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Pharm III > Flood Chapter 41 > Flashcards

Flood Chapter 41 Flashcards

1
Q

It is estimated that 21% of all prescriptions written for antimicrobials are for

A

ambulatory patients seen in physicians’ offices with the diagnosis of upper respiratory tract infections or bronchitis.

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2
Q

SCIP stands for

A

Surgical Care Improvement Project

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3
Q

What are the SCIP measures related to prevention of surgical site infection?

A

SCIP-inf1: Prophylactic abx within 1hr is incision
SCIP-inf2: Prophylactic abx selection
SCIP-inf3: abx dc’d within 24hr after surg. 48hr CV pts
SCIP-inf4: CV surg pts 6am glu ≤200
SCIP-inf5: Post-op wound infection diagnosed during index hospitalizations
SCIP-inf6: Surg patients with appropriate hair removal
SCIP-inf7: Colorectal surg patients with immediate post-op normothermia

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4
Q

Patient-related risk factors for surgical site infection include?

A

Extremes of age (younger than 5 and older than 65 years).
Poor nutritional status.
Obesity.
diabetes mellitus and perioperative glycemic control.
peripheral vascular disease.
tobacco use.
coexistent infections.
altered immune response.
corticosteroid therapy.
preoperative skin preparation (surgical scrub and hair removal), and
length of preoperative hospitalization.

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5
Q

Institutional risk factors for surgical site infection include?

A

Surgical experience and technique (i.e., open vs. laparoscopic).
Duration of procedure.
Hospital environments including sterilization of instruments.
Maintenance of perioperative normothermia.

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6
Q

Perioperative glucose control has been studied predominantly in the cardiothoracic surgery population where it is associated with about a _____ decrease in deep sternal infection.

A

50%

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7
Q

A meta-analysis of four studies that have assessed the effect of _______ weeks of preoperative smoking cessation demonstrates a risk reduction of approximately__________.

A

4 to 8 weeks

50%

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8
Q

hypothermia will result in

A

peripheral vasoconstriction, decreased wound oxygen tension and recruitment of leukocytes, favoring infection and impaired healing.

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9
Q

warming was associated with a ______decrease in surgical site infections.

A

64%

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10
Q

Active prewarming of volunteers for 2 hours resulted in maintenance of core temperatures above 36°C for 60 minutes of general anesthesia at ambient temperature, whereas core temperatures in unwarmed subjects dropped an average of ________

A

1.9°C to below 35°C.

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11
Q

Immunosuppression on the basis of long-term use of corticosteroids has been considered a risk factor for surgical site infection, will you give steroids to surgical patients?

A

There is clear evidence that a single dose of corticosteroid given to prevent nausea and vomiting and reduce pain does not promote infection.

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12
Q

SCIP 1 Antibiotic treatment is not recommended for longer than 24 hours because of an increased incidence of drug-resistant organisms. True/False?

A

False

This recommendation is based on findings of no benefit to prolonged dosing.

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13
Q

SCIP measure 2 states

A

The antibiotic chosen should be appropriate for the most likely microorganism related to the procedure and patient characteristics

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14
Q

The predominant organisms causing surgical site infections after clean procedures are

A

Skin flora (Staphylococcus aureus and Staphylococcus epidermidis).

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15
Q

Most common antibiotic used for cardiac surgery (Table 41-3)

A

Cefazolin, Cefuroxime.

If allergic to beta-lactam then Clindamycin, vancomycin.

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16
Q

Most common antibiotic used for non-cardiac thoracic procedures (Table 41-3)

A

Cefazolin, ampicillin-sulbactam.

If allergic to beta-lactam then Clindamycin, vancomycin.

