Pharm Week 3 Flashcards

0
Q

How are antimicrobials different from other classes of drugs

A

The exert their action on bacteria infecting the host not the host itself

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1
Q

How can you prevent resistance

A

Dual therapy= using two drugs with different mechanisms of action
Ex: TB, pseudomonas aeruginosa, and enterococcal endocarditis

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2
Q

Things to avoid when prescribing antimicrobials

A
  • misuse of anitbiotics
  • overuse of broad spectrum antibiotics
  • suprainfection (alterations of normal flora= yeast infection from too strong of an antibiotic)
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3
Q

Should you leave colonized flora in tact?

A

Yes

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4
Q

Pathogen

A

Organism causing active infection

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5
Q

Normal flora

A

Organisms normally found on the host: non pathogenic

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6
Q

Colonization

A

Presence of bacteria that are not causing disease

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7
Q

Do you culture otitis media, sinus infection, or UTI in otherwise healthy patients?

A

NO

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8
Q

How do you select your appropriate antimicrobial

A
  • Spectrum of activity
  • Effects on non-targeted microbial flora
  • Appropriate dose
  • Pharmacokinetic and pharmacodynamic properties
  • ADR’s
  • Drug interactions
  • Cost
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9
Q

What is Empirical Therapy

A

An educated guess based on patient and antimicrobial specific factors: anatomical location, pathogens associated with presentation, potential for ADR’s, and antimicrobial spectrum of activity

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10
Q

What are patient specific considerations in antimicrobial selections?

A
  • Recent previous antimicrobial exposure
  • anatomical location
  • Hx of drug allergies
  • Organ dysfunction affecting drug clearance
  • Immunosuppression
  • Pregnancy
  • Compliance
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11
Q

De-escalation

A

If you’re using a broad spectrum antimicrobial and you ID the pathogen with culture results, you narrow your antibiotic to something sensitive to the pathogen

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12
Q

What causes antimicrobial failure?

A
  • Inadequate diagnosis
  • Poor source control (removing catheters or draining an abscess)
  • Development of new infection with resistant organism
  • Non adherence
  • Insufficient dosing
  • Drug interactions
  • Suprainfections
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13
Q

MIC

A

Minimal Inhibitory Concentration: you have to be above the MIC to effectively kill the pathogen

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14
Q

Gram positive

A

Has a cell wall and cell membrane, will hold the purple stain

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15
Q

Gram Negative

A

Has cell wall, cell membrane, and outer envelope which inhibits pink stain from sticking

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16
Q

Atypical

A

Possess uncommon qualities, colorless after staining, not a typical cell wall, can replicate, they ARE common

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17
Q

Anaerobic

A

Do not require O2 to live

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18
Q

What are the types of bacterial classification?

A

Gram Positive
Gram Negative
Anaerobic
Atypical

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19
Q

B-Lactam Antibiotics

A

Selectively interfere with the synthesis of the peptidoglycan bacterial cell wall. They are divided based on chemical structure and spectrum of activity

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20
Q

Why do you dose antimicrobials around the clock? q4h

A

antibiotics work best if the drug dosing trough concentration remains above the MIC throughout the entire dosing interval

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21
Q

Penicillin

A

Founded by Alexander Flemming on accident in 1929. It is the least toxic drug known, members of the family differ by a single side chain (R group)

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22
Q

Penicillin mechanism of action

A

interfere with bacterial wall synthesis by binding to PBP’s (penicillin binding proteins) disrupting the peptidoglycan layer

