Penicillins, Cephalosporins, Macrolides, Tetracyclines, Aminoglycosides, Fluoroquinolones, Sulfonamides, Antituberculars, Antifungals, Peptides(Ch. 29-32 Exam 3)
carbapenems
-antibiotics used for the treatment of infections known or suspected to be caused by multi-drug resistant bacteria -used primarily in hospitalized patients -broader spectrum than penicillins or cephalosporins
zidovudine (AZT)
-counsel pt about hand washing technique -monitor lab values for decreasing CD4 counts and rising viral load -emphasize protection precautions -Advise pt to eat a variety of foods, to avoid raw eggs and raw fish, and to cook meats to correct temp -discuss diet of banana, rice, applesauce, and toast for management of diarrhea
amoxicillin
-decreased effect with acidic fruits/juices -take with food -use additional contraceptives -take entire prescription
azithromycin, antacids
Administer oral _______________ one hour before or two hours after meals. What should be given either two hours before or two hours after administration?
Bactrim and doxycycline
Besides vancomycin, what two other drugs are effective for treatment of MRSA?
hypersensitivity, superinfection
Common adverse reactions to penicillin administration are __________ and ___________. NVD are common GI disturbances. Rash is an indicator of a mild to moderate allergic reaction. Severe allergic reaction leads to anaphylactic shock.
amoxicillin
Contraindications: allergy to penicillin, Renal impairment,seizures asthma, IBD, ulcerative colitis, mononucleosis,
doxycycline (Vibramycin)
Contraindications: hypersensitivity, sulfite hypersensitivity, pregnancy, severe hepatic or renal disease Interactions: dairy products, antacids, iron, calcium and magnesium decrease drug absorption; digoxin absorption is increased, which may lead to digitalis toxicity.
fluconazole (Diflucan)
Contraindications: hypersensitivity; caution: pregnancy Interactions: increases hypoglycemia when taken with oral sulfonmylureas -For thrush, pneumonia, and oropharyngeal candidiasis -Avoid operating motor vehicle
levofloxacin (Levaquin)
Contraindications: severe renal disease, myasthenia gravis, pregnancy and breastfeeding -increase fluid to 2000/day -Do not take with caffiene -antacids and iron preps decrease absorption
Bactrim
Contraindications: severe renal or hepatic disease, hypersensitivity to sulfonamides, megaloblastic or folate deficiency anemia, pregnancy, breastfeeding, infants
Azithromycin (Zithromax)
Drug Class: antibacterial macrolide MA: inhibits the steps of protein synthesis; bacteriostatic or bactericidal effect
amoxicillin
Drug class: Broad-spectrum penicillin Therapeutic use: to treat respiratory tract infection, UTIs, otitis media, and sinusitis Interactions: increase effect with aspirin; increase bleeding with oral anticoagulants
ceftriaxone (Rocephin)
Drug class: Third generation cephalosporin MA: Inhibition of bacterial cell wall synthesis, causing cell death; bactericidal effect
gentamicin(Garamycin)
Drug class: antibacterial aminoglycoside MA: inhibits bacterial protein synthesis; bactericidal effect
levofloxacin (Levaquin)
Drug class: antibacterial fluoroquinolone MA: Interferes with the enzyme DNA gyrase, which is needed for bacterial DNA synthesis; bactericidal effect
Bactrim
Drug class: antibacterial sulfonamide MA: inhibits folic acid synthesis and protein synthesis of nucleic acids; bactericidal effect
doxycycline (Vibramycin)
Drug class: antibacterial tetracycline MA: inhibits the steps of protein synthesis; bacteriostatic or bactericidal
fluconazole (Diflucan)
Drug class: antifungal MA: Increase permeability of the fungal cell membrane
Isoniazid
Drug class: antitubercular MA: inhibition of bacterial cell wall synthesis
vancomycin
Drug class: glycopeptide bactericidal antibiotics USE: drug resistant S. aureus and in cardiac surgical prophylaxis for individuals with penicillin allergies.
