pharm antimicrobial

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pharm antimicrobial
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2012-02-06 23:31:38
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pharm exam 2
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  1. what is antibiotic
    Natural chemical produced by a microbe to inhibit or kill other microbes
  2. what is antimicrobial
    includes any chemicals natural or syntheti which acts against microbes
  3. What is bacteriostatic
    inhibit bacterial growth and reproduction but don't kill bacteriol
  4. what is bacteriostacidal
    directly kills bacteria at adequate concentration
  5. Penicillins do what to cells
    causeses cell lyses
  6. what type of drugs are preferred for lifethreatening or CNS infection
    bacteriocidal
  7. what is beta lactamaze
    enzyme produced by bacteria to descroy structures of penicillins and cephalosporin and inactivate drug
  8. resistance bacterial
    acquired when bacteria survives to pass on genetic information.
  9. what are examples of frequent resistant organisms in health care
    • Methicillin resistant staph aureus
    • vancomycin resistan
    • enteroccoccus
    • c-diff
  10. best defense against resistant organismsq
    • handwashing and equipment disinfection
    • obtain specimin before therapy
  11. which organism cannot be eliminated by the use of antimicrobial gell
    • strep, pseudomonas, e.coli, c.diff
    • answer-cdiff because it forms spores to kill c.dif hand washing and dilute bleach is needed.
  12. what are teaching needs for patients on antibiotics
    • symptoms management and transmission
    • when antibiotics are not needed
    • how to take
    • timing for absorption
    • side effects
    • preventing and reporting complications
    • prebiotic and probiotic to prevent antibiotic associated diarrhea/thrush/candidiasis
  13. what drugs inhibit cell wall synthesis
    penicillins, cephalosporins, imipenens
  14. what antibiotic drugs inhibit intracellular protein synthesis
    tetracyclines and macrolides
  15. what antibiotic inhibit enzyme activity insse the cell
    fluoroquinolones, inhibits DNA synthesis
  16. Penicilin where does it come from
    mold has beta lactam structure
  17. how does penicillins act
    attach to proteins in bacterial cell wall and inhibit cell wass synthesis. kills bacteria by inhibiting cell wall synthesis
  18. 4 groups of penicilin
    natural, amino, penicilinase resistant and extended spectrum penicillins
  19. if strep throat has you chillin than you need a cillin
    penicillin most effective agains gram positive aerobic bacteria
  20. extended spectrum anti psudomonal penicillins
    has added chemicals to keep them from being broken dow. (ticarcillin and piperacillin)
  21. which penicillins have beta lactabase inhibitors
    extended spectrum anti-pseudomonal penicillins to prevent bacterial inactivation
  22. pharmacokinetics of penicilins
    • wide therapeutic index, short half life 4-6 hours, renal excretion,
    • hyperkalemia may occur
  23. adverse effects of penicillin
    • allergic reaction-maculopapular rash to severe anaphylaxyser
    • monitor client after 1st dose
    • Gi upset, diarrhea
    • headaches, seizures (high dose)
    • blood dyscrasias
    • overgorwth of fungus or resistant bacteria
    • penicillin is not metabolized in liver it is renally excreted
  24. Gentamycin and penicilin
    gentamycin weakens cell wall, penicillin can howerver inactivate gentamycin and therefore they must be given in seperate tubing
  25. How is potassium penicillin G available
    Only available IV
  26. how is procaine or banzathine "depot" penicillin available and what is it used for
    • IM formulation
    • Use for Gram positive cocci such as streptococcus pneumoniae and gram positive bacilli clostridium and anthrax; meningococcal meningitis; syphillis
  27. how should narrow specturm procaine and benzathine penicillin G be given
    Deep in muscle because it causes seizures and respiratory arrest in if given IV
  28. what is penicillin V used for and how is it administered
    • Oral formulation used for treating strep 25-50mg in children every 4 hours
    • 500mg in adults
  29. What are narrow spectrum penicillins used for
    Gram positive bacteria
  30. what are
  31. broad spectrum penicillin used for
    gram negative pacteria such as E. coli, salmonella, shigella, flue
  32. Ampicillin how can it be given
    can be given IV or PO. can be combine with sulabactam as IV (unasyn)
  33. when giving Ampicillin IV what must be done
    it must be diluted with 0.9% (normal) saline and given over 30 minutes
  34. why should ampicillin be given slowly
    given to fast or too high a dose can cause cns toxicity and seizures
  35. why is amoxicillin good when given PO
    it causes less diarrhea and better blood control. and when combined with clavulanic acid it is called augmentin
  36. what to do to reduce resitance to amoxicilin
    • absorb on empty somach 1 hour before or 23 hours after meals.
