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DNURS 836 Advanced Pharmacology for Anesthesia II > Lecture 8-Antimicrobials > Flashcards

Lecture 8-Antimicrobials Flashcards

1
Q

The lowest concentration of antibiotic required to prevent growth is the ___

A

minimum inhibitory concentration (MIC)

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2
Q

The lowest concentration of antibiotic required to kill bacteria is the ___

A

minimum bactericidal concentration (MBC)

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3
Q

You can compare MICs of different antibiotics to each other–T/F?

A

False–cannot compare MICs of different antibiotics to each other

You can, however, compare MIC of one single antibiotic to different organisms (i.e.: MIC of cipro for klebsiella vs. pseudomonas)

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4
Q

Bacterial sensitivity–disc diffusion technique–multiple discs of antibiotic are placed on an inoculated growth medium; antibiotic diffuses outward from the discs; antibiotic susceptibility is determined by the ___ around each disc

A

antibiotic susceptibility is determined by the radius around each disc

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5
Q

What is the difference between bactericidal and bacteriostatic?

A

Bactericidal = kills the bacteria

Bacteriostatic = stops the bacteria from replicating (but does not kill the existing bacteria)

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6
Q

Penicillins, cephalosporins, aminoglycosides, vancomycin, quinolone, aztreonam, imipenem, bacitracin, and polymyxins are all bacteri___

A

bactericidal

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7
Q

Tetracyclines, chloramphenicol, eryrthromycin, clindamycin, sulfonamides, and trimethoprim are all bacteri___

A

bacteriostatic

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8
Q

Narrow-spectrum antibiotics kill ___ (many/few) bacteria

A

few bacteria

examples = penicillin G, erythromycin, clindamycin

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9
Q

Broad-spectrum antimicrobials kill ___ (many/few) bacteria

A

many bacteria

examples = ampicillin, cephalosporins, ahminoglycosides, tetracyclines, chloramphenicol, quinolones

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10
Q

Time-dependent killing = antibiotics that increase their rate of microbial killing with concentrations up to ___x MIC

A

4x MIC

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11
Q

Time-dependent killing–greater concentrations ___ (do/do not) kill bacteria faster or in greater numbers

A

greater concentrations do NOT kill bacteria faster or in greater numbers

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12
Q

Time-dependent killing–clinical efficacy is related to the duration for which these levels are maintained–T/F?

A

True

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13
Q

What (3) antibiotic classes demonstrate time-dependent killing?

A
  • Beta-lactams
  • Monobactams (aztreonam)
  • Macrolides (erythromycin, clindamycin)
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14
Q

Continuous infusion of time-dependent killing antibiotics ___ (has/has not) shown to be more effective than intermittent boluses

A

continuous infusion of time-dependent killing antibiotics has NOT shown to be more effective than intermittent boluses

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15
Q

What term describes the following?–some antibiotics continue to suppress the growth of bacteria even after the antibiotic is no longer detectable

A

Post Antibiotic Effect (PAE)

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16
Q

PAE is demonstrated virtually for all antimicrobials–T/F?

A

True

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17
Q

PAE can be ___ (increased/decreased) in acidic, infected media

A

decreased

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18
Q

During the PAE phase, bacteria are ___ (more/less) susceptible to killing by leukocytes–this is known as what?

A

During the PAE phase, bacteria are MORE susceptible to killing by leukocytes–this is known post antibiotic leukocyte effect

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19
Q

What is the judicious use of antibiotics to reduce resistance development?

A

Antimicrobial stewardship

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20
Q

(2) types of antibiotic resistance–___ and ___

A

intrinsic and acquired

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21
Q

___ (intrinsic/acquired) resistance is natural resistance to the antimicrobial

A

Intrinsic resistance is natural resistance to the antimicrobial

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22
Q

___ (intrinsic/acquired) resistance reflects a genetic alteration in the bacteria that renders a once effective antimicrobial ineffective

A

Acquired resistance reflects a genetic alteration in the bacteria that renders a once effective antimicrobial ineffective

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23
Q

What are some ways that acquired antibiotic resistance can occur?–___ (increased/decreased) permeability; ___ (increased/decreased) efflux pumps; ___activation; ___ of the antimicrobial target

A

decreased permeability; increased efflux pumps; inactivation; modification of the antimicrobial target

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24
Q

The majority of nosocomial (hospital-acquired) infections are ___, ___, and ___ infections

A

urinary, respiratory, and blood infections

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25
Q

2018 CDC data–1 in ___ hospitalized patients will develop an infection

A

1 in 31 hospitalized patients

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26
Q

Nosocomial infections are highly associated with the use of ___

A

devices–i.e.: ventilator, vascular access catheter, urethral catheter

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27
Q

Nosocomial infections occur due to breakdown or bypass of normal host defenses and clearance mechanisms–T/F?

A

True

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28
Q

Different devices support various microorganisms differently–T/F?

