Exam 1: Antimicrobials and Antibiotics Flashcards Preview

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Flashcards in Exam 1: Antimicrobials and Antibiotics Deck (107):
1

Class of antibiotic to use in immunocompromised patients:

Bactericidal

2

Reason for preserving normal/GI flora if possible:

Normal flora have antixenobiological action

3

Type of abx usually used in OR:

Cheap, broad spectrum

4

Are abx always necessary in OR?

No; pts with allergies and superficial surgeries may not need

5

SCIP guidelines for abx:

Single dose within 1 hr of incision

6

Considerations for selection of abx:

ID of causative organism
Drug delivery to site
Single drug if possible
Route, duration, cost

7

Pts who particularly need prophylactic abx:

Bowel/appy
Hardware
Diabetics
Extended surgical time

8

Relationship between hypersensitivity reaction and dose:

Independent

9

Relationship between drug toxicity and dose:

Dose related

10

Abx concerns with parturients:

Most abx cross the placenta and enter milk
Possible teratogenicity

11

Abx concerns with elderly:

Renal impairment
Decreased plasma protein
Reduced GI mobility, acidity
Increased body fat = more drug in tissues

12

Penicillin structure and mechanism of action:

Bactericidal beta-lactam

Interferes with bacterial cell wall

13

Organisms susceptible to penicillin:

-coccals

Pneumococcal
Meningococcal
Streptococcal

14

Penicillin elimination:

Renal

15

Ampicillin organisms:

Gram(-)
H. influenza, e. coli

16

Notable ampicillin adverse effect:

Skin rash

17

Amoxicillin advantage over ampicillin:

More efficiently absorbed from GI tract

18

Most allergenic antimicrobial:

Penicillins

19

Most common adverse reaction to PCNs:

Allergy/hypersensitivity

20

Signs of PCN allergy:

Rash and/or fever
Anaphylaxis
Hemolytic anemia

21

Classes of abx with cross-sensitivity and % chance:

PCNs and cephalosporins
8% chance

22

Cephalosporin mechanism of action:

Bactericidal
Inhibits bacterial cell wall synthesis

23

Cephalosporin elimination route:

40% bile
60% renal

24

Cephalosporin organisms:

Broad spectrum

25

Primary s/s of cephalosporin allergy:

Rash

26

% incidence of anaphylactic rxn to cephalosporin:

0.02%

27

First, second, and third generation cephalosporins:

1st: cefazolin
2nd: cefoxitin
3rd: cefotaxime

28

Type of surgery that often uses cephalosporins and why:

Ortho - cephalosporins penetrate into joints

29

Differences in cephalosporin generations:

Better anti-Gm(-) activity in later generations

30

Aminoglycoside mechanism of action:

Bactericidal
Inhibits cellular activity inside microbe

31

Aminoglycoside organisms:

Aerobic Gm(-)

32

Aminoglycoside elimination & elimination half-time

Extensively renal
2-3hr elimination half-time in healthy pt
20-40x increase in renal failure

33

Aminoglycoside adverse effects:

Ototoxicity
Nephrotoxicity
Skeletal muscle weakness
Prolongs NMB

34

Mechanism of aminoglycoside ototoxicity:

Irreversible damage to vestibular/cochlear hairs
Dose dependent

35

Mechanism of aminoglycoside nephrotoxicity:

Accumulation in renal cortex --> tubular necrosis --> proteinuria, dilute urine, RBC casts
Reversible!

36

Most nephrotoxic aminoglycoside:

Neomycin (mostly given topical for this reason)

37

Mechanism of aminoglycoside muscle weakness:

Inhibits pre-synaptic ACh release
Decreases post-synaptic sensitivity to ACh

38

Patient population in whom aminoglycosides should be avoided:

Myasthenia gravis

39

"Sneaky" way aminoglycosides become systemically absorbed:

From irrigation fluid

40

Drug effect enhanced by aminoglycosides:

NM blocking properties of lidocaine

41

Five aminoglycosides:

Streptomycin
Kanamycin
Gentamicin
Amikacin
Neomycin

42

Toxic level of gentamicin:

> 9mcg/ml

43

Unique use of neomycin:

Adjunct therapy to hepatic coma

44

Aminoglycosides with limited use due to ototoxicity:

Streptomycin/kanamycin

45

Tetracyclines mechanism of action:

Bacteriostatic
Inhibits bacterial protein synthesis

46

Common use of tetracyclines:

Treatment of acne via decrease in fatty acid content of sebum

47

Tetracyclines elimination:

Excreted in urine and bile

48

Tetracyclines side effects:

Discoloration of teeth (in developing fetus/children)
Photosensitivity
Hepatic/renal damage in high doses

49

Administration of tetracycline:

PO only

50

Administration of doxycycline:

IV or PO

51

Macrolide drugs:

Erythromycin, azithromycin

52

Erythromycin mechanism of action:

Can be bacteriostatic or bactericidal
Inhibits bacterial protein synthesis

53

Erythromycin organisms:

Gm+ bacteria
Narrow spectrum

54

Erythromycin elimination:

CYP450 metabolism
Excreted mostly in bile

55

Erythromycin adverse effects:

GI (esp. IV)
QT effects
Thrombophlebitis (prolonged IV use)

