BETA-LACTAMS
What was the very first antimicrobial (antibiotic) discovered?
PENICILLAN
The AE called "Antibiotics-Associated Pseudo-membranous Colitis" (AAPC) is a fancy name for an infection with Clostridioides difficile, more commonly known by THIS SHORT-HAND name
"C. diff"
NOTE: The majority of the antimicrobials introduced this week (ampicillin, cefazolen, imipenem, ciprofloxacin) have "C. diff" (=AAPC) as a potential Adverse Effect, because this highly contagious bacteria often comes to flourish in a patient's body after their native gut flora have been killed off by abx treatment. Vancomycin is one of the few effective at treating C. Diff.
Can antimicrobials/antibiotics (ABX) be used to treat viral infections?
NO, abx are only for BACTERIAL INFECTIONS
This concept is key. Never give or take an antibiotic to try to treat a virus (such as influenza), it will do NOTHING TO TREAT THAT ILLNESS and can result in the creation of more harmful strains of antimicrobial drugs (due to abx overuse)
TRUE OR FALSE: One of the major uses for the bactericidal cephalosporin called cefazolin (Ancef) is that it is given to patient's pre-surgery as a prophylactic (protection) against the potential for surgical-associated infection. True or False?
TRUE
Explain WHAT ACTION your
pharm instructor insists that you remember to do early on,
"...before the bug meets the drug!"
DRAW A BLOOD CULTURE TO SEND TO THE LAB
(i.e. before giving any antibiotics (abx), as tempting as it might be to start a patient on abx right away)
Why? Because you need to get that blood culture to the lab for a Culture and Sensitivity (C&S) test so that the patient will be able to be switched from a broad spectrum antibiotic to a narrow spectrum one specifically targeted to combat that bacterial strain.
Name the prototype drug for the Bactericidal class of Beta-Lactem antimicrobials known as Penicillans.
BONUS: Can this particular drug be taken PO?
AMPICILLIN
BONUS: YES, but if taken PO, it must be taken on an empty stomach, at least 1 hr before or 2 hrs after a meal.
Why did the UO women's track team, when they all came down with a serious E.coli-caused infection, completely REFUSE to take the antimicrobial ciprofloxacin (Cipro) because of one of this drug's potential serious AEs that could involve their achilles tendons?
TENDON RUPTURE
Note: On her lecture slides, Christine included a picture of a FOOT with ruptured tendons when introducing this drug ciprofloxacin (Cipro) and its general class (Fluroquinolones)
Antimicrobial resistance is a growing problem in the world today.
Name AT LEAST TWO REASONS that this problem is growing
(1) Antibiotics (ABX) prescribed unnecessarily
(2) ABX over-used in meat production
(3) Patients who do not take the full course of ABX and thereby create more drug-resistant strains
Name the antimicrobial we learned this week that is commonly used in the Critical Care setting (such as in an Intensive Care Unit) because of its powerful and broad spectrum application to many bacteria that may be resistant to other treatments.
imipenem (Primaxin)
This drug is in the "Carbapenem" class
NOTE: It is NOT useful against Methicillin-Resistant Staphylococcus Aureus (MRSA), nor against "Carbipenem-Resistant Entero-bacteriaceae" (CRE) OR against "Carbipenem-Resistant Acinetobacter baumannii" (CRAB)
"The lowest concentration that is needed to completely suppress bacterial growth." What is this description a definition of,
MIC (Minimum Inhibitory Concentration)
or MBC (Minimum Bactericidal Concentration)?
BONUS: What is the general pharmacological concept,
applying to all drugs, that the above concept is very similar to?
MIC, MINIMUM INHIBITORY CONCENTRATION
Think: What does this amount of concentration of the abx "inhibit"? It inhibits GROWTH.
BONUS: This is similar to the broader concept of Minimum Effective Dose (MED) needed to achieve a "therapeutic level" of drug in the body. Why a different term is used here likely has to do with what is considered "effective" in these circumstances, solely stopping growth of the pathogenic bacteria (MIC)
or wiping those bacteria out completely (MBC)?
This is the name of the prototype 1st generation Cephalosporin, which should be taken with food but NOT with alcohol, and NOT by a patient who has a true allergy to any penicillins, and NOT by a patient who is breastfeeding.
cafazolin (Ancef)
This antimicrobial is counter-indicated in patients with renal failure or any other sort of kidney damage since it is considered "nephrotoxic" (harmful to the nephrons in the kidneys).
Which drug is it?
gentamicin (Garamycin)
NOTE: Christine includes a picture of a pair of kidneys when introducing this drug and its general class (Aminoglycosides). By the way, the Glycopeptide vancomycin (Vancocin)
is considered nephrotoxic, too.
The therapeutic uses for the foundational antimicrobial known as penicillin (PCN) was first discovered in the 1940's. In which decade was bacterial resistance to PCN first described?
The 1940's
(see lecture slide titled "as time marches on..")
Gram negative (-) bacteria (such as E.coli and Salmonella) are a bit more difficult to wipe out than gram positive (+) bacteria. Name AT LEAST ONE of the two drugs introduced this week that can be used to treat a gram negative (-) infection.
(1) ciprofloxicin (Cipro)
or
(2) gentamicin (Garamycin)
Name AT LEAST TWO patient teachings that might be said to apply to ALL antimicrobial drugs
(1) Take the full course of antimicrobials as directed,
even if you feel better sooner.
(2) Report to your provider and health care team any allergies to antimicrobials.
(3) Report any rash or diarrhea to your provider (do NOT self-treat diarrhea).
