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Flashcards in Antibiotics! Deck (129)
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1

What is selective toxicity?

Antibiotics are harmful to the microbe but harmless to the human host.

2

Antibiotic categories work by different ___________.

Mechanisms

3

What is bacteriocidal?

Drugs are directly lethal to bacteria at clinically achievable concentrations

4

What is bacteriostatic?

• Drugs can slow bacterial growth but do not cause cell death. Compromises the bacteria enough so the immune system can sweep in and save the day.

5

Name two kinds of antiobiotic use?

Prophylaxis and treatment

6

Name some examples of using antibiotics prophylactically:

THIS IS NOT ROUTINE!
◦ Used to prevent infection
◦ Pre-surgery
◦ Special populations: heart valves, rheumatic
fever
◦ Immunosuppressed

7

Name examples of using antibiotics as treatment:

◦ Empiric therapy
◦ Based on identification of organism

8

When might using a bacteriostatic antibiotic not be helpful?

If someone is immunocompromised -- HIV, organ transplant, chemo drugs. Immune system can't kick in to kill the microorgs like it should.

9

When does the WHO say it is ok to use abx prophylactically with surgery?

Abx should be used to prevent infection before and during surgery but NOT after.

10

We should be giving _____________ abx ___ hours before incision, per the WHO.

Broad spectrum, 2

11

Some example of when we would use abx before and during sx?

Bowel sx, c-section, abdominal sx. Not minor surgeries.

12

If you see someone on abx post-sx, what is likely going on?

We are actively treating an infection.

13

What does empiric therapy mean?

Treating someone based on experience. Based on our best guess of what is causing the infection (ex: e coli causes most UTIs, will treat for it before getting culture).

14

What are three main ways we want to identify bacteria?

◦ Gram positive vs. gram negative
◦ Shape: bacilli, cocci, spirilla
◦ Ability to grow in relation to oxygen: aerobic vs. anaerobic

15

Ideally when should a C&S be taken?

BEFORE anti-infectives are started

16

What is the first action we would take in a lab to ID bacteria?

Gram stain

17

After we have done a gram stain, what will happen in the lab?

We will begin to grow it out on a petri dish (takes up to 48 hours).

18

What is it called when you are growing out the bacteria?

A culture

19

Why is it the best practice to get a sample of the bacteria before starting anti-infectives?

You risk killing off some of the microorgs, thus making it harder to ID what the problem bacteria might be.

20

What does PCR stand for?

Polymerase Chain Reaction

21

What is the benefit of a PCR test?

We can detect bacteria and viruses and very low titers

22

Name some gram + organisms:

Staphylococcus, streptococus, enterococus

23

Name some bad things caused by gram + bacteria:

carbuncles, furuncles, impetigo, group A hemolytic strep, necrotizing fascitis, MRSA, skin, pneumonia,
catheter infections

24

Name some gram - organisms:

GI tract: E.coli, Shigella, Salmonella, Klebsiella, Enterobacter, Serratia, Proteus, etc.

25

Name some bad things caused by gram - bacteria:

H. influenza, Neisseria (meningitis & gonorrhea), pseudomonas

26

Where would you find anaerobic bacteria and what is probably happening/what are you seeing when you find it?

Deep wounds, tissues, and internal organs
Abscess formation, tissue destruction, foul smelling pus

27

Name 3 examples of anaerobic bacteria:

C.diff, clostridium botulinum, MRSA, e. coli, clostridum tetani

28

Are anaerobic organisms are harder or easier to treat?

Harder. These are the bad guys!

29

Are anaerobic organisms more often:

Gram +
Gram -
Can be both

Can be both

30

Name two common treatments for anaerobic microorganisms.

Flagyl, Clindamycin

31

We have taken our sample to send out for C&S, what kind of antibiotics do we generally start with now?

Broad spectrum (effective against a wide variety of different microorganisms)

32

After we get our C&S back, what kid of antibiotic do we switch to?

Narrow spectrum (effective against only one or
restricted group of microorganisms)

33

What is an example of a broad spectrum antibiotic?

