Pharmacology Exam 1

First choice antibacterial drug of choice for: Gingivitis (Spirochaetal organisms, streptococci and oral anaerobes)

Penicillin V and Metronida-zole

* imipenem [primaxin] (prototypic)

* Drug class: beta-lactam antibiotic, Carbapenem * Mechanism of action: binds to two PBPs causing weakening of the bacterial cell wall with subsequent cell lysis and death. antimicrobial effects are enhanced by the drug's resistance to practically all beta-lactamases, and by its ability to penetrate the gram-neg cell envelope; resistant to beta-lactamases and has broad antimicrobial spectrum * Indication: extremely broad antimicrobial spectrum (broader than nearly all other antimicrobial drugs, special use for treating mixed infections in which anaerobes (Staph aureus and gram-neg bacilli) are involved, active against most bacterial pathogens (except MRSA) , included organisms resistant to other antibiotics. highly active against gram + cocci and most gram - cocci and bacilli. most effective beta-lactam antibiotic for use against anaerobic bacteria, most effective beta-lactam antibiotic for use against anaerobic bacteria (often affect GI tract) * Administration: must be given IV, not absorbed from GI tract. penetrates the meninges to produce therapeutic concentrations in the cerebrospinal fluid (CSF) * Contraindications * Side effects: generally well-tolerated, GI effects most common, superinfections develop in 4%, rarely seizures; patients with other beta-lactam antibiotics may be cross-allergic * Drug interactions: * Notable info: supplied in fixed dose combinations with cilastatian (inhibits destruction by renal enzymes)

Meropenem

* Drug class: beta-lactam antibiotic, Carbapenem * Mechanism of action: weaken bacterial cell wall, resistant to beta-lactamases and has broad antimicrobial spectrum * Indication: active against most clinically important gram + and gram - aerobes and anaerobes. indications are bacterial meningitis in children age 3mo.+, intra-abdominal infections in children and adults, complicated skin and skin infections in children and adults, especially useful for healthcare or community-associated infections caused by organisms resistant to other antibiotics * Contraindications * Side effects: rashes, diarrhea, nausea, vomiting, risk of cross-sensitivity in patients with allergies to penicillin is ~1%, rarely seizures and bacterial meningitis * Drug interactions: * Notable info

doripenem

* Drug class: beta-lactam antibiotic, carbapenem * Mechanism of action: weaken bacterial cell wall, resistant to beta-lactamases and has broad antimicrobial spectrum * Indication: active against a broad spectrum of gram +, gram -, anaerobic bacteria. activity against P. aeruginosa is greater than with other carbapenems. two indications: complicated intra-abdominal infections and complicated UTIs. * Contraindications * Side effects: generally well-tolerated, common are headache, nausea, diarrhea, rash * Drug interactions: * Notable info: should be reserved for seriously ill patients or infection with multidrug-resistnat, gram - bacteria or pseudomonas

ertapenem

* Drug class: beta-lactam antibiotic, carbapenem * Mechanism of action: weaken bacterial cell wall, resistant to beta-lactamases and has broad antimicrobial spectrum (but less broad than Imipenem and Meropenem) * Indication: actives against most gram + bacteria and anaerobes, parental therapy of acute pelvic infections, community acquired pneumonia and prophylaxis following elective colorectal surgery and complicated infections of the urinary tract, abdomen, skin and skin structures * Contraindications: no activity against P. aeruginosa or acinetobacter species, minimal against pneumococci that are highly resistant to penicillin and no activity against methicillin resistant staphylococci, enterococcus faecium, enterococcus faecalis, or atypical respiratory tract pathogens, including chlamydia species, legionella species and mycoplasma pneumoniae * Side effects: generally well-tolerated, common adverse effects are diarrhea, nausea, infused-vein complications, headache, vomiting, edema, CNS effects, promote C. diff infection * Drug interactions: * Notable info

