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Pharm 2 via Jeff > Antimicrobials > Flashcards

Antimicrobials Flashcards

(106 cards)

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1
Q

What is MIC?

A

Minimum Inhibitor Concentration

The lowest concentration of antibiotic required to prevent growth

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2
Q

What is MBC?

A

Minimum Bacterial concentration

Lowest concentration required to kill bacteria

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3
Q

What is the action for bactericidal antimicrobials

A

Destroys bacterial cell wall

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4
Q

What is the action for bacteriostatic antimicrobials?

A

Stops bacteria from growing stops DNA synthesis of bacteria and halts production of new bacteria

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5
Q

What is the difference between narrow spectrum and broad spectrum antimicrobials?

A

Narrow spectrum kills specific types of bacteria

Broad spectrum kills every type of bacteria

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6
Q

Explain concentration dependent killing of bacteria?

A

Anitibiotic which increase the rate and extent of bacteria killing wih increased concentration

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7
Q

What type of antibiotics are concentration dependent killing antibitics?

A

Aminoglycosides

Fluoroquinolone

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8
Q

Explain time dependent killing of bacteria

A

Greater concentration do not kill vecteria faster. Clinical efficacy is related to the length of time for which high levels of concentration of the antibiotics are maintained

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9
Q

What types of antibiotics are considered time dependent killing antibiotics?

A

Beta lactams
monobactams (aztronam)
Macrolides (erythromycin, clindamycin)

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10
Q

T/F: Continuous infusion of antibiotics has shown to be more effective than intermittent boluses

A

FALSE

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11
Q

Some antibiotics continue to suppress the growth of bacteria after the antibiotc is no longer detectable. What is this known as?

A

Post antibiotic effect PAE

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12
Q

What is the post antibiotic leukocyte effect?

A

After the majority of the bacteria is killed the body can begin to start killing bacteria itself with its own leukocytes

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13
Q

What are the two types of resistance to antimicrobials?

A

Intrinisic - natural resistance to antimicrobial

Acquired - genetic alteration in the bacteria occurs which causes a once effective antimicrobial ineffective

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14
Q

Describe decreased permeability for resistance

A

The porins are altered which inhibits the antibiotic from entering the cell causing resistance to the antibiotic

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15
Q

Describe decreased efflux in antibiotic resistance

A

Cells will actually pump out the antibiotic - importance for macrolides, fluoroquinolones and some beta lactams

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16
Q

Describe inactivation in antibiotic resistance

A

Bacteria forms its own wnzymes which bust open the beta lactams and inactivates them - the enzyme is betalactamases

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17
Q

Which enzyme inactivates beta lactam antimicrobials?

A

Beta lactamase busts open the beta lactams an inactivates them causing resistance

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18
Q

What is an example of target modification in antimicrobial resistance?

A

The bacteria which is suseptable to penicilllin modifies its peniclillin binding proteins which disallow penicillin to bind to its receptors causing resistance to penicillin MRSA is an example

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19
Q

What is a positive reason to use multiple drug therapy?

A

More then 1 drug may be needed to treat infections. Broad spectrum agents may be able to adequately cover multiple organisms with a single agent

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20
Q

What is a negative outcome of muliple drug therapy

A

The unintended bacteria is introduced to antimicrobials and begins to produce antibodies against that antimicrobial leading to future resistance

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21
Q

What is an effective way to prevent resistant strains of organisms during mulidrug therapy?

A

Administer 2 antibiotic with different MOA to prevent resistance

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22
Q

What are the different synergies associated with multidrug therapy

A

Antagonist 1 +1 = 0.5

Indifferent 1 + 1 =1

Inbetween 1 +1 =1.5

Additive 1+1 = 1.5

Synergistic 1 + 1 = 3

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23
Q

Treatment of an infection with an effective therapeutic course of antimicrobial agents is based on what?

A

The right concentration of the right antimicrobial reaching the right site of action for a sufficient period of time to kill or inhibit bacterial growth

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24
Q

What is an antibiogram?

A

Antibiotics are tested against each known bacteria. Antibiograms list the degree of susceptibility and resistnace bacteria has to each antibiotic. Helps to choos the best antibiotic against a specific bacteria

