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ANTI INFECTIVE AGENTS Antibiotics and Antimicrobial Agents

What are the four types of classifications for microbes? Gram positive/Gram negative Anaerobic/ Aerobic
Gram negative microbes gram negative narrow spectrum drugs; Broad spectrums have a lot of kill; Narrow spectrums are preferred drugs; most antibiotics are resistatnt to them
Which type of microbe ( Anaerobic or aerobic) is harder to kill? Anaerobics are harder to kill
How many days of medicine do you get to treat gram negative/anaerobic microbes? + 10 days
What are the selective toxicity options? 1.Disruptions of bacterial cell wall 2.Inhibition of enzyme unique to bacteria 3.Disruption of bacterial protein synthesis
Selective toxicity: MOA of inhibition of cell wall ( weaken cell) synthesis or activate enzymes that disrupt cell wall: penicillins, cephalosporins
What drugs weaken the cell wall Penicilins and Cephalosporins
Selective Toxicity: MOA what increases cell membrane permeability? Increase cell membrane permeability ( cell develops a leak problem) antifungals
Selective Toxicity: What causes lethal inhibition of bacterial protein synthesis: aminoglycosides
What drugs do Nonlethal inhibitions of bacterial protein synthesis tetracyclines ( bacteriostatic; slows down growth which makes the body get its defenses up)
What Inhibit bacterial synthesis of nucelic acids? 1.: fluoroquinolones 2. rifampin
What are Antimetabolites and what is a fact abuout them? Sulfonamides ( a lot of people are allergic)
What are Inhibitors of viral enzymes? 1. Protease inhibitors 2. nucleosides analogs
Do viruses reproduce differently than bacteria? Yes
Antibiotics: Factors affecting outcome of therapy: Resistance Resistance to antibiotics: Examples. MRSA and E.Coli
Antibiotics: Factors affecting outcome of therapy: Swab test to know what is making you sick Important to know what is making you sick. Do a swab to determine what is making one sick.
Antibiotics: Factors affecting outcome of therapy: Location Know the location of infection.
Antibiotics: Factors affecting outcome of therapy: Clinical Status If immune system is compromised; Examples :kidney damage; hepatic ; genetic traits; pregnancy
What are the 4 factors that affect the outcome of antibiotic therapy? 1. Resistance 2. Identification of microbe 3. Location of infection 4. Clinical status of patient
What are common problems with antibiotic therapy? 1. Direct toxicity 2. Allergic reactions 3. Superinfections and supra infections 4. Viral infections 5. Early discontinuation- 6.Instability of stored antibiotics 7. Potential dangers to children
What is the difference between Superinfections and supra infections? Superinfections- Is what you are treating Supra infrections- new infection appears when you are trying to treat another.
What is supra infection? A new infection that appears during the course of treatment for a primary infection.
What do we do before we give antibiotics Culture and sensitivity (blood, urine, feces, emesis)
What is the specific mechanism of action of penicillin's? They weaken the cell wall causing bacteria to take up excessive water and rupture. Penicillin's are only active in bacteria that are undergoing growth and division.
Can you kill viral infections? No.
Beta-Lactam antibiotics are effective for? Against most commonly encountered pathogens
What drugs inhibit bacteria cell wall? Penicillins, carbapenems, monobactams & cephalosporins
Do Penicillins, carbapenems, monobactams & cephalosporins cross the blood brain barrier? No
Do Penicillins, carbapenems, monobactams & cephalosporins cross into the placenta? Yes
Bactericidal drugs are most effective against what? Actively multiplying bacteria
What are Beta-lactamases? Beta-lactamases are enzymes produced by some bacteria that provide resistance to beta-lactam antibiotics like penicillins, cephamycins, and carbapenems,
What do Beta-lactamaes promote? MRSA-
How are Beta-Lactam antibiotics excreted? Renally
Do Penicillin G & Penicillin V cross the blood brain barrier? No
When do Penicillin G and Penicillin V cross the blood brain barrier? Only when there is inflammation because the pores are open.
