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What are the antibiotics that target the cell wall, causing lysis of bacteria?
B-lactams
Vancomycin
Daptomycin
What are the antibiotic(s) that inhibit RNA synthesis?
Rifamycins
What are the antibiotics that block protein synthesis?
Aminoglycosides
Tetracyclines
Pxazolidinones
Macrolides
Clindamycin
Streptogramins
What are the antibiotics that target DNA or DNA synthesis?
Quniolones
Metrondazole
What are the antimetabolite antibiotic(s)?
Trimethoprim-sulfamethoxazole
What are the beta lactams?
Penicillins
Cephalosporins
Carbapenems
Monobactams
What do they do?
Interfere with peptidoglycan synthesis by binding transpeptidases
What type of bacteria do Vancomycin and Daptomycin target?
Gram + cocci
What do transpeptidases do?
Catalyse the crosslinking of peptodoglycan residues.
What do beta-lactams do to transpeptidases?
Bind to and block the crosslinking resulting in weak cells walls and lysis.
What are the 4 types of Penicillins?
Natural Penicillins
Anti-Staphylococcal Penicillins
Aminopenicillins
Extended Spectrum Penicillins
What are Natural Penicillins active against?
Most streptococcal species
Most gram+ anaerobes
N. meningitidis
Treponema pallidum
What type of bacteria do Natural Penicillins have no effect on?
Intracellular bacteria
What do Staphylococcal strains make that can stop B-lactams?
B-lactamases
How do Anti-Staphylococcal Penicillins prevent the B-lactamases from inhibiting them?
They have large R side groups
What are 3 Anti-staphylococcal penicillins?
Nafcillin
Oxacillin
Dicloxacillin
How do MRSA and MRSE get their resistance?
An altered PBP
What are 2 Aminopenicillins?
Ampicillin
Amoxicillin
What makes an Aminopenicillin an aminopenicillin? What does this do?
The addition of an amino group to the side chain
Allows for penetration through porins of some gram-'s
Into addition to the spectrum of activity Natural Penicillins have, what bacteria are Aminopenicillins effective against?
E. coli
Shigella
Salmonella enterica
Borrelia burgdorferi
What are 3 Extended Spectrum Penicillins?
Piperacillin
Ticarcillin
Carbenicillin
Can Aminopenicillins or Extended Spectrum Penicillins penetrate gram- porins better?
ESP
Into addition to the spectrum of activity Natural Penicillins have, what bacteria are ESPs effective against?
More enterobacteriaceae
Some strains of Pseudomonas aeruginosa
Which 3 bacteria were specifically mentioned to have B-lactamases?
Staphylococcus aureus
Haemophilus influenzae
Neiserria gonorrhoeae
What are 3 B-lactamase inhibitors?
Clavulanic acid
Sulbactam
Tazobactam
What 2 classes of Penicillins do you administer with B-lactamase inhibitors?
Aminopenicillins
ESPs
What 2 types of hypersensitivity can Penicillins cause?
Type 1: Skin rash & anaphylaxis
Type 2: Drug-induced hemolytic anemia
Describe the basic structure of Penicillins
B-lactam ring
5 membered ring
1 r-group
Decribe the basic structure of Cephalosporins/Cephamycins
B-lactam ring
6 membered ring
2 r-groups
Name the important Cephalosporins/Cephamycins and their associated generation?
1st: Cefazolin & Cephalexin
2nd: Cefotetan, Cefoxitin & Cefurozime
3rd: Ceftriazone
4th: Cefepime
In general what do Cephalosporins/Cephamycins have over natural Penicillins?
More active against gram-
More stable again B-lactamases
What is the generalization about increasing generation for Cephalosporins/Cephamycins?
Decreased activity against aerobic gram+
Increased activity against aerobic gram-
What are Cefazolin/Cephalexin used for? What is their major Pro.
Minor skin and soft tissue infections & UTIs
Inexpensive
For which disease is the drug of choice a third generation Cephalosporin?
Neisseria gonorrheae
What is special about Ceftriaxone?
It can cross the blood-brain barrier
What are the Pros for the 4th generation, Cefepime
Activity against Pseudomonas
Can be used on bacteria making extended spectrum B-lactamases
What type of B-lactamantibiotic is considered the "Hail mary"? Why?
