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137 Cards in this Set
- Front
- Back
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what should you be certain of before prescribing an antimicrobial
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if the agent is indicated clincally, if the appropriate specimens have been obtained to establish dx, likely etiology, prevention and protection of pt., will the drug benefit pt.
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what can be prescribed if a specific microbe has been identified
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narrow spectrum drug
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what should you ask yourself when prescribing
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drug comb.? optimal dose? route of administration? duration? tests to determine if pt. will not respond to therpy? decrease dose in immunosupressed w/ organ transplants? adjunctive measures? immunomodulatory drugs for preexisting immune def.?
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what is the correct term for the use of antibiotics prior to the identification of a pathogen
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empiric therapy
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what is required of empiric therapy
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a presumptive dx on the basis of clinical findings, some evidence of early intervention outcome
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what host factors should be considered when choosing antimicrobial agents
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concomitant dz states, prior adverse drug effects, impaired elimination/detox of drug, age of pt., pregnancy status
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what pharmacologic factors should be considered when choosing antimicrobial agents
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kinetics- absorption, distribution, elimination; ability of drug to be delivered to site of infection; potential toxicity; pharmacokinetic/dynamic interactions w/ other drugs
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how might you reduce the frequency of dosing
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by knowing the pharmacokinetic differences among agents w/ similar antimicrobial spectrums (ex. ceftriaxone or azithromycin)
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what factors should be considered in pharmacodynamics
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pathogen susceptibility testing, static vs cidal, drug synergism/antagonism, postantibiotic effects (ex. aminoglycosides)
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true or false static and cidal drugs are equivalent for the Tx of most infectious dz in immunocompetent hosts
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true
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what are bacteriocidal agents prescribed for
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endocarditis, meningitis, and in immunosuppressed
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what type of agents are cell wall-active agents
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bacterocidal
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what type of agents are drugs that inhibit protein synthesis, with the exception of aminoglycosides
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bacteriostatic
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what is the pattern of concentration dependent killing
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Rate and extent of killing increase with concentration (aminoglycosides and fluoroquinolones)
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what is the pattern of time dependent killing
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don’t exhibit increased killing with increasing concentrations above the minimal bactericidal concentration (MBC)
Examples are beta lactams and vancomycin |
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what is Postantibiotic effect (PAE)
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-Persistent suppression of bacterial growth after limited exposure to an antibiotic
-reflects the time required for bacteria to return to logarithmic growth |
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what are the PAE Proposed Mechanisms
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1. Slow recovery after reversible nonlethal damage to cell structures
2. Persistence of the drug at a binding site or within the periplasmic space 3. The need to synthesize new enzymes before growth can resume |
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when should antimicrobials be administered through an IV
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1. critically ill pts. 2. bacterial meningitis/endocarditis 3. NV gastrectomy, dz that impairs oral absorption 4. giving antimicrobials that are poorly absorbed following oral administration
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what might cause a decrease in elimination of an agent
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Impairment of renal or hepatic function
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what pts. may have increased dosage requirements for selected agents
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burns, cystic fibrosis, or trauma
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in which pts are the pharmacokinetics of antimicrobials are also altered
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elderly, in neonates, and in pregnancy.
