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Pharmacology > Pharm 19- Antimicrobials > Flashcards

Pharm 19- Antimicrobials Flashcards

1
Q

Outcomes in patients with deep sternal wound infections/cost

A

Significantly worse long-term survival

Costs between $200 and $250 to treat

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2
Q

What are the two major causes of device “failure” in assist devices?

A

Infection/sepsis

Thrombosis/Hemorrhage

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3
Q

MIC

A

Minimum Inhibitor Concentration; lowest concentration of antibiotic that inhibits bacterial growth

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4
Q

MBC

A

Minimum Bacteriocidal Concentration; lowest concentration of antibiotic that kills 99.9% of bacteria

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5
Q

Cidal vs. Static

A

Cidal kills bacterial, static just stops growth

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6
Q

If you mix a cidal with a static antibiotic…..

A

Static inhibitors growth
Cidal requires the bacteria to be dividing
So combination is less effective.

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7
Q

Three Major Pathogen Categories

A
  1. Gram Positive Bacteria
  2. Gram Negative Bacteria
  3. Fungi
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8
Q

How do penecillins and cephalosporins work?

A

Prevent bacterial cell wall peptidoglycan cross-linking so newly produced bacterial cell walls are “weak” and the bacteria “fall apart” (Marfan’s Disease)

These are cidal!

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9
Q

Marfan’s Disease

A

Abnormal connective tissue; can affect the heart

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10
Q

Cidal Antibiotics

A

Pencillins

Cephalosporins

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11
Q

How are penciilins and cephalosporins classified?

A

By “spectrum of activity” and resistance to B-lactamases (as well as potency, methods of administration, toxicities and dynamics)

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12
Q

What attachment differentiates the penicillins?

A

“R group”

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13
Q

What is a significant source of antibiotic resistance among microbes?

A

B-lactamase

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14
Q

What antibiotics are derived from mold?

A

Penicillins

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15
Q

“First Generation” Penicillins were effective against what?

A

Gram-positive organisms (particularly Strep)
Gram Negative Cocci
But resistance levels are high and growing

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16
Q

What is the archetype Penicillin?

A

Penicillin-G (Benzylpenicillin)

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17
Q

What developed in response to growing resistance among Staph? Describe the spectrum.

A

Anti-staphylococcal Penicillins; much narrower spectrum and are used specificially for Methicillin resistant Staph aureus and should be used sparingly

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18
Q

Types of Anti-Staphylococcal Penicillins

A

Dicoxacillin (Dynapen)
Nafcillin (Nallpe)
Oxacillin

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19
Q

What is no longer used clinically because to some toxic side effects?

A

Methicillin

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20
Q

Broad Spectrum Penicillins; Drug Examples

A

Spectrum similar to Pen-G, but more activity against gram-negatives
Resistance to broad-spectrum pens has increased dramatically (especially MRSA)

Ampicillin; Amoxicillin

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21
Q

What is the drug of choice for pre-cardiac surgery dental prophylaxis?

A

Amoxicillin

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22
Q

Antipseudomonal Penicillins Drugs

A

Carbenicillin (Geocillin)
Piperacillin (piperacil)
Ticarcillin (Ticar)

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23
Q

Pseudomonas Aeruginosa

A

very problematic, very pathogenic gram negative that readily develops resistance to antibiotics; notorious for causing blue-green pus

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24
Q

Antipseudomonal Penicillin Drugs are effective against what?

A

Pseudomonas Aeruginosa

Other gram-negative bacilli

25
Q

Clavulanic Acid

A

B-lactam ring like the penicillins but no antimicrobial activity; suicide inibitor of bacterial B-lactamase that attaches to and permanently deactivates the enzyme

26
Q

Clavulanic Acid is comibined with what?

A

Amoxicillin (Augmentin)
Ticarcillin (Timentin)
(work synergistically)

27
Q

How can penicillins be administered?

A

PO, IV, SQ

28
Q

How are penicillins excreted?

A

Kidneys (not metabolized there)

29
Q

Can penicillins cross the BBB?