    • contact prescriber if symptoms dont resolve in 48-72 hours
    • complete all drug therapy
    • reduce risk of superinfection by takin with active bacterial/yeast cultures to prevent overgrowth of resitant organisms
  37. What are cephalosporins how to they act
    • They are bacterialcidal, low toxicity and wide therapeutic index; and are renally excreted
    • they have a beta lactam structure
  38. what generation of cephalosporins are used propholactically
    1st generation (cefazolin (ancef), cephalexin)
  39. 3rd generation cephalosporins
    Cefixime, cefotaxime, cetriaxoone (rocephin) they have a browad spectrum of activity and long halp life. anare are eliminated in bile
  40. what are the adverse effects for cephalosporins
    • 1% of those allergic to penicillin are allergic to cephalosporins
    • if allergic to penicillin avoid cephalosporin
    • vein wall erritation and thrombophlebitis are common with IV- can be prevented by slow administration and monitoring of iv site
    • bleeding can occure with cefotetan (cefotan)
    • if renal impaired need dose adjustment exception is ceftriaxone (rocephin) which is excreted through liver
  41. what is 1st generation cephalosporins used for
    given for surgical prophylaxis, it is used for gram positive bacteria. they are an alternative to penicillin
  42. side effects and nursing implication with cephalosporins 1st generation
    • Nausea, Canida growth
    • Diarrhea -if severe or accompanied with abdominal bloatting or fever test for c dif.
    • cefazolin (ancef) long acting
  43. what are 1st generation cephalosporins good for
    Gram + infection and surgical prophylaxi for skin organisms
  44. What are 3rd generation cephalosporins used for and characteristics
    • Active gram negative organism.
    • Good CNS penetration
  45. what are 3rd generation cephalosporins used for
    to treat gonorrhea (cefixime (supra))
  46. How is ceftriaxone excreted
    via liver rather than kidneys. can bind calcium (not good)
  47. describe ceftriaxone
    • active agains gram - bacteria, good CNS penetration,
    • can form fatal precipitate if given with calcium or IV solutions containing calcium (ringers or ringers lactate)
  48. describe 4th generation cephalosporins
    • Cefepime (maxipine)
    • Good CNS activity
    • reserve for serious infection to prevent resistance
  49. what should you look for in treatment with 4th generation cephalosporins
    Signs of AAPC and fungal overgrowth.
  50. describe imipenem
    • they have a beta lactam structure. and are very broad spectrum bacteriocidal
    • resistant to beta lactamase enzymes. when combine with cilastatin it prevents its distruction by renal enzymes and improves efficacy
    • they have good CNS penetration
    • cross sensitivity with penicillin
  51. what are the use of imipenes; carbapenems
    infections with mixed organisms and anearobes
  52. what are adverse effects of Impinem and carbapenems
    • Gi upset
    • diarrhea
    • alergic reactio n may occur
    • suprainfection.
  53. describe vancomycin (vancocin)
    • Active agains MRSA and G+bacteria.
    • it is a glycopetide
    • Poorly absorbed in GI but useful PO for treatment of C.Diff
  54. what can happen if vancomycin is rapidly infused
    • can cause histamine release with hypotension
    • tachycardia
    • flushing and hives
    • thrombophlebitis-monitor iv site
  55. what are the dangers of vancomycin
    at serum blood levels >30 ototoxicity can occur . therefore serum blood levels must be monitored 1.5 -2.5 hours after dose completed.
  56. how is vancomycin given
    • Po 125-500mg
    • Iv- 1gm over 60-90 minutes every 12-24 hours.
  57. antibiotics that inhibit protein synthesis
    tetracylines, macrolides, aminoglycosides
  58. characteristics of tetracylines
    • broad spectrum antibiotic which inhibits protein synthesis
    • has a transport system that allows tetracycline to enter bacterial cell but not human
  59. what is tetracycline used for
    • rickettsial diseases (rocky mt. spotted fever, typhus)
    • chlamydia infections
    • cholera
    • mycoplasma pneumonia
    • lyme disease
    • anthrax
    • H. Pylori treatment
    • topical for acne and peiodontal rinses
  60. characteristics of short acting tetracyclines
    • poorly lipid soluble, forms insoluble complex with calcium, iron, magnesium aluminum and zyinc
    • Ca, Mg, Fe, Al, Zn
  61. how should tetracycline be taken
    • absorption is reduced by food. must be taken 1 hour before or 2 hours after meals.
