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NUR720 FNP Review > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

who should receive antibiotic prophylaxis?

A

certain surgical patients (cardiac, peripheral vascular, ortho, GI, hysterectomy), severely neutropenic patients, the patient at risk for bacterial endocarditis, the patient with recurrent UTIs, severe rheumatic endocarditis

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2
Q

PCN: Narrow- spectrum penicillinase sensitive

A

Pen G, Pen V- Useful for strep spa, Neisseria spa, many anaerobes, spirochete

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3
Q

PCN: Narrow- spectrum penicillinase resistant

A

Nafcillin, oxacillin, cloxacilin, dicoxacillin- useful for staph aureus

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4
Q

PCN: Broad- spectrum

A

Ampicillin, amoxillin, bicampicillin- Useful for H. influenzae, E.Coli, P.mirabilis, N. gonorrhoeae, entercocci

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5
Q

PCN- Extended- Spectrum pencillins

A

carbenicillin indanyl, ticarcillci, mezlocillin, piperacillin- useful for H. Influenzae, E.Coli, P.Mirabilis, N. Gonorrhoeae, entercocci, plus, Pseudomonas, enterobacter spp., bacterioides fragilis, many klebsiella

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6
Q

PCN- Side effects and toxicities

A

Pain at IM inn site, rare neurotoxicity, reactions to procaine and potassium, allergy in 2-30min is immediate, accelerated is 1-72 hours, late is days to weeks, anaphylactic retains more common than other drugs

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7
Q

Cephalosporins

A

are beta-lactam antibiotics that bind to PBPs, resistance to cephalosporins occurs due to beta-lactamases which cleave open the drugs. Groups into generations which take into account spectrum of activity, susceptibility, to beta-lactamases, and increasing ability to penetrate the CSF

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8
Q

First generation cephalosporins

A

Good gram positive coverage

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9
Q

second generation cephalosporins

A

gram positive coverage and some gram negative coverage

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10
Q

third generation cephalosporins

A

gram negative aerobes, ceftazidime is effective against pseudomonas

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11
Q

fourth generation cephalosporin

A

cefipime- broadesr spectrum, good penetration

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12
Q

Side effects and toxicities of cephalosporins

A

allergy- micropapular rash after several days is the most common manifestation
Increased bleeding tendencies (cefmetazole, cefoperazone, cefotetan), alcohol intolerance

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13
Q

Carbapenems

A

broad spectrum beta-lactam anx. Include imipenem (most broad), meropenem, ertapenem

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14
Q

Vancomycin

A

reserved for serious infections- AAPMC (second choice to metronidazole) MRSA, serious infections in the PCN allergic patients. Binds to cell wall synthesis but is not a beta lactam, ototoxicilty at high levels. Other rxn include rashes, thrombophlebilits, no cross- reactivity in the PCN allergic patient

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15
Q

Tetracyclines

A

tertracycline, oxytetracyline, demeclocycline, methacycline, doxycycline, and minocycline

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16
Q

Therapeutic uses of tetracycline

A

infection diseases: rickettsia, chlamydia trachomitis, brucellosis, cholera, mycoplasma pneumonia, lyme disease, anthrax, H Pylori. TX of acne- topical and PO. PUD, periodontal disease

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17
Q

Side effects and toxicities of tetracyclines

A

GI irritation; NVD, esophageal ulceration, Staining of teeth- avoid during pregnancy, avoid form ages 4mos to 8yrs, supra infection; AAPMC, candida, hepatoxicity, renal toxicity, photosensitivity

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18
Q

Macrolides

A

Erythromycin, clarithromyscin, azithromycin and dirithromycin

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19
Q

erythromycin- Activity, SE, drug interactions

A

macrolide. has activity against most gram + and some gram -, drug of choice for the PCN allergic for whooping cough and legionnaires disease.
SE: NVD, cholestatic hepatitis (10-20 days after, reversed with d/c of drug) and supra infection
Drug interaction- Cyp450 inhibitor; theophylline, carbamezepine, warfarin- monitor closely. Do not combine with clinda or chloramphenicol

