Infections- Exam 2 Flashcards
1
Q
Define Antibiotic
A
A bacteria creating a substance to kill another bacteria- All Natural
2
Q
Define Antimicrobial Agent
A
Synthetics
3
Q
Selective toxicity- 3 mechanisms
A
- Disrupt bacterial cell wall
- Inhibit enzyme unique to bacteria
- Disrupt bacterial protein synthesis
4
Q
Define narrow spectrum
A
Only treat 1 particular pathogen
5
Q
Broad- spectrum
A
Kill several bacteria- Wide net
Gram positive and gram negative
6
Q
Bacteriocidal
A
Kill bacteria
7
Q
Bacteriostatic
A
Only cause damage, no kill shot
8
Q
Why would you use broad spectrum vs narrow spectrum
A
Narrow is when the bacteria is identified and you are zeroing in on it while broad spectrum is for the patient who is extremely sick, condition deteriorating and you need to throw the biggest guns at them to eliminate any of the bacteria causing this illness- which we might not have an idea of at this point
9
Q
Drug resistance- ways the Bacteria resists- Microbial mechanisms (4)
A
- Decrease CONCENTRATION of a drug at its site of action
- INACTIVATE a drug
- Alter the STRUCTURE of drug target molecules
- Produce a drug ANTAGONIST
10
Q
Resistance acquired mechanisms of bacteria (2)
A
Spontaneous mutations and Conjugation (Bacteria sex- Bacteria with resistance hooks up with the bacteria who is able to link up)
11
Q
Drug Resistance: Antibiotic use
A
- Broad spectrum use of antibiotics allowed a broad exposure to bacteria and then not killing them all off allowed the bacteria to develop resistance
- Extent of use. Over prescribed, further unnecessary exposure to all the guns
12
Q
Nosocomial Infection
A
Happens within the hospital, arises post admittance, problematic- perfect nesting ground to develop these new issues.
13
Q
Superinfection
A
Treating infection and another arises as a result
14
Q
Antimicrobial Stewardship
A
Big message in last 10 years. Emphasizing importance of completing the entire course of an antibiotic as well as providers not overprescribing
15
Q
Purpose of gram staining
A
Blood culture before starting antibiotic
16
Q
PCR vs Gram staining
A
More precise than GS but possibly cost prohibitive
17
Q
Minimim Inhibitory concentration
A
Minimum amount of drug that is effective to reduce growth
18
Q
Minimum bactericidal concentration
A
Lowest concentration of drug required to kill a bacteria
19
Q
Empiric treatment
A
Through trial and error of treatment- typical pathogens are identified nowadays to cause certain infections. Reisenberg talks about little book guide
20
Q
Common misuses of antibiotics
A
- Attempted treatment of viral infections (7-10 days)
- Treatment of fever of unknown origin (Give time before treatment and know cause of fever)
- Improper dosage (Lower dosages than needed allow possible resistance)
- Treatment without adequate bacteriologic information (Reasoning behind)
- Omission of surgical drainage (Drainage of wound prevents re-infection
21
Q
Effective penetration of antibiotics can be impeded by….
A
- BBB- cant cross- to get to site
- Bacteria are difficult to penetrate- Endocarditis is challenging to penetrate
- Poor vascularity and purulent drainage- hard to get to
Examples of each
- Meningitis
- Endocarditis
- Infected abscess
22
Q
Penicillin MOA
A
Weakens bacterial cell wall
23
Q
What type of antibiotic is Penicillin, has what ring in chemical structure?
A
Beta-lactam Antibacterial agent
24
Q
Penicillin other name
A
Ampicillin
25
Penicillin used for what bacteria
Gram positive bacteria
26
Penicillin Onset of action, Routes, Metabolism and excretion
Rapid
PO, IV, IM
Liver
Renal
27
Common side effects of penicillin
Diarrhea, rash, urticaria (raised rash)
| Classic trifecta of antibiotics.