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17
Q

Most common antibiotic used for gastroduodenale procedures (Table 41-3)

A

Cefazolin

If allergic to beta-lactam then:
Clindamycin/ vancomycin + aminoglycoside/ aztreonam/ fluoroquinolone

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18
Q

Most common antibiotic used for biliary tract open procedures, high risk elective laparoscopic procedures and appendectomy (Table 41-3)

A

Cefazolin, cefoxitin, cefotetan, ceftriaxone, ampicillin-sulbactam

If allergic to beta-lactam

Clindamycin/vancomycin + aminoglycoside/aztreonam/fluoroquinolone.
Metronidazole + aminoglycoside/fluoroquinolone

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19
Q

Most common antibiotic used for low risk elective laparoscopic procedures (Table 41-3)

A

none

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20
Q

cephalosporin such as cefazolin are the antimicrobials of choice for surgical procedures in which skin flora and normal flora of the GI & GU tracts are the most likely pathogens. This is because of their?

A

wide therapeutic index and low incidence of side effects

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21
Q

Patients with documented ____________reaction to cephalosporins are rare and often mistaken for more common intolerances such as nausea or yeast infection

A

immunoglobulin E (IgE)

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22
Q

IgE-mediated anaphylactic reactions to antimicrobials usually occur ____________ minutes after dosing and often include_____________.

A

30 to 60 minutes

urticaria, bronchospasm, and hemodynamic collapse.

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23
Q

Grandma had urticaria after taking penicillin, can she get a cephalosporin instead?

A

Cephalosporins can safely be used in patients with an allergic reaction to penicillins that is not an IgE-mediated reaction (e.g., anaphylaxis, urticaria, bronchospasm)or exfoliative dermatitis (Stevens-Johnson syndrome, toxic epidermal necrolysis)

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24
Q

In patients with documented IgE-mediated anaphylactic reactions, β-lactam antibiotics can usually be substituted with

A

clindamycin or vancomycin

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25
Q

In patients with MRSA colonization what antibiotic may be considered

A

Vancomycin

Nasal application of mupirocin has been considered as an alternative and has been found to be effective in eliminating MRSA colonization in adults and children.

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26
Q

Routine prophylaxis with vancomycin is not recommended for any patient population in the absence of?

A

documented or highly suspected colonization or infection with MRSA (recent hospitalization of nursing home stay and hemodialysis patients) or known IgE-mediated response to β-lactam antibiotics.

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27
Q

The recommendation against routine prophylaxis with vancomycin is due to?

A

Concerns about selection of resistant organisms.

Its risk of inducing hemodynamic instability due to histamine release (red man syndrome) if given rapidly.

Evidence that vancomycin is less effective than cephazolin in methicillin-susceptible S. aureus

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28
Q

If given rapidly, vancomycin will cause?

A

Red Man Syndrome- hemodynamic instability due to histamine release

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29
Q

Clean-contaminated procedures such as colorectal and abdominal surgeries require additional coverage for?

A

gram-negative rods and anaerobes in addition to skin flora.

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30
Q

Metronidazole can be added to __________ in clean-contaminated procedures

A

cefazolin or cefoxitin, cefotetan, ampicillin-sulbactam, ertapenem, or ceftriaxone

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31
Q

_________with oral antimicrobials has been studied as a potentially less costly alternative

A

Bowel preparation

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32
Q

What is the most frequent complication of prophylactic antimicrobials, including the IV cephalosporins.

A

Pseudomembranous colitis

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33
Q

Mechanical bowel preparation alone does not reduce infection, but selective decontamination of the digestive tract with ____________eradicates the colonization gram-negative microorganisms, S. aureus, and yeasts from oral cavity to rectum.

A

oral topical polymyxin, tobramycin, and amphotericin

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34
Q

Vancomycin would be active against MRSA in selective decontamination of the digestive tract but is not recommended because?

