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PHARM > Weaken bacterial cell wall (Bactericidal) > Flashcards

Weaken bacterial cell wall (Bactericidal) Flashcards

1
Q

What are 4 beta-lactam antibacterial agents?

A

penicillin, cephalosporin, carbapenem, and monobactam

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2
Q

Prototype for broad spectrum Penicillin?

A

Ampicillin

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3
Q

Therapeutic use of Ampicllin?

A

Treat infections d/t gram-positive bacteria

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4
Q

Adverse effects of Ampicillin?

A

diarrhea, rash, allergic rxn, anaphylaxis, pseudomembranous colitis (C diff)

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5
Q

Contraindications for Ampicillin?

A

hypersensitivity or allergic rxn

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6
Q

Ampicillin preacutions?

A

cautious if you have severe renal insufficiency, infectious mononucleosis (rash), ALL, and CMV infections

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7
Q

Routes for Ampicillin administration?

A

PO, IV, IM; rapid onset of action

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8
Q

How is Ampicillin metabolized and excreted?

A

metabolized: liver
excreted: kidneys

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9
Q

What should be obtained prior to administration of Penicillins?

A

cultures and any drug allergies

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10
Q

T/F. The dosage of Penicillin G is prescribed in units

A

True; all others in mg or g

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11
Q

How should oral Penicillin be administered?

A

with a full glass of water 1hr AC or 2 hr PC

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12
Q

Which Penicillins should be taken with meals?

A

Penicillin V, Ampicillin, and Amoxicillin/Clavulanate

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13
Q

Why should we monitor kidney function with use of Penicillins?

A

impaired renal function can cause toxic levels of PCN

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14
Q

If administering a Penicillin IV how long should we monitor for an allergic rxn?

A

30 minutes

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15
Q

Education with use of Penicillins?

A

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

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16
Q

Drug interactions with Penicillins?

A

Penicillin should not be mixed in the same IV solution as aminoglycosides (Gentamicin) because penicillin inactivates the aminoglycoside. Precipitate will form.

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17
Q

What are beta lactamases?

A

family of enzymes involved in bacterial resistance to beta-lactam antibiotics; enzymes that inactivate the beta-lactam ring

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18
Q

What are beta-lactamase inhibitors?

A

co-administered with beta-lactam antimicrobials to prevent antimicrobial resistance

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19
Q

Types of Beta-lactamase inhibitors?

A

Clavulanate, sulbactam, tazobactam

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20
Q

Combination drugs with beta-lactamase inhibitors?

A

ampicillin-sulbactam (Unasyn IV);

Ampicillin & clavulanate (Augmentin PO); Piperacillin/Tazobactam (Zosyn IV)

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21
Q

Prototype for 1st generation Cephalosporin?

A

Cefazolin (Ancef)

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22
Q

Therapeutic use of Cefazolin (Ancef)?

A

gram-positive, infection of bone, prophylaxis for surgical procedures

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23
Q

Adverse effects of Cefazolin?

A

N/V/D, rash, PAIN AT INJECTION SITE, phlebitis, pseudomembranous colitis; bleeding tendencies from cefotetan and ceftriaxone use

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24
Q

Contraindications for Cefazolin?

A

hypersensitivity, serious hypersensitivity to PCN

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25
Q

Routes of Cefazolin administration?

A

IM and IV; rapid onset

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26
Q

Where is Cefazolin metabolized and excreted?

A

metabolism: not by the liver
excretion: almost entirely by the kidney

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27
Q

Advantages of newer generations of cephalosporins?

A
  1. More likely to reach CSF
  2. Less susceptible to destruction by beta-lactamase
  3. More effective against gram-negative organisms
28
Q

Which generations of cephalosporins can be used as broad spectrum?

A

3rd and 4th

29
Q

Why should patients with renal insufficiency be given a lower dose?

A

to prevent accumulation of toxic levels except with ceftriaxone

30
Q

Routes of cephalosporin administration?

A

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.

31
Q

Why should you not consume alcohol with the use of Cephalosporins?

A

Disulfiram rxn (intolerance to alcohol)

32
Q

Calcium and ceftriaxone interaction with cephalosporins?