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what is the pattern of monitoring of serum concentrations
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monitoring is routinely performed on patients receiving aminoglycosides
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true or false: Despite the lack of supporting evidence for its usefulness or need, serum vancomycin concentration monitoring is also widespread
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true
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cross reactivity b/w which 2 drugs is <10%
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cephalosporins and penicillin
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Cross-reactivity between cephalosporins and penicillin is what %
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<10%
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Cephalosporins are contraindicated in patients with a history
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anaphylaxis to penicillin
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what is contrindicated in pts w a hx of anaphylaxis to pcn
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cephalosporins
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what may be administered to patients with penicillin-induced maculopapular rashes
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cephalosporins
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Cephalosporins may be administered to who
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patients with penicillin-induced maculopapular rashes
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cross-reactivity between penicillins and carbapenems may exceed what %
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50%
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what does not cross-react with penicillins and can be safely administered to patients with a history of penicillin-induced anaphylaxis
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aztreonam
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aztreonam does not cross-react with penicillins and can be safely administered to patients with a history of what
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penicillin-induced anaphylaxis
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what can be safely administered to patients with a history of penicillin-induced anaphylaxis
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aztreonam
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what patients have an unusually high incidence of toxicity to a number of drugs
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AIDS
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what pts have an unusual toxicity to clindamycin, aminopenicillins, and sulfonamides
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AIDS
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AIDS pts have unusual toxicity to what drugs in particular
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clindamycin, aminopenicillins, and sulfonamides
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what reaction might an AIDS pt. have w/ certain drugs
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rash and fever
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what might the rash and fever reactions of an AIDS pt respond to
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dosage reduction or treatment with corticosteroids and antihistamines
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when should combination therapy be used
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1. broad spec. empiric therapy in seriously ill pts 2.polymicrobial infections such as intra-abdominal abscesses 3. decrease the emergence of resistant strains
4. decrease dose-related toxicity 5. obtain synergy |
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what is synergism
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effect of two or more antibiotics used together is greater than expected from their effects when used separately (1+1>2)
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what are the mechanisms of synergism
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1. Blockade of sequential steps in a metabolic sequence 2. Inhibition of enzymatic inactivation 3. Enhancement of antimicrobial agent uptake
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what drugs work synergistically by enhancement of antimicrobial agent uptake
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amphotericin B enhances the uptake of Flucytosine (cell wall active agents increase the uptake of aminoglycosides)
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what drugs work synergistically by blockade of sequential steps in a metabolic sequence
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trimethoprim-sulfamethoxazole
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what drugs work synergistically by inhibition of enzymatic inactivation
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Amoxicillin plus clavunlanic acid
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what are the mechanisms of antagoism
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1. Inhibition of cidal activity by static drugs 2. Induction of enzymatic inactivation
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what do the cidal effects of cell-wall active agents agents require
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bacteria be dividing rapidly
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what two drugs interact antagonistically to inhibit cidal activity by static drugs
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Penicillin and tetracycline
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what do some gram negative bacteria possess
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inducible beta lactamases
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what drug is a potent inducer of beta lactamase
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ampicillin
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what might happen if an inducing agent is combined with an intrinsically active but hydrolyzable beta-lactam such as piperacillin
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antagonism
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when should antimicrobial prophylaxis be used
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when efficacy has been demonstrated and benefits outweigh the risks of prophylaxis
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what are the two types of anitmicrobial prophylaxis
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surgical prophylaxis and nonsurgical prophylaxis
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what are the 4 independent risk factors for postoperative wound infection (prophylaxis)
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1. abdominal procedures 2. Procedures lasting more than 2 hours 3. Contaminated or dirty procedures 4. Three co-morbid medical diagnoses
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what should be considered as part of surgical prophylaxis
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1. contam./clean-contaminated operations 2.Operations in which postoperative infection may be catastrophic such as open heart surgery 3. Clean procedures that involve placement of prosthetic materials 4. Any procedure in an immunocompromised host
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what procedures are considered "clean"
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Elective, primarily closed procedure; respiratory, gastrointestinal, biliary, genitourinary, or oropharyngeal tract not entered; no acute inflammation and no break in technique; expected infection rate ≤ 2%.
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what procedures fall under the "clean contaminated"
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1. Urgent or emergency case that is otherwise clean 2. Elective, controlled opening of respiratory, gastrointestinal, biliary, or oropharyngeal tract 3. Minimal spillage or minor break in technique; expected infection rate ≤10%.