A

True

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29
Q

Rate of central line related infections (from highest risk location to lowest risk location)

A

Femoral > IJ > Subclavian

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30
Q

Antibiotic impregnated catheters may decrease bacteremia, but this is not shown to be true in all studies–T/F?

A

True

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31
Q

Clostridium difficile is now known as ___

A

Clostridioides difficile

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32
Q

What provokes C. difficile disease? How?

A

Antibiotic therapy, including prophylaxis…it alters normal bowel flora

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33
Q

Pathogenesis of C. diff–typically ___-mediated; bacteremia with C. diff is extremely ___ (rare/common)

A

toxin-mediated–enterotoxin A, cytotoxin B; bacteremia with C. diff is extremely rare

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34
Q

Diagnosis of C. diff is confirmed by detection of one of the ___

A

toxins

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35
Q

C. diff spores are extremely hearty and impervious to antibiotic therapy, resulting in a 10% relapse rate in successfully treated patients–T/F?

A

True

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36
Q

Treatment of C. diff = oral ___

A

oral vancomycin

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37
Q

Dificid (fidaxomicin) is another antibiotic that can be used to treat C. diff with similar cure rates as Vancomycin and reduced recurrence for moderate to severe infection–T/F?

A

True

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38
Q

In patients with ongoing original infection [the infection that they had before getting C. diff]…treat the infection with appropriate ___-spectrum antibiotics; continue C. diff therapy also and extend the C. diff therapy course for ___ to ___ days after the completion of the other antibiotics

A

In patients with ongoing original infection [the infection that they had before getting C. diff]…treat the infection with appropriate broad-spectrum antibiotics; continue C. diff therapy also and extend the C. diff therapy course for 5 to 10 days after the completion of the other antibiotics

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39
Q

Treatment course of C. diff is usually ___ to ___ days

A

Treatment course of C. diff is usually 10 to 14 days

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40
Q

In the future, C. diff ___ (can/cannot) be provoked with subsequent antibiotic courses because of the presence of latent ___

A

In the future, C. diff can be provoked with subsequent antibiotic courses because of the presence of latent spores

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41
Q

C. diff risk factors–anti___ use; ___ suppressant therapy; inappropriate ___ and ___ techniques

A

antimicrobial use; acid suppressant therapy; inappropriate hand washing and cleaning techniques

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42
Q

Surgical antibiotic prophylaxis ___ (is/is not) usually necessary to continue past the 1st post-op day

A

Surgical antibiotic prophylaxis is NOT usually necessary to continue past the 1st post-op day

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43
Q

For surgical antibiotic prophylaxis, usually use what antibiotic class?

A

1st generation cephalosporin–cefazolin

Low cost, broad spectrum, low incidence of allergic reactions

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44
Q

Wound classification–classes __-__

A

classes I-IV

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45
Q

Class I = ___; ___traumatic, no break in ___ technique; ___, ___, and ___ tracts not entered

A

Class I = clean

  • atraumatic
  • no break in sterile technique
  • respiratory, GI, and GU tracts not entered
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46
Q

Class II = ___; surgery in areas known to harbor ___; ___ spillage of contents

A

Class II = clean-contaminated

  • surgery in areas known to harbor bacteria
  • no spillage of contents
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47
Q

Class III = ___; major break in ___ technique; surgery on ___ wounds; gross ___ spillage; entrance into an infected ___ or ___ tract

A

Class III = contaminated

  • major break in sterile technique
  • surgery on traumatic wounds
  • gross GI spillage
  • entrance into an infected biliary or GU tract
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48
Q

Class IV = ___; infection existed ___ the surgery, i.e.: old wound with devitalized tissue, perforated viscera

A

Class IV = dirty-infected; infection existed before the surgery, i.e.: old wound with devitalized tissue, perforated viscera

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49
Q

Surgical prophylaxis recommendations for clean wounds–___ species most common; ___ (need/no need) for prophylaxis for some clean procedures, Gm(+) coverage with ___

A

Surgical prophylaxis recommendations for clean wounds–Staphylococcal species most common; no need for prophylaxis for some clean procedures, Gm(+) coverage with cefazolin

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50
Q

Surgical prophylaxis recommendations for clean-contaminated and contaminated wounds–administer ___ antibiotics; also for ___ and most ___ tract procedures

A

Surgical prophylaxis recommendations for clean-contaminated and contaminated wounds–administer prophylactic antibiotics; also for hysterectomies and most urinary tract procedures

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51
Q

Surgical prophylaxis recommendations for patients at high or moderate risk undergoing procedures involving infected tissues or receiving prosthetic cardiac valves–include anti___coccal antibiotics for cellulitis and osteomyelitis; coverage for ___ (active/inactive) infections

A

include antistaphylococcal antibiotics for cellulitis and osteomyelitis; coverage for active infections

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52
Q

Efficacy of prophylaxis for fungal infection is difficult to prove–T/F?

A

True

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53
Q

Diagnosis of invasive candidal infection is difficult to prove even with modern blood culture techniques because it is difficult to distinguish between candidal colonization and invasion–T/F?

