Card Set Information
What does TMP/SMX stand for?
Which two anitbiotic drugs are commonly used together?
What is the MOA of TMP/SMX?
Inhibit enzyme systems used by bacteria to synthesize TetrahydroFolic Acid (TFA, same as folic acid.)
How does bacteria obtain THF (folic acid), how do we obtain it, and why is the difference important?
Bacteria synthesize their own folic acid, we obtain it from our diet. Imporant because it is selective action against microbes.
Which type of bacteria has an outer membrane and why is it significant?
Gram-, it makes it harder to kill
Which has more peptidoglycan, gram + or -?
What are the three most common indications for TMP/SMX?
2. Otitis Media
3. PCP (pneumocytis jiroveci)
What are common adverse effects of TMP/SMX?
Nausea, vomiting, rash
What renal considerations apply with TMP/SMX?
Pt needs to maintain good hydration because TMP/SMX can crystalize in the renal tubules causing blockage.
Why should TMP?SMX not be used with infants, breastfeeding moms or preggers?
Causes Kinicterus (biliruben in kids brain)
Are all narrow or all broad penicillins suspectible to beta lactamase?
What is another term used to describe penicillins?
What is the MOA for beta lactams?
Inhibit cell wall synthesis.
What is penicillin G considered narrow spectrum even though it works against many gram+ and - bacteria?
Lacks coverage against gram- bacilli
What is pruritis?
What is special about broad spectrum penicillins?
Work against gram- bacilli
What is unique about Zosyn and when is it used?
It contains Tazobactum, a B-lactamase inhibitor. It is used with Piperacillin, a 4th generation penicillin.
What contains Tozabactum and is used as an adjuvant with Piperacillin?
How do B-lactams inhibit cell wall synthesis?
As the cell wall weakens, the penicillin binds to the proteins on the cell membrane. These are called PBP, penicillin binding proteins.
What is the most common adverse side effect of penicillin? Provide examples.
Hypersensitivities such as maculopapular rash, angiodema (selling in face/lips) and anaphylaxis.
What is diarrhea a common side effect of penicillin?
List nursing interventions with penicilin use.
Wear medic alert bracelet
Instruct pt to report pruritus, urticaria or difficulty breathing
What is the most widely used group of antibiotics?
How do cephalosporins resemble penicillin in structure? What is different?
Cephalosporins have two Beta lactam rings, not just one like pencillin has
We do NOT use Vancomycin for C. diff; what do we use instead? How do you remember it?
Metranidozole; We give metranidozole to people on the metra because they all have C. diff.
What is the MOA of Cephalosporins?
Inhibit cell wall synthesis
What do we see with each new generation of cephalosporins?
↑activity against gram- and anaerobes, ↑ resistance to destruction by B-lactamase, ↑ ability to penetrate the CNS
What cephalosporin is commonly sued as a profylactic b/f surgery? What generation is it?
Cefazolin; first generation
Describe a 1st generation cephalosporin.
Excellent gram+ coverage, poor gram-
Good alternative for people with mild penicillin allergies
Describe a 3rd generation cephalosporin.
excellent gram-, poor gram +, good CNS penetration and good resistance to beta lactamase.
Describe a 4th generation cephalosporin.
Excellent gram + coverage, good gram - coverage, good CNS penetration, resistance to beta lactamases.
What is a common 4th generation cephalosporin?
Why is it importan that 3rd and 4th generation Cefasporins have good CNS distribution?
Because they can be used to treat some meningitis.
List 4 adverse reactions to cephalosporins.
Describe why there are bleeding tendancies associated with some cephalosprins.
Disturbances of vitamin K metabolism
Describe why there is a risk for thrombophlebitis with cephalosporins.
Irritation to vein when cnocentrated solutions are infused to rapidly.
Describe why there is a risk for renal toxicity with some cephalosporins.
Cephalosporins are eliminated by the kidneys which is problematic for people with renal impairment, so watch BUN/Creatinine.
Which drug should you NOT use with C. diff?
What does Vancomycin vanquish?
Phospholipids in the cell wall
How does the stucture of vacomycin differ from penicillin?
Does not contain a B-lactam ring.
What is the MOA for vancomycin?