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what falls under the "contaminated" category
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1. Acute nonpurulent inflammation 2. Major technique break or major spill from hollow organ 3. Penetrating trauma less than 4 hours old 4. Chronic open wounds to be grafted or covered 5.Expected infection rate about 20%
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what falls under the "dirty" category
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1. Purulence or abscess 2. Preoperative perforation of respiratory, gastrointestinal, biliary, or oropharyngeal tract
3. Penetrating trauma more than 4 hours old 4. Expected infection rate about 40%. |
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what is the prophylactic agent of choice for head and neck, gastroduodenal, biliary tract, gynecologic, and clean procedures
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cephazolin
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what is cephazolin prophylaxis for
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head and neck, gastroduodenal, biliary tract, gynecologic, and clean procedures
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what does not cross-react with penicillins and can be safely administered to patients with a history of penicillin-induced anaphylaxis
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aztreonam
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aztreonam does not cross-react with penicillins and can be safely administered to patients with a history of what
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penicillin-induced anaphylaxis
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what can be safely administered to patients with a history of penicillin-induced anaphylaxis
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aztreonam
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what patients have an unusually high incidence of toxicity to a number of drugs
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AIDS
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what pts have an unusual toxicity to clindamycin, aminopenicillins, and sulfonamides
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AIDS
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AIDS pts have unusual toxicity to what drugs in particular
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clindamycin, aminopenicillins, and sulfonamides
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what reaction might an AIDS pt. have w/ certain drugs
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rash and fever
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what might the rash and fever reactions of an AIDS pt respond to
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dosage reduction or treatment with corticosteroids and antihistamines
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when should combination therapy be used
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1. broad spec. empiric therapy in seriously ill pts 2.polymicrobial infections such as intra-abdominal abscesses 3. decrease the emergence of resistant strains
4. decrease dose-related toxicity 5. obtain synergy |
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what is synergism
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effect of two or more antibiotics used together is greater than expected from their effects when used separately (1+1>2)
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what are the mechanism of synergism
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1.Blockade of sequential steps in a metabolic sequence 2. Inhibition of enzymatic inactivation 3. Enhancement of antimicrobial agent uptake
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what drugs work synergistically by blockade of sequential steps in a metabolic sequence
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trimethoprim-sulfamethoxazole
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what drugs work synergistically by Inhibition of enzymatic inactivation
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Amoxicillin plus clavunlanic acid
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what drugs work synergistically by enhancement of antimicrobial agent uptake
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(cell wall active agents increase the uptake of aminoglycosides, amphotericin B enhances the uptake of Flucytosine)
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what are the mechanisms of antagonism
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1. Inhibition of cidal activity by static drugs 2. Induction of enzymatic inactivation
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what do the cidal effects of cell-wall active agents agents require
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that bacteria be dividing rapidly
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what drugs work antaoginstically by Inhibition of cidal activity by static drugs
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Penicillin and tetracycline
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Some gram negative bacteria possess what
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inducible beta lactamases
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what is a potent inducer of beta lactamase
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ampicillin
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If an inducing agent is combined with an intrinsically active but hydrolyzable beta-lactam such as piperacillin what might occur
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antagonism
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when should anitmicrobial prophylaxis be used
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when efficacy has been demonstrated and benefits outweigh the risks of prophylaxis.
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what are the 2 type of anttimicrobial prophylaxis
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surgical/nonsurgical
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what are the 4 independent risk factors for postoperative wound infection (prophylaxis)
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1. abdominal procedures 2. Procedures lasting more than 2 hours 3. Contaminated or dirty procedures 4. Three co-morbid medical diagnoses
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what falls in the surgical prophylaxis category
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1. Contaminated and clean-contaminated operations 2.Operations in which postoperative infection may be catastrophic such as open heart surgery 3.Clean procedures that involve placement of prosthetic materials 4. Any procedure in an immunocompromised host
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what falls in the 'clean" category
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Elective, primarily closed procedure; respiratory, gastrointestinal, biliary, genitourinary, or oropharyngeal tract not entered; no acute inflammation and no break in technique; expected infection rate ≤ 2%
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what falls in the clean contaminated category
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1. Urgent or emergency case that is otherwise clean 2.
Elective, controlled opening of respiratory, gastrointestinal, biliary, or oropharyngeal tract 3. Minimal spillage or minor break in technique; expected infection rate ≤10%. |
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what falls in the contaminated category
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1. Acute nonpurulent inflammation 2.
