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EXAM 1: NURS 5334 Antimicrobials
Which narrow spectrum antibiotic is good for strep and syphilis and contains a Beta Lactam ring in their structure? - ANSWER Penecillins How do Beta-lactam antibiotics work? - ANSWER Weaken the cell wall causing bacteria to take up excessive amounts of water and rupture Other than penicillins what are the 6 other antibiotics that contain a Beta lactam ring in their structure? - ANSWER Cephalosporins Carbapenems Aztreonams Imipenems Meropenems Ertrapenem Hint: cephalosporin and the -penems Which penicillin is recommended for kids but is often dismissed to to it's bad taste? - ANSWER Penicillin V Oxacillin/Nafcillin/Dicloxacillin are ____ resistant Penicillins. - ANSWER Penicillinase
Oxacillin/Nafcillin/Dicloxacillin can be used to fight against which two gram positive bacteria? - ANSWER Staph Aureus and Staph Epidermis What is the result of rapidly administering Penicillin G? - ANSWER Hyperkalemia Why type of antibiotic is given if the patient has an allergy to penicillins, but is avoided if patient has experienced penicillin induced anaphylaxis? - ANSWER Cephalosporins Which three antibiotics are effective and safe alternatives for patients with a penicillin allergy? - ANSWER Vancomycin Erythromycin Clindamycin What are the two Broad Spectrum Penicillins that has the same antimicrobial spectrum as Penicillin G plus increased activity against H. Influenzae, E. Coli, Salmonella, and Shigella species? - ANSWER Ampicillin and Amoxicillin What is the two main adverse effects of Ampicillin? - ANSWER Rash and Diarrhea What microbes are Piperacillin effective against? (4) - ANSWER Pseudomonas aeriginosa Enterobacter
Which generation of cephalosporins is commonly used for pseudomonas and hospital acquired infections? - ANSWER Fourth Generation Cephalosporin Which category of antibiotics can increase the risk of bleeding if taken with antiplatelet or anticoagulant therapy? - ANSWER Cephalosporins Which Cephalosporins can increase the risk of bleeding? - ANSWER Cefortetan Cefazolin Ceftriaxone Cefmetazole Cefoperazone Which Generation of cephalosporins cover pseudomonas aeruginosa? - ANSWER Forth Generation Which generation of Cephalosporins is given for pseudomonas, and Eneterobacteriaceae species but mostly for MRSA? - ANSWER Fifth Generation Which TWO Cephalosporins can never be mixed with Alcohol? - ANSWER Cefazolin Cefoetan (Lin cannot get a Tan while drinking alcohol)
Which two generation of Cephalosporins are rarely used for ACTIVE infection? - ANSWER First and Second generations ____ generation Cephalosporins cover Staph and Strep and are mostly used for surgical prophylaxis. - ANSWER First ____ generation of Cephalosporins covers H. Influenzae, Klebseilla, Pneumococci and Staphylococci and can be used for otitis, sinusitis, and a respiratory tract infection? - ANSWER Second Which class of Cephalosporins is the preferred class for treating meningitis? - ANSWER Third generation Which Cephalosporins is not recommended if the patient has cardiac issues such as atrial fibrillation? - ANSWER Ceftriaxone What's the name of the category of antibiotics that is broad spectrum, low toxicity, but is NOT active against MRSA? - ANSWER Carbapenems Which Carbapenem is a broad spectrum and is usually given with Vancomycin? - ANSWER Imipenem How does Imipenem destroy microbes? - ANSWER Imipenem binds to two PBPs (PBP1 and PBP2) causing weakening of the bacterial cell wall causing lysis and death
MRSA, Staph Epidermis, and C. Diff can be destroyed by this narrow spectrum antibiotic? - ANSWER Vancomycin When giving Vancomycin for C. diff what route do you need to prescribe the medication for the patient? - ANSWER Oral route What is a common side effect of Vancomycin? - ANSWER Thrombophlebitis Ototoxicity Red Man Syndrome Thrombocytopenia (rare) Why might Vancomycin be a poor choice of antibiotic for a Dialysis patient? - ANSWER Antibiotic is harsh on the kidneys, Telavancin is effective against gram negative organisms only, True or False? - ANSWER False, gram Positive Only How does Telavancin work to destroy microbials? - ANSWER Inhibits the synthesis of the cell wall Telavancin should be used cautiously with meds such as anti fugal, microliters, flurquinolones, and Simvastatins due to what major cardiac side effect? - ANSWER Prolonged QT interval
