Term
| Chemical substances that kill or suppress growth of microorganisms |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Suppress growth of microorganism |
|
Definition
|
|
Term
| Mechanisms of action for antibiotics/antivirals |
|
Definition
Inhibit cell wall synthesis (bactericidal)
Inhibit protein synthesis (bacteriostatic)
Disrupt cell wall permeability (bacteriostatic)
Inhibit synthesis of metabolites (bacteriostatic)
Inhibit nucleic acid synthesis |
|
|
Term
| Which drugs inhibit cell wall synthesis? |
|
Definition
Penicillins
Cephalosporins |
|
|
Term
| Which drugs inhibit protein synthesis? |
|
Definition
Linezolid
Erythromycin
Tetracycline |
|
|
Term
| Which drugs disrupt cell wall permeability? |
|
Definition
|
|
Term
| Which drugs inhibit synthesis of metabolites? |
|
Definition
|
|
Term
| Which drugs inhibit nucleic acid synthesis? |
|
Definition
|
|
Term
| Which organism is the most common cause of UTIs? |
|
Definition
|
|
Term
| Which organism is the most common cause of throat infections? |
|
Definition
|
|
Term
| What is the major principle for selection of antibiotics? |
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Definition
| Select the narrowest spectrum possible, so that it has less impact on the good/beneficial bacteria in the body |
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|
Term
| 2 categories of antibacterials |
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Definition
Work over time
Concentration dependent |
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Term
| Work over time antibacterials are used for: |
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Definition
Thick celled bacteria (Gram +)
Critical to keep even concentration of drug over several days
Usually requires dosing around the clock |
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Term
| Concentration dependent antibacterials are dosed how? |
|
Definition
Need enough to destroy DNA of bacteria
Can be once or twice daily dosing |
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Term
|
Definition
Those that occur during or after administration of antimicrobial therapy
Most common with a broad spectrum antibiotic that also affects normal flora (pseudomembranous colitis, candidiasis) |
|
|
Term
| Why is it so important to complete entire therapy of antibiotics? |
|
Definition
| Leads to recurrence of infection and/or bacteria can develop resistance |
|
|
Term
| 3 prototypes of penicillins |
|
Definition
Penicillin G
Penicillin V
Methicillin |
|
|
Term
|
Definition
Act on the developing bacterial cell wall, making it susceptible to osmotic pressure and it explodes
Most effective against Gram (+) bacteria
Contain a molecular structure called a beta-lactam ring which is essential to its antibiotic abilities |
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|
Term
|
Definition
Allergic reactions (< 5%)
Most common is uticaria within 3 days of use
Anaphylactic Shock (0.05%)
Treat mild rx with antihistamines or steroids
GI - N/V/D, stomatitis, glossitis
Renal - Interstitial nephritis
Phlebitis from IV PCNs (most are salts) |
|
|
Term
| How are bacteria resistant to penicillins? |
|
Definition
Over time, developed enzymes to dismantle beta lactam ring
B-lactamase or penicillinase destroy the B-lactam ring
Causes resistance to many penicillins and some cephalosporins that have B-lactam ring |
|
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Term
| What two drugs can contain B-lactam ring? |
|
Definition
Penicillins
Cephalosporins |
|
|
Term
| Indications for Pencillins G and V |
|
Definition
Gram (+) bacteria (staph if not producing penicillinase, strep)
Prophylaxis for suspectible pt undergoing dental or invasive procedures
Spirochetes and Gram (-) cocci (syphillis, lyme disease, meningitis) |
|
|
Term
| Antibiotics can cause pregnancy how? |
|
Definition
| Antibiotics mess with estrogen and affect oral birth control. Another form must be used while on an antibiotic regimen. |
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Term
| Penicillin Drug-Drug Interactions |
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Definition
