Exam 2 Review Flashcards
1
Q
What are the key considerations when approaching treatment for infections?
A
- Is this an infection?
- What is the site of infection?
- What are the most likely pathogens?
- What are the options for treatment?
- What makes the patient unique?
Patient uniqueness includes factors like age, co-morbidities, pregnancy, etc.
2
Q
What is an antibiogram?
A
A report that shows the susceptibility of bacteria to various antibiotics
It is used to guide appropriate antibiotic selection.
3
Q
Which antibiotics inhibit cell wall synthesis?
A
- Beta-lactams
- Vancomycin
These antibiotics target the bacterial cell wall, disrupting its synthesis.
4
Q
What are the types of beta-lactam antibiotics?
A
- Penicillins
- Cephalosporins
- Carbapenems
- Monobactams
These groups of antibiotics share a common beta-lactam structure.
5
Q
What is the mechanism of action of clavulanic acid?
A
Inhibits beta-lactamases, broadening spectrum of coverage and reducing resistance
Clavulanic acid is often combined with penicillin to enhance effectiveness against resistant bacteria.
6
Q
What is the mechanism of action of penicillin?
A
Bactericidal; inhibits cell wall synthesis
This mechanism is crucial for its effectiveness against bacterial infections.
7
Q
Name a few drugs that are important to know for penicillin.
A
- Amoxicillin
- Penicillin VK
- Amoxicillin-clavulanate (Augmentin)
8
Q
What is the safest antibiotic in pregnancy?
A
Penicillin, if appropriate for the type of infection and the patient is not allergic
It is considered the best choice for treating infections in pregnant patients.
9
Q
What should be done if a patient develops a rash to penicillins?
A
Examine to ensure it’s an allergic reaction; rash could be due to other causes
Many viruses can cause rashes, so it’s important to differentiate between an allergic rash and other types.
10
Q
If a patient is allergic to penicillins, what can they take?
A
Cephalosporins, unless they have anaphylaxis from a -cillin
Anaphylaxis indicates that cephalosporins should also be avoided.
11
Q
Which first generation cephalosporins provide the best gram-positive coverage?
A
Cephalexin and cephazolin
These drugs are effective against staphylococci and streptococci.
12
Q
What happens to gram-negative coverage as you increase from one generation of cephalosporins to the next?
A
You gain gram-negative coverage but lose gram-positive coverage
This shift is important for understanding the appropriateness of cephalosporins for various infections.
13
Q
What is the route for many of the fourth-generation cephalosporins?
A
IV only and are given in the hospital
Their administration route reflects the severity of infections they treat.
14
Q
What type of antibiotic is vancomycin?
A
Glycopeptide antibiotic with wide spectrum of gram-positive coverage
It is particularly important for treating serious infections like MRSA.
15
Q
How is vancomycin administered for C. diff infections?
A
Orally
Despite being poorly absorbed, oral administration is effective for this specific indication.
16
Q
How is vancomycin administered for serious staph infections?
A
IV
This method is used for treating life-threatening infections caused by resistant staphylococci.
17
Q
Which antibiotics block protein production?
A
Macrolides, tetracyclines, clindamycin
18
Q
Name three macrolide antibiotics.
A
Erythromycin, azithromycin, clarithromycin
19
Q
What is a common brand name for azithromycin?
A
Z pack
20
Q
What is the spectrum of coverage for macrolides?
A
Gram positive (pneumococci, strep, staph)
Gram negative (H. Influenzae)
atypical bacteria (M. Pneumoniae)
21
Q
What are some adverse effects of macrolides?
A
Cardiac arrhythmias
22
Q
What is a significant risk associated with macrolides?
A
QT prolongation
23
Q
What are the risk factors for QT prolongation? (6)
A
Electrolyte imbalances
Meds
Female
Heart conditions
Age (older people)
Genetics
24
Q
Why is erythromycin rarely used?
A
Frequently causes diarrhea and cramping
25
What gastrointestinal effects are associated with erythromycin?
Diarrhea and cramping
26
What are the names of the drugs listed in the review for tetracyclines?