28
Serious side effects of peniciilin
Allergic reaction, anaphylaxis, pseudomembranous colitis (C dif)
29
Ampicillin patient PMH
**Hard no- history of severe allergic reaction to other beta lactams**
severe renal insufficiency, MONO, ALL, or CMV infections
30
Dosage of penicillin
Penicillin G is prescribed in units while all others are g or mg
31
Administration of penicillin
Oral with full glass of H20 empty stomach. PCN V good with meals
32
"Empty stomach"
1 hour before meals and 2 hours after
33
Ongoing eval and interventions for Ampicillin
- Monitor kidney function (impaired kidney can cause toxic levels)
- Monitor closely for 30 minutes when through IV route
- Do not mix PCN with aminoglycoside
34
Clavulanate, Sulbactam, Tazobactam
"I ate in the am"
All examples of what
Beta lactamase inhibitors
35
How are Beta lactamase inhibitors administered
Added to Ampicillin regimen
36
MOA of Beta Lactamase inhibitors
Pathogens secrete beta lactamase- which can attach to an antibiotic and destroy it. This add on inhibitor acts as a decoy. The beta lactamase attaches to the inhibitor, allowing the antibiotic to run free and do its job
37
Cephalosporin 1st generation drug
Cefazolin (Ancef)
38
Use of Cefazolin
Weaken bacterial cell wall, Gram-positive coverage, given pre-operation prophylaxis
39
Cefazolin Onset of action, Routes, Distribution, Metabolsim, Excretion
Rapid, IV or IM, Penetrates bones and synvovial fluid, not metabolized by the liver, excretion is almost entirely by the kidneys
40
Common Side affects of Cefazolin
Classic Diarrhea, nausea, vomiting, rash
| **Pain at injection site**
41
Cefazolin
| "A man who did not live long because of blood issues played violin so beautiful it was painful"
Live-Not metabolized by liver
Blood issues- leukopenia, neutropenia, thrombocytopenia
Painful- pain at injection site
42
Serious side affects of Cefazolin
Pseudomembranous Colitis
| Look at the CBC- Leukopenia, Neutropenia, Thrombocytopenia
43
Fourth Generation Cephalosporins
Most effective- Highest activity against gram-negative bacteria and anaerobes, highest resistance to beta-lactamases, and good distribution to CSF
44
First generation cephalosporins
Low, Low, Poor
45
Second Generation Cephalosporins
Higher, Higher, Poor
46
Pre administration for Nurse on Cefazolin
Get a culture, Class of drug includes 5 subgroups so don't confuse,
**Hard no PMH of severe allergic reaction to other beta lactams**
47
Dosing of Cefazolin
Reduce dose when renal impairment except for ceftriaxone
- Oral dose with meals
- Im administration is painful so forewarn client
- IV piggyback IV push (3-5 minutes)
48
Evals and interventions of Cefazolin
Bleeding problems with some of the drugs, c dificile, don't drink alcohol, don't take drugs that promote bleeding, calcium drugs can have a bad combo
Cefotetan- Bleeding and sulfa reaction
X- just bleeding
Z- Just Sulfa
49
Carbapenems: Imipenem-Cilastatin Name
Primaxin
50
Use of Carbapenems: Primaxin
Still Cell Wall- Extremely broad spectrum antibiotic
51
Carbapenems (Primaxin) Onset of action, routes, metabolism and excretion
Rapid, IM and IV, Renal dehydropeptidase, Almost entirely kidney
52
Common side effects of Carbapenems (Primaxin)
Diarrhea, rash, nausea, vomiting
| The classics of Beta Lactam Antibiotics
53
Severe side effects of Carbapenems (unique to this drug)
- Pseudomembranous colitis
- CNS toxicity
- Seizures
54
Precautions of Primaxin
Previous renal impairment and seizure disorders,
Interacts with lots of drugs (Probenecid, cyclosporine, ganciclovir, valproate).
No IM if Severe shock or AV block
55
Glycopeptide
Vancomycin
56
Use of Vancomycin
Gram positive bacteria, cdif, MRSA
57
Route of vancomycin
IV and PO
58
Vancomycin Common and Serious adverse (3)
Common- thrombophlebitis (clot in vein causing swelling)
| Serious: Renal failure, ototoxicity, red man syndrome
59
Carbapenims (Primaxin) typically used for what
Used for illnesses considered critical
60
Vancomycin typical administration va IV
Typically 250 mL of fluid dilution given over 1-1.5 hours
61
Vancomycin trough level
@ 4th dose check level of drug, has narrow therapeutic range so must be mindful of this prior to administration
62
MAR/PMH considerations for patients taking Vancomycin
Px is taking any other drug that causes ototoxicity (loop diuretics, erythromycin, etc)
**Hard no is renal impairment for patient**
Be aware of hearing loss and administration to older adults since its hard on kidneys- old peoples kidneys are already not operating great
63
Dosage of Vancomycin
Reduce dose with renal impairment
| affective serum trough level- 15-20mcg/ml
64
Administration of Vancomycin
IV Piggyback slowly (60 minutes or longer)
65
Evals and interventions for Vancomycin
Trough levels, no other nephrotoxic drugs, infuse slowly to avoid red man syndrome
66
Monobactams: Aztreonam
Azactam
67
Azactam Onset of action, Routes
Rapid, IM, IV, Inhaled!!
68
Azactam Use
Serious gram negative infections. Inhaled route used to treat patients with cystic fibrosis (P. aeruginosa)
69
Azactam common and serious adverse effects
Common- pain at IM site
| Serious- seizures, anaphylaxis, pseudomembranous colitis
70
Can you give px with PCN allergy Azactam?