Penicllin G and Penicillin V are active against what? gram + & gram - bacteria
What is the most common adverse effect for Penicillin G and Penicillin V? Allergic reactions
What is the second most common adverse effect for Penicillin G and Penicillin V? GI distress
what is the key go to drug to treat strep throat? Penicillin G & Penicillin V
Penicllin G and Penicillin V cause sensitivty to what? Cross sensitivity to cephalosporins
Is the drug toxicity high or low for Penicillin G and Penicillin V? Low
What does Probenecid treat? Treats gout, gouty arthritis, and other problems caused by too much uric acid in your body. Also helps some antibiotics work better.
What helps some antibiotics work better? Probenecid
What effect does Probenecid have? Increase effective duration of action; increases activity and effectiveness of original drug
What is Procaine Penicillin G designed for? For slow absorption from IM sites
What is the best route for Procaine Penicillin G administration? Must be given deep IM
What spectrum does Procaine Penicillin G have? Narrow Spectrum
What drug treats STD's? Procain Penicilling G
When do you use Procain Penicillin G? Used for mild/medium serious infections. Also used prophylactically
How are the adverse drug reactions for Procain Penicillin G Usually transient
What are the adverse effects for Procain Penicillin G? Headache and dizziness
What is the route of administration for Penicillin V? PO
Do you administer Penicillin V with or without food? No food. Should be on an empty stomach.
What are the two Aminopenicillins? Ampicillin and amoxicillin
Do Aminopenicillins have a narrow or broad spectrum? Broader spectrum than natural & penicillinase-resistant
Are Aminopenicillins ( ampicillin and amoxicillin effective against staph infection? No
What are Aminopenicillins used to treat? Used to Rx gonococcal infection, URI,UTI, & otitis media, gram negative
What is the pregnancy drug categofry for aminopenicillins? Pregnancy Drug B
If you are administering Aminopenicillins to a pregannat woman what do you do before administering? Ask patient if she has had any allergic reactions to penicillins in the past?
Where do you notice the first allergic reactions on the body? The skin. Reactions usually show up on the skin first to indicate a reaction.
What are Extended- spectrum PCN used for? treat serious infections caused by gram negative organisms
What can happen when extended spectrum PCN are used? Hypersensitivity
How are Carbenicillin & ticarcillin administered By IV
What effects do Carbenicillin & ticarcillin have in the body Increase potassium
What do Carbenicillin and ticarcillin inhibit? Inhibit platelet aggregation
What is likely to happen to a patient who is taking carbenicillin and ticarcillin? More likely to bleed or bruise
What pregnancy category are Carbenicillin & ticarcillin? Pregnancy B drugs.
Do Carbenicillin & ticarcillin cross the placenta? Yes
How are Carbenicillin & ticarcillin excreted? Breast milk
What are the nursing implications for Carbenicillin & ticarcillin? 1. Take samples for culture before initiation of treatment 2. Identify high-risk clients 3. Take 1 hour ac or 2 hr pc- by mouth empty stomach 4. Monitor kidney function – teach them to have a med alert bracelet 5. Minimize adverse effects
What are Carbapenems? Bactericidal. Broadest antibacterial.
What do Carbapenems do? inhibits cell wall synthesis
What are Carbapenems reservered for? 1. Complicated body cavity 2. Connective tissue infections.
What are the small riskf of Carbapenems? 1. cross allergenicity 2. seizures
How do you give Carbapenems? Run it for an hour. Must be slow
What are examples of Carbapenems? 1. Primaxin 2. imipenem
What do monobactams do? Preserve normal gram positive and anaerobic flora.
What do monobactams lack? It lacks cross-allergenicity with PCN
What are monobactams similar to? aminoglycosides
What are examples of monobactems? 1. aztreonan 2. Azactam
What are Cephalosporins? Are a class of β-lactam antibiotics. It is bactericidal.
What are β-Lactam antibiotics (beta-lactam antibiotics) are a broad class of antibiotics, consisting of als that contains a β-lactam ring in their molecular structures.
What are included in the b-Lactam antibiotics? This includes penicillin derivatives (penams), cephalosporins (cephems), monobactams, and carbapenems.[
How do B-Lactam antibiotics work? Most β-lactam antibiotics work by inhibiting cell wall biosynthesis in the bacterial organism and are the most widely used group of antibiotics.
