Antimicrobials in Pregnancy Nursing Lecture
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Questions and Answers

What is a major cause of preterm birth?

  • Prelabour rupture of membranes
  • Infection (correct)
  • Pregnancy
  • Antibiotic prophylaxis

    • What is the purpose of prescribing antibiotics to women with preterm prelabour rupture of membranes?

  • To treat infection
  • To delay delivery and reduce the incidence of infection (correct)
  • To prevent preterm birth
  • To induce labour

    • What are the agents of first choice in pregnancy?

  • Antimicrobials and antibiotics
  • Chemotherapeutic agents and antibiotics
  • Penicillins and cephalosporins (correct)
  • Erythromycin and cephalosporins

    • What is the risk associated with using most antibiotics in pregnancy?

    <p>Increased risk of fetal malformation</p> Signup and view all the answers

    What is the concept of selective toxicity?

    <p>Toxicity to the parasite or the unwanted cell but non-toxic to the host</p> Signup and view all the answers

    What is the pivot of chemotherapy?

    <p>Selective toxicity</p> Signup and view all the answers

    What is the reason why a drug can be highly toxic to microbes but harmless to the host?

    <p>Differences in the cellular chemistry of mammals and microbes</p> Signup and view all the answers

    What are biochemical processes critical to microbial well-being that do not take place in mammalian cells?

    <p>Metabolic pathways</p> Signup and view all the answers

    What is the main difference between antimicrobials and antineoplastic agents?

    <p>Antimicrobials act on microbes, while antineoplastic agents act on malignant cells.</p> Signup and view all the answers

    What is the term for the ability of an antibiotic to inhibit the growth of bacteria?

    <p>Bacteriostatic</p> Signup and view all the answers

    What is the characteristic of Gram-positive bacteria?

    <p>Thick cell wall with peptidoglycan directly accessible from the environment</p> Signup and view all the answers

    Who is known as the 'Father of Chemotherapy'?

    <p>Paul Ehrlich</p> Signup and view all the answers

    What is the term for the phenomenon of antibiosis?

    <p>Antibiosis</p> Signup and view all the answers

    What is the term for the destruction or dissolution of bacterial cells?

    <p>Bacteriolytic</p> Signup and view all the answers

    When was penicillin discovered?

    <p>1929</p> Signup and view all the answers

    What is the term for antibiotics that are produced from microbes?

    <p>Antibiotics</p> Signup and view all the answers

    What is one of the prophylactic applications of penicillin G?

    <p>Preventing syphilis in sexual partners of infected individuals</p> Signup and view all the answers

    What is the route of elimination of penicillin from the body?

    <p>Kidney excretion</p> Signup and view all the answers

    What is the main mechanism of renal excretion of penicillin?

    <p>Active tubular secretion</p> Signup and view all the answers

    What is the half-life of penicillin in older children and adults?

    <p>About 30 minutes</p> Signup and view all the answers

    What happens to the half-life of penicillin in patients with renal impairment?

    <p>It increases dramatically</p> Signup and view all the answers

    Why was probenecid used concurrently with penicillin in the past?

    <p>To prolong antibacterial effects</p> Signup and view all the answers

    What is the main difference between penicillin G and penicillin V?

    <p>Penicillin V is similar to penicillin G in most respects</p> Signup and view all the answers

    When is monitoring of kidney function recommended for patients taking penicillin?

    <p>For patients at high risk of toxicity (those with renal impairment, the acutely ill, the very young, older adults)</p> Signup and view all the answers

    What is an alternative to penicillins in patients with penicillin allergy?

    <p>Vancomycin</p> Signup and view all the answers

    How many carbapenems are available?

    <p>Four</p> Signup and view all the answers

    What is the mechanism of action of imipenem?

    <p>Weakening of the bacterial cell wall</p> Signup and view all the answers

    Why is imipenem effective against anaerobic bacteria?

    <p>All of the above</p> Signup and view all the answers

    How is imipenem administered?

    <p>Intravenously</p> Signup and view all the answers

    What is the role of cilastatin in imipenem therapy?

    <p>It inhibits destruction of imipenem by renal enzymes</p> Signup and view all the answers

    What happens to imipenem when it is employed alone?

    <p>It is inactivated by dipeptidase</p> Signup and view all the answers

    What is the primary route of elimination of imipenem?

    <p>Renal</p> Signup and view all the answers

    What is unique about vancomycin compared to other drugs discussed?

    <p>It does not contain a beta-lactam ring</p> Signup and view all the answers

    What is vancomycin typically used to treat?

    <p>Serious infections caused by MRSA or Staph.epidermidis</p> Signup and view all the answers

    Why is vancomycin used as an alternative to penicillins and cephalosporins?