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20
Q

clarithromycin

A

for soft tissue and skin infections, H pylorim respiratory tract infections in PCN allergic patients

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21
Q

azithromycin

A

for skin and soft tissue infections, H pylori, respiratory tract infections, and drug of choice for chlamydia trachoma tis

22
Q

sulfonamides uses and side effects

A

UTIs, nocardiosis, burns, superficial eye infections. Hypersensitivity reactions: rash, drug fever, photosensitivity, stevens-johnson syndrome. Hemolytc anemia- seen in patients with G6PD deficiency. Kernicterus- do not give in preggo, breastfeeding, or infants, 2 months. Renal damage from cystalluria

23
Q

Trimethoprim uses and side effects

A

rarely used alone for uncomplicated UTIs

24
Q

Fluoroquinolones uses and side effects

A

borad spectrum antibiotics used for bone and soft tissue infections, UTIs, respiratory tract infections, GI infections and prevention of anthrax. Mild GI side effects, CNS s/e include dizziness, headache, restlessness, seizures rare. TENDON RUPTURE (usually achilles tendon) rare but d/c at first sign of tendon pain, do not use in children ,18yo, may elevate warfarin and theophylline

25
Q

metronidazole uses

A

used to treat anaerobic bacterial infections of CNS , abdominal organs, skin, joints, soft tissues, and GU and protozoal infections. Also prophylactic antibiotic for colorectal surgery, abdominal surgery, vaginal surgery. May be used in combo for H pylori.

26
Q

metronidazole side effects

A

GI: nausea, dry mouth, metallic taste, urine may turn darker color, avoid using in first trimester pregnancy, causes disulfiram-like reaction with alcohol, lower doses of warfarin when used with metronidazole

27
Q

What do you use to treat empirically for PCN resistant strep for pneumococcal disease?

A

ceftriaxone/ cefotaxime or quinolones (levo or moxifloxin)

28
Q

General antibiotic classes

A

BETA-LACTAMS- Penicillins= ampicillin, amoxicillin, nafcillin, diclocillin, piperacillin, ticarcillin. Cephalosporins= Cefazolin, cephalexin, cefoxitin, cefotetan,ceftriaxone, ceftazidime, cefepime) Monobactam (aztreonam) Carbapenem (imppenem, meropenem)
COMBINATIONS- Amoxicillin/clavulanate, ampicilin/sulbactam, piperacillin/tazobactam
GLYCOPEPTIDES- vancomycin, teicoplanin
MACROLIDES- erythromycin, clarithromycin, azithromycin
LINCOSAMIDES- clindamycin
AMINOGLYCOSIDES- gentamycin, tobramycin
QUINOLONES- norfloxacin, ciprofloxacin, oflaxacin, levofloxacin, gemifloxacin, moxifloxacin
SULFONAMIDES- trimethoprim + sulfamethoxazole
TETRACYCLINE- tetracycline, doxycyline, minocyline
NITROIMIDAXZOLE- metronidazole

29
Q

ANTIBIOTIC SIDE EFFECTS: PCN, CEPHALOSPORINS, CARBAPENEMS, VANCOMYCIN

A

PCN: Allergic reactions (1-5%), anaphylaxis (rare), cross reactions (3-7% with ceph), prolonged high dose- granulocytopenia, interstitial nephritis
CEPHALOSPORINS- Allergic reactions (1-3%), cerfotetan- disulfiram-like reaction and hemostasis (hypoprothrombinemia)
CARBAPENEMS (allergic reactions with PCN, SZ in high doses)
VANCOMYCIN- red man syndrome, nephrotoxicity when used with amino glycosides

