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Pharmacology > Chapter 17: Bacterial Infections > Flashcards

Chapter 17: Bacterial Infections Flashcards

1
Q

Natural bacterial barriers include

A

skin

mucous membranes

lactic acid

long-chain fatty acids

lysozymes

reticuloendothelial system

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2
Q

bacterial barriers other than the body’s natural ones

A

overall health

age

nutritional status

comorbidities

blood supply near infection site

natural and acquired antibodies

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3
Q

most commonly used classes of antibiotics

A

PCNs

fluoroquinolones

cephalosporins

macrolides

tetracyclines

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4
Q

bacteriocidal antibiotics

A

kill the invading organism

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5
Q

bacteriostatic antibiotics

A

inhibit growth of invading organism so the body’s defenses can kill it

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6
Q

methods by which antimicrobial drugs effect the invading microbe

A
  1. inhibition of cell wall synthesis/repair
  2. inhibition of protein synthesis
  3. disruption of membrane permeability
  4. inhibition of nucleic acid synthesis
  5. inhibition of specific biochemical pathways
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7
Q

cell wall structure of gram- and gram+ bacteria

A

gram + tends to be a simpler structure and easier to damage

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8
Q

empricial prescribing

A

prescribing based on previous experience when treatment must be started prior to lab results

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9
Q

what are the 3 things used to classify all organisms

A

morphology (cocci, bacilli)

growth characteristics (anaerobic, aerobic)

other qualities (gram+, gram-)

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10
Q

patient education for antimicrobials

A

take as prescribed and finish entire course

do not take for viral infections

do not take someone else’s

patient’s should ask about potential for resistance

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11
Q

which 2 agents are most commonly asociated with clinically significant drug interactions

A

quinolones and macrolides

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12
Q

interactions between ABTs and other medications

A

coumadin interacts with many

birth control with PCN

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13
Q

classess of bacteriocidal ABTs that affect cell wall synthesis

A

Natural Penicillins

expanded-spectrum PCNs

extended spectrum PCNs

penicillinase resistant PCNs

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14
Q

4 groups of PCNs

A

natural PCNs

PCN G

PCN V

aminopenicillins (amoxicillin, ampicillin)

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15
Q

signs of superinfection to watch for when prescribing PCNs

A

abdomina cramps

fever

watery diarrhea

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16
Q

hypersensitivity reactions to PCN can include

A

angioedema

serum-sickness

anaphylaxis

severe local inflammaotory reaction at injection site

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17
Q

PCNs effect on Comb’s test

A

can cause false positive

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18
Q

IV administration of PCN G, K+, or Na_

A

administer slowly

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19
Q

other conscientious consideration with prescribing PCNs

A

renal impairment may require dosage adjustments

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20
Q

PCN patient education

A
  • oral tabs 1hr before or 2hr after meals
  • take all medication for 14 days
  • alternate birth control
  • doses should be dividied equally over 24 hour period
  • notify clinicain if blood, pus, mucus in stool
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21
Q

important pieces to remeber about pharmacokinetics of PCNs

A

GI absorption is variable

widely distributed (crosses CSF and breast milk)

partial metabolism in liver but mostly excreted unchanged in urine

more page 316

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22
Q

which medications can inhibits PCN bacteriocidal activity

A

chloramphenicol

macrolide ABTs

methotrexate

tetracycline

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23
Q

what effect does probenecid have on PCNs and cephalosporins

A

potentates activity by raising their blood levels

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24
Q

contraindications for natural PCNs

A

infectious mononucleosis as it can cause extensive rash

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25
Q

cross sensitivity of PCN and cephalosporin sensitivity

A

about 10%

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26
Q

extended-spectrum PCNs

(cephalosporins)

A

semisynthetic agents

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27
Q

how are cephalosporins grouped

A

4 generations based on antimicrobial properties

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28
Q

things to remember in general about cephalosporins

A

low toxicity

broad spectrum of activity

not reliable against MRSA

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29
Q

action of cephalosporins

A

1st generation is more useful among gram+

as classification increases, so does spectrum, and ability to effect gram-

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30
Q

cephalosporin mechanism of action

A

interferes with bacterial cell wall synthesis

(Bacteriocidal)

