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Patho Fall 2023 Block 1 > Test 1A > Flashcards

Test 1A Flashcards

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1
Q

What are the 4 classes of antibiotics that INHIBIT CELL WALL SYNTHESIS?

A
  1. Penicillin
  2. Cephalosporin
  3. Carbapenem
  4. Vancomycin (Glycopeptide is the class)
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2
Q

What does “inhibit cell wall synthesis” mean?

A

These antibiotics inhibit transpeptidase to weaken the cell wall…Letting fluid into the cell.

Antibiotic does not let the cell wall be what it is supposed to be: when bacteria don’t have a stable cell wall–> they DIE!

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3
Q

MOA of penicillins:

A

Disrupt cell wall synthesis, inhibit transpeptidases, activate autolysis (kill themselves).

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4
Q

Penicillin typically treats:

A

UTI, STI (gonorrhea), URI/pneumonia, peritonitis, septicemia.

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5
Q

Adverse reactions of penicillin:

A

Pruritis (itching), rash, GI upset, yeast, anaphylaxis.

Get a good medicine history: lots of drug interactions!

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6
Q

The 4 types of penicillin:

A
  1. Natural PCN
  2. Penicillinase resistant PCNs
  3. Aminopenicillins
  4. Extended spectrum
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7
Q

Fun Facts about Natural PCN: PCN G&V:

A

-Usually IM/IV, but PO is a thing.
-LEAST toxic.
-Works on gram -/+, cocci, anaerobic bacteria, spirochetes.
-1/2 life is 30 min (unless kidney dysf)
-CAN be used with aminoglycosides (gets in cell & disrupts protein synthesis).
-USED IM A LOT to treat SDIs.

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8
Q

Fun Facts about Penicillinase Resistant PCNs: NAFCILLIN (IV):

A

-IV ONLY
-Resist breakdown by penicillinase enzyme.
-Sometimes called “ANTI-STAPH PCN”

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8
Q

Fun Facts about Aminopencillins: AMPICILLIN:

A

-1st broad spectrum
-SE: diarrhea and rash.
-PO/IV–> if giving a PO Aminopenicillin, give Amoxicillin.
-Renal sensitive (monitor kidneys).
-Lots of drug resistance.

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8
Q

What are the 2 types of aminopenicillins?

A

Ampicillin and Amoxicillin

*Structure allows these to work better against GRAM - than other PCNs.

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9
Q

Fun Facts about Aminopenicillins: AMOXICILLIN:

A

-Less side effects than ampicillin.
-Common PEDS med: ear, nose, throat, genitourinary and skin. STREP A
-PO only.

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10
Q

Fun Facts about Extended Spectrum PCN: PIPERACILLIN:

A

-WIDER spectrum: MOST intense!
-Always given with beta lactamase inhibitor.
-ANTI-pseudomonal–>good for pseudomonas infections.
-SE: Affects platelet function and watch patient’s with renal dysfunction.

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11
Q

MOA of Cephalosporins:

A

Inhibit cells wall synthesis (inhibit transpeptidases); activate autolysis (they kill themselves).
-Often resistant to beta-lactamase.

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12
Q

SE of Cephalosporins:

A

-Some cross-sensitivity with PCN allergy (don’t give if patient has PCN anaphylaxis).
-Mild diarrhea, abdominal cramps, RASH, pruritis, redness, edema.
-Pregnancy B category.

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13
Q

1st generation Cephalosporins:

A

Cefazolin & Cephalexin

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14
Q

Fun Facts: 1st generation Cephalosporins: CEFAZOLIN & CEPHALEXIN:

A

“Fazolis LEX”
-works well for Gram (+) bacteria: Staph and non-enterococcal strep infections.
-Given PO and IV (Cefazolin is IV ONLY).
-Treats: UTIs (keflex) and skin infections.
-CEFAZOLIN: common for surgical prophylaxis.
-NO BBB.

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15
Q

Fun Facts: 2nd generation Cephalosporins: CEFUROXIME & CEFOTETAN:

A

“FUR FOX TAN”
-NOT common
-More gram (-), but does have gram (+) coverage.
-IV & PO
-CEFUROXIME: does not kill anerobic bacteria (bac that don’t need O2); BUT IS USED for some intestinal infections.
-NO BBB & NO pseudomonas.

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16
Q

Fun Facts: 3rd generation Cephalosporins: CEFTRIAXONE, CEFTAZIDIME, & CEFOTAXINE:

A

“ONE DIME TAX$$$”
-Most potent in fighting Gram (-).
-IV and IM only.
-CEFTRIAXONE:
-Extremely long-acting (long 1/2 life) so
only 1x/day.
-CROSSES BBB.
-DO NOT give to pts with liver failure.
-CEFTAZIDIME:
-Works well for pseudomonas (although
becoming more resistant.

