Antibiotics Flashcards
(159 cards)
1
Q
What was the first Abx introduced for clinical use?
A
Penicillins
2
Q
How do penicillins work?
A
-inhibit bacterial wall synthesis
-stops the enzyme needed for cell division
3
Q
Penicillins are _____ _____ antibiotics
A
Beta lactam
Group of drugs that contain beta-lactam ring & are used to Tx bacterial infections by binding to enzyme essential for building bacterial cell walls
4
Q
Are penicillins bactericidal or bacteriostatic?
A
Bactericidal → kill off bacteria
5
Q
Do penicillins work against gram pos or gram neg bacteria?
A
Both gram positive & gram negative bacterias
6
Q
List the bacterias penicillins are effective against
A
streptococcal, staphylococcal, pneumococcal infections
7
Q
List the different versions of penicillins
A
Penicillin G
Penicillin K
Penicillin V
Amoxicillin (prototype)
Ampicillin
8
Q
Give examples of penicillinase-resistant Abx
A
nafcillin
oxacillin
9
Q
What is the suffix for penicillin drugs?
A
“cillin”
10
Q
Types of penicillin:
Penicillin VK
A
2/3 of the dose is absorbed orally
Less potent than PCN G
Most used in oral form
11
Q
Common infections penicillin VK is used to Tx?
A
strep throat
oral infections
12
Q
Types of penicillin:
Penicillin G Benzathine
A
Can be given PO or parenteral
only 1/3 of oral dose absorbed (usually given as injection)
short acting
injection is very painful
13
Q
Types of penicillin:
Procaine penicillin G
A
Has an anesthetic to decrease pain
14
Q
When/ why are beta lactamase inhibitors added?
A
When taking broad spectrum Abx; adding beta lactamase inhibitor makes Abx more effective against the beta lactamase producing bacteria
15
Q
Correlation between PCN use & beta lactamase inhibitors
A
used when there is concern for beta lactamase resistant in organisms usually sensitive to PCN
used to enhance what the penicillins do
16
Q
Give examples of bacterias treated by PCN that would have a beta lactamase added
A
streptococcus pneumoniae
staphylococcus aureus
17
Q
Give 3 examples of medications that combine a beta lactam Abx with a beta lactamase inhibitor
A
Augmentin = Amoxicillin + Clavulanic acid
Zosyn = Piperacillin + Tazobactam
Unasyn = Ampicillin + sulbactam
18
Q
List 6 beta lactamase inhibitors
A
Clavulanate
Sulbactam
Tazobactam
Avibactam
Vaborbactam
Relebactam
19
Q
Contraindications of taking PCN?
A
If person is allergic to PCN or cephalosporins
Use with caution in patients w/ renal impairment
20
Q
Is PCN safe to use during pregnancy or breastfeeding?
A
yes
21
Q
What should a pt taking PCN & oral contraceptive do to prevent pregnancy?
A
Take a second form of contraception
22
Q
List adverse effects of PCN use
A
GI tract → N/V & stomatitis
Superinfection
Pain & inflammation @ injection site
Hypersensitivity
23
Q
Drug-drug interactions of PCN
A
tetracyclines
aminoglycosides
24
Q
What is penicillin cross reactivity?
A
Those who are allergic to PCN can have cross reactivity allergic reactions w/ cephalosporins
25
PCN cross reactivity is typically seen with what generation cephalosporins?
1st generation (cephalexin) & % is low
-rarely seen in 3rd-5th generations
26
What patients might you see penicillin cross reactivity?
those who experience anaphylactic reactions to PCN
27
What type of bacteria are aminoglycosides effective against?
gram negative bacteria
28
Aminoglycosides are very strong Abx for serious infections such as?
bacteremia
abdominal infections
29
List some contraindications of aminoglycosides
known allergies
renal/ hepatic disease
pre-existing hearing loss
active herpes/ mycobacterial infection
myasthenia gravis
parkinson's
lactation
30
What kind of disease is myasthenia gravis
autoimmune disease → a lot of diff drugs people Dx cannot take b/c it makes Sx worse
-Hard to treat
31
What formulation of aminoglycosides requires drug monitoring?
IV administration
32
List examples of aminoglycosides
Gentamycin (IV, IM, topical → prototype)
Tobramycin (IV, IM, topical, nebulizer)
Neomycin (PO, topical)
Amikacin
Streptomycin (IM)
33
List some adverse effects of aminoglycosides
Nephrotoxicity
Ototoxicity
CNS
GI tract
Cardiotoxicity
34
What are important labs to monitor to prevent nephrotoxicity when using aminoglycosides?