zidovudine (AZT)
Drug class: nucleoside reverse transcriptase inhibitor MA: inhibits viral enzyme reverse transcriptase, an enzyme necessary for viral HIV replication
vancomycin (Vancocin)
For S aureus resistant infections and cardiac surgical prophylaxis in patients with penicillin allergy. Adverse reactions include vascular collapse, ototoxicity, nephrotoxicity and red neck syndrome.
isoniazid
For __________, peripheral neuropathy can be a problem, especially for those who are malnourished, have diabetes or are alcoholics.
tetracycline
For years, oral and topical _________ has been used to treat severe acne vulgaris.
phlebitis (pain at injection site)
IV macrolides should be infused slowly to avoid what?
ceftriaxone (Rocephin)
Interactions: increase nephrotoxicity with loops diuretics, aminoglycosides, calcium salts, vancomycin, increase bleeding with anticoagulants -culture infected area before therapy -take entire course -take with food and adequate fluid
gentamicin (Garamycin)
Interactions: increase risk of ototoxicity with loop diuretics Contraindications: hypersensitivity, severe renal disease, pregnancy, and pseudomembranous colitis
first line
Is Isoniazid a first or second line antitubercular drug?
azithromycin
Macrolides including __________ are broad spectrum antibiotics.
disulfiram reaction
Metronidazole (flagyl) with alcohol may produce a ____________ __________(facial flushing, severe headache, tachycardia, palpitations, hypotension, dyspnea, sweating, slured speech, abdominal cramps, nausea and vominting):
H pylori
Metronidazole is commonly used with other agents to treat ___ ________ which is associated with frequent recurrent peptic ulcers.
sepsis
Most third and fourth generation cephalosporins are effective in treating _______ and many strains of gram negative bacilli.
cell lysis
Penicillin's beta lactam structure interferes with bacterial cell wall synthesis by inhibiting the bacterial enzyme that is necessary for cell division and cellular synthesis. The bacteria die of ____ ______.
liver disease
Prophylactic antitubercular therapy is contraindicated for persons with ______ _______.
levofloxacin (Levaquin)
SE: NVD, ab cramps, flatulence, headache, blurred vision, dizziness, tinnitus Adverse: hepatotoxicity, nephrotoxicity, hyperkalemia
doxycycline(Vibramycin)
SE: NVD, rash, flatulence, abdominal discomfort, headache, photosensitivity, pruritus, heartburn, color vision changes, teeth discoloration Adverse: superinfections, severe photosensitivity, angioedema, hyperglycemia, hypertension -GI complaints, photosensitivity & thrombocythemia
metronidazole (Flagyl)
SE: dizziness, headache, confusion, depression, irritability, weakness, insomnia. High doses: dark or reddish brown urine, dry mouth, metallic or bitter taste, GI distress, paresthesias, nasal congestion, decreased libido, dysuria, incontinence, ECG changes.
gentamicin (Garamycin)
SE: muscle cramps or weakness, nephrotoxicity, ototoxicity -check for hearing loss, increase fluid intake and use sunblock -Report SE: N/V, tinnitus, muscle cramps
zidovudine (AZT)
SE: numbness, tingling, burning and pain in lower extremities, abdominal pain, rash, GI intolerance, fever, difficulty swallowin, mental changes, insomnia, bluish brown bands on fingernails Adverse: NV, anemia, neutropenia, seizures
isoniazid
SE: peripheral neuropathy and hepatotoxicity Contraindications: severe renal or hepatic disease, alcoholism, diabetic retinopathy -encourage eye exams b/c visual disturbances -Report any numbness/tingling -DO NOT take with meals or antacids
yes
Should you advise a patient to take penicillin with food?
amoxicillin
Side effects: seizures, rash, respiratory distress and superinfections
crystalluria
Sulfonamides should be taken with plenty of water to prevent ___________.