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17
Q

Fun Facts: 4th generation: Cephalosporins: CEFEPIME:

A

“4th Pie”
-VERY broad spectrum (gram+/-).
-NOT SURE OF what kind of infection??? A lot of time will start pt on Cefepime b/c it works against A LOT!
-Treats: skin infections, UTIs, pneumonias and DOES CROSS BBB and work against pseudomonas.

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18
Q

Fun Facts: 5th generation: Cephalosporins: CEFTAROLINE:

A

“end of the LINE”
-Good for multi-drug resistant staph: MRSA, MSSA, VRSA/VISA.
-NOT good for enterobacteria, pseudomonas, ESBL or Klebsiella.
-IV only.
-Renally dosed–>monitor kidneys.

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19
Q

What are the Carbapenems?

A

Imipenem/Cilastin & Meropenem

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20
Q

MOA of Carbapenems:

A

Inhibits cell wall synthesis.

-VERY BROAD SPECTRUM

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21
Q

AE of Carbapenems:

A

Drug-induced seizure.
-All IV & must be infused over 60 MIN b/c of seizure

-Typically used as a last resort med so that resistance does not develop (BROADEST SPECTRUM OF ALL ABX).

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22
Q

Fun Facts about Carbapenems: IMIPENEM/CILASTIN:

A

-USED FOR COMPLICATED infections.
-Imipenem is combo’d with Cilastin–> which inhibits enzyme in kidneys (dehydropeptidase) so imipenem is not broken down and stays in system longer/more effective.
-Very resistant to beta-lactamase.
-AE: nephrotoxicity (monitor kidneys) and seizures (especially in elderly).
-CAN CROSS BBB
-IV only.

