Test 1 Flashcards
(172 cards)
1
Q
Anti microbial definition
A
natural and synthetic compounds that either inhibit or kill micro organisms
2
Q
Chemotherapy definition
A
application of a chemical agent that has a specific toxic effects on a disease producing organism
3
Q
Antibiotic definition
A
an agent derived from a microorganism that inhibits or kills other microorganisms
4
Q
Anti infectives include what?
A
antibiotics, antivirals, antifungals
5
Q
What is the empiric therapy?
A
treatment based on best guesses from available data as to causative agents
6
Q
Bacteria that need oxygen are called what?
A
aerobic
7
Q
Bacteria that dont need oxygen are called what?
A
anerobic
8
Q
What type of bacteria are harder to treat?
A
anerobic
9
Q
Gram positive organisms stain what color?
A
purple
10
Q
Gram negative organisms stain what color?
A
pink
11
Q
Are gram negative or gram positive harder to treat?
A
gram -
12
Q
What is the Kirby Bauer disk diffusion?
A
classic test in which bacteria are cultured and grown on solid media in an agar dish. Antibiotic containing paper disks are then placed on the lawn of bacteria
13
Q
What is the E test or elliptical test?
A
the E test strip is placed on an agar plate and heavily inoculated with the organism, the strip creates an antimicrobial gradient which results in the zone of inhibition
14
Q
The E test allows to determine what?
A
minimal inhibitory concentration
15
Q
If the MIC is at levels that cannot be safely achieved in the patient the organism is termed what?
A
resistant
16
Q
The minimal drug concentration that kills the organism after a 24 hour incubation is termed what?
A
minimal bactericidal concentration
17
Q
MRSA is resistant to what drug?
A
methicillin resistant (gram +)
18
Q
VRSA is resistant to what drug?
A
vancomycin resistant (gram +)
19
Q
Clindamycin have excellent levels in what part of the body?
A
the bone
20
Q
Aminoglycosides, quinolones achieve high levels in what part of the body?
A
urine
21
Q
Time dependent definition
A
if microbial kill rate is influenced by the time of drug concentration meets or exceeds the MIC
22
Q
Concentration dependent definition
A
if microbial kill rate is influenced by a high enough concentration of the drug (synergist effects)
23
Q
What does post antibiotic effect mean?
A
refers to the sustained suppression of bacterial growth even after the concentration of antibiotic declines below detectable levels
24
Q
Bacteriostatic
A
inhibit growth kill the bacteria
25
Bactericidal
kill the bacteria
26
Beta lactams include what following classes of drugs
penicillians, cephalosporins, monobactams, carbapenems
27
Beta lactams are all what?
time dependent organism killers
28
most penicillins are destroyed if taken orally due to gastic pH except for what two drugs?
ampicillin and amoxicillin
29
Mechanism of action of penicillin
inhibit bacterial cell wall synthesis, activate autolytic system within bacteria resulting in self destruction
30
Cephalosporins are what?
similar to penicillin in mechanisms of action but they have longer half lives
31
Are cephalosporins bactericidal or bacteriostatic
bactericidal
32
Mechanism of action for cephalosporins
inhibit cell wall synthesis resulting in cell lysis
33
2nd and 4th generations are used for what?
respiratory and urinary tract infections
34
What is the only drug available in the monobactam category?
Aztreonam (Azactam)
35
Are monobactams bactericidal or bacteriostatic
bactericidal
36
Carbapenems are what?
broad spectrum and active against many organisms that are penicillin and cephalosporin resistant
37
Quinolones are what?
block the enzyme responsible for DNA growth and are bactericidal
38
What is a potential side effect of quinolones
tendon rupture, need to wear sunscreen
39
What are some common quinolones
ciprofloxacin (Cipro), Levofloxacin (Levoquin), Moxifloxacin (Avelox), Gemifloxacin (Factive)
40
Aminoglycosides are bactericidal or bacteriostatic
bactericidal
41
Aminoglycosides are used a lot for what patients?
CF patients
42
Aminoglycosides are synergistic when used with what?
Beta lactams
43
Aminoglycosides that are useful in treating VAP are what?
Tobramycin, Gentamicin, Amikacin
44
Protein synthesis inhibitors classifications
Macrolides, Tetracyclines, Tigecycline (tiger)
45
Macrolides
active agent used to treat gram positive, gram negative, and atypical bacteria
46
Macrolides are the preferred treatment choice for what?
atypical pneumonias
47
Examples of macrolides are what?
