Pharm Final Exam Antibiotics

Front 1

What are some types of drugs that weaken the bacterial cell wall?

Back 1

Penicillins
Cephalosporins
Carbapenems
Vancomycin
Aztreonam
Teicoplanin
Fosfomycin

Front 2

What kinds of bacteria do penicillins target?

Back 2

bacterial cell wall
active against a variety of bacteria
but only active against bacteria undergoing growth and division
they are generally bacteriocidal (kill all bacteria)
very active against gram positive but not really gram negative because most PCN cant pass thru the extra outer layer of gram - bacteria

Front 3

what is the molecular target of PCN and how does gram positive differ from gram negative bacteria?

Back 3

THe molecular target of PCN is PBP (penicillin binding proteins)
PCNs are generally very active against gram + bacteria because the cell wall is readily penetrated and makes easy access to PBPs. Also gram + bacteria only have 2 lays of cytoplasmic membrane and a thick cell wall for the PCN to pass thru. On the other hand, gram negative bacteria has an extra outer layer (3 layers total) with small pores so most PCN cant pass thru that outer membrane

Front 4

adverse effects/toxicity of PCN

Back 4

toxicity of PCN is low so its very well tolerated.
the principle AE is an allergic reaction

Front 5

True or false: PCNs contain a beta lactam ring.

Back 5

TRUE. PCN contains a beta lactam ring and is thus a beta lactam antibiotic

Front 6

what other drugs besides penicillins are beta lactam antibiotics and contain a beta lactam ring?

Back 6

penicillins
cephalosporins
carbapenems
and aztreonam

Front 7

Antibitoic resistance to bacteria is a big problem. What is bacterial resistance from Penicillin due to?

Back 7

1. inability of PCN to reach target penicillin binding proteins PBPs.
2. inactivation of PCN by bacterial enzymes
3. Production of PBPs that have low affinity for PCN

Front 8

Explain the history of Staphylococcus Aureus since the 1940s

Back 8

In 1940s all strains of Staph A were sensitive to PCN.
IN 1960s, 80% displayed STaph resistance and PCN was no longer as effective so Methicillin was created. Today, many patients have MRSA (methicillin resistant Staph Aureus)

Front 9

what is the drug that is a PCN derivative created in the 1960s to combat Staph A?

Back 9

Methicillin

Front 10

What are some examples of narrow spectrum Penicillins

Back 10

Penicillin G
Methicillin

Front 11

What are some broad spectrum Penicillins

Back 11

Amoxicillin
Ampicillin

Front 12

Penicillin G is the drug of choice for what?

Back 12

PNA and meningitis caused by Strep pneumonia, pharyngitis caused by strep pyrogenes and infectious endocarditis (heart infection) cause by strep viridans, syphillis, some gonorrhea, gas gangrene

Front 13

is PCN G bacteriocidal or bacteriostatic

Back 13

bacteriocidal

Front 14

what are the routes of administration for PCN G

Back 14

never given po because unstable in stomach acid.
Given IM but different salts absorbed different rates. PCN G with K is given IV too but benzathine salts is never given IV

Front 15

true or false: PCN G is given orally

Back 15

False. PCN G is unstable in stomach acid so never given po.

Front 16

PCN G(K potassium) can be given by which route

Back 16

IV or IM

Front 17

PCN G with benzathine salts can be given by which route

Back 17

only IM, never IV

Front 18

What is the drug interaction with PCN G

Back 18

PROBENECID.
When Probenecid and PCN G are taken together, renal excretion of PCN is delayed so increase risk of toxicity

Front 19

TRUE OR FALSE: Penicillins are the most common cause of drug allergy

Back 19

TRUE

Front 20

Facts about PCN allergy

Back 20

there is no direct relationship between size of dose and intensity of reaction.
PCN allergy occurs from prior exposure to PCN is required or may occur in absense of prior exposure.
Be careful of cross sensitivty (allergy to PCN can confer allergy to other antibiotics)
If patient is allergic to PCn the general rule is to avoid it.
Desensitization may occur in which you give them a small dose and slowly increase dose over time while also giving benadryl to counteract allergy
Greatest risk for anaphylaxis is 30 minutes after drug is given. Sx of anaphylaxis is laryngeal edema, bronchial constriction.