| Probenecid - PCN drugs easily excreted from kidneys and this drug blocks that. This is a HELPFUL drug interaction. |
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Term
| What form of PCN can last from 24 hours to 4 weeks? |
|
Definition
Long-acting formulas given IM
Must be injected in gluteal muscle
Very thick/viscous formula
Inject slowly |
|
|
Term
| Penicillinase-resistant PCNs |
|
Definition
Methicillin
Dicloxacillin
Used to treat staph |
|
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Term
| Drug Resistance in Bacteria |
|
Definition
Most bug populations are not homogenous; some are only crippled and survive
If the susceptible ones die off, only the non-susceptible ones survive and pass on this trait to their offspring
Broad-spectrum are most likely to cause resistance
B/c different types of species can conjugate, DNA can be swapped and resistance can be created between species |
|
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Term
| Multiple Drug Resistant Organisms |
|
Definition
MRSA
TB
Vancomycin Resistant Enterrococcus
Syphilis
Strep pneumococcus |
|
|
Term
| Aminopenicillins (Broader spectrum) Prototype |
|
Definition
|
|
Term
|
Definition
Useful in selected Gram (-) bacteria, so broader spectrum, but not penicillinase-resistant
Protected from B-lactamase when potassium clavulanate added (Augmentin) |
|
|
Term
|
Definition
|
|
Term
| How are antipseudomonal PCNs typically used? |
|
Definition
| Combined with B-lactamase inhibitor |
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|
Term
|
Definition
Anticoags - Increased bleeding
Estrogen - Inactivates, need backup contraception
Viruses - esp mono - get a macular rash (not an allergy), esp with amoxicillin
Real risk of yeast infection with women |
|
|
Term
| Generations of Cephalosprorins and Uses |
|
Definition
First - Primarily Gram (+)
Second - Increased Gram (-)
Third - More active against Gram (-) than (+)
Fourth - Like 3rd generation, but more resistant to B-lactamase |
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|
Term
|
Definition
GI Sx
Superinfections, esp C. difficile
100% allergic Rx (cousin of PCN)
Candidiasis
Rash, pruritis, edema |
|
|
Term
| 1st Generation Cephalosproin Prototype and Main Use |
|
Definition
Cefazolin (Ancef)
Most frequent use is for wound infections, early post surgery pt |
|
|
Term
| 2nd Generation Cephalosproin Prototype and Main Use |
|
Definition
Cefoxitin (Mefoxin)
Cefotetan (Cefotan)
More effective against H. flu
Used for soft tissue infections |
|
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Term
| 3rd Generation Cephalosporin Prototype and Main Use |
|
Definition
Ceftriaxone (Rocephin)
Crosses BBB while others do not |
|
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Term
| 4th Generation Cephalosproin Prototype |
|
Definition
|
|
Term
|
Definition
Erythromycin (Emycin)
Azithromycin (Zithromax)
Clarithromycin (Biaxin) |
|
|
Term
|
Definition
| GI Sx can affect compliance |
|
|
Term
| Macrolide/Erythromycin (Emycin) Properties |
|
Definition
Oral and topical preparations
Drug of choice for many respiratory infections
One of the least toxic, few allergies |
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Term
| Macrolide/Erythromycin (Emycin) Indications |
|
Definition
Legionella
Brodetella
Diptheria
Chlamydia |
|
|
Term
| Macrolide/Erythromycin (Emycin) Drug-Drug |
|
Definition
Digoxin
Warfarin
Theophylline
Clindamycin
Carbamazepine |
|
|
Term
| How does food affect Erythromycin (Emycin)? |
|
Definition
|
|
Term
| Antiobiotic used for serious staph infections of bone, joint, septicemia, MRSA, prophylaxis for endocarditis |
|
Definition
|
|
Term
| When is the oral form of Vancomycin (Vancocin) used? |
|
Definition
| C. difficile (poorly absorbed) |
|
|
Term
| What is the histamine flush associated with Vancomycin (Vancocin)? |
|
Definition
|
|
Term
| How do you avoid red man syndrome? |
|
Definition
Keep infusion slow
Premedicate with Benedryl |
|
|
Term
|
Definition
Oto- and nephrotoxic
Red man syndrome |
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|
Term
|
Definition
|
|
Term
| Gentamicin (Garamycin) Indications |
|
Definition
Serious Gram (-) infections (pseudomonas, e. coli)