Cephalosporins

* Drug class: cephalosporin, beta-lactam antibiotic * Mechanism of action: drug that weakens the bacterial cell wall (bind to PBPs and disrupt cell wall synthesis and activate autolysins) * Indication: employed widely against a variety of infections, can be useful for patients with mild penicillin allergy, first gen used for infections by sensitive staphylococci—the first and second generation are rarely drugs of choice for active infections. third gen are preferred therapy for several infections and fourth and fifth are effective against resistant organisms. fifth is used to treat skin infections, including MRSA and healthcare associated pneumonia * Contraindications * Side effects: allergy, bleeding, thrombophlebitis, hemolytic anemia * Drug interactions: probenecid: delays renal excretion, alcohol—not advised, can cause intolerance/poisoning, calcium can produce highly toxic/fatal precipitates * Notable info: most widely used group of antibiotics; all bacericidal and given parenterally, low toxicity and similar to penicillin structure. most effective against cells undergoing active growth and division. Divided into 5 generations—the higher generations are not as susceptible to bet-lactamase...ex. gen 1 is generally destroyed by beta-lactamase * 1st generation: the most susceptible to beta-lactamases, generally destroyed. most active against Gram + organisms. widely used for prophylaxis against infection in surgical patients; rarely used for active infections: cephalexin (prototypic), cephalothin, cephapirin, cephradine, cefadroxil * 2nd generation: less sensitive to beta-lactamases; specific indications are limited: cefoxitin (prototypic), cefazolin, cefamandole, cefonicid, cefmetazole, cefotetan, cefuroxime (oral cefuroxime is useful for otits, sinusitis, and URIs) * 3rd generation: more resistant than 1-2 gen agents to beta-lactamases; preferred therapy for several infections, highly active against gram-negative organisms, able to penetrate to cerebrospinal fluid, shouldn't be used routinely but rather only when circumstances demand to reduce resistance: cefotaxime (prototypic), cefacior, cefoperazone, ceftizoxime, ceftazidime, ceftriaxone, cetixime, moxlactam * 4th and 5th generation: more resistant than 1-2 gen agents to beta-lactamases; 4th: commonly used to treat health care and hospital associated pneumonias, included those caused by resistant organism pseudomonas; 5th: infections associated with MRSA: cefepime (prototypic), ceftaroline (prototypic), cefozopran, cefpirome, cefquinome, ceftobiprole, fosamil

Penicillin V

* Drug class: penicillin, beta-lactam antibiotic * what makes it different than the prototypic drug: very similar to penicillin G but for its acid stability: penicillin V is stable in stomach acid, whereas Penicillin G is not. Because of its acid stability, penicillin V has replaced penicillin G for oral therapy. Penicillin V can be taken with meals.

Ampicillin

* Drug class: penicillin, beta-lactam antibiotic/broad-spectrum penicillin * Mechanism of action: weaken bacterial cell wall * first broad-spectrum penicillin in clinical use * therapeutic use: infections caused by enterococcus faecalis, Proteus mirabilis, E. coli, Salmonella, Shigella, H. influenza * administration: oral or IV but oral therapy is preferred with amoxicillin * side effects: rash and diarrhea (occur most frequently with ampicillin than any other penicillin) * key note: is available in fixed-dose combination with sulbactam, inhibitor of beta-lactamase (Unasyn)

* Amoxicillin [Moxatag]

* Drug class: penicillin, beta-lactam antibiotic/broad-spectrum penicillin * Mechanism of action: weaken bacterial cell wall * similar to Ampicillin is structure and actions; differ by acid stability (amoxicillin is more stable) * Administration: orally * side effects: produces less diarrhea than ampicillin (less amoxicillin remains unabsorbed in the intestines) * key note: available in a fixed dose combination with clavulanic acid, inhibitor or bacterial beta-lactamases (Augmentin)

Tircarcillin

* Drug class: penicillin, beta-lactam antibiotic/extended-spectrum penicillin * Mechanism of action: weaken bacterial cell wall * Indication * Side effects: since administered as the disodium salt with large IVs, symptoms of sodium overload can develop (e.g. congestive heart failure), can interfere with platelet function and promote bleeding * Drug interactions * Notable info: penicillinase sensitive, only available in a fixed-dose combination with clavulanic acid (Timentin), one of the broadest antimicrobial spectra of all penicillins—susceptible to destruction by penicillinase, can trigger allergic reactions