Front 21

If patient with PCN allergy has an anaphylactic reaction what is the tx

Back 21

give epinephrine and respiratory support

Front 22

What are PCNs with beta lactamase inhibitor

Back 22

These are drugs that inhibit beta lactamase allowing for extension of the antimicrobial spectrum of the PCN. the beta lactamase inhibitor PCNs are broader spectrum
These PCNs are well tolerated and work well against the 3 most notable bacterial in the hospital

Front 23

what are the types of PCNs with beta lactamase inhibitors (broader spectrum)

Back 23

Unasyn: Amoxicillin+Sulbactam
Augmentin: Amoxicillin + Clavulanate
Zosyn: Piperacillin + Tazobactam

Front 24

WHat are the 3 most notable bacteria in hospital that beta lactam inhibitor PCNs work against

Back 24

Klebsiella
Enterobacter
Pseudomonas

Front 25

MRSA

Back 25

Methicillin resistant staph aureus via skin to skin contact that causes skin, soft tissue and bloodstream infections.
It is a major public health concern, very costly.

Front 26

2 types of MRSA

Back 26

HA-MRSA- hospital aquired MRSA
CA-MRSA (POA) community aquired MRSA present on admission

Front 27

what do we use to treat and care for pt with hospital aquired MRSA thats complicated

Back 27

1. contact precautions
2. Vaconmycin IV, Daptomycin (Cubicin), Ceftarolin (Teflaro) Televancin (Vibativ and Clindamycin.
3. handwashing followed by alcohol based sanitizer

Front 28

Facts about cephalosporins

Back 28

bacteriocidal
beta lactam antibiotic
low toxicity

Front 29

true or false: penicillins and cephalosporins are both bacteriocidal and beta lactam antibiotics but PCN target gram + and cephalosporins target gram -

Back 29

TRUE

Front 30

what is the main problem with cephalosporins

Back 30

resistance principally caused by production of beta lactamase (not all are equally susceptible to beta lactamase)

Front 31

how many types of cephalosporins are there

Back 31

4. there are 4 generations

Front 32

true or false. if someone is allergic to PCN they most likely will be allergic to cephalosporins. what is this called

Back 32

TRUE
cross sensitivity

Front 33

pharmacotherapeutics for cephalosporins

Back 33

infection of skin, bone, heart, blood (bacteremia/septicemia), respiratory, GI GU like UTIs

Front 34

contraindication for cephalosporins

Back 34

allergic reaction to PCN (cross sensitivity)

Front 35

interactions with cephalosporins

Back 35

1. alcohol ETOH
2. aminoglycosides
3. anticoagulants (PT PTT INR) increase effect

Front 36

what are concerns AE with cephalosporins

Back 36

when taking with anticoagulants it increases effects so we are concerned about bleeding.
thrombophlebitis risk with IV so rotate IV sites and check iv site every hour
must adjust dose for impaired renal function

Front 37

Ceftriaxone (a type of cephalosporin)

Back 37

dont need to adjust dose for renal impairment bc ceftriaxone is eliminated by liver** so this drug is a good cephalosporin for a renal patient on dialysis. Also, calcium and ceftriaxone should NOT be used with ringers solution. it should be mixed with D5 or saline. NOT RINGERS LACTATE

Front 38

nursing diagnosis for pt on cephalosporin

Back 38

risk for injury (r/t bleeding from concomittent use with anticoagulants)
risk for injury (r/t risk for thrombophlebitis with IV use)

Front 39

nursing asst in pt taking cephalosporins

Back 39

if also taking an anticoagulant, check PT PTT and INR to assess bleeding tendency.
check IV site and rotate IV sites to prevent thrombophlebitis
teach patient not to take alcohol ETOH with cephalosporin
IF giving Ceftriaxone, dont use with ringers lactate.
assess for allergy to PCN bc it will likely have cross sensitivity.

