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Pharmacology > Antibiotics/Anti-Infectives > Flashcards

Antibiotics/Anti-Infectives Flashcards

1
Q

Chemical that is produced by one microbe and has the ability to harm other microbes

A

Antibiotic

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2
Q

Any agent, natural or synthetic, that has the ability to kill or suppress microorganisms

A

Antimicrobial drug

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3
Q

“Ability of a drug to injure a target cell or organisms without injuring other cells or organisms that are in intimate contact with the target.”

A

Selective Toxicity

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4
Q

Drugs are directly lethal to bacteria at clinically achievable concentrations

A

Bacteriocidal

lethal to kill

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5
Q

Drugs can slow bacterial growth but do not cause cell death

A

Bacteriostatic

slow bacterial growth

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6
Q

New infection that appears during the course of treatment for a primary infection

A

Superinfection

ex. C. Diff

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7
Q

Penicillins Include:

A
  • penicillin G
  • amoxicillin
  • Nafcillin

COMBINATIONS

-amoxicillin/clavulanate (Augmentin) -piperacillin/tazobactam (Zosyn)

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8
Q

Class: Penicillins

A
  • MOA: Weaken the CELL WALL, causing bacteria to take up excessive water and rupture; BACTERIOCIDAL
  • Active against a variety of bacteria
  • Principal adverse effect: Allergic Reaction
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9
Q

Mechanism of Bacterial Resistance (in penicillins)

A

3 factors:

  1. Inability of penicillins to reach their targets
  2. Inactivation of penicillins by bacterial enzymes
  3. Production of penicillin-binding proteins (PBPs) that have a low affinity for penicillins
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10
Q

Penicillin G (Benzylpenicillin)

IV, IM, Oral

A

-Bactericidal to numerous gram-positive and some gram-negative organism

  • Adverse Effects:
  • LEAST TOXIC OF ALL ANTIBIOTICS
  • Penicillins are the most common cause of drug allergy
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11
Q

If a patient has a history of mild reaction to penicillin, consider ________.

A

Cephalosporins***

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12
Q

If a patient has a history of anaphylaxis, ____ administration of penicillin or cephalosporins

A

Avoid

Hx of anaphylaxis, avoid penicillin or cephalosporins

Have to get Vancomyocin instead

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13
Q

Aminopenicillins (Broad-Spectrum Penicillins)

A
  • Ampicillin
  • Amoxicillin

Adverse Effects:

  • Rash
  • Diarrhea
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14
Q

Amoxicillin

A
  • Broad-spectrum penicillin
  • Same antimicrobial spectrum as penicillin G, plus increased activity against certain gram-negative bacilli (H. influenzae, E. coli, Salmonella, & Shigella)
  • Reduce dose for renal impairement
  • S/E: rash and diarrhea
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15
Q

Nafcillin

A
  • Penicllinase-resistant penicillin

- Do not give drug orally, usually IV

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16
Q

Amoxicillin/Clavulanate (Augmentin)

A

-Extends antimicrobial spectrum when combined with penicillinase-sensitive antibiotics

17
Q

Piperacillin/tazobactam (Zosyn)

A

-Extends antimicrobial spectrum when combined with penicillinase-sensitive antibiotics

18
Q

Class: Cephalosporins

A
  • Most widely used group of antibiotics
  • Beta-lactam antibiotics
  • Bactericidal
  • Similar to penicillin in structure and action

-MOA: Bind to penicillin-binding proteins (PBPs), disrupt cell wall synthesis, and cause cell lysis

(interference with Vitamin K, at risk for bleeding tendancies)

19
Q

Classification of Cephalosporins:

A
  1. First generation (prophylaxis against infection in surgical patients; rarely used for active infections) *Cephalexin
  2. Second generation (rarely used for active infection) *Cefoxitin
  3. Third generation (highly active against gram-negative infections, able to penetrate CSF) *Cefotaxime
  4. Fourth generation (commonly used to treat hospital-associated pneumonias, including those caused by resistant organism Pseudomonas) *Cefepime
  5. Fifth generation (infections associated with MRSA) *Ceftaroline
20
Q

Pseudomembranous colitis

A

Overgrowth of E. coli - bloody diarrhea, fever, abdominal pain.

If patient have symptoms, stop cephalosporin that they are on

SUPERINFECTION

21
Q

Class: Carbapenems

A

-Imipenem (Primaxin)

  • Active against most bacterial pathogens
  • Highly active against gram-positive cocci and most gram-negative cocci and bacilli
  • Most effective beta-lactam antibiotic for use against anaerobic bacteria
22
Q

Class: Vancomyocin

A

-MOA: Inhibits cell wall synthesis (bacteriocidal)

Uses: Severe infections only, MRSA, Staphylococcus epidermidis, Clostridium difficle

*DOC for MRSA

a/e: OTOTOXICITY, “RED MAN” SYNDROME, nephrotoxic, thrombophlebitis, thrombocytopenia, allergy

23
Q

Occurs when the drug is given way too fast. Complain of itching, hypotension, tachycardia