BUN/ Creatinine
LFTs
35
List drug-drug interactions of aminoglycosides
Penicillins & Cephalosporins
Diuretics
Anesthetics
36
What is the the suffix for aminoglycosides?
"mycin"
37
Cephalosporins are ____ ____ Abx
beta lactam
38
What Abx are cephalosporins similar to?
Penicillins
39
Cephalosporins are both ____ & ____ depending on dose & specific drug
bactericidal & bacteriostatic
*kill of bacteria or stop microorganism from dividing*
40
What spectrum Abx are cephalosporins?
broad spectrum
41
Cephalosporins are used for Tx of what kind of infections?
Skin; urinary; respiratory infections
42
Contraindications of Cephalosporins
Known allergies
An allergy to PCN
Hepatic / Renal impairment
Pregnant or lactating patients
43
First generation cephalosporins
**Oldest**
effective against gram (+) bacteria → i.e. staph aureus & streptococcus
can treat some gram (-) bacteria → i.e. E. coli & klebsiella
Used for skin infections, UTI, strep throat
44
List examples of first generation cephalosporin drugs
Cefadroxil
Cephalexin (Keflex)
45
Second generation Cephalosporins
Work on same bacteria as 1st generation as well as H. influenzae (gram (-))
**Issues with resistance in URIs**
46
List examples of 2nd generation Cephalosporin drugs
Cefaclor (prototype)
Cefoxitin
Cefprozil
Cefuroxime
47
Third generation Cephalosporins
Effective against previously mentioned gram (+) but MORE effective against gram (-)
48
List 3rd generation Cephalosporin drugs
Cefdinir (oral)
Cefotaxime (IV)
Cefpodoxime (oral)
Ceftazidime (IV)
Ceftriaxone (IV, IM)
49
What generations of cephalosporins are more likely to cross through CSF & BBB to Tx infection?
Fourth & fifth generation
50
Fourth generation Cephalosporins
Active against both gram (+) & gram (-) organisms
Only available for IV admin
51
Fourth generation cephalosporins are saved to Tx what kind of infections?
Hard to treat infection → i.e. MRSA
52
List an example of 4th generation Cephalosporin
Cefepime (maxipime)
53
Fifth generation Cephalosporins
Has broad spectrum activity against many resistant bacteria → i.e. MRSA & VRSA)
54
List an example of a 5th generation Cephalosporin
Ceftaroline
55
What is the prefix for Cephalosporins?
"cef"
56
What is the most common adverse effect of Cephalosporins?
GI tract → from superinfection can cause C. diff
57
Can Cephalosporins treat C. diff?
NO → cephalosporins can cause C. diff but not treat it
58
List some other adverse effects of Cephalosporins
CNS
Nephrotoxicity
Superinfections
59
What are some superinfections caused by Cephalosporins?
C. diff
Vanco resistant enterococci (VRE)
Klebsiella pneumoniae
β-lactam resistant acinetobacter species
60
Patients prescribed cephalosporins IV or IM are at increased risk for...
Phlebitis at IV site
Abscess at IM site
61
What should be done to decrease risk of phlebitis & abscesses when giving cephalosporins IV or IM?
Make sure IV site does NOT infiltrate
Use Z track method if giving IM
62
What location should be used when giving cephalosporins IM?
deep gluteal (ventrogluteal)
63
List drug-drug interactions of Cephalosporins
Aminoglycosides
Anticoagulants
Alcohol (ETOH)
64
Carbapenems are _____ _____ Abx
broad spectrum
65
What type of bacteria are Carbapenems effective against?
Both gram (+) & gram (-) bacteria
66
Are Carbapenems bactericidal or bacteriostatic?
Bactericidal → kills off bacteria
67
Carbapenems are reserved for what type of patients?
Patients with highly resistant bacteria such as:
-Complicated UTIs
-Pneumonia
-Certain forms of sepsis
68
List the contraindications of Carbapenem use
Known allergies
Seizure disorders
Meningitis
Lactating clients
Renal impairment
69
What should be monitored in patients with renal impairment taking Carbapenems?
BUN & creatinine
70
List the routes of administration of Carbapenems
IV or IM
71
List the medications considered to be carbapenems
Ertapenem (prototype)
Doripenem
Imipenem-cilastin
meropenem
72
List adverse effects of Carbapenems
GI tract
Superinfections → causes C. diff
CNS
73
List drug-drug interactions of Carbapenems
Valproic acid
Ganciclovir
74
What can happen to a patient on anti-seizure medication if they take a Carbapenem?
It can contraindicate & actually cause seizures
75
Fluoroquinolones are ___ ___ Abx
Broad spectrum
76
What do Fluoroquinolones interfere with?