Cephalosporins
Tell pt to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area with which class of drugs?
cephalosporins
The SE and adverse reactions to __________ include GI disturbances, alteration in blood clotting time (increased bleeding) with admin of large doses, and nephrotoxicity in individuals with a preexisting renal disorder.
candidiasis
The azole group of antifungals is effective against ________, coccidioidomycosis, cryptococcosis, histoplasmosis, and paracoccidioidomycosis.
tetracyclines
The desired action of oral contraceptives can be lessened when taken with ______________.
fluoroquinolones
The mechanism of action of _____________ is to interfere with the enzyme DNA gyrase, which is needed to synthesize DNA.
antacids
The peak level of azithromycin may be decreased by __________.
peptides
The two groups of ________ used as antibiotics are the polymyxins and bacitracin. This group appears to interfere with bacterial cell membrane function.
doxycycline (Vibramycin)
Therapeutic use: For respiratory infections, skin infections and STD like gonorrhea, chlamydia, syphilis, etc.
ceftriaxone (Rocephin)
Therapeutic use: For respiratory, urinary, bone, joint, and skin infections; sepsis, gonorrhea, Klebsiella pneumonia (treatment of pneumonia, UTI and sepsis) SE: abdominal pain, superinfections, seizures
levofloxacin (Levaquin)
Therapeutic use: To treat commjunity acquired pneumonia, UTI and PID Bacterial action against strep, staph and E coli, etc.
fluconazole (Diflucan)
Therapeutic use: to treat Candida infections and cryptococcal meningitis SE: nausea, vomiting, diarrhea(large amounts), stomach cramps, rash, seizures, hepatotoxicity, nephrotoxicity
isoniazid
Therapeutic use: to treat TB; prophylactic measure against tuberculosis
Bactrim
Therapeutic use: to treat UTI, otitis media, bronchitis SE: photosensitivity, seizures, renal failure
azithromycin (Zithromax)
Therapeutic use: to treat gram positive and some gram negative organisms; for patients who are allergic to penicillin; to treat upper respiratory tract infections, gonorrhea, and skin infections
gentamicin (Garamycin)
Therapeutic use: to treat serious infections caused by gram negative organisms; to treat pelvic inflammatory disease, effective against methicillin resistant Staph aureus infections and P. aeruginosa
Aminoglycosides
These are for serious infections; they cross the blood brain barrier in children but not adults; Serious adverse reactions include ototoxicity and nephrotoxicity:
vancomycin (Vancocin)
Too rapid an IV injection of _________ can cause a condition known as "red man" syndrome or red neck syndrome characterized by red blotching of the face, neck, and chest, this is a toxic effect rather than an allergic reaction.
zidovudine (AZT)
Use: management of patients with HIV infection; prevention of maternal fetal HIV transmission
5-8 mcg/ml
What are the peak values for Gentamicin?
hypersensitivity, superinfection and organ toxicity
What are the three major adverse reactions associated with the administration of antibacterial drugs?
0.5-2 mcg/ml
What are the trough values for Gentamicin?
broad spectrum penicillins (amoxicillin)
What drug class can decrease the effectiveness of oral contraceptives?
vitamin B6
What is frequently prescribed with isoniazid to avoid deficiency ad possible occurrence of peripheral neuropathy?
they may have grown a thicker cell wall
What is one explanation for why mutant bacteria strains may have become resistant to antibiotics?
prophylactic antitubercular therapy
What is suggested for 1.) individuals who have been in close contact with persons with TB 2.) for those who test positive for HIV and also have a positive TB skin test or are in close contact with someone who has TB and, 3.) patients who have converted from a negative to a positive TB skin test.
vancomycin
What is the treatment of choice for MRSA?
B6
What must be given with isoniazid to prevent peripheral neuropathy?
alcohol
What should a pt taking metronidazole avoid for at least 48 hours after treatment is completed?
aminoglycosides
When _____________ are administered concurrently with penicillins, the desired effects are greatly decreased; these drugs should be given several hours apart.
sensitive, resistant
When bacteria are __________ to a drug, the pathogen is inhibited or destroyed; if bacteria are _________ to an antibacterial, the pathogen continues to grow, despite administration of that antibacterial drug.