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23
Fun Facts: Carbapenems: MEROPENEM:
-Little less coverage than imipenem, but still gram (-/+) and broad spectrum. -Does NOT degrade kidneys & LESS seizure activity. -SE: rash/diarrhea/GI distress. -IV only.
24
SE of Imipenem/Cilastin:
Nephrotoxicity: monitor kidneys Seizure (esp. elderly).
25
MOA of Glycopeptide: VANCOMYCIN:
Inhibits cells wall synthesis: destroys by binding to bacterial cell wall, producing immediate inhibition of cell wall synthesis and death.
26
Vancomycin is used to treat:
-Gram (+) infections (including MRSA & PCN resistant pneumococcus). -ORAL VANC--> given to treat C-DIFF & pseudomembranous colitis. -DOES NOT cross BBB.
27
LOTS of SE for Vancomycin:
-Monitor kidneys: kidneys eliminate Vanc; decrease dose for renal dysfunction. -OTOTOXICITY: with high levels (reversible) -Immune-mediated thrombocytopenia: damage to platelets--> monitor platelets. -Monitor neuromuscular blockades (paralytics)-->respiratory -RED MAN syndrome: from rapid infusion: flush, rash, itchy, tachycardia, hypotension. -1/2 the dose (slower, over longer time) -Pre-medicate with Benadryl. -Draw peak and trough levels.
28
Classes that INHIBIT PROTEIN SYNTHESIS:
1. Aminoglycosides 2. Lincosamides 3. Macrolides 4. Tetracyclines 5. Fluoroquinolones 6. Sulfonamides 7. Metronidazole
29
How does inhibition of protein synthesis work?
By targeting: -Transcription: nucleus, messenger RNA or cytoplasm. OR -Translation: cytoplasm, ribosomes, add amino acids, protein synthesis (damage). -STOPS the bacteria from making competent protein--> which then kills the,/stops them from reproducing.
30
MOA of Aminoglycosides:
Inhibits/alters protein synthesis--> binds to bacterial ribosomes and prevents protein synthesis.
31
Fun Facts about Aminoglycosides: GENTAMYCIN, AMIKACIN & TOBRAMYCIN:
-Potent ABX that work well on Gram (-)... also work on gram (+), but need other ABX for synergistic effect. - Used to treat COMPLICATED infections: complicated UTIs, gynecological infections, peritonitis, endocarditis, PNS, osteomyelitis (related to DM).
32
SE of Aminoglycosides: GENTAMYCIN, AMIKACIN & TOBRAMYCIN:
SE: nephrotoxicity (monitor BUN/Cr), Ototoxicity. Gentamycin: be careful giving with paralytics (PROFOUND respiratory dysfunction); myasthenia gravis; CNS--> confusion, depression, numb/tingling; cochlear damage (permanent). -Therapeutic monitoring: peak and trough levels-->dose accordingly to renal function.
33
SE of Gentamycin:
Gentamycin: be careful giving with paralytics (PROFOUND respiratory dysfunction); myasthenia gravis; CNS--> confusion, depression, numb/tingling; cochlear damage (permanent).
34
MOA of Sulfonamides: SULFAMETHOXALE & TRIMETHOPRIM: (Bactrum)
Don't destroy, but inhibit bacteria growth by preventing the synthesis of FOLIC ACID needed for DNA synthesis.
35
Sulfonamides: SULFAMETHOXALE & TRIMETHOPRIM Treats:
uncomplicated UTIs, respiratory infections, salmonella, shigellosis. -Often given to HIV patients.
36
SE of Sulfonamides: SULFAMETHOXALE & TRIMETHOPRIM:
-Don't give to patients with sulfa allergies. -Photosensitivity.
37
MOA of Metronidazole: & Treats:
Inhibits DNA synthesis: Anerobic only. Antiprotozoal and antibacterial -Crohn's disease -antibiotic associated diarrhea (c-diff)...flagyl + PO vanc. -"flagyl"
38
SE of Metronidazole:
-DO NOT TAKE WITH ALCOHOL (24 hours before or 36 hours after)--> toxic metabolite. -AE: N/V, xerostomia (dry mouth), vaginal candidiasis. -Lots of drug-drug interactions. -(Flagyl)
39
MOA of Fluroquinolones: CIPROFLOXACIN & LEVOFLOXACIN:
Destroys bacteria by altering their DNA. -Mostly Gram (-) and some gram (+) coverage. VERY POTENT- Broad spectrum. -Very good oral absorption: good for home use!
40
Fun Facts about Fluroquinolones: CIPROFLOXACIN:
-PO, IV, topical. -treats: UTIs, STIs (gonorrhea), U/L RTIs, ANTHRAX. (RAPID GROWING ORGANISMS) -NO BBB SE: prolonges post-ABX effects: concentrated in neutrophils: -stays in bone, joints. -DONT give to under 18 and over 60 (arthropathy effect). -If there is bone pain---> STOP!
41
SE of CIPROFLOXACIN:
SE: prolonges post-ABX effects: concentrated in neutrophils: -stays in bone, joints. -DONT give to under 18 and over 60 (arthropathy effect). -If there is bone pain---> STOP!
42
Fun Facts about Fluroquinolones: LEVOFLOXACIN:
-Broad spectrum of activity (like CIPRO), but advantage of only taking 1X/day. -PO or IV--> 100% bioavailability orally. -Less resistance. USES: more activity against pneumococcal and other 'atypical' respiratory inf (acute sinus inf, bronchiolitis, comm-acquired PNA). SE: seizures, kidney failure, heart rhythm, photosensitivity.
43
SE of Levofloxacin:
SE: seizures, kidney failure, heart rhythm, photosensitivity.
44
What are the 3 Tetracyclines:
1. Tetracycline 2. Doxycycline 3. Minocycline
45
What are the 2 Fluroquinolones?
1. Ciprofloxacin 2. Levofloxacin
46
MOA of Tetracyclines:
Bacteriostatic drugs that inhibit protein synthesis by binding to ribosomes. -Broad spectrum--> major resistance has developed.
47
Uses of Tetracyclines:
Rocky mountain spotted fever, chlamydia & trichomonas, Lyme disease, cholera, PID, mycoplasma PNA, acne.
48
SE of Tetracyclines:
-NO pregnant women/nursing women or children under 8: enamel hypoplasia, discoloration of teeth. -photosensitivity, yeast inf and thrombocytopenia.