56

Physiologic alteration that increases erythromycin side effects:

CYP450 inhibition

57

Clindamycin class:

Linomycins

58

Clindamycin mechanism of action:

Bacteriostatic
Inhibits bacterial protein synthesis

59

Clindamycin organisms:

Anaerobes

60

Clindamycin uses:

Serious GI or female genital tract infections

61

Clindamycin dosing considerations:

Decrease dose with severe liver disease

62

Clindamycin adverse effects:

Pseudomembranous colitis
Pre- and post-synaptic effects at NMJ - unantagonizable with calcium or anticholinesterases

63

Vancomycin class:

Glycopeptide derivative

64

Vancomycin mechanism of action:

Bactericidal
Impairs cell wall synthesis

65

Vancomycin organisms:

Gm(+) bacteria
Staph
Strepto- and enterococcus
MRSA

66

Vancomycin elimination & elimination half-time:

Renal excretion
6 hrs
Up to 9 days in renal patients

67

Vancomycin surgical uses:

Cardiac procedures
Ortho procedures with prosthetics
CSF, shunt infections

68

Vancomycin dosing & concentration:

10-15 mg/kg over 60 min
(1gm/250ml concentration)

69

Vancomycin adverse effects:

*Profound hypotension with rapid infusion*
Red man syndrome
Ototoxicity/nephrotoxicity

70

Mechanism of red man syndrome:

Facial/truncal erythema from histamine release

71

Sulfonamides mechanism of action:

Bacteriostatic
Inhibit bacterial folic acid synthesis

72

Sulfonamide uses:

UTIs

73

Sulfonamide elimination:

Hepatic metabolism
Renal excretion

74

Sulfonamide side effects:

Skin rash, anaphylaxis
Drug fever
Hepatotoxicity
Acute hemolytic anemia
Increase PO anticoagulant effect

75

Polymixin B/colistimethate mechanism of action:

Bactericidal
Affects bacterial cell wall phospholipids

76

Polymixin B/colistimethate organisms:

Gm(-) bacteria

77

Polymixin B/colistimethate uses:

Severe UTIs
Skin, mucous membrane, eye, ear infections
GI tract sterilization (poop transplant)

78

Polymixin B/colistimethate elimination:

Renal elimination

79

Polymixin B/colistimethate side effects:

Most potent at NMJ
Very nephrotoxic

80

Metronidazole mechanism of action:

Bactericidal

81

Metronidazole organisms:

Anaerobic Gm(-) bacteria

82

Metronidazole uses:

CNS infections
Abdominal/pelvic sepsis
Pseudomembranous colitis

83

Fluoroquinolones mechanism of action:

Bactericidal

84

Fluoroquinolones organisms:

Enteric Gm(-) bacilli

85

Fluoroquinolones elimination & elimination half-time:

Mostly renal excretion
3-8 hr half-time

86

Fluoroquinolones drug example:

Ciprofloxacin

87

Fluoroquinolones adverse effects:

CYP450 inhibition
GI disturbances (mild)

88

Fluoroquinolones uses:

Systemic infections, bone, soft tissue, respiratory tract, GI, GU

89

Rifampin mechanism of action:

Bactericidal
Inhibits RNA chain in microbe

90

Rifampin organisms:

Mycobacteria - tuberculosis
Gm(+) - most
Gm(-) - many

91

Rifampin administration and excretion:

Oral or parenteral
Bile and urine excretion
Penetrates into CNS

92

Rifampin side effects:

CYP450 induction
Thrombocytopenia
Anemia
Hepatitis
Fatigue/weakness
Numbness

93

Amphotericin B use:

Yeasts and fungi

94

Amphotericin B administration:

IV only

95

Amphotericin B elimination:

Renal - slowly!

96

Amphotericin B adverse effects

Renal function impairment (80%!!)
Fever, chills, dyspnea, hypotension
Hepatic impairment
Hypokalemia
Allergies
Seizures
Anemia/thrombocytopenia

97

Classification of viruses:

DNA or RNA

98

Acyclivir & valacyclovir use and elimination:

For the herps
Renal excretion

99

Vidarabine uses and side effects:

Cytomegalic inclusion disease
HSV encephalitis
Mutagenic, carcinogenic

100

Famciclovir use:

Acute herpes zoster

101

Ganciclovir use and adverse effect:

CMV disease
Hematologic toxicity

102

Amantadine use and elimination:

Influenza A virus and Parkinson's
Renal excretion

103

Interferons mechanism of action:

Induce enzymes that inhibit viral replication
Enhance anti-tumor activities of macrophages

104

Interferons uses:

Hepatitis B (chronic)
Hepatitis C
Nasal sprays

105

Interferons side effects:

Flulike symptoms
Hematologic toxicity
Depression, irritability, decreased concentration
Autoimmune conditions
Rash, alopecia
CV, thyroid, hepatic changes

106

Types of AIDS antivirals:

Nucelotide reverse transcriptase inhibitors
NON-nucleotide reverse transcriptase inhibitors
Protease inhibitors

107

AIDS antiviral side effects:

Pancreatitis, hepatitis, lactic acidosis, fat changes, increased cholesterol/trigs, hypersensitivity

Protease inhibitors are potent CYP450 inhibitors