Term
| bactericidal vs bacteriostatic |
|
Definition
|
|
Term
| antibiotics that break down cell wall integrity |
|
Definition
|
|
Term
| messes with dna synthesis |
|
Definition
|
|
Term
|
Definition
|
|
Term
| messes with rna polymerase |
|
Definition
|
|
Term
| messes with phospholipid membrane |
|
Definition
|
|
Term
| messes with cell wall synthesis (6) |
|
Definition
| D-cycloserine, PCN, Cephalosporins, Vanco, Bacitracin, Cephamycins |
|
|
Term
| Messes with protein synthesis (50S inhibitors) x4 |
|
Definition
| erythromycin, chloramphenicol, cindamycin, lincomycin |
|
|
Term
| messes with protein wall synthesis, 30S x4 |
|
Definition
| Tetracyclines, streptomycin, spectinomycin, kanamycin |
|
|
Term
| true or false, PCNs have a beta lactam ring and an R group side chain that creates the many compounds |
|
Definition
| false, also has a thiazolidine ring |
|
|
Term
| Is PCN bactericidal or bacteriostatic? |
|
Definition
|
|
Term
| What is the bactericidal action of PCN? |
|
Definition
| peptidoglycan synthesis interference (cell wall) |
|
|
Term
| PCN has a wide distribution - which 3 places are listed on the slide? |
|
Definition
| CSF, prostate, intraocular |
|
|
Term
|
Definition
| renal (prolonged in renal patients) |
|
|
Term
| what types of surgeries is PCN good for? |
|
Definition
|
|
Term
| what is the standard antibiotic for dental/oral/esophageal/URI procedures? |
|
Definition
|
|
Term
| What is the oral equivalent for ampicillin? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| inactivates enzyme in bacteria that makes them susceptible to PCN |
|
|
Term
|
Definition
| penicillanase resistance PCN |
|
|
Term
| what are beta lactamases? |
|
Definition
| enzymes produced by some bacteria that are responsible for their resistance to beta lactam antibiotics |
|
|
Term
| What is the structure of cephalosporins? |
|
Definition
| b-lactam ring, dihydrothiazine ring, 2 altered R groups |
|
|
Term
| how does the spectrum change with 1st gen to 4th gen antibiotics? |
|
Definition
| activity against gram positive decreases and gram negative cocci increases from 1-3rd generation |
|
|
Term
| are cephalosporins bacteriocidal or static? |
|
Definition
|
|
Term
| what is the bacteriocidal action of cephalosporins? |
|
Definition
| inhibition of cell wall synthesis |
|
|
Term
| which gen of cephalosporins go to CSF? |
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Definition
|
|
Term
| do cephalosporins cross hte placenta? |
|
Definition
|
|
Term
| how are cephalosporins eliminated? |
|
Definition
|
|
Term
| 2 AE's of cephalosporins? |
|
Definition
| allergic reaction, thrombophlebitis |
|
|
Term
| what % of patients have an allergic reaction? anaphylaxis? |
|
Definition
|
|
Term
| for cephalosporins- cross reactivity likely within ___________ |
|
Definition
| Classification (if allergy to 1st gen, don't give 3rd gen) |
|
|
Term
| what generation is cefazolin? |
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Definition
|
|
Term
| cefazolin fights gram negative, true or false |
|
Definition
|
|
Term
| what is the redosing time of cefazolin? |
|
Definition
| q6-12h, can be given q4 intraop |
|
|
Term
| true or false, you have to reduce dose of cefazolin for renal patients? |
|
Definition
|
|
Term
| which 2nd gen cephalosporin crosses BBB? |
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Definition
|
|
Term
| which 2nd gen cephalosporin is good for GI anarobes? |
|
Definition
|
|
Term
| which 3rd gen cephalosporin is good for endocarditis? |
|
Definition
|
|
Term
| which gen has more gram-negative coverage but reduces gram positive coverage? |
|
Definition
|
|
Term
| which cephalosporin adds gram negative coverage? |
