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APRN Pharmocology > Week 2 - Antibiotics > Flashcards

Week 2 - Antibiotics Flashcards

1
Q

What factors contribute to antimicrobial resistance?

4 factors

A
  1. Increasing number of immunocompromised pts
  2. Number of invasive procedures
  3. Usage of antimicrobials
  4. Survival of pts with chronic diseases
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2
Q

Leading risk factors for having a drug resistant pathogen

4 factors

A
  1. Recent antimicrobial use
  2. Multiple comorbidities
  3. Recent hospitalization
  4. Immunosuppresion
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3
Q

Inappropriate use of antimicrobials

3 examples

A
  1. Use for viral etiologies
  2. Excessive duration of therapy
  3. Empirical use when not indicated
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4
Q

Define

Antimicrobial

A

All drugs with ability to kill or inhibit microbes

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5
Q

Define

Antibiotic

A

Antimicrobials that target bacteria

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6
Q

Define

Bactericidial

A

99.9% Eradication of a bacterial colony in 24 hours

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7
Q

Define

Bacteriostatic

A

Kills bacteria but less than 99.9% eradication in 24 hours

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8
Q

4 Types of beta-lactam antibiotics

A
  1. Penicillins
  2. Cephalosporins
  3. Carbapenems
  4. Monobactams
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9
Q

MOA of Beta-Lactams

A

Inhibit the biosynthesis of the bacterial cell wall by binding to PBPs (Penicillin binding proteins) stopping the formation of the peptidoglycan structure

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10
Q

Types of Natural Penicllins

4 types

A
  1. Penicillin V
  2. Procaine Penicillin
  3. Benzathine Penicillin
  4. Penicillin G
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11
Q

Types of Aminopenicillins

2 types

A
  1. Amoxicillin
  2. Ampicillin
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12
Q

Antistaphyloccoccal Penicillins

3 Types

A
  1. Nafcillin
  2. Oxacillin
  3. Dicloxacillin
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13
Q

How is resistance mediated by staphylococci?

Gene and Action

A

mecA Gene encodes a PBP with low affinity for beta-lactams

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14
Q

Antipseudomonal Penicillin

1 Type

A

Piperacillin/Tazobactam

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15
Q

What is the most common mechanism of resistance to beta-lactams?

A

Beta-lactamases
Group of enzymes with the ability to inactivate beta-lactams

S. aureus and Haemophilus specificity for penicllins

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16
Q

Beta-lactamase Inhibitors

3 Types and action

A
  1. Clavalanate Acid
  2. Sulbactam
  3. Tazobactam
    Minimal antibacterial activity but inactivate beta-lactamase enzymes
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17
Q

ESBLs

Species and activity

A

Enterobacerales produces Extended spectrum beta-lactamases
Broader activity - work against penicillins and cephalosporins

Beta-lactamase Inhibitors are generally ineffective against ESBLs

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18
Q

Penicillin ADRs

4 Main points

A
  1. Type 1 hypersensitivity
  2. Rash (common for pts with mononucleosis or CLL)
  3. GI Upset and possibility for CDI
  4. Irritability and Seizures possible w/ renal insufficient patients
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19
Q

First Generation Cephalosporins

3 Types

A
  1. Cefadroxil
  2. Cefazolin
  3. Cephalexin
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20
Q

2nd Generation Cephalosporins

5 Types

A
  1. Cefaclor
  2. Cefotetan
  3. Cefoxitin
  4. Cefprozil
  5. Cefuroxime
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21
Q

3rd Generation Cephalosporins

6 Types

A
  1. Cefdinir
  2. Cefixime
  3. Cefotaxime
  4. Cefpodoxime
  5. Ceftazidime
  6. Ceftriaxone
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22
Q

1st Generation Cephalosporin Susceptibility

5 answers

A
  1. Gram-positive Cocci (e.g Staphylococcus)
  2. Streptococci
  3. E. Coli
  4. Proteus Mirabilis
  5. Klebsiella

3-5 are enterobacterales; if isolated from a hospital setting may be res

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23
Q

2nd Generation Cephalosporin Susceptibility

A

1st Generation +
1. H. influenzae

Drugs in this generation are unique; perform susceptibility testing

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24
Q

Third Generation Cephalosporin Susceptibility

A
  1. S. pneumoniae
  2. MSSA
  3. H. influenzae
  4. N. gonorrhoeae
  5. N. meningitidis
  6. E. coli
  7. Klebsiella
  8. Proteus
  9. Salmonella
  10. Pseudomonas aeruginosa

May retain ability against some beta lactamase producing H. influenzae

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25
Q

Cephalosporin ADRs

5 Answers

A
  1. Type 1 hypersensitivity
  2. Seizure activity w/ renal impairment
  3. Coagulation abnormalities
  4. Immune hemolytic anemia
  5. CDI
26
Q