A

True

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54
Q

Some agree with the use of pre-emptive therapy with fluconazole in certain clinical situations–T/F?

A

True

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55
Q

Issue with antifungal prophylaxis is complicated by Fluconazole-resistant ___ emerging

A

Fluconazole-resistant C. albicans emerging

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56
Q

Prophylactic antibiotic administration is initiated within ___ minutes prior to the surgical incision

A

120 minutes prior to the surgical incision

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57
Q

Ancef is initiated within ___ minutes prior to the surgical incision

A

Ancef is initiated within 60 minutes prior to the surgical incision

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58
Q

Vanco is initiated within ___ minutes prior to the surgical incision

A

Vanco is initiated within 120 minutes prior to the surgical incision

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59
Q

JAMA surgery 2019–increasing duration of antimicrobial prophylaxis was associated with higher odds of acute ___ injury and ___ infection in a duration-dependent fashion

A

increasing duration of antimicrobial prophylaxis was associated with higher odds of acute kidney injury and C. diff infection in a duration-dependent fashion

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60
Q

JAMA surgery 2019–extended duration of antibiotic prophylaxis (3 days, 5 days post-op) ___ (did/did not) lead to additional SSI reduction

A

extended duration (3 days, 5 days post-op) did NOT lead to additional SSI reduction

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61
Q

Antibiotic medications by class–beta-___; ___sporins; ___bactams, ___penems; ___lides; ___quinolones; ___cyclines; ___glycosides

A
  • beta-lactams
  • cephalosporins
  • monobactams, carbapenems
  • macrolides
  • fluoroquinolones
  • tetracyclines
  • aminoglycosides
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62
Q

What (4) antibiotic classes are beta-lactams?

A
  • Penicillin
  • Cephalosporins
  • Carbapenem
  • Monobactam
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63
Q

Beta-lactams bind to the ___; they are ___ inhibitors

A

Beta-lactams bind to the penicillin binding protein (PBP); they are cell wall synthesis inhibitors

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64
Q

What enzyme causes penicillin resistance?

A

B-lactamase–breaks a bond in the B-lactam ring of penicillin to disable the molecule

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65
Q

Bacteria with B-lactamase can resist the effects of ___ and other ___ antibiotics

A

can resist the effects of penicillin and other B-lactam antibiotics (cephalosporins, carbapenem, monobactam)

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66
Q

What can be added to penicillin antibiotics to prevent resistance?

A

A beta-lactamase inhibitor

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67
Q

(3) beta-lactamase inhibitors = ___bactam, ___bactam, ___ acid

A

sulbactam, tazobactam, clavulanic acid

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68
Q

Penicillins end in -___

A

-cillin

Examples = penicillin ampicillin, amoxicillin, piperacillin, ticarcillin, oxacillin, nafcillin, dicloxacillin, methicillin

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69
Q

Zosyn = ___ + ___

A

piperacillin + tazobactam

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70
Q

Penicillin ___ (is/is not) stable to beta lactamase

A

Penicillin is NOT stable to beta lactamase (have to add a beta-lactamase inhibitor to it)

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71
Q

Penicillin is effective in treating strep __ and __; ___

A

Strep A and B; treponema pallidum (syphilis)

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72
Q

Side effects of penicillin–hyper___; ___ upset; ___rrhea; ___ reaction

A

hypersensitivity; GI upset; diarrhea; Jarisch-Herxheimer reaction

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73
Q

What is Jarisch-Herxheimer reaction? What antibiotic may cause it?

A

high fevers, rash, similar to Rocky Mountain spotted fever; penicillin may cause it

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74
Q

Penicillin is often used before ___ procedures

A

dental procedures (lots of strep in the mouth)

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75
Q

If someone has a penicillin allergy, what are the next antibiotic choices? ___ or ___

A

vancomycin or cleocin

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76
Q

Clinical Infectious Diseases October 2017–patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of ___-line perioperative antibiotics

A

attributable to the receipt of second-line perioperative antibiotics

Because people with penicillin allergy will often receive vancomycin or cleocin instead–vanco only covers gram positive infections (staph, strep); cleocin has some broad spectrum coverage but doesn’t really cover some of the common bacteria that cause SSIs

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77
Q

MRSA and C. diff rates are ___ (lower/higher) in patients with a reported penicillin allergy because they have higher use of ___-spectrum antibiotics

A

MRSA and C. diff rates are higher in patients with a reported penicillin allergy because they have higher use of broad spectrum antibiotics

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78
Q

What antibiotic has the highest rates of resultant C. Diff infection?

