Antibiotics

Question 1

What is the mechanism of action for Sulfonamides (trimethoprim/sulfamethoxazole, Bactrim)?

Answer 1

Inhibit the growth of susceptible bacteria by inhibiting the bacterial synthesis of FOLIC ACID.
Folic Acid is essential for production of DNA/RNA (hence why you need it during pregnancy)

Question 2

What is the drug effect of Sulfonamides?

Answer 2

Bacteriostatic

Question 3

What are the indications of Sulfonamides?

Answer 3

Broad spectrum (gram negative or positive) includes
E coli
klebsiella
proteus
enterobacter
N gonorrhoeae
Very successful in treating UTI

Question 4

What is a contraindication of Sulfonamides?

Answer 4

Sulfa allergy

Question 5

What are some adverse effects of Sulfonamides?

Answer 5

Photosensitivity

Steven Johnson’s Syndrome

Question 6

What is Steven Johnson’s Syndrome?

Answer 6

Is a rare, serious disorder of the skin and mucous membranes. It is usually a reaction of meds of an infection. It begins with flu like symptoms, followed by painful red or purplish rash that spreads and blisters.

Question 7

What is the mechanism of action for penicillins (amoxicillin, piperacillin/tazobactam, Zosyn)?

Answer 7

Destroys bacteria by weakening the bacterial cell wall.

Question 8

What is the drug effect of penicillin?

Answer 8

Bactericidal

Question 9

What is beta-lactamases?

Answer 9

Any group of enzymes produced by bacteria that catalyze the chemical opening of the crucial beta-lactam ring structures in the beta-lactam antibiotics. As a result, the medication is not effective.

Question 10

What are beta-lactamase inhibitors?

Answer 10

Medications combined with certain penicillin drugs to block the effect beta-lactamase enzymes.

Question 11

How are penicillin and cephalosporins related?

Answer 11

They are both bactericidal and work by interfering with bacterial cell wall synthesis. Both bind to the same penicillin-binding protein inside the bacteria. Both can destroy a broad spectrum of bacteria.

Question 12

What is the mechanism of action for cephalosporins?

Answer 12

Structurally and pharmacologically related to penicillins. Bactericidal in action by interfering cell wall.

Question 13

What are the indications of cephalosporins?

Answer 13

They are divided into four generations. The level of gram-negative coverage increases with each successive generation. Anaerobic coverage with the second generation.

Question 14

What are the adverse effects of cephalosporins?

Answer 14

Potential cross-sensitivity with penicillins if allergy exists (1-4%).

Question 15

What is the first generation of cephalosporins?

Answer 15

Fist generation
Good gram-positive coverage and poor gram-neg.
Used for surgical prophylaxis and susceptible staph infections.
Ex- cefazolin (Ancef IV), cephalexin (Keflex PO)

Question 16

What is the second generation of cephalosporins?

Answer 16

Second generation
Good gram + and some gram -.
Kills anaerobes.
Used prophylactically for abdominal or colorectal surgeries.
Ex- cefotetan (Cefotan), cefaclor (Ceclor)

Question 17

What is the third generation of cephalosporins?

Answer 17

Third generation
Most potent group against gram -
Passes meninges and diffuses into the CSF to treat CNS infections such as meningitis
Ex- ceftriaxone (Rocephin), cefotaxime (Claforan)

Question 18

What is the fourth generation of cephalosporins?

Answer 18

Fourth generation
Broader spectrum of antibacterial activity than third generation, especially against gram +
Used for uncomplicated and complicated UTI, skin infections, and pneumonia
Ex- cefepime (Maxipime)

Question 19

What is the mechanism of action and drug effect for carbapenems (imipenem/cilastatin, Primaxin)?

Answer 19

Destroy bacterial cell wall

Bactericidal

Question 20

What are the indications of carbapenems?

Answer 20

Very broad spectrum

Often used for complicated body cavity and CT infections in the hospitalized pt

Question 21

What are the adverse effects of carbapenems?

Answer 21

Cross-sensitivity to PCN

Induce seizure activity

Question 22

What is the mechanism of action and drug effect of macrolides (Zithromax)?

Answer 22

Bacteriostatic but may be bactericidal in larger doses.

Inhibit protein synthesis.

Question 23

What are the indications of macrolides?

Answer 23

Pneumona (Strep, H Influ)
H Pylori
STDs- including gonorrhea and chlamydia

Question 24

What are the mechanism of action and drug effects of fluoroquinolone (Ciprofloxacin, Levaquin)

Answer 24

Potent, broad spectrum bactericidal antibiotic
Kill both gram + and gram - by inhibitor of the enzyme necessary for DNA replication.
Have excellent oral absorption

Question 25

What are the indications of fluoroquinolone?

Answer 25

``` UTI GI infection Joint infections Respiratory illness STDs Anthrax exposure ```

Question 26

What are the adverse effects of fluoroquinolone?

Answer 26

Achilles tendon rupture- black box warning

Question 27

What is the mechanism of action of aminoglycosides (gentamicin)?

Answer 27

Potent antibiotics with serious toxicities Bactericidal Disrupts protein synthesis in bacteria

Question 28

What are the indications of aminoglycosides?

Answer 28

``` Serious gram - infections and some gram + infections Pseudomonas aeruginosa E coli proteus klebsiella ```

Question 29

What are the toxic effects of aminoglycosides?

Answer 29

Nephrotoxicity: 5-25%; toxicity to kidneys, often drug induced and manifesting in compromised kidney function Ototoxicity: 3-14%; toxicity to the ears, often drug-induced and manifested by varying degrees of hearing loss then is like to be permanent.

Question 30

What are the mechanism of action and drug effects of tetracyclines?

Answer 30

Bacteriostatic | Inhibit bacterial protein synthesis

Question 31

What are the indications of tetracycline?

Answer 31

``` Acne periodontal disease rickettsia chlamydia lymes disease anthrax H pylori ```

Question 32

What are the adverse effects of tetracyclines?

Answer 32

Binds to Ca++ During gestation it can cause staining of deciduous teeth. Will lead to discoloration of permanent teeth in children It is contraindicated in children under 8 years of age, pregnant and nursing mothers Photosensitivity

Question 33

What is the mechanism of action and drug effect of vancomycin?

Answer 33

Bactericidal

Question 34

What are the indications of vancomycin?

Answer 34

MRSA | C diff

Question 35

What are the nursing implications of vancomycin?

Answer 35

Infuse over at least one hour to avoid red-man syndrome. Must perform therapeutic drug monitoring (peak level 18-50 mcg/ml, trough level 10-20 mcg/ml) to prevent ototoxicity and nephrotoxicity

Question 36

What is red-man syndrome?

Answer 36

An infusion related reaction caused by vancomycin. Includes pruritus, an erythematous rash that involves the face, neck, and upper torso.

Question 37

What are the signs and symptoms of toxicities of vancomycin?

Answer 37

``` serious allergic reactions (anaphylactoid reactions), including low blood pressure, wheezing, indigestion, hives, or. itching. Rapid infusion of Vancomycin may also cause flushing of the upper body (called "red neck" or "red man syndrome"), dizziness, ```