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PHARM > Week 7 - Antibiotics > Flashcards

Week 7 - Antibiotics Flashcards

1
Q

Which antibiotics inhibit protein synthesis?

A

Macrolides, Tetracyclines, Aminoglycosides

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2
Q

Which antibiotics inhibit cell wall synthesis?

A

Penicillins, Cephalosporins, Glycopeptides

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3
Q

Which antibiotics inhibit DNA and RNA synthesis?

A

Fluoroquinolones, lipopeptides

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4
Q

Which antibiotic interferes with cell metabolism?

A

Sulfonamides - folic acid formation

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5
Q

How do you gain acquired resistance?

A

Prior exposure

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6
Q

3 examples of acquired resistance to antibacterials

A

MRSA, VRSA, VREF

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7
Q

Cockcorft and Gault Formula for estimating GFR

A

[ (140 – age) x (weight in Kg)] / (72 x serum creatinine)

-Multiply product by 0.85 for females

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8
Q

When do you estimate the GFR?

A

Before administering

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9
Q

What procedures do you do before antibiotic administration?

A

GFR, culture and sensitivity

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10
Q

What is the significance of measuring creatinine clearance or GFR?

A

Exchange info with the healthcare team to determine need to adjust medication dose

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11
Q

3 categories of Major adverse reactions to antibacterials

A

Allergy/hypersensitivity, superinfection, organ toxicity

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12
Q

Which two organs usually experience damage from antibacterials?

A

Liver (hepatotoxicity) and kidney (nephrotoxicity)

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13
Q

What is another term for secondary infection?

A

Superinfection

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14
Q

If a patient goes into anaphylactic shock, how do you treat them?

A

Epinephrine!! And anti-histamine, bronchodilators, corticosteroids, saline or plasma expanders for BP

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15
Q

The two examples given for broad spectrum antibiotics

A

Tetracycline and cephalosporin

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16
Q

What do you give if a microorganism is not identified by culture and sensitivity?

A

Broad spectrum

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17
Q

Penicillin structure

A

Beta lactam ring

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18
Q

Which antibiotics have beta-lactam structure?

A

Penicillin and cephalosporins

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19
Q

What do basic penicillins kill?

A

Staph

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20
Q

Probenecid

A

Uricosuric drug that increases effectiveness of penicillin by decreasing excretion

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21
Q

What is another term for broad-spectrum penicillins

A

Aminopenicillins

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22
Q

What gram (-) in particular does broad-spectrum penicillin treat?

A

E. coli, Haemophilus influenzae, Salmonella spp.

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23
Q

Amoxicillin - category

A

Broad-Spectrum penicillin

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24
Q

Excretion route of broad-spectrum penicillins

A

Kidneys

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25
Q

Penicillinase-Resistant Penicillins: mechanism, routes

A

Treats penicillinase-producing S. aureus; can be oral, IM, IV

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26
Q

Piperacillin (Pipracil) category

A

Extended-spectrum penicillin

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27
Q

Which gram (-) does extended-spectrum penicillin work on?

A

Pseudomonas aeruginosa, proteus, Klebsiella

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28
Q

Another term for extended-spectrum penicillin

A

Anti-pseudomonal

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29
Q

What kind of infections does extended-spectrum penicillin treat? (6)

A

Bone, joint, skin, soft tissue, respiratory tract, urinary tract

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30
Q

What are beta-lactamase inhibitors given in combination with?

A

Penicillinase-sensitive penicillin to intensify the effect of the penicillin

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31
Q

Example of beta-lactamase + penicillin

A

Augmentin (Amoxicillin-clavulanate)

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32
Q

Amoxicillin is what type of penicillin?

A

Broad spectrum

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33
Q

Side effects of penicillin

A

Hypersensitivity, anaphylaxis, N/V, diarrhea

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34
Q

If a patient has a history of mild reaction to penicillin….

