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Bacterial Infections

Drugs for Bacterial Infections (PT LPN Ch 6)

An organism that causes disease in humans Pathogen
Ways Pathogens enter a host broken skin, ingestion, inhalation, mucus membranes
Anaerobic Without Oxygen
Aerobic With Oxygen
Pathogenicity the ability of an organism to cause infection
Virulence the degree of pathogenicity. the higher the virulence the easier to produce disease even in small numbers
Anti-Infectives General term given to a drug that is effective against pathogens
Anti-Infectives are classified by chemical structure or by mechanism of action
How an Anti-Infective works selectively targeting pathogen metabolism OR life cycle.
Antibiotic a natural substance made by a bacteria that kills other bacteria
Bacteriocidal Drugs kill bacteria
Bacteriostatic slows growth of bacteria allowing for natural defenses to eliminate organism
Acquired Resistance Ability of microorganism to resist activity of antimicrobial agents.
Wide spread or unwarranted use of antibiotics can cause Acquired Resistance by an organism
Nosocomial Infection Hospital Acquired Infection
Nosocomial Infections are often resistant to common antibiotics
Two common resistant infections methicillin-resistant Staphylococcus aureus (MRSA) vancomycin-resistant enterococci (VRE)
Ways to prevent infections - immunizations - proper infection control procedures (wash hands)
Ways to prevent Acquired Resistance - Restrict use of antibiotics to conditions necessary - Advise pt to take for full length of therapy
Culture and Sensitivity Organism grown and then tested for effective antibiotics
Broad-spectrum Antibiotics One that is effective against a wide variety of different microbial species
Narrow-spectrum Antibiotics One that is effective against a smaller group of microbes or only an isolated species.
Broad-spectrum are more likely to cause Secondary or Super Infections
Super (Secondary) Infections Common side effect to anti-infective therapy - when microorganisms normally present are killed or allowed to overgrow
Examples of Super Infections pseudomembranous colitis (C-Diff) Yeast Infections (Thrush, vaginal)
Penicillins kill bacteria by disrupting their cell walls
S/Sx of allergy to Penicillins (4) Skin rash, Urticaria, Pruritis, wheezing
Penicillins given to this pt group for prevention of infection Pre-op patients
The 4 groups of Penicillins - Natural - Penicillinase-resistant - Aminopenicillins - Extended-spectrum penicillins
Natural Penicillin is what spectrum antibiotic Narrow Spectrum
Is Natural Penicillin commonly used? No
Examples of Natural Penicillins (2) PCN G and PCN V
Abbreviation for Penicillin PCN
Penicillinase Resistant PCN (what is it effective against and what spectrum) effective against penicillinase producing bacteria and is a narrow spectrum antibiotic
Penicillinase enzyme made by certain bacteria that inactivates PCN
Penicillinase Resistant PCN examples dicloxacillin (Dynapen) Oxacillin
Aminopenicillins (what spectrum antibiotic) Broad Spectrum
What is frequently possible with Aminopenicillins Super/Secondary Infections
Examples of Aminopenicillins (2) *hint: AM.... Amoxicillin Ampicillin
Extended Spectrum PCN's Effective against more microbial species than broad spectrum
Examples of Extended Spectrum PCN's (2) piperacillin carbenicillin (Geocillin)
What are PCN - beta-lactamase Inhibitor Combinations PCN combined with drugs that inhibit bacterial enzyme beta-lactamase
What is beta-lactamase Enzyme that can destroy part of PCN called beta lactam ring
Examples of PCN-beta-lactamase Inhibitor Combinations amoxicillin/clavulanate potassium (Augmentin) piperacillin/tazobactam (Zosyn)
If using anticoagulants, what can PCN increase Large doses of PCN may increase bleeding risk
PCN and Birth Control Alternatives to the BC pill may be necessary
You should take PCN's with what A full glass of water
How to take PCN's with Meals give 1 hour before meals or 2 hours after meals (exceptions of PCN V and Amoxicillin)
How to reduce the risk of Super Infections (2) - Eat yogurt or take acidophilus caps daily - Take the whole course of the antibiotic even if feeling better
A pt taking an oral PCN reports he has a sore mouth. On inspection, the nurse notes black, furry tongue and bright red mucous membranes. These S/Sx may be caused by: A. Vitamin C deficiency B. Superinfection C. Dehydration D. Poor oral hygiene B. Superinfection (PCN work against bacteria and can sometimes kill good bacteria or increase it's growth when used as broad spectrum)
Cephalosporins Similar to PCN. Bacteriocidal. Inhibit bacterial cell wall synthesis
Primary Uses for Cephalosporins Gram-Negative Infections UTI, Bone/Joint, Resp, Otitis media
Special Use for Cephalosporins Sexual Assaults
What can Cephalosporins have a cross allergy with PCN
Cephalosporins are classified by Generations
First Generation Cephalosporins PCNase producing bacteria will be resistant to these
Examples of First Generation Cephalosporins Ancef, Kefzol (only given IV/IM cephalexin (Keflex) PO *Michelle is allergic to this
Second Generation Cephalosporins More potent and more resistant to PCNase Broader spectrum than 1st Gen
Examples of 2nd Gen Cephalosporins Ceclor Ceftin, Zinacef
Third Generation Cephalosporins Even broader spectrum and are PCNase resistant Longer duration of action
Examples of 3rd Gen Cephalosporins Omnicef PO Rocephin IM/IV
Fourth Generation Cephalosporins Effective against organisms that have developed resistance to earlier cephalosporins
Example of 4th Gen Cephalosporins Maxipime IV/IM
AE of Cephalosporins N/V/D
Special allergic reaction of Cephalosporins Stevens-Johnson Syndrome
Cephalosporins are contraindicated in pt's with an allergy to PCN
Use caution with Cephalosporins in pt's that take Loop diuretics and anticoagulants
Should ETOH be consumed within 72 hours of taking a Cephalosporin? No.
abbreviation for alcohol ETOH
Tetracyclines Broad Spectrum Bacteriostatic
Common uses of Tetracyclines GI amebiasis Skin and soft tissue infections urethral infections endocervical infection rectal infection
Examples of Tetracyclines (2) Tetracycline Doxycycline (Vibramycin)
AE's of Tetracyclines (3) N/V/D Epigastric distress Photosensitivity!!