A

Cleocin

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79
Q

Pencillins, when given alone, ___ (are/are not) stable to beta-lactamase

A

Penicillins, when given alone, are NOT stable to beta-lactamase

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80
Q

Penicillins with beta lactamase inhibitors ___ (do/do not) cover MRSA

A

Penicillins with beta lactamase inhibitors do NOT cover MRSA

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81
Q

Ticarcillin +/- Clavulanate (Timentin) causes what electrolyte abnormalities?–___natremia, ___kalemia

A

hypernatremia, hypokalemia

82
Q

Piperacillin +/- Tazobactam (Zosyn) side effects–prolonged ___ time; ___kalemia; ___penia at high doses

A

prolonged bleeding time; hypokalemia; neutropenia at high doses

83
Q

Cephalosporin antibiotics are bacteri___

A

bactericidal–cell wall synthesis inhibitors, beta lactam ring

84
Q

Cephalosporin MOA is the same as ___

A

penicillins

85
Q

Cephalosporins are ___ (more/less) susceptible to penicillinases (ESBLs)

A

Cephalosporins are less susceptible to penicillinases (ESBLs)

So cephalosporins are more effective against bacteria with beta lactamase

ESBL = extended spectrum beta lactamase

86
Q

Spectrum of action of cephalosporins is based on ___

A

generation

87
Q

How many generations of cephalosporins are there?

A

5 generations–1st to 5th

88
Q

As you go up in generation of cephalosporins, you lose gram ___ coverage and gain gram ___ coverage

A

As you go up in generation of cephalosporins, you lose gram positive coverage and gain gram negative coverage

89
Q

___ generation cephalosporins = cefazolin, cephalexin

A

1st generation

90
Q

___ generation cephalosporins = cefaclor, cefoxitin, cefprozil, cefuroxime, loracarbef

A

2nd generation

91
Q

___ generation cephalosporins = cefotaxime, cefpodoxime, ceftazidime, ceftibutne, ceftriaxone

A

3rd generation

92
Q

___ generation cephalosporins = cefepime

A

4th generation

93
Q

___ generation cephalosporins = ceftobiprole, ceftaroline

A

5th generation

94
Q

Half-life of ancef is ___ hours

A

1.8 hours

95
Q

If procedure is going beyond ___ hours, need to redose ancef

A

If procedure is going beyond 4 hours, need to redose ancef

96
Q

Cephalexin (keflex) and cefazolin (ancef) are both ___ eliminated

A

renally eliminated

97
Q

Cefazolin (ancef) is generally safe–T/F?

A

True

98
Q

3rd generation cephalosporins have even less gram ___ activity but have an extended gram ___ spectrum

A

3rd generation cephalosporins have even less gram positive activity but have an extended gram negative spectrum

99
Q

Ceftazidime and cefoperazone [3rd generation cephalosporins] are anti-___

A

anti-pseudomonal

100
Q

Which 3rd generation cephalosporins cross the BBB and can be used to treat meningitis?

A

Ceftriaxone (rocephin); cefotaxime (claforan)

101
Q

Classes of cephalosporins can be used interchangeably–T/F?

A

False–cannot switch between classes for treatment

102
Q

What 3rd generation cephalosporin has significant biliary excretion?

A

Cefotaxime (Claforan)

103
Q

Ceftazidime (Fortaz) is a ___ generation cephalosporin; it covers most gram ___ with good ___ coverage

A

Ceftazidime (Fortaz) is a 3rd generation cephalosporin; it covers most gram negatives with good pseudomonas coverage

104
Q

Ceftazidime (Fortaz) [3rd gen cephalosporin] + avibactam (beta lactamase inhibitor) offers significant gram ___ coverage and is usually reserved to treat ___

A

Ceftazidime (Fortaz) + avibactam offers significant gram negative coverage and is usually reserved to treat MDROs–multidrug resistant organisms

105
Q

Ceftriaxone (Rocephin) is a ___ generation cephalosporin; it covers ___ better than most 3rd gens and most ___; covers most gram ___; ___ (does/does not) cover pseudomonas

A

Ceftriaxone (Rocephin) is a 3rd generation cephalosporin; it covers staph better than most 3rd gens and most strep; covers most gram negatives; does NOT cover pseudomonas

106
Q

Max dose of ceftriaxone (rocephin) per day = ___ grams

A

4 grams/day

107
Q

Side effects of ceftriaxone (rocephin) = ___ and biliary ___, particularly in young children; precipitates with ___ if running in the same IV line

A

diarrhea and biliary sludging, particularly in young children; precipitates with calcium if running in the same IV line

108
Q

Main differences between ceftazidime (fortaz) and ceftriaxone (rocephin)–fortaz covers more gram ___, better ___ coverage; rocephin has more gram ___ coverage (not as good as 1st and 2nd generation cephalosporins), ___ (does/does not) cover pseudomonas

A

fortaz covers more gram negatives, better pseudomonas coverage; rocephin has more gram positive coverage (not as good as 1st and 2nd generation cephalosporins), does not cover pseudomonas

109
Q

Ceftaroline (Teflaro) is a ___ generation cephalosporin; covers ___; gram ___ bacteria; has broad-spectrum activity against gram ___ bacteria

A

Ceftaroline (Teflaro) is a 5th generation cephalosporin; covers MRSA; gram positive bacteria; has broad-spectrum activity against gram negative bacteria

