Week 7 - Antibiotics Flashcards
Which antibiotics inhibit protein synthesis?
Macrolides, Tetracyclines, Aminoglycosides
Which antibiotics inhibit cell wall synthesis?
Penicillins, Cephalosporins, Glycopeptides
Which antibiotics inhibit DNA and RNA synthesis?
Fluoroquinolones, lipopeptides
Which antibiotic interferes with cell metabolism?
Sulfonamides - folic acid formation
How do you gain acquired resistance?
Prior exposure
3 examples of acquired resistance to antibacterials
MRSA, VRSA, VREF
Cockcorft and Gault Formula for estimating GFR
[ (140 – age) x (weight in Kg)] / (72 x serum creatinine)
-Multiply product by 0.85 for females
When do you estimate the GFR?
Before administering
What procedures do you do before antibiotic administration?
GFR, culture and sensitivity
What is the significance of measuring creatinine clearance or GFR?
Exchange info with the healthcare team to determine need to adjust medication dose
3 categories of Major adverse reactions to antibacterials
Allergy/hypersensitivity, superinfection, organ toxicity
Which two organs usually experience damage from antibacterials?
Liver (hepatotoxicity) and kidney (nephrotoxicity)
What is another term for secondary infection?
Superinfection
If a patient goes into anaphylactic shock, how do you treat them?
Epinephrine!! And anti-histamine, bronchodilators, corticosteroids, saline or plasma expanders for BP
The two examples given for broad spectrum antibiotics
Tetracycline and cephalosporin
What do you give if a microorganism is not identified by culture and sensitivity?
Broad spectrum
Penicillin structure
Beta lactam ring
Which antibiotics have beta-lactam structure?
Penicillin and cephalosporins
What do basic penicillins kill?
Staph
Probenecid
Uricosuric drug that increases effectiveness of penicillin by decreasing excretion
What is another term for broad-spectrum penicillins
Aminopenicillins
What gram (-) in particular does broad-spectrum penicillin treat?
E. coli, Haemophilus influenzae, Salmonella spp.
Amoxicillin - category
Broad-Spectrum penicillin
Excretion route of broad-spectrum penicillins
Kidneys
Penicillinase-Resistant Penicillins: mechanism, routes
Treats penicillinase-producing S. aureus; can be oral, IM, IV
Piperacillin (Pipracil) category
Extended-spectrum penicillin
Which gram (-) does extended-spectrum penicillin work on?
Pseudomonas aeruginosa, proteus, Klebsiella
Another term for extended-spectrum penicillin
Anti-pseudomonal
What kind of infections does extended-spectrum penicillin treat? (6)
Bone, joint, skin, soft tissue, respiratory tract, urinary tract
What are beta-lactamase inhibitors given in combination with?
Penicillinase-sensitive penicillin to intensify the effect of the penicillin
Example of beta-lactamase + penicillin
Augmentin (Amoxicillin-clavulanate)
Amoxicillin is what type of penicillin?
Broad spectrum
Side effects of penicillin
Hypersensitivity, anaphylaxis, N/V, diarrhea
If a patient has a history of mild reaction to penicillin….
Give cephalosporin instead
If a patient has a history of severe reaction to penicillin…
AVOID cephalosporin
Penicillins should be avoided in what kind of condition?
Severe renal insufficiency
Cephalosporin mechanism
Inhibits cell wall synthesis by dissolving it
Cephalosporins treat what kind of infections?
Bone, joint, skin, respiratory, urinary tract, genital
Cefazolin (Ancef, Kefzol) vs Cefepime (Maxipime)
Cefazolin - 1st generation, works on gram (+)
Cefepime - 4th generation, broader gram (+) and more extended gram (-) including pseudomonas, excreted by kidney, may cross blood brain barrier
What antibiotic can cross the blood brain barrier?
Cefepime
Cephalosporin side effects (6)
- Hypersensitivity
- N/V, diarrhea
- Alterations in blood clotting with large doses
- Neutropenia
- Hemolytic anmeia
- Nephrotoxicity
Penicillin and Cephalosporin Assessment (4)
Ask about history of hypersensitivity, labs for liver and renal function, vitals, urine output
Client Education - what should you do with chewable tablets before swallowing?
Chew or crush
IV glycopeptides vs Oral glycopeptides
IV - treats drug resistant staph. infections, excreted by kidney
Oral - treats staph. enterocolitics, antibiotic-associated pseudomembranous colitis due to C. diff, excreted by feces
What kind of reaction is Red Neck and how does it appear?
Toxic reaction due to rapid IV infusion - vascular dilation, skin flushing to head/neck/upper body, rash
What irritates the skin in vancomycin IV?
HCl
How do you prevent Red Neck?
Dilute 500 mg in 100 mL or 1000 mg in 250 mL, administer over 60-120 min
IV Vancomycin adverse reactions (5)
Red neck, Stevens-Johnson, blood dyscrasias, nephrotoxicity, ototoxicity
Macrolide mechanism
Inhibits protein synthesis
Which macrolide can be given in place of pencillin?
