Nr566 Complete Questions And Answers

NR566 COMPLETE QUESTIONS AND ANSWERS β-lactam antibiotic MOA - CORRECT ANSWER-All antibiotics in class share the same mechanism of action: disruption of the bacterial cell wall. Inhibition of cell wall synthesis Empiric Therapy - CORRECT ANSWER-start treatment without cultures or prior to receiving the results of a culture immediate empiric antibiotics - CORRECT ANSWER-Critically ill patients receive (Fill in the Answer) after the first set of cultures obtained; do not wait for results. Bactericidal antibiotics - CORRECT ANSWER-Directly kill bacteria: Agents include aminoglycosides, beta-lactams, fluoroquinolones, metronidazole, most antimycobacterial agents, streptogramins, and vancomycin. preferred for immunocompromised patients such as those with diabetes, HIV, or cancer and for those who have overwhelming infections Bacteriostatic agents - CORRECT ANSWER-inhibit bacterial proliferation while the host's immune system does the killing. Agents include clindamycin, macrolides, sulfonamides, and tetracyclines β-lactam Antibiotics - CORRECT ANSWER-Penicillins, Cephalosporins, Carbapenems, Monobactams Penicillins MOA - CORRECT ANSWER-Weaken bacterial cell wall by two actions: (1) inhibition of transpeptidases (2) disinhibition (activation) of autolysins. PBPs (Penicillin Binding Proteins) - CORRECT ANSWER-Transpeptidases, Autolysins, and other bacterial enzymes are collectively named as because antibiotic class must bind to them to produce antibacterial effects. gram-positive bacteria - CORRECT ANSWER-two layers: the cytoplasmic membrane and a relatively thick cell wall; penicillins are generally very active against these organisms. gram-negative bacteria - CORRECT ANSWER-three layers: the cytoplasmic membrane, a relatively thin cell wall, and an additional outer membrane; only certain penicillins (e.g., ampicillin) are able to cross and reach penicillin binding proteins (PBPs) Four Major Groups of Penicillins - CORRECT ANSWER-(1) narrow-spectrum penicillins that are penicillinase sensitive (2) narrow-spectrum penicillins that are penicillinase resistant (antistaphylococcal penicillins) (3) broad-spectrum penicillins (aminopenicillins) (4) extended-spectrum penicillins (antipseudomonal penicillins). narrow-spectrum penicillins: Penicillinase sensitive penicillins - CORRECT ANSWERPenicillin G, Penicillin V narrow-spectrum penicillinase sensitive susceptible pathogens - CORRECT ANSWERStreptococci, Neisseria, anaerobes very narrow antimicrobial spectrum and are used only against penicillinase-producing strains of staphylococci (S. aureus and S. epidermidis). - CORRECT ANSWER-narrowspectrum penicillins: penicillinase resistant penicillins narrow-spectrum penicillins: penicillinase resistant penicillins - CORRECT ANSWERNafcillin, Oxacillin, Dicloxacillin narrow-spectrum- penicillinase resistant susceptible pathogens - CORRECT ANSWERS. Aureus, S. Epidermidis Drugs of choice for most staphylococcal infections - CORRECT ANSWER-penicillinaseresistant penicillins (Nafcillin, Oxacillin, Dicloxacillin) Broad spectrum Penicillin: Aminopenicillins - CORRECT ANSWER-Ampicillin, Amoxicillin Broad spectrum Aminopenicillin susceptible pathogens - CORRECT ANSWERHaemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci, Neisseria gonorrhoeae Extended spectrum penicillins (antipseudomonal penicillin) - CORRECT ANSWERPiperacillin Has the same antimicrobial spectrum as penicillin G, plus increased activity against certain gram-negative bacilli, including Haemophilus influenzae, Escherichia coli, and Salmonella and Shigella - CORRECT ANSWER-Broad spectrum Penicillin: Aminopenicillins First line for acute otitis media and sinusitis - CORRECT ANSWER-Amoxicillin Extended spectrum penicillins suceptible pathogens - CORRECT ANSWERHaemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci, Neisseria gonorrhoeae, pseudomonas, enterobactor, klebsiella Principle pathogenic target of Piperacillin - CORRECT ANSWER-Pseudomonas aeruginosa beta-lactamase inhibitors to broaden penicillin spectrum - CORRECT ANSWERclavulanate, sulbactam, tazobactam Penicillin/Beta-Lactamase Combinations - CORRECT ANSWER-Ampicillin/sulbactam (Unasyn) Amoxicillin/clavulanate (Augmentin) Piperacillin/tazobactam (Zosyn) MRSA Drug of Choice - CORRECT ANSWER-Vancomycin Most Important AE of Penicillins - CORRECT ANSWER-Hypersensitivity Reaction Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicillins - CORRECT