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NURS 5334 Antimicrobial Review Questions With Complete Solutions Gram positive organisms Staph, Strep, Enterococcus 1st line Treatment of Gram positive Penicillins 2nd line treatment of Gram positive with Penicillin Allergy Cephalosporins: 3rd generation (cefdinir, cefuroxime) Macrolides: if anaphylactic (azithromycin, clarithromycin) AOM and sinusitis organisms Haemophilus influenzas, Moraxella catarrhalis, Streptococcus pheumoniae 1st line tx for AOM high dose amoxicillin 5-10 days AOM pain Ibuprofen, acetaminophen for Antibiotic resistant AOM amoxicillin- clavulanate or ceftriaxone AE with clavulante
diarrhea Renders PCNs G and V inactive beta-lactamases to Tx Step and AOM Ampicillin, amoxicillin DOC for PCN allergies Macrolides Narrow spectrum PCNs resistant to penicillinase enzymes Oxacillin, Nafcillin, dicloxacillin, extended spectrum antipseudomonal PCN Piperacillin/tazobactam Not affected by beta lactamase bacteria oxacillin, nafcillin, dicloxacillin Piperacillin (given with tazobactam)=Zosyn effective against pseudomonas, Enterobacter, Bacteroides fragilis and klebsiella. is not given alone. Beta lactamase inhibitors never given alone: clavulanic acid, tazobactam, sulbactam no MRSA coverage piperacillin/tazobactam
5th generation cephalosporins Ceftaroline: MRSA, VRSA, community-acquired pneumonia, broad-spectrum with gram- and + cover, pseudomonas and some Enterobacteriaceae 3rd generation cephalosporin names cefotaxime, cefdinir, cefditoren, cefixime, cefpodoxime, ceftazidime, ceftibuten, ceftriaxone, cefoperazone, ceftibuten, ceftizoxime cephalosporins Side effects Cross allergy with PCN; NO: Alcohol increased bleeding=decreased prothrombin via interference with Vitamin K cephalosporins that cause bleeding and are contraindicated with Alcohol Cefotetan, cefmetazole, cefoperazone Carbapenems weakens the cell wall, big Guns, Broad spectrum, given in hospital and not given alone. end with -enem, except for avibactam. covers gram -, gram + and anaerobes, renal excretion Carbapenems contraindicated with reduces levels of Valproate Imipenem
not given alone: broadest spectrum given with vancomycin Meropenem meningitis ertapenem complicated GI, GU, soft tissue infection, CAP Doripenem complicated intra-abdominal infections/complicated UTIs Avibactam combined with ceftazidime for intra-abdominal and UTIs Vancomycin glycopeptide; inhibits cell wall synthesis; narrow-spectrum used only for MRSA and C.Diff, only oral is for C. Diff. Vancomycin AEs ototoxicity, nephrotoxicity, red man syndrome, thrombocytopenia, rashes Telavancin alternative to vancomycin; Lipogycoprotein for skin infections/hospital-acquired pneumonia Telavancin AE
Broad-spectrum; inhibits bacterial protean synthesis. They are BIG (MACRO). Erythromycin, azithromycin, clarithromycin Macrolides therapy respiratory infections, H.pylori, Mycobacterium, alternative to PCN. Macrolide monitoring QT prolongation, GI disturbances: May give with food. Tetracyclines Bacteriostatic protein synthesis inhibitors, broad spectrum. Names of tetracyclines -cycline: long acting: doxycycline, minocycline, intermedicate: demeclocycline, short: tetracycline Tetracyclines AE Test Q stain deciduous teeth (no for children under), GI distress, liver/kidney toxicity, photosensitivity, superinfections. Tetracycline contraindications test Q do not take with calcium, milk, iron, magnesium or antacids Tetracyclines therapy use acne, respiratory infections, skin infections demeclocycline
long acting: strep, respiratory, skin, eye, lymphatic, GI, UTI. infections caused by ticks, lice, mites, infected animals. doxycycline most likely to be tested on CA-MRSA, Pneumonia, RMSF, Lyme, acne, PUD, anthrax, chlamydia minocycline RA, Acne drug of choice for chlamydia's Doxycycline Macrolides when allergic to PCN Macrolides -mycin also Aminoglycosides end in -mycin macrolide therapy covers pneumonia, mycobacteriaum (HIV); chlamydia, H. Flu; whooping cough/pertusis Macrolide names azithromycin, Erythromycin(lots of drug interactions), clarithromycin, clindamycin macrolide with most drug interactions
Telithromycin AE liver injury's, Prolonged QT, visual disturbances, muscle weakness Dalfopristin and Quinupristin only tx VRE when not responding/ hepatotoxicity Chloramephenicol only in life-threatening ER; AE: fatal aplastic anemia and bone marrow depression two drug classes that end in -mycin Aminoglycosides and macrolides Aminoglycosides names Gentamycin, tobramycin, amikacin, neomycin, kanamycin, streptomycin sulfate, Streptomycin Sulfate Not used alone Aminoglycosides AE TQ ototoxicity and nephrotoxicity, blood dyscrasias, teratogenic: monitor with Aminoglycosides monitor Peek and trough levels 2 hours and 12 hours after dosing Aminoglycosides therapeutic use