49
Fun Facts about Tetracycline: TETRACYCLINE:
-Bacteriostatic. -PO: give fasting, giving more decreased % of absorption. -NO IV. -concentrates in bone, liver, spleen and TEETH. -SE: N/V/D, H/A, photosensitivity, dizziness, angioedema and anaphylaxis.
50
Fun Facts about Tetracycline: DOXYCYCLINE:
-Treats: Chlamydia and mycoplasma infections. -Prophylaxis for STIs -Acne and other non-dangerous skin infections.
51
Fun Facts about Tetracycline: MINOCYCLINE:
-Neisseria meningitides. -Decreases symptoms of RA -USES: meningitis, RA, acne, rosacea.
52
What are the Macrolides?
1. Erythromycin 2. Azithromycin
53
MOA of Macrolides:
Inhibit protein synthesis by binding to ribosomes. -Bacteriostatic in general, bactericidal in high concentrations.
54
USES of Macrolides:
"YUCK DRUGS" - upper/lower resp inf, skin inf, soft tissue inf, STIs (gonorrhea) & unique infections: Legionnaire's, Listeria, mycoplasma PNA. -Works well against bacteria that get into a host cell and reproduce.
55
Fun Facts about Macrolides: ERYTHROMYCIN:
-Has hypomotility benefits for DM gastroparesis & increased gastric motility & emptying. NO BBB -PO & IV (IV very painful) & oral absorption isn't great. -DO NOT TAKE ON AN EMPTY STOMACH! (GI upset)
56
Fun Facts about Macrolides: AZITHROMYCIN:
(ZPACK) -Less GI upset -DONT TAKE WITH FOOD--> decreases absorption. -Very good tissue penetration and long duration of action.
57
MOA of LINCOSAMIDES: CLINDAMYCIN:
Binds to ribosomes and inhibits protein synthesis (stops the bacteria from reproducing).
58
USES for Lincosamides: CLINDAMYCIN:
-Chronic bone infections, GU tract infection, intra-abdominal infection, anaerobic PNA, septicemia, serious skin infections, prophylaxis for endocarditis. -ALL enterobacteria (VRE/CRE) are resistant to Clindamycin.
59
SE of CLINDAMYCIN:
-GIVES C-DIFF -Monitor use of paralytics for respiratory distress. -VERY TOXIC--> monitor peak and trough levels
60
MOA of ACYCLOVIR:
3 ways: 1. INTERFERES with viral nucleic acid synthesis (stop DNA/RNA synthesis); 2. PREVENTS virus from binding to cells (can't get in = can't replicate; 3. STIMULATES body's immune system to kill virus.
61
USES of ACYCLOVIR:
HSV1 (oral) HSV2 (genital) VZV (varicella/chicken pox) -Decreases symptom severity & frequency- NOT a CURE! (the "gift" that keeps on giving") -Used for initial and recurrent treatment -Routes: PO, IC, topical
62
SE of ACYCLOVIR:
GI distress, renal impairment, seizures, ITP (careful with patients with low platelets). IV: tissue necrosis.
63
MOA of OSELTAMIVIR:
Inhibit neuraminidases in flu virus. (TAMIFLU)
64
USES of OSELTAMIVIR:
Prophylaxis and treat ACTIVE FLU -Before/within 48 hours of symptom onset. -Mostly elderly/immunocompromised after known exposure to FLU A or B.
65
SE of OSELTAMIVIR:
N/V; seizures; renal impairments.
66
MOA of GANCICLOVIR:
Inhibits DNA polymerases--> chain termination (stops replication).
67
USES of GANCICLOVIR:
Cytomegalovirus (CMV): immunocompromised pts (AIDS/transplant). -Controls--> DOES NOT CURE! -IV and PO
68
SE of GLANCICLOVIR:
4 BLACK BOX warnings: 1. hematologic toxicity (low blood ct) 2. Fertility 3. Fetal toxicity 4. Carcinogenesis -Don't give with Imipenem/Cilastin (seizure) -Watch kidneys -If you as a RN crush it and it gets on your skin--> wash with soap and water
69
Bacteriostatic
Medications that slow or inhibit bacterial growth.
70
Bactericidal
Medications that KILL the bacteria.
71
Narrow spectrum
Effective against a "few" species of organisms. -Using a BB gun -Know the organism and what the drug s sensitive to.
72
Resistance
Ability of an organism to survive against an antimicrobial or render the antimicrobial ineffective. -Innate: always been that way. -Acquired: mutated to resist.
73
Selective toxicity
Toxic to a specific cell while sparing other cells around it: so normal cells in close proximity don't also get killed.
74
Example of a super infection:
C-Diff... Giving the patient antibiotics for one thing/primary infection in the process give them C-Diff.
75
Ceftriaxone:
1of3 3rd generation Cephalosporins: -EXTREMELY long-acting: long 1/2 life--> 1X/day. -DOES cross BBB -IV/IM only. -DO NOT give to patients with liver failure.
76
Ceftaroline
5th generation cephalosporin: -Give for NASTY STAPH or MULTI DRUG resistant bacteria (MRSA/VRSA). -Therefore, watch kidneys! STONG broad spectrum drug--> monitor kidney function! -IV only.
77
Peak
Draw a peak when theoretically the drug would be at the highest level in the patient's system--> 15-30 min AFTER the drug is started/its in the patient's system.
78
Trough
Lowest level of the drug in patient's system. Measured immediately before the next dose is given. (30 minutes prior to next dose due).
79
What are some drug interactions of penicillin?
Oral contraceptives, warfarin & NSAIDs
80
Biggest worry with Carbapenems:
SEIZURES -infuse over 60 min
81
What ABX causes red man?
Vanc
82
What are the cephalosporins? Name them.
1st: Cefazolin & Cephalexin 2nd: Cefuroxime & Cefotetan 3rd: Ceftriaxone, Ceftazidime & Cefotaxine 4th: Cefepime 5th: Ceftaroline
83
Penicillin G & V is used in combo with:
aminoglycosides.
84
ABX that are good against pseudomonas?
-Piperacillin -Ceftazidime -Cefepime -Vanc (pseudomembranous colitis)

Patho Fall 2023 Block 1 (3 decks)

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