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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
Clavulanic Acid
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
Clavulanic Acid is comibined with what?
Amoxicillin (Augmentin) Ticarcillin (Timentin) (work synergistically)
27
How can penicillins be administered?
PO, IV, SQ
28
How are penicillins excreted?
Kidneys (not metabolized there)
29
Can penicillins cross the BBB?
No, except with meningitis inflame miniges are more permeable to it, permitting rapid penetration of the drug into CSF
30
Cephalosporins
B-lactams essentially just like penicillins
31
How are cephalosporins classified?
1st, 2nd, 3rd, and 4th generation based on their resistance to the B-lactamases and their antimicrobial spectrums
32
What is very commonly used in open heart surgery and as part of the prime?
Cephalosporins (or vancomyocin as alternative)
33
1st generation Cephalosporins
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
1st Generation Cephalosporin Drug
Cefazolin (Kefzol)
35
Cefazolin (Kefzol)
Typically dosed at a fixed amt (1g/circuit) or by weight (50mg/kg) Cleared by the kidneys Cross sensitivity with penicillins is high
36
2nd Generation Cephalosporins
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
2nd Generation Cephalosporin Examples
Cefoxitin (Mefoxin) Cefotetan (Cefotan) Cefuroxime (Ceftin)
38
Vancomycin
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
MRSA
methicillin resistance staph epidermidis
40
How is Vancomycin excreted?
Renally
41
Vancomycin Side Effects
More common than pens and cephs | Fever, chills, flushing, phlebitis
42
Phlebitis
Inflammation of the vasculature
43
Aminoglycosides Derived from?
Derived from fungi (like penicillins)
44
Aminoglycosides ending in "mycin"
From streptomyces
45
Aminoglycodies ending in "micin"
from micromonospora sp.
46
How do aminoglycosides work?
Interefere with bacterial protein synthesis by binding to bacterial ribosomal 30S subunit... "cidal" action
47
Aminoglycoside Spectrum of Activity
limited to gram negative bacteria, such as E. coli, proteus mirabilis, pseudomonas aeruginosa
48
When do aminoglycosides exhibit a synergistic effect?
When used with pens, cephs, vacomycin for resistance bacteria
49
What exhibites concentration dependent killing?
Aminoglycosides
50
Concentration-Dependent Killing
INcreasing concentrations of aminoglycosides kill increasing proportions of bacteria at increasing rates
51
How are all aminoglycosides given?
Parenterally or used topically
52
Do aminoglycosides penetrate CNS?
NO
53
Aminoglycoside DRugs
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
What aminoglycoside drug has the least bacterial resistance?
Amikacin (Amikin)
55
How are aminoglycosides excreted?
Renally and readily become "more toxic" in the presence of renal failure
56
What minimzes side effects of aminoglycosides?
adequate hydration/urine output
57
Where do aminoglycosides concentartion?
Cross the blood/placenta barrier | Concentrate in fetal tissue
58
Aminoglycoside Toxicity
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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