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NUR 326-Pathopharm > Antimicrobial Drugs > Flashcards

Antimicrobial Drugs Flashcards

PCNs, Cephalosporins, Carbapenems, and others (65 cards)

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1
Q

Drug classes that inhibit cell wall synthesis:
-Weaken the cell wall
-Influx of fluid into the cell
-Cell swells and burst
-Cell lysis and death

A

Penicillins
Cephalosporins
Carbapenems
Vancomycin

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2
Q

The function of Beta-Lactam Antibiotics

A

Inhibit the synthesis of the bacterial peptidoglycan cell wall

Never given individually

Ex: Sulfabactam, clavulanic acid, tazobactam, avibactam

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3
Q

Penicillin MOA

A

Disrupt the synthesis of the cell wall

-Bacteria must be growing
-Inhibit transpeptidases (cell wall synthesis)
-Activates autolysis

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4
Q

Adverse effects of Penicillins

A

Uticaria (hives), pruritis (itching), angioedema (swelling under the skin)

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5
Q

Indications for Penicillin

A

Works against many different organisms

Low toxicity

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6
Q

4 Different types of PCNs

A

-Natural PCNs (PCN G & V)
-Penicillinase-Resistant PCN (nafcillin)
-Aminopenicillins (amoxicillin & ampicillin)
-Extended-spectrum PCNs (piperacillin)

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7
Q

Natural PCNs and indication

A

Penicillin G & V
-Works well on gram +/- cocci, anaerobic bacteria, spirochetes
-Least toxic
-Can be used with aminoglycosides

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8
Q

PCN G&V route

A

Route: IV/IM (PO available)
-IM commonly used for STDs

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9
Q

Natural PCNs AE/considerations

A

-1/2 life about 30 minutes (unless kidney dysfunction

-Allergy: Rash to anaphylaxis
Allergic to 1 PCN, allergic to ALL PCNs

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10
Q

Penicillinase Resistant PCNs

Drug and Indication

A

Drug: Nafcillin

Indication: Drug of choice for Penillinase Resistant PCNs
-Can be used for staph bacteria (anti-staphylococcus PCN)

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11
Q

Nafcillin class and route

A

Class: Penicillinase
Route: IV ONLY

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12
Q

Aminopenicillins

Drug and MOA

A

Ampicillin and Amoxicillin

Disrupt the synthesis of the cell wall
-Can work better against gram (-) because of the chemical structure

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13
Q

Ampicillin

Indication and Route

A

Indication: 1st broad spectrum
Route: IV or PO (if giving PO usually prefer Amoxicillin)

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14
Q

Ampicillin

Adverse effects and considerations

A

AE: Diarrhea and rash are common

Considerations:
-Renal sensitive
-Stopping using ampicillin as much because of drug resistance
-Allergy

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15
Q

Amoxicillin

Indication and route

A

Indication:
-Very common in pediatric patients (doses are sometimes higher because of strep-resistant organisms)
-Common for ear, nose, throat, genitourinary and skin infections

Route: ONLY PO

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16
Q

Amoxicillin

Adverse effects and considerations

A

AE: Diarrhea and rash (although less side effects compared to ampicillin)

Consideration: Allergy

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17
Q

Extended-spectrum PCN

Drug

A

Piperacillin

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18
Q

Piperacillin

Indication

A

Indication:
-Wider spectrum than other PCNs
-Anti-pseudomonal (especially piperacillin)

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19
Q

Piperacillin

Class and nursing considerations

A

Class: Extended-spectrum PCN

Nursing considerations:
-Affects platelet function
-Watch for patients with renal dysfunction

-always given with a beta lactamase inhibitor

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20
Q

How many generations of cephalosporins?

