PHAR W5

What are **drugs that fight disease-producing microorganisms** such as bacteria, viruses, fungi, etc.?

**Anti-Infectives**

What are also known as __**prokaryotes**__, in which these are ***single-celled organisms lacking a true nucleus and nuclear membrane***?

**Antibacterials**

How long do ***bacteria reproduce by cell division***?

20 minutes

What do you call a **rod-shaped bacteria**?

**Bacillus**

What do you call a **spherical bacteria**?

**Cocci**

What do you call **clusters of bacteria**?

**Staphylo**

What do you call **chains of bacteria**?

**Strepto**

What process was discovered by ***Hans Christian Gram***, a __**danish bacteriologist**__?

**Gram staining**

What is determined by the ***ability of the bacterial cell wall to retain a purple stain by a basic dye***?

**Gram staining**

What __**dye**__ is used in the ***Gram staining process***?

**Crystal violet**

What do you call the ***bacteria that retained a purple stain in Gram staining***?

**Gram positive**

What do you call the ***bacteria that did not retain a purple stain in Gram staining***?

**Gram negative**

What **destroys beta-lactam antibiotics** such as *penicillins* and *cephalosporins*?

**Beta-lactamase**

What is the __**classification of bacteria**__ in which it is ***effective against one type of organism****, Gram positive or not*?

**Narrow spectrum**

What is the __**classification of bacteria**__ in which it is **effective on** ***both Gram positive or negative organisms***?

**Broad spectrum**

***Penicillin*** and ***erythromycin*** are what spectrum?

**Narrow spectrum**

***Tetracycline*** and ***cephalosporin*** are what spectrum?

**Broad spectrum**

What do you call the ***drugs that inhibit growth of bacteria***?

**Bacteriostatic**

What do you call the ***drugs that kill bacteria***?

**Bactericidal**

T/F: **Antibacterials** and **antimicrobials** are the same.

TRUE

What are **chemicals produced by microorganisms** that ***eithe***r ***inhibit or kill bacteria***?

**Antibiotics**

What refers to the term in which the ***pathogen is either inhibited or destroyed***?

**Sensitive**

What refers to the term in which the ***pathogen continues to grow***?

**Resistant**

T/F: When two antibiotics are combined, the result is additive, ***potentiative***, or ***antagonistic***.

TRUE

What __**effect**__ is ***equal to the sum of the effects of two antibiotics***?

**Additive effect**

What __**effect**__ occurs when ***one antibiotic potentiates the effect of the second antibiotic***, __increasing their effectiveness__?

**Potentiative effect**

What result is a **combination of a drug that is bactericidal,** such as ***penicillin***, and **a drug that is bacteriostatic**, such as ***tetracycline***?

**Antagonistic effect**

What are the __**two kinds of allergy**__?

***Mild*** and ***severe*** **allergy**

What is a __**secondary infection**__ because the ***antibiotic has altered the normal bacterial flora***, including the good bacteria?

**Superinfection**

What is **common with broad-spectrum antibiotic**, especially if you give the antibiotic less than a week?

**Superinfection**

What is the **major site of metabolism**?

**Liver**

What is a __**natural antibacterial agent**__ ***obtained from the mold genus Penicillium***, was *introduced to the military during World War II and is considered to have saved many soldiers' lives*?

**Penicillin**

What is the ***first antibacterial drug*** __**made in 1928**__?

**Penicillin**

Who discovered ***penicillin***?

**Alexander Fleming**

Who ***expanded Fleming's study*** and ***purified the penicillin obtained from the mold*** so it could be used commercially?

**Howard Florey**

What was **labeled as a** ***miracle drug***?

**Penicillin**

The beta-lactam structure of ____ interferes with bacterial cell wall synthesis by inhibiting bacterial enzyme necessary for cell division and synthesis, and then the bacteria die of cell lysis.

**Penicillin**

T/F: The penicillins can be both bacteriostatic and bactericidal, depending on the drug and dosage.