Tetracycline, doxycycline, minocycline
27
What is the spectrum of coverage for tetracyclines?
Gram positive, gram negative, atypical bacteria, rickettsiae
28
Which disease is treated with tetracyclines in addition to those listed in the exam review?
Lyme disease
29
Which patients cannot take tetracyclines and why?
* Pregnant women
* Children under 8
* Can affect tooth enamel or impair bone growth
30
What is a common adverse effect of tetracyclines?
Photosensitivity
31
What should patients be educated about regarding photosensitivity when using tetracyclines?
To avoid sun exposure
32
Why should tetracyclines not be given within two hours of antacids?
Due to calcium content
33
What is the most important adverse effect associated with clindamycin?
Clostridium difficile colitis
34
What is the mechanism of action (MOA) of clindamycin?
Similar to macrolides due to overlapping receptors
35
What percentage of patients may develop C. diff when taking clindamycin according to a 2023 study?
Up to 6.6%
36
What symptoms should patients be monitored for when prescribed clindamycin?
Loose, watery stool
37
What do all antibiotics that target DNA and replication generally do?
Inhibit enzymes involved in DNA synthesis
## Footnote
Important to know mechanisms for quinolones and sulfa drugs
38
What are the three main categories of antibiotics that target DNA and replication?
* Sulfa drugs
* Fluoroquinolones
* Metronidazole
39
What is the common use of Trimethoprim-sulfamethoxazole (TMP-SMX)?
Often used for UTI and skin infection
## Footnote
TMP-SMX is not really used individually
40
What spectrum of coverage does Bactrim provide?
* Gram positive
* Gram negative
* MRSA
41
What should you remember about Bactrim's coverage?
Covers MRSA
## Footnote
Important for understanding its clinical use
42
What is the mechanism of action for sulfa drugs?
Inhibits folic acid synthesis → essential for bacterial DNA replication
43
Name the most common fluoroquinolones.
* Levofloxacin (Levaquin)
* Ciprofloxacin (Cipro)
* Ofloxacin (Floxin)
44
What is the spectrum of coverage for fluoroquinolones?
Excellent gram-negative coverage, moderate gram-positive coverage, and atypical bacteria
45
Which fluoroquinolone is more effective against gram positive bacteria?
Levofloxacin
46
Which fluoroquinolone is more effective against gram negative bacteria?
Ciprofloxacin
47
What should you focus on while studying fluoroquinolones?
* Mechanism of action
* Adverse effects
48
What is a high risk associated with fluoroquinolones?
Tendon rupture
49
In which patients is the risk of tendon rupture from use of fluoroquinolones more common? (3)
* Elderly patients
* Patients on prednisone
* Young runners
50
Other than tendon rupture, what is another potential adverse effect of fluoroquinolones?
QT prolongation
51
In which populations should fluoroquinolones not be used?
* Children
* Pregnant women
52
When should fluoroquinolones be used?
In resistant situations when other drugs have been tried or when the patient is allergic to other antibiotics
53
Why should fluoroquinolones be used sparingly?
Due to their adverse effects
54
What organisms are fluoroquinolones effective against?
* Multi-drug resistant organisms
* Pseudomonas (gram-)
* Enterobacter (gram-)
55
When should fluoroquinolones be reserved?
For serious infections or when other more suitable antibiotics cannot be used
56
What are the basic principles for treating tuberculosis?
Must use multiple drugs to which Mycobacterium tuberculosis is susceptible, drugs must be taken regularly (every day), drugs must be taken long enough to resolve the illness (9 months)
57
Name one antitubercular drug.
Isoniazid (INH)
58
What is the mechanism of action of Isoniazid?
Inhibits bacterial cell wall synthesis
59
What are the adverse effects of Isoniazid?
Liver toxicity, peripheral neuropathy
60
What can patients take to help avoid peripheral neuropathy with Isoniazid?
Vitamin B6
61
What is the mechanism of action of Ethambutol?
Inhibits bacterial cell wall synthesis
62
What is an adverse effect of Ethambutol?