What are cephalosporins most active against? Active against most gram positive cocci & many gram negative bacilli.
What is the cross sensitivity to PNC? 10%
The higher the generationf or Cephalosporins the... (1)the better they treat gram negative bacteria & anaerobes, (2) increasing resistance to destruction by beta-lactamases, gram negative actions (3) decrease Rx gram positive bacteria, increase gram negative (4) increasing ability to reach CSF.
What are 1st generation of Cephalosporins? 1st generation: cefazolin/ancef, cephalexin/keflex
What are the 1nd generation of Cephalosporins? 2nd: cefoxitin/mefoxin- for h influenza; causes meningitis;; only in IV form
What is the 3rd generation of Cephalosporins? ceftazidime/fortaz, ceftriaxone/rocephin; starts entering CNS; not that toxic
What is the 4th generation of Cephalosporins? 4th:cefepime/maxipime- MAXI- highly resistant
What is the drug interaction of Cephalosporins? Drug interactions: Probenecid, alcohol, aminoglycosides ; if take alcohol will have anabuse reaction; they will have a violent GI response
What are the precautions of Cephalosporins? Precautions; false reading on blood glucose for diabetics ; esp urine test
What is a major care implication for Cephalosporins? Identify high risk factors
Advise patient to take Cephalosporins with? Food if gastric is upset
How should you store cephalosporins? Must be refrigerated.
Regarding giving Cephalosporins what would you want to minimize? Minimize adverse effects, adverse interactions
Who will need a lower dose of Cephalosporins? Patients with renal problems
Macrolides: Bacteriostatic has a ____concentration? Low concentration
Macrolides: Bactericidal has a +______ concentration? Higher concentration
Macrolides are __ bound? Protein Bound.
How are Macrolides eliminated Hepatic elimination
What are examples of Macrolides? 1. Erythromycin 2. Clarithromycin 3. Dirithromycin 4. Azithromycin
Which of the Macrolides antibiotics is the most safe? Erythromycin one of safest antibiotics
What is the alternative drug for those that are allergic PCN's? Penicillin G
When is Erythromycin given? Before dental procedures
Does Erythomycin cross placenta? Yes, crosses placenta but adverse effects in fetus not observed.
What are the side effects of Erythomycin? GI tract complaints; superinfection of bowel; thrombophlebitis
What is thrombophlebitis? Inflammation of blood vessel that can promote clot formation) if given IV
What are the effects of high dosage of Erythomycin? transiet effects; hearing impairment
Are allergic reactions rare re: Erythomycin? Yes
What are examples of erythromycin? Azithromycin & Clarithromycin
Azithromycin drug is called? Zithromax- zpac
Facts about Zithromax-zpac Excellent tissue penetration Long duration of action=dosing qd Food decreases rate and extent of GI absorption Used in MAC
Clarithromycin drug is called? Biaxin
Facts about Biaxin PO bid Can be given with or without food Used in MAC- bacteiral infections from birds; found in individuals that have HIV Used in combination to treat Heliocobacter pylori- cause for pelvic ulser
What do Tetracyclines treat? rickettsial diseases chlamydial infections peptic ulcer disease, acne
Do not give the following along with Tetracyclines Should not be given with calcium supplements, milk products, iron supplements, Mg laxatives, and most antacid;
Does tetracyclines enter the placenta & fetal circulation Yes
What are the adverse effects of Tetracyclines? GI irritation, discolors permanent teeth, superinfection, hepatoxicity, renal toxicity
What are examples of tetracylines? Doxycycline/Vibramycin:
What does Doxycycline/Vibramycin treat? Travelers Diarrhea
What are the major care implications of tetracycline? Advise client to take on an empty stomach and full glass of water Minimize adverse effects Minimize adverse interactions
Aminogylcosides are used against? Aerobic gram negative bacilli
Are aminoglycosides absorbed in the GI tract? NO
Does the aminoglycosides pass the blood brain barrier? NO
How are aminoglycosides excreted? Quickly excreted
Is neomycin an aminoglycoside Yes
Neomycin is a ___ drug Topical Drug
What are the adverse effects of aminoglycoside? Ototoxicity, nephrotoxicity, neuromuscular blockade, hypersensitivity
What are examples of aminoglycosides? Gentamicin, tobramycin, amikacin, kanaycin, streptomycin
Aminoglycosides are administered parenteral Serious infections cause by gram negative organisms
Aminoglycosides administerd orally do Suppress bowel flora prior to elective colorectal surgery
Topical therapy of aminoglycosides are used for treating local infections of the eyes, ears, and skin
What are the major caring implications for aminoglycosides? Intravenous infusions should be given slowly (30+ min) Monitor aminoglycoside levels Minimize adverse effects Minimize adverse interactions
What are Fluoroquinolones? Are bactericidals
Fluoroguinolone are used to treat against? For growing bacteria
Flyoroguinolones work better Good for gram negative more than positive
What can Fluoroquinolones cause? Can cause tendon rupture; use with care; if you’re a runner sit home for a while
Ciprofloxacin is a ____? Fluoroquinolones
Ciprofloxacin is good against P. aeruginosa, many anarobic, UTI, bone joint, and skin infections, infectious diarrhea, gonococcal infections
Crystalluria occurs at__? high doses in alkaline pH.