110
Q

Cefiderocol (Fetroja) is a ___ generation cephalosporin; it is the first cephalosporin to cover ___

A

Cefiderocol (Fetroja) is a 5th generation cephalosporin (just came out in 2020); it is the first cephalosporin to cover Acinetobacter baumannii complex

111
Q

Carbapenems–imipenem/cilastatin (primaxin) … cilastatin ___ (is/is not) a beta-lactamase inhibitor

A

cilastatin is NOT a beta-lactamase inhibitor

112
Q

What does cilastatin do?–it inhibits ___ enzyme from breaking down imipenem

A

Cilastatin inhibits dihydropeptidase enzyme from breaking down imipenem

113
Q

Imipenem/cilastatin (primaxin) has a high risk of ___

A

seizures

114
Q

Primaxin [imipenem/cilastatin] + relebactam = ___, reserved for ___ gram negative infections in the ___ and ___

A

Primaxin [imipenem/cilastatin] + relebactam = recarbrio, reserved for MDRO gram negative infections in the urine and abdomen

115
Q

Carbapenems are best to treat ___

A

ESBLs–extended spectrum beta lactamases

116
Q

Meropenem is a ___; it has a ___ (lower/higher) incidence of seizures than imipenem

A

Meropenem is a carbapenem; it has a lower incidence of seizures than imipenem

117
Q

Primaxin vs. meropenem–primaxin has ___ (better/worse) coverage, ___ (lower/higher) risk of seizures; meropenem has (better/worse) coverage, ___ (lower/higher) risk of seizures

A

Primaxin has better coverage, higher risk of seizures; meropenem has worse coverage, lower risk of seizures

118
Q

Ertapenem (Invanz) has a ___ (low/high) seizure risk

A

low seizure risk

119
Q

What is one monobactam antibiotic?

A

Aztreonam

120
Q

Aztreonam has same MOA as ___; it is ___-spectrum

A

Aztreonam has same MOA as carbapenems; it is narrow-spectrum

121
Q

Vancomycin inhibits ___ formation; disrupts cell wall ___; bacteri___; ___ (concentration/time) dependent

A

Vancomycin inhibits peptidoglycan formation; disrupts cell wall synthesis; bactericidal; concentration dependent

122
Q

Vanco is given PO to treat ___ only; usually is given IV for treatment of other infections

A

Vanco is given PO to treat C. diff only; usually is given IV for treatment of other infections

123
Q

If you take vanco orally, it does not leave the GI tract–T/F?

A

True

124
Q

Vancomycin ___ (is/is not) a beta lactam

A

Vancomycin is not a beta lactam

125
Q

Beta lactams are ___ (time/concentration) dependent

A

Beta lactams are time dependent

126
Q

Vancomycin is ___ (time/concentration) dependent

A

Vancomycin is concentration dependent

127
Q

Vancomycin offers ___ (broad/narrow) spectrum gram ___ (positive/negative) coverage

A

Vancomycin offers broad spectrum gram positive coverage

Treats staph, strep, enterococci, C. diff

128
Q

Vancomycin is ___ eliminated

A

renally

129
Q

Side effects of vanco = ___ syndrome; ___toxicity; ___toxicity; ___penia

A

Red-Man syndrome; nephrotoxicity; ototoxicity; thrombocytopenia

130
Q

New guidelines for serious infections dose vanco based on the ___

A

AUC–area under the curve

131
Q

Vanco weight based dosing–___mg/kg

A

15 mg/kg

1 g usually does not cut it as a loading dose

132
Q

Linezolid (Zyvox) inhibits protein synthesis by binding ___S ribosomal subunit of the ___S ribosome to prevent the formation of a functional ___S initiation complex

A

Linezolid (Zyvox) inhibits protein synthesis by binding 23S ribosomal subunit of the 50S ribosome to prevent the formation of a functional 70S initiation complex

133
Q

Linezolid (Zyvox) is bacter___ against enterococci and staph; bacteri___ against most strep

A

Linezolid (Zyvox) is bacteriostatic against enterococci and staph; bactericidal against most strep

134
Q

Linezolid (Zyvox) offers ___ (broad/narrow) gram ___ (positive/negative) coverage against MRSA, VRE, enterococci faecalis and faecium

A

Linezolid (Zyvox) offers broad gram positive coverage against MRSA, VRE, enterococci faecalis and faecium

135
Q

Side effects of linezolid (Zyvox)–___suppression–___emia, ___penia, ___penia, ___penia…check CBC; drug interaction with ___, potential for ___ syndrome

A

myelosuppression–anemia, leukopenia, pancytopenia, thrombocytopenia…check CBC; drug interaction with MAO (monoamine oxidase), potential for serotonin syndrome

136
Q

What should you do if a person is on an SSRI and is going to be started on linezolid (Zyvox)?