Cephalosporin Drug Interactions

3 Answers

A
  1. Probenecid
  2. Loop Diuretics
  3. Warfarin
27
Q

Fluoroquinolones MOA

A

Inhibits DNA gyrase preventing relaxation of supercoiled microbial DNA

28
Q

Fluoroquinolone Boxed Warning

A
  1. Risk of tendon rupture
    This is increased for older patients, pts on corticosteroids, and transplant pts
  2. Myasthenia Gravis pts
29
Q

Fluoroquinolone Drugs

4 Types

A
  1. Ciprofloxacin
  2. Levofloxacin
  3. Moxifloxacin
  4. Ofloxacin
30
Q

Fluoroquinolone ADRs

5 answers

A
  1. CDI
  2. Stevens-Johnson Syndrome
  3. Phototoxicity
  4. Cardiovascular Events including aortic aneurysm
  5. AKI
31
Q

Fluoroquinolone Drug Interactions

5 Answers

A
  1. Antacids
  2. Antidiabetic Drugs (low BS)
  3. Antiarrhythmics
  4. Glucocorticoids
  5. Warfarin
32
Q

Fluoroquinolone Monitoring

A
  1. Organ function assessment
  2. ECG
  3. CNS irritability
33
Q

Clindamycin MOA

Only drug in class

A

Binds to 50s ribosome subunit suppressing protein synthesis

34
Q

Clindamycin ADRs

2 answers

A
  1. GI Upset to include CDI
  2. Rise in hepatic indicators
35
Q

Macrolides MOA

A

Binds to 50s ribosomal subunit and inhibits protein synthesis

36
Q

Macrolides Drug types

3 answers

A
  1. Azithromycin
  2. Erythromycin
  3. Clarithromycin
37
Q

Macrolide Resistance Types

3 Answers

A
  1. Reduced membrane permability or active efflux
  2. Binding site modification
  3. Esterase production
38
Q

Macrolide Side effect warning

A
  1. Qtc elongation
39
Q

Macrolide ADRs

4 answers

A
  1. GI and CDI
  2. Liver abnormalities
  3. Stevens-Johnson Syndrome
  4. Hearing Loss
40
Q

Oxazolidinones MOA and drug type

A

Linezolid
Inhibits ribosomal formation by binding with 50s subunit

41
Q

Linezolid Contraindication/Side Effects

4 answers

A
  1. Use of MAOI with 2 weeks (serotonin syndrome risk)
  2. Myelosuppression
  3. Lactic Acidosis
  4. Neuropathy w/ use > 4 weeks
42
Q

Linezolid and Adrenergics

A

May potentiate drug monitor and titrate

43
Q

Linezolid Monitoring

A

CBC at start and q2 weeks

44
Q

Sulfonamides MOA and Indication

A

Bacteriostatic by inhibiting the pathway of folic acid synthesis
Combined with trimethoprim for UTIs

45
Q

Trimethoprim MOA

A

Inhibits Dihydrofolic acid reductase which stops purine formation

46
Q

Nitrofurantoin MOA and Indication

A

Activated by bacteria and interferes with multiple processes
UTIs

47
Q

Fosfomycin MOA and Indication

A

Inhibits cell wall synthesis
UTIs
Reduces adherence of bacteria to urinary tract

48
Q

Sulfonamides Precautions

A
  1. Blood dyscrasias or G6PD deficiency
  2. Renal Impairment
49
Q

Nitrofurantoin ADR

A

Pulmonary Complications including PF

50
Q

Trimethoprim ADR

A

Inhibits Na+ channel in renal distal tubules causing hyperK+

51
Q

Sulfonamide ADRs

3 Answers

A
  1. Skin Eruptions (SJS)
  2. Liver injury
  3. Photosensitivity
52
Q

Tetracyclines MOA

A

Inhibit protein synthesis by binding to 30s ribosomal subunit

53
Q

Tetracycline Drugs

2 Answers

A
  1. Doxycycline
  2. Minocycline
54
Q

Tetracycline Precautions

4 Answers

A
  1. Renal Impairment
  2. Hepaitc Impairment
  3. Pregnancy (Do not use)
  4. Age < 8 y/o
55
Q

Tetracycline ADRs

4 Answers

A
  1. GI and CDI
  2. Lightheadness and Vertigo
  3. Photosensitivity and SJS
  4. Backup Contraception is warranted
56
Q

Glycopeptide MOA

A

Inhibits cell wall synthesis by binding to nascent peptidoglycan pentapeptide

57
Q

Syphilis Drug Choice

A

Penicillin G

58
Q

Gonorrhea Drug Choice

A

Ceftriaxone

59
Q

Chlamydia Drug Choice

A

Doxycycline

60
Q

Bacterial Vaginosis and Trichamoniasis Drug Selection

A

Metronidazole

61
Q
A

APRN Pharmocology (5 decks)

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