MOA of Cephalosporins

A

5 Generations (later generations increase spectrum/activity/and ability to penetrate CSF)

MOA: Inhibit cell wall synthesis through PCN-binding protein (inhibit transpeptidase). Leads to autolysis

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21
Q

Cephalosporin (general)

Indications

A

Same as PCNs: Gonorrhea, UTI, Peritonitis, Meningitis, Pneumonia, etc)

Low-toxicity
-Some cross-sensitivity with PCN allergy. Avoid if PCN anaphylaxis

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22
Q

Cephalosporin (general)

AE and considerations

A

AE: mild diarrhea, abdominal cramps, rash, pruritis, redness, edema

Considerations:
-Pregnancy Category B (pretty safe, used during pregnancy)
-Poor oral absorption

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23
Q

1st Generation Cephalosporins

Drug and indications

A

Drug: Cefazolin and Cephalexin

Indications:
-Works well for gram (+) bacteria
-Staph and non-enterococcal strep infections
-Cefazolin common for surgical prophylaxis

*DO NOT work in CNS infections

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24
Q

Cefazolin and Cephalexin

Route

A

Cephalexin: Either IV or PO

Cefazolin: ONLY IV

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25
2nd Generation Cephalosporins Drug and indications
Drug: Cefuroxime and Cefotetan Indications: More gram (-) coverage AND gram (+) coverage *Cefuroxime does NOT kill anaerobic bacteria but DOES work well on intestinal bacteria *Both DO NOT work CNS or pseudomonas
26
Cefuroxime and Cefotetan Route
IV and PO
27
3rd Generation Cephalosporins Drug and Indications
Drug: Ceftriaxone, Ceftazidime, Cefotaxine Indications: Most potent in fighting gram (-) bacteria BUT much less activity against gram (+) Ceftriaxone is EXTREMELY long-acting (once per day dosing benefit) -Able to cross the blood-brain barrier so effective in treating meningitis and other infections within the CNS Ceftazidime works well for Pseudomonas (although becoming more resistant)
28
Ceftriaxone, Ceftazidime, Cefotaxine Route and considerations
Route: IV/IM only (other drugs are PO) Considerations: Do NOT give Ceftriaxone to patients with liver failure (works well but hard on the liver)
29
4th Generation Cephalosporins Drug and Indications
Drug: Cefepime Indications: -Works against gram (-) and gram (+). Very broad spectrum -Uncomplicated/complicated UTIs, skin infections, and Pseudomonas Crosses the BBB (works well for CNS and Pseudomonas)
30
5th Generation Cephalosporins Drug and Indications
Drug: Ceftaroline Indications: -Treats MRSA and MSSA -Works against some VRSA/VISA -Mostly for nasty staph infection *Does NOT work on enterobacter, pseudomonas, ESBL, Klebsiella coverage
31
Ceftaroline Route and considerations
Route: ONLY IV Considerations: needs to be renally dosed (hard on kidneys) -Monitor BUN/Creatinine
32
Carbapenems Drug and MOA
Drug: -Imipenem/Cilastatin -Meropenem MOA: Binds to PCN-binding protein which inhibits cell wall synthesis -Very resistant to Beta-lactamase
33
Imipenem/Cilastatin Indications and Route
Indications: -BROADEST spectrum of ALL antibiotics -Can penetrate BBB and meninges -Used for complicated infections -Combo of the carbapenem with the inhibitor of the enzyme that breaks down imipenem Route: IV only (must be infused over 60 minutes
34
Imipenem/Cilastatin AE and considerations
AE: drug-induced seizure activity Considerations: -Monitor patients for seizures, especially in the elderly, and with other medications that can induce seizure ALL are IV and must be INFUSED OVER 60 MINUTES Cilastin helps inhibit dehydropeptidase that breaks down imipenem too quickly. Allows imipenem to stay in the system longer and work more effectively Doesn’t work against CRE
35
Meropenem Indications and Route
Indications: -A little less coverage than imipenem; but still gram (+) and (-) aerobes and anaerobes Route: IV only (infused over 60 min)
36
