Pharm 2 - exam 2

What term refers to the ability of a drug to injure a target cell or organism but not other cells or organisms in contact with the target?

Selective toxicity

What term refers to to the ability to kill bacteria?

Bactericidal

What term refers to the ability to suppress or slow microbial growth, but not kill it?

Bacteriostatic

What is a new infection that appears during the course of treatment for a primary infection?

Superinfection

What are the two ways an antimicrobial can be classified?

- By susceptible organism

- By mechanisms of action

What is the random change in a microbe's DNA or genetic code?

Spontaneous mutation

What occurs when DNA from one microbe is transferred to another?

Conjugation

What is the goal for treatment with antibiotics?

Most effect with least harm

What host factors assist in selecting antibiotics?

- Host defenses

- Site of infection

- Age

- Pregnancy

- Allergies

- Genetic factors

What are indications of antibiotic combination therapy?

- Initial treatment of severe infection of unknown etiology

- Mixed infections

- Prevent resistance

- Decreased toxicity

- Enhanced antibacterial action

When is prophylactic antibiotic use appropriate?

- Prior to surgery

- Patient susceptible to bacterial endocarditis undergoing an invasive procedure

- Neutropenic patient

- Recurrent UTI

How do you monitor antimicrobial therapy?

- Monitor clinical response

- Monitor lab results

- Monitoring frequency is directly proportional to infection severity

How does penicillin work?

Weakens the cell wall, water is absorbed, and the cell swells and bursts

What is the primary side effect of penicillin?

Allergic reaction

What are enzymes that cleave the beta-lactam ring, rendering antibiotics inactive?

Beta-Lactamases

Is penicillin G affective against gram+, gram-, or both?

Gram+ and some gram-

Does penicillin G have a broad or narrow spectrum?

Narrow

What are uses for penicillin G?

- Neisseria meningitides and non-penicillinase producing strains of Neisseria gonorrhoeae

- Anaerobic bacteria

- Spirochetes

Can penicillin G be given orally?

No

How is penicillin G excreted?

Through kidneys

Can patient's have an allergic reaction to penicillin G upon their first dose?

Yes

What may occur as an anaphylactic reaction to penicillin?

Laryngeal edema, bronchoconstriction, sever hypotension

Aside from allergic reactions, what are other adverse effects of penicillin G?

- Pain at IM injection site

- Prolonged sensory and motor dysfunction if injected into peripheral nerve

- Neurotoxicity (seizures, confusion, hallucination)

- Gangrene, necrosis, or soughing of tissue if injected into artery

What drug may be inactivated if given with a high-dose penicillin?

Aminoglycosides

Can penicillin V be given orally?

Yes

When should penicillin V be administered?

With meals

What type of drug is ampicillin?

Broad-spectrum penicillin

What type of drug is amoxicillin?

Broad-spectrum penicillin

What are side effects of broad-spectrum penicillins?

- Rash

- Diarrhea

What type of drug is ticarcillin?

Extended-spectrum penicillin

What type of drug is piperacillin?

Extended-spectrum penicillin

How is penicillin G administered?

IV or IM

What should be asked before administering antibiotics?

If patient has had a reaction before

What is a risk factor for potassium penicillin?

Hyperkalemia

What must the bacteria be doing in order for penicillin to work?

Actively growing and dividing

What may be taken if penicillin allergic reaction is minor?

Cephalosporin

Is narrow or broad spectrum better?

Narrow

What is the mechanism of action of cephalosporins?

Disrupts cell wall synthesis

Do cephalosporins contain a beta-lactam ring?

Yes

Are cephalosporins bactericidal or bacteriostatic?

Bactericidal

Do cephalosporins have a broad or narrow spectrum?

Broad

What are first generation cephalosporins used for?

Prophylaxis for surgery patients

What are second generation cephalosporins used for?

Haemophilius influenza, Klebsiella, pneumococci and staphylococci; orally for otitis, sinusitis, and respiratory tract infections

What are third generation cephalosporins used for?

Gram negative infections (able to penetrate CSF)

What are fourth generation cephalosporins used for?

Hospital associated pneumonias and pseudomonas

What are fifth generation cephalosporins used for?

MRSA

What are adverse effects of cephalosporins?

- Allergic reaction

- Bleeding (cefotetan & ceftriaxone)

- Hemolytic anemia

- Thrombophlebitis

What is the mechanism of action of Carbapenems?

Binds to penicillin binding proteins causing weakening of the bacterial cell wall and cell death

Do carbapenems have a broad or narrow spectrum?

Broad

What are carbapenems used for?

Serious infections caused by gram positive cocci, gram negative cocci, gram negative bacilli, and anaerobic bacteria

What is an adverse effect of carbapenems?

Superinfection with bacteria or fungus

What is the mechanism of action of vancomycin?

Disrupts the cell wall by binding to molecules that are precursors for cell wall synthesis

What are therapeutic uses for vancomycin?

- C. Difficile

- MRSA

Is vancomycin effective against gram positive or gram negative bacteria?

Positive

What are adverse effects of vancomycin?

- Ototoxicity

- Renal failure

- Red man syndrome

When given for C. Difficile, is vancomycin given orally, IV, or IM?

Orally

What is the mechanism of action of tetracycline?

Inhibits bacterial protein synthesis

Is tetracycline bactericidal or bacteriostatic?

Bacteriostatic

Does tetracycline have a broad or narrow spectrum?

Broad

What are therapeutic uses for tetracycline?

- Infectious disease (rickettsial diseases - rocky mountain spotted fever, typhus fever, Q fever, cholera, Lyme disease, H. pylori)

- Acne

What are adverse effects of tetracycline?

- GI irritation

- Effects on bone and teeth (discoloration)

- Photosensitivity

What is a contraindication for teteracycline?

Do not give to those under the age of 8

Pregnancy

What is the mechanism of action of macrolides?

Inhibits protein synthesis

Do macrolides have a broad or narrow spectrum?

Broad

What are therapeutic uses for macrolides?

- Bordetella pertussis

- Corynebacterium diptheria

- M. pneumoniae

What are adverse effects of macrolides?

- GI disturbances

- QT prolongation and sudden cardiac death