Pharm exam 1 continued

what do antimicrobial drugs do

used to prevent or treat infection

what is a broad spectrum drug

kills a wide spectrum of bacteria (gram + and gram -)

what is a narrow spectrum drug

specific against few groups of bacteria

what does bactericidal mean

kills bacteria directly

what does bacteriostatic mean

halts bacterial growth without killing bacteria

why is acquired resistance bad

its bad because eventually there will be no drugs that can take the disease out

how is drug resistance built up in bacteria

through conjugation

what is conjugation

when DNA is transferred from one bacterium to another

the bigger/ more stronger the drug we use, the more…

the more resistance we see

the more antibiotics used, the faster…

the faster drug resistant organisms emerge

what are nosocomial infections

health care associated infections (MRSA), usually much harder to treat

what are superinfections

new infection appears during the tx of another infection (c. diff)

what is a community acquired infection

infection from community (strep pneumo)

why won’t antibiotics treat viral infections

because antibiotics treat bacterial things, not viral things

what should you do before giving an antibiotic

do cultures!

empiric therapy

using a broad spectrum antibiotic to try and cure the infection when we don’t know which bacteria is causing the infection yet

which two drug endings are extremely broad spectrum

penem and cefepime

if you start feeling better, can you stop taking the antibiotic

no, you have to stick with the antibiotic even if you’re feeling better

when taking two drugs together for an additive reaction, what do you have to be careful for

increased toxicity, superinfections, and risk of resistance

what are prophylactic drugs and when are they taken

you don’t have an infection, but are taken to prevent an infection

when would you take a prophylactic drug

before a surgery

why don’t we always give antibiotics for fevers

because fevers aren’t always caused by infections (pain can cause fevers)

what do you have to do to abscesses before treating them with an antibiotic

you have to drain it before treating it

for what drugs do you have to pay close attention to drug levels

narrow therapeutic drugs

what three bacteria are gram positive

staphcoccal, streptococcal, and enterococcus

if a drug is given via IV, its given in what setting

its given inpatient

if a drug is given PO, it can be given in what setting

it can be given outpatient

what does beta lactam refer to

the structure of the drug

what drug is the number one cause of c diff

Clindamycin

whats should the pt not be taking when they’re on metronidazole

no alcohol during or 3 days after this tx

MOA of metronidazole

inhibit nucleic acid synthesis

spectrum of Metronidazole

anaerobes only

why do you have to be careful about taking “safe” drugs when you’re pregnant

because drug safety varies depending on which trimester you’re in

acronym for drugs that should be avoided during pregnancy

Don’t Forget About The Babe

which category of drugs should you not take during pregnancy

category D

What drugs are in the acronym Don’t Forget About The Babe

category D, Fluoroquinolone, Aminiglycosides, Tetracyclines, Bactrim (TMP/SMX)

which drugs belong in the acronym ChildCare (same drug group)

Cillins and cyclines

which drugs belong in the acronym Move The Food (same drug group)

Metronidazole, Tetracycline, Fluroquinolone

which drugs belong in the acronym My Friends Prolong Quiet Talks

Macrolides, Fluroquinolones

what is the second line tx for c diff

Metronidazole

what is the first line of tx for superinfections like c diff

Fidaxomicin

what drug primarily can help treat MRSA

Daptomycin

MOA of Daptomycin

disruption of bacterial DNA, RNA and protein synthesis

spectrum of Daptomycin

kills most gram positive bacteria

what levels should you watch when on Daptomycin and why

CPK levels for possible muscle injury

what drugs are you giving to the pt with TB for the first four months

RIPE

what does RIPE stand for

Rifampin, Isoniazid, Pyrazinamide, and Ethambutol

whats the primary agent for the tx and prophylaxis of TB

Isoniazid

main side effect of Rifampin

red to orange discoloration of body fluids, sweat, urine, tears

what about metabolism do you have to consider with Rifampin

its a strong inducer of CYP

what do you use Rifampin for

tx and prevention of TB

what drugs would you use in HIV pts who have TB

Rifabuten and Rifapentine

what is Pyrazinamide used for

prevention and tx of TB

used for TB tx in resistant cases

Ethambutol

what should you specifically be monitoring for when taking Ethambutol

optic neuritis, blurred vision

when taking Ethambutol, what causes blurred vision

its dose related

MOA of Carbampenems

binds to PCN binding protein and weakens cell wall

Spectrum of Carbampenems

Most broad spectrum

examples of Carbampenems

Meropenem, Imapenem, and Ertapenem

although in the same class as Imipenem and Meropenem, whats the deal about Ertapenem

its not as broad spectrum as its brothers and sisters in Christ

what is Doripenem excellent against

Pseduomonas

what do Monobactams only treat

gram - bacteria

example of a onobactam

Aztreonam

MOA of Monobactams

inhibits cell wall synthesis

most common effect when taking Aztreonam

allergic reaction

if Teracycline levels get high, what do you want to make sure you do

call the provider

MOA of Tetracyclines

inhibit protein synthesis

spectrum of tetracyclines

Broad

common uses for Tetracyclines

acne, lymes, malaria, peptic ulcer disease, rheumatoid arthritis

major Tetracycline adverse effects

DReSS, intracranial HTN

Tetracycline absorption is decreased if you take

ca and iron supplements, milk products, mg-containing laxatives, and most antacids

should people with kidney disease be on tetracyclines

no

why should people with kidney disease not be on tetracyclines

bc tetracycline is primarily eliminated in urine

what can tetracyclines potentially discolor premanently

teeth

if a pt is on doxycycline and complains of gastric irritation what should the nurse do

give pt food, such as crackers or toast, with meds

first line of tx for c diff

Vancomycin orally

MOA of Vancomycin

inhibits wall synthesis

spectrum of Vancomycin

gram + only

adverse effects to watch for when taking Vancomycin

red man syndrome, ototoxcitiy, and nephrotoxicity, DReSS

when taking Vancomycin, what is red man syndrome that can sometimes occur when you’re on it

not an allergy, this happens if the infusion rate is too fast, which varies depending on pt sensitivity to the drug

when taking vancomycin and aminoglycosides, what adverse effect can be permanent

ototoxicity

MOA of Fosfomycin

disrupts synthesis of peptidoglycan polymer strands that compse cell wall

when would you be given Fosfomycin

for single dose therapy of uncomplicated UTI

drug of choice for Legionnaire’s disease

Erythromycin

MOA of Macrolides

inhibit bacterial protein synthesis

when would you use macrolides

in place of PCN if pt has a PCN allergy

don’t give Macrolides to what pts

liver failure pts

adverse effect of erythromycin and Clarithromycin

prolonged QT interval (EC cause long QT)

MOA of Clindamycin

inhibits protein synthesis

spectrum of Clindamycin

gram +, anaerobic infections outside CNS, aerobes, alternative to PCN

what do you need to be sure to monitor in a pt on Linezolid

blood labs

MOA of Linezolid

inhibit protein synthesis

spectrum of Linezolid

gram + resistant bugs (MRSA, VRE)

adverse effects of Linezolid

headaches, myelosuppression

If you give a pregnant mom Chloramphenicol what might happen

grey baby syndrome

MOA of chloramphenicol

inhibits protein synthesis

spectrum of Chloramphenicol

broad spectrum, usually use in only life threatening situations when safer drugs are ineffective or contraindicated

adverse effects of Chloramphenicol

fatal aplastic anemia, gray syndrome

the two topical antibiotics indicated for impetigo

retapamulin and mupirocin

what drug is used for MRSA in nostrils

Mupirocin