Antimicrobials Antiseptics Chemotherapeutic Agents Flashcards by John-Mike Rujimora

Allergic reaction to Cephalosporins include?

Allergic reaction SE
=Uticaria
=Bronchospasm
=Hemodynamic collapse
=Substitute W/ Clindamycin or Vancomycin

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Which antimicrobial agents need to be changed in dosing, as well as monitor renal function for the elderly population?**

PCN, cephalosporin, Vanco and Aminoglycosides may need change in dosing schedule and regimen as well as monitor renal function**

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How does PCN G effect the cell wall?

Interfere with synthesis of peptidoglycon which is an essential component of cell wall

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How much is PCN G excreted from the kidneys?*

90% Renal Excreted**

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Intrathecal not recommended with with antimicrobials?***

PCN G Intrathecal administration is not recommended***

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Which penicillianse-resistant penicillins causes SE, if given IV,
Hemorrhagic cystitis and Allergic interstitial nephritis

Methicillin

Renal excretion

SE if given IV
Hemorrhagic cystitis
Allergic interstitial nephritis

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Which penicillianse-resistant penicillins is excreted in the bile?

Nafcillin

TX Staphylococcal meningitis

80% Excreted in bile**(this is different from the others )

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Which penicillianse-resistant penicillins causes hepatitis?

Oxacillin

Hepatitis with high dose

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What does Ampicillin cover?

Broader activity than PCN G

Covers Gram- Neg bacilli
Ecoli and Haemophilus influenzae

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What is the SE of Ampicillin?

High incidence of Skin Rash

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What determines the duration of action for Ampicillin?

Renal function influences duration of action

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What generation is Ampicillin?

Penicillinase-Susceptible Broad-Spectrum Penicillins 2nd Generation

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What is drug is chemically identical to ampicillin?

Chemically identical to ampicillin

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Which 2nd generation spectrum penicillin is more efficiently absorbed the GI tract?

Amoxicillin

Effective concentrations are in circulation 2x as long

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What is a Extended-Spectrum Carboxypenicillins 3rd Generation

Carbenicillin

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What is Carbenicillin

used to treat?

TX Pseudomonas aeruginosa & Proteus resistant to ampicillin

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Carbenicillin is ineffective against what bacteria?

Ineffective against S. Aureus

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Whit antibiotic is not absorbed in GI tract and must be given IV?
(Hint: Its a derivative of Ampicillin)

Carbenicillin

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What are examples of Extended-Spectrum Acylaminopenicillins 4th Generation?

Mezlocillin
Piperacillin
Azlocillin

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What are the roadest activity of all PCN?

Mezlocillin
Piperacillin
Azlocillin

Derivative of Ampicillin
Do not work against S. Aureus

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What is the MOA of Penicillinβ-Lactamase Inhibitor Combinations ?

Bind irreversibly to the β-lactamase enzymes, which are produced by many bacteria, thus inactivating these enzymes and rendering the organisms sensitive to β-lactamase–susceptible penicillins

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What are examples of Penicillinβ-Lactamase Inhibitor Combinations ?

Clavulanic Acid
Sulbactam
Tazobactam

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Cephalosporins MOA?

MOA

Bactericidal antimicrobials that inhibit bacterial cell wall synthesis and have a low intrinsic toxicity

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What are the SE of Cephalosporins?

SE
\+ Coombs Reaction with lg doses
--Hemolysis is rare
--Nephrotoxicity
--Incidence of allergic reactions 1-10%
-Usually Cutaneous manifests 24 hours after exposure
-Anaphylaxis 0.02%

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What is the major antigenic determinant for Cephalosporins and allergy to PCN?**

Approximately 95% of patients allergic to penicillin form this penicilloyl-protein conjugate (the major antigenic determinant)***

What is the minor antigenic determinant for cephalosporins and allergy to PCN?

The remaining allergic patients form 6-aminopenicillic acid & benzylpenamaldic acid (minor antigenic determinants)

what are the Manifestations of allergic reaction: (to cephalosporins)?

- Laryngeal edema - Bronchospasm - Cardiovascular collapse

What should you do with dose cephalothin and patients with renal dysfunction?

