ANTIBIOTICS Flashcards

Question

Sulfonamides: Indications effective againts which bacteria

Answer 1

Effective against both gram-positive and gram-negative bacteria Treatment of urinary tract infections caused by susceptible strains of Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Proteus vulgaris, Staphylococcus aureus Pneumocystis jiroveci pneumonia sulfamethoxazole/trimethoprim (SMX-TMP) Upper respiratory tract infections SMX-TMP is commonly used for outpatient Staphylococcus infections because of the high rate of community-acquired MRSA infections.

Answer 2

with celoxicib (Celebrex) if have known sulfonamide allergy in pregnant women and infants younger than 2 months

Answer 3

Sulfonamide + sulfonylureas = increased hypoglycemic effects Sulfonamide + Phenytoin = toxicity of phenytoin (seizure med) Sulf + Warfarin = increased bleeding Sulf + cyclosporine = nephrotoxicity

Answer 4

Blood: Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia Integumentary: Photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis GI: Nausea, vomiting, diarrhea, pancreatitis, hepatotoxicity Other: Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria, cough

Answer 5

Take with plenty of fluids to avoid crystalluria or precipitation in the kidneys Take with food

Answer 6

Penicillins Cephalosporins Carbapenems Monobactams

Answer 7

Natural penicillins Penicillinase-resistant penicillins Aminopenicillins Extended-spectrum penicillins

Answer 8

penicillin G penicillin V

Answer 9

cloxacillin sodium

Answer 10

amoxicillin ampicillin

Answer 11

β lactamase inhibitors

Answer 12

Clavulanic acid (clavulanate) tazobactam

Answer 13

piperacillin sodium/tazobactam sodium (Tazocin) piperacillin sodium clavulanic potassium/ticarcillin disodium

Answer 14

Penicillins enter the bacteria via the cell wall. Inside the cell, they bind to penicillin-binding protein. Once they are bound, normal cell wall synthesis is disrupted. As a result, bacteria cells die from cell lysis. Penicillins do not kill other cells in the body.

Answer 15

Prevention and treatment of infections caused by susceptible bacteria, such as: Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., and Staphylococcus spp.

Answer 16

Usually safe and well-tolerated medications Known medication allergy Type of reaction that occurs in patients who state they are allergic to penicillins Many medication errors have occurred when a penicillin drug called by its trade name is given to a patient with a penicillin allergy.

Answer 17

Not all names end in “cillin” (e.g., Clavulin® A,). Combination of amoxicillin and clavulanic acid)

Answer 18

Common adverse effects: Nausea, vomiting, diarrhea, abdominal pain Allergic reactions to the penicillins occur in 0.7% to 4% of treatment courses. -Urticaria, pruritus, angioedema Patients allergic to penicillins have an increased risk of allergy to other ß-lactam antibiotics. Only patients with a history of throat swelling or hives from penicillin should not receive cephalosporins.

Answer 19

Many interactions! NSAIDs compete for protein binding (increased effect of penicillin) Oral contraceptives (decreased effect) Potassium supplements (worsen hyper K+) Probenecid (prolongs penicillin effect) Rifampin (inhibit killing activity of penicillin) Warfarin (enhances anticoag effect)

Answer 20

caffeine, citrus fruit/juice, tomato juice, colas

Answer 21

First generation Second generation Third generation Fourth generation Fifth generation (none available in Canada) Semisynthetic antibiotics Structurally and pharmacologically related to penicillins Bactericidal action Broad spectrum Divided into groups according to their antimicrobial activity

Answer 22

Good gram-positive coverage Poor gram-negative coverage Parenteral and oral forms Example cephalexin (Keflex®) cefazolin

Answer 23

cefazolin: intravenous (IV) or intramuscular (IM) cephalexin (Keflex): oral dosage

Answer 24

Good gram-positive coverage Better gram-negative coverage than first- generation cephalosporins Examples cefoxitin cefuroxime cefaclor cefprozil

Answer 25

Used prophylactically for abdominal or colorectal surgeries Also kills anaerobes

Answer 26

cefuroxime axetil (Ceftin®) is oral form Surgical prophylaxis Does not kill anaerobes

Answer 27

Most potent group against gram-negative bacteria Less active against gram-positive bacteria Examples ceftazidime ceftriaxone cefotaxime sodium cefixime cefpodoxime proxetil ceftizoxime

Answer 28

IV and IM, long half-life, once-a-day dosing Elimination is primarily hepatic Easily passes meninges and diffused into cerebrospinal fluid to treat central nervous system infections

Answer 29

IV and IM forms Excellent gram-negative coverage Used for difficult-to-treat organisms such as Pseudomonas spp. Excellent spectrum of coverage Resistance is limiting usefulness.