Piperacillin

* Drug class: penicillin, beta-lactam antibiotic/extended-spectrum penicillin * Mechanism of action: weaken bacterial cell wall * Indication: active against P. aeruginosa * Administration: acid labile and must be administered parenterally (IV) * Side effects: can cause bleeding secondary to disrupting platelet functioning * Drug interactions * Notable info: available in fixed-dose combination with tazobactam (Zosyn), penicillinase sensitive, should not be mixed with an aminoglycoside in the same IV solution

methicillin

* Drug class: penicillin, beta-lactam antibiotic/penicillinase-resisitant penicillin * the oldest penicillinase-resistant penicillin, no longer available. in addition to causing allergic reactions typical of all penicillins, methicillin may produce interstitial nephritis, an adverse effect usually reversible but can lead to renal failure.

* oxacillin and dicloxacillin

* Drug class: penicillin, beta-lactam antibiotic/penicillinase-resisitant penicillin * these drugs are similar in structure and pharmokinetic properties. both are acid stable but only dicloxicillin is formulated for oral dosing (oxacillin is IV).

Nafcillin

* Drug class: penicillin, beta-lactam antibiotic/penicillinase-resisitant penicillin * usually administered IV (IM is rare). Absorption from GI tract is erratic and incomplete, hence oral formulations have been discontinued

Penicillin G (Benzylpenicilin)

* Prototype for Penicillin family * Drug class: beta-lactam antibiotics * Mechanism of action: weaken bacterial cell wall * Indication: drug of first choice caused by infections caused by sensitive gram-positive cocci (pneumonia and meningitis caused by Streptococcus pneumonia, pharyngitis and endocarditis), additionally useful for few strains of staph that do not produce penicillinase. Useful against gas gangrene and anthrax. can be used prophylactically (ex. syphilis, rheumatic fever, rheumatic heart disease) * Side effects: least toxic of all antibiotics and among the safest but penicillins are the most common cause of drug allergies * Drug interactions: aminoglycosides, probenecid, bacteriostatic antibiotics * Key notes: first available penicillin, bactericidal to gram-positive bacteria and some gram-negative, drug of choice for many infections, bactericidal to numerous gram-positive and some gram-negative organisms * adverse effects: least toxic of all antibiotics, largely the most common cause of drug allergy

What factors can affect each stage of drug movement through the body?

* Route of administration * Regional blood flow * Physiochemical properties the affect movement through body: lipid solubility, ionization, protein binding

What factors affect the intensity of a drug response?

* Route of administration—determines how much of a drug gets to the site of action (intensity of response); that fractional amount is called bioavailability (the best bioavailability is intravenous and intra-arterial because they bypass absorption). * Pharmacokinetics, including the volume of distribution, the elimination half life; essentially how much drug can make it to the site of action * Pharmacodynamics, the relationship between the drug and receptor * Potentially other drug and food interactions * Patient variability—can be pharmacodynamic or pharmacokinetic * issues of tolerance (also either pharmacodynamic or pharmacokinetic)

What is bioavailability?

* The fractional extent to which a dose of drug reaches the blood stream and its site of action

What are the properties of an ideal drug? Does one exist?

* There is no such thing as an ideal drug. * Properties of an ideal drug * Effective under all conditions * Specificity—only binds to the receptor that produces a therapeutic effect and no other receptors * Low cost * Safe and doesn't produce harmful effects * Reversible action—if you stop taking it the action reverses itself * Unique and easy to remember generic name—describing the active ingredient (every drug as 3 names: generic, trade and chemical name) * Ease of administration—ideally in a pill through self-administration * Predictability—we'll know the exact effects it will produce * Chemical stability—the amount of drug you have will remain stable over time * Wide therapeutic index—the effective dose is small compared to lethal dose

List, define, and compare the various names drugs have.

* Trade: proprietary/brand name given by pharmaceutical company (same drug can have a dozen or more trade names but only one generic and one chemical name) * Generic: active ingredient * Chemical: structure of the drug

What are the stages by which a drug moves through the body?

* absorption: not all go through absorption depending on route of administration * distribution * metabolism: not all go through metabolism; some drugs (esp water soluble) will be eliminated in their unchanged form (salicylic acid) * excretion

What is first pass-effect?

