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pharmocology > antimicrobials > Flashcards

antimicrobials Flashcards

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1
Q

Deep sternal wound infections:
~Significantly worse long-term survival
*Costs between

A

$200 and $250k to treat!!!

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2
Q

MIC =

A

Minimum INHIBITORY

Concentration”

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3
Q

MBC =

A

Minimum BACTERIOCIDAL

Concentration”

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4
Q

problem with VAD besides thrombosis

A

Infection/sepsis

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5
Q

cidal

A

min. conc. at which you are killing bacteria

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6
Q

static

A

min conc at which you stop bacteria growth

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7
Q

1) Gram Positive Bacteria

A

thick cell wall take up blue dye

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8
Q

gram negative bacteria

A

thin cell wall no blue dye . peptidoglycan is protected

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9
Q

fungi

A

valley fever depressed immune system

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10
Q

Penicillins & Cephalosporins

A

β-Lactam antibiotics
• *Prevent bacterial cell wall peptidoglycan cross-linking so newly produced bacterial cell walls are “weak” and the bacteria “fall apart” (think bacterial Marfan’s Disease)
• Theseantibioticsare“cidal”

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11
Q

Penicillins & Cephalosporins

*Classified by their

A

pectrum of activity” and resistance to β-lactamases (as well as potency, methods of administration, toxicities, expense, and pharmacokinetics and –dynamics)
• “R group” attachment differentiates the penicillins

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12
Q

penicilli derived from

A

Penicillium mold

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13
Q

First Generation” Penicillins

are effective against

A

gram-positive organisms (particularly Strep), gram negative cocci (what’s that?) and a few others, but resistance levels are high and growing!

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14
Q

Penicillin-G

A

(benzylpenicillin) 1st gen

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15
Q

Anti-staphylococcal Penicillins

• Developedinresponse

A

to
growing resistance among Staph. *These antibiotics have a much
narrower “spectrum” and are used specifically for Methicillin resistant Staphylococcus aureus…
…AND SHOULD BE USED SPARINGLY (why?)

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16
Q

Dicloxacillin

A

(Dynapen) Anti-staphylococcal Penicillins

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17
Q

Nafcillin

A

(Nallpe) Anti-staphylococcal Penicillins

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18
Q

-Oxacillin

A

Anti-staphylococcal Penicillins

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19
Q

Broad-Spectrum Penicillins

• Spectrum similar to Pen-G against

A 
ram negatives (such as?)
• Resistance to broad-spectrum pens has increased dramatically (especially MRSA)
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20
Q

-Ampicillin

A

Broad-Spectrum Penicillins

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21
Q

-Amoxicillin

A

Broad-Spectrum Penicillins DRUG OF CHOICE

for pre-cardiac surgery dental prophyllaxis

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22
Q

Antipseudomonal Penicillins

A

Pseudomonas aeruginosa is a very problematic, very pathogenic gram negative that readily develops resistance to antibiotics. Also effective against other gram-negative bacilli.

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23
Q

-Pseudomonas aeruginosa is notorious for causing

A

blue/green pus!