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31
Q

some clinical uses of cephalosporins

A

respirtaory tract infections

pneumonia

otitis media

skin infections not caused by MRSA or MRSE

more page 319

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32
Q

cephalosporin patient education

A

evenly space dosages around the clock

take missed dose ASAP but do not double

do not share

report signs of superinfection

do NOT self-treat any diarrhea that develops

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33
Q

hematologic side effects of cephalosporins

A

anemia, leukopenia

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34
Q

cephalosporin interactions

A

aminoglycosides and LOOP diuretics can add to nephrotoxicity

anticoagulants can cause hypoprothrombinemia

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35
Q

cephalosporin contraindication

A

hypersensitivity

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36
Q

beta-lactamase resistant PCNs mechanism of action

A

resist the action of penicillinase and bind to the cell wall which causes cell death

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37
Q

what causes resistance to PCNs

A

invading microbe produces penicillinase which hydrolyzes the beta-lactam ring of the ABTs, rendering it ineffective

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38
Q

examples of penicillinase resistant PCNs

A

cabenicillin

geocillin

cloxacillin

dicloxacillin

methicillin

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39
Q

examples of first generation cephalosporins

A

cefadroxil (Duricef)

cephalexin (Keflex)

cefazolin (Ancef)

cephradine (Velosef)

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40
Q

examples of second generation cephalosporins

A

cefuroxime axetil (Ceftin)

cefprozil (Cefzil)

loracarbef (Lorabid)

cefotetan (Zinacef)

cefaclor (Cecor)

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41
Q

examples of third generation cephalosporins

A

ceftibuten (Cedax)

ceftriaxone (Rocephin)

cefotaxime (Claforan

cefixime (Suprax)

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42
Q

examples of fourth generation cephalosporins

A

cefdinir (Omnicef)

cefepime (Maxipime)

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43
Q

clinical uses of penicillinase resistant PCNs

A

soft tissue and bone infections

respiratory tract infections

sinusitis

UTIs

endocarditis

septicemia

meningitis

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44
Q

what decreases absorption of penicillinase resistant PCNs

A

gastric acids and acidic juices

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45
Q

extended spectrum PCNs mechanism of action

A

pass throught the pores in the outer membrane and can reach penicillin-binding proeins on inner cell’s cytoplasmic membranes

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46
Q

examples of extended spectrum PCNs

A

amoxicillin

ampicillin

amoxicillin/clavulanate (Augmentin)

ampicillin/sulbactam (Unasyn)

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47
Q

why is amoxicillin preferred over ampicillin

A

it is more completely absorbed and has a lower incidence of diarrhea

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48
Q

How do macrolides work

A

they inhibit protein synthesis at the 50S ribosome unit

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49
Q

Antibiotics that inhibit protein synthesis

A

macrolides

tetracyclines

aminoglycoside

50
Q

examples of macrolides

A

azithromycin (Z-pak)

erythromycin (E-mycin)

clarithromycin (Biaxin)

clindamycin

lincomycin (Linocin)

51
Q

macrolide clinical uses

A

mild-mod bacterial exacerbations of COPD

mild-mod pharyngitis/tonsilitis caused by strep

PID

community-acquired pneumonia caused by strep or flu

52
Q

conscientious considerations for macrolides

A

C&S is important

watch for nonadherance, anaphylaxis, drowsiness, superinfection

can take without regard to food

may cause photosensitivity

53
Q

Azithromycin is a derivative of what

A

erythromycin

54
Q

why is azithromycin one of the most popular ABT for respiratory, skin, and sexually transmitted infections

A

effective against so many gram+ and some gram- bacteria

55
Q

how is azithromycin different from older macrolides

A

longer half-life

56
Q

what decreases peak serum levels of azithromycin

A

aluminum and magnesium containing antacids

57
Q

what increases peak serum levels of azithromycin

A

digoxin, theophylline, and phenytoin triazolam

58
Q

azithromycin contraindications

A

pregnancy/breastfeeding

liver impairment

sensitivity

59
Q

absorption of erythromycin (Biaxin)

A

high but erratic

60
Q

clinical uses for erythromycin (Biaxin)