Answer 30

Broader spectrum of antibacterial activity than third-generation cephalosporins, especially against gram-positive bacteria Uncomplicated and complicated urinary tract infection cefepime hydrochloride (Maxipime®)

Answer 31

Similar to those of penicillins Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema Potential cross-sensitivity with penicillins if allergies exist

Answer 32

Broadest antibacterial action of any antibiotics to date Reserved for complicated body cavity and connective tissue infections in acutely ill hospitalized patients Must be infused over 60 minutes May cause drug-induced seizure activity This risk can be reduced with proper dosage.

Answer 33

imipenem/cilastatin (Primaxin®) meropenem (Merrem®) ertapenem (Invanz®)

Answer 34

Used for treatment of bone, joint, skin, and soft tissue infections; many other uses Cilastatin inhibits an enzyme that breaks down imipenem.

Answer 35

aztreonam (Cayston®) Synthetic ß-lactam antibiotic Primarily active against aerobic gram-negative bacteria (E. coli, Klebsiella spp., Pseudomonas spp.) Bactericidal Parenteral use only Used for management of cystic fibrosis patients with chronic pulmonary Pseudomonas aeruginosa infections

Answer 36

erythromycin (E-Mycin®, many others) azithromycin (Zithromax®) clarithromycin (Biaxin®) fidaxomicin (Dificid®)

Answer 37

Prevent protein synthesis within bacterial cells Considered bacteriostatic Bacteria will eventually die In high enough concentrations, may also be bactericidal

Answer 38

“Strep” infections -Streptococcus pyogenes (group A ß-hemolytic streptococci) Mild to moderate upper and lower respiratory tract infections -Haemophilus influenzae Spirochetal infections -Syphilis and Lyme disease Gonorrhea, Chlamydia, Mycoplasma

Answer 39

newest macrolide The most common adverse effects are nausea, vomiting, and GI bleed. Indicated only for the treatment of C. difficile–associated diarrhea Reasonably safe for use in pregnancy Minimal absorption

Answer 40

GI effects, primarily with erythromycin Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia, heartburn, abnormal taste. fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration

Answer 41

doxycycline hyclate (Doxycin®, Vibramycin®, others) tigecycline (Tygacil®) minocycline hydrochloride (Minocin®)

Answer 42

Natural and semisynthetic Obtained from cultures of Streptomyces Bacteriostatic: inhibit bacterial growth Inhibit protein synthesis Stop many essential functions of the bacteria

Answer 43

Dairy products, antacids, and iron salts reduce oral absorption of tetracyclines.

Answer 44

Bind (chelate) to Ca+++ and Mg++ and Al+++ ions to form insoluble complexes

Answer 45

Should not be used in children younger than 8 years of age or in pregnant or lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth

Answer 46

Wide spectrum Gram-negative and gram-positive organisms, protozoa, Mycoplasma spp., Rickettsia spp., Chlamydia, syphilis, Lyme disease, acne, others

Answer 47

calcium preludes use in... Children younger than 8 years of age Results in discolouration of permanent teeth Pregnant women and nursing mothers can be another route of exposure leading to tooth discoloration in nursing children May stunt fetal skeletal development if taken during pregnancy

Answer 48

Alteration of the intestinal flora May also cause: Vaginal candidiasis Gastric upset Enterocolitis Maculopapular rash

Answer 49

Before beginning therapy, assess drug allergies; renal, liver, and cardiac function; and other laboratory studies. Be sure to obtain a thorough patient health history, including immune status. Assess conditions that may be contraindications to antibiotic use or that may indicate cautious use. Assess potential drug interactions. Monitor adverse reactions. Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better. Watch for for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge. For safety reasons, check the name of the medication carefully, because there are many drugs that sound alike or have similar spellings. Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored. The most common adverse effects of antibiotics are nausea, vomiting, and diarrhea. All oral antibiotics are absorbed better if taken with at least 180 mL of water.

Answer 50

Take with 2 000 to 3 000 mL of fluid per 24 hours. Take oral doses with food. Encourage patients to immediately report worsening abdominal cramps, stomach pain, diarrhea, hematuria, severe or worsening rash, shortness of breath, and fever.

Answer 51

Take oral doses with water (not juices) because acidic fluids may nullify the drug’s antibacterial action. Monitor patients taking penicillin for an allergic reaction for at least 30 minutes after administration.

Answer 52

Assess for penicillin allergy; patient may have cross-allergy. Give orally administered forms with food to decrease GI upset even though this will delay absorption. Some of these drugs may cause a disulfiram (acute alcohol intolerance) reaction when taken with alcohol.