DNA synthesis
77
What type of bacteria do Fluoroquinolones treat?
Used in gram (-) bacteria; but can also be used for gram (+) bacteria
78
What type of infections are Fluoroquinolones used to treat?
Urinary & respiratory infections → i.e. E. coli UTI
Anthrax
Typhoid fever
79
List Fluoroquinolone drugs
Cirpofloxacin (PO, IV, topical → prototype)
Gemifloxacin (PO)
Moxifloxacin (PO)
Levofloxacin (PO, IV → common)
Ofloxacin (topical, PO)
Finafloxacin (ear)
80
What fluoroquinolone is the drug of choice if exposed to anthrax?
Ciprofloxacin
81
What is anthrax?
A rare but serious infection; typically found in animals (such as livestock); soil; & contaminated meat
82
What is the suffix for Fluoroquinolones?
"floxacin"
83
What are the black box warnings of fluoroquinolones?
**Tendonitis & achilles tendon rupture**
CNS effects
Peripheral neuropathy
Make Myasthenia Gravis worse
Possible Increased risk for AAA
84
Fluoroquinolone black box warning:
Tendonitis & achilles tendon rupture risk in increased when...
increased with steroid use
**Occurs more in older adult population**
85
List adverse effects of Fluoroquinolones
QT prolongation (cardiac effects)
Hypoglycemia in DM
Photosensitivty
GI effects
Immunologic effects
86
How can you monitor for cardiac effects in patients taking Fluoroquinolones?
Look for EKG changes
87
Cardiac effects from use of Fluoroquinolones could lead to...
Cardiac arrest or death
88
Why is it important to keep a really close eye on DM patients taking Fluoroquinolones?
Risk for hypoglycemia → blood glucose levels can drop fast
89
Contraindications of Fluoroquinolones
Pregnant & lactating patients
Children under 18 → possible cartilage damage
90
What do Macrolides interfere with?
Protein synthesis
91
Macrolides are ____ ____ Abx
Broad spectrum
92
Are Macrolides bactericidal or bacteriostatic?
Bacteriostatic → stop microorganism from dividing
93
What type of bacteria are Macrolides effective against?
Gram (+) bacteria
94
List the gram (+) bacteria Macrolides are effective against
Streptococcus pneumoniae
Legionella
Listeria
Lyme's disease
Sinusitis
STIs
95
What class of Abx has an increasing resistance due to overuse?
Macrolides
96
List the drugs classified as Macrolides
Azithromycin
Clarithromycin
Erythromycin (prototype)
Fidaxomicin
97
Macrolides should be used with caution in what type of patients?
Patients with hepatic dysfunction
**important to monitor LFTs**
98
Macrolides are often used as an alternative to what Abx?
Penicillins → for patients with allergies & can be used to Tx pneumonia
99
List drug-drug interactions of Macrolides
Anticoagulants
Antacids
Digoxin toxicity
100
List adverse effects of Macrolides
QT interval prolongation
GI tract effects
CNS
Superinfections
Hypersensitivity
101
Prolongation of QT interval from Macrolide use can lead to
Life threatening arrhythmias
102
What is important to teach patients about taking Macrolides to prevent GI effects?
They need to be taken on an empty stomach (1 hr before eating or 2-3 hrs after)
103
Macrolide use increases the risk of developing what superinfection?
C. diff
104
Sulfonamides (sulfa drugs) inhibit ____ ____ ____
folic acid synthesis
105
Sulfonamides are precursors of ____ & ____
DNA & RNA
106
Sulfonamides are effective against what type of bacteria?
Both gram (+) & gram (-) bacteria
107
Why are sulfonamides no longer used often?
Due to resistance
108
Sulfonamides are used to Tx what infections?
UTIs
Skin infections
MRSA
STIs
109
List sulfonamide drugs
Sulfasalazine
Sulfamethoxazole → trimethoprim (bactrim)
Cotrimoxazole (septra) → prototype
110
Sulfasalazine carried by ____ _____ _____
amino salicylic acids
111
Contraindications of sulfonamides
Teratogenic → use cautiously in pregnant women
Allergies to sulfa drugs
Use with caution in pts with renal impairment
112
What age group should not use Sulfonamides?
Children
113
Adverse effects of sulfonamides
GI tract effects
Renal → monitor BUN/ creatinine
CNS
Hypoglycemia → caution in Diabetics
Bone marrow depression
Skin reactions
114
List some skin reactions caused by sulfonamides
Photosensitivity
Rash/ itching (common)
Steven-Johnson's syndrome
115
List 4 things that are important to monitor for patients taking sulfa drugs
I & O
BUN/ Creatinine
Glucose levels
116
What is an important teaching factor for someone taking sulfa drugs?