TRUE

Penicillins are mainly referred to as what?

Beta-lactam antibiotics

What are the first penicillins given orally and parenterally (IM and IV)?

Basic penicillins

The __**beta-lactamases**__ which ***attack penicillins*** are called what?

**Penicillinases**

What ***penicillin decreases pain due to injection***?

**Penicillin G Procaine**

What ***penicillin*** is **long-acting**?

**Penicillin G Benzathine**

T/F: If one is allergic to penicillin, macrolides may be taken.

TRUE

What **penicillin is less potent than Pen G** and is ***more effective to mild and moderate infections***?

**Penicillin V Potassium**

What __**penicillin**__ has ***increased ability to penetrate gram negative bacteria compared*** to Penicillin G?

**Penicillin V Potassium**

T/F: After a few years, mutant strains of Staphylococcus develop resistance to Pen V and G, thus, developing broad-spectrum penicillins.

TRUE

What __**penicillins**__ are for ***gram positive and negative bacteria*** but are __**not broadly effective against all**__?

**Broad-spectrum penicillins** *(amino penicillins)*

What penicillins are __**not penicillinase-resistant**__ and __**not beta-lactamase resistant**__?

**Broad-spectrum penicillins** *(amino penicillins)*

T/F: Broad-spectrum penicillins are effective against Staphylococcus.

FALSE

What __**penicillins**__ are ***anti-Staphylococcal penicillins***?

**Penicillinase-resistant penicillins**

What __**penicillins**__ are ***not effective against gram negative bacteria*** and ***less effective than pen G against gram positive bacteria***?

**Penicillinase-resistant penicillins**

What __**penicillins**__ are ***antipseudomonal penicillins*** in which these are **effective against** __***Pseudomonas aeruginosa***__?

**Extended-spectrum penicillins**

What __**penicillins**__ are also ***useful against many gram-negative organisms*** such as Proteus spp., Serratia spp., Klebsiella pneumoniae, Enterobacter spp., and Acinetobacter spp.?

**Extended-spectrum penicillins**

Y/N: Are pseudomonal penicillins penicillinase-resistant?

NO

> therefore, beta-lactamase inhibitors must be added

What __**penicillins**__ have ***pharmacologic action is similar to that of aminoglycosides***, but are __**less toxic**__?

**Extended-spectrum penicillins**

T/F: One must avoid acidic foods and fluids when taking penicillin orally.

TRUE

T/F: Do not mix aminoglycosides with a high dose or extended spectrum penicillin G for it may inactivate the aminoglycoside.

TRUE

T/F: High doses of penicillins may cause decrease in platelet aggregation and result to bleeding.

TRUE

What __**fungus**__ was found to be ***active against Gram (+) and (-) bacteria*** and __**resistant to beta-lactamase**__?

**Cephalosporium**

To be more effective against numerous organisms, molecules are chemically altered, and now, what are used?

**Semisynthetic cephalosporins**

What also contain __**beta-lactam structure**__ ***similar to penicillins***?

**Cephalosporins**

What __**generation of cephalosporins**__ are ***effective against all gram (+) bacteria and most gram (-) bacteria***, but __**destroyed by beta lactamases**__?

**First Generation**

What __**generation of cephalosporins**__ are ***effective against all gram (+) bacteria and possess a broader spectrum on most gram (-) bacteria***, not all are affected by beta lactamases?

**Second Generation**

What __**generation of cephalosporins**__ are ***effective against all gram (+) and gram (-) bacteria***, __**resistant to beta lactamases**__?

**Third Generation**

What __**generation of cephalosporins**__ are ***effective against all gram (+) and gram (-) bacteria, possess broader spectrum on gram (+) bacteria***, and __**resistant**__ to beta lactamases?

**Fourth Generation**

What ***cephalosporins*** are given __**PO**__?

**Cefalexin, cefaclor, and ceferoxime**

What is the ***infective agent of cephalosporin superinfection***?