Used in conjunction with PCNs, cephs, or vanco |
|
|
Term
| Gentamicin (Garamycin) Absorption |
|
Definition
|
|
Term
| Gentamicin (Garamycin) Distribution |
|
Definition
| Wide distribution except for eye and CNS (opthalmic solution and ointment available) |
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|
Term
| Gentamicin (Garamycin) SE |
|
Definition
Nephrotoxic (kills renal tubules)
Ototoxic (kills sensory cells of inner ear) |
|
|
Term
| Gentamicin (Garamycin) OD |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Is Ciprofloxacin (Cipro)/Fluoroquinolone narrow- or broad-spectrum? |
|
Definition
| Synthetic, broad-spectrum |
|
|
Term
| Fluoroquinolone/Ciprofloxacin (Cipro) agent of choice for what 2 things? |
|
Definition
|
|
Term
| Fluoroquinolone/Ciprofloxacin (Cipro) is not effective against what? |
|
Definition
|
|
Term
| Fluoroquinolone/Ciprofloxacin (Cipro) Special Implications |
|
Definition
Tendon Rupture
Never given to pregnant pt or children
Can't take with Ca, Zinc, Pb, Al, or Mg (they chelate the drug and inactivate it) |
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|
Term
| Reaction that acts like anti-ETOH drug if taken with alcohol |
|
Definition
|
|
Term
| This antibiotic causes a disulfram reaction |
|
Definition
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|
Term
| Sulfonamides are synthetic and ______ (bacterio -cidal or -static) |
|
Definition
|
|
Term
| How do you take sulfonamides? |
|
Definition
| On empty stomach (good absorption) |
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|
Term
|
Definition
|
|
Term
| Sulfonamide Fluid Implications |
|
Definition
| Incr fluid intake (3 qt/day) |
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|
Term
|
Definition
GI Sx, crystalluria, bone marrow
Allergic Rx are common cross-sensitivity with some diuretics
Hematologic effects if long-term therapy
Kidney stones
Stevens Johnson Syndrome
Hypoglycemia risk with diabetics |
|
|
Term
| Urinary Tract Analgesic Prototype |
|
Definition
| Phenazopyridine (Pyridium) |
|
|
Term
| Phenazopyridine (Pyridium) use limits |
|
Definition
|
|
Term
| Phenazopyridine (Pyridium) SE |
|
Definition
Turns urine reddish-orange
Skin/sclera may appear jaundiced
Don't wear contacts |
|
|
Term
|
Definition
| Amphotericin B (Fungizone) |
|
|
Term
| Amphotericin B (Fungizone) Implications |
|
Definition
Wear gloves
Shake solution every half hour to keep in suspension
Tissue will slough away if infiltrates
Monitor renal function, bone marrow, and lungs |
|
|
Term
| Why are viruses so hard to treat? |
|
Definition
Virus has reached its peak of replication by the time symptoms appear
Viruses replicate in human cells and the drugs that inhibit replication affect host cells and might be toxic |
|
|
Term
| How are many viral conditions treated? |
|
Definition
|
|
Term
| Herpes/Varicella Prototype |
|
Definition
|
|
Term
| Acyclovir (Zovirax) Action |
|
Definition
| Interferes with DNA replication |
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|
Term
| Acyclovir (Zovirax) use, t 1/2, and dose |
|
Definition
Initiate within 24 hours of onset of S/S
T 1/2 is 2.5 hours
Need to take q4h while awake for acute infections
Chronic maintenance dose is bid (1x/day)
Available in PO, IV, and topical forms |
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|
Term
|
Definition
Poor absorption PO (20%), but can reach therapeutic blood levels, widely distributed even to CSF and the vesicles of herpetic lesions
Concurrent admin of probenecid (Benemid) incr serum levels |
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|
Term
|
Definition
GI Sx, dizziness
Phlebitis or acute renal failure can occur with rapid admin IV |
|
|
Term
| Acyclovir (Zovirax) Cautions |
|
Definition
Pt with dehydration or renal impairment are at risk for nephrotoxicity
IV admin over at least 1 hr to prevent renal crystals
Rotate infusion sites to prevent phlebitis
Monitor creatinine/BUN levels |
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|
Term
|
Definition
|
|
Term
| Amantadine (Symmetrel) Action |
|
Definition
| Blocks uncoating of the influenza A virus and the release of viral nucleic acid into host cell |