Front 40

difference between 1st thru 4th generation cephalosporins

Back 40

increased activity against gram negative an anaerobes.
increased resistance to destruction by beta lactamases
increased ability to reach cerebral spinal fluid CSF

Front 41

prototype 1st generation cephalosporin

Back 41

CEFAZOLIN
cefazolin doesn't work as well against gram negative and anaerobes as Ceftriaxone (a 3rs generation). Ceftriaxone also has greater resistance to destruction by beta lactamases than Cefazolin. Also Ceftriaxone has greater ability to reach CSF than Cefazolin.

Front 42

Prototype Carbapenems

Back 42

Imipenem (also Meropenem, doripenem, and ertapenem)

Front 43

Facts about carbapenems

Back 43

beta lactam antibiotics with broad spectrum coverage except to MRSA.
Carpapenems like Imipenem are used for treating MIXED INFECTIONS, gram positive cocci, gram negative bacilli and cocci and anaerobes

Front 44

true or false carbapenems are broad spectrum

Back 44

TRUE

Front 45

true or false carbapenems do not work against MRSA

Back 45

true

Front 46

how are carbapenems given by which route

Back 46

PARENTERALLY
not absorbed by GI tract.

Front 47

Interaction with carbapenems

Back 47

*VALPROIC ACID (DEPAKOTE)
when given concomitantly it decreases seizure threshold.

Front 48

nursing asst on pt newly prescribed a carbapenem

Back 48

what other meds do you take? checking for interaction with valproic acid(depakote)
do u have epilepsy?

Front 49

C DIFF COLITIS

Back 49

C DIFF COLITIS is a gram positive SPORE forming anaerobic bacillus that infects the bowel. toxin A and B attack colon wall. Occurs as a supra infection from antibitoic treatment.
sx are mild nausea and diarrhea to sever toxic megacolon, pseudomembranous colitis, sepsis and colon perforation. Treated with oral vancomycin and flagyl.
recurrence is 15-30% depending on geographic regions.

Front 50

treatment for C DIFF COLITIS

Back 50

oral vancomycin 250 mg 4X per day and flagyl 500 mg every 8 hours

Front 51

teaching for C DIF

Back 51

teach pt reoccurence is 15-30% so sx to look for

Front 52

fact about spores of CDIF

Back 52

spores can remain in environment for weeks on end

Front 53

how to wash hands with cdif

Back 53

dont wash hands with alcohol based products, must use soap and water. alcohol doesnt kill spores

Front 54

what is the primary risk factor for CDIFF colitis

Back 54

treatment with recent antibiotics

Front 55

to prevent CDIFF and other supra infections what should pt on antibitoics also take

Back 55

a probiotics like lactobacillus orally

Front 56

VANCOMYCIN

Back 56

pharmacotherapeutics:treats gram positive infections, MRSA, used also to treat CDIFF (pseudomembranous colitis infection; gut and bowel infections)

Front 57

what drug is good for patient with PCN allergy?

Back 57

vancomycin

Front 58

vancomycin is often given concurrently with what?

Back 58

aminoglycosides

Front 59

common AE of vancomycin

Back 59

red neck red man syndrome (neck or whole body gets red)

Front 60

serious adverse effects of vancomycin

Back 60

ototoxicity
nephrotoxicity
CONCERN IS EARS AND KIDNEYS

Front 61

monitoring of labs for vancomycin

Back 61

monitor peak and trough, monitor infusion times, vanco trough goal is 15-20

Front 62

nursing asst of vancomycin pt

Back 62

check ears: any tinnitus ? ringing can be ototoxicity
check kidneys: urine output, BUN, creatinine (assess for nephrotoxicity)
assess peak and trough levels and infusion times. MAKE SURE TROUGH IS 15-20.
assess for red neck red man syndrome and teach pt neck or body may get rly red

Front 63

nurse gets trough level back for vanco and it is 2 what should she do

Back 63

call dr to increase dose bc if trough is not 15-20 then its not working.