Erythromycin
What kind of infections/conditions do Macrolides treat? (8)
Soft tissue, skin, respiratory tract, GI tract, Mycoplasma pneumoniae, Legionnaire’s disease
4 side effects of Macrolides
GI distress, hepatotoxicity, ototoxicity, tinnitus
Which antibiotic increases serum levles of Carbamazepine, Theophylline, and Warfarin?
Macrolides
Which antibiotic increases Fluconazole and Ketoconazole
Erythromycin
Antacids reduce absorption of which antibiotics? (3)
Azizthromycin, levofolxacin, tetracycline
Tetracycline mechanism
Inhibits protein synthesis
Which antibiotic was the first effective broad-spectrum antibiotic?
Tetracycline
Continuous use of tetracyclines can result in
bacterial resistance
3 uses for tetracyclines
Mycoplasma pneumoniase, H. pylori in combination with Metronidazole and bismuth subsalicylate, severe acne
Tetracyclines side effects (6)
- Gastric irritation (heartburn, epigastric distress, N/V, diarrhea/flatulence, pain)
- Rash
- Pruritus
- Photosensitivity
- Teratogenic
- Can discolor teeth in kids less than 8
3 Tetracycline interventions
-Sun protection, don’t take with antacids or dairy, newer preparations (ex. doxycycline) are better absorbed
Aminoglycoside - classification and example
Inhibits protein synthesis, Gentamicin
Which antibiotic does NOT cross the blood-brain barrier
Gentamicin
Which antibiotic is used for “serious infections” and requires peak and trough levels?
Gentamicin
7 side effects of aminoglycosides
Rash, numbness, tremors, muscle cramps/weakness, visual disturbances, photosensitivity, tinnitus
5 adverse reactions of gentamicin
Oliguria, uticaria, palpitations, superinfection, ototoxicity
5 life threatening reactions of gentamicin
Nephrotoxicity, thrombocytopenia, granulocytosis, neuromuscular blockade, liver damage
What increases risk for ototoxicity with gentamicin?
Loop diuretics
Gentamicin + amphotericin B/polymixin/cisplatin/furosemide/vancomycin can increase risk for…
nephrotoxicity
What should you always check on gentamicin?
Urine output and creatinine clearance
Fluoroquinolones mechanism and example
Interrupts DNA synthesis; Levofloxacin
Which antibiotic is “readily absorbed by GI tract?
Fluoroquinolones
Which drug is “very irritating to the gastric mucosa”
Tetracyclines
What do fluroquinolones treat? 6)
UTI, bone and joint infections, gonnorrhea, bronchitis, pneumonia
Increased Levofloxacin effect with (2)
Oral hypoglycemics and theophylline
Decreased absorption of Levofloxacin with (2)
Antacids, iron
5 adverse effects of Levofloxacin
Stevens-Johnson, encophalopathy, seizures, pseudomonas colitis (C. Diff), dysrhythmias
Three drugs you might see Stevens-Johnson syndrome in
IV Vancomycin, Levofloxacin, Trimethoprim-Sulfamethoxazole
Lipopeptide mechanism and example
Inhibits DNA, RNA, and protein synthesis; Daptomycin (Cubicin)
3 uses of Lipopeptides
Complicated skin infections, Infected endocarditis due to MRSA (MRSA resistant to Vanco), speticemia due to Staph. A infections
Which drug includes side effects of hypo hypertension, burning on urination, and anemia?
Daptomycin
Which two drugs have side effects of numbness/tingling?
Gentamicin, Daptomycin
6 adverse reactions of Daptomycin
Elevated CK esp. with statins (rhabdomyolysis), hypo/hyperkalemia, unexplained myopathy, neuropathy, hyperglycemia, pleural effusion
Daptomycin + Tobramycin…
Increased toxicity
Daptomycin + Coumadin…
Increases bleeding
Which antibiotic is oldest?
Sulfonamides
Which antibiotics can be used for patients allergic to PCN? (2)
Erythromycin, sulfonamides
What kind of infections do sulfonamides treat?
UTI, prostatis, respiratory infection, burn wounds, meningococcal meningitis, newborn eye prophylaxis, chlamydia, toxoplasmosis
What drug is used for the Herpes Simplex Virus?
Acyclovir sodium (Zovirax)
9 side effects of Acyclovir sodium
N/V, diarrhea, H/A, lethargy, tremors, rash, pruritus, increased bleeding time, phlebitis at IV site
2 adverse reactions to acyclovir sodium
Uticaria, anemia
6 life threatening reactions to Acyclovir - Sodium
Nephrotoxicity, thrombocytopenia, leukopenia, bone marrow depression, granulocytopenia, acute renal failure
Contraindications for antivirals (2)
Hypersensitivity, severe renal or hepatic disease
Metronidazole mechanism and what kind of infections does it treat?
Interferes with DNA function to treat anaerobic infections
3 patient education points for Metronidazole
Avoid alcohol (Disulfram-type reaction), avoid in first trimester of pregnancy, dark reddish brown urine with high doses