Cephalothin Excreted by the kidneys Decrease dose with renal dysfunction**

Cefoxitin - Extends activity against (what kind of) bacteria

Cefoxitin - Extends activity against (GRAM NEGATIVE) bacteria

Which Cephalosprorin 2nd generation drug, poses a risk of bleeding and disulfiram-like reactions with concurrent use of alcohol??

Cefamandole

Which drug is the drug of choice for H. Influenza? | Hint: The only second-generation cephalosporin effective in the treatment of meningitis

Cefuroxime

Cefuroxime Cefamandole Cefoxitin How are these drugs eliminated?

All excreted by kidneys**

Which drug is used to Tx Meningitis caused by Gram negative other than Pseudomonas

Cefotaxime First 3rd Generation

Which drug has the ongest ½ life and is used to treat Neisseria and Haemophilus

Cetriaxone Rocephin

Which 3rd generation cephalosporin is PO and used to treat URI?

Cefixime

Which drugs can achieve levels is CSF therefore can Tx Meningitis?

Cephalosporins 3rd Generation

Which β-Lactam Antimicrobial is not absorbed in the GI tract and does not enter the CSF?

Aztreonam

What does Aztreonam | treat?

Tx Gram-negative bacteria

What is a SE of Azteronam?

SE enterococcal superinfection

Which β-Lactam Antimicrobial has NO cross reactivity between PCN or cephalosporin?

Aztreonam

what do the Aminoglycoside Antimicrobials treat?

Rapidly antibacterial aerobic gram-negative bacteria*

How are the Aminoglycoside Antimicrobials eliminated from the body??

Renal excretion* | Decrease dose with renal dysfunction*

What are the SE of the Aminoglycoside Antimicrobials?

Side Effects ==Ototoxicity** =Vestibular and auditory =Nephrotoxicity =Skeletal muscle weakness =Contraindicated in Myasthenia Gravis patients ==Potentiation of non-depolarizing neuromuscular blocking drugs*

Which aminoglycoside TX P. aeruginosa and gram Negative Bacilli?

Gentamicin Monitor toxic levels (>9ug/mL)

Which drug is 1st to TX Mycobacterium tuberculosis

Streptomycin

Which drug is used to TX Gentamicin or tobramycin resistant infections

Amikacin

Which Aminoglycoside should you not administer with PCN*?

Amikacin Do not administer with PCN* (can get a bad rash)

Which aminoglycoside is used as a Topical to TX infections of skin mucous membranes and cornea?

Neomycin 6-8% allergic reaction

What does Erythromycin treat?*

Gram positive * Alt to other ABX for TX Strep, bronchitis, & pneumonia

What are the SE of Erythromycin?

SE - GI intolerance - Thrombophlebitis - Tinnitus - Hearing loss - Torsade's des pointes - Ventricular arrhythmia - Death

Which macrolide has a Prolonged elimination time and is dosed QD ?

Azithromycin

Which macrolide is used for severe infection of the GI tract and female genital tract?

Clindamycin

What is the SE of clindamycin?

SE - pseudomembranous colitis (if you run this in really fast, this is diarrhea) - diarrhea - Lg doses can induce NMB in the absence of non-depolarizer (patient behaves like you gave them a paralytic) - Skin rash

Which macrolide is the drug of choice for MRSA?

Vancomycin

Vancomycin can be used for what heart procedure and/or condition?

Vanco also used for prosthetic heart valve and endocarditis

Why isn't vanco used routinely as a prophylaxis?

Routine prophylaxis with Vanco not recommended due to concerns of resistant organisms

Red Man Syndrome is related to which antibiotic?

Vancomycin

How does Red Man Syndrome occur?

Vancomycin directly activates mast cells to release histamine This is not a true allergic reaction

How do you manage Red Man Syndrome?

Stop Infusion, Administer antihistamine, | Can restart vanco at a slower rate once symptoms resolve

What are the clinical manifestations of Red Man Syndrome?

Flushing, Erythema, Pruritus, Maylgia, Dyspnea, hypotension

Dose of Vancomycin?

Vancomycin | IV dose 10-15mg/kg over 60 min to minimize histamine release

How is Vancomycin eliminated?

Excreted by kidneys Plasma levels need to be monitored

What are the SE of Vancomycin?

