Pharmacology Special Populations & Penicillin

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Questions and Answers

What is the significance of the maturation of kidneys and liver by 18 months in infants?

It allows for full absorption of oral medications.

It enhances the metabolism of certain drugs.

It marks the time when antibiotics may be safely administered without adjustment. (correct)

It indicates that they can safely receive all medications without concern.

Which of the following situations requires prophylaxis before a procedure?

Patients with no previous exposure to STDs.

Patients with a history of frequent headaches.

Individuals with a prosthetic heart valve undergoing dental work. (correct)

Routine dental visits without any prosthetic heart valves.

Why should Penicillin not be administered in the same solution as aminoglycosides?

It causes an allergic reaction.

It reduces the effectiveness of oral contraceptives.

Penicillin inactivates aminoglycosides. (correct)

It leads to increased kidney toxicity.

What is the effect of Penicillin on oral contraceptive effectiveness?

It may decrease effectiveness, necessitating additional precautions. Signup and view all the answers

Which group of individuals is considered to have a notable sensitivity to medications like antibiotics?

Elderly individuals with generally worn out kidneys and liver. Signup and view all the answers

Which condition is characterized by jaundice and increased bilirubin in newborns?

Kernicterus Signup and view all the answers

What is a common side effect of Nitrofurantoin/Macrobid when used for urinary tract infections?

Orange/brown urine color Signup and view all the answers

What is a significant risk associated with the use of fluoroquinolones in adolescents?

Achilles tendon rupture Signup and view all the answers

Which of the following conditions requires the utmost caution due to potential birth defects during pregnancy?

Nitrofurantoin/Macrobid Signup and view all the answers

What are the typical side effects of fluoroquinolones?

C. Diff infection and gastrointestinal issues Signup and view all the answers

What is a potential side effect of using tetracyclines in children under age 8?

Tooth staining Signup and view all the answers

Which of the following is a characteristic of carbapenems?

Bactericidal and typically used for high-risk infections Signup and view all the answers

Which of the following cephalosporins is less effective against gram-negative organisms?

Cefazolin Signup and view all the answers

What is a common risk associated with the use of antibiotics like cephalosporins?

Clostridium Difficile infection Signup and view all the answers

Which antibiotics should be avoided in pregnant women due to their teratogenic effects?

Tetracyclines Signup and view all the answers

What condition can result from the use of antibiotics leading to protective bacterial death?

Suprainfection Signup and view all the answers

Which statement about the generations of cephalosporins is true?

Earlier generations are less likely to penetrate the CSF. Signup and view all the answers

What is necessary when taking tetracyclines to avoid esophageal ulcers?

Sitting upright and drinking water Signup and view all the answers

What condition is most commonly associated with the rapid infusion of Vancomycin?

Red Man's Syndrome Signup and view all the answers

Which of the following conditions is NOT treated with Trimethoprim-Sulfamethoxazole?

Tuberculosis Signup and view all the answers

What is a significant side effect of Trimethoprim-Sulfamethoxazole?

Bone Marrow Suppression Signup and view all the answers

What is a recommended solution for counteracting crystalluria caused by Sulfonamides?

Increase fluid intake Signup and view all the answers

Which allergy contraindicates the use of Trimethoprim-Sulfamethoxazole?

Sulfa allergy Signup and view all the answers

What is a primary use of macrolides such as erythromycin and azithromycin?

Treatment of strep throat Signup and view all the answers

Which statement correctly describes a characteristic of aminoglycosides?

They have a narrow therapeutic window. Signup and view all the answers

What is the appropriate timing for drawing a trough level for aminoglycosides?

Immediately before next dose Signup and view all the answers

What should be monitored to assess for nephrotoxicity when using aminoglycosides?

BUN and creatinine Signup and view all the answers

Which condition contraindicates the use of macrolides?

Liver disease Signup and view all the answers

What is a known side effect of aminoglycosides?

Ototoxicity Signup and view all the answers

Which types of infections are aminoglycosides most effective against?

Gram-negative organisms Signup and view all the answers

What should be done if the trough level of aminoglycosides is too high?

Hold the dose and notify the doctor Signup and view all the answers

Study Notes

Special Populations & Prophylaxis

Infants have immature kidneys and livers which reach adult capacity by 18 months of age.
Elderly have worn-out kidneys and livers.
Pregnant women need to avoid antibiotics that can cross the placenta and harm the fetus.
Prophylaxis is needed before some surgeries (e.g., appendectomy, gastrointestinal, orthopedic, gynecologic).
Prophylaxis is also needed for those exposed to STDs (e.g., HIV PrEP), those with prosthetic heart valves before dental procedures, and those with recurring UTIs.
Prophylactic antibiotics are available for patients with neurogenic bladders who self-catheterize.

