PC707 Pharmacology Module 2 Infection/Antimicrobials Exam Questions With Correct Answers

ANTIMYCOBACTERIALS & ANTITUBERCULAR Patient Education - Answer ●Pt adherence crucial d/t long therapy ●Encourage good nutrition, & exercise. ●GI upset common first few weeks of therapy. ●Don't D/C medication if minor adverse effects. ●Take on empty stomach to ↑ absorption. ●Inform if epigastric distress or N occurs can take entire drug protocol w/meals or hour of dosing can be changed. ●Administration with food is preferable to splitting doses or changing to 2nd. line therapy. ●May discolor urine, tears, urine, saliva, & sweat; ●may stain clothing, dentures, & contact lens. ●Rifampin is one agent that DOES interfere with absorption of oral contraceptives, so a CONTRACEPTIVE BACK-UP method is CRUCIAL! Immunizations documentation basics: Document - Answer Signed consent form, vaccine, lot, expiration date, VIS given, and location given. Consideration before you immunize - Answer • Current Immunization Status of Patient • Immunization Schedule current recommended from CDC • Asses for Contraindications & Precautions • Permission -Vaccine Information Sheet (VIS) Immunizations administration basics: When giving immunizations, - Answer make sure they are being given in the right route with the right length of needle (SC,IM). Gestational age at which TDaP is recommended - Answer between 27-36 weeks Why is TDaP administration recommended between 27-36 weeks? - Answer Allow time for mom to build up immune response to transfer to the baby & have that immune response last until infant can be immunized themselves for pertussis TDap - Answer Tetanus Diptheria acellular Pertussis DTaP - Answer Diptheria, Tetanus, acellular Pertussis. Formulation used for people 2 months to 6 years old Populations for which pertussis can be lethal - Answer newborns and elderly Situations when TDaP can & should be given at other times in pregnancy? - Answer Injury with wound, pertussis outbreak, or other circumstance where it would be necessary. Primary reason TDaP is given during pregnancy & why we teach close contacts to also receive - Answer to protect baby against Pertussis. Live vaccine - Answer Live form, attenuated ; non-infective with low chance of causing disease; leads to long term immunity. (best and longest immune response) more likely to produce side effects Live vaccines contraindications: - Answer Do NOT give live vaccines to: 1. pregnant women 2. immunocompormised people 3. Infants < 12 mos of age Killed Vaccine contraindications: - Answer Encephalopathy, true allergy (egg > influenza) Reason Infants < 12 months should not get LIVE vaccines - Answer they are not mature enough to build a strong immune response. Killed vaccine - Answer Contains dead but antigenically active organism; might cause an immune response with symptoms but cannot cause the actual disease. Disadvantage of killed vaccine - Answer Provide a shorter duration of protection & needs to be boosted more often. Example of Natural Active Immunity - Answer contracting chicken pox & building your own antibodies to the varicella virus. Active Immunity - Answer Formation of antibodies related to direct exposure to antigen can be active natural or active artificial. Artificial Active Immunity - Answer Exposure to a vaccination, receiving the live attenuated antigen & then you make your own antibodies. Passive Immunity - Answer Antibodies passed from one person to the other Someone else makes them & gives them to you. Example of Passive Natural Immunity - Answer Antibodies given from mother to infant through the birth process or breast feeding. Passive Artificial Immunity - Answer taking blood products to isolate the antibodies specific to pathogens & give them to a person. Example of Passive Artificial Immunity - Answer Rhogam & rabies post exposure immunoglobulins Herd or Community Immunity - Answer Having a critical portion of the community immune to a particular contagious disease. How Herd immunity works - Answer If enough people are immune & an infection comes around, it is stopped from spreading b/c it cannot infect those vaccinated, ∴ they cannot spread it to those who are not vaccinated. Herd immunity is especially important in protecting these populations: - Answer 1. pregnant women 2. immunocompormised people 3. Infants < 12 mos of age 4. People allergic to vaccines POC of care vaccination guidance tools and documents available from the CDC - Answer ● schedules for adults & children ● make-up schedules ● Screening tools for precautions & contraindications ●Schedule reminder tools ●Current Guidelines & recommendations ●How vaccines are stored and supplied If patient has gelatin or latex allergy - Answer do NOT give MMR or Varicella or any combination of those Considerations for primary care providers regarding food allergies and vaccine components - Answer Review inserts so you're aware of contraindications if patient has medication, food, gelatin or latex allergy If patient can eat cooked eggs, may be okay to give immunization Precautions with vaccinations - Answer People who post vaccination previously developed: 1. fevers >105 w/in 48 hours of vaccination 2. continuous crying for greater than 3 hours 3. convulsions. Immunity - Answer the body's defense against pathogens • When a person gets an infection, the body reacts by producing substances called antibodies. • These antibodies fight the disease. • These proteins usually stay in the system, even after the disease has gone, and protect the person from getting the same disease again. Antigens - Answer Foreign substances that are capable of producing an immune response. Antibody - Answer the