Ciprofloxacin, Levofloxacin, Penicillin

34

What is an example of a narrow spectrum antibiotic?

Azithromycin, Clindamycin, Vancomycin

35

Why do we change from broad to narrow spectrum medications?

Decreases the risk of superinfections and antibiotic resistance.

36

What does MIC stand for?

Minimal Inhibitory Concentration

37

What does MIC mean?

Minimum Inhibitory Concentration. It is the lowest concentration of antibiotic that causes inhibition of bacteria growth.

38

Name 6 host considerations in antibiotic selection:

Allergy
Ability to penetrate the site
Immunocompromised patient
Foreign hardware within the body
Age
Genetic Factors

39

What is something we need to look into when we are examining an allergy to a drug?

Is it really an allergy or a SE?

40

Name two issues that would cause a difficult in a drug penetrating the site?

Mengitis (need a drug that will cross the BBB), abscess (is walled off, need to be drained first often)

41

Some drugs that have a high rate of allergic rxns?

Sulfa drugs, penicillin, cephalosporins, erythromycin

42

What are some example of foreign hardware within the body and how it affects which antibiotic we choose:

Hip replacement, pacemakers.
Body attacks the foreign material -- the phagocytes are busy fighting this

43

What do we think about when dosing infants?

They have a high level of toxicity

44

What do we think about when dosing children adolescents?

Certain drugs should not be used

45

What do we think about when dosing pregnant/lactating people?

Risk to mom and fetus

46

What are some drugs to avoid giving during pregnancy/lactation?

Gentamicin causes hearing loss; sulfonamides causes kernicterus in nursing newborns

47

What do we think about when dosing older people?

Heightened sensitivity to medications

48

What is a genetic factor we need to consider when dosing abx?

G6PD deficiency with the use of sulfonamides (more common in African American, Middle Eastern, and male patients)

49

How do we know the antibiotic is working?

Clinical/lab Response
◦ Reduction in signs/symptoms and fever
◦ Reduction in WBC
◦ Peak/trough levels--checking for toxicity

50

Why wouldn't we recheck the C&S while the patient is still on antibiotics?

We could get a negative culture reading, which may or may not be a true reading.

51

With antibiotic resistance, it is the __________ that becomes resistant, not the _________.

Microbe, patient

52

Name some things abx DON'T work for:

Flu, colds, vomiting, MOST coughs, MOST ear infections, MOST sore throats, MOST diarrhea, MOST cystitis

53

Name some things abx DO work for:

Serious bacterial infections including: Pneumonia, UTIs, STIs like gonorrhea, sepsis, meningococcal meningitis

54

Name 4 resistant organisms:

◦ MDRO
◦ MRSA
◦ VRE
◦ ESBL

55

What dies MDRO stand for?

Multi Drug Resistant Orgs

56

What dies MRSA stand for?

Methicillin-resistant Staphylococcus aureus

57

What dies VRE stand for?

Vancomycin resistant enterococcus

58

What dies ESBL stand for?

Extended spectrum beta-lactamase

59

Name some ways we can help stop the spread of drug resistant orgs?

◦ Using PPE -- isolation procautions
◦ Identifying patients with these resistant orgs
◦ Putting patients on the appropriate meds

60

What are some common SEs with antibiotics?

Superinfection (host flora killed off by antibiotic, strong bacteria takes over), nausea/vomiting/ diarrhea (GI distress)

61

Name a common antibiotic related super- / supra-infection SE?

Candidiasis in mouth, yeast infection
(probiotics can help!)

62

Name a common antibiotic related GI SE?

C diff (this is also a superinfection)

63

Name some common antibiotic related allergic reactions?

Rash, hives, difficulty breathing

64

What to do if suspect of allergy?

Assess before and monitor after administration
• If suspected-> STOP medication immediately, think about airway (secure airway)
• Call Rapid Response/ Code Cart

65

What is the most common antibiotic to result in Cdiff?

Clindamycin

66

If a patient is going to have an allergic rxn, when it the most likely time it will occur?

