Pharm Exam 4 > Antimicrobials > Flashcards

Antimicrobials Flashcards

(106 cards)

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1
Q

SCIP 1

A

Prophylactic abx received within 1 hr prior to surgical incision

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2
Q

SCIP 2

A

Prophylactic antibiotic selection for surgical patients - choose abx appropriate for patient and surgery

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3
Q

SCIP 3

A

discontinue prophylactic abx within 24 hours after surgery (48 hours for cardiac patient)

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4
Q

SCIP 4

A

cardiac surgery patient w/ controlled 6am post-op glucose (<200)

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5
Q

SCIP 5

A

post-op wound infection diagnosed during index hospitalization

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6
Q

SCIP 6

A

surgical patients with appropriate hair removal

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7
Q

SCIP 7

A

colorectal patients with immediate postoperative normothermia

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8
Q

hypothermia results in:

A

peripheral vasoconstriction, decreased wound oxygen tension and recruitment of leukocytes, favoring infection and impaired healing

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9
Q

How are PCN classified into subgroups?

A

B-lactamase susceptibility, structure, and spectrum of activity

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10
Q

Penicillins interfere with synthesis of _______

A

peptidoglycan

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11
Q

What is peptidoglycan?

A

essential component of cell walls in bacterias

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12
Q

Penicillins decrease the availability of an ______ of murien hydrolase

A

inhibitor

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13
Q

When murien hydrolase is uninhibited, it:

A

destroys (lyses) the structural integrity of bacterial cell walls

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14
Q

What do resistant gram-negative bacteria have/do that prevents PCN from working?

A

cell membranes that prevent the penicillin from getting to the site of peptidoglycan synthesis; the bacteria could produce B-lactamase enzymes that hydrolyze the B-lactam ring and make the penicillin inactive

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15
Q

T/F: Penicillin is ONLY active against growing bacteria

A

TRUE

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16
Q

High doses of PCN G may result in _____ and ______

A

Hyperkalemia and neurotoxicity

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17
Q

PCN G has ____ meq of K per 10 million U

A

16

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18
Q

PCN G is _____% ______ excreted

A

90% renally

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19
Q

3 drugs that prolong PCN duration of action

A

probenecid
procaine
benzathine

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20
Q

Penicillinase-Resistant PCN (list names of drugs)

A 
Methicillin
Nafcillin (80% bile excreted)
Oxacillin (hepatitis SE)
Cloxacillin (PO)
Dicloxacillin (PO)
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21
Q

Penicillinase-resistant PCN are used to treat what infections?

A

Staphylococci

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22
Q

What makes penicillinase-resistant penicillins resistant?

A

not susceptible to hydrolysis of B-lactam ring by bacteria

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23
Q

What generation are Penicillinase-susceptible broad spectrum penicillins?

A

2nd generation

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24
Q

Penicillinase-susceptible broad spectrum penicillins (list drugs)