    • avoid taking with calcium or iron supplement or antacids
  62. how is tetracycline illiminated
    kidney and bile
  63. example of long acting tetracyclines
    • doxycycline; minocycline
    • they have increased liid solubility
  64. how are long acting tetracyclines excreted
    through bile they are lipid soluble. fewer problems with concurrent renal disease
  65. what are adverse effects of tetracyclines
    • Gi upset,
    • esophagitis
    • they bind to bones and teeth and cause discoloration. should not be used in children younger than 8 or during pregnancy
    • photosensitivity
    • hepatoxicity at high does >2gm/day
    • thrombophelbitis with IV admin and muscle irritation with IM admin
  66. how is IV tetracycline given
    • given slowly cause it causes thrombophlebitis
    • give slowly over 1-4 hours diluted in >100ml 0.9% saline
  67. client teaching for tetracycline
    • avoid sunlight,
    • take with a full glass of water to prevent esophagitis and sit up
    • take with food. take 2 hours apart from anacids and mineral supplements
    • report rash, yellow skin/jaundice, easy bruising or bleeding, fever chills or mouth sores
  68. characteristics of macrolides
    • big bacteria protein inhibitors
    • alternative for those with penicillin alergy.
    • bacteriostatic at low dose bacteriocidal at high dose
  69. what disease are macrolides used for
    • respiratory illness; legionnairs disesease,
    • perstussis
    • diphtheria
    • chlamydia
    • mycoplasmial
    • pneumonia
    • strep infection
  70. how is macroclides excreted
    • metabilized by liver and excreted in bile
    • has poor CNS penetration
  71. what are adverse effects of macrolides
    • gi upset - nausea; because it increases gi motility
    • diarrhea - may be severe
    • life threathning arrhythmias
    • thrombophelibitis with IV administration
    • inhibits metabolism of other drugs---inceased risk for drug toxicity
  72. characteristics of azithromycin (zithromax)
    • Bacteriocidal against respiratory infections
    • long half life. daily dosing
    • loading dose given initially
    • poor absorption when given with food
  73. what infections are zithromycin used for
    • influenza
    • N. Gonorrhea
    • Mycoplasma pneumonia
    • chlamydia
    • legionelle pneumonia
  74. effects of azithromycin
    • does not inhibit metabolism of other drugs
    • less gi upset and diarrhea than other macrolides and
    • does not prolong cardiac conduction or contribute to arrhythmia
  75. macrolides side effects
    • Gi upset, diarrhea,
    • abdominal pain
    • jaundice
    • increased liver enzymes
    • photosensitivity; rash
    • blood dyscrasia ; rare
    • dizziness
    • superinfection - candida, c. diff
  76. how is macrolides taken
    1 hour before and 2-3 hours after meals avoid taking with antacids
  77. what should pt taking macrolides report
    • yellow skin or eyes
    • abdominal pain
    • diarrhea
    • palpitations
  78. erythromycin how is it given
    • 1 hour before or 2-3 hours after meals (except azithromycin);
    • avoid giving with antacids
  79. what to monitor with erythomycin
    • liver function
    • CBC and electrolytes
    • bruising
    • bleedings
  80. how does erythromycin (macrolide effect liver)
    ihibits liver enzymes by erythromycin can raise the blood level of other durgs.
  81. erythromycin drug interactions
    • digoxin
    • tehophylline
    • phenytoin
    • carbamazepine
    • warfarin
    • ***blood levels of these drugs will increase with erythromycin or
  82. Linezolids characteristics
    • new drug for used against multidrug resitance vancomycin resistant enterococci (VRE and MRSA)ein
    • ribosomal prot ein inhibitor- bacteriostatic against Gram + aerobic bacteria
  83. how is linezolid (zyvox) given
    • PO
    • IV- potential for hypertensive crisis if combined with sympathomimetics like ephedrine or food containing large amounts of tyramine
  84. what happen if linezolid (zyvox) is used long term
    peripheral neuropathy
  85. what does tyramine do
    • vasoconstriction.
    • it is found in aged products.
  86. aminoglycosides "Mycin" drugs
    • Is a narrow spetrum bacteriocidal antibiotics
    • active against aerobic Gram - bacteria
  87. what is aminoglycoside used to treat
    • e.coli
    • klebsiella
    • proteus,
    • pseudomonas
  88. how is aminoglycosides absorbed
    • poorly absorbed in GI
    • Polar molecules
    • parenteral admin for serious infection
  89. effects of aminoglycosides
    renal and ototoxicity requires blood levels to be obtained dosing need adjustment to prevent renal damage and hearing loss
  90. example of a drug that is an aminoglycoside
    gentamycin
  91. characteristics of sulfonamides
    • broad specturm antibiotics which inhibits folic acid synthesis in bacterial cells.