Erythromycin, Clarithromycin, Azithromycin, Telithromycin
48
Are macrolides bacteriostatic or bactericidal
bacteriostatic
49
Macrolides should not be used with what kind of drugs?
narrow therapeutic windows due to complications like inhibiting the cytochrome P450 system (warfarin, theophylline)
50
Tetracyclines are what?
broad spectrum bacteriostatic drug class
51
Tetracyclines should not be taken with what?
antacids, iron, or dairy
52
Examples of tetracyclines?
Doxycycline, and Minocycline
53
Tigecycline
newer, indicated for gram + (VRE, VRSA, MRSA, and S.pneumonie
54
Clinical use of tigecycline
skin infections, complicated inta abdominal infections, CAP
55
Folate inhibitors are what?
sulfonamide drugs that primarily treat uncomplicated urinary tract infections
56
Examples of folate inhibitors are what?
sulfamethoxazole/trimethoprin (Bactrim, Spetra), and sulfisoxazole
57
Folate inhibitors are used for what type of patients?
immunocompromised
58
Vancomycin
bactericidal glycoprotein antibiotic that lysis cell wall
59
Vancomycin is the primary medication to treat what?
MRSA
60
Streptogramins examples
Dalfopristin, Quinupristine
61
Is streptogramins bactericidal or bacteriostatic
bacteriostatic
62
Oxazolidinoes example
Linezolid, only drug available in this class
63
Lipopetides example
Daptomycin (Cubicin)
64
Lipopetides
bactericidal antibiotic that works by depolarizing the cell membrane
65
Lipopetides cannot be used to treat pneumonias because of what?
activity is inhibited by pulmonary surfactant
66
Metronidazole
synthetic drug that can treat anerobic infections (GI tract), bactericidal
67
What is the most common places to get TB
prison, college dorms
68
TB requires multiple drugs for how long?
6-12 months
69
What is the initial treatment of TB
Isoniazid, Pyrazinamide, Rafampin, Ethambutol
70
Isoniazid is distributed well in the body especially where?
Cerebral spinal fluid
71
Isoniazid is metabolized by what?
liver
72
Isoniazid is eliminated by what?
kidneys
73
Isoniazid is bacterialcidal against what?
replicating tuberculosis bacilli
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Isoniazid is bacteriostatic against what?
non replicating organisms
75
Rifampin and Rifabutin
do not penetrate CNS, absorbed orally, bactericidal
76
Rifampin
metabolized through the liver and induces the CYP system
77
What is CYP induction
known to decrease plasma concentrations of drugs hepatically metabolized
78
Rifabutin
metabolized in liver, weaker enzyme inducer than rifampin
79
Pyrazinamide
nicotinic acid derivative that is well distributed into most tissues including the CSF
80
What is the MOA of pyrazinamide
unknown, speculated against mycobacteria when tested in an acidic enviroment
81
Ethambutol
synthetic, orally administered, bacteriostatic
82
MOA of ethambutol
dec the synthesis of cell wall polysacchrides such as arabinogalactan to inhibit mycobacterial cell growth
83
Streptomycin
aminoglycoside used in 1940 for treatment of TB
84
Anti virals have common name ending of what?
cyclovir, ciclovir, mantadine, mivir
85
What are the most common infectious agents in humans
viruses
86
Acyclovir and Valacyclovir
V was developed as a prodrug in order to improve GI absorption of acyclovir
87
MOA of Valacyclovir and Acyclovir
disrupt viral DNA replication
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Clinical use of Valacyclovir and Acyclovir
both effective against HSV 1 and HSV 2 (herpes), varicella zoster virus, genital infections
89
Penciclovir and Famciclovir (prodrug) MOA
disrupt growing DNA chains, interfering with viral DNA syntheis and replication
90
Canciclovir and Valganciclovir (prodrug) MOA
both incorporate into growing DNA chains and terminate viral DNA synthesis and replication
91
Amantadine and Rimantadine MOA
inhibit viral replication and viral assembly
92
Clinical use of Amantadine and Rimantadine
active against influenza A only. can be used prophylactically
93
Oseltamivir MOA
inhibits flu A and B
94
Anti fungals end with what?
conazole, fungin
95
Fungal infections are now on the rise due to the inc. number of immunocompromised patients like what?