A

No, except with meningitis inflame miniges are more permeable to it, permitting rapid penetration of the drug into CSF

30
Q

Cephalosporins

A

B-lactams essentially just like penicillins

31
Q

How are cephalosporins classified?

A

1st, 2nd, 3rd, and 4th generation based on their resistance to the B-lactamases and their antimicrobial spectrums

32
Q

What is very commonly used in open heart surgery and as part of the prime?

A

Cephalosporins (or vancomyocin as alternative)

33
Q

1st generation Cephalosporins

A

Less expensive that others
Since the main open-heart infection culprits are staph and strep, no advantage found using more expensive later-generation cephalosporins for ECC prophylaxis

34
Q

1st Generation Cephalosporin Drug

A

Cefazolin (Kefzol)

35
Q

Cefazolin (Kefzol)

A

Typically dosed at a fixed amt (1g/circuit) or by weight (50mg/kg)
Cleared by the kidneys
Cross sensitivity with penicillins is high

36
Q

2nd Generation Cephalosporins

A

No proven advantage over 1st generation when used in the pump prime
May provide theoretical advantage of greater VOD and slightly broader spectrum of activity

37
Q

2nd Generation Cephalosporin Examples

A

Cefoxitin (Mefoxin)
Cefotetan (Cefotan)
Cefuroxime (Ceftin)

38
Q

Vancomycin

A

A glycopeptide
Similar action to pens/cephs; prevents peptidoglycan polymerization in the bacterial cell wall so they “fall apart”
Spectrum of activity limited to gram positives
Reversed for use in MRSA, MRSE, enterococcal infections

39
Q

MRSA

A

methicillin resistance staph epidermidis

40
Q

How is Vancomycin excreted?

A

Renally

41
Q

Vancomycin Side Effects

A

More common than pens and cephs

Fever, chills, flushing, phlebitis

42
Q

Phlebitis

A

Inflammation of the vasculature

43
Q

Aminoglycosides Derived from?

A

Derived from fungi (like penicillins)

44
Q

Aminoglycosides ending in “mycin”

A

From streptomyces

45
Q

Aminoglycodies ending in “micin”

A

from micromonospora sp.

46
Q

How do aminoglycosides work?

A

Interefere with bacterial protein synthesis by binding to bacterial ribosomal 30S subunit…
“cidal” action

47
Q

Aminoglycoside Spectrum of Activity

A

limited to gram negative bacteria, such as E. coli, proteus mirabilis, pseudomonas aeruginosa

48
Q

When do aminoglycosides exhibit a synergistic effect?

A

When used with pens, cephs, vacomycin for resistance bacteria

49
Q

What exhibites concentration dependent killing?

A

Aminoglycosides

50
Q

Concentration-Dependent Killing

A

INcreasing concentrations of aminoglycosides kill increasing proportions of bacteria at increasing rates

51
Q

How are all aminoglycosides given?

A

Parenterally or used topically

52
Q

Do aminoglycosides penetrate CNS?

A

NO

53
Q

Aminoglycoside DRugs

A

Neomycin- used only topically (too nephrotoxic)
Steptomycin- First produced. Lots of microbial resistance has developed
Tobramycin (Nebcin)-mid level microbial resistance
Gentamicin- midlevel microbial resistance
Amikacin (Amikin)- least microbial resistance, most expensive

54
Q

What aminoglycoside drug has the least bacterial resistance?

A

Amikacin (Amikin)

55
Q

How are aminoglycosides excreted?

A

Renally and readily become “more toxic” in the presence of renal failure

56
Q

What minimzes side effects of aminoglycosides?

A

adequate hydration/urine output

57
Q

Where do aminoglycosides concentartion?

A

Cross the blood/placenta barrier

Concentrate in fetal tissue

58
Q

Aminoglycoside Toxicity

A
  1. Ototoxicity (Vestibular and or cochlear)
  2. Neuromuscular Paralysis (esp. myastenia gravis patients)
  3. Nephrotoxicity ranging form mild to total renal destruction

Pharmacology (23 decks)

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