A

Give cephalosporin instead

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35
Q

If a patient has a history of severe reaction to penicillin…

A

AVOID cephalosporin

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36
Q

Penicillins should be avoided in what kind of condition?

A

Severe renal insufficiency

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37
Q

Cephalosporin mechanism

A

Inhibits cell wall synthesis by dissolving it

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38
Q

Cephalosporins treat what kind of infections?

A

Bone, joint, skin, respiratory, urinary tract, genital

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39
Q

Cefazolin (Ancef, Kefzol) vs Cefepime (Maxipime)

A

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

40
Q

What antibiotic can cross the blood brain barrier?

A

Cefepime

41
Q

Cephalosporin side effects (6)

A
  • Hypersensitivity
  • N/V, diarrhea
  • Alterations in blood clotting with large doses
  • Neutropenia
  • Hemolytic anmeia
  • Nephrotoxicity
42
Q

Penicillin and Cephalosporin Assessment (4)

A

Ask about history of hypersensitivity, labs for liver and renal function, vitals, urine output

43
Q

Client Education - what should you do with chewable tablets before swallowing?

A

Chew or crush

44
Q

IV glycopeptides vs Oral glycopeptides

A

IV - treats drug resistant staph. infections, excreted by kidney
Oral - treats staph. enterocolitics, antibiotic-associated pseudomembranous colitis due to C. diff, excreted by feces

45
Q

What kind of reaction is Red Neck and how does it appear?

A

Toxic reaction due to rapid IV infusion - vascular dilation, skin flushing to head/neck/upper body, rash

46
Q

What irritates the skin in vancomycin IV?

A

HCl

47
Q

How do you prevent Red Neck?

A

Dilute 500 mg in 100 mL or 1000 mg in 250 mL, administer over 60-120 min

48
Q

IV Vancomycin adverse reactions (5)

A

Red neck, Stevens-Johnson, blood dyscrasias, nephrotoxicity, ototoxicity

49
Q

Macrolide mechanism

A

Inhibits protein synthesis

50
Q

Which macrolide can be given in place of pencillin?

A

Erythromycin

51
Q

What kind of infections/conditions do Macrolides treat? (8)

A

Soft tissue, skin, respiratory tract, GI tract, Mycoplasma pneumoniae, Legionnaire’s disease

52
Q

4 side effects of Macrolides

A

GI distress, hepatotoxicity, ototoxicity, tinnitus

53
Q

Which antibiotic increases serum levles of Carbamazepine, Theophylline, and Warfarin?

A

Macrolides

54
Q

Which antibiotic increases Fluconazole and Ketoconazole

A

Erythromycin

55
Q

Antacids reduce absorption of which antibiotics? (3)

A

Azizthromycin, levofolxacin, tetracycline

56
Q

Tetracycline mechanism

A

Inhibits protein synthesis

57
Q

Which antibiotic was the first effective broad-spectrum antibiotic?

A

Tetracycline

58
Q

Continuous use of tetracyclines can result in

A

bacterial resistance

59
Q

3 uses for tetracyclines

A

Mycoplasma pneumoniase, H. pylori in combination with Metronidazole and bismuth subsalicylate, severe acne

60
Q

Tetracyclines side effects (6)

A
  • Gastric irritation (heartburn, epigastric distress, N/V, diarrhea/flatulence, pain)
  • Rash
  • Pruritus
  • Photosensitivity
  • Teratogenic
  • Can discolor teeth in kids less than 8
61
Q

3 Tetracycline interventions

A

-Sun protection, don’t take with antacids or dairy, newer preparations (ex. doxycycline) are better absorbed

62
Q

Aminoglycoside - classification and example

A

Inhibits protein synthesis, Gentamicin

63
Q

Which antibiotic does NOT cross the blood-brain barrier

A

Gentamicin

64
Q

Which antibiotic is used for “serious infections” and requires peak and trough levels?