Carbapenems (Imipenum)
VERY broad spectrum
What is the only licensed Monbactam?
Aztreonam
What is Aztreonam effective against?
Areobic, gram- bacteria
Moraxella
Neisseria
Enterobacteriaceae
Pseudomonas
Haemophilus
Burkholderia
Which type of B-lactam antibiotic is safe to give to people with penicillin allergies?
Monobactams (Aztreanam)
What are the 6 P's of bacterial resistance to B-lactams?
Penetration: Poor penetration
Porins: Mutations can result in exclusion
Pumps: Efflux pumps xport antibiotics back out
Penicillinases: Aka B-lactamases
PBPs: Can mutate to prevent binding
Peptidoglycan: No peptigoglycan = no inhibition
What 2 species do not have peptidoglycan?
Mycoplasma
Chlamydia
Can resistance genes be tranfered from gram- to gram+ bacteria?
Yes
Name the associated bacteria:
Production of B-lactamase
Staph
Enterobacteriaceae
Haemophilus
Pseudomonas aeruginosa
Neisseria gonorrhoeae
Name the associated bacteria:
Efflux pumps
Psuedomonas aeruginosa
Name the associated bacteria:
Modification of PBP
Pneumococci
MRSA
how does Vancomycin inhibit the cell wall?
Binds to D-Ala-D-Ala building block of peptidoglycan
When should Vancomycin be used?
MRSA
Penicillin-resistant S. pneumo
Susceptible Entero infections
What is the major scare regarding resistance to this antibiotic?
That the D-Ala-D-lac change could be transfered to a MRSA strain.
How does daptomycin work? What does it work against?
Lipid portion inserts and induces lysis
Gram+ cocci
When should Daptomycin be used?
MRSA
Penicillin-resistant S. pneumo
Vancomycin-resistant Entero infections
List the Aerobic gram+ bacteria
Staph
Strep
Enterococci
Listeria
List the Aerobic gram- bacteria
Enterobacteriaceae
Neisseria
Pseudomonas
Haemonphilus
List the Anaerobes
Clostridium
Actinomyces
Peptostreptococcus
Propionibacterium
Bacteroides
Fusobacterium
Prevotella
List the Atypical bacteria
Spirochetes
List the intracellular bacteria
Mycoplasma
Chlamydia
Legionella
Mycobacterium
Rickettsia
community-associated infections
an iinfection that is aquired by a person who has not been hospitalized or had a medical procedure (such as dialysis, surgery, catheterization) within the past year.
pseudomonas bacteria
Infection usually with Pseudomonas aeruginosa, the versatile "blue-green pus bacteria" that opportunistically infects people, especially those who are immunocompromised. Pseudomonas rarely causes infection in healthy individuals but it is a major cause of hospital acquired (nosocomial) infections. It tends to infect people with immunodeficiency or burns and those with indwelling catheters or on respirators.
*what are the two leading causes of death in the U.S for HAI's?
MRSA
VRE
definitive therapy:
antibiotic therapy tailored to treat organism identified with cultures.
prophylactic therapy:
treatment with antibiotics to prevent an infection, as in intraabdominal surgery or after trauma.
subtherapeutic response:
signs and symptoms of infection do not improve.
what are you at risk for when you take an antibiotic?
superinfection, you kill the normal flora as well as the bad.
can cause thrush or diarrhea.
pseudomembranous colitis
is a commonly occurring bacterial super infection may occurs after 4 to 9 days of treatment with penicillin or as long as 6 weeks after the drug is discontinued.
bactericidals action:
kill bacteria
bacteriostatics action:
inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death.
*suflonamides start with:
"sulf"
*sulfonamides are the choice for what type of patients?
AIDs patients.
what are the first and second gen antibiotics?
sulfa's
pennicillins
*what is the most common cause to UTI's?
E-coli bacteria
agranulocytosis
an acute blood disorder (often caused by radiation or drug therapy) characterized by severe reduction in granulocytes
stevens-johnson syndrome
Skin disorder with high mortality rate and associated with drug reactions, sloughing of skin and skin necrosis. ulcers from the mouth to anus.
*integumentary AE of sulfa's: (4)
photosensitivity
exfoliative dermatitis (skin peels off)
stevens-johnson syndrome
epidermal necrolysis
exfoliative dermatitis
a condition in which there is widespread scaling of the skin, often with pruritus, erythroderma, and hair loss
what is usually given to kids for upper respiratory infections?
amoxicillin.