Within 30 minutes of administration or second + administration (although can happen with first administration -- could have been exposed to abx through food sources)

67

How do tetracyclines work?

Inhibition of protein synthesis

68

What is the tetracycline prototype?

Tetracycline!

69

Name 3 other tetracyclines:

* demeclocycline
* doxycycline
* minocycline

70

What is a unique characteristic of tetracyclines?

Yellow-brown discoloration of teeth (do not rx children under 8 and during pregnancy)

71

Why is there a lot of resistance to tetracyclines?

Overuse in the 1950-60s. Now we just use for weird things (RMSF, typhus, cholera, Lyme disease, H.pylori, chlamydia, acne).

72

What happens if you tell someone to take tetracyclines with food to help their GI issues?

It will actually decrease absorption

73

What are some other SE of tetracyclines?

GI issues (n/v/d), superinfections (Cdiff, candidiasis), photosensitivity

74

How do tetracyclines interact with food?

DO NOT TAKE WITH Calcium, Iron, Mg, Al -- they bind to the drug and decrease drug absorption by 50%.

75

What should we tell people taking tetracyclines to avoid?

Avoid antacids, anti-diarrheal, dairy products

76

When is the best time to take the tetracyclines re: drug-drug or drug-food interactions?

1 hour before or 2 hours after contraindicated food/drugs

77

How do macrolides work?

Inhibition of Protein Synthesis

78

What is the prototype for macrolides?

erythromycin (E-mycin)

79

What are some other examples of macrolides?

Clarithromycin (Biaxin)
Azithromycin (Z-pack)

80

What is a unique trait of erythromycin?

Affects the motility of the GI tract (motilin)- this can used to HELP pts with diabetic gastroparesis and also with passing feeding tubes

81

What is a cardiac-related SE of erythromycin?

QT prolongation and cardiac death!

82

What are some drug-drug interactions with erythromycin?

Any drug that works through CYP3A4 pathway should be avoided. (CCB, antifungals, HIV protease inhibitors)

83

Why is azithromycin/Z-pack unique and why is this good?

It has a long duration of action (long 1/2 life), so it is given in a short course. Rx for 3-4 days, works in body for a week. This helps with compliance.

84

Some other SE of erythromycin?

GI upset, superinfections

85

Toxic levels with erythromycin (ASK KNOWLTON)

theophylline, carbamazepine, warfarin

86

How is administration preferred?

Continuous infusions rather that intermittent dosing (this is unusual).

87

How does clindamycin work?

Inhibition of protein synthesis

88

What is the biggest risk with using clindamycin?

C diff-associated diarrhea. Can be fatal. Stop immediately if concern for this, put on contact precautions. No alcohol-based hand sani.

89

What are the symptoms of C diff-associated diarrhea?

Profuse, watery diarrhea, abdominal pain, fever, leukocytosis.

90

If you give clindamycin rapidly IV, what can happen?

Risk for cardiac arrest. Give slow.

91

How do aminoglycosides work?

By inhibiting protein synthesis, but specifically by producing abnormal proteins -- are bacterialcidal. STRONGER.

92

What is our aminoglycoside prototype?

Gentamicin

93

Name 6 other aminoglycosides.

Tobramycin, Amikacin, Kanamycin, Neomycin, Paromycin, Steptomycin,

94

What are the two unusual adverse effects?

Ototoxicity and nephrotoxicity (just like vancomycin!)
Related to trough levels

95

What is often the first sign of vestibular toxicity/effects?

Headache

96

How common is nephrotoxicity with aminoglycosides? How should we monitor for this?

5-25%! Usually reversible though.
Monitor BUN & creatinine

97

What can ototoxicity with aminiglycosides affect?

Cochlea (tinnitus) and vestibular area

98

How do sulfonamides work?

Inhibition of folate synthesis

99

What is the sulfonamide prototype?

Trimethoprim/Sulfamethoxazole

100

What are some other names for Trimethoprim/Sulfamethoxazole?

TMP/SMX AKA: Bactrim, Cotrim, Septra, Co-trimoxazole

101

What is the TMP/SMX ratio?