A

legionnaire’s disease

syphylis

diptheria

atypical pneumonia

topically for acne

61
Q

what is often used as an alternative when a patient is allergic to PCN

A

Biaxin

62
Q

erythromycin interactions

A

ALOT

ethanol reduces plasma concentrations

decreases activity of PCN if co-administered

63
Q

erithromycin contraindications

A

hepatic disease or macrolide sensitivity

64
Q

why is erythromycin preferred over tetracyclines in young people being treated for acne

A

does not discolor teeth or bind to bone

65
Q

clinical uses of clindamycin

A

serious infections

most infections with gram- staph and strep

66
Q

clindamycin mechanism of action

A

bacteriostatic or bacteriocidal

inhibits protein synthesis at the ribosome 50S unit

67
Q

clindamycin interactions

A

kaolin/pectin preparations decrease absorption

68
Q

clindamycin contraindications

A

previous pseudomembranous colitis

severe liver impairment

diarrhea

alcohol tolerance

pregnancy/lactation

69
Q

why are tetracyclines contraindicated in children and pregnancy

A

binds to calcium where it stains teeth and affects long bone development

70
Q

examples of tetracyclines

A

doxycycline

tetracycline

minocycline

oxytetracycline

71
Q

tetracycline mechanism of action

A

broad spectrum bacteriostatic agents that inhibit protein synthesis by binding to the 30S ribosome unit

72
Q

clinical uses of tetracyclines

A

syphilis in PCN allergic patients

lyme disease. anthrax

adjunct to therapy for H. pylori ulcers

mycoplasma pneumoniae

(more page 325)

73
Q

tetracycline interactions

A

increase effect of warfarin

decrease effect of sucralfate and barbituates

74
Q

aminoglycoside mechanism of action

A

bind to ribosomal 30S and 50S subunits to inhibit protein synthesis which causes a defective cell membrane that cannot sustain the bacteria

75
Q

makeup of aminoglycosides

A

contain at least one sugar

76
Q

aminoglycosides clinical uses

A

serious bacteremia

respiratory/urinary tact infections

infected wounds

infected bone/soft tissues

perotinitis

burns complicated by sepsis

77
Q

treatment of serious infections with pseudomonas aeruginosa

A

may require combined therapy with aminoglycosides and ticarcillin, carbenicillin, pipercillin, or ceftazidime

78
Q

side effects to watch for with aminoglycosides

A

vestibular and cochlear disturbances, nephrotoxicity, hypersensitivities

79
Q

aminoglycoside interactions

A

long list

most result in nephrotoxicity or ototoxicity

80
Q

clinical considerations with aminoglycosides

A

poor oral absorption (most are IV)

therapy exceeding 7 days can cause kidney damage

resistance varies widely

81
Q

sulfonamides mechanism of action

A

inhibits bacterial folic acid synthesis producing a bacteriostatic effect

82
Q

examples of sulfonamides

A

sulfamethoxazole (Gantanol)

sulfamethoxazole/trimethoprim (Bactrim)

83
Q

clinical uses of sulfonamides

A

infection with toxoplasma, pneumocystitis jiroveci pneumonia, shigella enteritis, and UTIs

84
Q

sulfonamides as prophylaxis

A

against pneumocystitis in HIV and immucompromised patients

85
Q

sulfonamide interactions

A

increases the hypoprothrominemia effect of arfarin by inhibiting its metabolism

86
Q

sulfonamide patient education

A

notify if rash, sore throat, mouth sores, unusual bleeding

avoid driving until response is known

stay hydrated to prevent crystalluria

87
Q

sulfonamide conscientious considerations

A

watch for stevens-johnson syndrome

G6PD deficiency can lead to anemia

hypersensitivities can occur up to 12 days after exposure

88
Q

fluroquinolones mechanism of action

A

inhibits bacterial DNA synthesis to prevent replication

89
Q

fluroquinolones are effective against

A

most aerobi gram- bacteria and some gram+

90
Q

examples of fluroquinolones

A

ciprofloxacin (Cipro)

gatifloxacin (Tequin)

gemifloxacin (Factive)

levofloxacin (Levoquin)

moxifloxacin (Avelox)

ofloxacin (Floxin, Ocuflox)