A

Administering together can cause solutions to precipitate

33
Q

T/F. Ceph/cef- and -cillins cannot be mixed d/t cross sensitivity

A

True

34
Q

Prototype for Carbapenems?

A

Imipenem-cilastatin (Primaxin)

35
Q

Therapeutic use of Imipenem-cilastatin?

A

broad spectrum

36
Q

Adverse effects of CaRbaPeNemS?

A

N/V/D, rash, phlebitis, pseudomembranous colitis, CNS TOXICITY, seizures

37
Q

Carbapenems contraindications?

A

hypersensitivity, cross sensitivity to PCN and cephalosporins, no IM formulation if severe shock or AV block.

38
Q

Precautions for Carbapenems?

A

previous renal impairment and seizure disorders

39
Q

Interactions with Carbapenems?

A

probenecid, cyclosporine, ganciclovir, valproate (valproic acid) → can reduce these levels → breaktrhough seizures

40
Q

Route of administration for Imipenem-cilastatin?

A

IM or IV; rapid onset

41
Q

How is Imipenem-cilastatin metabolized and excreted?

A

Metabolism: renal dehydropeptidase
Excretion: almost entirely by the kidney

42
Q

T/F. Carbapenems should be reserved for patients who cannot be tx with a more narrow-spectrum abx.

A

True

43
Q

What are glycopeptides?

A

inhibits bacterial cell wall formation by inhibiting peptidoglycan synthesis. Do not have beta lactam rings.

44
Q

Prototype for glycopeptides?

A

Vancomycin

45
Q

Therapeutic use of Vancomycin?

A

gram + bacteria, c diff, and MRSA

46
Q

Adverse effects of VancOmycin?

A

thrombophlebitis, nephrotoxicity, ototoxicity, Red man syndrome

47
Q

What is Red man syndrome?

A

allergic response with a cluster of sx including rash, itching, flushing, ↑ HR ↓BP

48
Q

How can Red man syndrome side effect be avoided?

A

Diluting medication and infusing slowly

49
Q

Vancomycin contraindications?

A

vancomycin allergy

50
Q

Precautions with Vacomycin?

A

previous renal impairment or hearing loss, older adults (d/t renal impairment or hearing loss)

51
Q

Interactions with Vancomycin?

A

other drugs that cause ototoxicity like loop diuretics, erythromycin, and aminoglycoside abx

52
Q

Route of Vancomycin administration? and excretion

A

Route: IV and PO
Excretion: almost entirely by the kidneys

53
Q

How do we monitor for ototoxicity and renal toxicity with Vancomycin use?

A

Monitor trough levels so dosage adjustments can be made as needed

54
Q

Which labs should we evaluate prior to Vancomycin administration?

A

creatinine clearance and GFR to evaluate kidney function

55
Q

What is the serum target dose for Vancomycin?

A

15-20mcg/mL

56
Q

Rate of Vancomycin IV piggyback administration?

A

60 minutes or longer

57
Q

Prototype for Monobactams?

A

Aztreonam (Azactam)

58
Q

How are monobactams different than other beta lactams?

A

The beta lactam ring is alone and not fused to another ring

59
Q

Therapeutic use of Aztreonam?

A

serious gram negative infections including CYSTIC FIBROSIS

60
Q

Route of Aztreonam admnistration?

A

IM, IV, inhalation. Rapid onset of action.

61
Q

Adverse effects of Aztreonam?

A
  • inhalant: upper airway irritation, chest discomfort, cough, wheezing, and fever.
  • Pain at IM site.
  • seizures, anaphylaxis, pseudomembranous colitis
62
Q

Aztreonam contraindications?

A

hypersensitivity

63
Q

Aztreonam precautions?

A

renal impairment, cross sensitivity to PCN (rare), very low FEV1

64
Q

Is Aztreonam considered safe to patients with PCN allergy?

A

Yes

65
Q

Aztreonam route for cystic fibrosis tx?

A

inhalation

66
Q

Where is Aztreonam metabolized and excreted?

A

metabolism: small amounts in the liver
excretion: 60-70% unchanged by the kidney

PHARM (35 decks)

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