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25
What factos increase a patient risk for a specific type of infection?
``` Impaired host defenses: Anatomical neutropenia aspleenia malignancy HIB immunosuppression ```
26
In pregnant women which antibiotic causes acute necrosis of the live, pancreatitis, and possible renal failure and should be avoided?
Tetracycline
27
Which antibitiotic have been deemed safe for pregnancy?
Penicillins Cephalosporins Erythromycin Aminoglycosides if necessary
28
In regards to nosocomial infections, where do most occur in the body?
urinary tract respiratory blood Most in the urinary tracct - staph aureus is most common
29
What devices are highly associated with nosocomial infections
Ventilators Urethral catheters vascular access catheters
30
A catheter related infections is defined how
At least 1 positive blood culture drawn from both a catheter and a peripheral site A positive culture drawn through a catheter is nonspecific but a negative culture drawn through a catheter rules out a catheter related infection
31
What sites of cntral line insertion are associated with the highest rates of infection?
Femoral internal jugular subclavian
32
Which antibiotic should first be used to treat catheter related infections?
Vancomycin due to the high prevalence of methicillin reistant Staph aureus. Adjust the therapy when the actual offending organism is properly identified
33
Which antibiotic is probably the best to use for surgical prophylasxis
1 st generation cepalosporin such as Cefazolin due to it's low cost and broad spectrum and low incidence of allergic reactions
34
Usually, surgical prophylaxis antibiotics should not be continued for how long after surgery
No more than 24 hours post op
35
Describe the Class 1 clean wound?
Atraumatic, with no break in sterile technique. The respiratory, GI, and GU tracts are not entered. No need for prophylactic antibiotic
36
Describe Class II wound classification
Class II Clean Contaminated Surgery in areas known to harbor bacteria with no spillage of contents
37
Describe Class III wound classification
Cass III Contaminated Major break in sterile technique with a traumatic wound and gross GI spillage, entrance into biliary or GU tract
38
Describe Class IV would classification
Class IV Dirty infected Infection exists before surgery. OLd wound with devitalized tissue or perforated viscera
39
Which wound classification will require at least one dose of antibiotic?
Class II and beyond
40
Which antibiotic are best for UTI's?
Fluoroquinilone Aminoglycocides 3 rd generation cephalosporins
41
What is the proper timing of the initation of surgical prophylaxis antibiotics?
Antibiotics should be initiated within 1 hour prior to incision or start of procedure when no incision isrequired Fluoroquinolone or vancomycin may be initiated 2 hour prior to incision or precedure start
42
Which antibiotic is most recommended for surgical procedures and which antibiotic may be given as an alternative?
Cafazolin is most commonly given and Clindamycin is the most common alternative
43
Which antibiotic is more effective against anaerobes and should be given for aspiration pneumonia?
Clindamycin
44
Which bacteria is the leading cause of nosocomial GI infections?
C difficile Clostridium difficile
45
Which form of bacteria can be provoked by the use of antibiotic therapy
C. Difficile
46
Diagnosis of C. Difficile is confirmed by the presence of which toxins?
Either Enterotoxin A or Cytotoxin B
47
Which antibiotic is the first line of therapy for C. Difficile?
Metronidazole (Flagyl) PO Vancomycin may be used in cases not responding to metronidazole Diicid - new drug
48
Which antibiotics contain the beta lactam ring and inhibit cell wall synthesis
Beta lactams (PCN) Caphalosporins Carbapenems Monobactams
49
How do bacteria form resistance to PCN
Bacteria form beta lactamase which is an enzyme that breaks the beta lactam ring and disables the molecule . Bacteria with beta lactamse can resist the effects of beta lactam antibiotics.
50
What are the beta lactamase inhibitors?
Subactam Tazobactam Clavulanic Acid Bacteria with beta lactamase attack these inhibitors leaving the beta lactam ring of the true antibiotic intact
51
Which beta lactam can produce Jarisch Herxheimer reaction?
A flu like reaction caused by PCN along with GI upset and diarrhea
52
What is the IV form of PCN?
PCN G = IV/IM PO form given without food
53
Amoxicillin is given PO or IV?
-PO without regards to food with or wihout food
54
Older generations of betalactams (PCN) are better for gram + or gram - bacteria
Older generations are better for gram _ and newer generation are better for gram - bacteria
55
Which penicillins are poor for PO absorption?
Oxacillin Nafcillin
56
Use of Ticarcillin and piperacillin cause what adverse reactions?
Prolonged bleeding times hypokalemia neutropenia at high doses
57
What is the mechanism of action for cephalosporins
Bactericidal Spectrum of action based on generation 1 - 5 Gram + to Gram -
58
When should first generation Cephalexin and Cefazolin be redosed?
Redose after 2 half lives | Cefazolin half life is 4 hours (Cephalexin half life is 1 hour
59
