Final Part 2 Flashcards
1
Q
What is the basic process for starting someone on an anti-biotic?
A
Suspected infection Culture the site [begin empiric therapy] Gram stain Identification Susceptibility [change to definitive therapy]
2
Q
What are some prophylactic uses of antibiotics?
A
Surgery
Bacterial endocarditis
Neutropenia
Recurrent UTI
3
Q
When do you get the culture: before or after starting antibiotics?
A
BEFORE
4
Q
What are the 3 types of beta-lactams?
A
- Penicillins
- Cephalosporins
- Carbapenems
5
Q
Suffix of penicillin?
A
-cillin
6
Q
Prefix of cephalosporins?
A
cef- or ceph-
7
Q
Suffix of carbapenems?
A
-penem
8
Q
MOA of beta-lactams?
A
Causes the cross links of bacteria not to form. Bacteria need the cross links to be strong. Since beta-lactam causes them not to form, the bacteria walls become weak, fill with water and swell, and die!
9
Q
What is the added drug to counterattack beta lactamase? Explain.
A
- The drug is clavulanate.
- Some bacteria have become resistant to certain medicines.
- Usually we would give amoxicillin with a patient who has some problem.
- Well beta-lactamase enzyme destroys the beta-lactame ring of penicillins, which is the part of the drug that causes the bacterial walls to become weak.
- If a patient is originally given amoxicillin and comes back in a few days later with the same problems, we know the drug is resistant. Then we give the COMBO AMOXICILLIN/CLAVULANATE to counterattack!
- Clavulanate blocks the beta lactamase enzyme, so the beta lactamase enzyme can NO longer go and destroy the beta lactam ring of the pencillin, and the penicillin is able to go and destroy the wall of the bacteria again!
10
Q
Does beta-lactamase enzyme cause problems with cephalosporins?
A
No, cephalosporins have an added part to their chemic structure that makes the ring stronger and harder to break
11
Q
T/F: The newer the generation of cephalosporins, the better they work.
A
True
12
Q
What do the newer cep generations do better than the older ones?
A
Increase gram- coverage
Increase anaerobe coverage
Increase beta-lactamase resistance
Increase CSF distribution
13
Q
What generation is cephalexin?
A
1
14
Q
What generation is cefuroxime?
A
2
15
Q
What generation is cefdinir?
A
3
16
Q
What generation is ceftriaxone?
A
3
17
Q
What generation of ceph is used for surgery prophylactic?
A
1
18
Q
What generation of ceph can be given to people with meningitis?
A
3rd and up (remember the newer the generation, the more likely it is to increase CSF distribution)
19
Q
What generation is notorious for causing C.diff
A
3
20
Q
What cef generation is good for nosocomial infections?
A
4
21
Q
What ceph generation is good for MRSA?
A
5th; MRSA is very resistant! 5th generation is the ONLY generation that can kill it
22
Q
What do you do if you think your patient taking cefdinir or ceftriaxone has C.diff?
A
Stop the antibiotic!
Swap alcohol and use hand soap!
Switch to another antibiotic such as METRONIDAZOLE or VANCOMYCIN
23
Q
What are the 3 adverse effects of beta-lactams?
A
N/D (all antibiotics have this effect)
Superinfection (yeast, thrush, and C.diff)
ALLERGIC REACTION
24
Q
If a patient who was allergic to penicillin bc their reaction was anaphylaxis, is it okay to give a cef?
A
NO
25
If a patient who was allergic to penicillin bc their reaction was hives (pruitic), is it okay to give a cef?
NO
26
If a patient who was allergic to penicillin bc their reaction was morbilliform rash, is it okay to give a cef?
Yes
27
A patient who says they were allergic to penicillin bc they had an itchy rash wants to know if they can take a cep. Is that ok?
NO, itchy rash means they had hives and they will be allergic to the ceph too
28
A patient who says they were allergic to penicillin bc they had a rash but it didn't itch, is it ok to give a cep?
Yes
29
5 classes of protein synthesis inhibitors?
```
Tetracyclines
Macrolides
Clindamycin
Linezolid
Aminoglycosides
```
30
All tetracyclines end in what?
Common uses for tetracyclines?
Interactions of tetracyclines?
Major adverse effects?