|
Definition
|
|
Term
| which beta lactam is the broadest spectrum beta lactam available? what does it cover? |
|
Definition
|
|
Term
| is there a beta lactam cross reactivity? |
|
Definition
| yes, PCN is beta lactam and so are cephalosporins |
|
|
Term
| what is different about the structure of Aztreonam? |
|
Definition
| Mono-lactam, no PCN thiazolidine ring, no cephalosporin dihydrothiazine ring |
|
|
Term
| what does Aztreonam cover? |
|
Definition
|
|
Term
| true or false, aztreonam does not cross BBB |
|
Definition
| false, it does have CNS coverage |
|
|
Term
| what is the half life of aztreonam? |
|
Definition
|
|
Term
| is aztreonam cross reactive with other beta lactams? |
|
Definition
|
|
Term
| Imipenem and Aztreonam are very expensive, true or false |
|
Definition
| false, aztreonam is expensive $$ |
|
|
Term
| Aminoglycosides contain 3 amino sugars linked to aminocyclitol nucleus, true or false |
|
Definition
|
|
Term
| aminoglycosides- bacteriocidal or static? |
|
Definition
|
|
Term
| what is aminoglycoside bacterial action? |
|
Definition
| inhibit protein synthesis by irreversibly binding to 30S ribosomal units |
|
|
Term
| what is the spectrum for aminoglycosides? |
|
Definition
| gram negatives and some gram positives |
|
|
Term
| aminoglycosides are used in sepsis, bone/joint, skin/soft tissue, URI, intraabdominal infections, true or false? |
|
Definition
|
|
Term
| do aminoglycosides go to CSF? |
|
Definition
|
|
Term
| what toxicity do aminoglycosides have? |
|
Definition
|
|
Term
| what is the half life of aminoglycosides? how much is this prolonged in renal patients? |
|
Definition
| 2-4 hours, prolonged 20-40x in renal patients! |
|
|
Term
| how are aminoglycosides excreted? |
|
Definition
| almost unchanged by the kidneys, not metabolized |
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|
Term
|
Definition
|
|
Term
| What is the difference between tobra and gent? |
|
Definition
| tobra is similar to gent but more expensive |
|
|
Term
| which drug penetrates synovial, pleural, and ascitic fluid? |
|
Definition
|
|
Term
| monitor plasma gent levels, toxic if > _____ |
|
Definition
|
|
Term
| is gentamicin nephro or oto toxic? |
|
Definition
|
|
Term
| What's the dose of aminoglycosides? |
|
Definition
|
|
Term
| why do you infuse aminoglycosides over 30 minutes? |
|
Definition
| SE- deafness, renal failure, NMB |
|
|
Term
| if you're giving aminoglycosides- what other jobs do you need to be cautious of? |
|
Definition
| mannitol, lasix, vanco & other nephro/oto toxic drugs |
|
|
Term
| how does neostigmine affect NMB when patient is simultaneous receiving aminoglycosides? |
|
Definition
| reversal may be incomplete, does not reverse ABX coverage |
|
|
Term
| Do PCN's, cephalosporins, tetracyclines or e-mycin have NMJ effects? |
|
Definition
|
|
Term
| which drugs block the effects of lidocaine? |
|
Definition
|
|
Term
| what type of solution do surgeons use to irrigate peritoneal/pleural cavities? |
|
Definition
| AG solution- like Bacitracin |
|
|
Term
| What is the structure of Macrolides? |
|
Definition
| 14-16 carbon chain linked with various R groups |
|
|
Term
|
Definition
| erythromycin, azithromycin, clarithromycin |
|
|
Term
| are macrolides bacteriocidal or bacteriostatic? |
|
Definition
|
|
Term
| what is the bactericidal action of macrolides? |
|
Definition
| inhibit protein synthesis by 50S ribosomal units |
|
|
Term
| what is the bacterial spectrum of macrolides? |
|
Definition
|
|
Term
| why are macrolides usually given PO? |
|
Definition
| because they're actually stable in gastric pH |
|
|
Term
| do macrolides affect CSF? |
|
Definition
|
|
Term