ANSWER-Avoid cephalosporin; Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin allergy. Common drug used to treat bacterial infections in children. - CORRECT ANSWERPenicillins First line treatment for infection following animal or human bites - CORRECT ANSWERAmoxicillin/clavulanate (Augmentin) Medication common for streptococcal pharyngitis - CORRECT ANSWER-Penicillin Penicillin Risk in Pregnancy - CORRECT ANSWER-evidence suggests there is no second or third trimester fetal risk Penicillin Risk in Infants - CORRECT ANSWER-Used safely in infants with bacterial infections, including syphilis, meningitis, and group A streptococcus. Amoxicillin - CORRECT ANSWER-Safe use during breastfeeding Penicillin Use in Older Adults - CORRECT ANSWER-Doses should be adjusted in older adults with renal dysfunction. Cephalosporins - CORRECT ANSWER-β-lactam antibiotics similar in structure and actions to the penicillins. Are bactericidal, often resistant to β-lactamases, and active against a broad spectrum of pathogens. Useful alternative with mild penicillin allergy Cephalosporins MOA - CORRECT ANSWER-Bactericidal drug similar to penicillins that bind to penicillin-binding proteins (PBPs): (1) disrupt cell wall synthesis (2) activate autolysins (enzymes that cleave bonds in the cell wall). The resultant damage to the cell wall causes death by lysis. Most effective against cells undergoing active growth and division. Ceftriaxone (Rocephin) - CORRECT ANSWER-Cephalosporin eliminated largely by the liver. Dosage reduction is not necessary in patients with renal impairment. Cephalosporin Administration - CORRECT ANSWER-poor absorption from the gastrointestinal (GI) tract, many drugs in this class must be administered parenterally (by the intramuscular [IM] or intravenous [IV] route). Cephalosporin Elimination - CORRECT ANSWER-Practically all drugs in this class are eliminated by the kidneys; patients with renal insufficiency, dosages of drugs must be reduced (to prevent accumulation to toxic levels). Cephalosporin Monitoring - CORRECT ANSWER-Check renal function if prolonged therapy Cephalosporin Main Adverse Event - CORRECT ANSWER-Hypersensitivity reactions are the most frequent adverse events. Cephalosporins — Cefazolin, Cefotetan - CORRECT ANSWER-can induce a state of alcohol intolerance (the disulfiram effect) if to ingest alcohol while taking drugs Cephalosporins - Cefotetan, Cefazolin, Ceftriaxone - CORRECT ANSWER-can promote bleeding as they contain a side chain that interferes with Vitamin K metabolism which can inhibit the formation of clotting factors; Caution if combines with other agents that promote bleeding First generation cephalosporins indication - CORRECT ANSWER-Narrow Spectrum Gram+ Streptococci, Staphylococci, E.coli, K. Pneumoniae Use in mild penicillin allergy strep pharyngitis, skin infections, surgical prophylaxis First generation cephalosporin examples - CORRECT ANSWER-Cephazolin; Cephelexin (Keflex) Second generation cephalosporins indication - CORRECT ANSWER--Gram +/- -H. influenzae, Klebsiella, pneumococci, staphylococci -Otitis, sinusitis, respiratory tract infection -More broad than first generation Second generation cephalosporins examples - CORRECT ANSWER-ceFAclor, CeFOXitin, CeFURoxime (FAkeFOXFUR) Third generation cephalosporin indication - CORRECT ANSWER--Serious Gram (-) bacteria -Pseudomonas aeruginosa, Neisseria gonorrhoeae, and Klebsiella, Serratia Meningitis -More broad than first and second generations -meningitis, gram (-) nosocomial infections. Limit use Third generation cephalosporin examples - CORRECT ANSWER-ceftriaxone (Rocephin), cefotaxime, ceftazadime Fourth generation cephalosporin indications - CORRECT ANSWER--Narrow Spectrum -Gram (-) -Pseudomonas aeruginosa -Hospital-acquired pneumonia and complicated intra-abdominal and urinary tract infections -hospital-acquired pneumonia and resistant PSEUDOMONAS Fourth generation cephalosporin example - CORRECT ANSWER-Cefepime Fifth generation cephalosporin indication - CORRECT ANSWER--Narrow spectrum -Gram (+) -Methicillin-resistant Staphylococcus aureus -Health Care associated pneumonias -MRSA infections Fifth generation cephalosporin example - CORRECT ANSWER-Ceftaroline Cephalosporin Adverse Event - CORRECT ANSWER-Can promote Clostridiodies difficile infection. Instruct patients to report increase in stool frequency. Third-generation cephalosporins are used to treat bacterial infections - CORRECT ANSWER-Neonates and Infants