NURS 5334 Pharmacology Module 2 Quiz

Antibiotics DRUGS THAT WEAKEN CELL WALL Penicillins: weaken bacterial cell wall Beta lactam ring-beta lactimases split this ring and render Pcn inactive Pen G and Pen V: Narrow spectrum good for strep and syphilis (Penicillinase sensitive) Amoxicillin/Ampicillin: broad spectrum: Strep and AOM and lyme disease in children 8 Adverse reactions: allergic Macrolides drugs of choice for patients with allergies Narrow spectrum with penicillinase resistance Oxacillin, Nafacillin, dicloxacillin: staph aureus staff epidermis Dicloxacillin, Nafacillin, Oxacillin, can be given po Piperacillin: effective against pseudomonas and Enterobacter, Bacteroides fragilis and Klebsiella Beta Lactamase inhibitors Clavulanic acid, tazobactam, sulbactam- extend coverage when added to another antibiotic: Ampicillin/sulbactam Amoxicillin clavulanic acid Piperacillin/tazobactam-effective against pseudomonas No MRSA coverage Cephalosporins: weaken bacterial cell wall Most widely used antibiotics Like PCNs have beta lactam ring First generation: Cefadroxil, Cephalexin, cefazolin, cefadroxil mostly used for presurgical prophylaxis (mostly gram positive) Second generation: Cefoxitin (anerobeic bacteriodes fragilis); Cefaclor; Cefotetan; Cefprozil, Cefuroxime, cefmetazole, cefonicid, cefoxitin, cefotetan, loracarbef mostly gram positive coverage with second generation 2 Some gram neg coverage Cefuroxime is good for URI pneumonia from: h flu; pneumococci and staphylococci Gives some beta lactamase coverage but does not cover pseudomonas or meningitis Third generation Cefotaxime, Cefdinir, Cefditoren; Cefixime; cefpodoxime; ceftazidime; Ceftibuten; Ceftriaxone, Cefperazone, cefotaxime, cefibuten, ceftizoxime All can penetrate spinal fluid and have good gram negative aerobes coverage: klebsiella, Serratia, gonorrhea, and pseudomonas, strep pneumoniae, beta hemolytic strip, MSSA, H. flu, Neisseria meningitidis, e coli, Proteus, no pseudomonas or enterococcus activity Fourth generation: Cefipime pseudomonas only; Pseudomonas and hospital acquired infections Fifth generation: - Ceftaroline MRSA VRSA , community acquired pneumonia; Ceftolozane broad spectrum with gram positive and gram negative (pseudomonas and some Enterobacteriaceae species) Ceftolazone is usually given with tazobactam to increase spectrum SIDE EFFECTS Cross allergy with PCN: do not use if anaphylaxis Alcohol reactions: cephazolin, cefmetazole, cefoperazone and cefetotan Bleeding: cefotetan and ceftriaxone, cefmetazole, cefperazone decrease prothrombin through interference with vitamin K Carbapenems-weaken cell wall Imipenem- not given alone-broadest spectrum Meropenem-meningitis Ertapenem- not effective against pseudomonas-acute pelvic infections, complicated GI, GU, soft tissue infection, CAP Doripenem-complicated intraabdominal infections or complicated UTIs Avibactam- often used in combination with ceftazidime for intraabdominal and UTIs Big guns cover almost everything but atypicals Good for gram negative cocci and gram positive cocci and anerobes Carbapenems are renally excreed and reduces levels of valproate Vancomycin- glycopeptide antibiotic; inhibits cell wall synthesis 3 Narrow spectrum only used for MRSA and C diff Oral can only be used for Cdiff Side effects: ototoxicity; red man syndrome; thrombocytopenia and renal failure, rashes Telavancin : lipoglyopeptide; skin infections and hospital acquired pneumonia; may prolong QT Dalbavancin and oritavancin: lipoglycopeptide antibiotics; both used for skin and soft tissue infections; can be used as alternatives for vancomycin for staph and MRSA, strep infections, enterococcus faecalis Daptomycin- binds to cell membrane and depolarizes it, inhibits DNA, RNA, and protein synthesis; used for skin and soft tissue infections and enterococcus faecalis (gm + only) Side effects: myopathy, needs renal dosing Teicoplanin-narrow spectrum = gram + only Fosfomycin- disrupts cross-linking of cell wall peptidoglycan strands; single dose therapy for UTI from E coli or Enterococcus faecalis; check local antibiogram for resistance PROTEIN SYNTHESIS INHIBITORS Tetracyclines- bacteriostatic protein synthesis inhibitor Doxycycline, Minocycline (both long acting), Demeclocycline (intermediate acting), tetracycline (short acting) Broad spectrum: inhibit protein synthesis Uses: Doxycycline: CAMRSA Pneumonia (chlamydia and mycoplasma) RMSF (even children under 8), Lyme, acne, PUD, RA (minocycline), anthrax, chlamydia Stain deciduous teeth and can cause liver and renal toxicity and cause photosensitivity and superinfections Cannot take with calcium, milk, iron, magnesium or antacids Macrolides-inhibit protein synthesis 4 Used in patients allergic to PCN Azithromycin Erythromycin- has several drug interactions: increase half of carbamazepine, warfarin, theophylline Clarithromycin Clindamycin- can be used in CAMRSA; BB Warning for C diff All: Cover pneumonia, mycobacterium avian complex (HIV patients), chlamydia H flu All cause QT prolongation: Azithromycin is the least likely to cause this Avoid statins because of muscle breakdown and simvastatin prolonged QT