A

gram-positive flora plays an important role in the resistance to colonization

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35
Q

Which antibiotics are nephrotoxic (Table 41-4)

A

Aminoglycosides
Polymyxins
Amphotericin B

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36
Q

All antimicrobials can cause allergic reactions but most often seen with? (Table 41-4)

A

Beta-lactam derivatives

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37
Q

Inhibits platelet aggregation (Table 41-4)

A

Penicillins in high doses

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38
Q

Causes Prolonged PTT (Table 41-4)

A

Cephalosporins

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39
Q

Causes Bone marrow suppression (aplastic anemia, pancytopenia) (Table 41-4)

A

Chloramphenicol
Flucytosine
Linezolid (reversible)

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40
Q

causes hemolytic anemia

A

Chloramphenicol
Sulfanomides
nitrofurantoins
Primaquine

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41
Q

Causes agranulocytosis

A

Macrolides

Trimethoprin-sulfamethoxale

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42
Q

Causes leukopenia and thrombocytopenia

A

Trimethoprin

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43
Q

Causes normocytic normochromic anemia

A

Amphotericin B

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44
Q

Causes Ototoxicity

A

Aminoglycosides
Vancomycin (auditory neurotoxicity)
Minocycline (vestibular toxicity)

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45
Q

Causes seizures

A

Penicillins and other beta lactams (high doses, azotemic patients, history of epilepsy)

Metronidazole

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46
Q

Causes neuromuscular blockade

A

Aminoglycosides

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47
Q

Causes peripheral neuropathy

A

Nitrofurantoin (renal failure)
Isoniazid (prevent with pyridoxine)
metronidazole

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48
Q

Causes Benign intracranial hypertension (Pay attention)

A

Tetracyclines

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49
Q

Causes Optic neuritis

A

Ethambutol

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50
Q

Causes Hepatotoxicity

A 
Isoniazid
Rifampin
Tetracyclines (high doses)
Beta lactam antimicrobials ( high doses)
Nitrofurantoin
Erythromycin
SUlfonamides
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51
Q

Increased plasma bilirubin concentrations

A

Quinupristin-dalfopristin

Erythromycin

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52
Q

Causes GI irritation (Pay attention)

A

Tetracyclines

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53
Q

Causes prolongation of QTc interval (Pay attention)

A

Erythromycin

Fluoroquinolones

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54
Q

Causes exaggerated sympathomimetic effects in patient s receiving MOI

A

Linezolid

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55
Q

Causes hyperkalemia (Pay attention)

A

Trimethoprim-sulfamethoxole

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56
Q

Causes tendinitis (pay attention)

A

Fluroquinolones

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57
Q

Causes arthralgias and myalgias

A

quinupristin-dalfopristin

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58
Q

Causes photosensitivity

A

Sulfonamides
Tetracyclines
Fluroquinolones

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59
Q

Causes teratogenicity(pay attention)

A

Metronidazole
Rifampin
Trimethoprim
Fluroquinolones

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60
Q

___________ is essential for the selection of appropriate antimicrobial drugs to treat ongoing infection.

A

Prompt identification of the causative organism

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61
Q

The efficacy of antimicrobial therapy depends on?

A

drug delivery to the site of infection.

Transport across the blood–brain barrier varies greatly among antimicrobials.

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62
Q

Antimicrobial therapy is more likely to be effective if the infected material (foreign body, prosthesis) is?

A

removed.

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63
Q

Infections behind obstructing lesions such as pneumonia behind a blocked bronchus can be cured with antibiotics. True/False?

A

False

It will not respond to antimicrobials until the obstruction is relieved.

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64
Q

80% of nosocomial infections occur in?

A

urinary tract, respiratory system, and bloodstream

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65
Q

The most common causes of bacteremia or fungemia in hospitalized patients is?

A

Intravascular access catheters

66
Q

Initial therapy of suspected intravascular catheter infection usually includes vancomycin because of?

A

high incidence of MRSA and methicillin-resistant S. epidermidis in the nosocomial environment.

67
Q

Most antimicrobials cross the placenta and enter maternal milk. True/False?

A

True

68
Q

Pharmacokinetics and toxicities in the fetus are often different from those in older children and adults because?

A

The immature fetal liver may lack enzymes necessary to metabolize certain drugs

69
Q

Teratogenicity is a concern when any drug is administered during

A

early pregnancy.