HAS TO BE INFUSED OVER 1 HOUR

A

“Red Man” Syndrome

24
Q

Class: Tetracyclines

A
  • Broad-spectrum antibiotics
  • Inhibit protein synthesis
  • Increasing bacterial resistance has emerged
  • Bacteriostatic
  • DOC: Rocky Mt. Spotted Fever
  • Ca, Mg, Fe should be avoided. Completely take pt. off dairy products
25
Q

Tetracycline uses:

A
  • Tx of infectious disease
  • Tx of acne
  • Peptic ulcer disease
  • Periodontal disease
  • Rheumatoid arthritis
  • Mycoplasma peumoniae
  • Lyme disease
  • Anthrax
  • Helicobacter pylori
26
Q

Tetracyclines Cont…

A
  • Drug and Food interaction
  • Calcium supplements, milk products, iron supplements, magnesium containing laxatives, and most antacids

a/e:

  • GI irritation
  • Effects on bone and teeth (yellow to brown discoloration)
  • Can not be given to pregnant women or children under 8
  • Superinfection
  • Hepatotoxicity
  • Renal toxicity
  • Photosensitivity and other effects
27
Q

Doxycycline

A
  • Long acting agent that shares the actions and adverse effects described for the tetracyclines as a group
  • Absorption best on an empty stomach
  • Eliminated by nonrenal mechanisms (safe for patients with renal failure)
  • First line drug for: Lyme disease, anthrax, chlamydial infections, sexually acquired proctitis
28
Q

Class: Macrolides (erythromycin)

A
  • Broad-spectrum antibiotic
  • MOA: Inhibition of protein synthesis
  • Usually bacteriostatic, but can be bactericidal
  • Use if patient allergic to PENICILLIN
  • Empty stomach with full glass of water
  • Active against most gram-positive and some gram-negative bacteria
29
Q

Macrolides (erythromycin) cont.

A 
-Uses: 
WHOOPING COUGH (PERTUSSIS), acute diptheria, C. diptheria, chlamydial infections, M.pneumoniae, group A Streptococcus pyogenes
  • May be used as alternative to penicillin G in patients with penicillin allergy
  • A/E: GI, QT prolongation and sudden cardiac death, superinfections, thrombophlebitis, transient hearing loss
30
Q

Azithromycin

A

-Uses:
Resp. tract infections, cholera, skin infections, disseminated Mycobacterium avium

  • Metabolized by hepatic, excreted through bile, renal
  • A/E: diarrhea, nausea, pain
31
Q

Clindamycin (cleocin)

Other bacteriostatic inhibitors of protein synthesis - own class?

A
  • Can promote severe C. diff associated diarrhea
  • active against most ANAEROBIC bacteria (gram-positive and gram-negative)
  • indicated only for certain anaerobic infections outside the CNS
32
Q

Clindamycin (cleocin) cont.

A
  • Drug is not affected by food, does not cross BBB
  • Alternative to penicillin
  • A/E:
  • CDAD, hepatic toxicity, blood dyscrasias, diarrhea, hypersensitivity reactions
33
Q

Linezolid (Zyvox)

own class

A
  • Bacteriostatic inhibitor of protein synthesis
  • Active against multi-drug resistant gram-positive pathogens (VRE & MRSA)

a/e: diarrhea, n/v, headache, myelosuppresion (bone marrow suppression)

drug interaction: MAOIs

34
Q

Class: Aminoglycosides

A
  • Narrow-spectrum antibiotics
  • MOA: disrupts protein synthesis
  • Bactericidal
  • Use: Aerobic gram-negative bacilli
  • Can cause serious injury to inner ear and kidney
  • Microbial resistance
35
Q

Aminoglycosides Cont.

A
  • A/E:
  • Nephrotoxicity
  • Ototoxicity
  • Hypersensitivity reactions
  • Neuromuscular blockade
  • Blood dyscrasias (rare)
  • reversal with IV infusion of a calcium salt (ex. calcium gluconate) ANTIDOTE
  • Penicillins and aminoglycosides are frequently employed in combination to enhance bacterial kill
36
Q

Aminoglycosides Serum levels

A
  • The same aminoglycoside dose can produce a very different plasma level in different patients
  • Peak levels must be high enough to kill bacteria; trough levels must be low enough to minimize toxicity
  • Peak Levels: 30 minutes after IM injection or IV infusion
  • Trough levels: depends on dosing schedule
37
Q

Gentamicin

A
  • used to treat serious infections caused by aerobic gram-negative bacilli
  • P. aeruginosa
  • E. coli
  • Klebsiella
  • Serratia
  • Proteus mirabilis

a/e: nephrotoxicity and ototoxicity

**cheapest aminoglycoside (preferred)

38
Q

Amikacin (Amikin)

A
  • Of all the aminoglycosides, amikacin is active against the BROADEST spectrum of gram-negative bacilli and is the least vulnerable to inactivation by bacterial enzymes
  • DOC: when gentamicin is resistant in hospitals

a/e: nephrotoxicity and ototoxicity

Pharmacology (17 decks)

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