NSAIDs
When levofloxacin (Levaquin) is taken with ________, CNS reactions including seizures may occur.
narrow spectrum
Which antibiotics are primarily effective against one type of organism?
broad spectrum
Which antibiotics can be effective against both gram positive and gram negative organisms?
metronidazole (Flagyl)
Which drug acts by impairing DNA function of susceptible bacteria and is used to treat various disorders associated with organisms in the GI tract?
antifungals
Which drug class has SE seizures, hepatotoxicity and NVD?
carbapenems
Which drug class is used to treat community acquired intra abdominal infections, complicated UTIs, hospital acquired pneumonia and sepsis?
Azithromycin (Zithromax)
Which drug is frequently prescribed for upper and lower respiratory infections, STIs, and uncomplicated skin infections?
metronidazole (Flagyl)
Which drug is prescribed to treat intestinal amebiasis, trichomoniasis, IBD, anaerobic infections and bacerial vaginosis and is used as perioperative prophylaxis in colorectal surgery?
Levofloxacin (Levaquin)
Which drug is primarily used to treat respiratory problems such as community acquired pneumonia, chronic bronchitis, acute sinusitis, UTIs and uncomplicated skin infections?
vancomycin (Vancocin)
Which drug may cause nephrotoxicity, vascular collapse and ototoxicity?
levofloxacin (Levoquin)
Which drug should be infused over 60 minutes and should you watch for S/S of superinfection like stomatitis & furry black tongue?
fluoroquinolones
With which drug class should fluid intake be at least 2,000 mL/day?
tetracyclines
[Drug class, not specific drug] SE: GI disturbances, photosensitivity, teratogenic, difficulty maintaining balance, nephrotoxicity, superinfection, teeth discoloration
sulfonamides
[Drug class, not specific drug] SE: allergic response such as skin rash and itching; hemolytic anemia, aplastic anemia, low WBC and platelet counts, GI disturbances, crystalluria, hematuria, photosensitivity, cross sensitivity; avoid during 3rd trimester of pregnancy
macrolides
_______ can increase serum levels of theophylline and warfarin; their drug serum levels should be closely monitored.
Isoniazid
_______ is a bactericidal drug that inhibits tubercle cell wall synthesis and blocks pyridoxine (vitamin B6) which is used for intracellular enzyme production.
Bactrim
_______ is a sulfonamide effective in treating urinary, intestinal and lower respiratory tract infections; otitis media; prostatitis; and gonorrhea. It is also used to prevent Pneumocystis carinii in pts with AIDS.
alcohol
_______ with a cephalosporin can cause flushing, dizziness, headache, nausea, vomiting, and muscular cramps.
inherent resistance, acquired resistance
________ __________ occurs without previous exposure to the antibacterial drug; _________ _________ is caused by prior exposure to the antibacterial.
Macrolides
________ are used to treat mild to moderate infections of the resp tract, sinuses, GI tract, skin and soft tissue, diphtheria, impetigo and STIs.
sulfonamides
__________ are not classified as an antibiotic, because they were not obtained from biologic substances; they are bacteriostatic b/c they inhibit bacterial synthesis of folic acid which is essential for bacterial growth.
macrolides
__________ can be administered orally or IV, but not IM because it is too painful.
Tetracyclines
__________ should not be taken with magnesium and aluminum antacid preparations, milk products containing calcium or iron containing drugs, because these substances bind with and prevent absorption of the drug.
sulfonamides
___________ are approx 90% effective against E. coli; therefore they are frequently a preferred tratment for UTIs; they are also useful in the treatment o meningococcal meningitis and against the organisms Chlamydia and Toxoplasma gondii.
hepatotoxicity
____________ can occur when azithromycin is taken in high doses with other drugs such as acetaminophen.
Conjuncitivitis
____________ may develop as a SE of azithromycin; pt should avoid wearing contacts if this occurs.
cephalosporins
_____________ are a major antibiotic group used in hospitals and in health care offices; they are bactericidal with actions similar to penicillin.
sulfonamides
erythemia multiforme and exfoliative dermatitis are two severe hypersensitivity reactions that erupt on the skin if a patient is hypersensitive to ______________.