AIDS, cancer chemo, and organ transplant
96
Polyene group MOA
bind to ergosterol which is the building block for the cell wall, this binding creates pores allowing for essential components to escape through resulting in cell death
97
Amphotericin B is what?
polyene, treatment of choice for fungal infections, lipid based
98
Amphotericin B is the first line agent for several pulmonary fungal infections like what?
aspergillosis, blastomycosis, histoplasmosis, cocidioidomycosis
99
Nystatin
polyene, oral and topical cream, used to treat candidiasis
100
Azoles group includes what?
Ketoconazole, Fluconazole, Itraconazole, Vorionazole, and Posaconazole
101
MOA for Azoles
prevent the production of ergosterol causing a fungistatic effect
102
What was the first drug in the Echinocandin group
caspofungin and then Micafungin and Anidulafungin
103
MOA for the Echinocandin group
inhibit cell wall synthesis by inhibiting (1,3)- B-D-glucan synthesis, may be either fungicidal or fungistatic
104
Flucytosine MOA
inhibits RNA formation, which decreases protein synthesis and prevents cell growth, fungistatic
105
general considerations in anerosolizing antibiotics
more viscous and may affect neb performance, environmental contamination, physical incompatibilty b/w some antibiotics
106
What was the first commerically available drug for nebulization
TOBI
107
MOA of TOBI
aminoglycoside antibiotic for treatment of gram 1 infections, binds to bacterial ribosomes=block protein synthesis=cell death
108
Dosage of TOBI
300 mg BID X 28 days then 28 days off, vial 300mg/5mL
109
What organism does TOBI help with
P. aeruginosa in CF
110
Storage of TOBI
refrigerated, avoid intense light
111
TOBI administration
6 years and older, do not mix with other meds in neb, administer over 15 minutes with PARI LC neb
112
Administration order of TOBI
Bronchodilator, CPT, other nebulized meds, and TOBI
113
Adverse effects of TOBI
voice alteration rinse and expectorate post therapy, tinnitus (ear rinning), mucosal/airway edema, possible inc in bacterial resistance
114
Precautions with TOBI
potential to cause fetal harm, local airway irritation causing cough and bronchospasm
115
TOBI clinical use
Treat and prevent early colonization with Pseudomonas, maintain lung function, reduce rate deterioration, treatment of pneumonia due to MDR organisms
116
TOBI clinical pearls
<10% systemic absorption, preservative free, localized effect
117
MOA of Amikacin
aminoglycoside which inhibits protein synthesis in susceptible bacteria by finding to 30S ribosomal subunits in gram (-) bacterial infections, bactericidal, concentration dependent
118
Dosage of Amikacin
2 mL vial of 500 mg inhalation pre mixed Q8H
119
Storage of Amikacin
stored at controlled room temp, stable for 24 hours at room temp, 2 days at refrigeration when mixed in D5W, NS, and LR
120
Admin of Amikacin
must use with Respigard 2 neb
121
Adverse rxns of Amikacin
nephrotoxicity, ototoxicity, neurotoxicity
122
Clinical use of Amikacin
treatment of serious infections respiratory tract infections due to organisms to gentamicin and tobi including pseudomonas, proteus, serratia
123
Contraindications to Amikacin
hypersensitivity to amikacin sulfate or any component of the formulation
124
Colistamethate sodium (Colistin) MOA
inc. cell permeability, leak contents of cell, cell lysis/death, concentration dependent, bactericidal
125
Colistin dosage
75-150 mg every 8-12 hours, made of 2 components (E1 is associated with airway inflammation)
126
Colistin admin
dilute powder with 2 mL sterile water, swirl gently, administer immediately, use seperate neb
127
Storage of Colistin
room temp
128
Adverse effects of Colistin
bronchoconstriction, cough
129
Clinical use of Colistin
prevention and treatment of P. aeruginosa infections in CF pts, rapid bactericidal activity vs. gram (-) organisms
130
Colistin clinical pearls
<1% systemic absorption, localized effect, very potent vs. many resistant organisms
131
Cayston (aztreonam)
inhaled monobactam antibiotic, not indicated for patients below 7. bactericidal
132
Dosage of Cayston
75 mg/vial powder, reconstitute with 1 mL of saline, use immediately
133
Storage of Cayston
comes in 2 cartons for a 28 day supply, may store at room temp, should be protected from light
134
Admin of Cayston
Altera neb
135
Recommended order of admin for Cayston
Bronchodilator, mucolytic, and then Cayston. LABA can be taken 30 min-12 hours prior of admin
136
Procedure for Cayston