    • Folic acid is necessary for DNA, RNA and protein synthesis
  92. how is sulfonamides excreted
    metabolized in liver and renally excreted
  93. what drugs are sylfonamides
    • Sulfamethoxazole/trimethorpim/SMX-TMP (bactrim/septra)
    • combines to folic acid ihibitors in one drug preparation
  94. what is sulfamethoxazole trimethroprim/TMP/SMZ (bactrim/Septra) used for
    • Urinary tract infection
    • Chlamydia
    • listeria
    • pneumocystis pneumonia
    • toxoplasmosis and malaria
  95. Hos is bactrim/septra given
    • IV or PO
    • Po given with food
  96. adverse effects of bactrim /septra (sulfonamides)
    • nausea/vomitting; rash
    • Photosynsitivity
  97. what are special concern with treatment with bactrim / septra
    hemolytic anemia with G-6pd deficiency and megaloblastic anemia with folate deficientcy
  98. why is bacrtrim and septra not given to children under 2
    may cause kirnicterus.
  99. what are nursing implication with bactrim/sepra (sulfonamides
    • encourage adequate fluids and folic acid
    • sun protection
  100. what is kinecterus
    billirubin get into CNS and stains brain tissue
  101. adverse effects of bactrim and septra
    • severe skin reaction, rash
    • gi upset
    • diarhea
    • hepatitis
    • jaudice
    • blood dyscrasias
    • phlebitis at IV site
    • crystaluria
  102. nursing consideration with sulfas
    • assess allergy
    • monitor CBCor Iv
    • urinalysis and liver function tests
    • increase fluid intake to 2-3 liters daily
    • teach food sources of folic acid
    • monitor iv for phlebitis
    • give drug over 60-90 min diluted in dextrose
  103. Fluoroquinolones
    broad spectrum antibiotics which disrupts bacterial DNA by ihibiting enzymes needed for replication; bacteriocidal activity
  104. how is fluoroquinolones affected by body
    metabolized by liver and excreted by kineys
  105. what are fluoroquinolones used for
    • UTI, gynecological infections
    • bone and join infections
    • intra abdominal
    • respiratory and skin infections
  106. fluroquinolones effects
    • effects cartilage formation so it is not used in pregnancy of kids.
    • floixins for infection reign..but watch out for the muscle pain
  107. what is criprofloxacin used for
    • UTIs
    • gonorrhea
    • traverles diarhea
    • pseudomonas
    • antrhax
  108. what can cipro be given with
    do not give with dairy. it causes decreased absorption, antacids, or mineral supplements. give supplement 2 hours afer. can bound cations.
  109. adverse effects of cipro
    • abdominal pain,
    • nausea
    • diarhea
    • CNs- dizziness, drowsiness confusion especially elderly
    • achilles tendon or tendon rupture
    • photosensitivity
    • hypo or hyperglycemia in diabetics
    • phlebitis with iv- given slowly because of vein wall irritation.
  110. client teaching for cipro
    • use sunscreen
    • avoid taking with vitamin/mineral supplements or antacids
    • avoid excessive sun exposure
    • report new muscle pain/tenderness

    diarrhea, vaginitis or other signs of superinfection
  111. nursing consideration with cipro
    • assess pregnancy
    • assess for new muslce or tendon pain
    • monitor liver and renal function
    • oral forms binds cat ion avoid giving with vitamin/mineral supplements or antacids
    • assess for dizziness or confusion esp elderly
    • monitor for superinfection
  112. Metronidazole (flagyl) what does it do
    • causes DNA breakage and interferes with nucleic acid synthesis in anaerobic organisms only
    • bacteriocydal for anaerobic bacteria and protozoa
  113. what does metronidazole treat
    • given for variety of intra abdominal , CNS, genitoruinary, soft tissue and bone/joint infections often with other aerobact bacteria drugs
    • c.dif overgrowth and AAPC
  114. how is metronidazole given
    • po or IV
    • IV loading dose is given at least 1 hour then every 6hrs.
  115. adverse effects of metronadazole
    • nausea, metallic taste, darkening urine
    • Headaches , dizziness,seizures, neuropathy, metallic taste, gi upset, dairrhea
    • Antabuse like reaction (sweating, flushing, nausea) when taken with alcohol---bad bad bad reaction.
  116. nursing consideration with metronidazole
    • assess for pregnancy
    • monitor CBC
    • assess for neurologic problems or changes
    • monitor GI effects
    • evaluate response to therapy
  117. client teaching with metronidazole
    • take with meals to avoid nausea
    • may cause metallic taste chewing gum may help
    • urine will turn reddish brwon during treatment
    • avoid alcohol while taking and 48 hours after
    • report numbness and tinglin in extremities, extreme weakness, fer/vhills, mouth sores and call provider if symptoms do not improve
  118. antimicrobial is effective therapy for ?
    against bacterial organisms (not viral)

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