HAI & Abx pt2 (Ex2) Flashcards
_________ β-lactams are more stable against β-lactamase.
Cephalosporin
Cephalosporin β-lactam antibiotics are the drug of choice for what?
- Surgical prophylaxis
- PCN allergy patients (except true anaphylaxis)
What drug was noted for treatment of gonorrhea?
Ceftriaxone (Rocephin)
What cephalosporins do not penetrate the blood brain barrier?
Generation 1: Cefazolin
Generation 2: Cefuroxime, Cefoxitin, Cefotetan
What generation of cephalosporins penetrate the blood brain barrier well?
Generation 4: Cefepime (maxipime)
Most resistant to β-lactamase.
Reserved for multi-resistant organisms.
What cephalosporins are third generation? How well do they cross the BBB?
Cefotaxime
Ceftriaxone
Ceftazidime
Some cross BBB.
What drugs should be used if true anaphylaxis to penicillin exists?
Vancomycin or clindamycin
What are the adverse effects that are associated with cephalosporins?
- Rashes, fever, nephritis, anaphylaxis
- Vitamin K production deficit
What drugs are a common cause of colitis?
3rd generation cephalosporins
Carbapenem β-lactams have good activity against _______ __ _______ and ________.
Gram - rods (Pseudomonas Aeruginosa) and enterobacter
What β-lactam drug class has the broadest spectrum of activity and can inhibit the β-lactamase enzyme?
Carbapenems
What type of infections are carbapenems saved for?
- Intra-abdominal
- resistant UTIs
- pneumonia
What examples of carbapenems were given?
- Ertapenem (Invanz)
- Meropenem (merrem)
- Imipenem (primaxin)
(-penem)
IM formulations of carbapenems contain _______.
Lidocaine
Consider LA allergies prior to IM administration.
Carbapenems can decrease what medication by up to 90%?
What can this precipitate?
Valproic Acid (Depakote); and can precipitate seizures
How does vancomycin work?
Inhibition of cell wall synthesis
Vancomycin is active against _____ bacteria but is too large to penetrate ______ bacteria.
Active against gram + ; too large for gram - bacteria
Vancomycin is most useful against what infections?
Blood stream MRSA
MRSA endocarditis
What are the most common adverse reactions to vancomycin? (4)
- Phlebitis at site
- Chills, fever
- Nephrotoxicity
- “Red man” syndrome
.
How do Aminoglycosides work?
Inhibition of ribosomal proteins and cause mRNA misreading
Aminoglycosides have a _________ post-antibiotic effect.
prolonged/significant
Aminoglycosides are _______ w/ β lactams or vancomycin.
Synergistic
Especially useful for enterococcal endocarditis.
What are the adverse reactions associated with gentamycin?
- Ototoxicity
- Nephrotoxicity
- Curare-like affect
Explain the curare-like effect of gentamycin (aminoglycoside).
Gentamycin can interfere with ACh receptors and potentiate effects of NMB drugs.
What is the treatment for curare-like effects from gentamycin?
Ca⁺⁺
How do fluoroquinolones work?
Inhibit bacterial DNA synthesis
Fluoroquinolones are best used for what type of bacteria? What are examples of these infections? (3)
Gram (-) organisms:
- UTI
- Bacterial diarrhea
- Bone/joint infections
What examples are there of fluoroquinolones?
- Ciprofloxacin (cipro)
- Levofloxacin (levaquin)
What are the adverse reactions for fluoroquinolones?
- N/V/D
- QT prolongation
- Cartilage damage / Tendon rupture
What three factors will contribute to cartilage damage and tendon rupture associated with fluoroquinolones?
- Renal insufficiency
- Concurrent steroids
- Advanced age
What type of antibiotic is metronidazole?
Antiprotozoal / Anaerobic antibacterial
How does Metronidazole work?
Forms toxic byproducts that destabilize bacterial DNA.
What is metronidazole (flagyl) indicated for? (3)
- Intra-abdominal infections
- Vaginitis
- C-diff
What drug should Flagyl not be combined with?
EtOH
Disulfiram effect induces hangover-like s/s (flushing, dizziness, HA, chest/abd pain)
What are the adverse reactions associated with metronidazole?
- Nausea
- Peripheral neuropathy (w/ prolonged use)
- Disulfiram-like effect
What is the first line antibiotic for essentially all surgical prophylaxis (with no β-lactam allergy)?
Cefazolin (ancef)
What is the most common alternative to cefazolin for surgical prophylaxis?
Clindamycin (or vancomycin)
What drug(s) increases the likelihood of nephrotoxicity when paired with aminoglycosides?
Loop Diuretics (s/a furosemide)
What generation(s) of cephalosporin has better gram - coverage?
Generation 2: better gram - coverage
Generation 3: even better gram - coverage
What are the trade names for each:
- cefazolin
- cefuroxime
- cefoxitin
- cefotetan
- cefotaxime
- ceftriaxone
- ceftrazidime
- cefepime
- cefazolin (ancef, kefzol)
- cefuroxime (ceftin)
- cefoxitin (mefoxin)
- cefotetan (cefotan)
- cefotaxime (claforan)
- ceftriaxone (rocephin)
- ceftrazidime (fortaz)
- cefepime (maxipime)
Do carbapenems penetrate the BBB?
Yes, most penetrate BBB
What adverse reactions are associated with carbapenems?
-N/V/D
-Rashes
cross sensitivity to PCN <1%
What specifics contribute to aminoglycosides nephrotoxic effects? (4)
- elderly
- use more than 5 days
- higher doses
- concurrent with loop diuretics (furosemide)
What is the weight-based adult dosing parameters for Cefazolin?
≤ 80kg = 1 gram
81-119kg = 2 gram
≥ 120kg = 3 gram
What is the administration time (min) and redose time (hours) for cefazolin?
- Admin time: 3-5 min
- Redose: 4 hours (1 gram)
Review Chart for abx dosages and redosing times
Know trade names
Crossword answers:
