Part 2- Antimicrobial, antiseptic etc Flashcards by Amanda D

what ABX do we use to treat syphilis

PCN-highly effective

How well did you know this?

Not at all

Perfectly

Higher doses of this drug is needed to treat gonococci due to resistance

PCN

How well did you know this?

Not at all

Perfectly

PCN is the drug choice for these 5 infections

pneumococcal
streptococcal
meningococcal
Treating all forms of actinomycosis and clostridial infections causing gas gangrene

How well did you know this?

Not at all

Perfectly

prophylactic administration of PCN is highly effective against ___infection

streptococcal infections, accounting for its value in pts with rheumatic fever

How well did you know this?

Not at all

Perfectly

Clinical indications for PCN

Transient bacteremia occurs in the majority of patients undergoing dental extractions, emphasizing prophylactic need of PCN for those patient with cardiac issues and tissue implants.

Transient bacteremia can accompany procedures such as T&A, GU, GI, and vaginal deliveries

How well did you know this?

Not at all

Perfectly

Penicillin G IV 10 million U contains 16 mEq of potassium - what is the concern with this potassium administration

patients with renal dysfunction

may result in neurotoxicity and hyperkalemia

How well did you know this?

Not at all

Perfectly

IF PCN G is needed and the potassium content would promote a risk- what can be administered

a sodium salt of PCN G or a similar medication such as ampicillin or carbenicillin

How well did you know this?

Not at all

Perfectly

anuria increases penicillin G by how many fold

10 fold

How well did you know this?

Not at all

Perfectly

Slide 36

How well did you know this?

Not at all

Perfectly

Major Resistance to PCN:

Bacterial produces B-lactamase enzymes

The hydrolyzed the B-lactam ring rendering it inactive

How well did you know this?

Not at all

Perfectly

Drugs not susceptible to hydrolysis by staphylococcal penicillinases that would otherwise hydrolyze the cyclic amide bond of the B-lactam ring and render the antimicrobial inactive:

Methicillin
Oxacillin
Nafcillin
Cloxacillin
Dicloxacillin

How well did you know this?

Not at all

Perfectly

Specific indications for these drugs are infections caused by staphylococci known to produce the staphylococcal penicillinases enzyme:

Methicillin
Oxacillin
Nafcillin
Cloxacillin
Dicloxacillin

How well did you know this?

Not at all

Perfectly

what is nafcillin used for

Nafcillin can penetrate the CNS sufficient enough to treat staphylococcal meningitis

How well did you know this?

Not at all

Perfectly

Extensive renal excretion for what three drugs

Methicillin
Oxacillin
cloxacillin

How well did you know this?

Not at all

Perfectly

High dose Oxacillin therapy has been associated with

hepatitis

How well did you know this?

Not at all

Perfectly

what can accompany Methicillin administration:

hemorrhagic cystitis and an allergic interstitial nephritis (hematuria, proteinuria)

How well did you know this?

Not at all

Perfectly

what two drugs have superseded methicillin

oxacillin and nafcillin

How well did you know this?

Not at all

Perfectly

what is the advantage of high dose therapy of nafcillin for patients with renal impairment

80% is excreted in the bile

How well did you know this?

Not at all

Perfectly

unlike methicillin, oxacillin and nafcillin are relative stable in an acidic medium and adequately works in what form

PO form

How well did you know this?

Not at all

Perfectly

what two drugs are available as PO medications and may be preferable over oxacillin and nafcillin d/t its ability to produce higher blood levels

cloxacillin and dicloxacillin

How well did you know this?

Not at all

Perfectly

2nd generation PCN

ampicillin, amoxicillin and carbenicillin

How well did you know this?

Not at all

Perfectly

2nd generation PCN- ampicillin, amoxicillin and carbenicillin. bactericidal against what bacteria?

Bactericidal against both gram positive and gram negative bacteria

How well did you know this?

Not at all

Perfectly

what generation of abx provide wider range of activity than other PCNs

ampicillin, amoxicillin and carbenicillin 2nd gen

How well did you know this?

Not at all

Perfectly

which drugs are not effective against most staphylococcal infections

2nd generation PCN

ampicillin, amoxicillin and carbenicillin

How well did you know this?

Not at all

Perfectly

which drug has a broader ranger than PCN G

ampicillin

what does ampicillin cover

pneumocci, meningococci, gonococci, and various streptococci

what gram negative bacilli does ampicillin cover

Haemophilus influenza and Escherichia coli

is ampicillin well absorbed in the GI

Yes

in the first 6 hours of a PO dose of ampicillin how much is excreted unchanged by the kidneys

50%

ampicillin is among PCN's associated with the highest incidence of ""This"" which typically appears 7-10dyas after initiation therapy

skin rash

the rash from ampicillin may not be true allergic reaction - what is it more associated with

protein impurities in commercial preparation

amoxicillin is chemically identical to what drug

ampicillin

even though amoxicillin and ampicillin are chemically identical- what is the advantage of amoxicillin

more efficiently absorbed from GI

concentrations of amoxicillin are present in the circulation how many times as long as ampicillin

2x's

what generation is carbenicillin and what is it derived from

3rd generation | derivative of ampicillin

the principle advantage of carbenicillin is its effectiveness in Tx of infections cause by what

pseudomonas aerugingsa and certain proteus strains resistant to ampicillin

carbenicillin is penicillinase (b-lactamase) susceptible and ineffective against most strains of

s. Aureus.

is carbenicillin aborbed from the GI tract

NO- must be administered parentally

what does probenecid do to the plasma concentration of carbenicillin

delays renal excretion thus increases plasma concentration of carbenicillin by 50%

greater than 10% of carbenicillin is sodium (30-40g) - in light of this, what can develop in susceptible patient

CHF dt this acute drug produced sodium load.

what acid base imbalance and electrolyte imbalance may occur with carbenicillin

Hypokalemia and metabolic alkalosis may occur d/t obligatory excretion of K+ with the large amounts of nonreabsorbable carbenicillin

what is the effect for platelets and carbenicillin

Interferes with normal platelet aggregation and prolongs bleeding time even when platelet count remains the same.

