immunity pt 1 - meds inhib cell wall synthesis

Question 1

penicillins
C:
MOA:
SOA:
CI:

Answer 1

C: antibiotic; beta lactamase inhibitor
MOA: inhib cell wall synthesis, bind with PBP = cell burst
SOA: +,-
CI: PCT/cephalosporin allergies, elder/renal pts

Question 2

penicillins
K: unstable in ____? TR?
INT:

Answer 2

K: unstable in stomach acid (no PO), rapid clearance = hard to get TR
INT: aminoglycosides, anticoags, BC, tetracyclines, probenecid

Question 3

SE of penicillins

Answer 3

yeast inf, IM site pain, rash, GI upset, hypersensitivity

Question 4

how many hours apart should you give penicillins and aminoglycosides

Answer 4

2 hrs

Question 5

3 types of PCN reactions and their reaction times

Answer 5

immediate: 20-30min
accelerated: 1-72hrs
delayed: days/weeks

Question 6

nursing int with a PCN allergy

Answer 6

1. stop IV
2. epi + antihistamine
3. resp support
4. BP, push fluids

Question 7

pt education with PCNs

Answer 7

take other forms of birth control

Question 8

class of PCN for penicillin G and penicillin V

Answer 8

narrow spectrum PCNs

Question 9

class of PCN for ampicillin and amoxicillin

Answer 9

aminopenicillins

Question 10

class of PCN for piperacillin and ticarcillin

Answer 10

extended spectrum PCNs

Question 11

class of PCN nafcillin, oxacillin, methacillin

Answer 11

penicillinase resistant PCNs

Question 12

why is PCN G given with probenecid

Answer 12

inc effects, longer in system

Question 13

what is the least toxic PCN

Answer 13

PCN G

Question 14

cephalosporins
C:
MOA:
CI:

Answer 14

C: antibiotic; cephalosporins
MOA: inhib cell wall synthesis, bactericidal
CI: alcohol, watch for compatibility with other IV meds

Question 15

cephalosporins have a twin structure with ______

Answer 15

PCNs

Question 16

cephalosporins
K:
INT:

Answer 16

K: half life short
INT: aminoglycosides, oral anticoags, probenecid

Question 17

SE of cephalosporins

Answer 17

cross rxn with PCN, thrombocytopenia/phlebitis, Red Man’s, superinfections

Question 18

what is at risk if cephalosporins are given with aminoglycosides

Answer 18

nephrotoxicity

Question 19

explain first gen cephalosporins: cefazolin, cephalexin

Answer 19

not used as much bc lots of SE, low beta lact resistance

Question 20

explain second gen cephalosporins: cefaclor, cefuroxine

Answer 20

have higher beta lact resistance

Question 21

explain third gen cephalosporins: ceftriaxone, ceftazidine

Answer 21

higher beta lact resistance, can cross BBB and penetrate CSF

Question 22

explain fourth gen cephalosporins: cefepime

Answer 22

have the most beta lact resist!! can cross BBB and penetrate CSF

Question 23

explain fifth gen cephalsporins: ceftaroline, ceftobiprole

Answer 23

target more resistant strains

Question 24

which cephalosporins have the most beta lactamase resistance

Answer 24

4th gen: cefepime

Question 25

trimethoprim-sulfamethoxazole (Bactrim) C: MOA: I: CI:

Answer 25

C: antibiotic; sulfonamides MOA: inhib folic acid by int with specific enzyme; bacteriostatic I: UTI (go to), colitis, c.diff CI: diabetics (risk hypoglycemia), potassium supplements

Question 26

trimethoprim-sulfamethoxazole (Bactrim) K: INT:

Answer 26

K: stay in GI tract w/o abs for GI issues INT: anticoags, diuretics, salt subs

Question 27

SE of trimethoprim-sulfamethoxazole (Bactrim)

Answer 27

crystalluria, kernicterus, hyperkalemia (no salt subs), blood abnormalities, n/v/d, hypersensitivity

Question 28

t/f: Bactrim inhib multiplication of new and kills existing

Answer 28

false: only inhib multiplication of new but cannot kill existing

Question 29

what are other sulfonamide antibiotics

Answer 29

sulfadiazine, silversulfadizine (Silvadene)

Question 30

what is Silvadene used for

Answer 30

topical inf and burn patients (only apply small amt, very silky)

Question 31

aztreonam (Azactam) C: MOA: SOA: I:

Answer 31

C: antibiotic; monobactam MOA: inhib cell wall synthesis SOA: - I: pts w/ PCN allergy

Question 32

aztreonam (Azactam) K: SE:

Answer 32

K: IV, IM, 1/2 life inc in renal failure SE: thrombophlebitis

Question 33

why can you give aztreonam to pts with PCN allergy?

Answer 33

structurally different

Question 34

vancomycin (Vancocin) C: MOA: SOA: I: CI:

Answer 34

C: tricyclic glycopeptide MOA: inhib cell wall synthesis, bactericidal SOA: + I: severe inf, MRSA, c.diff CI: aminoglycosides, IBS (no PO vanco), renal/elder pts

Question 35

vancomycin (Vancocin) K: 1/2 life? give over? SE:

Answer 35

K: 1/2 = 4-6 hrs, 1/2 for elder = 146hrs SE: nephrotoxicity #1, extravasation, Red Man's, thrombophlebitis/penia

Question 36

when to measure vancomycin peak and trough?

Answer 36

peak = 1hr after infusion trough = 30min before next dose

Question 37

imipenem + cilastatin (Primaxin) C: MOA: SOA: CI:

Answer 37

C: antibiotic; carbapenem MOA: inhib cell wall synthesis SOA: +,- CI: seizures

Question 38

imipenem + cilastatin (Primaxin) K: always give with ___ and why? SE:

Answer 38

K: always give with cilastatin to prev breakdown and inc half life SE: cross rxn with PCN, seizures, edema, rash

Question 39

what are other carbapenem antibiotics

Answer 39

doripenem, ertapenem