A

Ampicillin

Amoxicillin

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25
Does staphylococcus respond to Penicillinase-susceptible broad spectrum penicillins (2nd generation PCN)?
No
26
Of penicillins, which has highest incidence skin rash?
Ampicillin
27
Ampicillin has (broader/narrower) activity then PCN G
broader
28
Amoxicillin or Ampicillin: which is better absorbed from GI tract?
Amoxicillin
29
Amoxicillin or Ampicillin: which has longer effective circulating concentrations?
Amoxicillin
30
Which generation are Extended-Spectrum Carboxypenicillins?
third generation
31
Extended-Spectrum Carboxypenicillins (list the drugs)
Carbenicillin
32
Is Carbenicillin effective against staph aureus?
No
33
Side effects of Carbenicillin:
CHF (>10% drug is Na) hypokalemia metabolic alkalosis increased bleeding time with normal platelet count
34
What generation are extended-spectrum acylaminopenicillins?
4th generation
35
Are extended-spectrum acylaminopenicillins effective against staph aureus?
No
36
Extended-spectrum acylaminopenicillins (list drugs)
Mezlocillin piperacillin azlocillin
37
Which subgroup has broadest spectrum of all penicillins?
extended-spectrum acylaminopenicillins
38
Is piperacillin effective against staph aureus and penicillinase-producing bacteria?
No
39
Penicillinase B-lactamase Inhibitors MOA:
B-lactam compounds have little intrinsic antimicrobial activity. They bind irreversibly to B-lactamase enzyme so drugs that were inactivated by this enzyme (and breaking of the B-lactam ring) are no longer susceptible, and can work against these bacteria
40
Penicillinase B-lactamase Inhibitors (list them)
Clavulanic acid Sulbactam Tazobactam
41
Penicillinase B-lactamase Inhibitors Combinations (list the pairings)
Clavulanic acid + amoxicillin Sulbactam + ampicillin Tazobactam + piperacillin
42
Why do we use cephalosporins?
wide therapeutic index cost effective low incidence of side effects
43
What surgery are cephalosporins used in?
GI/GU surgery
44
Incidence of allergic reactions in cephalosporins
1-10%
45
Side effects cephalosporins:
``` + Coombs reaction (antibodies react against RBCs) hemolysis nephrotoxicity bronchospasm urticaria hemodynamic collapse ```
46
Life threatening anaphylaxis in cephalosporins:
0.02%
47
Most common adverse reaction to B-lactam antimicrobials:
hypersensitivity (IgE antibodies)
48
Most allergenic of all drugs:
Penicillin, 1-10%
49
95% of patients allergic to PCN for ____ metabolite
penicilloyl-protein conjugate (major antigenic determinant) minor antigenic determinant is 6-aminopenicillicacid + benzylpenamaldic
50
T/F: 1st gen cephalosporins are just as good as 2nd and 3rd gen against staphylococci and nonenteral streptococci
True
51
allergy to one penicillin increases likelihood of allergy to other penicillins because of ____, which also is a potential for cross reactivity between PCN and cephalosporins
a common nucleus (B-lactam ring)
52
Actual cross reactivity between cephalosporins and PCN
textbook says rare, in class she said 1-3%
53
First generation cephalosporins (list them)
Cephalothin | Cephazolin
54
How are cephalosporins eliminated?
kidneys
55
Drug of choice for antimicrobial prophylaxis for many surgeries
Cephazolin
56
Second generation cephalosporins (list them)
Cefoxitin Cefamandole Cefuroxime
57
Which is the only second generation cephalosporin effective in treating meningitis?
Cefuroxime
58
Generally, activity against gram ___ cocci decreases and activity against gram ____ cocci increases from the first to the third generation
positive; negative
59
Third generation cephalosporin is different from the others... how?
enhanced ability to resist hydrolysis by the B-lactamases of many gram negative bacilli and can achieve therapeutic levels in CSF (so used against meningitis)
60
Third generation cephalosporins (list them)
Cefotaxime Ceftriaxone Cefixime
61
Do you reduce the cephalosporins dose or frequency in ESRD?
yes first generation: decrease dose second generation: do not give ESRD third generation: cleared renal and hepatic, still reduce dose in renal patient
62
Aztreonam effective against gram ____ bacteria only
negative
63
Does Aztreonam have B-lactam ring?
Yes
64
Is Aztreonam cross sensitive with PCN/cephalosporins?
No
65
Side effect Aztreonam:
enterococcal superinfection
66
Aminoglycosides are excreted:
renally
67
Aminoglycoside lipid solubility:
poor. less than 1% oral administration is absorbed systemically
68
Aminoglycoside normal half-life 2-3 hours in normal renal function. half-life in renal failure:
20-40x normal
69
Side effects aminoglycosides:
ototoxicity (vestibular and auditory) nephrotoxicity skeletal muscle weakness (potentiates NMB, do not give in MG)
70
Aminoglycosides (list them)
gentamicin streptomycin amikacin neomycin
71
Gentamicin is active against:
P. aeruginosa and gram negative bacilli
72
Important to _____ when administering gentamicin
monitor plasma concentration
73
What is toxic level of gentamicin?
>9 ug/ml
74
Macrolides are absorbed (well/poorly) from GI tract
well
75
Macrolides (list them)
Erythromycin Azithromycin Clindamycin Vancomycin
76
Do you need to alter erythromycin dose in renal failure?
No, excreted in bile
77
Part of new combo treatment for COVID-19
Azithromycin
78
Clindamycin is used for infection of:
GI tract and female genital tract
79
Clindamycin is excreted:
hepatic ally, decrease dose in liver patients
80
Side effects of clindamycin:
pseudomembranous colitis (swelling or inflammation of large intestine due to c. diff) diarrhea large dose can induce NMB in absence of non depolarizer skin rash
81
Clindamycin has (more/less) activity against anaerobes (usually gram negative) than erythromycin
More
82
MRSA drug of choice
Vancomycin
83
Is routine prophylaxis with vancomycin recommended?
No, because concerns of resistant organisms
84
Vancomycin works against gram ____ bacteria
positive (impairs cell wall synthesis)
85
Is vancomycin absorbed in GI tract?
no, poorly absorbed in GI tract
86
Vancomycin should be infused over ____ minutes to minimize ______
60 minutes; occurrence of drug-induced histamine release and hypotension
87
Vancomycin should be started ____ hour(s) before surgery for prophylaxis
2 (per stoelting)
88
Vancomycin is excreted by _____
kidney
89
Does vancomycin dose have to be adjusted in renal failure?
yes
90
Important guide to dosing vancomycin (especially in renal failure):
plasma vancomycin levels
91
Side effects vancomycin administration:
``` Red Man Syndrome arterial hypoxemia, low SpO2 ototoxicity nephrotoxicity (with aminoglycoside) Vanco + succs = NMB histamine release bronchospasm ```
92
Red man syndrome
rate dependent infusion reaction- NOT A TRUE ALLERGIC RXN intense facial and truncal erythema rapid infusion (<30 min) can cause hypotension and cardiac arrest pruritus myalgia, dyspnea venodilation, decreased ventricular filling
93
Treatment of pseudomembranous colitis
Metronidazole
94
Which abx causes pseudomembranous colitis?
Clindamycin
95
Fluoroquinolones (list them)
Ciprofloxacin (M. tuberculosis) | Moxifloxacin (serious SE, last resort)
96
Vancomycin dose
10-15 mg/kg over 60 min prophylaxis: <90 kg 1 gm 90-120 kg 1.5 gm >120 kg 2 gm
97
Silver nitrate is used as a:
caustic, antiseptic, astringent
98
Silver nitrate is strong bactericidal, especially for
gonococci
99
Silver nitrate is used in prophylaxis for
ophthalmia neonatorum
100
Silver nitrate SE
hypochloremia hyponatremia methemoglobinemia
101
Chlorhexidine MOA
disrupts cell membranes of the bacterial cells
102
Chlorhexidine is effective against gram ____
positive and negative
103
Chlorhexidine is ____ effective in decreasing number of normal cutaneous bacteria than povidone-iodine and hexachlorophene
more- greater initial decrease
104
Chlorhexidine is used for
preoperative reduction of cutaneous flora for the surgeon and patient
105
Chlorhexidine solution in alcohol base can cause:
deafness and corneal injury (if instilled in middle ear or eye)
106
Chlorhexidine potential for contact sensitivity and photosensitivity is:
Low
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