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NURS 306 > Antibiotics Part 1 > Flashcards

Antibiotics Part 1 Flashcards

(75 cards)

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1
Q

Sulfonamides include

A 
Sulfamethoxazole-trimethoprim 
Others: 
Sulfamethoxazole
Sulfisoxazole
Sulfadiazine
Sulfamethiozole
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2
Q

Mechanism of Action and Drug Effects: Sulfonamides

A
  • Bacteriostatic (inhibits growth of bacteria)
  • Inhibits folic acid synthesis (folic acid is required for proper synthesis of purines, a chemical component of nuclei can acids)
  • Competitive inhibition (competes with PABA for bacterial enzyme tetrahydropteroic acid synthetase, which incorporates PABA into the folic acid molecule)
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3
Q

Indications for Sulfonamides

A

Broad spectrum: act against gram (+) and (-)
UTI’s
Respiratory Tract Infections
Pneumocystis Jerovecii (HIV associated pneumonia)
Skin and soft tissue infections
Infections due to Staph or MRSA

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4
Q

Contraindications to Sulfonamides

A

Allergy to sulfa
Cyclooxyrgenase-2 inhibitor (Celebrex)
Pregnant women at term and infants younger than 2 months
Sulfite so: preservatives in food, wine, injectable drugs.

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5
Q

Chemical components of folic acid

A

PABA

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6
Q

Adverse Effects of Sulfonamides

A

Allergic Reaction
Stevens Johnson Syndrome, Renal Damage from crystalluria, Kernicterus (bilirubin deposited in infants)
Delay cutaneous reactions, fever followed by rash
Photosensitive try reaction: skin reaction induced by exposure to sunlight, sunburn
Other: mucocutaneous, GI, hepatic, renal and hematologist complications
Immune mediated: involve production of reactive drug metabolites in the body

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7
Q

Interactions of Sulfonamides

A

Sulfonylureas, hypoglycemic effects in diabetes treatment
Phenytoin toxic effects
Warfarin anticoagulant effects hemorrhage
(Increased?) likelihood of cyclosporine-induced nephrotoxicity
(Decreased?)efficacy of oral contraceptives

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8
Q

Assessment of Sulfonamides

A

Drug allergies to sulfa type drugs or sulfites (oral sulfonylureas, thiazides diuretics)
Skin assessment during therapy d/t Stevens-Johnson syndrome
RBC count before therapy d/t possibility of drug related anemias
Renal function d/t potential for drug related crystalluria
Meds and med he for any manifestations of GSPD and slow acetylation.

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9
Q

Implementation of Sulfonamides

A

Avoid in pts w/ G6PD and slow acetylation
Fluids: 2000-3000 mL/24 hrs to prevent crytalluria
Take w/ food to minimize GI upset
Report: worsening abdominal cramps, stomach pain, diarrhea, blood in urine, severe or worsening rash, SOB, fever

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10
Q

Penicillins (PCNs) are divided into 4 subgroups

A
  1. Natural PCNs
  2. Aminopenicillins
  3. Penicillinase-resistant PCNs
  4. Extended spectrum PCNs
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11
Q

Natural PCNs include

A

Penicillin G and V

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12
Q

Aminopenicillins include

A

Amoxicillin

Ampicillin

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13
Q

Penicillinase-resistant PCNs include

A

Nafcillin
Dicloxacillin
Oxacillin
Cloacal lion

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14
Q

Extended spectrum PCNs include

A

Amoxicillin/clavulanic acid
Ampicillin/sulbactam
Ticarcillin/clavulanic acid
Piperacillin/tazobactam

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15
Q

Mechanism of Action and Drug Effects of PCNs

A

Bactericidal (kills a wide variety of gram (+) and some (-)
Inhibits cell wall synthesis -> formation of defective cells walls = cell death from lysis
Doesn’t affect human cells

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16
Q

Beta-Lactam Antibiotics have four major subclasses

A
  1. Penicillins
  2. Cephalosporins
  3. Carbapenems
  4. Monobactams
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17
Q

Beta-Lactam Antibiotics structure and MOA

A

Share a common structure and MOA

Inhibits synthesis of bacterial peptidoglycan cell wall.