30
Q

ANTIOBIOTIC SIDE EFFECTS: MACROLIDES, AMINOGLYCOSIDES, QUINOLONES, SULFONAMIDES, TETRACYLCINES, METRONIDAZOLE

A

Macrolides- GI COMPLAINTS, Cramping, diarrhea, drug interactions
Aminoglycosides- nephrotoxicity, ototoxicity,
QUINOLONES- GI and CNS complaints, SZ with high doses
SULFONAMIDES- Allergic reactions, stevens johnson
TETRACYCLINES- photosensitity
METRONIDAZOLE- Disulfiram-like reactions with ETOH, CNS( SZ) and neuropathy

31
Q

Treatment of skin and soft tissue infections (not bite wounds)

A

staph aureus, strep pyogenas (impetigo, erysipelas, lymphangitis, cellulitis, surgical wound infections, pyomyositis, necrotizing fasciitis).
Cefazolin, cephalexin, nafcillin, dicloxacillin, clindamycin, vancomycin, amox/ clav. ampicillin/ sulbactam. DURATION; 10 days

32
Q

Treatment of skin and soft tissue infection: Bite wounds

A

staph and strep (including microaerophilic), Eikenella (animal bites: pasturella), bactericides, prevotella, fusobacterium, peptostreptococcus. Treatment: clean, deride and tetanus shot. Amox/clavulanate, ampicillin, sulbactam

33
Q

Upper Respiratory Tract infections: Pharangitis, otitis media, sinusitis/ bronchitis

A

Pharangitis: Group A strep, PCN x10days
Otitis media: Pneumococcus, H influenze, moraxella catarrhalis- amocillin (augmentin) Macrolides, Cephalosporins
Sinusitis/ bronchitis: Pneumococcus, Hinfluenze, Klebsiella, moraxella, staph aureus, anaerobes. TMP/SMX. Second choice amoxicillin, augmentin, macrolides, cephalosporins, quinolones

34
Q

Community acquired pneumonia: Typical

A

Acute once, symptoms ,1week, productive cough, SOB, Chest X-ray shows lobar infiltrates. bugs: Streptococcus pneumoniae, H. influenzae, Moraxella catarhalis, klebsiella pneumoniae, staph aureus, aspiration or naerobic lung abscess. empiric treatment with ceftriaxone or cefotaxime; alternatives are vanco, clindamycin, or quinolone (levo, gemi, moxi)

35
Q

Community acquired pneumonia: Atypical/walking

A

insidious onset, symptoms >1week (2-3 weeks usually), nonproductive cough, dyspnea on exertion (then SOB), chest X-ray shows interstitial infiltrates. Bugs: mycoplasma pneumonia, chlamydia pneumoniae, legionella pneumophila, influenza A 7B (parainfluenze, adenovirus) TB, miliary, fungal, pneumocystis carinii. Treatment with erythromycin (clarithromycin, azithromycin). Alternative is quinolones

36
Q

UTI: bugs, DX, and TX

A

Ecoli, enterococcus, s.saprophyticus, proteus klebsiella, pseudomonas. DX: Clean catch. Pyuria, leuocyte esterase, hemturia, >100,000 bacterial colonies. TX: Empiric TMP/SMX, quinolone for 5-7 days. Pyelonephritis: 14 days

37
Q

GI bugs and treatments

A

GASTEROENTERITIS: Shigella, salmonella, enterotoxic E coli, campylobacter- Hydration, TMP/SMX, quinolones.
C DIFF COLITIS- Metronidazole, Vanco
HEPATOBILIARY- enteric gram neg, enterococcis, anaerobes- Ceftriaxone, ampicillin/ sulbactam, cefoxiten
CATASTROPHIC GI- polymicrobial- cefoxiten, amp/sulbactam, amp+gent+metronidazole

38
Q

Urethritis/ Cervicits, nongonnococcal urethritis (NGU), bugs and tx

A

Chlamydia trachomatis, ureaplasm urealyticum, mycoplasma genitalium, HSV and trichomonas vaginalis. Tx Doxycyline 100mg BID x7days or Azithromycin 1 gram single dose. Other alternatives are erythromycin 500mg QIDx7dys, ofloxacin 300mg BID x7days, refractory metronidazole 2 gram in single dose