Meropenem AE and considerations
AE: -Less seizure activity than Imipenem/cilastatin -Rash and diarrhea most common side effects Considerations: -Doesn’t degrade in kidneys -Doesn’t work against CRE -Must be INFUSED OVER 60 MINUTES
37
Glycopeptide Antibiotic Drug and MOA
Drug: Vancomycin MOA: Destroys by binding to the bacterial cell wall, producing immediate inhibition of cell wall synthesis and death
38
Vancomycin Indications and Route
Indication: -Works on gram (+) infections (including MRSA and PCN-resistant pneumococcus) Route: IV (some PO for C.Diff and pseudomembranous colitis)
39
Vancomycin AE and considerations
AE: Toxic side effects: -Ototoxicity with high levels (can be reversible) -Immune-mediated thrombocytopenia -Nephrotoxic→ watch when using with other drugs (aminoglycosides, cyclosporin’s, IV contrast) that affect kidneys -Watch with neuromuscular blockades (paralyzers) Usually NOT harmful -Red Man Syndrome: usually related to rapid infusion (flushing, rash, pruritus, tachycardia, hypotension) -infuse slowly and over longer periods Considerations: Doesn't work for CNS infections Kidney eliminates drug: decrease doses for renal dysfunction -Monitor kidney levels (not as much for PO) Draw peak and trough levels (therapeutic) -15 to 30 minutes after med is given (peak) - 30 minutes before next dose (tough)
40
Aminoglycosides Drug and MOA
Drug: Gentamycin, Amikacin, Tobramycin MOA: Inhibit bacterial ribosomes→ unable to make proteins -Used in combination with beta-lactamase or vancomycin. Use other medicines first
41
Gentamycin, Amikacin, Tobramycin Indications and Route
Indications: Used since 1944 for complicated infections: UTIs/pyelonephritis, gynecological infections, peritonitis, endocarditis, PNA, osteomyelitis (DM-related infections) Potent antibiotics that work well on gram (–) bacteria -Also work on gram + but need other anti-biotics for a synergistic effect Route: Mostly IM but also ophthalmic and topical *googled
42
Gentamicin, Amikacin, Tobramycin AE and considerations
AE: Severe side effect profile: -Nephrotoxicity: 5-25%, usually reversible -Ototoxicity: 3-14%, usually permanent Neuromuscular blockade → can cause PROFOUND respiratory distress (myasthenia gravis) CNS side effects: confusion, depression, disorientation, numbness, and tingling Cochlear damage- ototoxicity, high-frequency hearing loss, high-pitched tinnitus Considerations: Therapeutic drug monitoring -Peak/Trough levels Transitioned from 3x day dosing to 1x day dosing
43
Lincosamides Drug and MOA
Drug: Clindamycin MOA: binds to ribosomes and inhibits protein synthesis
44
Clindamycin Indications and Route
Indications: -Chronic bone infections, GU tract infections, intra-abdominal infections, anaerobic pneumonia, septicemia, serious skin infections, prophylaxis for endocarditis Often used for anaerobic bacteria Route: PO and IV
45
Clindamycin AE and considerations
AE: very toxic -Can cause deadly pseudomembranous colitis Considerations: Monitor use with neuromuscular blockade medications→ respiratory distress Therapeutic drug monitoring -peak and though All enterobacter bacteria are resistant to clindamycin (doesn’t work for VRE and CRE)
46
Macrolides Drug and MOA
Drug: Erythromycin and Azithromycin MOA: Inhibit protein synthesis by binding to ribosomes -Good at entering host cells
47
Erythromycin Indications and Route
Indications: used to treat MANY infections. Has hypomotility benefits for diabetic gastroparesis and increases gastric motility and emptying Route: PO and IV (topical and ophthalmic also available) -IV is painful, and oral absorption isn’t great
48
Azithromycin Indications and Route
Indications: -differs structurally from other macrolides → has some advantages in coverage compared to erythromycin -Very good at tissue penetration and long duration of action Route: PO and IV
49
Erythromycin and Azithromycin AE and considerations:
