Penicillins and Cephalosporins Overview
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Questions and Answers

What is the mechanism of action for aminoglycosides?

  • Interferes with microbial protein synthesis
  • Inhibits production of bacterial DNA
  • Destroys bacteria's ribosomes (correct)
  • Inhibits bacterial cell wall synthesis

    • What is a key nursing implication for administering cefazolin?

  • Reconstitute with normal saline only
  • Administer 60 minutes prior to the first incision (correct)
  • Requires no monitoring for kidney function
  • Administer immediately after surgery

    • Which antibiotic class is indicated as a first line for Bacillus anthracis?

  • Aminoglycosides
  • Penicillins
  • Tetracyclines
  • Fluoroquinolones (correct)

    • Which of the following is a noted side effect of tetracycline?

    <p>Teeth discoloration in children under 8 years old</p> Signup and view all the answers

    What is the spectrum of activity of monobactams like aztreonam?

    <p>Lack gram positive activity but strong against gram negative</p> Signup and view all the answers

    Which of the following nursing implications is associated with sulfonamides?

    <p>Diminished contraceptive effects are common</p> Signup and view all the answers

    Imipenem-cilastatin is primarily used in which context?

    <p>Very broad spectrum, saved for critical illness</p> Signup and view all the answers

    Which antibiotic class is particularly associated with a Black Box Warning for ototoxicity?

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

    What is a significant nursing implication for administering fluoroquinolones?

    <p>Avoid exposure to sunlight</p> Signup and view all the answers

    What is the primary action of penicillins in treating infections?

    <p>Inhibit bacterial cell wall synthesis</p> Signup and view all the answers

    What is the primary mechanism of action of isoniazid (INH)?

    <p>Inhibits bacterial cell wall formation</p> Signup and view all the answers

    What is the mechanism of action for vancomycin?

    <p>Inhibits bacterial wall synthesis</p> Signup and view all the answers

    Which of the following adverse effects is associated with rifampin (Rifadin)?

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

    Which antibiotic is specifically indicated for C. diff when administered orally?

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

    Linezolid is indicated for the treatment of which type of bacteria?

    <p>Gram-positive bacteria only</p> Signup and view all the answers

    What nursing implication is crucial when administering vancomycin intravenously?

    <p>Infuse slowly over 1-2 hours to prevent red man syndrome</p> Signup and view all the answers

    What nursing implication is essential for patients taking isoniazid?

    <p>Monitor for jaundice and elevated liver function tests</p> Signup and view all the answers

    Which of the following side effects is associated with clindamycin?

    <p>Pseudomembranous colitis</p> Signup and view all the answers

    Which of the following is a contraindication for linezolid treatment?

    <p>Concurrent use of serotonergic drugs</p> Signup and view all the answers

    Which statement is true regarding the spectrum of activity for rifampin?

    <p>It has a broad spectrum of activity</p> Signup and view all the answers

    What is a common bacterial target for metronidazole?

    <p>Clostridium difficile</p> Signup and view all the answers

    What is an important nursing consideration when administering tuberculosis drugs?

    <p>Avoid alcohol during and after treatment</p> Signup and view all the answers

    Clindamycin is similar in action to which class of antibiotics?

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

    Which of the following best describes the spectrum of activity for vancomycin?

    <p>Narrow spectrum limited to certain gram positive organisms</p> Signup and view all the answers

    What should be administered to counteract peripheral neuropathy caused by isoniazid?

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

    What is a key nursing consideration when administering metronidazole?

    <p>It does not require renal dose adjustments</p> Signup and view all the answers

    Which of the following types of bacteria does linezolid mainly treat?

    <p>Gram-positive bacteria</p> Signup and view all the answers

    What side effect is associated with the usage of linezolid?

    <p>Myelosuppression (anemia)</p> Signup and view all the answers

    Which of the following antibiotics is primarily indicated for the treatment of MRSA?

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

    What is one of the primary uses for clindamycin?