- Cycline
- Unique infections (RMSF, cholera, lyme disease, anthrax); acne; peptic ulcer disease, PERIODONTAL disease
- Chleating agents (Iron, magnesium, calcium, zinc, aluminum)
- TETRUS: Teeth discoloration, esophageal irritation, and photosensitivity
31
What are the 3 macrolides?
Erythromycin
Clarithromycin
Azithromycin
32
Common use for all macrolides?
| Adverse effects?
URT and LRT infection for all 3
Erythromycin ONLY can increase gastric motility
- GI upset
- Distorted taste: metallic & CYP interactions (clarithromycin only)
33
Which protein synthesis inhibitor can absorb easily and get into the bone but cannot get into brain?
Clindamycin
34
What is the bad thing about clindamycin?
Causes C.diff
35
What major nosicomial infections does linezolid kill?
What is linezolid and what does that mean?
Is linezolid cheap or expensive?
Adverse effects?
- MRSA and VRE
- MAOI--avoid tyramines, SSRI, TCA, SNRI, etc
- Expensive
- Lactic acidosis, optic neuritis, peripheral neuropathy, bone marrow suppression
36
What are the 2 aminoglycosides?
Adverse effects?
How many times a day do you give it?
Amikacin & Gentamicin
* Synergies with beta-lactam
- Nephrotoxic and ototoxic
- ONCE daily
37
What is the MOA of the protein synthesis inhibitors?
Bind to ribosomes of bacteria and cause them to no longer work. Bacteria need ribosomes to make proteins to survive
38
TMP/SMZ (antimicrobial) are commonly used ___ & ____.
Skin infections like MRSA & UTIs
39
Adverse effects of SMZ?
| Adverse effects of TMP?
SMZ: Hypersensitivity (allergic reaction-SJS); Hemolytic anemia (common in blacks and mediterrean); Kernicterus; renal injury (pt. must drink lots of H20)
TMP: HYPERkalemia
40
What is kernicterus and which drug causes it? Who can't take this drug?
Too much billiruben in brain; SMZ; infants younger than 2 months old, pregs 32 past gestation, or breastfeeding mothers
41
Nitrofurantoin
UTI drug
42
Nitrofurantoin (UTI drug): take on empty stomach or with food? turns urine what color and is that ok?
TAKE WITH FOOD
| Brown--thats ok!
43
MOA of fluoroquinolone class?
Inhibits the bacterial enzymes (DNA gyrase and topoisomerase IV) from making DNA..so the bacteria no longer can divide/reproduce
44
MOA of beta-lactam drugs?
Penicillins and cephs
| Break down the tough walls that surround bacteria
45
MOA of protein synthesis inhibitors?
Tetracyclines, Macrolides, Clindamycine Linezolid, Aminoglycosides
Binds to ribosoomes in bacteria and break them so bacteria is unable to produce new protein, which causes them to die
46
MOA of TMP/SMZ?
Block formation of folic acid
47
MOA of nitrofurantoin (UTI drug)?
Trojan horse...nice and sweet, but once the bacteria absorbs it, it turns toxic!
48
MOA of fluoquinolone?
Mess up bacterias DNA
49
Suffix of fluoquinolone?
-floxacin
50
Who takes fluoquinolone?
People with travelers diarrhea (cipro)
Complicated UTI
Pneumonia and bacterial sinusitis (levo and moxi)
51
What are the common adverse effects of fluoquinolones (-floxacin)?
GI upset
Photosensitivity (avoid direct sunlight)
Altered mental status
52
What are the RARE adverse effects of fluoquinolones (-floxacin)?
PQ'R'ST
- Peripheral neuropathy: numbing/tingling-CALL DOC
- Prolonged QT interval
- Seizures
- Superinfection (c.diff)
- TENDON RUPTURE!!!!!
53
```
One rare adverse effect of fluoquinolone (-floxacin) is TENDON RUPTURE. THIS IS IMPORTANT TO KNOW!!!!!!!
How rare is this?
What tendon?
Who is at risk? (3)
Who should avoid and why?
```
- VERY rare
- Can happen with ANY tendon but most common is ACHILLES
- Those at risk: 60+, people taking corticosteroids, and people who had organ transplants (bc they are on corticosteroids)
- Avoid: Children bc they are still forming joints and tendons; Pregs. avoid too
54
Can a child with a UTI take a cipro (fluoquinolone) even though children should not take these types of drugs due to the TENDON RUPTURE? what about a child with anthrax?