Cipro increases ____ levels? theophylline levels
RE: ciprofloxacin what do Antacids & sucralfate do? Lower Absorption
When taking ciproflaxin it increases prothrombin time in patients who are taking which drug? Warfarin
When taking NSAIDS and Ciproflaxin there is a higher risk of what? Increasing the risk of becoming jittery or having seizures
What are Sulfonamides? Are medicines that prevent the growth of bacteria in the body.
Are Sulfonamides bacteriostatic or bacteriocidal? Bacteriostatic
Sulfonamides are ____ absorbed and ___? Well absorbed and distributed
Acute UTI caused by E. coli & chronic upper URI are best treated with? Sulfonamides
Where are Sulfonamides metabolized? Liver
Where are Sulfonamides excreted Kidneys
What are adverse effects for Sulfonamides? Hypersensitivity reactions, blood dyscrasias, kernicterus, crystalluria, photosensitivity
Hypersensitivity reactions, blood dyscrasias, kernicterus, crystalluria, photosensitivity are adverse effects for which drugs? Sulfonamides
Sulfadiazine treat _____? toxoplamosis
Toxoplamosis is treated by which drug? Sulfadiazine
Sulfamethoxazole/bactrim treat___? UTI,P.carinii, resp infections, gonococcal urethritis
What are examples of Sulfadiazin? Sulfisoxazole/gantrisin
What are nursing implications for Sulfanamides? Identify hi-risk pts Take oral sulfonamides on empty stomach & full glass of water Discont drug @ 1st sign of hypersensitivity Avoid prolonged exposure to sunlight Periodic blood cell counts Do not give to pregnant or infants under age 2 mos
Re: sulfanamides you must take on a ____ stomach and a _____ glass water? Empty Stomach and a full glass of water
When taking Sulfadiazine you must avoide prolonged exposure to ___? Sunlight
You must perform periodic ___ cell count when taking Sulfonamides Blood cell count
What are two Miscellaneous antibiotics? Chloamphenicol: and Vancomycin:
What is Chloampenicol used for? used infections that can’t be treated with other antibiotic.
What are adverse effects of Chloamphenicol? Bone marrow suppression; gray-baby syndrome; otic neuritis
What Vancomycin used to treat? destroys most gram +ive MRSA. Useful in pt allergic PCN and cephalosporins. Not absorbed after PO & not useful for systemic infections.
What are adverse effects of Vancomycin? Red man’s syndrome. Ototoxicity & nephrotoxicity;
Clindamycin/cleocin is useful to treat Useful in anaerobic infections;
What is the major adverse effect of Clindamycin/cleocin? pseudomembrane colitis
What is Flagyl/metronidazole? It is misc. antibiotic used against Effective against protozoal infections
Flagyl is effective against? Against anaerobic organism
Flagyl has a cute drug interactions with alcohol, lithium, benzodiazepams ( or benzodiazepines)
Created by: jwhite223