* drug through the liver * only applicable through enteral administration * significant first pass effect, means the liver is metabolizing a substantial amount of the drug as it passes through after absorption * drugs that are less likely to be given through enteral route (low bioavailability)

Define, compare, and contrast: endogenous ligand, agonist, partial agonist, antagonist

* endogenous ligand: same as endogenous chemical. a ligand is any chemical that binds to a receptor * agonist * partial agonist * antagonist: blocker (it blocks the endogenous chemical from binding to the receptor)

Compare and contrast different routes of drug administration.

* most important categories: enteral and parenteral * routes: * oral (benefit is easy and best patient adherence, cheap) * intravenous * subcutaneous * intramuscular * sublingual * transdermal: major concern of transdermal patch: intact skin; anything that increases blood flow to the skin will increase rate of absorption of drug (heat or exercise) * rectal * intra-arterial * intrathecal * inhaled * topical

What is fat and bone sequestration?

* some drugs accumulate in fat and bone and create a reservoir of drug. * so much of drug movement is diffusion from high to low—when entering the body in enters to the tissue, when blood concentration dips below bone and fat it redistributes. * the movement back and forth is through diffusion, depend on the direction of the concentration gradient. when taking the drug, blood concentrations rise and it moves into fat and bone. when blood concentrations drop low enough the bone and fat become the high concentration it moves back out of the blood

What is drug affinity?

* the ability to bind to a site; how well or tightly it binds * no affinity to a certain receptor means it cannot bind * just because it can bind does not mean it can immediately activate the receptor * intrinsic activity—ability to immediately activate a receptor

What is a drug half life?

* time it takes for the blood concentration to drop by half * in the graph a lot of the drug drops quickly and has an elongated tail

What is the primary difference between the first, second, and 3rd/4th generation cephalosporins?

1st generation: the most susceptible to beta-lactamases, generally destroyed. most active against Gram + organisms. widely used for prophylaxis against infection in surgical patients; rarely used for active infections 2nd generation: less sensitive to beta-lactamases; specific indications are limited. 3rd generation: more resistant than 1-2 gen agents to beta-lactamases; preferred therapy for several infections, highly active against gram-negative organisms, able to penetrate to cerebrospinal fluid, shouldn't be used routinely but rather only when circumstances demand to reduce resistance 4th and 5th generation: more resistant than 1-2 gen agents to beta-lactamases; 4th: commonly used to treat health care and hospital associated pneumonias, included those caused by resistant organism pseudomonas; 5th: infections associated with MRSA

First choice antibacterial drug of choice for: Pyelonephritis and complicated urinary tract infection

2nd gen Cephalo-sporin and Gentamicin or a quinolone

First choice antibacterial drug of choice for: Diabetic foot infections (Polymicrobial infection - Enterobacteriaceae, Staph aureus, streptococci, anaerobic bacteria)

2nd or 3rd gen Cephalo-sporin and Metronida-zole or Betalactam-betalacta-mase inhibitor combination

What are the most common causes of medication errors?

90% of all errors are due to: Performance deficits are the most common, followed by knowledge deficits and miscalculation of dosage Fatal -Overdose 36.4% -wrong drug 16.2% -wrong route 9.5%

Which statement about allergic reactions to penicillin does the nurse identify as true? A. Anaphylactic reactions occur more frequently with penicillins than with any other drug. B. Allergy to penicillin always increases over time. C. Benadryl is the drug of choice for anaphylaxis due to penicillin allergy. D. Patients allergic to penicillin are also allergic to vancomycin.