*what are the enzyme that is secreted by bacteria that is capable of destroying penicillins:
the enzymes beta-lactamases.
*what are the chemicals that have been developed to inhibit these enzynmes? (4)
clavulanic acid
tazobactam
sulbactam
angioedema
an allergic skin disease characterized by patches of circumscribed swelling involving the skin and its subcutaneous layers, the mucous membranes, and sometimes the viscera. (remember the swollen faces)
*AE of penicillin is cross-reactivity between ________ and _______ is between %1 and 4%.
cross-reactivity between penicillins and cephalosporins.
(because they are structurally and pharmacologically related to penicillins)
*if you are allergic to cephalosporins, then you are probably allergic to _________ and vice versa.
penicillins
*if a women is on oral contraceptives and taking penilillins, what can happen?
you can still get pregnant
the contraceptive may not work while on penicillins
what are broad spectrum antibiotics?
they work on gram positive and gram negative.
*what is the antibiotics that are SALADS?
cephalosporins,
so make sure to have prescriptions spelled back.
without treatment, this has a 100% fatality rate:
bacterial meningitis
what test must you monitor with cephalosporins?
liver funtion tests (LFTs)
elimination is primarily hepatic in the 3rd generation of cephalosporins.
what is the reason why cancer patients or any other immunocompromised patient cannot have fresh flowers, fruits, or veggies delivered to them?
the bacteria pseudomonas spp. (the greenish/blue bacteria in soil & water) are difficult to treat and are found in those items.
*what is the 2nd choice for UTI's?
cephalosporins
uncomplicated UTI
occurs in otherwise normal urinary tract and usually only involves the bladder
complicated UTI
complicated: include those with coexisting presence of obstruction, stones, or catheters; existing diabetes/neuro disease; pregnancy AT RISK FOR PYELO, UROSEPSIS, RENAL DAMAGE.
this is the type that diabetics are more prone too.
cephalosporins can kill what two most difficult organisms?
MRSA
pseudmonas spp.
with the antibiotics carbapenems, they may cause __________________ , this risk can be reduced with proper dosage.
drug-induced seizure activity
haemophilus influenzae
flu
LRI
lower respiratory infection
examples:
chlamydia pnuemonia (atypical)
Haemophilus influenzae (Gm-)
Klebsiella pneumoniae(Gm-)
Mycoplasma Pneumoniae(atypical)
streptococcus pneumoniae (Gm+)
clarithromycin, another name for:
Biaxin, Biaxin XL
macrolide antibiotic
what is the only drug is the Ketolide class?
telithromycin (Ketek)
"clines"
tetracyclines (an antibiotic class)
what is the last ditch antibiotic drug class?
Ketolide (telithromycin (Ketek) )
because it is associated with severe liver disease.
what are the 6 classes of tetracyclines?
demeclocycline (declomycin)
doxycycline (doryx, vibramycin)
minocycline
oxytetracycline
tetracycline
tigecycline (tygacil)
*what reduces oral absorption of of tetracyclines? (3)
dairy products
antacids
iron salts
*what should no be used in children under age 8 or in pregnant/lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth?
tetracyclines
SIADH
syndrome of inappropriate antidiuretic hormone
what is a very contatious STD, that you must make sure you do not touch?
syphilis
what is used to treat SIADH?
demeclocycline (a tetracycline antibiotic)
*________ has a strong affinity for calcium.
tetracyclines
candida
any of the yeastlike imperfect fungi of the genus Candida
maculopapular rash
flat to slightly raised colored bumps
ex: measles, rubella, roseola, 5th disease (slapped cheek)
vaginal candidiasis
a vaginal infection caused by the yeast-like fungus Candida albicans; also known as a yeast infection
*nursing implication for antibiotics, before you begin therapy:
it is essential to obtain cultures from appropriate sites before beginning antibiotic therapy
S/S of superinfection: (5)
cough
fever
lethargy
any unusual discharge
perineal itching
what are the thress most common AE of antibiotics?
nausea
vomiting
diarrhea
*all oral antibiotics are absorbed better if they are taken with?
8oz. or more of water.