A

Gentamicin

65
Q

7 side effects of aminoglycosides

A

Rash, numbness, tremors, muscle cramps/weakness, visual disturbances, photosensitivity, tinnitus

66
Q

5 adverse reactions of gentamicin

A

Oliguria, uticaria, palpitations, superinfection, ototoxicity

67
Q

5 life threatening reactions of gentamicin

A

Nephrotoxicity, thrombocytopenia, granulocytosis, neuromuscular blockade, liver damage

68
Q

What increases risk for ototoxicity with gentamicin?

A

Loop diuretics

69
Q

Gentamicin + amphotericin B/polymixin/cisplatin/furosemide/vancomycin can increase risk for…

A

nephrotoxicity

70
Q

What should you always check on gentamicin?

A

Urine output and creatinine clearance

71
Q

Fluoroquinolones mechanism and example

A

Interrupts DNA synthesis; Levofloxacin

72
Q

Which antibiotic is “readily absorbed by GI tract?

A

Fluoroquinolones

73
Q

Which drug is “very irritating to the gastric mucosa”

A

Tetracyclines

74
Q

What do fluroquinolones treat? 6)

A

UTI, bone and joint infections, gonnorrhea, bronchitis, pneumonia

75
Q

Increased Levofloxacin effect with (2)

A

Oral hypoglycemics and theophylline

76
Q

Decreased absorption of Levofloxacin with (2)

A

Antacids, iron

77
Q

5 adverse effects of Levofloxacin

A

Stevens-Johnson, encophalopathy, seizures, pseudomonas colitis (C. Diff), dysrhythmias

78
Q

Three drugs you might see Stevens-Johnson syndrome in

A

IV Vancomycin, Levofloxacin, Trimethoprim-Sulfamethoxazole

79
Q

Lipopeptide mechanism and example

A

Inhibits DNA, RNA, and protein synthesis; Daptomycin (Cubicin)

80
Q

3 uses of Lipopeptides

A

Complicated skin infections, Infected endocarditis due to MRSA (MRSA resistant to Vanco), speticemia due to Staph. A infections

81
Q

Which drug includes side effects of hypo hypertension, burning on urination, and anemia?

A

Daptomycin

82
Q

Which two drugs have side effects of numbness/tingling?

A

Gentamicin, Daptomycin

83
Q

6 adverse reactions of Daptomycin

A

Elevated CK esp. with statins (rhabdomyolysis), hypo/hyperkalemia, unexplained myopathy, neuropathy, hyperglycemia, pleural effusion

84
Q

Daptomycin + Tobramycin…

A

Increased toxicity

85
Q

Daptomycin + Coumadin…

A

Increases bleeding

86
Q

Which antibiotic is oldest?

A

Sulfonamides

87
Q

Which antibiotics can be used for patients allergic to PCN? (2)

A

Erythromycin, sulfonamides

88
Q

What kind of infections do sulfonamides treat?

A

UTI, prostatis, respiratory infection, burn wounds, meningococcal meningitis, newborn eye prophylaxis, chlamydia, toxoplasmosis

89
Q

What drug is used for the Herpes Simplex Virus?

A

Acyclovir sodium (Zovirax)

90
Q

9 side effects of Acyclovir sodium

A

N/V, diarrhea, H/A, lethargy, tremors, rash, pruritus, increased bleeding time, phlebitis at IV site

91
Q

2 adverse reactions to acyclovir sodium

A

Uticaria, anemia

92
Q

6 life threatening reactions to Acyclovir - Sodium

A

Nephrotoxicity, thrombocytopenia, leukopenia, bone marrow depression, granulocytopenia, acute renal failure

93
Q

Contraindications for antivirals (2)

A

Hypersensitivity, severe renal or hepatic disease

94
Q

Metronidazole mechanism and what kind of infections does it treat?

A

Interferes with DNA function to treat anaerobic infections

95
Q

3 patient education points for Metronidazole

A

Avoid alcohol (Disulfram-type reaction), avoid in first trimester of pregnancy, dark reddish brown urine with high doses

PHARM (11 decks)

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