| how are macrolides eliminated? |
|
Definition
|
|
Term
| how do macrolides affect cytochrome p450 enzymes? |
|
Definition
| inhibit them so watch your benzos and narcs for prolongation |
|
|
Term
| what cardiac effect does erythromycin have? |
|
Definition
|
|
Term
| Why do you give macrolides dilute and SLOW? |
|
Definition
| venous irritation, thrombophlebitis |
|
|
Term
| What GI symptoms do macrolides have? |
|
Definition
| NVD, cramps, GI motility stimulation |
|
|
Term
| Clindamycin is a derivative of ______ and resembles _______ in antimicrobial activity |
|
Definition
|
|
Term
| what drug do we usually give for patients with PCN allergy? |
|
Definition
|
|
Term
| Clindamycin covers ________ |
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Definition
|
|
Term
| which bacteria are resistant to clindamycin? |
|
Definition
| all aerobic gram negative |
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|
Term
| the action of clinda is similar to the class of _______ |
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Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| bile and urine (10% active, remainder inactive metabolites |
|
|
Term
| what is the half life of clinda? |
|
Definition
|
|
Term
| what type of adverse effects are common with clinda? |
|
Definition
| GI effects- pseudomembranous colitis |
|
|
Term
| what effect does clinda have on Succ and NMDR's? |
|
Definition
| can potentiate succ and NDMR's- CANNOT be reversed with anticholinesterase drugs |
|
|
Term
|
Definition
| glycopeptide inhibiting bacterial cell wall synthesis and alters the cytoplasmic membrane |
|
|
Term
| what bacteria does Vanc work on? |
|
Definition
| Gram positive, including staph a |
|
|
Term
| which drug treats endocarditis, osteomyelitis, PNA, sepsis, soft tissue infections, Cdiff, PO, MRSA, CSF shunt infections related to stap? |
|
Definition
|
|
Term
| Is Vanc safe to use with beta lactam allergies? |
|
Definition
| yes, it is often used for those allergic to beta lactam |
|
|
Term
| how long is Vanco therapeutic for? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| rapid infusion of Vanco may cause what? |
|
Definition
| hypotension, arrest, red man syndrome from histamine release |
|
|
Term
| How does Vanc cause VQ mismatch as an adverse effect? |
|
Definition
|
|
Term
| does vanc potentiate NMDR's? |
|
Definition
|
|
Term
| Are quinolones bactericidal or static? |
|
Definition
|
|
Term
| What is the half life of quinolones? |
|
Definition
|
|
Term
| how are quinolones eliminated? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| flagyl bactericidal spectrum? |
|
Definition
| anaerobic gram negative bacilli and cdiff |
|
|
Term
| What drug is used most commonly for colorectal surgery? |
|
Definition
|
|
Term
| Which drug is usually added as a second drug? Which do you give first? |
|
Definition
| Flagyl often added as #2, give second |
|
|
Term
| sulfonamides bactericidal action? |
|
Definition
| inhibits microbial synthesis of folic acid |
|
|
Term
| what are sulfonamides used for mainly? |
|
Definition
| UTI's from ecoli and otitis media in kids |
|
|
Term
| true or false, sulfonamides enter pleural, peritoneal, synovial, ocular and CS fluid |
|
Definition
|
|
Term
| how are sulfonamides metabolized? eliminated? |
|
Definition
| metabolized by acetylation in liver, eliminated GFR, renal secretion |
|
|
Term
|
Definition
| inhibit protein synthesis at bacterial cell ribosome 30S |
|
|
Term
| 3 things Tetracycline works against |
|
Definition
| gram negative, gram positive and rocky mountain spotted fever |
|
|
Term
| Adverse effects of Tetracycline |
|
Definition
