Exam Review

Question 1

2 ways of Mechanism of Bacterial Resistance

Answer 1

1. if the bacteria can prevent penicillin from getting to Penicillin Binding Protein, they will win
2. Bacteria have developed defense against pencillins by creating BETA-LACTAMASES (aka penicillinase) which the bug makes, gets in and tears up the Beta Lactam Ring

Question 2

Penicillin G

Answer 2

the golden standard, narrow spectrum, antibiotic of choice to this day

Question 3

Penicillin G

Antimicrobial Spectrum

Answer 3

Gram+ bacteria; Gram- cocci! Still considered a narrow spectrum antibiotic meaning it’s going to do it’s job correctly without killing the good guys as well

Question 4

Penicillin G

Therapeutic Use

Answer 4

pneumonias and different meningitis, pharyngitis; Used prophylactically in pts at risk for bacterial endocarditis, w/infected sex partners, and recurrent attacks of Rheumatic Fever

Question 5

Penicillin G

Pharmacokinetics

Answer 5

well distributed, minimal metabolism via the kidney as unchanged drug;
1/2 life is about 30 minutes

Question 6

Penicillin G

Potential SIde Effects

Answer 6

considered least toxic of all antibiotics; perhaps the safest if you have side effects it is usually do to the stuff that it’s compounded with;
Pain at the IM site—> biggest side effect

Question 7

Penicillin G

Allergies

Answer 7

Don’t give to pt w/hx of allergies; nearly allergy free even though anaphylactic reactions occur more frequently w/penicillin that other antibiotics, the incidence is still very low;

VERY SAFE COMPARED TO OTHER ANTIBIOTICS; HAS MORE REACTIONS BUT IT HAS A VERY SMALL PERCENTAGE OF REACTIONS

Question 8

Penicillin G

Drug Interactions

Answer 8

no alcohol, monitor I&O, not all drug interactions are bad

Question 9

AMPICiLLIN

Answer 9

SEMI-SYNTHETIC PENICILLIN
broad spectrum penicillin; it has little additional amino acid; bacteria cell wall inhibitor….the additional amino acid allows it to be effective against more organism, it will kill more different types of bugs; works with the cell wall of trans peptidase

Question 10

Ampicillin

Potential side effects

Answer 10

rash diarrhea, can be given PO and IV, may decrease the effective of contraceptives

Question 11

4 pharmacologic targets

Answer 11

DNA synthesis, bacterial cell wall, folic acid, portent synthesis

Question 12

Cephalosporine

Answer 12

broad spectrum, semi synthetic beta lactam antibiotic. beta lactam rings in cephalosporins are quite often beta lactamase (penicillinase) resistant

Question 13

Cephalosporine

Mechanism of Action

Answer 13

bactericidal (destroying the cell walls); go to bind with PBP, which is a transport system (otherwise they won’t get to their target);; most effectives against cells that are active/growing/dividing

Given PO most are given parentally (IV)

Question 14

Cephalosporine

Pharmacokinetics

Answer 14

distributie well, lungs, kidneys, and urine;

synovial, pleural and pericardial fluids; elimination via the kidneys–> not good to use if pt has kidney problems

Question 15

Cephalosporine

Microbial Resistance

Answer 15

beta lactmases, but these drugs are a little stronger against beta lactamases

Question 16

Cephalosporine

Cross Sensitivity

Answer 16

due to potential for cross sensitivity reactions in its allergic to penicillin, are generally not given cephalosporins because their chemical makeup is very similar; They

Question 17

Cephalosporine

Allergic Reaction

Answer 17

small chance of allergic reaction, pretty safe

Question 18

Cephalosporine

Potential Adverse Effects

Answer 18

can impair hemostasis so there is a risk of serious bleeding in patients that take this w/ an anticoagulant (BLOOD THINNER)

Greater risk for C. Diff

Risk for Thromnophletbitis (Seen with IV therapy)