pour the reconstituted solution into the handset of the neb, turn the unit on, place mouthpiece in mouth, breath normally, admin takes b/w 2-3 mins
137
Precautions for Cayston
do not use on patients with known allergy to aztreonam or beta lactams, bronchoconstriction
138
Aztreonam and pregnancy
crosses placenta, no known fetal toxicity, excreted in breast milk
139
Nebupent (pentamidine) MOA
anti protozoal agent, not fully understood, block RNA and DNA synthesis, bind lung tissue and then slowly absorbed into circulation
140
Nebupent dosage
300 mg inhaled once every 4 weeks, add 3-6 mL sterile water
141
Storage of nebupent
room temp for 48 hours once mixed, protect from light
142
Nebupent admin
Respirgard 2, rate 5-7 mL/min, do not mix with other meds, may induce bronchospasm
143
Nebupent admin enviromental risk
HCW: minimize exposure to drug, conjunctivitis and bronchospasm
144
Nebupent adverse effects
systemic: rash, dec WBC, hypoglycemia/DM, renal insufficiency. Local airway: cough and bronchial irriation, SOB, bitter/burning taste
145
Nebupent clinical use
2nd line for prevention of PCP, HIV w/CD4 <200 cells/mm3, prophylaxis in pregnancy during 1st trimester
146
Nebupent clinical pearls
PCP typically only in immunocompromised, higher lung concentrations than IV
147
dosage of Vancomycin
250 mg/5 mL solution nebulized BID
148
Admin of Vancomycin
PARI neb
149
Storage of Vancomycin
kept at room temp, the reconstituted drug is good for up to 14 days
150
Clinical use of Vancomycin
treatment of pneumonia caused by highly penicillin resistant S pneumoniae (MRSA), especially when cephalosporins cannot be used
151
Contraindications to Vancomycin
known hypersensitivity, known allergy to corn or corn products
152
Adverse rxns to Vancomycin
ototoxicity, nephrotoxicity, urticaria (hives), flaky skin, macular rashes, eosinophilia, shock like state, transient anaphylaxis, vasculitis, neutropenia, eosinophilia, diarrhea
153
Relenza (zanamavir) MOA
anti viral, neuroaminidase inhibitor, prevent viral replication, bind enzyme required for virus to be released after RNA replication and blocking the action
154
Relenza dosage
diskhaler- 4 blisters/rotadisk (one 5 mg blister per inhalation). Treatment: 2 inhalations (10mg) Q12 hoursX5 days
155
Relenza admin
must take within 48 hours to be effective for treatment. Not to be used with nebs, do not admin 2 weeks before or 48 hours after live flu vaccine
156
Relenza adverse effects
serious bronchospasm, nausea, dizziness, cough, ENT infections
157
Relenza clinical use
prophylaxis in unvaccinated, useful anti viral flu med, limited system absorption, > 5 years old
158
Clinical pearls of Relenza
active against flu A and B, dec duration of illness by 1 day, may dec. viral shedding
159
Virazole (ribavirin)
anti viral, used to treat pneumonia brought on by respiratory synctial virus (RSV), used to treat immuno suppressed pts with viral infections
160
Dosage of Virazole
6 grams/viral reconstituted to a 2 % solution, very expensive
161
Frequency of Virazole
3 vials/day for 3-7 days
162
Admin of Virazole
SPAG 2 neb, meds is to be given continuously over 12-18 hours per day
163
Complications of Virazole
attacking the intracellular virus may harm the host cell, viral replication is maximal before the appearance of symptoms
164
Adverse effects of Virazole
fatigue, headache, insomnia, nausea, anemia, bronchospasm
165
Amphotericin B MOA
anti fungals used to treat and prevent bronchopulmonary fungal infections in patients with neutropenia
166
Dose of Amphotericin
5-30 mg/day to a max of 50 mg/day
167
Supplied of Amphotericin
injection, powder for reconstitution
168
Storage of Amphotericin
prior to reconstitution store in refrigerator and protect against exposure to light, after that store at room temp for 24 hours protect from light or refrigerate for 1 week
169
Preparation of Amphotericin
reconstitute the powder with 10 mL sterile water, shake gently, do not reconstitute with saline solution. After each reconstitution each vial contains 50mg/10mL
170
Admin of Amphotericin
treatments must be given with Respigard 2, small volume neb should only be used for vented patients, may be pretreated with 4 inhalations albuterol
171
Clinical use of Amphotericin
potentially life threatening fungal infections like aspergillosis, mucomycosis, histoplasmosis (common)
172
Adverse effects of amphotericin
bronchospasm, anorexia, chills, nausea, shaking fever, hypotension, headache, coughing, vomiting, bad taste