| GI, phototoxicity, Fanconi's, thromobophlebitis, potentiates NMDR, teratogenic, tooth discoloration |
|
|
Term
| What is Fanconi's syndrome? |
|
Definition
| nausea, polyuria, proteinuria, polydipsia |
|
|
Term
| 3 ways antibiotic allergies are classified |
|
Definition
| 1. hypersensitivity reaction 2. direct drug toxicity 3. microbial superinfection |
|
|
Term
| is a hypersensitivity reaction dose dependent or dose independent? |
|
Definition
|
|
Term
| is direct drug toxicity dose dependent or dose independent? |
|
Definition
|
|
Term
| with antibiotic allergies, what are people usually allergic to? |
|
Definition
| b-lactam side chains (not rings) |
|
|
Term
| ____% of beta lactam antibiotic admin produces allergic reaction, but only ____% is true anaphylaxis |
|
Definition
|
|
Term
| What is the % of cross-sensitivity between PCN and Cephalosporin? |
|
Definition
|
|
Term
| What mediates immediate reaction? delayed reaction? |
|
Definition
| immediate reaction is IgE, delayed is non-IgE |
|
|
Term
| What if a patient has an anaphylactic allergy to PCN- then what is the cross-sensitivity? |
|
Definition
|
|
Term
| true or false, give Ancef to a patient with an anaphylactic allergy to PCN |
|
Definition
| FALSE! DO NOT give Ancef if PCN allergy |
|
|
Term
| what are the 4 "probably safe" allergic reactions? |
|
Definition
| rash/hives, fever, childhood unknown, N/V/D |
|
|
Term
| what are some bad reactions to antibiotics? |
|
Definition
| hypotensino, SOB, facial edema, seizures, renal failure, hyperK, severe myalgia, anemia |
|
|
Term
| Sulfa allergy- what antibiotic are they allergic to? what else are these patients allergic to? |
|
Definition
| septra/bactrim, Lasix, HCTZ, captopril, sulfasalazine, dapsone, glynase, Diabeta, Celebrex, Imitrex |
|
|
Term
| Is the class cross reactivity low or high with sulfa allergies? |
|
Definition
|
|
Term
| do most antimicrobials cross the placenta and into breast milk? |
|
Definition
|
|
Term
|
Definition
| liver toxicity- immature fetal liver |
|
|
Term
| 5 drugs with teratogenicity? |
|
Definition
| Tetracycline, flagyl, cipro, rifampin, trimethoprim |
|
|
Term
| why do the elderly have altered oral absorption? |
|
Definition
| decreased gastric acidity, reduced motility |
|
|
Term
| why is distribution altered in the elderly? |
|
Definition
| increased total body fat, decreased plasma albumin |
|
|
Term
| how is metabolism altered in the elderly? |
|
Definition
| decreased hepatic blood flow |
|
|
Term
| how is excretion altered in the elderly? |
|
Definition
|
|
Term
| Can you give Ancef to a patient with an allergy to sulfa- reaction swelling? |
|
Definition
| yes, low cross reactivity |
|
|
Term
| can you give ancef to a PCN allergy reaction rash? |
|
Definition
|
|
Term
| Can you give Ancef to a PCN allergy reaction SOB? |
|
Definition
|
|
Term
| Can you give Ancef to an avelox reaction- IDK |
|
Definition
| ask more quesitons, probably ok |
|
|
Term
| Can you give Ancef to a patient allergic to "some antibiotic" reaction "I got sick" |
|
Definition
|
|
Term
| anaphylactic reaction- BP support is what? |
|
Definition
| Epi 1:10,000 (100mcg concentration) 1-2 ml at a time |
|
|
Term
|
Definition
| H1- Benedryl H2- Cimedtidine |
|
|
Term
|
Definition
| ATX 1 hour prior to surgical incision |
|
|
Term
|
Definition
| prophylactic antibiotic selection for surgical patients |
|
|
Term
|
Definition
| surgery patients with perioperative temperature management |
|
|
Term
|
Definition
| surgery patients on beta blocker need to continue |
|
|
Term
| 80% of nosocomial infections occur in 3 places |
|
Definition
| UTI, bloodstream, respiratory tract |
|
|
Term
| avg cost of treating a CRBSI? |
|
Definition
|
|