Answer 53

These drugs are highly protein bound and will cause severe interactions with other protein-bound drugs. The absorption of oral erythromycin is enhanced when the medication is taken on an empty stomach. However, because of the high incidence of GI upset, many medications are taken after a meal or snack.

Answer 54

Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug binding that occur. Take all medications with at least 180 mL of fluid, preferably water. Because of photosensitivity, avoid sunlight and tanning beds.

Answer 55

Improvement of signs and symptoms of infection Return to normal vital signs Negative culture and sensitivity tests Disappearance of fever, lethargy, drainage, and redness

Answer 56

Organisms that are resistant to one or more classes of antimicrobial drugs Methicillin-resistant Staphylococcus aureus (MRSA) Vancomycin-resistant Enterococcus (VRE) Organisms producing extended-spectrum ß-lactamases (ESBLs) Organisims producing Klebsiella pneumoniae carbapenemase (KPC) Newer antibiotics have been developed to successfully treat VRE and MRSA.

Answer 57

Threat of MRSA becoming resistant to all antibiotics currently available No longer seen just in hospitals. It has spread to the community setting, and approximately 50% of staphylococcal infections contracted in the community involve MRSA.

Answer 58

usually seen in urinary tract infections (UTIs)

Answer 59

Organisms that produce ESBL are resistant to all ß-lactam antibiotics and aztreonam. Can be treated only with carbapenems or sometimes quinolones Use of carbapenems: resistance occurred; bacteria created a new means of resistance known as Klebsiella pneumoniae carbapenemase tigecycline and colistimethate sodium

Answer 60

Natural and semisynthetic Several routes available but not given orally because of poor oral absorption Very potent antibiotics with serious toxicities Bactericidal; prevent protein synthesis Kill mostly gram-negative bacteria, some gram-positive bacteria

Answer 61

gentamicin sulphate tobramycin sulphate neomycin sulphate streptomycin sulphate amikacin sulphate paromomycin sulphate

Answer 62

Used to kill gram-negative bacteria such as Pseudomonas spp., Escherichia coli, Proteus spp., Klebsiella spp., Serratia spp. Often used in combination with other antibiotics for synergistic effects Used for certain gram-positive infections that are resistant to other antibiotics such as Enterococcus spp., S. aureus, and bacterial endocarditis, which is usually streptococcal in origin

Answer 63

Most often given parenterally neomycin sulphate -Topical antibacterial gentamicin Available in injections, topical ointments, and ophthalmic drops and ointments

Answer 64

Serious toxicities -Nephrotoxicity (kidney damage) -Ototoxicity (auditory impairment and vestibular impairment [eighth cranial nerve]) Must monitor drug levels to prevent toxicities Minimum inhibitory concentration Other less common effects: Headache Paresthesia Fever Vertigo Skin rash Overgrowth of nonsusceptible organisms Neuromuscular paralysis (very rare and reversible)

Answer 65

ear poisoning damages a person's inner ear or auditory nerve can be permanent symptoms: ear fullness, unsteadiness, unable to tolerate head movement

Answer 66

kidney toxicity reversible upon d/c of drug symptoms: not noticeable, or decrease urination, thirst increased HR, dizziness, and decreased appetite

Answer 67

Therapeutic drug monitoring required

Answer 68

Serum levels measured to prevent toxicity Serum level needs to be higher than the minimum inhibitory concentration to kill the bacterial. Time-dependent killing Concentration-dependent killing Postantibiotic effect Resistance Drug interactions

Answer 69

Peak: highest drug levels for once-daily regimens Trough: lowest, to ensure adequate renal clearance of the drug and avoid toxicity

Answer 70

Concurrent use of nephrotoxic drugs increase nephrotoxicity -vancomycin, cylcosporine, amphotericin B Loop diuretics increase risk for ototoxicity Increased effect of warfarin/warfarin toxicity

Answer 71

Plenty of fluids up to 3000mL/day Consumption of probiotic type foods Monitor peak and trough levels Peak for gentamicin & tobramycin 5-10 mcg/mL Trough for gentamicin & tobramycin Less than 2 mcg/mL

Answer 72

Also called fluoroquinolones Excellent oral absorption, except for norfloxacin hydrochloride Absorption reduced by antacids, calcium, magnesium, iron, others Effective against gram-negative organisms and some gram-positive organisms

Answer 73

ciprofloxacin (Cipro®)* levofloxacin (Levaquin®)* norfloxacin hydrochloride (Apo-Norflox®) moxifloxacin hydrochloride (Avelox®)

Answer 74

* Not normally recommended for children less than 18 years of age because of adverse MSK effects

Answer 75

Bactericidal Alter deoxyribonucleic acid (DNA) of bacteria, causing death Do not affect human DNA Used to treat S. aureus, Serratia marcescens, and Mycobacterium fortuitum Bacterial resistance to quinolone antibiotics: Pseudomonas aeruginosa, S. aureus, Pneumococcus spp., Enterococcus spp., and the broad Enterobacteriaceae family that includes E. coli.