Inhibits synthesis cell wall phospholipids
Describe the antibacterial spectrum for Vancomycin.
gram+, MRSE, MRSA
What are vancomycin resistant organisms treated with?
Zyvox, tygacil, Cubicin
What is unique about the metabolism of Vancymycin?
Metabolism of the drug is minimal, with 90-100% excreted by the glomerular filtration, so unchanged drug appear in the urine.
Due to the side effects of Vancomycin, what should the nurse monitor?
List side effects of Vancomycin.
Plebitis at infusion site
Flushing accompanied by hypotension (red man syndrome)
Shock due to histamine relase caused by rapid release
Dose-related hearing loss in renal insufficiency
Ototoxicity and nephotxicity common when administered with other similar drugs
What is the treatment for C. diff?
Treat the people on the Metro train with Metronidazole because they have C. diff
Why did the person taking Vancomycin with renal insufficency cross the road?
Because they couldn't hear me say STOP!! HA HA HA... (vancomycin can cause dose-related hearing loss in people with renal insufficiency.)
T/F: Tetracycline is a class and a particular drug.
List three oral tetracyclines available in the U.S.
Tetracycline, Doxyclycline, Minocycline
What is the MOA of Tetracyclines?
Inhibits protein synthesis by binding reversibly to the 30S subunit. It works because the bacterial ribosome contains smaller and different subunits than the animal ribosome.
What should you not take tetracyclines with and why?
Dairy and antacids because tetracycline binds with calcium and magnesium to form insoluble complexes.
What is the bioavailability of Tetracyclines?
95% w/ or w/out food
What types of tetracyclines are used with people who have renal failure? Why?
Doxycycline and Minocycline because they are excreted via bile into the feces.
Why are Tetracyclines not used with mothers, preggers, or kids under 8?
Effects on calcified tissue (fucks up teeth).
List 4 side effects of Tetracyclines.
Effects on calcified tissue
Vestibular prolems (dizziness is worse with minocycline)
Are tetracyclines broad or narrow spectrum?
What type of drug is doxycycline? Why does Rush stockpile it?
Tetracyclin; good to use against anthrax
How do you remember Doxycyline?
People in their 30s can take Doxycycline for anthrax and H. pylori as long as they are not preggers cause it will fuck up the baby's teeth.
Are Macrolides broad or narrow spectrum?
What classification is erythromycin? What is a major side effect of it?
Macrolide; Can cause prolonged QT interval wich can cause sudden death.
What is the MOA of macrolides?
Macroglides inhibit protein synthesis by binding irreversibly with subunit 50S of the bacterial ribosome.
What is the most common Macrolide?
What drugs do we avoid using in conjunction with Macrolides?
Describe the distribution and 1/2 life of macrolides.
Wide distribution in tissues and long 1/2 life.
How are macrolides excreted from the body?
Macrolides are excreted in active form in the bile, while the metabolites are excreted in the urine.
What is the most common adverse side effects of macrolides.
What is the prototype Fluroquinolone? What is the MOA?
Cipro is an anti-bacterial that interferes with DNA gyrase.
What are the indications for Cipro?
What are the adverse side effects of Cipro?
CNS (dizzy, headache, nervousness, fever)
Tendon rupture in kids, don't give to preggers
Is Cipro Broad or Narrow?
What is the main idications for Aminoglycosides?
treatment of serious infections due to gram- bacilli
Are aminoglycosides broad or narrow? What is the main organism they are used against?
What is the MOA for aminoglycosides?
Disrupts protein synthesis at 30S subunit
What is the prototype drug for Aminoclycosides?
What is the preferred route for Amikacen? Why?
IV because of poor absorption orally
Describe the pharmacokinetic distribution of of Amikacin.
High distribution in the kidneys and inner ears
Low distribution in CNS and tissue
Do amyglucosides cross the placenta?
What is unique about the elimination/metabolism of Amikacin?
It is not metabilized in the host, it quickly leaves through the urine.
What is it important to monitor when giving Amikacin. Why?
Monitor blood levles for peak and trough serum levels to reduce toxicity.
Describe the possible side effects of Amikacin.
: dose related, irreversible deafness with fetus, tinnitus, vertigo, loss of balance, do not give with loop diuretics
: careful when giving other nephrotoxic drugs like vancomyin, aspirin, NSAIDS