NURS 5334 ANTIMICROBIALS EXAM (2026-
2027) REVIEW WITH QUESTIONS AND
CORRECT ANSWERS GRADED A+
CONTENTS
PART 1: CELL WALL INHIBITORS, BETA LACTAM ABX AND
INHIBITORS
PART 2: PROTEIN SYNTESIS INIBITORS, QUINOLONES, FOLIC ACID
ANTAGONISTS, URINARY TRACT ABX
,NURS 5334 ANTIMICROBIALS PART 1: CELL
WALL INHIBITORS, BETA LACTAM ABX AND
INHIBITORS
How do antimicrobials work?
ABX: kill pathogens without harming the cell or host
ABX selection requires what
identity and susceptibility of pathogen
site of infection
patient factors
safey and efficacy of agent
cost
Empiric Therapy
TXT provided prior to bacteria ID
Usualy in acute patients with neutropenia, meningitis, etc
Bacteriostatic
inhibits bacterial growth
Bacteriocidal
kills bacteria
it is possible for a drug to be both bacteriostatic for one microbe
and bacterocidal for another
Minimum inhibitory concentration (MIC)
,lowest abx concentration that stops visible bacteria growth after
24 hrs of incubation
Affects the efficacy of drug
Minimum bactericidal concentration (MBC)
The lowest concentration of an antibiotic that kills colony count
How does the BBB affect ABX
single layer of endothelial cells fused by tight junctions to stop
molecules from entering the brain (except small lipophilic ones -
like Metronidazole and Chloramphenicol)
PCN/Vancomycin=low lipid solubility
Infections=inflammed BBB=increased permeability
How does protein binding affect ABX
high protein binding=low entry into CSF
What patient factors affect Immunity to pathogens
ETOH
DM
HIV
Malnutrition
Autoimmune disease
Pregnancy
Old age
Immunosuppressants
How does renal disease affect ABX
some abx can accumulate = toxicity/dose adjustment/direct
monitoring
, How does liver disease affect ABX
Concentrated drugs or those metabolized in liver have to be
monitored
Erythromycin, Doxycycline
How does poor perfusion affect ABX
low circulation=low perfusion to GI=low absorption=hard to get
therapeutic dose orally
How does patient age affect ABX
NB: slow renal/liver elimination= toxicity
Kids: Tetryacyline or Quinolones affect bones, teeth, joints
Elders: low renal/liver function=slow metabolism and elimination
How does pregnancy affect ABX
many drugs cross placenta /breast milk
No Tetracyclines if pregnant
What are risks for multi-drug resistant organisms
1. Prior ABX use in last 90 days
2. Hospitalized for more than 2 d in last 90 days
3 . Current hospitalization more than 5 days
4. High resistance in the community
5. Immunosuppression
Least toxic of all ABX
PCN: interfere with a function unique to bacterial growth
Choosing Route of ABX
2027) REVIEW WITH QUESTIONS AND
CORRECT ANSWERS GRADED A+
CONTENTS
PART 1: CELL WALL INHIBITORS, BETA LACTAM ABX AND
INHIBITORS
PART 2: PROTEIN SYNTESIS INIBITORS, QUINOLONES, FOLIC ACID
ANTAGONISTS, URINARY TRACT ABX
,NURS 5334 ANTIMICROBIALS PART 1: CELL
WALL INHIBITORS, BETA LACTAM ABX AND
INHIBITORS
How do antimicrobials work?
ABX: kill pathogens without harming the cell or host
ABX selection requires what
identity and susceptibility of pathogen
site of infection
patient factors
safey and efficacy of agent
cost
Empiric Therapy
TXT provided prior to bacteria ID
Usualy in acute patients with neutropenia, meningitis, etc
Bacteriostatic
inhibits bacterial growth
Bacteriocidal
kills bacteria
it is possible for a drug to be both bacteriostatic for one microbe
and bacterocidal for another
Minimum inhibitory concentration (MIC)
,lowest abx concentration that stops visible bacteria growth after
24 hrs of incubation
Affects the efficacy of drug
Minimum bactericidal concentration (MBC)
The lowest concentration of an antibiotic that kills colony count
How does the BBB affect ABX
single layer of endothelial cells fused by tight junctions to stop
molecules from entering the brain (except small lipophilic ones -
like Metronidazole and Chloramphenicol)
PCN/Vancomycin=low lipid solubility
Infections=inflammed BBB=increased permeability
How does protein binding affect ABX
high protein binding=low entry into CSF
What patient factors affect Immunity to pathogens
ETOH
DM
HIV
Malnutrition
Autoimmune disease
Pregnancy
Old age
Immunosuppressants
How does renal disease affect ABX
some abx can accumulate = toxicity/dose adjustment/direct
monitoring
, How does liver disease affect ABX
Concentrated drugs or those metabolized in liver have to be
monitored
Erythromycin, Doxycycline
How does poor perfusion affect ABX
low circulation=low perfusion to GI=low absorption=hard to get
therapeutic dose orally
How does patient age affect ABX
NB: slow renal/liver elimination= toxicity
Kids: Tetryacyline or Quinolones affect bones, teeth, joints
Elders: low renal/liver function=slow metabolism and elimination
How does pregnancy affect ABX
many drugs cross placenta /breast milk
No Tetracyclines if pregnant
What are risks for multi-drug resistant organisms
1. Prior ABX use in last 90 days
2. Hospitalized for more than 2 d in last 90 days
3 . Current hospitalization more than 5 days
4. High resistance in the community
5. Immunosuppression
Least toxic of all ABX
PCN: interfere with a function unique to bacterial growth
Choosing Route of ABX