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|
Term
| Amantadine (Symmetrel) ADME |
|
Definition
Rapid absorption
Peak in 2-4 hr
Wide distribution, even to saliva/nasal secretions
Crosses BBB |
|
|
Term
|
Definition
|
|
Term
| How much does Oseltamivir (Tamiflu) help? |
|
Definition
Probably won't
Might decr length of illness by 1 day |
|
|
Term
|
Definition
Reverse Transcriptase Inhibitors
Protease Inhibitors
Nonnucleoside Reverse Transciptase Inhibitors |
|
|
Term
| How do protease inhibitors affect HIV? |
|
Definition
Affects the replication cycle of HIV
Results in immature, noninfectious viral particles |
|
|
Term
|
Definition
Lactic Acidosis
Lipodystrophy Syndrome |
|
|
Term
| Prototype for Hyperacidity |
|
Definition
|
|
Term
|
Definition
| Buffer/neutralize HCL acid and incr gastric pH |
|
|
Term
|
Definition
Hyperacidity r/t
Gastritis
Peptic Ulcer
GERD
Hiatal Hernia |
|
|
Term
| Goal of antacid neutralization |
|
Definition
|
|
Term
|
Definition
Rapid onset, lasts 20-40 minutes if fasting, but up to 3 hr if taken 1 hr pc
Small amt absorbed and the rest excreted in feces |
|
|
Term
|
Definition
Reduces absorption, causes chelation, of many drugs
B/c stomach is less acidic, the enteric coating dissolves faster, releasing drugs earlier than expected |
|
|
Term
| Calcium Carbonate (TUMS) Antacid SE |
|
Definition
Gastric acid hypersecretion
Constipation
Kidney failure
Incr Ca levels |
|
|
Term
| How many TUMS/day would be needed to get Ca dose? |
|
Definition
|
|
Term
| Long-term use of Calcium Carbonate (TUMS) and other antacides can cause what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Block receptors in the chemoreceptor trigger zone in the emetic center in the medulla that are activated by neurotransmitters |
|
|
Term
|
Definition
Anticholenergic
Antihistamines
Phenothiazine
Dopamine Receptor Blockers
Serotonin Receptor Blockers
Cannabinoid
Bismuth Salts |
|
|
Term
| Dopamine Receptor Blocker Antiemetic Prototype |
|
Definition
|
|
Term
| Metoclopramide (Reglan) SE |
|
Definition
Drowsiness
Diarrhea
Extrapyramidal Effects |
|
|
Term
|
Definition
|
|
Term
| Maalox is a combination of what two things? |
|
Definition
Aluminum Hydroxide
Magnesium Hydroxide |
|
|
Term
| 4 Main Drug Groups for Ulcers/Reflux |
|
Definition
Antacids
H2 Receptor Blockers
Cytoprotective Agents
Proton Pump Inhibitors |
|
|
Term
|
Definition
Cimetidine (Tagamet)
Also, Ranitidine (Zantac), Pepcid, Axid |
|
|
Term
| Cimetidine (Tagamet) Action |
|
Definition
Prevent histamine from stimulating H2 receptors on gastric parietal cells, thus reducing volume of gastric acid secretion
Relieves pain from hyperacidity |
|
|
Term
|
Definition
Tablets
Parenteral for IV use |
|
|
Term
|
Definition
Anorexia
N/V/D
Constipation
Confusion |
|
|
Term
|
Definition
If taken with antacids, will have reduced effect
Reduces hepatic metabolism of many drugs |
|
|
Term
|
Definition
Tachycardia
Changes in mental state |
|
|
Term
| Cytoprotective Agent Prototype |
|
Definition
|
|
Term
| Sucralate (Carafate) Action |
|
Definition
| Chemically combines with substances from damaged cells in the ulcer crater, forms a protective acid-resistant barrier in the crater and prevents further errosion |
|
|
Term
| Sucralate (Carafate) Indications |
|
Definition
Peptic ulcer Tx
Prevent NSAID ulcers |
|
|
Term
| Sucralate (Carafate) ADME |
|
Definition
Minimal systemic absorption
Excreted in feces |
|
|
Term
| Sucralate (Carafate) Drug-Drug |
|
Definition
| Binds to some meds, such as Dilantin |
|
|
Term
| Proton Pump Inhibitor Prototype |
|
Definition
|
|
Term
| Omeprazole (Prilosec) Action |
|
Definition
| Blocks acid secretion by inhibiting the ATPase enzyme at the gastric parietal cells |
|
|
Term
| Omeprazole (Prilosec) Indications |
|
Definition
Severe erosive esophagitis from GERD
Duodenal ulcer
Long-term Tx of hypersecretion |
|
|
Term
| Omeprazole (Prilosec) ADME |
|
Definition
Rapid onset
Peak 2 hr
Duration 3-4 days |
|
|
Term
|
Definition
Heartburn, weakness, dizziness (esp long-term)
Incr risk of C. diff, pneumonia, development of food allergies
Osteopenia |
|
|
Term
| Omeprazole (Prilosec) Education |