**Candida albicans**

How long must you infuse all IV cephalosporins to prevent pain and irritation?

Over 30 minutes

What are __**broad spectrum antibiotics**__ which ***bind to ribosomal subunit and inhibit protein synthesis***?

**Macrolides**

What are __**bacteriostatic**__ ***at low to moderate doses and*** __**bactericidal**__ ***at high doses***?

**Macrolides**

What drugs are administered PO or IV, in which if given IV, must infuse slowly to avoid phlebitis, and __**not given IM**__ for it is very painful?

**Macrolides**

What are **active against most gram (+)** and **moderately active against some gram (-)** bacteria?

**Macrolides**

What are **effective to mild-moderate infections** such as respiratory system infections, GI infections, skin infection, and soft tissue infection?

**Macrolides**

T/F: Are macrolides effective against some STDs?

TRUE

Give 3 macrolides

* Azithromycin


* Clarithromycin


* Erythromycin

T/F: When considering macrolides, monitor liver enzymes such as alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and bilirubin.

TRUE

When should you administer azithromycin?

2 hours before or after meal

When should you administer antacids when taking azithromycin?

2 hours before or after azithromycin

T/F: If erythromycin is given concurrently with Verapamil, Diltiazem, Clarithromycin, Fluconazole, Ketoconazole, and Itraconazole, risk of sudden cardiac death increases.

TRUE

What are the __**macrolides**__ that are ***antihypertensive drugs***?

**Verapamil** and **diltiazem**

What are the __**macrolides**__ that are ***antifungal drugs***?

**Fluconazole** and **ketoconzole**

What **inhibit bacterial protein synthesis** and have ***both bactericidal and bacteriostatic effects***?

**Lincosamides**

What drugs are __**active against most Gram (+)**__ and n__**ot effective against Gram (-) organisms**__?

**Lincosamides**

What **drugs are incompatible** with *aminophylline*, *phenytoin*, *barbiturates*, and *ampicillin*?

**Lincosamides**

Which __**lincosamide**__ is more __widely prescribed__ because it is ***absorbed better in the GI tract*** and has h***igher maintenance of serum concentration***, making it more effective?

**Clindamycin**

T/F: Lincomycin causes colitis.

TRUE

What __**drugs**__ that ***inhibit bacterial cell wall synthesis*** and ***peak action is 30 minutes after administration***?

**Vancomycin**

What is a __**glycopeptide bactericidal antibiotic**__ used against drug resistant staphylococcus aureus organism and for cardiac surgical prophylaxis in clients with penicillin allergy?

**Vancomycin**

If client with bacteremia is resistant to vancomycin, what may be used?

**Quinupristin/Dalfopristin** (Synercid) and **Linezolid** (Zyvox)

What are the routes for vancomycin?

**PO** (colitis only) and **IV for** ***systemic*** and ***GI infections***

T/F: We should always give vancomycin via infusion as it may cause redneck syndrome.

TRUE

Y/N: Is vancomycin effective in Enterococcus?

NO.

What is a __**reserve antibiotic for Gram-positive bacteria**__ and also a __**weak MAOI**__, in which because of the risk of the hypertensive crisis, ***foods that are rich with tyramine must be avoided***?

**Linezolid**

What __**drugs**__ are ***structurally related to macrolides***?

**Ketolides**

What is a __**new classification of antibiotics**__ structurally related to macrolides that ***blocks protein synthesis***?

**Telithromycin**

What __**ketolide**__ is well ***absorbed by GI (only PO)*** and is **not affected by food intake**?

**Telithromycin**

What __**ketolide**__ is ***effective against Streptococcus pneumoniae*** and ***Haemophilus influenza organisms***?

**Telithromycin**

What __**ketolide**__ is **used for adults 18 years of age and older** to ***treat mild or moderate community-acquired pneumonia***, ***acute bronchitis***, ***acute bacterial sinusitis***?

**Telithromycin**

Where is telithromycin excreted?

Feces and urine