Optic neuritis
63
What are the symptoms of optic neuritis? (3)
Blurred vision, decreased peripheral vision, color blindness
64
What should patients be taught to do if they experience symptoms of optic neuritis?
Report these symptoms immediately
65
What is the mechanism of action of Rifampin?
Blocks bacterial protein production
66
What is a notable characteristic of Rifampin regarding drug interactions?
Multiple drug-drug interactions
67
What are some adverse effects of Rifampin?
Nausea/vomiting, red-orange discoloration of urine, saliva, tears
68
What should patients who wear contact lenses know about Rifampin?
It will permanently stain their contacts; they will need to wear glasses
69
What is a key factor that increases the risk for microbial resistance?
Overuse of antibiotics
## Footnote
Overuse of antibiotics can lead to the development of resistant strains of bacteria.
70
What is another factor that contributes to microbial resistance?
Inappropriate prescription of antibiotics
## Footnote
Prescribing antibiotics when they are not needed or using the wrong type can promote resistance.
71
What is a risk factor for microbial resistance related to medication levels?
Low dose and inadequate levels leading to sub-inhibitory exposure
## Footnote
Inadequate dosing can allow bacteria to survive and develop resistance.
72
What living conditions can increase the risk of microbial resistance?
Day care and crowded living
## Footnote
Crowded environments can facilitate the spread of resistant bacteria.
73
What is the first mechanism of microbial resistance?
Decreased permeability/Limiting drug uptake
## Footnote
Bacteria can limit the entry of antibiotics through porin channels.
74
What is the second mechanism of microbial resistance?
Antibiotic efflux pump
## Footnote
Active pumps can expel antibiotics from bacterial cells, reducing their effectiveness.
75
What is the third mechanism of microbial resistance?
Drug inactivation
## Footnote
Enzymes may destroy antibiotics or prevent them from binding to their target sites.
76
What is the fourth mechanism of microbial resistance?
Altered target site
## Footnote
Changes in binding proteins on bacterial surfaces can prevent antibiotics from binding effectively.
77
What are the two classes of antiviral drugs discussed?
Neuraminidase inhibitors and Nucleoside Analogs
78
What are the names of the neuraminidase inhibitors?
Oseltamivir (Tamiflu) and Zanamivir (Relenza)
79
How is Oseltamivir administered?
Well absorbed orally
80
How is Zanamivir administered?
Via inhalation
81
What is the mechanism of action for neuraminidase inhibitors?
Act by breaking the bond that attaches the viral particles to the host cell
82
What are the indications for using neuraminidase inhibitors?
Prophylaxis and treatment for influenza A and B
83
Who are the ideal candidates for neuraminidase inhibitors?
People with comorbidities
84
What are common adverse effects of neuraminidase inhibitors?
Headache (HA), Nausea/Vomiting (N/V), CNS effects
85
When should neuraminidase inhibitors be started for maximum effectiveness?
Within 72 hours of symptom onset
86
What is a current concern regarding Tamiflu?
A lot of Tamiflu resistance right now
87
What are the names of the nucleoside analogs?
Acyclovir (Zovirax), Valacyclovir (Valtrex), Famciclovir (Famvir)
88
How often must Acyclovir be taken?
5 times a day
89
Which nucleoside analog is the most effective?
Valacyclovir (Valtrex)
90
What advantage does Valacyclovir have over Acyclovir?
Achieves higher serum levels and penetration
91
What is the mechanism of action for nucleoside analogs?
Blocks an enzyme essential for viral replication
92
What are common adverse effects of nucleoside analogs?
Headache (HA), Nausea/Vomiting (N/V)
93
What are the indications for using nucleoside analogs?
Herpes simplex (genitals or mouth) and varicella zoster (Shingles)
94
When should nucleoside analogs be started for maximum effectiveness?
Within 72 hours of onset of symptoms
95
What is a special consideration for prescribing nucleoside analogs for shingles in elderly patients?
Higher risk of developing postherpetic neuralgia after rash goes away
96
True or False: Nucleoside analogs are effective after 72 hours of symptom onset.