70
Q

Plasma antimicrobial concentrations may be decreased (10% to 50%), especially late in pregnancy and in the early postpartum period due to?

A

Increases in maternal blood volume, glomerular filtration rate, and hepatic metabolic activity.

71
Q

absorption of orally administered antimicrobials in parturients is?

A

decreased in some parturients due to delayed gastric emptying

72
Q

Physiologic changes that occur with increasing age can lead to alteration in?

A

Oral absorption- decreased gastric acidity, reduced gastrointestinal motility.

Distribution- increased total body fat, decreased plasma albumin concentrations.

Metabolism- decreased hepatic blood flow.

Excretion -decreased glomerular filtration rate.

73
Q

Penicillins and cephalosporins obviate the need for significant changes in dosage schedules in elderly patients who have normal serum creatinine concentrations because?

A

they have a large therapeutic index

74
Q

Administration of ___________and ________ to elderly patients may require adjustments in dosing regimens.

A

aminoglycosides and vancomycin

75
Q

Favorable intervention to reduce risk of opportunistic infection in HIV patient is?

A

good preoperative control on an antiretroviral regimen with preserved T4 cell counts.

76
Q

The basic structure of penicillins is

A

a dicyclic nucleus (aminopenicillanic acid) that consists of a thiazolidine ring connected to a β-lactam ring.

77
Q

The penicillins may be classified into subgroups because of their

A

structure, β-lactamase susceptibility, and spectrum of activity.

78
Q

The bactericidal action of penicillins reflects (MOA)

A

interferes with the synthesis of peptidoglycan, which is an essential component of cell walls of susceptible bacteria. Penicillins also decrease the availability of an inhibitor of murein hydrolase such that the uninhibited enzyme can then destroy (lyse) the structural integrity of bacterial cell walls.

79
Q

Cell membranes of resistant gram-negative bacteria are in general resistant to penicillins because?

A

they prevent access to sites where synthesis of peptidoglycan is taking place.

80
Q

What is the drug of choice for treatment of pneumococcal, streptococcal, and meningococcal infections.

A

penicillins

81
Q

What are the 3 cephalosporin which can take care of pseudomonas ?

A

3rd generation - Ceftezidime
4th generation - Cefepime
5th generation - Cefolazane/Tazobactam

82
Q

Which cephalosporins have anaerobic coverage?

A

2nd generations : Cefuroxime and Cefoteton
And
5th generations: ceftolazane/ Tazactam & Ceftoraline
Anaerobic bacteria are commonly found intraabdominal

83
Q

What are 1st generation cephalosporins and describe their properties

A

Cefazolin( Ancef ), Cephalexin ( Keflex)
Great for skin and soft tissue infections
-Cidal by inhibiting enzymes in the cell wall of the bacteria = no bacterial cell synthesis
NO anaerobic coverage *
Great Gram + coverage ( i.e. Staph and Strep)
Some Gram - coverage ( i.e E-Coli, Proteus, Kiebsiella)
Think Skin and soft tissue infections

84
Q

Renal dosing is needed with cephalosporins bc they are primarily eliminated in the urine . Except which 2 :

A

Ceftriaxone ** and Cefoperazone ( don’t think you have to know that one )
Those have significant elimination in the bile

85
Q

Which is the only cephalosporins with MRSA coverage ?

A

5th generation : Ceftaroline ( Teraflo) , the one and only .

86
Q

Contraindication with ceftriaxone ( Rocephin)

A

Can’t give with calcium in the same IV tubing, will cause calcium salt.