All broad spectrum penicillins

Question 19

Cephalosporine

Drug Interactions

Answer 19

can’t be used with blood thinners or alcohol

Question 20

Three anticoagulants

Answer 20

ASA, warfarin, plavix, heparin

Question 21

FIRST GENERATION CEPHALOSPORINES

Answer 21

ANCEF(CEFAZOLIN)
KEFZOL(CEFAZOLIN)
KEFLEX (CEPHALEXIN)

Question 22

SECOND GENERATION CEPHALOSPORINES

Answer 22

CEFZIL (CEFPROZIL)
CECLOR (CEFACLOR)
CEFOTETAN (CEFOTAN)

Question 23

THIRD GENERATION CEPHALOSPORINES

Answer 23

OMINEF

ROCEPHIN (CEFTRIAXONE)–> WHEN COMBINED WITH CALCIUM IT IS FATAL, ESPECIALLY WITH NEONATES

SUPRAX (CEFIXIME)

Question 24

FOURTH GENERATION CEPHALOSPORINES

Answer 24

CEFEPIME (MAXIPIME)

CEFPIROME (CEFROM, KEITEN, BROACT)

Question 25

Carbapenems

Answer 25

block growth of bacterial cell wall

Question 26

Carbapenems | Mechanism of Action

Answer 26

destroy bacterial cell wall; weaken and then lyse it; BROAD SPECTRUM, low toxicity, all given parenterally, only used with patients that can't be treated with more narrow spectrum drug

Question 27

CARBAPENEMS | IMIPENEM (PRIMAXIM)

Answer 27

always given with Cilastatin, inhibits cell wall synthesis, does pretty good again a lot of bacteria;

Question 28

Carbapenems- Imipenem (primaxim) | Pharmacokinetics

Answer 28

Not absorbed in the GI, administered IV and IM.

Question 29

Carbapenems-Imipenem(primaxim) | Metabolism/excretion

Answer 29

rapidly degraded by renal enzyme when administered alone, so it is always given with Cilastatin ; protects the renal tubules and the kidneys

Question 30

Carbapenems -Imipenem (primaxim) | Potential Adverse Effects

Answer 30

GI problems, pregnancy C

Question 31

Carbapenems | Meropenem (Merem)

Answer 31

good for bacterial meningitis in kids 3 or older; that's good news; PREGNANCY B

Question 32

Carbapenems | ERTAPENEM (INVANZ)

Answer 32

given by injection into muscle or vein; 1 daily that's pretty cool, pregnancy B

Question 33

Carbapenems- DORIPENEM (Doribax)

Answer 33

good for complicated intrabdominal infections and complicated UTIS, given IV, has a 1/2 life of 1 hour; pregnancy baker

Question 34

MONOBACTAMS | Azetreonam (Azactam)

Answer 34

only binds to PBP of gram - bacteria; has a single ring pretty stable again most beta lactamases

Question 35

Vancomycein | Miscellaneous Cell Wall Inhibitors

Answer 35

does not have a beta lactam ring, it is a glycopeptide antibiotic; Good with gram +, C.diff, MRSA, and patients with serious infections that are allergic to penicillin; will mess up synthesis

Question 36

Vancomycein | Potential adverse Effects

Answer 36

ototoxicity, loss of hearing, confusion, and hallucinations; Serious side effects, pretty easily toxic; only used for serious infections not common infections! if infused rapidly may cause infusion reactions--> sometimes called redneck syndrome; Rashes, flushing, tachycardia, and hypotention, administered slowly over 60 minutes, pregnancy , also renal toxicity

Question 37

What three combination of medicines will enhance effectiveness?

Answer 37

Bling, potassium, probenicid

Question 38

Tetracycline

Answer 38

work by suppressing growth and replication rather than out right killing of the bug; Not 1st line drugs, we don't reach for these immediately.

Question 39

Tetracycline is used for?

Answer 39

rocky mountain spotted fever, typhus, Q fever cholera, some pneumonia, acne, rheumatoid arthritis, periodontal disease, also used for treatment/prevention of inflation anthrax