Which vephalosporin causes diarrhea and biliary sludging and should not be given to kids?
Ceftriaxone (Rocephin)
60
Which cephalosporin precipitates with calcium in the same IV line?
Ceftriaxon (Rocephin)
61
Which carbapenem has a high risk for seizures?
Imipenem With cilastatin - inhibits dihydropeptidase which is an enzyme that breaks down imipenem
62
Which form of Vancomycin is best given for C. Diff?
PO Vancomycin
63
Highest concentration levels for MIC for vancomycin are for what infections?
Pneumonia, CNS, infection, seer osteomyelitis
64
What adverse effects are seen with vancomycin?
``` Red man syndrome nehprotoxicity otoxicity thrombocytopenia All from rapid infusion ```
65
Vancomycin should be infused at what rate
No more than 1 gram / hour
66
What is a good loading dose for vanomycin?
30 mg/kg
67
What is the mechanism of action for vancomycin?
Disrupts cell wall synthesis, vactericidal
68
Is vancomycin concentration or time dependent?
Concentration dependent
69
Which antibiotic causes myelosuppression, anemia leukopenia, pancytopenia, and thrombocytopenia?
Linezolid (Zyvox) Causes accelerated HTN and Fever
70
Which family of antibiotics causes the most GI upset and toxicity?
Macrolides
71
Which antibiotic is best for upper and lower respiratory infections?
Azithromycin (Zithromax)
72
What effect on the heart may macrolides such as azithromycin have?
Prolonged QT
73
Which macrolides are potent inhibitors of CY3A4?
Clarithromycin (Biaxin) Erythromycin
74
Which macrolids is the 2nd choice for gastroporesis
Erythromycin
75
Whihc family of antibiotics have many drug interaction including NSAIDS, Warfarin, Antacids, Amiodarone?
Fluoroquinolones
76
What CNS effects are seen with fluoroquinolones?
Insomnia, | Anxiety altered glucose
77
T/F: Fluoroquinolones may be given to trauma and orth patients
False Have a higher risk of post op pain
78
T/F: Fluoroquinolones may be given to children?
False Not for children under 12 Could cause joint damage
79
Which antibiotic is the best drug of choice for GI infections?
Cipro
80
Which fluoroquinolone is best for lung infections?
Moxifloxacin (avelox?
81
Which antibiotic (Tetracycline) causes permanent tooth discoloration?
Doxycycline (vibramycin)
82
At what age should doxycycline not be given to children?
After their adult teeth have come in
83
Which tetracycline has high incidences of nausea and vomiting?
Tigecycline (Tyfacil)
84
Which family of anitbiotics prolongs neuromuscular blockade?
Aminoglycosides - interferes with Ca++ and Mg++ cross bridges between cell membranes
85
Which aminoclycoside has the best gram positive coverage?
Gentamycin
86
2 bacteriostatic antibiotics has the same mechanism of actions?
bactericidal
87
Which antibiotic is best for dirty surgeries involving the GI tract?
Clindamycin (cleocin)
88
Which antibiotic has the highest risk for C. Diff?
Clindamycin (Cleocin)
89
What effect does clindamycin have on neuromuscular blockade?
Prolongs neuromuscular blockade
90
What effects are seen with metronidazole-coumadin reaction
Coumadin levels increase and PT levels are increased
91
Which antibiotic is a CYP 450 inducer and shortens the life of medication using th eCYP system?
Rifampin and Rifabutun
92
What side effects will be seen in all body fluids including tears, saliva, and urine when taking rifampin?
Will see orange red in color
93
Are beta lactams time dependent or concentration dependent?
Beta lactams are time dependent
94
Are aminoglycocides time dependent or concentration dependent
Aminoglycosides are concentration dependent
95
Which antibiotics are of the beta lactam confiuration
``` PCN Cephalosporins Carbapenems Monobactams Beta lactamase inhibitors ```
96
What is the most common form of resistance in antibiotics?
Bacteria cells produce beta lactamase which breaks down the beta lactam ring of the molecule and mades the molecule inactive causeing resistance
97
When is the best time for administration of PCN?
1-2 hours before a meal with the exception of amoxicillin
98
Which antimicrobial present the risk of prolonging neuromuscular blockade when paralytics are used?
Aminoglycocides Clindamycin Tetracycline Particularly when used with non depolarizing neuromuscular blocking agents
99
Hown may prolonged neuromuscular blockade be treated?
Neostigmine and colcium all increase the presence of acetylcholine at the neuromuscular junction
100
Which 3rd generation cephalosporin antimicrobial is best for pseudomonas?
Ceftazimide (Fortaz)
101
Which 3rd generation cephalosporin is best for staph coverage?
Ceftriaxone (Rocephin)
102
Patients with active seizure should not take which antimicrobial?
Carbapenem | Imipenem (Primaxin)
103
Which antibiotics are responsible for prolonging QT intervals?
Flurorquinolones - CIPRO , levaquin | Macrolides - erythromycin, azithromycin, clarithromycin
104
Which antibiotic may have the longest half life
Azithromycin - 68 hours
105
During pregnancy , which antibiotics should be avoided due to potential for injury to the fetus?
``` Metranidazole Tetracycline Fluoroquinolones Rifampin Ticarcillin Trimethoprim ```
106
Which antibiotic are safe to use during pregnancy?
PCN Cephalosporins Erythromycin

Pharm 2 via Jeff (2 decks)

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