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24
Q

Carbenicillin

A

(Geocillin) Antipseudomonal Penicillins

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25
Piperacillin
(Piperacil) Antipseudomonal Penicillins
26
Ticarcillin
(Ticar) Antipseudomonal Penicillins
27
Clavulanic acid (CA) also has
β-lactam ring like the penicillins but no antimicrobial activity.
28
Clavulanic acid (CA) is a
suicide inhibitor of bacterial β-lactamase that | attaches to and permanently deactivates the enzyme.
29
Clavulanic acid (CA)
with amoxicillin (Augmentin) and ticarcillin (Timentin) (why?
30
penicillins are not excreted or metabolized by the kidneys so...
x
31
penicillins Don’t cross the blood/brain barrier except.
when meninges are inflamed
32
β-lactams essentially just like penicillins | *Classified as
1st, 2nd, 3rd, & 4th generation based on their resistance to β-lactamases and their antimicrobial spectrums *Very commonly used in open heart surgery and as part of the “prime”
33
1st Generation Cephalosporins
The “Pen-G’s” of Cephs. • Less expensive then 2nd, 3rd, 4th generations. • Since the main open-heart infection culprits are Staph. (mostly) and Strep. sp., no advantage found using more expensive later-generation cephalosporins for ECC prophyllaxis!
34
Cefazolin
Kefzol) -The only parenteral 1st generation -Typically dosed at a fixed amount (1 gram/circuit, e.g.) or by weight (50mg/kg, e.g.) *Cleared by the kidneys *Cross sensitivity with penicillins is high (so check the charts!!!)
35
2nd Generation Cephalosporins
Again, no proven advantage over 1st gens when used in the pump prime! • May provide the theoretical advantage of a greater V.O.D. and slightly broader spectrum of activity.
36
-Cefoxitin
2nd Generation Cephalosporins(Mefoxin)
37
Cefotetan
2nd Generation Cephalosporins Cefotan)
38
Cefuroxime
2nd Generation Cephalosporins (Ceftin)
39
Vancomycin
A glycopeptide • Similar action to pens/cephs - Prevents peptidoglycan polymerization in the bacterial cell wall so they “fall apart.” * Spectrum of activity limited to gram positives
40
vancomycin *Reserved for use in
MRSA, Methicillin Resistant Staph epidermidis (MRSE) and enterococcal infections.
41
Vancomycin | • Excreted
renally (like pens and cephs) | • Side effects much more common than pens and cephs:
42
sides of vancomycin
fever chills flushing phlebitis
43
Aminoglycosides | • Derived
from fungi (like penicillins)
44
-If they end in “...mycin
they’re from | Streptomyces sp.
45
If they end in “...micin
they’re from Micromonospora sp.`
46
Aminoglycosides | • Interfere with bacterial
protein synthesis by binding to bacterial ribosomal 30S subunit..*This action is “cidal
47
Aminoglycosides | • Spectrum of activity
limited to gram negative bacteria, such as E. coli, Proteus mirabilis, and Pseudomonas aeruginosa
48
Aminoglycosides Exhibit a synergistic effect when used with
pens, cephs, and vancomycin (why?) for resistant bacteria.
49
Aminoglycosides | • Exhibit
oncentration-dependentkilling: - Increasing concentrations of aminoglycosides kill increasing proportions of bacteria at increasing rates. * **All aminoglycosides are given parenterally or used topically!
50
Aminoglycosides | • Unlike other drugs discussed,
aminoglycosides exhibit poor CNS penetration even in the presence of meningitis.
51
Resistance to aminoglycosides is complicated.
Multiple methods of resistance, but cross- resistance doesn’t necessarily occur (bugs can be resistant to gentamycin and not amikacin) -Streptomycin (little used, lots of resistance)
52
Tobramycin
(Nebcin) Streptomyces sp.
53
gentamicin
Micromonospora sp.`
54
Amikacin
Micromonospora sp.`(Amikin) = LEAST bacterial resistance
55
Aminoglycosides | • All are excreted
renally and readily become “more toxic” in the presence of renal failure (a self-fulfilling prophecy since one of their major side-effects is renal toxicity!)
56
Aminoglycosides | • Adequate hydration/urine output
minimizes side effects (what’s that mean for us?)
57
All aminoglycosides cross the
blood/placenta barrier and concentrate in fetal tissue!
58
Aminoglycoside Toxicity | *This reflects a “classic triad” of
``` #1) Ototoxicity: vestibular &/or cochlear #2) Neuromuscular Paralysis PARTICULARLY with myasthenia gravis patients. #3) Nephrotoxocity ranging from mild to total renal destruction ```
59
Neomycin:
used only topically (too nephrotoxic)
60
Streptomycin
first produced. LOTS of microbial resistance has developed
61
Gentamicin and Tobramycin
mid-level microbial resistance
62
Amikacin
least microbial resistance (also most expensive!)

pharmocology (20 decks)

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