A. Anaphylactic reactions occur more frequently with penicillins than with any other drug.

A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? A. Warfarin B. Milk products C. Digitalis D. Alcohol

A. Warfarin

First choice antibacterial drug of choice for: Acute epiglottitis

Acute epiglottitis is a medical emergency and hospitalisation with aggressive therapy is required

First choice antibacterial drug of choice for: Acute exacerbations of chronic bronchitis

Ampicillin or Strep pneumonia - Penicillin G/V or Amoxicillin Haemophilus influenza - Trimethorprim/sulfamethoxazole

First choice antibacterial drug of choice for: Acute bronchitis

Ampicillin or Strep pneumonia - Penicillin G/V or Amoxicillin Haemophilus influenza - Trimethorprim/sulfamethoxazole Acute bronchitis is primarily a viral infection and antibiotics are not indicated. However 2o bacterial infection may occur in severe cases. Erythromycin is preferred if Mycoplasma is suspected

First choice antibacterial drug of choice for: Acute otitis media and acute sinusitis

Ampicillin or Strep pneumonia - Penicillin G/V or Amoxicillin Haemophilus influenza - Trimethorprim/sulfamethoxazole Most strains of Strep pneumoniae and Haemophilus influenzae in Malaysia are sensitive to ampicillin. However many strains of Moraxella catarrhalis are resistant to ampicillin.

First choice antibacterial drug of choice for: Pneumonia Community acquired pneumonia - mild to moderate

Ampicillin or Strep pneumonia - Penicillin G/V or Amoxicillin Haemophilus influenza - Trimethorprim/sulfamethoxazole Mycoplasm - Erythromycin, clarithromycin, azithromycin, a tetracycline Klebseilla pneumonia - Cefotaxime, ceftriaxone, cefepime, cefazidime When Staph aureus is suspected or demonstrated use cloxacillin and gentamicin.

What is the difference between an antibiotic vs. an antimicrobial agent?

An antibiotic is a chemical produced by one microbe that can harm other microbes (more specific to bacterial infections). An antimicrobial agent is any agent that can kill or suppress microorganisms (inclusive of drugs that fight bacteria, viruses and other form of infectious organisms).

What is CDAD? What antibiotics drugs can cause this condition? Why?

C. difficile associated diarrhea. seen with clindamycin, cephalosporins or penicillins why using an antibiotic cause a bacterial infection—kills the good microbes in your gut (competing bacteria)

First choice antibacterial drug of choice for: Neisseria meningitides

Penicillin G

A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? A. Administer the cephalosporin as ordered. B. Contact the health care provider for a different antibiotic. C. Administer a test dose of cephalosporin to determine reactivity. D. Have an epinephrine dose available when administering the cephalosporin.

B. Contact the health care provider for a different antibiotic.

A patient is diagnosed with C. difficile infection. The nurse anticipates administering which medication? A. Daptomycin B. Metronidazole C. Rifampin D. Rifaximin

B. Metronidazole

A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? A. Milk intolerance B. Skin rash, hives, or itching C. Constipation, nausea, or vomiting D. Headache, contusions, or seizures

B. Skin rash, hives, or itching

The nurse is reviewing laboratory values from a patient who has been prescribed gentamicin. To prevent ototoxicity, it is most important for the nurse to monitor which value(s)? A. Serum creatinine and blood urea nitrogen levels B. Trough drug levels of gentamicin C. Peak drugs levels of gentamicin D. Serum alanine aminotransferase and aspartate aminotransferase levels

B. Trough drug levels of gentamicin

First choice antibacterial drug of choice for: Cellulitis (Strep pyogens)

Penicillin G or V

What is the difference between a bacteriocidal vs. bacteriostatic agent?

Bacteriocidal: drugs are directly lethal to bacteria at clinically achievable concentrations (used prophylactically) Bacteriostatic: drugs can slow bacterial growth but do not cause cell death (rarely taken alone and used particularly for an active infection)

A patient who takes warfarin has been prescribed sulfadiazine. When teaching the patient about this drug, which statement will the nurse include? A. "If you become pregnant, it is safe to take sulfadiazine." B. "You should limit your fluid intake while taking sulfadiazine." C. "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." D. "You will most likely need to have an increase in the dose of warfarin while taking sulfadiazine."

C. "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin."

First choice antibacterial drug of choice for: Impetigo (Strep pyogenes, Staph aureus)

Penicillin G or V

What foods/supplements should be avoided when a patient is taking minocycline? Why?