87
Q

Cefepime aka Maxipime , class, generation and coverage

A

4th generation cephalosporin
GREAT Gram + and GREAT gram + also bonus of Pseudomonas coverage
No anaerobic coverage
Think all kind of serious infections

88
Q

Cefazolin dose

A

Adults: 2g, 3g if>120kg
Pediatrics: 30mg/kg
Redose after 4hrs
half life 1-2.2

89
Q

Ceftriaxone dose

A

Adults: 2g
Pediatrics: 50-75 mg/kg
Do not redose
half life 5.4-10.9hrs

90
Q

Cipro dose

A

Adults: 400mg
Pediatrics: 10mg/kg
Do not redose
half life 3-7hrs

91
Q

Clindamycin dose

A

Adults: 900mg
Pediatrics: 10mg/kg
Redose after 6hrs
half life 2-4hrs

92
Q

Gentamicin

A

Adults: 5mg/kg(Dosing weight
Pediatrics: 2.5mg/kg(dosing weight)
Do not redose
half life 2-3hrs

93
Q

Levofloxacin

A

Adults: 500mg
Pediatrics: 10mg/kg
Do not redose
half life 6-8hrs

94
Q

Metronidazole

A

Adults: 500mg
Pediatrics: 15mg/kg
Do not redose
half life 6-10hrs

95
Q

Vancomycin

A

Adults: 15mg/kg
Pediatrics: 15mg/kg
Do not redose
half life 4-8hrs

96
Q

Penicillin is the drug of choice for treatment of

A

pneumococcal, streptococcal, and meningococcal infections.

all forms of actinomycosis and clostridial infections causing gas gangrene.

97
Q

_____infections have gradually become more resistant to penicillin, requiring higher doses for adequate treatment.

A

Gonococci

98
Q

highly effective drug for treatment of syphilis

A

Penicillin

99
Q

Penicillin is of value to patients with rheumatic fever because?

A

Prophylactic administration of penicillin is highly effective against streptococcal infections.

100
Q

Transient bacteremia occurs in most patient undergoing

A

dental extractions
tonsillectomy
operations on the genitourinary and gastrointestinal tracts,
vaginal delivery.

101
Q

Transient bacteremia is prevented by prophylactic penicillin for dental procedures most importantly in which patient population?

A

patients with congenital or acquired heart disease or tissue implants undergoing dental procedures.

102
Q

Administration of high doses of penicillin G IV to patients with renal dysfunction may result in

A

neurotoxicity and hyperkalemia (10 million U of penicillin G contains 16 mEq of potassium).

substitute with a sodium salt of penicillin G or a sodium salt of a similar penicillin, such as ampicillin or carbenicillin.

103
Q

Can you give a patient Intrathecal penicillin?

A

NO

Intrathecal administration of penicillins is not recommended because these drugs are potent convulsants when administered by this route. Furthermore, arachnoiditis and encephalopathy may follow intrathecal penicillin administration.

104
Q

Other drugs should not be mixed with penicillin because?

A

the combination may inactivate the antimicrobial.

105
Q

Penicillin elimination

A

Approximately 10% is eliminated by glomerular filtration, and 90% is eliminated by renal tubular secretion.

106
Q

Anuria increases the elimination half-time of penicillin G approximately

A

10-fold.

107
Q

Methods to prolong the duration of action of penicillin include

A

the simultaneous administration of probenecid, which blocks the renal tubular secretion of penicillin.

IM injection of poorly soluble salts of penicillin, such as procaine or benzathine, delays absorption and thus prolongs the duration of action.

108
Q

Procaine penicillin contains

A

120 mg of the local anesthetic for every 300,000 U of the antimicrobial.

109
Q

The major mechanism of resistance to the penicillins is

A

bacterial production of β-lactamase enzymes that hydrolyze the β-lactam ring, rendering the antimicrobial molecule inactive.

110
Q

______are not susceptible to hydrolysis by staphylococcal penicillinases that would otherwise hydrolyze the cyclic amide bond of the β-lactam ring and render the antimicrobial inactive.

A

Methicillin (dimethoxybenzylpenicillin), oxacillin, nafcillin, cloxacillin, and dicloxacillin

111
Q

Penetration of ________ into the central nervous system (CNS) is sufficient to treat staphylococcal meningitis.

A

nafcillin

112
Q

Parenteral methicillin has largely been superseded by?