What's the antibiotic that binds to the cell membrane to depolarize it, inhibits DNA, RNA and protein synthesis, and cane be used for MRSA and enterococcus faecalis (gm + only)? - ANSWER Daptomycin Teicoplanin is a narrow spectrum antibiotic that targets gram positive macteri and MRSA, True or False? - ANSWER True Maria is pregnant and was diagnosed with an uncomplicated UTI cause by E. Coli. she wants antibiotics that will be quick to take so she can feel better fast. What medication would you recommend for Maria? - ANSWER Fosfomycin: single dose therapy for women with uncomplicated UTI due to E. Coli and E. Faecalis How does Fosfomycin kill bacteria? - ANSWER Disrupts the production (synthesis) of the peptidoglycan polymer strand that compose the cells wall Tetracyclines, target gram negative and gram-positive bacteria, True or False? - ANSWER True A young 8 year old boy comes into the office with his mother. He has a rash that looks like a bull's-eye on his arm. What condition does he have and what is the likely medication of choice? - ANSWER Doxycycline Eight-year-old Connor is prescribed doxycycline. He plays soccer on the weekends, what advice should you give to Connor's mother? - ANSWER Photosensitivity, patient should refrain from outdoor sports until the treatment is complete
Why would a patient need to get a CBC done weekly when taking Linezoid? - ANSWER Linezoid causes bone marrow suppression and the bone marrow is where the RBC are matured Patient with myasthenia gravis Is admitted to the hospital with a Strep Pneumonia infection. What antibiotic that targets Strep Pneumonia could be an issue for this patient due to its black box warning? - ANSWER Telithromycin Micheal is has high cholesterol and is taking Sinvastatin for his routine care, which category of antibiotics should he avoid? - ANSWER Microlides (Erythromycin) Baby Julie is given Chloramphenicol for a life threatening emergency infection. She has abdominal distention, hemodynamic collapse and very pale ashen skin, what adverse effect could she have? - ANSWER Gray baby Syndrome How do aminoglycosides work? - ANSWER by inhibiting formation of the initiation complex and cause misreading of mRNA. Inhibiting protein synthesis Are aminoglycosides bactericidal or bacteriostatic? - ANSWER bactericidal Are Aminoglycosides narrow or broad spectrum antibiotics? What do they target? - ANSWER Narrow Spectrum
Target Aerobic Gram Negative Bacilli Gentamicin, Tobramycin, Amikacin are what type of antibiotic? - ANSWER Aminoglycosides What two body parts are likely to be damaged if Aminoglycosides are _____ and _____. - ANSWER Kidney and Ear Why do Aminoglycosides cause neuromuscular blockade and are contraindicated in patients with myasthenia gravis? - ANSWER They inhibit the release of acetylcholine which causes weakness and paralysis. In high doses can cause respiratory paralysis Are you able to give Aminoglycosides to a patient who is pregnant? - ANSWER No, Aminoglycosides have a teratogenic effect When should peak levels of Aminoglycosides be taken? - ANSWER 30 mins after giving an IM injection Or After completing a 30 minute IV infusion For divided dosing of Aminoglycosides when should trough levels be obtained? - ANSWER Take one sample just before the next dose
Why would you refrain from prescribing a Fluoroquinolones to someone with Neisseria Gonorrhoeae? - ANSWER Resistance develops slowing but has become common in Neisseria Gonorrhoeae Which Fluoroquinolones inhibits bacterial DNA gyrase and topoisomerase II in order to destroy a bacteria? - ANSWER Ciprofloxacin What Fluoroquinolones is the drug of choice for Anthrax? - ANSWER Ciprofloxacin Which second generation Fluoroquinolones is good for respiratory infections, UTI, intractable infectious diarrhea, pyelo and prostatitis? - ANSWER Levofloxacin Which second generation Fluoroquinolones works for eye, ear drops, skin, lungs, prostate, and UTI? - ANSWER Ofloxacin What does Moxifloxacin and Gemifloxacin treat? (Third Generation Fluoroquinolone) - ANSWER Respiratory infections The Fourth Generation Delafloxacin treats infections of the ____. - ANSWER Skin
Which Fluoroquinolone is the ONLY drug that can treat Gram Negative UTI? - ANSWER Nalidixic Acid Why should we refrain from giving Nalidixic Acid to children? - ANSWER Cartilage erosion in children Which antibiotic is used for gut and Vaginal infections (Protozoal infections, anaerobes, H. Pylori, C. diff, trichonanias, and BV) - ANSWER Metronidazole Do not use Metronidazole during the ____ trimester of pregnancy? - ANSWER First Amanda has an uncomplicated UTI, she is allergic to sulfa, nitrofurantoin, and is currently pregnant. What drug should you recommend for her treatment? - ANSWER Amoxicillin Clavulanate Cephalexin Prophylaxis recurrent UTIs: Provider would give Trimethoprim/sulfamethoxazole how frequently for how long? - ANSWER 3x weekly for 6 months Prophylaxis recurrent UTIs: Provider would give Trimethoprim how frequently for how long? - ANSWER 100mg ha for 6 months