Calcium supplements, milk products, iron supplements, magnesium-containing laxatives and most antacids—causes decreased absorption

Broad spectrum antibacterial drugs

Classified under antimicrobial drugs by susceptible organism Gram (+) cocci & Gram (-) bacilli -Broad-spectrum penicillins: ampicillin, etc. -Extended-spectrum penicillins: piperacilin, etc -Cephalosporins (3rd gen) -Tetracyclines -Carbapenems: impenem, etc. -Trimethoprim -Sulfonamides -Flouroquinolones: ciprofloxacin, etc. this type of drugs are useful but overuse is cause for a lot of resistance.

Narrow spectrum Antibacterial Drugs

Classified under antimicrobial drugs by susceptible organism Three types: Gram (+) Cocci & Gram (-) Bacilli -Penicillin G&V -Penicillinase Resistant Penicillins: oxacillin, nafcillin -Vancomycin -Erythromycin -Clindamycin Gram (-) Aerobes -Aminogylcosides: gentacymin, etc. -Cephalosporins (1st and 2nd gen) Mycobacterium Tuberculosis -Isonizid -Rifampin -Ethembutol -Pyrazinamide

A patient is prescribed vancomycin orally for antibiotic-associated pseudomembranous colitis. The nurse will monitor the patient for what? A. Leukopenia B. "Red man" syndrome C. Liver impairment D. Ototoxicity

D. Ototoxicity

The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy? A. Blurred vision B. Hand tremors C. Urinary frequency D. Tinnitus

D. Tinnitus

First choice antibacterial drug of choice for: Borrelia burgdorferi

Doxycycline, amoxicillin, cefuroxime

Bacteriocidal

Drugs are directly lethal to bacteria at clinically achievable concentration

Bacteriostatic

Drugs can slow bacterial growth but do not cause cell death Rarely taken alone, particularly for an active infection Frequently taken prophylactically Can be paired with the other type of antibiotics to increase efficacy

First choice antibacterial drug of choice for: Acute urinary tract infection

E. Coli - Cefataxime, ceftazidime, cefepime, ceftriaxone Staphylococcus saprophyticus - Ampicillin, Amoxicillin Many hospital acquired pathogens are now resistant to ampicillin. In uncomplicated cystitis in adults 4 tabs cotrimoxazole in a single dose has been shown to be effective. In pregnancy ampicillin should be given for 10 days

What is ED50? What is LD50? How do they relate to therapeutic index?

ED50 is the average effective dose (the individual effective dose may vary person to person but the ED50 is an average across people) LD50 is the average lethal dose to 50% of animals treated The therapeutic index is a ratio of the LD50 to its ED50

First choice antibacterial drug of choice for: Periodontal infections (Streptococci and oral anaerobes)

Penicillin G or V

First choice antibacterial drug of choice for: Diphtheria

Erythromycin Antibiotics are not the mainstay of treatment. Antitoxin and supportive treatment are critical in management. Close contacts should receive erythromycin. Non-immunised contacts should be immunised.

First choice antibacterial drug of choice for: Pertussis

Erythromycin, azithromycin, Clarithromycin Antibiotic treatment does not significantly alter the course of disease. If given early it helps to eradicate oropharyngeal organisms thus interrupting transmission.

What types of penicillin allergies (in terms of time-course) exist?

Immediate (2-30 min) Accelerated (1-72 hrs) Delayed (days or weeks)

What types of adverse drugs reactions can we observe?

Mild reactions (drowsiness, nausea, itching, rash) Severe reactions (respiratory depression, neutropenia, hepatocellular injury, anaphylaxis, hemorrhage)

Cephalosporins basic facts, mechanism of action and resistance

Most widely used group of antibiotics -beta-lactam antibiotics -similar to penicillin structure -bactericidal -usually given parentally -low toxicity Mechanism of action: bind to penicillin-binding proteins (PBPs), disrupt cell wall synthesis, cause cell lysis. most effective against cells undergoing active growth and division Resistance: beta-lactamases (cephalosporinases); first-generation destroyed, second-generation less sensitive, third-, fourth-, and fifth-gen agents are more resistant than the first- and second-generation agents

First choice antibacterial drug of choice for: acute pharyngitis/tonsilitis, scarlet fever

Penicillin V or G The majority of sore throats are viral in origin and antibiotics are not indicated for treatment or prevention of secondary bacterial infections.