A

oxacillin and nafcillin.

113
Q

Hemorrhagic cystitis and an allergic interstitial nephritis (hematuria, proteinuria) may accompany administration of?

A

methicillin.

114
Q

Hepatitis has been associated with high-dose ______ therapy. (Penicillins)

A

oxacillin

115
Q

Renal excretion of _________ is extensive. (Penicillins)

A

methicillin, oxacillin, and cloxacillin

116
Q

More than 80% of an IV dose of ________________is excreted in the bile, which may be an advantage when high-dose therapy is necessary in a patient with impaired renal function.

A

nafcillin

117
Q

__________ unlike methicillin, are relatively stable in an acidic medium, resulting in adequate systemic absorption after oral administration.

A

Oxacillin and nafcillin

118
Q

_____________ are available only as oral preparations and may be preferable because they produce higher blood levels than do oxacillin and nafcillin.

A

Cloxacillin and dicloxacillin

119
Q

Broad-spectrum penicillins have a wider range of activity than other penicillins, being bactericidal against ?

A

gram-positive and gram-negative bacteria

120
Q

Broad-spectrum penicillins such as ampicillin, amoxicillin, and carbenicillin are all inactivated by penicillinase produced by certain gram-negative and gram-positive bacteria. True or false?

A

True

121
Q

Ampicillin (α-aminobenzylpenicillin) has a broader range of activity than penicillin G. T/F?

A

True

122
Q

Among the penicillins, __________ is associated with the highest incidence of skin rash (9%), which typically appears 7 to 10 days after initiation of therapy.

A

ampicillin

123
Q

Ampicillin spectrum encompasses not only pneumococci, meningococci, gonococci, and various streptococci but also______________

A

a number of gram-negative bacilli, such as Haemophilus influenzae and Escherichia coli.

124
Q

Ampicillin is well absorbed after oral administration because?

A

It’s stable in acid

125
Q

Approximately 50% of an oral dose of ampicillin is excreted unchanged by the kidneys in

A

the first 6 hours, emphasizing that renal function greatly influences the duration of action of this antimicrobial.

126
Q

______________ also appears in the bile and undergoes enterohepatic circulation.

A

Ampicillin

127
Q

Skin rash after a dose of ampicillin mostly represent true allergic reactions. True/ False?

A

FALSE

Many of these rashes are due to protein impurities in the commercial preparation of the drug and do not represent true allergic reactions.

128
Q

Amoxicillin is chemically identical to ampicillin except for_______

A

an −OH substituent instead of an −H on the side chain.

129
Q

Its spectrum of activity is identical to that of ampicillin, but it is more efficiently absorbed from the gastrointestinal tract than ampicillin, and effective concentrations are present in the circulation for twice as long.

A

Amoxicillin

130
Q

Penicillinase-Susceptible Broad-Spectrum Penicillins (Second-Generation Penicillins) include

A

ampicillin, amoxicillin, and carbenicillin

131
Q

Extended-Spectrum Carboxypenicillins (Third-Generation Penicillins) include

A

Carbenicillin

132
Q

________ results from the change from an amino to carboxy substituent on the side chain of ampicillin.

A

Carbenicillin (α-carboxybenzylpenicillin)

133
Q

The principal advantage of carbenicillin is

A

its effectiveness in the treatment of infections caused by Pseudomonas aeruginosa and certain Proteus strains that are resistant to ampicillin.

134
Q

Carbenicillin is penicillinase susceptible and therefore ineffective against most strains of _________

A

S. aureus.

135
Q

Carbenicillin is not absorbed from the gastrointestinal tract; therefore, it must be administered parenterally. T/F

A

true

136
Q

The elimination half-time of carbenicillin is approximately 1 hour and is prolonged to approximately _________ hours when there is hepatic or renal dysfunction.

A

2 hours

137
Q

Approximately 85% of the unchanged drug is recovered in urine over 9 hours. __________ by delaying renal excretion of the drug, increases the plasma concentration of carbenicillin by approximately 50%.