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18
Q

Beta Lactamase inhibitors are added to

A

Penicillin AB. Makes drug more powerful against beta Lactamase bacterial strains. (Some bacterial strains produce enzyme: beta lactamase)

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19
Q

Beta Lactamase

A

Resists these antibiotics by breaking the chemical bond of C and N atoms in structure of beta-lactam ring loss of antibacterial efficacy.

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20
Q

Penicillins were first derived from a

A

mold (fungus) seen on bread or fruit

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21
Q

Penicillinases

A

Beta lactamase that inactivates penicillin molecules

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22
Q

Three beta lactamase inhibitors

A

Cleveland acid
Tazobatam
Sulbactam

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23
Q

Natural Penicillin

A

Only 2 in clinical use
Pen G: injectable or IV/IM use
Pen V: PO (tablet & liquid)

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24
Q

Penicillinase-resistant drugs

A

Stable against hydrolysis of staphylococcal Penicillinases

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25
Aminopenicillins
has amino group attached | ? activity against gram (-) bacteria compared with natural penicillins
26
Extended spectrum drugs
Wider spectra of activity compared to all other penicillins
27
Combos of Penicillin + Beta-lactamase inhibitors
ampi + sulbactam amoxi + clavulanic acid ticar + clavulanic acid pipera + tazobactam
28
Indications for Penicillins
- to prevent and treat infections caused by gram (+) bacteria (strepto, entero, and staphylo -end coccus - for prophylaxis (i.e amoxicillin) - extended spectrum penicillins have gram + and - and anaerobic coverage: used in HAI (pneumonia, intraabdominal infections and sepsis)
29
Contraindications for Penicillins
drug allergy: very common, incidence (0.7% - 4%)
30
Adverse Effects of Penicillin
Related to drug allergies/Type 1 hypersensitivity reactions | mostly GI effects such as diarrhea, N/V, taste alterations, oral candidiasis
31
How does penicillin affect the CNS?
causes lethargy, anxiety, depressions and seizures.
32
How does penicillin affect hematologic functions?
causes anemia, bone marrow depression and granulocytopenia
33
How does penicillin affect metabolic functions?
causes hyperkalemia and hypernatremia | alkalosis
34
How does penicillin affect the skin?
causes pruritus, hives and rash.
35
What drugs interact w/ penicillins?
``` Aminoglycosides (IV) and Clavulanic Acid Methotextrate NSAIDs Oral Contraceptives Probenecid Rifampin Warfarin ```
36
How does Aminoglycosides and Clavulanic Acid interact with penicillin?
Mechanism: Additive Result: More effective killing of bacteria
37
How does Methotrexate interact with penicillins?
Mechanism: ? renal elimination of methotrexate. Result: ? methotrexate levels
38
How do NSAIDs interact with penicillins?
Mechanism: Compete for protein binding Result: More free and active penicillin
39
How do oral contraceptives interact with penicillins?
Mechanism: uncertain Result: May ? efficacy of contraceptive
40
How does probenecid interact with penicillins?
Mechanism: competes for elimination Result: prolongs effects of penicillins
41
How does rifampin interact with penicillins?
Mechanism: inhibition Result: may inhibit the killing activity of penicillins
42
How does warfarin interact with penicillins?
Mechanism: ? vitamin K from gut flora Result: enhanced anticoagulant effect of warfarin
43
Assessment for Penicillin Administration
Determine drug allergies and potential drug interactions Hx: asthma, allergens, aspirin allergy and sensitivity to cephalosporins Neuro, abdominal and bowel assessment (electrolyte disturbed, cardiac and renal disease pts.) Serum Na+ and K+ levels: an ? in levels can exacerbate a patient w/ HF, fluid overload or cardiac dysrhythmias Don't always end in cillin; zosyn and augmentin
44
Implementation of penicillin