pseudomonas, klebsiella, Serratia, proteus Antimetabolites Trimethoprim/sulfamethoxazole marked as bactrim Trimethoprim/Sulfamethoxazole (Bactrim) therapy CA-MRSA, UTI, listeria Trimethoprim/Sulfamethoxazole (Bactrim) in children base on trimethoprim dose Trimethoprim/Sulfamethoxazole (Bactrim) AEs skin reactions, kernicterus in newborns, hypoglycemia, hyperkalemia, G6PD=hemolytic anemia, Crystalluria Luria=renal damage; thrombocytopenia, megaloblastic anemia Trimethoprim/sulfamethoxazole Cross reactions thiazides, loop diuretics', Celebrex, sulfonylureas Trimethoprim/sulfamethoxazole in pg no, blocks folate sulfa drug used from burns silvadene ointment Quinolones therapy
Tendon Rupture, mental changes in elderly, photosensitivity, muscle weakness with MS, Prolonged QT Nalidixic acid=cartilage erosion in children Dazoles inhibit bacterial nucleic acid synthesis Dazole drugs metronidazole: tinidazole Dazole therapy gut and vaginal infections Dazole AE TQ no with Alcohol x 72 hours post medication=disulfiram reaction, neurotoxicity, cancer in rats, no in 1st trimester of Pg Dazole SE TQ nausea, dry mount, metallic taste, dark urine Topicals mupriocin=impetigo, retapamulin, ozenoxacin-costly and
2months, bacitracin, polymyxin B. (ears, eyes, skin) UTI/Acute cystitis 1st line drugs trimethoprim/sulfamethoxazole, nitrofurantoin, fosfomycin UTI/Acute cystitis 2nd line drugs
ciprofloxacin, levofloxacin Complicated UTI and Acute Uncomplicated 2nd line Amoxicillin/clavulanate, cefadroxil, cefdinir, cefpodoxime Complicated UTI and Acute Uncomplicated 1st line Trimethoprim/sulfamethoxazole, ciprofloxacin, levofloxacin Complicated UTI trimethoprim/sulfamethoxazole, cipro, leveo, amox/clavu, cephalexin prophylaxis for recurrent UTI trimethoprim/sulfamethoxazole 3 X week X 6 months trimethoprim 100 mg after intercourse X 6 months Nitrofurantoin 50-100 mg after intercourse X 6y months Flu Medications - how soon? give within 48 hours = neuraminidase inhibitors Neuraminidase inhibitors Flu vaccines: oseltamivir (tamiflu); Zanamivir (Relenza); Peramivir (Rapivab); Baloxavir (Xofluza) Oseltamivir (Tamiflu)
2 weeks BID X 5 d AE: N/V Zanamivir (Relenza)
causing the level of the free drug to rise most important cause of AE in elderly drug accumulation rt reduced renal excretion In the elderly, the proper index of renal function is Cr Cl or GFR the primary mechanism of antibacterial action of the PCN involves inhibition of Cell wall synthesis by binding and inactivation PCN binding proteins= PBPs Vancomycin (Vancocin) bactericidal, yes for MRSA, causes red man syndrome, Tetracycline MOA inhibit protein synthesis Aminoglycosides MOA Bactericidal; inhibit the formation of initiation complex and cause misreading of mRNA. Also, block translocation. Require O2 for uptake; therefore ineffective against anaerobes. inhibits protein synthesis, blood dyscrasias antibacterial action of gentamicin continues to exert antibacterial effects even after plasma levels decrease below detectable levels
treated with the macrolide, erythromycin what education stop simvastatin before starting traveler's diarrhea =gram negative bacillus adult=ciprofloxacin Child=Amoxicillin Fluoroquinolones different therapeutic applications depending on the generation Sulfonamides AE skin reactions most likely to occur ciprofloxacin AE tendon rupture TB drug combinations reasoning delay resistance fluconazole prolong QT, renal elimination UTI C & S = E coli lowest minimum inhibitory concentration (MIC) ampicillin=38 mg/L / ciprofloxacin = 2.5= give cipro 55 yo male on anticoagulant, dx with TB which antimicrobial would induce cytochrome P450 enzyme in the liver and effect anticoagulant therapy?
cephalosporin has activity against gram negative anaerobic pathogens such as Bacteroides fragilis cefoxitin 2nd generation UTI= enterococcus faecalis amoxicillin immuno-suppressed pneumonia 1st line tx, or antimicrobials within the previous month levofloxacin 4 wk old with chlamydial pneumonia erythromycin the primary method of Beta=lactam resistance with Streptococcus pneumoniae modification of the target site 80 yo taking cefdinir (omnicef) know CrCl Clindamycin warning C-diff