    <p>Active against Bacteroides fragilis</p> Signup and view all the answers

    Study Notes

    Penicillins

    • Ampicillin (Principen) is the prototype penicillin which inhibits bacterial cell wall synthesis.
    • Ampicillin has a strong activity against gram-positive bacteria and a weak activity against gram-negative bacteria.
    • Ampicillin can cause allergic reactions and hypersensitivity.
    • Administration of ampicillin may inactivate aminoglycosides.
    • Piperacillin-tazobactam (Zosyn) is a combination of ampicillin and a beta-lactamase inhibitor.
    • The beta-lactamase inhibitor increases activity against both gram-positive and gram-negative bacteria.
    • Piperacillin-tazobactam can also inactivate aminoglycosides.

    Cephalosporins

    • Cefazolin (Ancef, Kefzol) is the prototype cephalosporin.
    • Cefazolin inhibits bacterial cell wall synthesis and is commonly used for surgical prophylaxis.
    • Cefazolin has strong activity against gram-positive bacteria and weak activity against gram-negative bacteria.
    • Cefazolin should be administered 60 minutes prior to the first incision.
    • Ceftriaxone (Rocephin) is another cephalosporin that effectively inhibits bacterial cell wall synthesis.
    • Ceftriaxone is very effective and frequently used as an antibiotic, even for empiric therapy.
    • Ceftriaxone has moderate activity against both gram-positive and gram-negative bacteria.
    • Ceftriaxone can be administered via a deep intramuscular injection.
    • The deep IM injection of ceftriaxone is very painful and should be reconstituted with 1% lidocaine.
    • Ceftriaxone is the only beta-lactam antibiotic that doesn't require a renal dose adjustment.

    Carbapenems

    • Imipenem-cilastatin (Primaxin) is the prototype carbapenem.
    • Imipenem-cilastatin inhibit bacterial cell wall synthesis and have a very broad spectrum of activity, including Pseudomonas aeruginosa.
    • Carbapenems are considered "critical illness" antibiotics.
    • Imipenem-cilastatin has been associated with pre-existing seizures.

    Monobactum

    • Aztreonam (Azactam) is the prototype monobactum and inhibits bacterial cell wall synthesis.
    • Aztreonam is considered safe for patients with penicillin allergy because of limited cross-allergenicity.
    • Aztreonam has a narrow spectrum of action, lacking gram-positive activity but with strong activity against gram-negative bacteria..
    • Aztreonam is considered a "critical illness" antibiotic.

    Aminoglycosides

    • Gentamicin (Garamycin) is the prototype aminoglycoside.
    • Aminoglycosides destroy bacterial ribosomes.
    • Gentamicin is commonly used for empiric therapy of serious infections and is typically not used as mono-therapy.
    • Gentamicin has strong activity against gram-negative bacteria.
    • Aminoglycosides have a black box warning for ototoxicity and nephrotoxicity.
    • Gentamicin "peaks" are monitored for signs of toxicity, and they occur 15-30 minutes after administration.
    • There are two dosing schedules for gentamicin: conventional (multiple daily doses) and extended-interval (one daily dose)
    • The extended dosing utilizes the drug's postantibiotic effect, which is its continued bactericidal activity even after plasma levels decline.

    Fluoroquinolones

    • Ciprofloxacin (Cipro) is the prototype fluoroquinolone.
    • Fluoroquinolones interfere with the production of bacterial DNA.
    • Ciprofloxacin is commonly used for many infections, and it is considered first-line for Bacillus anthracis (anthrax).
    • Ciprofloxacin has limited activity against gram-positive bacteria but moderate activity against gram-negative bacteria.
    • Ciprofloxacin can be taken orally.
    • Ciprofloxacin can cause QT prolongation.
    • The absorption of Ciprofloxacin is affected by multivitamins, calcium, and dairy products.
    • Avoid exposure to sunlight when taking Ciprofloxacin.
    • There is a black box warning for tendonitis and tendon rupture, and the drug may exacerbate weakness from myasthenia gravis.

    Tetracyclines

    • Tetracycline hydrochloride is the prototype tetracycline.
    • Tetracyclines interfere with microbial protein synthesis.
    • Tetracyclines are effective against Mycoplasma, Chlamydia, and Rickettsia.
    • Tetracyclines have broad spectrum activity.
    • Tetracyclines should be avoided in patients with renal failure.
    • Tetracyclines can diminish contraceptive effectiveness.
    • Tetracyclines can cause teeth discoloration in children under eight years old.