Front 64

nurse gets trough level back for vancomycin and its 30 what should she do

Back 64

immediately hold the vancomycin
call Dr and tell them trough is 30 and risk for toxicity bc it should be 15-20

Front 65

Monobactams prototype

Back 65

Prototype monobactams is Aztreonam

Front 66

Monobactams (prototype Aztreonam) facts

Back 66

give safely to PCN allergic patients,
ONLY WORKS GRAM NEGATIVE
doesnt work gram positive or anaerobes
beta lactam antibitoic

Front 67

culture comes back from lab and bacteria is a gram negative. Pt is allergic to PCN. what drug should be used?

Back 67

Dont give cephalosporins bc although work agaisnt gram - they have cross sensitivity with allergy to PCN. Monobactams such as Aztreonam work against gram negative organisms specifically and safe in PCN allergy patient.

Front 68

Pt comes in with a bad infection and a history of having mixed infections but we dont know what it is and labs have just been sent out. nasal swab for MRSA came back and is negative. What drug should we give

Back 68

A carbapenem like Imipenem because it is broad spectrum (although doesnt work for MRSA)

Front 69

Meropenem

Back 69

a type of carbapenem.
treatment for bacterial meningitis, complicated skin infections, intraabdominal infections.
1 gram every 8 hours is the usual dose
reconstituted IV over 15-30 mins

Front 70

Ertrapenem (Invanz)

Back 70

not as broad spectrum as other carbapenems
pelvic infections
community aquired pneumonia CAP
prophylaxis for colorectal surgery
complicated skin urinary or abdominal infections
adults 1 gram daily IV over 30 mins

Front 71

Dorapenem

Back 71

dose depends on renal function
for normal creatinine clearance 500 mg IV every 8 hrs

Front 72

some examples of bacteriostatic inhibitors of protein synthesis

Back 72

tetracyclines like Doxycycline, Tigacycline (tygacil)
Macrolides like azythromycin
Lincosamides like CLindamycin

Front 73

route for tetracyclines

Back 73

orally or topically

Front 74

are tetracyclines bacteriocidal or bacteriostatic and what is the pharmacodynamics?

Back 74

tetracyclines are bacteriostatic (patients immune system must be working) inhbiits binding of transfer RNA to mRNA. Selective toxicity is what makes tetracyclines effective with therapeutic utility because they have poor ability to cross the cell membranes of mammals.

Front 75

adverse effects of tetracyclines

Back 75

discoloration of teeth (wash mouth out after, use straw, dilute with OJ etc)
photosensitivity: wear sunscreen
GI irritation
Suprainfection like coif

Front 76

contraindications for tetracyclines

Back 76

pregnancy
breast feeding
children < 8 yrs

Front 77

why is tetracycline a second line drug and when is it first?

Back 77

second line because bacteriostatic so pts immune system must be good to combat infection.
It's first line drug for rocky mountain spotted fever, mycoplasma pneumonia and limes disease

Front 78

nursing administration of tetracycline

Back 78

better absorbed on EMPTY STOMACH (with short and intermediate acting agents)

space 2 hrs apart from dairy, iron, mg laxatives and antacids, calcium etc. = forms non absorbable coumpound with Ca Fe and Mg. (decreasing absorption rate when gived together)

Front 79

prototype long acting tetracycline

Back 79

Doxycycline (Vibramycin)
treats lymes disease and chlamydia, acne
better absorbed, can be given with meals, longer half life than tetracycline
safe in renal patients

Front 80

difference between tetracycline and doxycycline (tetracycline derivative)?

Back 80

doxycycline has longer half life so is longer acting and good patient compliance.
its better absorbed and can be given with meals while tetracycline needs to be on empty stomach and 2 hrs apart from Fe Ca and Mg products like antacids, laxatives , vitamin supplements etc.