What is the difference between a drug's efficacy and drug's potency?

Potency is an expression of the activity of a drug in terms of the concentration or amount of the drug required to produce a defined effect, whereas clinical efficacy judges the therapeutic effectiveness of the drug in humans. maximal efficacy is what determines the highest intensity of response. two drugs with different maximal efficacy, you will never get the same maximal efficacy of drug A

Bacteriostatic inhibitors of protein synthesis

Tetracyclines, macrolides, and others

First choice antibacterial drug of choice for: Catheter associated infections (Enterobacteriaceae, Pseudomonas and Enterococcus)

Treat accord-ing to culture & sensitivity report Enterobacteriaceae - imipenem, meropenem, cefepime, Pseudomonas - Ciprofloxacin, Enterococcus - - Ampicillin, Amoxicillin

First choice antibacterial drug of choice for: Antibiotic associated colitis (Clostridium difficile)

Vancomycin (oral) or Metronidazole

First choice antibacterial drug of choice for: MRSA - Methicilin-resistant Staph aureus

Vancomycin with or without gentamicin with or without rifampin

Antibiotic

a chemical produced by one microbe that can harm other microbes more specific to bacterial infections use the most in agriculture two classifications: bacteriocidal and bacteriostatic

What is the difference between a generic and a brand name drug?

a generic name describes the active ingredient of a drug and the brand name is a proprietary name given by a pharmaceutical company

Antimicrobial agent

any agent that can kill or suppress microorganisms inclusive of drugs that fight bacteria, viruses and other forms of infectious organisms (anything that can kill or suppress an organism) has various classification systems, but two for us: classification by susceptible organism or classification by mechanism of action

Which antibiotic drugs are widely used for topical application but are generally too toxic to be used systemically.

bacitracin (neosporin)

What is beta-lactamase or penicillinase? Who produces it? How does it affect the therapeutic efficacy of the beta-lactam and penicillin-like drugs?

beta-lactamase or penicillinase are enzymes produced by bacteria to inactivate penicillins or other antibiotics over time natural selection allows bacteria to have certain defenses ESBL: extended-spectrum betalactamase

Which antibiotic drug carries the risk of tendon rupture?

ciprofloxane (fluoroqunilone); avoid in children high risk of achilles tendon rupture

Why is doxycycline rarely used as monotherapy for infections?

doxycycline is bacteriostatic—it slows down infection but won't wipe it out; inhibits protein synthesis. you can use it prophylactically or for a low level infection

What is "red man" syndrome? Which drug ( or drugs) is this adverse affect associated with?

flushing, rash, pruritus, urticaria, tachycardia, hypertension associated with vancomycin (vancocin, vancoled)--specifically PO (don't see with IV)

By what mechanism do the penicillin drugs work?

how penicillin's work: they inhibit cell wall synthesis Production of altered penicillin-binding proteins (PBPs)--the drug cannot bind to the target of action (ex. MRSA) because it is inhibited by a penicillin-binding protein

What is the 5th generation cephalosporins primarily used for?

infections associated with MRSA

Infection with what kind of microorganism would most warrant the use of an Aminglycoside?

most effective against aerobic gram(-) bacilli can be used with penicillin allergies

Why are serum levels evaluated when taking an aminoglycoside antibiotic?

the therapeutic index is narrow ED50—average effective dose LD50—average lethal dose you want to ED50 and LD50 far apart for safety. there are times when you measure peak and trough (peak is the highest point and trough is lowest point—usually talking about when you give a drug every few hours)...measure peak 30 min after a drug (the peak circulation), the trough you measure right before you give the next dose

Why is clanic acid, or tazobactam, or sulbactam sometimes added to a penicillin drug?

these substances are beta-lactamase inhibitors (inactivate the enzyme that breaks down penicillin)—gives penicillin the chance to work If symptoms don't resolve with pencillin first line drugs, it can be combined with penicillinase-sensitive antibiotics for example, someone on amoxicillin but symptoms don't resolve, so they may be switched to augmentin—because the bacteria was producing betalactamase but not until the clavulanic acid added to the amoxicillin it becomes effective; useful step up when the first line drug is not effective against infection