Hypotension - Cardiac arrest - Histamine release - Red Man Syndrome - Erythema - Bronchospasm - Arterial hypoxemia/ low SPO2 - Ototoxocity and nephrotoxicity with given with aminoglycoside* - Vanco and Succs can result in NMB (will behaive like non depolarizer?)

What does Ciprofloxacin | treat?

- GI & GU infections - Systemic concentrations - M. tuberculosis susceptible

What does Moxifloxacin treat?

-TX acute bacterial sinusitis

What are the SE of Moxifloxacin?

- -peripheral neuropathy - -SIADH - -Tendonitis - -Acute liver failure - -QTc prolongation - -Toxic epidermal necrolysis - -Psychotic reactions - -Stevens-Johnson syndrome

MOA for Alkylating Agents?

MOA - Form covalent alkyl bonds with nucleic acid bases, resulting in intrastrand or interstrand DNA cross-links which are toxic to cells undergoing division. - By altering the structure of DNA, these drugs inhibit DNA replication and transcription. - DNA damage produced by alkylating chemotherapeutic drugs is more likely to kill malignant cells than nonmalignant cells because rates of proliferation are greater for the cancer cells - Resistance is common

Which Nitrogen mustard is used to Tx wide variety of CA, RA, Wegner granulomatosis?

Cyclophosphamide

Which nitrogen mustard is often used when lymph node involvement Breast CA?

Cyclophosphamide

Which drug should you D/C w/ dysuria and hematuria? | Hint: It has less thrombocytopenia and more alopecia

Cyclophosphamide

Which drug is associated with Hodgkin's regimen?

Mechlorethamine Most effective when injected into blood supply of tumor Limited by leukopenia, thrombocytopenia

Which nitrogen mustard is used to treat multiple myeloma, Ovarian epithelial CA, Hodgkin lymphoma, Amyloidosis?

Melphalan Bone marrow suppression necessary for therapeutic effect

Which Nitrogen mustard treats | Chronic lymphocytic leukemia, Macroglobulinemia, Polycythemia vera?

Chlorambucil

Which chemo drugs should you be cautious about because of herpes zoster and thrombophlebitis??

All NMs: herpes zoster, thrombophlebitis | Handle with care

Which alkyl sulfonates is used to treat chronic myelogenous leukemia?

Bisulfan Cell-cycle non-specific antineoplastic agent Pulmonary fibrosis Prognosis poor

Which nitrosoureas is used for gastric adenocarcinoma?

Mitomycin

70% pts experience renal or hepatic toxicity and hyperglycemia with which nitrosourea?

Streptozocin

Interstitial pneumonitis, fibrosis, 20-30% pulmonary toxicity, can be delayed weeks, high mortality occurs with which nitrosourea?

Carmustine

Which platinating drug causes Ototoxicity, emetogenic, myelosuppression, peripheral sensory neuropathies, paresthesia, hyperuricemia, seizures, dysrhythmias, allergic reactions?

Cisplatin

Which drug treats Non-hematologic cancers- lung, bladder, testicular, ovarian

Cisplatin

Which drug is used for Palliative for carcinoma of breast, GI tract

Fluorouracil

Which antimetabolite is used to treat Mesothelioma and lung CA?

Pemetrexed

Which antimetabolite is used for Non-hematologic CAs, Solid organ CA, pancreas, breast, lung?

Gemcitabine

Which medication is considered a folic acid inhibitor?

Methotrexate

Which drug is used for Wilms tumor in children, inhibit immunologic response w/ organ transplant?

Dactinomycin

Which two drugs are natural products of soil fungi, contain tetracycline ring, (anthracycline antibiotics), leukemia?

Doxorubicin & Daunorubicin

which topoisomerase inhibitor causes Cardiomyopathy- dose related increased plasma concentrations of troponin T (late), CHF, LV dysfunction?

Doxorubicin

Which Topoisomerase inhibitor causes Pulmonary toxicity?

Bleomycin Pulmonary toxicity- dose related 4% patients***** Cough, dyspnea, rales, fibrosis, infiltrates

Which tubulin-binding drugs cause severe neurotoxicity?

Paclitaxel, Docetaxel Extract from pacific Yew tree Breast, lung, ovarian, bladder CA Severe neurotoxicity*** precludes use

Antimicrobials Antiseptics Chemotherapeutic Agents Flashcards

(89 cards)