Consumption of probiotics: lactobacillus or dairy products (yogurt, buttermilk, kefir) Oral: 6oz of water, NOT juices Penicillin V, amoxicillin and amoxicillin-clavulanate: given w/ water 1 hour before or 2 hours after meals Procaine and Benzathine salt penicillins (thick): give as ordered IM, 21 gauge Reconstitute IM imipenem/cilastatin in sterile saline w/ plain lidocaine Anaphylactic Reaction: give epinephrine or other emergency drugs w/ supportive treatment @ all times(O2)
45
Cephalosporins: First-Generation
cefadroxil cefazolin cephalexin cephradine
46
Cephalosporins: Second-Generation
``` cefactor ceforetan cefoxitin cefprozil cefuroxime ```
47
Cephalosporins: Third-Generation
``` cefdinir cefditoren cefixime cefoperazone cefotaxime cefpodoxime ceftazidime ceftibuten ceftizoxime ceftriaxone ```
48
Cephalosporins: Fourth-Generation
cefepime
49
First Generation Cephalosporin drugs
have the most gram (+) coverage, later generations have more gram (-) coverage
50
Anaerobic coverage is found only in
second generation drugs
51
Ceftaroline
newest cephalosporin 5th generation broad spectrum and covers gram + and MRSA
52
Cephalosporins are NOT active against
fungi and viruses.
53
Mechanism of Action: Cephalosporin
Bactericidal Disrupt bacterial cell wall = lysis and death Depends on generation, level of coverage increases as generation increases.
54
Cephalosporin Indications
moderate to severe infections and choice of drug depends on pathogens and generation
55
Contraindications for Cephalosporins
Allergy to cephalosporins and PCNs, renal disease
56
Adverse Effects of Cephalosporins
similar to PCNs
57
What drugs interact with cephalosporins?
ethanol antacids, iron probenecid oral contraceptives
58
How do cephalosporins interact with ethanol?
accumulation of acetaldehyde metabolite ethanol = acute alcohol intolerances after drinking ale, beverage w/in 24 hours of taking cefotetan symptoms: stomach cramps, N/V diaphoresis, pruritus, headache and hypotension
59
How do cephalosporins interact with antacids and iron?
? absorption of certain oral cephalosporins (cefdinir, cefditoren) = ? effectiveness of drug
60
How do cephalosporins interact with probenecid?
? renal excretion = ? cephalosporin levels
61
How do cephalosporins interact with oral contraceptives?
enhanced OC metabolism = ? risk for unintended pregnancy
62
First Generation cephalosporins
Active against gram + and limited activity to gram -. Parenteral and Oral forms Cefazolin: for surgical prophylaxis and susceptible staphylococcal infections: (P) form Cephalexin: (O) form
63
Second Generation Cephalosporins
Active against gram + and enhanced activity of gram -. | P/O forms
64
Second Generation Cephalosporin: Cefoxitin
-(P) form, used as prophylactic AB in pts undergoing abdominal surgery because it can effectively kill intestinal bacteria
65
Second Generation Cephalosporin: Cephamycins
coverage of anaerobic bacteria (cefoxitin and cefotetan)
66
Second Generation Cephalosporin: Cefuroxime
prodrug, doesn't kill anaerobes, little antibacterial activity until hydrolyzed in liver to its active form. (O) form
67
Third Generation Cephalosporins
The most potent of the 1st three generations in killing gram - but less active against gram +. Kills pseudomonas
68
Third Generation Cephalosporin: Ceftriaxone
-long acting, once a day, treats most infections -able to pass through blood brain barrier treating meningitis -(IV/IM) form NOT given to hyperbilirubinemic neonates or liver dysfunction pts.
69
Third Generation Cephalosporin: Ceftazidime
difficult to treat infections like pseudomonas.
70
Fourth Generation Cephalosporins
? activity against enterobacter gram negative and gram positive organisms
71
Fourth Generation Cephalosporins: Cefepime
treats complicated/uncomplicated UTIs, uncomp. Skin and skin structure infections and pneumonia
72
Fifth Generation Cephalosporins
newest adjust dose for ? renal function injectable form
73
Fifth Generation Cephalosporin: Ceftaroline
S. aureus MRSA, acute skin and skin structure infections and CAP
74
Cephalosporin Assessment
Allergies, allergy to penicillin d/t cross sensitivity | Note generation of cephalosporins; different effects
75
Implementation of Cephalosporins
give w/ food to avoid GI upset | avoid alcohol and alcohol containing products - potential disulfiram like reaction (acute alcohol intolerance)

NURS 306 (26 decks)

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