A

Hold SSRI to prevent the development of serotonin syndrome because linezolid is a MAOI

137
Q

Macrolides MOA–bind to the ___S ribosomal subunit targeting ___S ribosomal RNA –> inhibit protein ___ –> bacterio___

A

bind to the 50S ribosomal subunit targeting 23S ribosomal RNA –> inhibit protein synthesis –> bacteriostatic

138
Q

Azithromycin (Zithromax) is a ___; half-life is ___ hours, only dose ___ per day; may prolong ___ interval

A

Azithromycin (Zithromax) is a macrolide; half-life is 68 hours, only dose once per day; may prolong QT interval

139
Q

Azithromycin (Zithromax) has drug interactions with ___phylline, ___sporine, ___toin, ___mazepine, ___vudine; interactions ___ (are/are not) a CYP3A4 mechanism

A

theophylline, ciclosporine, phenytoin, carbamazepine, zidovudine (AZT–azidothymidine…drug used to prevent/treat HIV/AIDS); interactions are NOT a CYP3A4 mechanism (so it’s not an inhibitor or inducer of these medications)

140
Q

Macrolides end in -___

A

-thromycin

141
Q

Clarithromycin (Biaxin) may prolong ___ interval, has significant ___ toxicity, same drug interactions as azithromycin but is a potent ___ (inhibitor/inducer) of CYP3A4

A

Clarithromycin (Biaxin) may prolong QT interval, has significant GI toxicity, same drug interactions as azithromycin but is a potent inhibitor of CYP3A4

142
Q

Erythromycin is the drug of choice for ___ disease; also used to treat gastro___, alternative to reglan

A

drug of choice for Legionnaires’ disease; also used to treat gastroparesis, alternative to reglan (because reglan has extrapyramidal side effects)

143
Q

Erythromycin may cause significant ___ toxicity, may prolong ___ interval, and has CYP3A4 interactions

A

Erythromycin may cause significant GI toxicity, may prolong QT interval, and has CYP3A4 interactions

144
Q

Which macrolide has the most drug interactions?

A

Clarithromycin (Biaxin) because it is a CYP3A4 inhibitor

But all macrolides have CYP3A4 drug interactions

145
Q

Fluoroquinolones have many drug interactions–___s, ___, ant___, ___, pro___

A

NSAIDs, warfarin, antacids, amiodarone, probenecid–used to treat gout

146
Q

How do fluoroquinolone work?–inhibit ___ synthesis

A

inhibit DNA synthesis

147
Q

FDA safety communication for fluoroquinolones–black box warning for patients > ___ years

A

black box warning for patients > 65 years

Avoid in elderly patients > 65 years when other antibiotics are appropriate

148
Q

High risk of side effects with fluoroquinolones–___itis/___ tendon rupture; ___logic effects; ___glycemia (fatal); ___idity/___ality; ___ prolongation

A

tendonitis/Achilles tendon rupture; neurologic effects; hypoglycemia (fatal); morbidity/mortality; QT prolongation

149
Q

Ciprofloxacin (Cipro) is a ___; it treats most gram ___ including P. aeruginosa; drug of choice for bacterial ___ infections

A

Ciprofloxacin is a fluoroquinolone; it treats most gram negatives including P. aeruginosa; drug of choice for bacterial GI infections (traveler’s diarrhea)

150
Q

Fluoroquinolones end in -___

A

-floxacin

Examples = ciprofloxacin, levofloxacin, ofloxacin, moxifloxacin

151
Q

Main things to know for FQ antibiotics–they can cause ___ prolongation; they cover a lot of gram ___; black box warning for elderly > age ___

A

they can cause QT prolongation; they cover a lot of gram negatives; black box warning for elderly > age 65

152
Q

Delafloxacin (Baxdela) is used to treat acute bacterial ___ and ___ structure infections

A

used to treat acute bacterial skin and skin structure infections

153
Q

Delafloxacin (Baxdela) is the first fluoroquinolone antibiotic with activity against ___; unlike other FQs, it is not associated with ___ prolongation or ___sensitivity

A

Delafloxacin (Baxdela) is the first fluoroquinolone antibiotic with activity against MRSA; unlike other FQs, it is not associated with QT prolongation or photosensitivity

154
Q

Tetracyclines bind irreversibly to the ___S ribosomal subunit; they inhibit ___ synthesis; they are bacter___

A

Tetracyclines bind irreversibly to the 30S ribosomal subunit; they inhibit protein synthesis; they are bacteriostatic

155
Q

Side effects of tetracycline antibiotics–___ upset; ___sensitivity; inhibition of ___ growth; ___toxicity; tooth dis___ and enamel ___plasia

A

Side effects of tetracycline antibiotics–GI upset, photosensitivity; inhibition of bone growth; hepatotoxicity; tooth discoloration (yellow teeth) and enamel hypoplasia

156
Q

Tetracycline antibiotics inhibit bone growth during ___ and ___ trimesters through the age of ___

A

inhibit bone growth during 2nd and 3rd trimesters through the age of 8

157
Q

Doxycycline (Vibramycin) has excellent tissue ___, including into the ___; causes permanent tooth ___; rare but fatal ___toxicity; drug interactions with ___farin, ___toin, ___pine, oral ___

