Sulfonamides –

  • What class are they in?
  • Negative effects?
A

Sulfonamides –

  • Antibacterials that inhibit DNA/RNA synthesis
  • Negative effects: photosensitivity
73
Q

List the Antibacterials Dr. T listed that act on bacterial cell wall synthesis (5?)

A
  1. Pencillin
  2. Cephalosporins
  3. Carbapenems (meropenem?)
  4. Topicals?
  5. Vancomycin
74
Q

List the Antibacterials Dr. T listed that act on bacterial protein synthesis (5-6)

A
  1. Erythromycin
  2. Tetracycline
  3. Chloromycetin
  4. Clindamycin
  5. Ketek
  6. (Book also listed Aminoglycosides)
75
Q

List the Antibacterials Dr. T listed that inhibit bacterial DNA/RNA synthesis (5)

A
  1. Anti-TB
  2. Anti-leprosy
  3. Fluoroquinolones
  4. Sulfonamides

Thompson class fall 2015 (12 decks)

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