NURS 5334 Antimicrobial Review latest update correctly answered already passed

NURS 5334 Antimicrobial Review latest update correctly answered already passedGram positive organisms Staph, Strep, Enterococcus 1st line Treatment of Gram positive Penicillins 2nd line treatment of Gram positive with Penicillin Allergy Cephalosporins: 3rd generation (cefdinir, cefuroxime) Macrolides: if anaphylactic (azithromycin, clarithromycin) AOM and sinusitis organisms Haemophilus influenzas, Moraxella catarrhalis, Streptococcus pheumoniae 1st line tx for AOM high dose amoxicillin 5-10 days AOM pain Ibuprofen, acetaminophen for Antibiotic resistant AOM amoxicillin- clavulanate or ceftriaxone AE with clavulante diarrhea Renders PCNs G and V inactive beta-lactamases to Tx Step and AOM Ampicillin, amoxicillin DOC for PCN allergies Macrolides Narrow spectrum PCNs resistant to penicillinase enzymes Oxacillin, Nafcillin, dicloxacillin, 00:02 01:19 extended spectrum antipseudomonal PCN Piperacillin/tazobactam Not affected by beta lactamase bacteria oxacillin, nafcillin, dicloxacillin Piperacillin (given with tazobactam)=Zosyn effective against pseudomonas, Enterobacter, Bacteroides fragilis and klebsiella. is not given alone. Beta lactamase inhibitors never given alone: clavulanic acid, tazobactam, sulbactam no MRSA coverage piperacillin/tazobactam effective against pseudomonas amoxicillin/clavulanic acid ears, lungs, sinus, skin, and urinary tract. used to treat infections caused by beta-lactamase producing organisms. Beta lactamase inhibitors combined drugs ampicillin/sulbactam; amoxicillin/clavulanic acid; Piperacillin/tazobactam NO:MRSA coverage Cephalosporins most widely used, has a beta lactam ring 1st generation Cephalosporins presurgical prophylaxis, gram-positive, 2nd generation cephalosporins mostly gram-positive. cefoxitin-(anaerobic Bacteroides fragilis),cefuroxime (URI, pneumonia from h flu, pneumococci and staph) some beta-lactamase cover 3rd generation cephalosporins meningitis=penetrates the CSF. good Gram negative aerobe coverage. no pseudomonas or enterococcus activity. 4th generation cephalosporins pseudomonas and hospital acquired infections; Ceftaolozane/tazobactam; cefepime 5th generation cephalosporins Ceftaroline: MRSA, VRSA, community-acquired pneumonia, broad-spectrum with gram- and + cover, pseudomonas and some Enterobacteriaceae 3rd generation cephalosporin names cefotaxime, cefdinir, cefditoren, cefixime, cefpodoxime, ceftazidime, ceftibuten, ceftriaxone, cefoperazone, ceftibuten, ceftizoxime cephalosporins Side effects Cross allergy with PCN; NO: Alcohol increased bleeding=decreased prothrombin via interference with Vitamin K cephalosporins that cause bleeding and are contraindicated with Alcohol Cefotetan, cefmetazole, cefoperazone Carbapenems weakens the cell wall, big Guns, Broad spectrum, given in hospital and not given alone. end with -enem, except for avibactam. covers gram -, gram + and anaerobes, renal excretion Carbapenems contraindicated with reduces levels of Valproate Imipenem not given alone: broadest spectrum given with vancomycin Meropenem meningitis ertapenem complicated GI, GU, soft tissue infection, CAP Doripenem complicated intra-abdominal infections/complicated UTIs Avibactam combined with ceftazidime for intra-abdominal and UTIs Vancomycin glycopeptide; inhibits cell wall synthesis; narrow-spectrum used only for MRSA and C.Diff, only oral is for C. Diff. Vancomycin AEs ototoxicity, nephrotoxicity, red man syndrome, thrombocytopenia, rashes Telavancin alternative to vancomycin; Lipogycoprotein for skin infections/hospital-acquired pneumonia Telavancin AE Prolonged QT Dalbavancin and oritavancin watch renal clearance: glycopeptide antibiotics; skin and soft tissue. alternatives for Vanc with staph and MRSA, strep infections, and enterococcus faecalis. Daptomycin depolarizes cell membranes, inhibits DNA/RNA/Protein synthesis. good for MRSA, soft tissue infections, Enterococcus faecalis (gram Teicoplanin narrow spectrum gram positive only MRSA Aztreonam monobactam gram negative only: h. flu, pseudomonas, Enterobacteriaceae, e coli, klebsiella, proteas, salmonella, shigella Fosfomycin used 1st line for UTI only. one time dose. ok in pregnancy, e coli, enteroccoccus UTI pregnant women macrolides, PCN, cephalosporins, fosfomycin macrolides Broad-spectrum; inhibits bacterial protean synthesis. They are BIG (MACRO). Erythromycin, azithromycin, clarithromycin Macrolides therapy respiratory infections, H.pylori, Mycobacterium, alternative to PCN. Macrolide monitoring QT prolongation, GI disturbances: May give with food. Tetracyclines Bacteriostatic protein synthesis inhibitors, broad spectrum. Names of tetracyclines -cycline: long acting: doxycycline, minocycline, intermedicate: demeclocycline, short: tetracycline Tetracyclines AE Test Q stain deciduous teeth (no for children under), GI distress, liver/kidney toxicity, photosensitivity, superinfections. Tetracycline contraindications test Q do not take with calcium, milk, iron, magnesium or antacids Tetracyclines therapy use acne, respiratory infections, skin infections demeclocycline long acting: strep, respiratory, skin, eye, lymphatic, GI, UTI. infections caused by ticks, lice, mites, infected animals. doxycycline most likely to be tested on CA-MRSA, Pneumonia, RMSF, Lyme, acne, PUD, anthrax, chlamydia minocycline RA, Acne drug of choice for chlamydia's Doxycycline Macrolides when allergic to PCN Macrolides -mycin also Aminoglycosides end in -mycin macrolide therapy covers pneumonia, mycobacteriaum (HIV); chlamydia, H. Flu; whooping cough/pertusis Macrolide names azithromycin, Erythromycin(lots of drug interactions), clarithromycin, clindamycin macrolide with most drug interactions Erythromycin: increases carbamazepine, warfarin, theophylline macrolide with BB warning Clindamycin for C-diff macrolide AE QT prolongation (least likely=azithromycin): GI upset, may take with food Macrolides contraindications statins due to muscle breakdown/ simvastatin=QT prolonged Prolongs QT=arrhythmias macrolides, fluoroquinolones, Telithromycin, amiodarone, simvastatin clindamycin ( TQ) CA-MRSA