False
97
What is a key characteristic of antifungal drugs when given orally?
Highly protein bound
## Footnote
This characteristic leads to interactions with many drugs.
98
What should be monitored during long-term use of antifungal drugs?
Liver function tests (LFTs)
## Footnote
Long-term use is associated with hepatotoxicity.
99
For how long are antifungals often taken?
3-6 months
100
What is the primary focus when studying antihelmintic drugs?
Treat parasitic infections caused by worms
101
What is a common treatment for pinworms in pediatric patients?
Mebendazole or Pyrantel (OTC)
102
What are some adverse effects of antihelmintic drugs?
* Nausea
* Diarrhea
* Stomach pain
103
True or False: Antifungal drugs have multiple drug-drug interactions.
True
104
What are anxiolytics?
Medications used to reduce anxiety
## Footnote
Includes drugs like benzodiazepines and Buspar.
105
What is the mechanism of action (MOA) of benzodiazepines?
Act at GABA receptors to increase GABA action
## Footnote
This decreases neuronal excitation and firing.
106
List four common benzodiazepines.
* Alprazolam (Xanax)
* Lorazepam (Ativan)
* Temazepam (Restoril)
* Clonazepam (Klonopin)
107
What are the indications for benzodiazepines?
* Reduction in anxiety
* Muscle relaxation
* Ataxia
* Anticonvulsant activity
108
True or False: Benzodiazepines are usually used alone for anticonvulsant activity.
False
## Footnote
They are usually used in combination with another anticonvulsant.
109
What is Buspar commonly used for?
Treatment of Generalized Anxiety Disorder (GAD)
## Footnote
Sometimes referred to as an atypical anxiolytic.
110
What type of receptor does Buspar primarily act on?
Serotonin-1A (5-HT1A) receptor
## Footnote
It is a full agonist at this receptor.
111
Fill in the blank: Buspar also has action at the _______ receptor.
dopamine
112
How should Buspar be taken to decrease the first-pass effect?
With food
113
What is the half-life and onset of action of Buspar?
Short half-life; slow onset of action
114
What are antidepressants?
Medications used to treat depression and other mental health disorders
## Footnote
Antidepressants can include various classes such as SSRIs and SNRIs.
115
What are SSRIs and their mechanism of action?
Selective Serotonin Reuptake Inhibitors; they act at the Serotonin receptor
## Footnote
SSRIs increase serotonin availability in the synaptic cleft.
116
What should you focus on as you study SSRIs?
Know indication, MOA, side effects, patient education
## Footnote
Indications include major depressive disorder, generalized anxiety disorder, etc.
117
Name a few SSRIs.
* Paroxetine (Paxil)
* Fluoxetine (Prozac)
* Sertraline (Zoloft)
* Citalopram (Celexa)
* Escitalopram
118
What are common adverse effects of SSRIs?
* Nausea
* Dry mouth
* Headache
* Sexual side effects
119
What patient education is important when prescribing SSRIs?
* Nausea improves over time; try to tolerate it
* Take medication at the same time every day
* Inform about possible adverse effects
* Expect symptom improvement in about 2 weeks
120
What are symptoms of serotonin syndrome?
Symptoms can include confusion, rapid heart rate, and high blood pressure
## Footnote
Serotonin syndrome can be life-threatening and requires immediate medical attention.
121
What is a drug-drug interaction concern with SSRIs?
Interaction with linezolid (Zyvox)
## Footnote
Linezolid is an antibiotic that can cause serotonin syndrome when combined with SSRIs.
122
What are the indications for SSRIs? (5)
* Major depressive disorder (MDD)
* Generalized anxiety disorder (GAD)
* Obsessive-compulsive disorder (OCD)
* Post-traumatic stress disorder (PTSD)
* Panic disorder
123
What is the mechanism of action of SNRIs?
They block serotonin and norepinephrine transporters, inhibiting reuptake
## Footnote
SNRIs increase the levels of both serotonin and norepinephrine in the brain.