Yes, considered safe
71
Precautions for administering Aztreonam (Azactam)
- Renal impairment
| - Low FEV1, Pulmonary function test- cant get inhaled drug down with force where it needs to go
72
Two bacteriastatic antibiotics
Tetracyclines and Macrolides
73
Tetracyclines Use
Mycoplasma bacteria, STDs and Acne, or if you have a PCN allergy
74
MOA of Tetracyclines
Binds with 3OS ribosomes and inhibits microbial protein synthesis- bacteriostatic
75
Tetracycline Onset of action, route, absoroption, metabolism, excretion
rapid, PO, 75% stomach, liver metabolism, excreted renal
76
Common adverse effects of Tetracycline
Trifecta (Diarrhea, nausea, and vomiting)
| ***photosensitivity**
77
Hard nos of tetracycline
Pregnant, less than 8 years of age, and significant renal impairment
78
Severe effects of tetracyclines
Hepatotoxicity, pancreatitis, superinfection, discoloration of teeth (enamel hypoplasia- 8 years of age or less), interfere with bone growth- 8 years of age or less
79
Admin of Tetracyclines
Take on empty stomach, 2 hours between tetracycline and chelators (heavy metal therapy)
80
Tetracycline what do I do if I have GI upset
Let provider know I need to take with food, don't take with milk because this will interfere with absorption
81
Macrolides: Erythromycin use
PCN substitutute!! and used for STIs
82
Erythromycin MOA
Suppresses protein synthesis at the level of the 50S bacterial ribosome- bacteriostatic
83
Erythromycin Onset of action, route, metabolism and excretion
rapid, PO and IV, partially by liver and CYP450 and CYP3A4
| excreted mainly through bile and a small amount through urine
84
Serious side affects of Erythromycin
Ototoxicity, superinfection, QT interval prolongation, pseudomembranous colitis
85
Hard nos of Erythromycin
history of long QT syndrome, taking inhibitors of CYP3A4, (verapamil and diltiazem, HIV protease inhibitors, antifungals)
86
Aminoglycoside
Gentamicin
87
Use of Gentamicin
Serious aerobic gram-negative infections in combo with vanco or beta lactam
88
MOA of Gentamicin
Inhibits protein synthesis in bacteria at level 3OS ribosome, bactericidal
89
Gentamicin Onset of action, Routes, Metabolism, Excretion
Rapid, IM IV, Not in liver, 90% via kidneys
90
Serious side effects of Gentamicin
Ototoxicity, nephrotoxicity, inhibits neuromuscular transmission
(Trough level checking is big for this drug as well)
91
Gentamicin pre admin
Monitor serum creatinine/BUN, withhold if oliguria/anuria
92
Gentamicin PMH and MAR considerations
PMH: Renal impairment or possible hearing impairment
MAR: nephrototoxic and ototoxic drugs
93
Administration of Gentamicin
Reduce dose with renal impairment, adjust dose to achieve effective trough level
Give slowly- IV piggyback 30 minutes or longer
94
Ongoing eval and interventions- things to be mindful of when giving this drug
Instruct px to report tinnitus, high-frequency hearing loss, headache, nausea, dizziness or vertigo
95
Sulfonamides
Trimethoprim-sulfamethoxazole
96
Trimethoprim-sulfamethoxazole Use
Bronchitis, Shigella, Ear infections (otitis media), pneumonia, UTI, travelers diarrhea
97
Trimethoprim-sulfamethoxazole MOA
Inhibits the metabolism of folic acid bacteria at 2 different points (Bacteriostatic)
98
Trimethoprim-sulfamethoxazole Onset of action, Routes, Metabolism, excretion
Rapid, PO or IV, 20% liver, excreted active form via renal
99
Things to know with Trimethoprim-sulfamethoxazole
- Dont give to pregnant women (folic acid)
- Sulfa allergy is a no
- Renal or liver impairment is contraindicated
- Infants less than 2 months
- Serious side effects include hyperkalemia, hyponatremia, and steven johnson syndrome
100
Fluoroquinolones: Ciprofloxacin Use
| "Cip-pro-flox-a-cin"
Gram negative infections and some gram positive organisms
101
MOA of Ciprofloxacin
Inhibits bacterial DNA synthesis by inhibiting a DNA enzyme
| Bactericidal
102
Ciprofloxacin Onset of action, Routes, Metabolism, Excretion
Rapid, PO IV, Small amounts in liver, excreted 40-50% unchanged by kidney
103
Black box warnings of Ciprofloxacin
tendinitis, tendon rupture, peripheral neuropathy, seizures (elevated intracranial pressure) hepatotoxicity
104
Cannot take Ciprofloxacin with ______
titzanidine (Zanaflex)
105
Precautions and Interactions of Ciprofloxacin
Precautions: CNS disorder, Renal impairment, history of prolonged QT interval
Interactions: Be careful when taking with OTC meds- can cause prolonged QT intervals
