Weaken bacterial cell wall (Bactericidal) Flashcards
What are 4 beta-lactam antibacterial agents?
penicillin, cephalosporin, carbapenem, and monobactam
Prototype for broad spectrum Penicillin?
Ampicillin
Therapeutic use of Ampicllin?
Treat infections d/t gram-positive bacteria
Adverse effects of Ampicillin?
diarrhea, rash, allergic rxn, anaphylaxis, pseudomembranous colitis (C diff)
Contraindications for Ampicillin?
hypersensitivity or allergic rxn
Ampicillin preacutions?
cautious if you have severe renal insufficiency, infectious mononucleosis (rash), ALL, and CMV infections
Routes for Ampicillin administration?
PO, IV, IM; rapid onset of action
How is Ampicillin metabolized and excreted?
metabolized: liver
excreted: kidneys
What should be obtained prior to administration of Penicillins?
cultures and any drug allergies
T/F. The dosage of Penicillin G is prescribed in units
True; all others in mg or g
How should oral Penicillin be administered?
with a full glass of water 1hr AC or 2 hr PC
Which Penicillins should be taken with meals?
Penicillin V, Ampicillin, and Amoxicillin/Clavulanate
Why should we monitor kidney function with use of Penicillins?
impaired renal function can cause toxic levels of PCN
If administering a Penicillin IV how long should we monitor for an allergic rxn?
30 minutes
Education with use of Penicillins?
Wear medic alert bracelet; allergy to one penicillin means allergy to all others; use additional contraceptive method b/c penicillins can decrease oral contraceptive effectiveness
Drug interactions with Penicillins?
Penicillin should not be mixed in the same IV solution as aminoglycosides (Gentamicin) because penicillin inactivates the aminoglycoside. Precipitate will form.
What are beta lactamases?
family of enzymes involved in bacterial resistance to beta-lactam antibiotics; enzymes that inactivate the beta-lactam ring
What are beta-lactamase inhibitors?
co-administered with beta-lactam antimicrobials to prevent antimicrobial resistance
Types of Beta-lactamase inhibitors?
Clavulanate, sulbactam, tazobactam
Combination drugs with beta-lactamase inhibitors?
ampicillin-sulbactam (Unasyn IV);
Ampicillin & clavulanate (Augmentin PO); Piperacillin/Tazobactam (Zosyn IV)
Prototype for 1st generation Cephalosporin?
Cefazolin (Ancef)
Therapeutic use of Cefazolin (Ancef)?
gram-positive, infection of bone, prophylaxis for surgical procedures
Adverse effects of Cefazolin?
N/V/D, rash, PAIN AT INJECTION SITE, phlebitis, pseudomembranous colitis; bleeding tendencies from cefotetan and ceftriaxone use
Contraindications for Cefazolin?
hypersensitivity, serious hypersensitivity to PCN
Routes of Cefazolin administration?
IM and IV; rapid onset
Where is Cefazolin metabolized and excreted?
metabolism: not by the liver
excretion: almost entirely by the kidney
Advantages of newer generations of cephalosporins?
- More likely to reach CSF
- Less susceptible to destruction by beta-lactamase
- More effective against gram-negative organisms
Which generations of cephalosporins can be used as broad spectrum?
3rd and 4th
Why should patients with renal insufficiency be given a lower dose?
to prevent accumulation of toxic levels except with ceftriaxone
Routes of cephalosporin administration?
PO with meals
IM: warn patients of pain
IV: intermittent infusion (piggy back) or IV push slowly over 3-5 min and in a dilute solution for bolus dosing.
Why should you not consume alcohol with the use of Cephalosporins?
Disulfiram rxn (intolerance to alcohol)
Calcium and ceftriaxone interaction with cephalosporins?
Administering together can cause solutions to precipitate
T/F. Ceph/cef- and -cillins cannot be mixed d/t cross sensitivity
True
Prototype for Carbapenems?
Imipenem-cilastatin (Primaxin)
Therapeutic use of Imipenem-cilastatin?
broad spectrum
Adverse effects of CaRbaPeNemS?
N/V/D, rash, phlebitis, pseudomembranous colitis, CNS TOXICITY, seizures
Carbapenems contraindications?
hypersensitivity, cross sensitivity to PCN and cephalosporins, no IM formulation if severe shock or AV block.
Precautions for Carbapenems?
previous renal impairment and seizure disorders
Interactions with Carbapenems?
probenecid, cyclosporine, ganciclovir, valproate (valproic acid) → can reduce these levels → breaktrhough seizures
Route of administration for Imipenem-cilastatin?
IM or IV; rapid onset
How is Imipenem-cilastatin metabolized and excreted?
Metabolism: renal dehydropeptidase
Excretion: almost entirely by the kidney
T/F. Carbapenems should be reserved for patients who cannot be tx with a more narrow-spectrum abx.
True
What are glycopeptides?
inhibits bacterial cell wall formation by inhibiting peptidoglycan synthesis. Do not have beta lactam rings.
Prototype for glycopeptides?
Vancomycin
Therapeutic use of Vancomycin?
gram + bacteria, c diff, and MRSA
Adverse effects of VancOmycin?
thrombophlebitis, nephrotoxicity, ototoxicity, Red man syndrome
What is Red man syndrome?
allergic response with a cluster of sx including rash, itching, flushing, ↑ HR ↓BP
How can Red man syndrome side effect be avoided?
Diluting medication and infusing slowly
Vancomycin contraindications?
vancomycin allergy
Precautions with Vacomycin?
previous renal impairment or hearing loss, older adults (d/t renal impairment or hearing loss)
Interactions with Vancomycin?
other drugs that cause ototoxicity like loop diuretics, erythromycin, and aminoglycoside abx
Route of Vancomycin administration? and excretion
Route: IV and PO
Excretion: almost entirely by the kidneys
How do we monitor for ototoxicity and renal toxicity with Vancomycin use?
Monitor trough levels so dosage adjustments can be made as needed
Which labs should we evaluate prior to Vancomycin administration?
creatinine clearance and GFR to evaluate kidney function
What is the serum target dose for Vancomycin?
15-20mcg/mL
Rate of Vancomycin IV piggyback administration?
60 minutes or longer
Prototype for Monobactams?
Aztreonam (Azactam)
How are monobactams different than other beta lactams?
The beta lactam ring is alone and not fused to another ring
Therapeutic use of Aztreonam?
serious gram negative infections including CYSTIC FIBROSIS
Route of Aztreonam admnistration?
IM, IV, inhalation. Rapid onset of action.
Adverse effects of Aztreonam?
- inhalant: upper airway irritation, chest discomfort, cough, wheezing, and fever.
- Pain at IM site.
- seizures, anaphylaxis, pseudomembranous colitis
Aztreonam contraindications?
hypersensitivity
Aztreonam precautions?
renal impairment, cross sensitivity to PCN (rare), very low FEV1
Is Aztreonam considered safe to patients with PCN allergy?
Yes
Aztreonam route for cystic fibrosis tx?
inhalation
Where is Aztreonam metabolized and excreted?
metabolism: small amounts in the liver
excretion: 60-70% unchanged by the kidney