4th generation PCN

Acylaminopenicillins: Mezlocillin Piperacillin Azlocillin

4th generation abx are derivatives of

ampicillin

what generation abx is the broadest spectrum abx of all PCN

4th generation

how do the sodium contents of 4th generation abx compare to the sodium content of carboxypenicillins

lower sodium concentrations but similar side effects

what are 4th generation PCN ineffective against

penicillinase-producing strains of S. AUREUS

PENICILLIN BETA-LACTAMASE INHIBITOR COMBINATIONS name the three drugs

clavulanic acid sulbactam tazobactam

what is special about these three drugs clavulanic acid sulbactam tazobactam

beta lactam compounds that bind irreversibly to beta lactase enzyme- very little antimicrobial activity

clavulanic acid is available with what PO drug

po amoxicillin

sulbactam is combined with

IV ampicillin.

cephalosporins are bactericidal and what do they inhibit

bacterial cell wall synthesis and have low intrinsic toxicity

bacteria can produce cephalosporinases (beta-lactamases) which does what to the beta lactate structure of cephalosporins

disrupts it

newer cephalosporins have broad spectrums but the issue is

they are expensive

what are the three things cephalosporins vary in

Vary in oral absorption Vary in the severity of pain at IM site Vary in protein binding

what can IV administration of any cephalosporin cause

thrombophlebitis

diacetyl metabolites produced by cephalosporins are associated with what?

decreased antimicrobial activity

large doses of cephalosporins frequently cause what reaction

a positive coombs reaction, hemolysis is rare

With the exception of cephaloridine, cephalosporins have less frequency of what.

With the exception of cephaloridine, cephalosporins have less frequency of nephrotoxicity than aminoglycosides or polymyxins.

if allergic to cephalosporins cross-reactivity occurs- does it occur with PCN

Cross-reactivity between cephalosporin and PCN are infrequent.

if you have a PCN allergy what can be used as an alternative

cephalosporins may be used as an alternative

CEPHALOSPORINS AND PCN ALLERGIES less often but more serious - mediated by IgE characterized by what three symptom

laryngeal edema bronchospasm CV collapse

PCN allergy can occur more commonly with parental or more than with oral administration?

parenteral administeration

what does the ring structure of a PCN open to form

Hapten metabolite: Penicilloyl

what do Hapten Act as

an antigen

can a hapten induce formation of antibodies? what does it do?

no formation of antibodies but bound to a protein may cause an immune response

what allergic issue do 95% of patients allergic to PCN form

penicilloyl-protein conjugate

how do we detect those who would have an allergic reaction to PCN

skin test with penicilloyl-polylysine antigen

are minor antigenic reactions detected by the skin test with penicilloyl polylysine antigen

no- but patients could still develop severe allergic reactions

cephalosproins- Classified as 1st, 2nd, 3rd (4th, 5th) generations d/t what

antimicrobial spectrum

as the cephalosporins increase from 1st to 3rd generation- how does their against against various cocci change

Generally activity against gram + cocci decreases and activity against gram – cocci increases

what is the appeal of 1st generation cephalosporins

inexpensive and exhibit low toxicity

1st generation cephalosporins are commonly used as prophylaxis in patients under going surgeries such as

``` CV Orthopedic Biliary Pelvic Intraabdominal ```

1st generation cephalosporins are as active as 2nd and 3rd generation cephalosporins against what bacteria

staphylococci and nonenterococcal streptococci

what is the prototype cephalosporin

cephalothin

tell me about PO, IM, IV absorption of cephalothin

PO-poorly absorbed IM-painful IV- commonly administered

what is the limitation of cephalothin

does not enter CSF- not recommended for meningitis

does cephalothin need to be decreased in renal patients

excreted largely unaltered by kidneys, decrease dose in renal patients

cefazolin what is the advantage of this drug

Has advantage of achieving higher blood levels, presumably d/t slower renal elimination

what is the drug of choice for surgical prophylaxis

cefazolin

how is cefazolin tolerated

well after IM or IV injection

2nd GENERATION CEPHALOSPORINS | cefoxitin and cefamandole have extended activity against what bacteria

gram negative bacteria

Cefoxitin is resistant to _____produced by gram negative bacteria

cephalosporinases

Cefamandole- pharmacologically similar to cefoxitin but what are the risk with concurrent use of ETOH

risk of bleeding and disulfiram like reactions

cefuroxime is the only 2nd generation effective in treatment of

meningitis

cefurozime is more effective than cefamandole against

h. influenza

3rd generation cephalosporins have enhanced ability to resist hydrolysis by the beta-lactamases of many gram-negative bacilli including

E. coli, Klebsiella, Proteus, and H. influenza

3rd generation cephalosporins can achieve therapeutic levels in the cerebrospinal fluid meaning it can treat

treat meningitis

does 3rd generation have to same toxicity as older cephalosporins

yes

what drug has the longest elimination 1/2 time of any 3rd generation

ceftriaxone

ceftriazone is highly effective against gram negative bacilli name 2

neisseria | haemophilus

name the 3rd generation effective PO medication

cefixime

cefixime is active against

pneumococci group a streptococci h influenza

Cefixime is less effective against s aureus and not active against anaerobes such as

pseudomonas

Part 2- Antimicrobial, antiseptic etc Flashcards

(94 cards)