124
Name a few SNRIs.
* Venlafaxine (Effexor)
* Duloxetine (Cymbalta)
125
How does venlafaxine primarily affect neurotransmitter reuptake at lower doses?
It predominantly affects serotonin reuptake
## Footnote
At higher doses, venlafaxine also affects norepinephrine reuptake.
126
Which patients should avoid taking SNRIs?
Patients with uncontrolled hypertension or those who are sensitive to serotonin and norepinephrine levels
## Footnote
Caution is advised in patients with a history of cardiovascular issues.
127
128
What are tricyclic antidepressants primarily used for?
They are used to treat depression but are not prescribed as much.
129
What is the mechanism of action for tricyclic antidepressants?
They inhibit the reuptake of serotonin and norepinephrine at the presynaptic neuron and also act on histamine and acetylcholine.
130
List contraindications for prescribing tricyclic antidepressants.
* Patients with CV disease
* Uncontrolled epilepsy
* Urinary retention
* Angle-closure glaucoma
131
True or False: Patients can overdose on tricyclic antidepressants.
True
132
What should you avoid when prescribing tricyclic antidepressants?
Do not give anyone at risk for suicide a TCA.
133
What is the mechanism of action for bupropion (Wellbutrin)?
It is a norepinephrine-dopamine reuptake inhibitor.
134
What are the contraindications for bupropion?
* Patients with seizure disorders or conditions that increase the risk of seizures
* Angle-closure glaucoma
135
What additional benefit does bupropion provide?
Can help people stop smoking.
136
What is a key characteristic of carbamazepine (Tegretol) regarding its metabolism?
It is completely metabolized and induces its own metabolism, leading to increased clearance and shortened half-life.
137
What effect does carbamazepine have on neuronal firing? Which type of channel is affected?
It inhibits neuronal firing by blocking sodium channels.
138
What types of seizures is carbamazepine most effective against?
Partial seizures.
139
What is the binding characteristic of carbamazepine in the body?
It is highly bound to plasma proteins.
140
List common side effects of carbamazepine.
* Drowsiness
* Headaches
* GI distress
141
What are less common side effects of carbamazepine?
* Cardiac arrhythmias
* Blurred or double vision
* Decreased blood cells or platelets
* Aplastic anemia (rare)
142
Fill in the blank: Bupropion weakly inhibits the uptake of _______ and _______.
[Norepinephrine] and [Dopamine]
143
144
What is the primary action of Gabapentin (Neurontin)?
Inhibits the release of excitatory neurotransmitters in the presynaptic area to decrease seizure activity
## Footnote
Gabapentin is primarily used in the treatment of seizures.
145
List the medical conditions Gabapentin is used to treat.
* Seizures
* Restless legs syndrome
* Postherpetic neuralgia
* Neuropathic pain
* Off-label uses (mostly pain)
## Footnote
Gabapentin has various applications beyond its primary indications.
146
What should be monitored in patients taking seizure medications like Gabapentin?
Monitor patients for psychiatric side effects
## Footnote
Patients on any seizure medications must be monitored for potential psychiatric effects.
147
What are some adverse effects of Gabapentin?
* Depression
* Suicidal thoughts/behaviors
* Nausea/Vomiting
* Somnolence
* Dizziness
* Dry mouth
## Footnote
Adverse effects can be significant and require monitoring.
148
What is a key focus area for patient education regarding Levetiracetam (Keppra)?
Understanding the medication and its effects is crucial for patient compliance.
149
What should be a focus area regarding side effects of Levetiracetam (Keppra)?
Side effects
## Footnote
Awareness of side effects can help in managing patient care.
150
What are the symptoms of toxicity associated with Lithium?
Coarse tremors of the hands that impair function
N/V
Diarrhea
Confusion
Stupor
Polydipsia/Polyuria
Muscle weakness
Ataxia
151
What happens if a Lithium patient gets out in the sun, sweats, and loses sodium?
Increased risk of toxicity
## Footnote
Sodium loss can lead to elevated Lithium levels, increasing toxicity risk.