*what type of liquid must you take with penicillins?
water, not juices, as acidic fluids may nullify drugs antibacterial action.
when you start someone on a medication for the first time in the office, what must you do?
never send a patient home until 20-30 minutes from ingestion of meds to assure no allergic reaction.
chelation
Chemical binding (inactivation) of another drug.
*because of _______ , you should avoid sunlight and tanning beds with ________.
photosensitivity
tetracyclines
*increase your water intake with?
tetracyclines
what are the antibiotics that are taken before exposure to an infectious organism in an effort to prevent the development of infection?
proplylactic
the classification for the drug doxycycline:
tetracycline
an antibiotic derived from a fungus or mold often seen on bread or fruit:
penicillin
antibiotics that kill bacteria:
bactericidal
the classification for the drug cefazolin:
cephalosporin
the classification for the drug erythromycin:
macrolide
the classification for the drug sulfisoxazole:
sulfonamide
antibiotics that inhibit the growth of bacteria:
bacteriostatic
an infection that occurs during antimicrobial treatment for another infection and involves overgrowth of a nonsusceptible organism?
superinfection
The nurse is reviewing the drugs ordered for a patient A drug interaction occures between penicillins and which drugs? (select all that apply)
a. alcohol
b. oral contraceptive
c. digoxin
d. nonsteroidal antiinflammatory drugs
e. warfarin
f. anticonvulsants
b. oral contraceptives
d. nonsteroidal antiinflammatory drugs
e. warfarin
Which intervention is important for the nurse to perform before beginning antibiotic therapy?
a. obtain a specimen for culture and sensitivity
b. give with an antacid to reduce gastrointestinal (GI) upset
c. monitor for adverse effects
d. restrict oral fluids
a. obtain a specimen for culture and sensitivity
The nurse will instruct a patient who is receiveing a tetracycline antibiotic to take it using which guideline?
a. it should be taken with milk
b. it should be taken with 8oz. or more of water
c. it should be taken 30 minutes before iron preparations are taken
d. an antacid should also be taken to decrease GI discomfort.
b. it should be taken with 8oz or more of water.
A patient is to receive antibiotic therapy with a cephalosporin. When assessing the patient's drug history, the nurse recognizes that an allergy to which drug class may be a possible contraindication to cephalosporin therapy?
a. cardiac glycosides
b. thiazide diuretics
c. penicillins
d. macrolides
c. penicilllins
When asked about drug allergies, a patient says, "I cant take sulfa drugs because i'm allergic to them."
which question should the nurse ask next?
a. "do you have any other drug allergies?"
b. "who prescribed that drug for you?"
c. "how long ago did this happen?"
d. "what happended when you took the sulfa drug?"
d. "what happened when you took the sulfa drug?"
Which statement accurately describes the actions of actiseptics?
a. they are used to kill organisms on living tissue.
b. they are contracted in a hospital or institution
c. they are used to sterilize equipment
d. they are used to inhibit the growth of organisms on living tissue.
d. they are used to inhibit the growth of organisms on living tissue.
During a class on health care-associated infections, the nurse shares several facts about these infections. Which statements about health care-associated infections are true? (select all that apply)
a. they are contracted in the home or community
b. they are contracted in a hospital or institution
c. they are more difficult to treat
d. the organisms that cause these infections are more virulent
e. the infection is incubating at the time of admission.
b. they are contracted in a hospital or institution
c. they are more difficult to treat
d. the organisms that cause these infections are more virulent
A patient is to receive 2 million units of penicillin G potassium per day, every 6 hours in IV piggyback doses. The medication is available in vials of 1 million units/50mL, and each dose needs to be mixed in 50mL of D5W. How many mL will the nurse draw up for each IV piggyback does?
25mL per dose.
each dose will contain 500,000 units.
Mr. R., a 50-year-old banker, is scheduled for colorectal surgery tomorrow. The surgeon is planning to administer a prophylactic antibiotic. What drug is frequently used for this purpose, and why?
Cefoxitin (mefoxin) is frequently used in patients undergoing abdominal or colorectal surgeries because it can effectively kill intestinal bacteria such as gram-positive, gram-negative, and anerobic bacteria.
another name for cefoxitin:
mefoxin (broad spectrum antibiotic)
(mefoxin) cefoxitin
one of several broad spectrum antibiotic substances obtained from fungi and related to penicillin (trade names Mefoxin)