A

Doxycycline (Vibramycin) has excellent tissue distribution, including into the CNS; causes permanent tooth discoloration; rare but fatal hepatotoxicity; drug interactions with warfarin, phenytoin, carbamazepine, oral contraceptives

158
Q

Aminoglycosides irreversibly bind ___S ribosomal subunit; also interfere with ___ and ___ cross bridging between cells at membrane level, causing cell wall damage (not as significant as beta lactams or vanco); bacter___

A

Aminoglycosides irreversibly bind 30S ribosomal subunit; also interfere with Ca and Mg cross bridging between cells at membrane level, causing cell wall damage (not as significant as beta lactams or vanco); bactericidal

159
Q

Aminoglycosides are ___ and ___toxic, prolong ___ blockade

A

Aminoglycosides are oto and nephrotoxic, prolong neuromuscular blockade

160
Q

Amikacin is an aminoglycoside used to treat ___

A

tuberculosis

161
Q

Gentamicin (Garamycin) is an ___; treats most gram ___ including pseudo___, S. ___, ___cocci; when used for gram positive, use with a ___

A

Gentamicin (Garamycin) is an aminoglycoside; treats most gram negatives including pseudomonas, S. aureus, enterococci; when used for gram positive, use with a beta lactam (cell wall destruction agent)

162
Q

Gentamicin is the most ___ spectrum of aminoglycosides and is the easiest to dose

A

Gentamicin is the most broad spectrum of aminoglycosides and is the easiest to dose

163
Q

Need to check ___ of aminoglycosides; want to prevent ___toxicity and ___toxicity

A

Need to check levels of aminoglycosides; want to prevent nephrotoxicity and ototoxicity

164
Q

Trimethoprim/sulfamethoxazole (Bactrim, Septra) are 2 bacter___ antibiotics, which = ___

A

Trimethoprim/sulfamethoxazole (Bactrim, Septra) are 2 bacteriostatic antibiotics, which = bactericidal

165
Q

Bactrim affects ___ synthesis to starve out bacteria so that it can’t create new DNA

A

Bactrim affects folic acid synthesis to starve out bacteria so that it can’t create new DNA

166
Q

Resistance to Bactrim is ___ (increasing/decreasing)

A

increasing…especially E. coli UTIs

167
Q

Bactrim is an alternative to vanco to treat ___ and ___

A

MRSA and VRSA

168
Q

Side effects of Bactrim–___cytopenia, ___penia, ___penia, ___ syndrome

A

pancytopenia, neutropenia, thrombocytopenia, Stevens Johnson Syndrome

169
Q

Bactrim is a ___ antibiotic, so take ___ allergies seriously

A

Bactrim is a sulfonamide antibiotic, so take sulfa allergies seriously

170
Q

Nitrofurantoin (Macrobid, Macrodantin) is used to treat ___ pathogens

A

urinary pathogens

171
Q

Side effects of nitrofurantoin (Macrobid, Macrodantin)–___/___; ___; ___; ___ache; ___ness; ___ion; peripheral ___itis; ___ complications; ___ damage; ___ dyscrasias

A

nausea/vomiting; rash; itch; headache; dizziness; confusion; peripheral neuritis; pulmonary complications; hepatic damage; blood dyscrasias

172
Q

Clindamycin (Cleocin) is used to treat ___ (aerobes/anaerobes), specifically ___ bacteria

A

Clindamycin (Cleocin) is used to treat anaerobes, specifically gut bacteria

173
Q

Clindamycin (Cleocin) has the highest ___ risk; and can cause prolonged ___ blockade

A

Clindamycin (Cleocin) has the highest C. diff risk; and can cause prolonged neuromuscular blockade

174
Q

Metronidazole (Flagyl) is used to treat all ___ (aerobes/anaerobes)

A

Metronidazole (Flagyl) is used to treat all anaerobes–both bacterial and protozoa

175
Q

Metronidazole (Flagyl) is ___ (time/concentration) dependent

A

Metronidazole (Flagyl) is concentration dependent

176
Q

Side effects of metronidazole = ___titis, peripheral ___pathy; ___taxia; ___ion; ___pathy; ___ors

A

pancreatitis, peripheral neuropathy; ataxia; confusion; encephalopathy; tremors

177
Q

What happens if you drink alcohol while taking flagyl?

A

Disulfiram like reaction–alcohol withdrawal symptoms

178
Q

Flagyl interacts with what blood thinner?