Yes, if benefits outweigh risk, give them cipro!
55
Fluoquinolone (-floxacin) has interactions just like the tetracyclines (protein synthesis inhibitors). What interaction am I referring to?
The cheating agents (magnesium, zinc, aluminum, calcium, iron)
*take -floxacin first, then take the supplement 2 hours later
56
Metronidazole (drug given for C.diff + other indications) has a MOA similar to Nitrofurantoin (UTI drug). Explain.
Starts out totally harmless but once absorbed by ANAEROBIC BACTERIUM, it is converted into something toxic. Only toxic to anaerobic bacteria or protozoa!!!
57
Who takes metronidazole?
When you have problems with the gut
- Abdominal bacteria (anaerobes)
- Parasites (protozoa)
- C.diff
- H. pylori
58
What are the adverse effects of metronidazole?
- N/D (not with c.diff)
- Metallic taste (macrolides also have this effect-specifially clarithromycin)
- Perioheral neuropathy
- Disulfiram reaction
59
Who takes Vancomycin (3)?
- C.diff
- MRSA
- Other serious infections
60
If someone has a penicillin allergy, what drug do we give instead?
Vancomycin
61
MOA of vancomycin?
Deactivates the building materials for a bacterial cell wall
62
Adverse effects of vancomycin (4)?
- Nephrotoxicity
- Ototoxicity
- Thrombophlebitis
- Red man syndrome
63
What is red man syndrome? What drug causes it? Effects? What do we do if they have it?
Too much histamine is released when taking VANCOMYCIN--not dangerous
RED skin
ITCHY
TACHYcardic
HYPOtensive
Slow down next infusion; premedicate with Benadryl
64
Vancomycin is NOT lipid soluble. Why would we ever want to give it PO?
When a patient has C.diff so it will just stay in the GI tract and kill the C.diff
65
Manifestations of TB?
```
LOW grade fever
Dry cough--can progress to bloody one
Night sweats
Fatigue
Weight loss
```
66
Two TB drugs?
Isoniazid
| Rifampin
67
2 big effects with Isoniazid (TB drug)?
Peripheral neuropathy
*give vit b6 to help with peripheral neuropathy or give it prophylactically in those who are at risk (diabetic and alcoholics)
Hepatoxicity
*watch AST level; if it goes up 3-5X original amount, prescriber will stop drug
68
Pyridozine
Vit. B6--given for TB pts taking Isoniazid to help with peripheral neuropathy
69
Rifampin is for TB, but also for ____. What is its MOA? Take rifampin on empty stomach or with food? Adverse effect? Weird effect?
```
MRSA
Blocks protein synthesis
EMPTY stomach
Hepatoxicity
Red-orange secretions (common, avoid contact lenses)
```
70
Isoniazid is an inhibitor or inducer?
Inhibitor (don't take with drugs that have narrow therapeutic index)
71
Rifampin is an inhibitor or inducer?
Inducer (don't take if on BC or use another form)
72
What are the 2 anti fungal drugs?
Amphotericin B
| Azols
73
Amp B binds to _____ and causes the FUNGAL membrane to be more permeable, K+ leaks out, and slows production/kills fungus. Does it work on bacteria? Does it hurt us humans?
Ergosterol
No
Yes, bc our cell membrane has cholesterol and they are very similar
74
Red man syndrome is caused by ____. Infusion reaction is caused by _____. Which is worse? What are their differences?
Red man caused by vancomycin
Infusion reaction caused by Amp. B
Infusion reaction=WORSE
Red man caused by too much histamine. Infusion reaction bc too many cytokines
75
Red man vs. infusion reaction side effects?
Red man: TACHYcardia, HYPOtension, Red skin, itchy
Infusion reaction: Chills, fever, headache, nausea, rigors
76
Other adverse effects of Amp. B (anti fungal)?
```
Infusion reaction
Phlebitis
Nephrotoxicity
HYPOkalemia
Bone marrow suppression
```
77
Suffix of azoles?
-azole
78
MOA of azole?
Blocks the enzyme that is part of the CYP system--no ergostol is made
79
What is better tolerated: Amp B or azole?
Azoles
80
Adverse effects of azoles?
-Decreased ejection fraction (intraconazole only)
Hepatoxicity
CYP interactions- INHIBITORS!!