91
Q

respiratory quinolones

A

gemifloxacin, levofloxacin, and moxifloxacin

all have good activity against PCN-resistant strains of pneumonia

92
Q

cipro is used widely for

A

enteric infections (bacterial enteritis and diverticulitis)

UTIs (including prostatitis)

bone/joint infections

93
Q

what drugs have approval to treat uncomplicated gonorhhea

A

oxyfloxacin, norfloxacin, gatifloxacin, and ciprofloxacin

minimum of 7 day treatment

94
Q

what are special use ABTs used for

A

parasitic and bacterial infections

95
Q

examples of special use ABTs

A

metronidazole (Flagyl)

daptomycin (Cubicin)

tigecycline (Tygacil)

Linezolid (Zyvox)

Quinupristin/dalfopristin (Synercid)

96
Q

metronidazole (Flagyl)

mechanism of action

A

causes metabolites to accumulate in the susceptible organism which disrupts DNA and protein synthesis

97
Q

clinical uses of flagyl

A

anaerobic bacteria and some protozoa

intestinal parasite Giardia

vaginitis

amebic dysentery

trichomoniasis

tx of c-diff

more page 332

98
Q

flagyl interactions

A

cimetidine can reduce metabolism

phenobarbital can increase metabolism

alcohol causes disulfiram-like reaction

99
Q

symptoms of disulfiram-like reaction

A

headache, dizziness, flushing, nausea, sweating, hyperventilation, disorientation

100
Q

flagyl contraindications

A

hypersensitivities

first trimester of pregnancy

101
Q

flagyl conscientious considerations

A

use with caution in CNS diseases (potential for neurotoxicity)

102
Q

flagyl patient education

A

severe interaction with alcohol

possible furry tongue and metallic taste

may darken urine

may take with food if GI upset occurs

103
Q

daptomycin (Cubicin)

mechanism of action

A

cyclic lipopeptide with rapid bacteriocidal activity against wide variety of gram+ and bacteria resistant to vancomycin and methicillin

(binds to bacterial cell membrane)

104
Q

clinical uses of daptomycin

A

complicated skin and skin structure infections

s. aureua bacteremia

right sided endocarditis

105
Q

daptomycin interactions

A

none clinically significant

manufacturer warns against statin drugs d/t risk of myopathy

106
Q

what can be done to minimize the risk of daptomycin resistance

A

always drain any abcesses

107
Q

tigecycline (Tygacil)

mechanism of action

A

inhibits bacterial protein synthesis by binding to 30S ribosomes

chemically similar to tetracyclines

108
Q

administration of Tygacil

A

IV only

109
Q

clinical uses of Tygacil

A

severe skin and soft tissue infections

complicated intra0abdominal infections with resistant pathogens (VRE, MRSA)

110
Q

Tygacil interactions

A

oral contraceptives

111
Q

tygacil contraindications

A

<18

pregnant/breastfeeding

112
Q

linezolid (Zyvox)

mechanism of action

A

inhibits protein synthesis by binding to 50S ribosomal unit

treats nearly all gram+ resistant bacteria

113
Q

major drawback of Zyvox

A

reversible thrombocytopenia

114
Q

clinical uses of Zyvox

A

bacteriocidial: gram+ (sterptococci)
bacteriostatic: resistant enterococci and staphylococci

115
Q

Zyvox interactions

A

dopaminergic, vasopressors, sympathomimetics should be reduced

(mild MAOI)

OTC cold medicines can increase BP

116
Q

contraindications for Zyvox

A

not determined for pregnancy

caution with antiplatelets

117
Q

quinupristin/dalfopristin

(Synercid)

mechanism of action

A

bacteriostatic

quinupristin inhibits late phase of protein synthesis

dalfopristin inhibits early phase of protein synthesis

118
Q

Synercid clinical uses

A

treatment of infections with antibiotic resistant gram+ organisms

(VRE, MRSA, VREF)

119
Q

Synercid interactions usually result in

A

increased risk of toxicity

listed page 335

120
Q

pregnancy,geriatric, pediatric

A

page 336

121
Q
A

Pharmacology (28 decks)

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