    <p>Because patients are allergic to beta-lactam antibiotics</p> Signup and view all the answers

    What is a common adverse effect of vancomycin infusion?

    <p>All of the above</p> Signup and view all the answers

    Why is vancomycin administered slowly?

    <p>To reduce the risk of red man syndrome</p> Signup and view all the answers

    What is red man syndrome?

    <p>A constellation of disturbing effects caused by rapid infusion of vancomycin</p> Signup and view all the answers

    What can increase the risk of ototoxicity when using vancomycin?

    <p>All of the above</p> Signup and view all the answers

    What is bacitracin used for?

    <p>Topical treatment of skin, eye, and ear infections</p> Signup and view all the answers

    Study Notes

    Infection and Pregnancy

    • Infection is a major cause of preterm birth
    • Antibiotic prophylaxis has not proven useful in preventing preterm birth, but prescribing antibiotics to women with preterm prelabour rupture of membranes can delay delivery and reduce the incidence of infection
    • Penicillins and cephalosporins are generally considered the agents of first choice in pregnancy, as they are associated with lower risks of fetal malformation

    Antimicrobials and Chemotherapy

    • Selective toxicity is the pivot of chemotherapy, referring to the ability of a drug to be toxic to parasites or unwanted cells while leaving the host or environment relatively unharmed
    • Chemotherapeutic agents act selectively against microbes or malignant cells, without affecting body cells
    • Antimicrobials are used to treat infectious diseases, and can be classified into different types based on their chemical structure, mechanism, and spectrum

    Mechanisms of Action

    • Bacteriostatic agents stop the growth of bacteria
    • Bactericidal agents kill bacteria
    • Bacteriolytic agents cause the destruction or dissolution of bacterial cells

    Gram Positive and Gram Negative Bacteria

    • Gram positive bacteria have a thick cell wall and peptidoglycan directly accessible from the environment
    • Gram negative bacteria have a thin cell wall, surrounded by inner and outer membranes, and are resistant to diffusion of antibiotics

    Historical Perspectives

    • Louis Pasteur discovered the phenomenon of antibiosis in 1877
    • Paul Ehrlich coined the term "chemotherapy" in 1906 and is considered the father of chemotherapy
    • Gerhard Domagk discovered sulfonamides in 1935
    • Alexander Fleming, Ernst Chain, and Howard Florey discovered penicillin in 1929, 1939, and 1941
    • Selman Waksman discovered streptomycin and coined the term "antibiotic" in 1944

    Antimicrobial Classification

    • Antimicrobials can be classified based on their chemical structure, mechanism, and spectrum
    • Examples of antimicrobial classes include:
      • Penicillins
      • Cephalosporins
      • Aminoglycosides
      • Chloramphenicol
      • Tetracyclines
      • Macrolides
      • Glycopeptides
      • Rifamycins
      • Nitroimidazoles
      • Quinolones
      • Trimethoprim
      • Oxazolidinones
      • Lipopeptides

    Penicillin

    • Penicillin is a bactericidal agent that inhibits bacterial cell wall synthesis
    • Penicillin G has important prophylactic applications, including preventing syphilis and recurrent attacks of rheumatic fever
    • Penicillin distributes well to most tissues and body fluids, but penetration into the meninges and into fluids of joints and the eyes is poor in the absence of inflammation
    • Penicillin undergoes minimal metabolism and is eliminated by the kidneys, primarily as the unchanged drug
    • Renal impairment can cause the half-life of penicillin to increase dramatically and may necessitate a reduction in dosage

    Vancomycin

    • Vancomycin is a bactericidal agent that inhibits bacterial cell wall synthesis
    • Vancomycin should be reserved for serious infections, and is the drug of choice for infections caused by MRSA or Staph. epidermidis
    • Vancomycin is also used to treat severe Clostridium difficile infections
    • Common adverse effects of vancomycin include:
      • Ototoxicity
      • Red man syndrome (flushing, rash, pruritus, urticaria, tachycardia, and hypotension)
      • Thrombophlebitis
      • Nephrotoxicity

    Carbapenems

    • Carbapenems are beta-lactam antibiotics with a broad antimicrobial spectrum
    • Examples of carbapenems include:
      • Imipenem
      • Meropenem
      • Ertapenem
      • Doripenem
    • Carbapenems are active against most bacterial pathogens, including organisms resistant to other antibiotics
    • Imipenem is supplied in fixed-dose combinations with cilastatin, which inhibits destruction of imipenem by renal enzymes

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    Description

    This quiz covers the use of antimicrobials in pregnancy, specifically the prescription of antibiotics to women with preterm prelabour rupture of membranes. Learn about the impact of infection on preterm birth and the role of antibiotics in delaying delivery.

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