Answer 76

Gram-negative and gram-positive bacteria Complicated urinary tract, respiratory, bone and joint, gastrointestinal, and skin infections ciprofloxacin and levofloxacin, both oral and injection norfloxacin hydrochloride has limited oral absorption and is available only in oral form, so its use is limited to genitourinary infections.

Answer 77

PO/ IV infections of bone, joint, soft tissues, ophthalmic, resp, GI, abd, prostate, UTIs, STDs inhibits DNA gyrase and topoisomerase bactericidal

Answer 78

Oral quinolones: antacids, calcium, magnesium, iron, zinc preparations, or sucralfate Patients need to take the interacting drugs at least 1 hour before or after taking quinolones. Dairy products Enteral tube feedings probenecid nitrofurantoin Oral anticoagulants

Answer 79

Body system/adverse effects Central nervous: Headache, dizziness, insomnia, depression, restlessness, convulsions Gastrointestinal: Nausea, vomiting, diarrhea, constipation, oral candidiasis, dysphagia, increased liver function study results, others Integumentary: Rash, pruritus, urticaria, flushing Other: Ruptured tendons*, tendonitis*, fever, chills, blurred vision, tinnitus

Answer 80

*Health Canada warning: increased risk of tendonitis and tendon rupture

Answer 81

clindamycin (Dalacin C®) metronidazole (Flagyl®) vancomycin hydrochloride (Vancocin®) linezolid (Zyvoxam®) nitrofurantoin (MacroBID®, Furantoin®) quinupristin and dalfopristin (Synercid®) colistimethate sodium (Coly-Mycin®)

Answer 82

Used for chronic bone infections, genitourinary infections, intra-abdominal infections, other serious infections May cause pseudomembranous colitis (also known as antibiotic-associated colitis, Clostridium difficile diarrhea, or C. difficile infection) Potential interaction with vecuronium bromide

Answer 83

New class: oxazolidinones Used to treat vancomycin-resistant Enterococcus faecium (commonly referred to as VRE), hospital-acquired, and skin structure infections, including infections with MRSA Strengthens effects of vasopressive drugs, serotonin syndrome if taken with selective serotonin reuptake inhibitors (SSRIs), and reactions if taken with tyramine-containing foods

Answer 84

Used for anaerobic organisms Intra-abdominal and gynecological infections Protozoal infections Several drug interactions

Answer 85

Primarily used for UTIs (E. coli, S. aureus, Klebsiella spp., Enterobacter spp.) Use carefully if kidney function is impaired. Drug concentrates in the urine. May cause fatal hepatotoxicity; very rare

Answer 86

30:70 combination; works synergistically Used for bacteremia and infections caused by VRE and for treatment of complicated skin and skin structure infections caused by S. pyogenes and S. aureus, including MRSA May cause arthralgias or myalgias Drug interactions are limited; most severe cyclosporine Injectable form only

Answer 87

Treatment of choice for MRSA and other gram-positive infections Oral vancomycin is indicated for the treatment of antibiotic-induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis. Must monitor blood levels to ensure therapeutic levels and prevent toxicity May cause ototoxicity and nephrotoxicity

Answer 88

Red man syndrome may occur. Flushing or itching of head, neck, face, upper trunk Additive neuromuscular blocking effects in patients receiving neuromuscular blockers Should be infused over 60 minutes Rapid infusions may cause hypotension.

Answer 89

Polypeptide antibiotic that penetrates and disrupts the bacterial membrane of susceptible strains of gram-negative bacterial Indicated for Klebsiella pneumoniae carbapenemase–producing organisms Serious adverse effects IV, intramuscular, inhalation administration

Answer 90

Before beginning therapy, assess drug allergies; hepatic, kidney, and cardiac function; and other laboratory study results. Be sure to obtain a thorough patient health history, including immune status. Assess for conditions that may be contraindications to antibiotic use or that may indicate cautious use. Assess for potential drug interactions. It is essential to obtain cultures from appropriate sites before beginning antibiotic therapy. Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early even if they feel better. Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge For safety reasons, check the name of the medication carefully because there are many drugs that sound alike or have similar spellings. Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored. Monitor therapeutic effects. Improvement of signs and symptoms of infection Return to normal vital signs Negative culture and sensitivity tests Disappearance of fever, lethargy, drainage, and redness Observe for and monitor adverse reactions.

ANTIBIOTICS Flashcards

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