Front 81

Assessment of patient on a tetracycline

Back 81

any sunburn? do u wear sunscreen?
check teeth for discoloration
pregnancy test bc no use in pregnancy/BF
report diarrhea bc suprainfection CDIF can happen
dont take with meals, avoid Ca Fe and Mg products within 2 hrs
GI upset? probably reduce dose or take with meals but will decrease absorption rate.
can drink you tetracycline with OJ dilute it to reduce teeth discoloration but DONT take with milk bc lower absorption with calcium

Front 82

prototype macrolide antibiotic

Back 82

Erythromycin

Front 83

pharmacotherapeutics of erythromycin

Back 83

more effective for gram positive than gram negative
benefit for gastroparesis

Front 84

routes for erythromycin (macrolide abx)

Back 84

IV
oral
topical (eye ointment)

Front 85

serious AE of erythromycin (macrolide abx)

Back 85

GI upset common AE
serious is suprainfection like CDIF and QT prolongation which is rare

Front 86

nursing asst pt on macrolide antibiotic like erythromycin

Back 86

assess for GI upset
teach to report diarrhea (suprainfection CDIF)
assess apical hr full minute for arrythmias r/t QT prolongation
check vein and rotate iv site to prevent thrombophlebitis
try not to take with food will decrease absorption

Front 87

azithromycin (Zithromax aka Z pack)

Back 87

new macrolide derivative or erythromycin
take with or without food but not antacids

Front 88

difference between azithromycin and generic erythromycin

Back 88

erythromycin food decreases absorption so no food
azithromycin can be taken with or without food but not antacids

Front 89

clarithromycin (Biaxin)

Back 89

standard tablets and oral suspensions take without regard to meals
extended release forms take with meal

Front 90

prototype lincosamides

Back 90

Clindamycin

Front 91

pharmacotherapuetics with clindamycin

Back 91

anaerobic infections outside CNS
BACTERIOSTATIC

Front 92

routes for clindamycin

Back 92

IV
oral
topical (vaginal)

Front 93

serious AE

Back 93

pseudomembranous colitis
rapid IV administration causes EKG changes and hypotension

Front 94

treatment for pseudomembranous colitis

Back 94

vancomycin oral or metronidazole (flagyl)

Front 95

patient education with lincosamides like clindamycin

Back 95

take with full glass of water, can take it with meals.
report diarrhea possible CDIF

Front 96

nursing asst patient taking clindamycin

Back 96

diarrhea?
take with full glass of water and food if wanted
if giving IV check EKG and assess for hypotension (check BP)

Front 97

important info when giving clindamycin IV

Back 97

give at prescribed rate bc can cause EKG changes and bottom out
CHECK BLOOD PRESSURE FOR HYPOTENSION

Front 98

Oxazolidinones prototype

Back 98

Linezolid (Zyvox)

Front 99

what to oxazolidinones (linezolid aka Zyvox) treats

Back 99

developed for MRSA and VRE and required ID approval

Front 100

what drugs require infectious disease approval

Back 100

Oxazolidinones like Linezolid/Zyvox
and Streptogramins like Quinupristin/Dalfopristin (synercid)

Front 101

pharmacodynamics of oxazolidinones ( Linezolid aka Zyvox)

Back 101

blocks early stages of process bacteria use to make proteins, may not be able to develop resistance as quick, cross resistance less likely to occur

Front 102

serious adverse effects of oxazolidinones (Linezolid/Zyvox)

Back 102

MYELOSUPPRESSION aka BMS
common AE: nausea diarrhea headache

Front 103

drug interactions with oxazolidinones like linezolid/zyvox

Back 103

MAOIs and sympathomimetics = hypertensive crisis
SSRIs

Front 104

nursing asst for patient on oxazolidinones like linezolid/zyvox

Back 104

depression hx? taking antidepressents? MAOIs, SSRIs?
check CBC monitoring for bone marrow suppression (low h&H, wbc, platelets etc)
any gi effects like nausea diarrhea headache

Front 105

patient is taking prozac and linezolid. what should nurse do

Back 105

mental status exam
psych consult bc interaction with oxazolidinones and antidepressents like SSRIs

Front 106

Streptogramins prototype

Back 106

quinupristin/dalfopristin (Synercid)

Front 107

pharmacotherapeutics for streptogramins like quinupristin/dalfopristin (synercid)

Back 107

MRSA
VRE

Front 108

what drugs besides vacomycin, clyndamycin and daptomycin are sometimes use for MRSA or VRE