A

Probenecid

138
Q

Congestive heart failure may develop in susceptible patients in response to acute drug-produced sodium load by which drug

A

Carbenicillin

The sodium load administered with a large dose of carbenicillin (30 to 40 g) is considerable because greater than 10% of carbenicillin is sodium (about 5 mEq/g).

139
Q

Hypokalemia and metabolic alkalosis may occur with Carbenicillin because of?

A

obligatory excretion of potassium with the large amount of nonreabsorbable carbenicillin.

140
Q

___________interferes with normal platelet aggregation such that bleeding time is prolonged but platelet count remains normal.

A

Carbenicillin

141
Q

Extended-Spectrum Acylaminopenicillins (Fourth-Generation Penicillins) include

A

mezlocillin, piperacillin, azlocillin

142
Q

Drugs with the broadest spectrum of activity of all the penicillins are

A

Acylaminopenicillins (mezlocillin, piperacillin, azlocillin)

143
Q

Like the carboxypenicillins, the acylaminopenicillins are derivatives of?

A

ampicillin.

144
Q

_______, _________and ________- are β-lactam compounds that have little intrinsic antimicrobial activity.

A

Clavulanic acid, sulbactam, and tazobactam

145
Q

Clavulanic acid is available with oral amoxicillin and parenteral ampicillin preparations have been combined with?

A

sulbactam.

146
Q

_____________ like the penicillins, are bactericidal antimicrobials that inhibit bacterial cell wall synthesis and have a low intrinsic toxicity.

A

Cephalosporins,

147
Q

Cephalosporins antimicrobials are derived from

A

7-aminocephalosporanic acid.

148
Q

Individual cephalosporins differ significantly with respect to?

A

the extent of absorption after oral ingestion

severity of pain produced by IM injection

protein binding.

149
Q

Resistance to the cephalosporins, as to the penicillins, may be due to

A

an inability of the antimicrobial to penetrate to its site of action.

cephalosporinases (β-lactamases) produced by bacteria, which disrupt the β-lactam structure of cephalosporins and thus inhibit their antimicrobial activity.

150
Q

IV administration of any of the cephalosporins can cause _________

A

thrombophlebitis.

151
Q

_________ metabolites of cephalosporins can occur and are associated with decreased antimicrobial activity.

A

Diacetyl

152
Q

A positive Coombs’ reaction frequently occurs in patients who receive large doses of

A

cephalosporins.

Hemolysis, however, is rarely associated with this response.

153
Q

Nephrotoxicity owing to cephalosporins,________ compared to aminoglycosides or polymyxins.

A

is less frequent

154
Q

The incidence of allergic reactions in patients being treated with cephalosporins ranges from

A

1% to 10%.

155
Q

This antimicrobial is an exception among the cephalosporin family due to its nephrotoxicity

A

cephaloridine

156
Q

The majority of the cephalosporin allergic reactions consist of?

A

cutaneous manifestations, which occur 24 hours after drug exposure.

157
Q

patients who are allergic to one cephalosporin are likely to be allergic to others because?

A

Because the cephalosporins share immunologic cross-reactivity

158
Q

The possibility of cross-reactivity between cephalosporins and penicillins seems to be very infrequent, and cephalosporins are often selected as alternative antimicrobials in patients with a history of penicillin allergy. T/F

A

True

159
Q

Like the newer penicillins, the new cephalosporins have an extraordinarily broad spectrum of antimicrobial action but are expensive. T/F

A

True

160
Q

The most common adverse reaction to β-lactam antimicrobials is?

A

Hypersensitivity

161
Q

Most often, the allergic response to cephalosporins and penicillins is a delayed reaction characterized by

A

a maculopapular rash and/or fever.

162
Q

Manifestations of immediate hypersensitivity may include

A

laryngeal edema, bronchospasm, and cardiovascular collapse.

Pharm III (11 decks)

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