|
Definition
Therapy for healing of uclers is 4-6 weeks
Long-term use can change gastric secretions |
|
|
Term
| Does H2 blocker or PPI work better for gastritis or ulcer prevention? |
|
Definition
| Cheaper H2 is just as effective as PPI |
|
|
Term
| Does H2 blocker or PPI work better for repair of gastritis or ulcers? |
|
Definition
|
|
Term
| Why are IV doses of H2s or PPIs given? |
|
Definition
| Given in hospital to prevent stress or curling's ulcers from the heavy physiologic stress of illness |
|
|
Term
|
Definition
Antibiotic (H. pylori infection)
Bismuth
PPI
Treatment for 2 weeks or longer (85-90% cure rate) |
|
|
Term
| What are the steps for therapy in constipation? |
|
Definition
Incr water intake, fiber-rich foods, and exercise
Limit constipating drugs such as aluminum antacids, calcium/iron supplements, opiates
Laxatives if nothing else works |
|
|
Term
| Ingredients of combination antacid, Mylanta |
|
Definition
Aluminun Hydroxide
Magnesium Hydroxide
Simethicone |
|
|
Term
| Laxative Stimulant Prototye |
|
Definition
|
|
Term
| Bisacodyl (Dulcolax) Action |
|
Definition
| Works on intestinal muscles and secretory cells to stimulate motility and fluid movement |
|
|
Term
| Bisacodyl (Dulcolax) Onset |
|
Definition
|
|
Term
|
Definition
Cramping
Watery discharge
Fluid loss
Dependancy |
|
|
Term
| As a GI stimulant, how does metoclopramide (Reglan) work? |
|
Definition
Incr acetylcholine levels and stimulates PNS
Incr GI secretions and motility to rapidly move food through the GI tract |
|
|
Term
| Metoclopramide (Reglan) Indications |
|
Definition
GERD
Postoperative risk for ileus
Eliminate barium |
|
|
Term
| When can you not give Metoclopramide (Reglan)? |
|
Definition
| Intestinal blockage (will cause rupture) |
|
|
Term
| Prescriptive Laxative Prototypes |
|
Definition
Lactulose (Chronulac, Duphalac)
Polyethylene Glycol (GoLYTELY) |
|
|
Term
| Lactulose (Chronulac, Duphalac) Action |
|
Definition
Consists of sugars which are metabolized to acids to produce osmotic effect with incr fluid accumulation, distention, peristalsis
Also decr serum ammonia levels in person with chronic liver disease |
|
|
Term
| Lactulose (Chronulac, Duphalac) ADME |
|
Definition
Bowel movement within 24-72 hours
Minimal absorption |
|
|
Term
| Lactulose (Chronulac, Duphalac) Indication |
|
Definition
| Chronic constipation that does not resond to OTC bulk laxatives |
|
|
Term
| Lactulose (Chronulac, Duphalac) SE |
|
Definition
Dose-related flatulence and intestinal cramps, gas, belching
Excessive doses may produce nausea and diarrhea |
|
|
Term
| Polyethylene Glycol (GoLYTELY) Action |
|
Definition
Mixture of PEG, sodium salts, and potassium chloride
Isotonic to body fluids so does not absorb or secrete electrolytes |
|
|
Term
| Polyethylene Glycol (GoLYTELY) Indications |
|
Definition
Bowel cleansing before colonoscopy or barium enema
Can be safely used in pt who are dehydrated or have renal or cardiac disease |
|
|
Term
|
Definition
Placement of drug can be important
Rotation of sites if transdermal patches
Protect self by wearing gloves |
|
|
Term
Placement of drug can be important
Rotation of sites if transdermal patches
Protect self by wearing gloves |
|
Definition
Muscous membranes have increased, even toxic doses possible
Abraded or open skin is greater
Less used in intertriginous areas
Washed off for next application? |
|
|
Term
| Order of Effectiveness for Topicals |
|
Definition
Ointments
Gels
Creams
Lotions
Spray |
|
|
Term
| Meds that can cause Stevens Johnson Syndrome |
|
Definition
Sulfas
Barbs
Carbamazepine
Gold
Griseofulvin
PNC
Phenothiazines
Phenytoin
Tetracyclines |
|
|
Term
|
Definition
If PE tubes in place, use otic drops with caution
Should not swim or shower immediately after drops |
|
|
Term
|
Definition
Warm in hands to decr sudden blink
Turn head so that med and tears do not cross bridge of nose and impact contra-lateral eye
Make a pocket with inferior lid to place drops into
Do not touch tip of bottle to eye
Place finger over tear duct for 3 minutes
If more than one type of drop needed, wait 5 minutes between drops |
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