Ratio 1:5. FIXED DOSE PRODUCT

102

When put together, Trimethoprim and Sulfamethoxazole have a/an _________________ effect.

Synergistic

103

SEs of TMP/SMX?

GI (N/V)
Rash (CONCERN FOR SJS, stop medication immediately)
Blood dyscrasias (abnormal or disordered, more common with DS)
Crystalluria- Pts should increase hydration
Photophobia – Pts need sun protection, will easily get burned
CNS effects

104

What are some blood dyscrasias that are seen as SEs of TMP/SMX?

- Hemolytic anemia (with G6PD deficiency)
- Bone marrow suppression (folks with alcohol use disorder and pregnant people more at risk for this)

105

Refresher: Who is more likely to have a G6PD deficiency?

More common in AA and ME males

106

TMP/SMX is taken in what population to treat ________________ prophylactically?

HIV positive patients, PCP pneumonia

107

Whra CNS effects can TMP/SMX have?

Headaches, depression, hallucinations

108

If we give TMP/SMX to a pregnant woman, what can happen to the baby?

Kernicterus risk (bilirubin build up, nephrotoxic) & birth defects.

Should not be used in pregnancy, breast-feeding or in children under the age of 2months (this is used for UTI tx -- should get a preg test first?).

109

What are some drug-drug interactions with TMP/SMX?

Warfarin, Dilantin
(is 68% protein bound)

110

If patients say they have a sulfa allergy what else should they not take?

Thiazide diuretics, loop diuretics, sulfa-DM meds
(other drugs in same category)

111

TMP/SMX can also cause _________kalemia.

Hyper

112

Tell me a little bit about SJS?

Symptoms: Widespread lesions, fever, malaise
Mortality rate 25%
Often treated in burn unit

113

How do fluroquinolones work?

Disrupt DNA Replication/cell division

114

What is our fluroquinolone prototype?

Ciprofloxacin (Cipro)

115

Name some other fluroquinolones:

ofloxacin
moxifloxacin
levofloxacin
gemifloxacin

116

How are fluroquinolone given?

Oral or IV. BOTH ARE EQUAL IN BIOAVAILABILITY!

117

If giving cipro via IV how should it be pushed?

Over 60 minutes (SAME AS VANCOMYCIN)

118

What is a unique side effect of ciprofloxacin?

Tendon rupture!
High risk with elderly & people on steroids (Think: COPD patients with exasperation)
Watch for heel pain
Avoid in kids under 18

119

Name other SEs of ciprofloxacin:

CNS issues in elderly
Photosensitivity
Dysrhythmias if on anti-dysrhythmia agent
Superinfections (Candida & Cdiff)

120

What is the main drug-food interaction with cipro?

Interacts with Al, Mg, iron, zinc, Ca
Milk/dairy products
Give drug 6 hours after or 2 hours before these food/supplements.

121

What happens when cipro is taken with milk/dairy products?

Medication binds to Al, Mg, iron, zinc, Ca, reduces absorption by 90%!!!!

122

Name some drug-drug interactions with cipro

Sucralfate, theophylline, warfarin, tinidazole

123

How does metronidazole (Flagyl) work?

Inhibition of nucleic acid synthesis

124

What does metronidazole work best against?

Protozoa and anaerobic bacteria. Has NO action against aerobic bacteria.

125

How does metronidazole work against these anaerobic bacteria?

Is only taken up by anerobic orgs and then converted into an active form, then causes death.

126

When is metronidazole often prescribed?

C.difficile (PO)
GI and Pelvic surgery

127

How do you give vancomycin for treatment of c diff?

ONLY IN ORAL FORM. IV will not work.

128

How do you administer metronidazole via IV?

Infuse over 1 hour (Same as vanco, cipro)

129

What are some unusual SEs of metronidazole?

- NO alcohol (3 days) due to Disulfiram (antabuse )-like reaction ALTHOUGH THIS IS BEING DEBATED, research not supporting this.
- Urine may turn dark reddish-brown
- Metallic taste in mouth