Penicillin (PCN)

PCN is bactericidal (lethal) and targets Gram-positive streptococcus and Gram-negative Neisseria bacteria.
It is used to treat meningitis and for dental prophylaxis.
Observe patients for 30 minutes post-injection for allergic reactions.
PCN cannot be given in the same solution as aminoglycosides because it inactivates them.
PCN decreases oral contraceptive effectiveness.
PCN is safe for pregnant women.
PCN can increase bleeding time by interfering with platelet aggregation.

Cephalosporins (Ceph/Cef)

Cephalosporins are bactericidal (lethal).
They are broad-spectrum antibiotics, with five generations, each increasing in effectiveness and resistance.
Common examples include Ceftriaxone (Rocephin), Cephalexin (Keflex), Cefazolin (Ancef), and Cefepime (Maxipime).
They are contraindicated in patients with major PCN allergy due to cross-sensitivity.
They pose a risk for diarrhea and Clostridium difficile (C.Diff) infection.
Cephalosporins are safe during pregnancy.

Carbapenems

Carbapenems are bactericidal (lethal).
They are broad-spectrum antibiotics, including Meropenem (Merrem) and Ertapenem (Invanz).
They are reserved for high-risk infections resistant to other antibiotics.

Suprainfection

Suprainfection is a secondary infection due to the death of protective bacteria.
It can cause colitis (diarrhea), oral thrush (yeast overgrowth), black hairy tongue, and vaginal yeast infections.

Tetracyclines (Doxycycline)

Tetracyclines are used to treat acne, Rocky Mountain Spotted Fever, Chlamydia, Mycoplasma Pneumonia, Lyme disease, Anthrax, and H. pylori.
Side effects include tooth staining in children under 8, GI discomfort, esophageal ulcers, photosensitivity, and teratogenicity (not safe for pregnancy).
Tetracyclines interact with milk products, calcium, iron, magnesium, and antacids.
They decrease the effectiveness of birth control.

Macrolides (Erythromycin, Azithromycin)

Macrolides are bacteriostatic (stops growth) but can be bactericidal at high doses.
They are an alternative for patients allergic to PCN.
They are used to treat pertussis (whooping cough), Legionnaires' disease, Diphtheria, Chlamydia, Mycoplasma pneumonia, and strep.
They are contraindicated in patients with liver disease or prolonged QT intervals.

Aminoglycosides (Gentamicin, Tobramycin, Neomycin, Streptomycin)

Aminoglycosides are bactericidal (lethal).
They target Gram-negative organisms like E. coli and Pseudomonas aeruginosa.
They are known for ototoxicity (tinnitus, hearing loss, vertigo) and nephrotoxicity (acute kidney injury).
Monitor BUN and creatinine levels, and watch for symptoms of AKI: proteinuria, casts, elevated BUN & creatinine, and poor urine output.
Aminoglycosides are inactivated by PCN.

Toxicity of Aminoglycosides

Aminoglycoside levels require peak and trough monitoring.
Draw trough levels 15-30 minutes before the next dose.
Draw peak level 30 minutes post-infusion (IV), 60 minutes post-IM injection, and 2 hours post-oral administration.
If the trough level is too high, withhold the dose and notify the physician.
The therapeutic window for aminoglycosides is narrow, so levels must be carefully monitored to prevent kidney damage or ineffective treatment.
Kidney lab values to watch include BUN > 20 and creatinine > 1.3.

Vancomycin

Vancomycin is used for serious infections.
It is irritating to veins and can cause thrombophlebitis - monitor injection sites carefully.
It is preferred to administer through a central line.
Red Man Syndrome is caused by too rapid an infusion of vancomycin.
Administer vancomycin slowly over at least 60 minutes.
Signs of Red Man Syndrome include hypotension, flushing, itching, and a large red rash.

Sulfonamides (Trimethoprim-Sulfamethoxazole/Bactrim)

Sulfamides are used to treat UTIs (E. coli), otitis media (ear infection), chancroid (STD), pertussis, shigellosis, and Pneumocystis jirovecii pneumonia (HIV).
They are contraindicated in patients with sulfa, thiazide diuretic (e.g., hydrochlorothiazide), or sulfonylurea (e.g., Glyburide) allergies.
Side effects include bone marrow suppression, crystalluria, kernicterus (neurotoxic for newborns), photosensitivity, and Steven Johnson's syndrome.

Urinary Tract Antiseptic (Nitrofurantoin/Macrobide)

Nitrofurantoin is commonly used as a first-line treatment for uncomplicated UTIs.
It turns urine orange-brown, and can stain teeth if the capsule is opened.
Nitrofurantoin is contraindicated in pregnancy as it can cause birth defects

Fluoroquinolones (Ciprofloxacin, Levofloxacin)

Fluoroquinolones are bactericidal and reserved for severe infections, including anthrax.
Side effects include GI discomfort, C.Diff, Achilles tendon rupture, and an increased risk of tendon rupture in adolescents.

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Description

This quiz focuses on the pharmacological considerations for special populations, including infants, the elderly, and pregnant women. It also covers the use of penicillin, its applications, and important safety measures. Test your knowledge on prophylaxis procedures and antibiotic use in various patient groups.