39
Q

Urethritis/cervicitis: Gonoccal urethritis bugs and tx

A

Mucopurulent, n gonorrhoeae, cefixime 400mg or cirpfloxin 500mg or ofloxacin 400mg orally in single dose or ceftriaxone 125mg IM in a single dose PLUS doxycyline 100mg BID x 7days or azithromycin 1 gram unless using ofloxacin BD x7day regime. GC pharyngitis is same but cefixime is not effective. Disseminated GC needs IV

40
Q

Vaginal discharge: Bacterial Vaginosis. S/SX, DX, and TX

A

White, noninflammatory discharge, clue cells, Ph.4.5, fishy odor, (+/- KOH 10%). Metronidazole 500mg BID x7days. Alternative Clindamycin cream 2% or metronidazole gel 0.75% intravaginally QHS x7days

41
Q

Vaginal discharge: Trichomoniasis. S/SX and TX

A

Malodorous, yellow-green with irritation, trichomonad vaginalis protozoan. Metronidazole 2 grams orally in single dose or 500mg BID x 7days

42
Q

Vaginal discahrge: Vulvovaginal candidiasis

A

White discharge with parities +/- or burning. Candida albicans or others. Topical azole antifungals 3-14 days or fluconazole 150mg orally in a single dose

43
Q

PID- S/Sx, bugs and tx

A

upper genital tract: endometriosis, salpingitis, tubo-ovarian abscess, pelvic peritonitis. Lower abdominal pain, adenexal, cervial motion tenderness +/- temp, discharge, ESR, CRP pr histopath/ US/ Laparoscopic N. gonorrhoeae, C. Trach, anaerobes, G. Vaginalis, Hinfluenze. oral regimen: ofloxacin BIDx14days plus metronidazole 500mg BID x14days

44
Q

Syphilis

A

Primary and Secondary- Benzathine Penicillin G 2.4Mill IM x1 week. If PCN allergy: Doxycyline 100mg PO BID x2 weeks
Latent syphilis-> tertiary syphilis- Benzathine PCN G 7.2 million IM weekly x3 days. Neuro syphilis needs IV

45
Q

Chancroid

A

multiple painful ulcers, no syphilis, adenopathy, H ducreyi

TX: Azithromycin 1 gram x1 or ceftriaxone 250 IM or ciprofloxacin 500mg BIDx3 days or erythromycin 500mg QID x7days

46
Q

Herpes Simplex

A

Painful ulcers, positive culture for HSV. Acyclovir 400mg TID or famciclocie 250mg TID or Valacyclovir 1 gram BID for 7-10days

47
Q

Tips for COMMON INFECTION: OTITIS MEDIA

A

1/3 cases are viral, antibiotics can be deferred for 48h in mild cases, Amoxicillin, TMP/SULFA are most appropriate,. If no clinical improvement in 48-72 hours, change ANX

48
Q

Tips for COMMON INFECTION: ACUTE BRONCHITIS

A

most are self-limiting and viral. Consider ANX for COPD, suggestive of PNA, or symptoms lasting longer than 10days

49
Q

tips for common infection: PHARYNGITIS

A

MOst are self limiting, only 12% caused by group a strep. Determine that strep is the causative agentPCN drug of choice

50
Q

Tips for the common infection: COLD AND ACUTE SINUSITIS

A

most are viral. Green or yellow discharge is not indicative of bacterial infection. Defer tx unless temp is >39C, facial pain or swelling, or cough with purulent rhinorrhea for .7-10 days

51
Q

Guidelines for prevention of spread of antibiotic resistance

A

Do not use broad spectrum as freebies, use local epidemiological data, educate patient about taking full course of and, shorter courses when possible

NUR720 FNP Review (24 decks)

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