AE: YUCK drugs (GI upset, especially erythromycin) Considerations: Erythromycin: -Do NOT take on an empty stomach -Lots of drug-drug interactions Azithromycin: -Take WITHOUT food; taking with food decreases absorption
50
Macrolides Indications (general)
Indications: various infections of upper and lower respiratory infections, skin infections, soft tissue infections; STIs -Legionnaire’s, Listeria, and mycoplasma pneumonia can all be treated with macrolides
51
Tetracyclines Drug and MOA
Drug: Tetracycline, Doxycycline, Minocycline MOA: bacteriostatic drugs that inhibit synthesis by binding to ribosomes
52
Tetracycline, Doxycycline, Minocycline Indications
Indication: Broad spectrum; major resistance has developed Infections still commonly treated with tetracyclines: -Rickettsia (Rocky Mountain spotted fever) -Chlamydia and trichomonas -Lyme disease -Cholera -Pelvic inflammatory disease -Mycoplasma pneumonia -Acne
53
Tetracycline, Doxycycline, Minocycline AE and considerations
Adverse effects: discoloration of the permanent teeth and tooth enamel hypoplasia in features and children, photosensitivity, and many others Diarrhea, yeast infections More serious: thrombocytopenia Considerations: Contraindications: Pregnant and nursing women, children younger than 8 (damage teeth) Wear sunscreen
54
Fluoroquinolones Drug and MOA
Drug: Ciprofloxacin and Levofloxacin MOA: destroys bacteria by altering their DNA (interfering with the bacterial enzymes DNA gyrase and topoisomerase)
55
Fluoroquinolones Indication (general)
Mostly gram (-) and some gram (+) coverage Very potent, broad-spectrum antibiotics Very good oral absorption
56
Ciprofloxacin Indication and Route
Indication: UTIs, some STIs, upper respiratory and lower respiratory tract infections, gonorrhea, and other infections -Also treats anthrax→ infection with Bacillus anthracis Minimal penetration of the BBB/CSF Works well on rapid and slow-growing organisms Route: PO, IV, and topical
57
Ciprofloxacin AE and considerations
AE: arthropathy (joint disease), often irreversible -prolonged post-antibiotic effects→ concentrated in the neutrophils Considerations: Avoid in patients under 18 and over 60
58
Levofloxacin Indication and Route
Indication: Most widely used quinolones -Broad spectrum of activity like cipro but advantage is once-daily dosing Less resistance More activity against pneumococcal and other ‘atypical’ respiratory infections Route: PO (100% bioavailability) or IV
59
Levofloxacin AE and considerations
AE: CNS disorders that predispose to seizures, and kidney failure, can cause prolongation of QT interval, photosensitivity Considerations: Monitor kidney levels, wear sunscreen
60
Sulfonamides Drug and MOA
Drug: Sulfamethoxazole and Trimethoprim MOA: don’t actually destroy bacteria but inhibit their growth=bacteriostatic by preventing the synthesis of folic acid needed for DNA synthesis
61
Sulfamethoxazole and Trimethoprim Indications and typical population
Indications: uncomplicated UTIs, respiratory infections, salmonella, shigellosis Population: Often given to patients with HIV
62
Sulfamethoxazole and Trimethoprim AE and considerations:
AE: Sulfa allergies: usually start with fever and end with skin rash Photosensitivity Considerations: Adverse reactions are more common in patients with HIV
63
Antiprotozoal and Antibacterial Drug and MOA
Drug: Metronidazole MOA: inhibit DNA synthesis (destroys bacteria by altering their DNA- interfere with the bacterial enzymes DNA gyrase and topoisomerase)
64
Metronidazole AE and considerations
AE: N/V, xerostomia (dry mouth), vaginal candidiasis Considerations: DO NOT TAKE WITH ALCOHOL -Cannot have had alcohol 24 hours before and 36 hours after. Can create toxic metabolic in the system
64
Metronidazole Indications
Indications: Anaerobic activity only -Crohn’s disease -Antibiotic-associated diarrhea or C-Diff -Antiprotozoal and antibacterial

NUR 326-Pathopharm (24 decks)

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