Major technique break or major spill from hollow organ 3. Penetrating trauma less than 4 hours old 4. Chronic open wounds to be grafted or covered 5. Expected infection rate about 20% |
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what falls under the "dirty" category
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1. Purulence or abscess
2. Preoperative perforation of respiratory, gastrointestinal, biliary, or oropharyngeal tract 3. Penetrating trauma more than 4 hours old 4. Expected infection rate about 40%. |
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what is the prophylactic agent of choice for head and neck, gastroduodenal, biliary tract, gynecologic, and clean procedures
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cefazolin
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Cefazolin is the prophylactic agent of choice for what
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head and neck, gastroduodenal, biliary tract, gynecologic, and clean procedures
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Oral erythromycin and neomycin are prophylaxic for what
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elective colorectal procedures
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what is prophylactic for elective colorectal procedures
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Oral erythromycin and neomycin
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what is prophylactic for emergency colorectal procedures
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Cefotetan, cefoxitin, ceftizoxime, or cefmetazole
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Cefotetan, cefoxitin, ceftizoxime, or cefmetazole are prophylatic for what
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emergency colorectal procedures
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what is nonsurgical prophylaxis indicated for
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individuals who are at high risk for temporary exposure to selected virulent pathogens and in patients who are at increased risk for developing infection because of underlying disease (eg, immunocompromised hosts).
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in meningococcal infection who should you prophylax and with what
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close contacts of a case with rifampin, ciprofloxacin, or ceftriaxone
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what can be used prophylactiaclly for rheumatoid fever
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Benzathine penicillin
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what is Benzathine penicillin used prophylactiaclly for
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rheumatoid fever
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what is Erythromycin used prophylactically for
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Pertussis
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what is Pertussis treated with prophylactically
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erythromycin
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what does Penicillin or erythromycin treat prophylactically
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Diphtheria
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what can Diphtheria be treated prophylactically with
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Penicillin or erythromycin
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what is Influenza A treated prophylactically with
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Amantadine
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what does Amantadine treat prophylactically
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Influenza A
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what is Influenza B treated prophylactically with
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Oseltamivir
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what is Oseltamivir used to
treat prophylactically |
Influenza B H1N1
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what is H1N1 treated w/ prophylactically
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Oseltamivir
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what targets bacterial cell walls
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Beta-lactams, Bacitracin, Vancomycin, INH, Ethambutol
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Beta-lactams, Bacitracin, Vancomycin, INH, Ethambutol
target what |
bacterial cell wall
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what is H1N1 treated w/ prophylactically
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Oseltamivir
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what targets protein synthesis of bacteria
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Aminoglycosides, tetra-cycline, macrolides, chloramphenicol, clindamycin
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what is H1N1 treated w/ prophylactically
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Oseltamivir
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what targets bacterial cell walls
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Beta-lactams, Bacitracin, Vancomycin, INH, Ethambutol
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Aminoglycosides, tetra-cycline, macrolides, chloramphenicol, clindamycin
target what |
protein synthesis in bacteria
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Beta-lactams, Bacitracin, Vancomycin, INH, Ethambutol
target what |
bacterial cell wall
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what targets cell metabolism in bacteria
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Antifolate drugs
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what targets protein synthesis of bacteria
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Aminoglycosides, tetra-cycline, macrolides, chloramphenicol, clindamycin
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Antifolate drugs target what in bacteria
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cell metabolism
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what targets bacterial cell walls
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Beta-lactams, Bacitracin, Vancomycin, INH, Ethambutol
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what targets DNA synthesis of bacteria
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Quinolones
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Aminoglycosides, tetra-cycline, macrolides, chloramphenicol, clindamycin
target what |
protein synthesis in bacteria
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Beta-lactams, Bacitracin, Vancomycin, INH, Ethambutol
target what |
bacterial cell wall
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Quinolones target what
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DNA synthesis
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what targets cell metabolism in bacteria
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Antifolate drugs
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what targets protein synthesis of bacteria
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Aminoglycosides, tetra-cycline, macrolides, chloramphenicol, clindamycin
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Antifolate drugs target what in bacteria
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cell metabolism
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Aminoglycosides, tetra-cycline, macrolides, chloramphenicol, clindamycin
target what |
protein synthesis in bacteria
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what targets cell metabolism in bacteria
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Antifolate drugs
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what targets DNA synthesis of bacteria
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Quinolones
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Antifolate drugs target what in bacteria
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cell metabolism
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Quinolones target what
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DNA synthesis
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what targets DNA synthesis of bacteria
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Quinolones
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Quinolones target what
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DNA synthesis
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what targets RNA synthesis in bacteria
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Rifampin
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what does Rifampin target in bacteria
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RNA synthesis
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what targets DNA strand breakage in bacteria
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Nitrofurantoin
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what does Nitrofurantoin target
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DNA strand breakage
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