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23
Q

Penicillin therapeutic uses

A

treatment for bacterial pathogens

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24
Natural Penicillins
Penicillin G aqueous- INJ Penicillin G procaine and benzathine- IM only Penicillin V (PenVeeK, Vi-CillinK)- PO
25
Penicillin G Aqueous- INJ
Natural Penicillin
26
Penicillin G Procaine and Benzathine- IM only
Natural Penicillin
27
Penicillin V (PenVeeK, Vi-CillinK) PO
Natural Penicillin
28
Amino Penicillins
Amoxicillin (Amoxil)- PO | Ampicillin (Omipen)- INJ, PO
29
Amoxicillin (Amoxil) PO
Amino Penicillin
30
Ampicillin (Omipen) INJ, PO
Amino Penicillin
31
Antistaphylococcal Penicillins
Dicloxacillin (Dynapen)- PO Nafcillin (Nafcil, Unipen)- INJ Oxacillin (Prostaphlin)- INH, PO
32
Dicloxacillin (Dynapen) PO
Antistaphylococcal penicillins
33
Nafcillin (Nafcil, Unipen) INJ
Antistaphylococcal penicillin
34
Oxacillin (Prostaphlin) INJ, PO
Antistaphylococcal penicillin
35
Antipseudomonal Penicillins
Piperacillin (Piperacil) INJ | Ticarcillin (Ticar) INJ
36
Piperacillin (Piperacil) INJ
Antipseudomonal Penicillin
37
Ticarcillin (Ticar) INJ
Antipseudomonal penicillin
38
B-Lactamase Inhibitor Combos (extended spectrum)
Ampicillin/Sulbactam (Unasyn)- INJ Amoxicillin/clavulanate (Augmentin)- PO Piperacillin/Tazobactam (Zosyn)- INJ Ticarcillin/clavulanate (Timentin)- INJ
39
Ampicillin/Sulbactam (Unasym) INJ
B-Lactamase Inhibitor Combos (extended spectrum)
40
Amoxcillin/clavulanate (Augmentin) PO
B-Lactamase inhibitor combos (extended spectrum)
41
Piperacillin/tazobactam (Zosyn) INJ
B-Lactamase inhibitor combos (extended spectrum)
42
Ticarcillin/Clavulanate (Timentin) INJ
B-Lactamase inhibitor combos (extended spectrum)
43
What are the types of Penicillins
``` Natural Amino Antistaphylococcal Antipseudomonal B-Lacatamse inhibitor combos ```
44
Name the types of Cephalosporins
1st, 2nd, 3rd, 4th generation
45
Cefadroxil (Duricef) PO
1st generation cephalosporins
46
1st generation cephalosporins
Cefadroxil (Duricef) PO Cefazolin (Ancef, Kefzol) INJ Cephalexin (Keflex) PO
47
Cefazolin (Ancef Kefzol) INJ
1st generation cephalosporins
48
cephalexin (Keflex) PO
1st generation cephalosporins
49
2nd Generation cephalosporins
``` Cefaclor (Ceclor) PO Cefotetan (Cefotan) IV Cefoxitin (Mefoxin) IV Cefprozil (Cefzil) PO Cefuroxime (Zinacef) INJ Cefuroxime axetil (Ceftin) PO ```
50
2nd Generation cephalosporins
``` Cefaclor (Ceclor) PO Cefotetan (Cefotan) IV Cefoxitin (Mefoxin) IV Cefprozil (Cefzil) PO Cefuroxime (Zinacef) INJ Cefuroxime axetil (Ceftin) PO ```
51
Cefprozil (Cefzil) PO
2nd Generation cephalosporins
52
Cefuroxime axetil (Ceftin) PO
2nd Generation cephalosporins
53
3rd Generation Cephalosporins
``` Cefdinir (Omnicef) PO Cefditoren (Spectracef) PO Cefixime (Suprax) PO Cefotaxime (Claforan) INJ Cefpodoxime (Vantin) PO Ceftazidime (Fortaz) INJ Cefibuten (Cedax) PO Ceftriaxone (Rocephin) INJ ```
54
Cefdinir (Omnicef) PO
3rd Generation Cephalosporins
55
Cefditoren (Spectracef) PO
3rd Generation Cephalosporins
56
Cefixime (Suprax) PO
3rd Generation Cephalosporins
57
Cefpodoxime (Vantin) PO
3rd Generation Cephalosporins
58
Cefibuten (Cedax) PO
3rd Generation Cephalosporins
59
Cefotaxime (Claforan) INJ
3rd Generation Cephalosporins
60
Ceftazidime (Fortaz) INJ
3rd Generation Cephalosporins
61
Ceftriaxone (Rocephin) INJ
3rd Generation Cephalosporins
62
Cefuroxime (Zinacef) INJ
2nd Generation Cephalosporins
63
4th Generation Cephalosporins
Cefepime (Maxipime) INJ
64
Penicillin Mechanisms of Resistance
- B-lactamase/penicillinase: inactivate the drug's B-Lactim ring - Modified PBPs: Decreased affinity for the penicillins - Decreased Permeability: gm-neg with modified external surfaces reduce drug permeability
65
What kills mostly gram-positive cocci, strep viridans, strep pyogenes? Treats syphillis, endocarditis, Strep. pneumonia, strep throat, group B strep infections
Natural Penicillins!!!!!
66
What treats otitis media & sinusitis (H. influenzae, Strep. pneumoniae) and simple UTIs?
Amino Penicillins!!!!
67
Why is amoxicillin preferred to ampicillin?
Better absorption and less diarrhea | -Ampicillin is just Amoxicillin dissolved in water.
68
What treats in any type of infection with documented pseudomonas aeruginose, serratia, of klebsiella (nosocomila pneumonia or UTI, complicated cellulitis, or abdominal infections
Antipseudomonal Penicillins!!!
69
If you add a B-Lactamase inhibitor to an penicillin what will it do?
Enhance the gram negative and anaerobic coverage of the original antibiotic making it broad spectrum coverage
70
What are B-Lactamase inhibitor combinations useful for?
Anaerobic infections or polymicrobial infections such as abscess, diabetic foot, abdominal infections, animal bites, fever of unknown origin, and sometimes refractory sinusitis/otitis media
71
Stink places: mouth, feet, and gut
Anaerobes
72
What do antistaphylococcal penicillins treat?
Staph. aureus and other gram positive cocci | -useful in soft tissue and bone infections, endocarditis
74
Cephalosporin
- same mechanism as penicillins (attacking bacterial cell wall) - same mechanism of resistance (tend to be more resistant to B-Lactamase)
75
Cefotetan (Cefotan) IV
2nd Generation Cephalosporins
76
Cefoxitin (Mefoxin) IV
2nd Generation Cephalosporins
77
What are some classes of antibiotics that have the mechanism of action: inhibits bacterial ribosomal protein synthesis?
Tetracyclines Clindamycin(Cleocin) Macrolides
78
What are the three MACROLIDES?
clarithromycin (Biaxin) -PO azithromycin (Z-pak, Zithromax) - PO,IV erythromycin (multiple brands) -PO,IV, topical
79
What antibiotic class do these antibiotics fall into? - clarithromycin (Biaxin) - azithromycin (Z-pak, Zithromax) - erythromycin (multiple brands)
Macrolides