A

Coumadin

179
Q

Quinupristin/Dalfopristin (Synercid) (30/70) are bacter___ individually but together are bacter___

A

Quinupristin/Dalfopristin (Synercid) (30/70) are bacteriostatic individually but together are bactericidal

180
Q

Quinupristin/Dalfopristin (Synercid) (30/70) should be given via ___ due to significant phlebitis

A

should be given via central line due to significant phlebitis

181
Q

Side effects of Quinupristin/Dalfopristin (Synercid) (30/70)–___gias, ___gias, ___ (increased/decreased) LFTs; CYP3A4 ___ (inhibitor/inducer)

A

myalgia, arthralgias, increased LFTs; CYP3A4 inhibitor

182
Q

Side effects of Daptomycin (Cubicin)–___/___ pain; ___gias; ___ (increased/decreased) CPK; ___ache; ___nia; ___ upset; ___; ___ (increased/decreased) LFTs

A

limb/muscle pain; myalgias; increased CPK; headache; insomnia; GI upset; rash; increased LFTs

183
Q

Rifampin and Rifabutin, when used as monotherapy, can cause rapid ___

A

Rifampin and Rifabutin, when used as monotherapy, can cause rapid resistance

184
Q

Rifampin and Rifabutin are potent ___ (inhibitors/inducers) of the CYP 450 system with significant interactions

A

Rifampin and Rifabutin are potent inducers of the CYP 450 system with significant interactions

185
Q

Rifampin and Rifabutin can rarely cause ___toxicity, ___ body fluids

A

Rifampin and Rifabutin can rarely cause hepatotoxicity, orange-red body fluids

186
Q

Rifampin and Rifabutin are used mostly to treat ___ and if a ___ has developed on a prosthetic

A

Rifampin and Rifabutin are used mostly to treat TB and if a biofilm has developed on a prosthetic

187
Q

What (3) antibiotics are OK to use in pregnant patients?

A
  • Penicillins
  • Cephalosporins
  • Erythromycin
188
Q

What (2) antibiotics should only be used in pregnancy if necessary?

A
  • Aminoglycosides

- Isoniazid–usually only used to prevent or treat TB

189
Q

What antibiotics should be avoided completely in pregnancy?–___dazole, ___cillin, ___fampin, ___prim, ___lones, ___cyclines

A

metronidazole, ticarcillin, rifampin, trimethoprim, fluoroquinolones, tetracyclines

190
Q

Tetracycline in pregnant women is associated with acute ___ of the liver, ___titis, and possible ___ injury

A

Tetracycline in pregnant women is associated with acute fatty necrosis of the liver, pancreatitis, and possible renal injury

191
Q

Canadian Population Study 11/2017–cleocin, doxycycline, FQs, macrolides, phenyoxymetylPCN = ___ (increased/decreased) risk of congenital malformations, risk of organ specific malfunctions; ___ (higher/lower) risk if used first trimester

A

increased risk of congenital malformations, risk of organ specific malfunctions; higher risk if used first trimester

192
Q

Canadian Population Study 11/2017–___cillin, ___sporins, ___bid = no increased risk of congenital malformations/organ specific malfunctions

A

amoxicillin, cephalosporins, Macrobid = no increased risk of congenital malformations/organ specific malfunctions

193
Q

Antivirals–Acyclovir (Zovirax) and Valacyclovir (Valtrex) ___ (induce/inhibit) viral DNA polymerases

A

inhibit viral DNA polymerases

194
Q

Side effects of Acyclovir (Zovirax) and Valacyclovir (Valtrex)–infrequent ___; ___ache; ___ea; ___nations; ___ors; ___ation; kidney ___

A

infrequent malaise; headache; nausea; hallucinations; tremors; agitation; kidney stones

195
Q

What antiviral medication is an option for those unresponsive to previous antiviral agents?

A

Foscarnet

196
Q

Amphoteracin B–anti___; half-life ___ hours; side effects = ___ failure; infusion ___; ___kalemia and ___ wasting; ___emia

A

antifungal; half-life 24 hours; side effects = renal failure; infusion reactions; hypokalemia and magnesium wasting; anemia

197
Q

Besides amphoteracin B, what other antibiotics cause hypokalemia?

A

penicillins–Piperacillin +/- tazobactam (zosyn), Ticarcillin +/- Clavulanate (Timentin)

198
Q

Fluconazole (Diflucan) is fungi___; side effect = rare ___toxicity; drug interactions d/t CYP___

A

Fluconazole (Diflucan) is fungistatic; side effect = rare hepatotoxicity; drug interactions d/t CYP3A4

199
Q

Itraconazole (Sporanox) is fungi___; side effects = ___/___, ___kalemia, ___ (increased/decreased) LFTs

A

Itraconazole (Sporanox) is fungistatic; side effects = nausea/vomiting, hypokalemia, increased LFTs

200
Q

Voriconazole (Vfend) has severe drug interactions–T/F?

A

True

201
Q

Side effects of voriconazole (Vfend) = ___/___; ___ (increased/decreased) LFTs, ___ vision, ___

A

nausea/vomiting; increased LFTs; blurred vision; rash

202
Q

Echinocandin antifungals are fungi___ against yeast, fungi___ against molds; used to treat ___ and ___

A

Echinocandin antifungals are fungicidal against yeast, fungistatic against molds; used to treat Aspergillus and Candida

Examples = caspofungin (Cancidas); micafungin (Mycamine); anidulafungin (Eraxis)

DNURS 836 Advanced Pharmacology for Anesthesia II (12 decks)

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