(4) If you are a person with a uterus and take an oral contraceptive, use a different form of contraception while on this drug, for the oral contraceptive may not be effective in preventing pregnancy while taking an antimicrobial
Name the three general classes of drugs that should be used with caution, or not at all, with patients who claim to have some type of allergy to Penicillin
(1) PENICILLINS (obviously, but not completely obviously, if the self-reported allergy does not appear to be a "true" allergy but instead mild discomfort or one of the milder but expected AE's; prototype: ampicillan)
(2) CEFALOSPORINS (prototype: cefazolin/Ancef)
(3) CARBAPENEMS (prototype: imipenem/Primaxim)
The powerful bactericidal drug vancomycin (Vancocin), a Glycopeptide which is OVERVIEW ONLY in this unit but is important to know for the NCLEX, has a serious side effect that a patient may experience if the nurse infuses their vancomycin through the IV route too quickly. What is this Adverse Effect called, and how can it be avoided?
RED MAN SYNDROME
(now beginning to be known under the more precise name "vancomycin-hypersensitivity infusion reaction" or VIR)
It not only turns some patients' skin bright red and itchy due to an allergic histamine reaction, plus causes tachycardia and hypotension. This AE can be avoided by infusing the IV more SLOWLY as per the drug guide (which you'll learn to use 2nd yr).
What percentage of antibiotics taken by people to treat the common cold were taken unnecessarily (0-100%)?
BONUS: What about abx taken to treat bronchitis?
100%
The "common cold," which is more properly called "Viral Rhinitis," is viral in origin, not bacterial. Abx won't help treat it at all, and this type of abuse of abx contributes to growing antibiotic resistance.
BONUS: 80% taken for bronchitis are also taken unnecessarily,
according to lecture slides.
ALL of the following antimicrobials work by inhibiting the synthesis or formation of microbial CELL WALLS except WHICH ONE?
(a) imipenem (Primaxin)
(b) vancomycin (Vancocin)
(c) ciprofloxacin (Cipro)
(d) cefazolin (Ancef)
(e) ampicillin (Principen)
(C) ciprofloxacin (Cipro)
Match each antimicrobial with its corresponding class:
(1) cefazolin (Ancef) (a) Glycopeptide
(2) ciprofloxicin (Cipro) (b) Cephalosporin
(3) gentamicin (Garamycin) (c) Penicillin
(4) vancomycin (Vancocin) (d) Aminoglycoside
(5) ampicillin (Principen) (e) Fluroquinolone
(6) imipenem (Primaxin) (f) Carbapenem
(1) cefazolin (Ancef) = (B) CEPHALOSPORIN
(2) ciprofloxicin (Cipro) = (E) FLUROQUINOLONE
(3) gentamicin (Garamycin)=(D) AMINOGLYCOSIDE
(4) vancomycin (Vancocin) = (A) GLYCOPEPTIDE
(5) ampicillin (Principen) = (C) PENICILLIN
(6) imipenem (Primaxin) = (F) CARBAPENEM
Among the three groups of Beta Lactem antibiotics that were introduced in the unit this week, this is the one that Christine claimed in lecture as "one of the most widely used, and generally safest overall" (name both the class of drug and the specific prototype in that class)
CLASS: Cephalosporins
PROTOTYPE: cefazolin (Ancef)
NOTE: Almost all the generic names of the drugs in this class begin with the prefix "CEF-" though some of the older ones begin with "CEPH-" Still, when you see cef- or ceph- at the start, think cephalosporin as a class (closely related to PCN)
This drug can cause temporary or permanent tinnitus ("ringing in ears") or other more serious type of hearing loss ("ototoxicity"). Patients are instructed to report tinnitus or hearing loss to their provider ASAP.
Which drug in our unit is it?
BONUS: What other antimicrobial, if taken together with this drug, may increase the risk for this AE?
gentamicin (GARAMYCIN)
This drug is the prototype of the class Aminoglycoside that was also introduced this week
BONUS: vancomycin (Vancocin) also can cause ototoxicity. You still get points if you switched these two drugs in your answer -- they both potentiate each other to increase the risk. Note that Christine used a picture of an ear when introducing vanco's broader class of drugs, Glycopeptides. I decided to make gentamicin the main answer here, though,
since vanco is "Overview Only" in this unit.
VRE, VISA, and VRSA are all acronyms to describe microbial strains that are resistant to WHICH antimicrobial drug whose use was especially big in the 1970's and 1980's (and still used today to treat specific types of major infections)?
vancomycin (Vancocin)
YES, this drug is "Overview Only," but the fact that so many strains of drugs are named specifically for their resistance to "vanco" should tell you that this is one of the drugs that it's probably good to know at least a little about.
Name AT LEAST FOUR reasons that are among the "reasonable reasons" why antimicrobials can be and are prescribed to patients "prophylactically" (that is, given without any sign of illness but instead given "in advance" as a protective measure)
(1) SURGERY
(2) DENTAL/MEDICAL PROCEDURES
(for patients with valve disease)
(3) SEVERE RHEUMATIC ENDOCARDITIS
(4) NEUTROPENIA (e.g. patients with low WBCs,
such as those undergoing cancer treatments)
(5) RECURRENT UTI's
(6) EXPOSURE TO STI's (formerly known as STDs:
"sexually transmitted diseases")
Name what is distinctive about the COMBO drug with the
generic name sublactam
(trade names Augmentin or Unysyn).
HINT: One of the drugs in the combo is from the Penicillin family, but this combo was developed to help solve a problem that is sometimes encountered when giving Penicillin (PCN) alone...
THE COMBO INCLUDES A BETA-LACTAMASE INHIBITOR
In other words, the form of resistance developed by some microbials to PCN is to break up its outer shell (beta-lactam [barrier-] -ASE [lysing enzyme]). Christine mentioned this drug combo (which is in this week's required list, though not on the handout) just after talking about PCN, for it inhibits that form of PCN resistance, making some otherwise resistant microbials once again susceptible to bacteriocide by PCN