protective protein that is produced in response to an antigen. B Lymphocytes - Answer produce antibodies & mediate humoral immunity T Lymphocytes - Answer responsible for cell mediated immunity & these are particularly active vs. VIRUSES. Toxoid vaccine - Answer vaccine against toxins requires sufficient standing antibody titer to be effective and needs boosting ei. Tetanus toxoid Recombinant vaccine - Answer contains only part of the microorganism ∴ less effective than whole cell vaccines, but also has less side effects. Booster - Answer re-vaccination with same vaccine to help re-awaken or replenish the immune response Can people who have had a severe allergic reaction to eggs receive a vaccination with egg components - Answer Yes, if you are in a medical setting have healthcare providers capable of monitoring the patient after administration and able to manage a severe allergic response. Live & Attenuated vaccines spacing considerations - Answer • Two or more killed antigens may be given together or at any interval between doses • Killed and live may be given together or at any time interval • Two live 4 weeks between if not given together Live ORAL vaccines can be administered simultaneously or at any interval before or after live or inactivated injectable vaccines Does interruption in the vaccination schedule require restarting the entire series of a vaccine or toxoid or addition of extra doses? - Answer No, with the exception of oral typhoid vaccine. What happens to passive immunity newborns received through the transfer of maternal antibodies? - Answer This immunity doesn't last. It wears off during the first year of life. CDC, ACOG & ACNM TDaP recommendation - Answer Give TDap each pregnancy Prescribing factors that contribute to the development of antibiotic resistance - Answer Incorrect prescription of antibiotics ● given for viral infections ● insufficient dose ● incorrect duration Other societal factors that have contributed to antibiotic resistance - Answer ●Excessive use ●Increased # of immuncompromised ●↑ invasive medical procedures ● ↑ survival of patients w/chronic diseases ●Day care of young children ● Overcrowding ●Travel ●Use of antibiotics in agriculture Measures prescribers can use to minimize development of resistance - Answer ● Consider most likely pathogen you're treating ● Know your microbes: which are beneficial, which are harmful, and which anti-infectives are most likely to combat the latter ● Use the Sanford Guide to Antimicrobial Therapy ● Use Antibiograms ● Prescribe broad- spectrum antibiotics as a last resort Sanford Guide to Antimicrobial Therapy - Answer ●Helps you consider the site of infection ●identify the most likely causative organism ●develop an effective treatment plan Staphylococcus, Streptococcus and Enterococcus are - Answer Gram (+) bacteria If NOT Staphylococcus, Streptococcus or Enterococcus then bacteria are - Answer Gram(-) bacteria Processes of Antimicrobial resistance - Answer ● chromosomal mutation ● inductive expression of latent chromosomal gene ● exchange of genetic material through transformation (exchange of DNA), bacteriophage, extrachromosomal DNA, jumping genes- enter transmissible plasmids or chromosomes Process of Antimicrobial resistance simplified: - Answer ● diverse bacteria get bathed in antibiotics. ●Most of the normal bacteria die. ● The resistant bacteria multiply and become more common. ●Eventually the entire infection evolves into a resistant strain. Antibiogram - Answer ● Report generated by each hospital that shows local activity re: antibiotic resistance. ● Includes a list of drug names, organism group, whether it's gram -/+, and the percentage sensitive to a particular antibiotics Importance of Antibiograms - Answer ● Helps you be familiar w/ the organisms commonly causing infections in your area. ● Textbook info may become outdated over time as resistance develops ●Being up to date with what is happening in your community will inform you of local development of microbial resistance Why you want to pick an antibiotic with a high sensitivity? - Answer 0% sensitivity is a terrible choice no matter how big a dose you give you will not be killing the bacteria. PENICILLINS MOA - Answer Interrupt of cell wall synthesis. Works by weakening the organism cell wall causing excessive amount of water to be taken up and rupturing the cell wall. PCN MOA memorization tip - Answer Cell wall inflates w/ H2O & POPs PCN Spectrum of Activity - Answer Most anaerobic & gram + organisms including Enterococci, Streptococci, & non-penicillinase staphylococci. Penicillins Bacteriostatic or Bactericidal? - Answer Bactericidal Reason Penicillins are safe in mammamlians - Answer Cell walls are not found in mammalian cells PCN Potential Side Effects: - Answer ● Most likely antibiotic to cause allergic reaction ● Hypersensitivity ● N, V ● Pruritis ● tachycardia ● severe dyspnea ● diaphoresis ● stridor ● severe vertigo ● LOC ● peripheral circulatory failure Ampicillin has higher tendency to produce non-allergic rashes the 2 types are - Answer 1) urticarial rash and 2) maculopapular rash. Confounders to diagnosis of true PCN allergies - Answer ● Scarlatina Rash in with strep infection: not an allergy but a Strep rash that would have developed regardless of abx administration ● Pts with mononucleosis if given amoxicillin may develop a NON allergic maculopapular rash from virus-antibiotic reaction. PCN Contraindications - Answer ● Type 1 allergic reaction to any PCN. PCN Precautions - Answer Use w/caution in patients: ●with allergy to cephalosporin ●HIV positive are susceptible to hepatotoxicity ● Pts with renal insufficiency - irritability, seizures