    Sulfonamides

    • Trimethoprim-sulfamethoxazole (Bactrim, Septra) is the prototype sulfonamide.
    • Sulfonamides stop the multiplication of new bacteria.
    • Trimethoprim-sulfamethoxazole is commonly used for infections and can be used to treat Pneumocystis jiroveci.
    • Sulfonamides have broad spectrum activity though resistance is common.
    • Sulfonamides are associated with common allergies.
    • Sulfonamides can diminish contraceptive effectiveness.
    • Sulfonamides should be avoided in patients with renal failure and should not be used during breastfeeding.

    Urinary Antiseptics

    • Nitrofurantoin (Macrobid, Macrodantin) is the prototype urinary antiseptic.
    • Nitrofurantoin is an adjuvant for urinary tract infections (UTIs).
    • Nitrofurantoin is contraindicated in patients with poor kidney function or pregnancy.
    • Nitrofurantoin may turn the urine brown.

    Macrolides

    • Erythromycin is the prototype macrolide.
    • Macrolides inhibit bacterial protein synthesis by binding to bacterial ribosomes.
    • Erythromycin is a common penicillin substitute.
    • Erythromycin is used to prevent conjunctivitis in newborns.
    • Erythromycin has moderate activity against both gram-positive and gram-negative bacteria.
    • Erythromycin is contraindicated in patients with hepatic failure.
    • Erythromycin does not require renal dose adjustments.
    • Erythromycin can induce mood changes.
    • Erythromycin can cause a variety of gastrointestinal effects, including pseudomembranous colitis (caused by Clostridium difficile (C.diff), or CDAD).

    Miscellaneous Antibiotics

    • Clindamycin (Cleocin) has a similar mechanism of action as macrolides and is highly active against Bacteroides fragilis.

    • Clindamycin has moderate activity against both gram-positive and gram-negative bacteria.

    • Clindamycin has a black box warning for pseudomembranous colitis (caused by Clostridium difficile (C.diff), or CDAD).

    • Vancomycin (Vancocin) inhibits bacterial wall synthesis.

    • Vancomycin is effective against methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive Staphylococcus aureus (MSSA), and Clostridium difficile (oral administration only).

    • Vancomycin has activity only against gram-positive organisms.

    • Vancomycin should be administered slowly intravenously over one to two hours.

    • Rapid administration can cause flushing or the "red man syndrome."

    • Vancomycin requires monitoring of drug levels (troughs) and renal dose adjustments.

    • Metronidazole (Flagyl) disrupts bacterial DNA.

    • Metronidazole is the first-line drug for treating C.diff infections.

    • Metronidazole is effective against mostly anaerobic bacteria.

    • Avoid alcohol during treatment and for three days after treatment with metronidazole.

    • Linezolid (Zyvox) inhibits bacterial protein synthesis.

    • Linezolid is effective against vancomycin-resistant enterococci (VRE) and MRSA.

    • Linezolid has activity only against gram-positive organisms.

    • Linezolid has a black box warning for interaction with serotonergic drugs that can lead to serotonin syndrome.

    • Linezolid can also cause myelosuppression (anemia).

    Tuberculosis Drugs

    • Rifampin (Rifadin) inhibits RNA synthesis.

    • Rifampin is used alone for latent TB and in combination with other drugs for active TB.

    • Rifampin has broad spectrum activity.

    • Rifampin can cause hepatotoxicity and renal failure and can turn body fluids red-orange.

    • Rifampin is an enzyme inducer (CYP450).

    • Isoniazid (INH) inhibits bacterial cell wall synthesis.

    • Isoniazid is used alone or in combination with other drugs for TB, but active TB is always treated in combination with multiple drugs.

    • Isoniazid has selective activity against mycobacteria.

    • Isoniazid can cause hepatotoxicity (monitor for jaundice and elevated liver function tests), and peripheral neuropathy (counter with pyridoxine (vitamin B6).

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    Description

    This quiz covers the key concepts of penicillins and cephalosporins, focusing on their mechanisms, activities against bacteria, and potential allergic reactions. Learn about prototypes like ampicillin and cefazolin, along with their combinations and clinical uses in treatment. Test your understanding of these important antibiotics and their appropriate applications.

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