Back 108

oxazolidinones like Linezolid/Zyvox and Streptogramins like QUinipristin/Dalfopristin (Synercid)
but these require ID approval

Front 109

caution with streptogramins like quinipristin and dalfopristin (synercid)

Back 109

caution in patients with decreased hepatic function
monitor LFTs bilirubin
not comatible with saline or heparin.. flush line with D5W
monitor for thrombophlebitis

Front 110

possible contraidinication of streptogramin like synercid

Back 110

liver cirrhosis , liver failure

Front 111

Tigacycline (Tygacil)

Back 111

tetracycline good for multi drug resistant strains like MRSA VRE
sometimes used for CDIF
not under age 8
get LFTs and decrease dose in pt with liver problems. give IV loading and maintenance

Front 112

Example aminoglycosides

Back 112

1. gentamycin
2. streptamycin
neomycin
tobramycin
parmyomycin

Front 113

facts about amingolycosides

Back 113

narrow spectrum antibiotics
bacteriocidal
disrupt bacterial protein synthesis
post antibiotic effect (persists even after serum level has dropped below MBC

Front 114

some examples of aerobic gram negative bacilli

Back 114

pseudomonias
serratia
ecoli
klebsiella
proteus

Front 115

what type of bacteria do amingoclycosides target

Back 115

aerobic gram negative bacilli
(not anerobes)

Front 116

why cant aminoglycosides kill anaerobes

Back 116

to produce antibacterial effects aminglycosides must be transported across bacterial cell membrane, a process whcih requires oxygen

Front 117

routes for amino glycosides

Back 117

topical
oral
parenteral

Front 118

gentamycin can be given by which route

Back 118

topical for conjunctivitis and parenteral. NOT ORAL

Front 119

tobramycin can be given which way

Back 119

parenteral and topical

Front 120

neomycin can be given

Back 120

topical for conjunctivitis or before bowel surgery

Front 121

paromyomycin can be given which way

Back 121

oral to treat intestinal amoebas

Front 122

prototype aminoglycoside

Back 122

GENTAMYCIN

Front 123

when is gentamycin used

Back 123

to treat serious aeorbic gram negative bacilli like proteus klebsiella, ecoli. often used in combo with another beta lactam antibiotic like PCN

Front 124

true or false: gentamycin and penicillin may be run thru same IV solution

Back 124

FALSE

Front 125

dosing for gentamycin

Back 125

loading dose: 2 mg/kg.. and then it can be given every 8 hrs or daily... children 2 mg/kg every 8 hrs... total of 3-5 mg/kg/day for gentamycin

Front 126

trough goal for gentamycin

Back 126

<2 mcg/ml

Front 127

peak goal for gentamycin

Back 127

4-10 mcg/ml

Front 128

true or false: aminoglycosides like gentamycin do not penetrate into the CNS

Back 128

true (cant tx meningitis)

Front 129

true or false: gentamcyin has poor oral absorption and must be given IV or IM

Back 129

true

Front 130

distribution of gentamycin

Back 130

binds tightly to renal tissue, penetrates readily to the perilymph and endolymph of the inner ear

Front 131

pt on gentamycin says my ears r ringing. what should rn do

Back 131

stop gentamycin asap and call doctor

Front 132

serious adverse effects of gentamycin (aminoglycosides)

Back 132

1. nephrotoxicity (check BUN creatinine urine output)
2. ototoxicity (hearing loss and balance disturbance)
3. neuromuscular blockade - flaccid paralysis and respiratory depression
neurological disorders with streptomycin
bowel malabsorption with oral neomycin
contact dermatitis with topical neomycin

Front 133

nursing asst pt on gentamycin

Back 133

monitor trough to make sure <2 mcg/ml
assess urine output bun creatinine for nephrotoxicity
assess ears hearing any ringing and balance gait for ototoxicity
make sure not running thru same line as PCN

Front 134

half life of gentamycin

Back 134

2-3 hrs with normal kidney function

Front 135

dosing schedule for gentamycin

Back 135

may be once daily or 2-3 times. giving once daily allows trough levels to get low to allow kidneys to recover..