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NUR720 FNP Review > Antibiotics > Flashcards

Antibiotics Flashcards

(51 cards)

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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

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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

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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

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A

rarely used alone for uncomplicated UTIs

24
Q

Fluoroquinolones uses and side effects

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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
metronidazole uses
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
metronidazole side effects
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
What do you use to treat empirically for PCN resistant strep for pneumococcal disease?
ceftriaxone/ cefotaxime or quinolones (levo or moxifloxin)
28
General antibiotic classes
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
ANTIBIOTIC SIDE EFFECTS: PCN, CEPHALOSPORINS, CARBAPENEMS, VANCOMYCIN
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
ANTIOBIOTIC SIDE EFFECTS: MACROLIDES, AMINOGLYCOSIDES, QUINOLONES, SULFONAMIDES, TETRACYLCINES, METRONIDAZOLE
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
Treatment of skin and soft tissue infections (not bite wounds)
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
Treatment of skin and soft tissue infection: Bite wounds
staph and strep (including microaerophilic), Eikenella (animal bites: pasturella), bactericides, prevotella, fusobacterium, peptostreptococcus. Treatment: clean, deride and tetanus shot. Amox/clavulanate, ampicillin, sulbactam
33
Upper Respiratory Tract infections: Pharangitis, otitis media, sinusitis/ bronchitis
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
Community acquired pneumonia: Typical
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
Community acquired pneumonia: Atypical/walking
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
UTI: bugs, DX, and TX
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
GI bugs and treatments
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
Urethritis/ Cervicits, nongonnococcal urethritis (NGU), bugs and tx
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
Urethritis/cervicitis: Gonoccal urethritis bugs and tx
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
Vaginal discharge: Bacterial Vaginosis. S/SX, DX, and TX
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
Vaginal discharge: Trichomoniasis. S/SX and TX
Malodorous, yellow-green with irritation, trichomonad vaginalis protozoan. Metronidazole 2 grams orally in single dose or 500mg BID x 7days
42
Vaginal discahrge: Vulvovaginal candidiasis
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
PID- S/Sx, bugs and tx
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
Syphilis
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
Chancroid
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
Herpes Simplex
Painful ulcers, positive culture for HSV. Acyclovir 400mg TID or famciclocie 250mg TID or Valacyclovir 1 gram BID for 7-10days
47
Tips for COMMON INFECTION: OTITIS MEDIA
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
Tips for COMMON INFECTION: ACUTE BRONCHITIS
most are self-limiting and viral. Consider ANX for COPD, suggestive of PNA, or symptoms lasting longer than 10days
49
tips for common infection: PHARYNGITIS
MOst are self limiting, only 12% caused by group a strep. Determine that strep is the causative agentPCN drug of choice
50
Tips for the common infection: COLD AND ACUTE SINUSITIS
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
Guidelines for prevention of spread of antibiotic resistance
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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