Teach to take medication w/ at least a cup of fluid (8 oz)
117
Lis drug-drug interactions of Sulfonamides
Many diabetic meds
Cyclosporine
Warfarin
118
Tetracyclines work by affecting...
protein synthesis
119
Tetracyclines are ____ ____ Abx
Broad spectrum
120
What type of bacteria are Tetracyclines effective against?
Both gram (+) & gram (-) bacteria
121
List some common infections tetracyclines would be prescribed to treat
Infections in skin (acne)
Upper respiratory (sinusitis; atypical pneumonia)
STIs
Lyme's disease
MRSA
Traveler's diarrhea
122
List drugs in tetracycline class of Abx
Demeclocycline (PO)
Doxycycline (IV, PO)
Minocycline (IV, PO)
Tetracycline (PO, topical) → prototype
123
What is the suffix for tetracycline drugs?
"Cycline"
124
Contraindications of Tetracyclines
Allergies to Tetracycline
Pregnant & lactating clients
Children under 8
125
What is the biggest contraindication of Tetracycline use?
Taking in children under 8 → can damage teeth & bones & impact a child's growth
126
Adverse effects of Tetracyclines
GI tract effects
Hepatotoxicity
Skeletal (bone growth & mineralization)
Skin
Superinfections
Hematologic
Local effects
Hypersensitivity
127
List drug-drug interactions of Tetracyclines
Penicillins
Digoxin
128
Absorption of Tetracycline is affected when taking
Calcium
Magnesium
Zinc
Iron
Bismuth
Food or dairy products
129
What is important teaching of Tetracycline administration?
They should be taken on an empty stomach → can block absorption
130
What is the drug class of clindamycin?
Lincosamides
131
Clindamycin interferes with _____ _____ _____
Bacterial protein synthesis
132
What type of bacteria is Clindamycin effective against?
gram (+) bacteria
133
List infections Clindamycin is used to treat
Staph infections (MRSA)
Strep infections
Anaerobes
Bacterial Vaginosis
134
Clindamycin is used when there is an allergy to what Abx?
Penicillins or Cephalosporins
135
Clindamycin is a ____ ____ Abx
Broad spectrum
136
What Abx is saved to use when no other Abx will do the job?
Clindamycin
137
Adverse effects of Clindamycin
Severe GI effects → fatal pseudomembranous colitis
Increased risk for C. diff
138
What drug class is vancomycin?
Glycopeptide Abx
139
Is Vancomycin a Strong or weak Abx?
Very very strong
140
What does vancomycin cause?
Cell death by disrupting the bacterial membrane
141
Vancomycin is effective against treating...
gram (+) bacteria → MRSA
C. diff
Endocarditis
142
How is Vancomycin usually administered?
Intravenously
143
What is the one exception where Vancomycin must be given orally?
To treat C. diff
144
Contraindications of Vancomycin
pregnant or lactating clients
145
Adverse effects of Vancomycin
GI tract effects
Nephrotoxicity
Ototoxicity
Phlebitis
146
Why must we monitor drug levels & infuse slowly when giving Vancomycin?
To prevent Red Man Syndrome
147
What does Red Man Syndrome have to do with?
The release of Histamine → triggered by stimulation of mast cells causing blood vessels to dilate & causing redness
148
Is Red Man Syndrome an allergy?
No → not technically an allergic reaction
149
How long should Vancomycin be run for to prevent Red Man syndrome?
An hour or more
150
How often is Vancomycin typically given?
Every 8-12 hours
151
What drug class is Metronidazole (Flagyl)?
Nitroimidazole
152
Is Metronidazole a Broad spectrum Abx?
Not necessarily → more specific
153
List a type of infection Metronidazole can be used to treat
Lower respiratory infections
154
List some bacterias Metronidazole is effective against
Anaerobic bacterial infections
Amebiasis
Protozoal infections
H. Pylori infection
Trichomoniasis
Pseudomembranous colitis (C. diff)
155
Ideally a patient with what type of impairment should not take Metronidazole?
Liver impairment → or use with caution
156
List adverse effects of Metronidazole
GI effects
Headaches
Dry mouth
Steven Johnsons syndrome
Disulfiram-like reaction
157
Described a Disulfiram-like reaction from taking Metronidazole
If someone drinks alcohol while on Flagyl they will have very intense/ very violent vomiting
**can least up to 48 hrs after stopping the medication**
158
What can a Disulfiram-like reaction from Metronidazole lead to
SOB; sweating; Chest pain → which can all lead to dehydration
159
List drug-drug interactions of Metronidazole
Warfarin → anticoagulant
NO ALCOHOL!!!