What to take Tetracyclines with Full glass of water Empty Stomach
What NOT to take with Tetracyclines Dairy, antacids, laxatives, iron
Contraindications of Tetracyclines Pregnancy and Lactation and children under 9 years old
Avoid this with use of Tetracyclines Direct exposure to sunlight
Children under 9yrs may develop this when taking Tetracyclines permanent yellow-brown teeth
Dairy/Calcium can inhibit tetracycline absorption. What is the best way to take the medication to enhance absorption? A. 1 hour before meals B. With Meals C. 1 hour after meals D. 2 hours before meals A. 1 hour before meals
Macrolide Antibiotics Used against wide range of infections Inhibit bacterial protein synthesis
Common uses of Macrolide Antibiotics UTI, Respiratory, Acne and Skin Infections
Macrolide Antibiotics are often a safe alternative to PCN
Examples of Macrolide Antibiotics (2) azithromycin (Zithromax) erythromycin (E-mycin)
AE's of Macrolide Antibiotics (3) N/V/D Abdomen Pain Super Infections
Use of Macrolide Antibiotics may increase these 2 things - Serum levels of Digoxin - Effects of anticoagulants
If GI upset occurs, Macrolide's can be given with Food
Aminoglycosides Broad Spectrum Bacteriocidal - inhibit protein synthesis
Aminoglycosides have serious potential for toxicity Levels must be monitored
Aminoglycosides used for Gram Negatve, mycobactera and some protozoan infections.
Aminoglycosides sometimes used as a prep for what and why Bowel prep because it cleans you right out!
Examples of Aminoglycosides (3) gentamicin (Garamicin) neomycin streptomycin
3 toxic areas of Aminoglycosides to watch for Nephrotoxicity Ototoxicity Neurotoxicity
S/Sx of Ototoxicity tinnitus, dizziness, vertigo, mild to severe hearing loss Hearing loss could be permanent
S/Sx of Nephrotoxicity proteinuria, hematuria, elevated BUN, decreased urine, increased serum creatinine
S/Sx of Neurotoxicity numbness, tingling, circumoral paresthesia, peripheral paresthesia, tremors, convulsions, weakness
Aminoglycosides are a long-term drug? No. Nein. Negative.
Aminoglycoside Contraindications (there's a few here....) previous hearing loss, myasthenia gravis, parkinsonism, pregnancy and lactation.
Loop diuretics may effect Aminoglycosides Increase risk of toxicity
Aminoglycosides may be taken with Meals
Trough Minimum drug concentration PRIOR to a dose.
When is a trough drawn Prior to next dose
Peak Maximum drug concentration following a dose
when is a peak drawn Drawn 30 minutes after IV dose
Fluoroquinolones Inhibit bacterial DNA synthesis Prevent cell reproduction
Common uses for Fluoroquinolones UTI, bone/joint, repsiratory, skin, and STI's
Examples of Fluoroquinolones (3) ciprofloxacin (Cipro) levofloxacin (Levaquin) moxifloxacin (Avelox)
AE's of Fluoroquinolones (4) Headache ABD pain Photosensitivity Superinfections
Fluoroquinolones are contraindicated in Children under 18 Pregnancy
Fluoroquinolones may increase effects of Oral coagulants
You may take Fluoro's with this but not these taken with food but not antacids
Increase this while on Fluoro's Increase fluid intake
Sulfonamides Broad Spectrum Bacteriostatic - inhibits folic acid in cell metabolism
Another name for Sulfonamides Sulfa Drugs
2 special uses for Sulfa Drugs Second and Third Degree Burns Choice drug to treat UTI
Examples of Sulfa Drugs (1) trimethoprim-sulfamethoxazole (Bactrim, Septra)
AE's of Sulfa Drugs (3) Anorexia Crystalluria Hematological Changes
Fluid Intake mL/day when on Sulfa Drugs 2000mL/day
Avoid this when on Sulfa Drugs prolonged sun exposure
Monitor pt's for this when on Sulfa Drugs fever
Monitor pt's with DM for this when on Sulfa Drugs Hypoglycemic Reaction
Sulfa Drug Contraindications (4) Allergy Lactation End of pregnancy Children under 2 years
Lincosamides Inhibit protein synthesis High potential for toxicity
Lincosamides are used when PCN or erythromycin is not effective against a serious infection
Example of Lincosamides (1) clindamycin (Cleocin)
AE's of Lincosamides (3) ABD Pain esophagitis Pseudomembranous Colitis 0_0!!!
clyndamycin may be taken with food
lincomycin may not be taken with food
Take Lincosamides with A Full glass of agua
Lincosamides are used cautiously with GI, renal, or liver impairment
Carbapenems Inhibit synthesis of bacterial cell wall Used to treat serious bacterial infections
Serious Bacterial Infections when Carbapenems are used (4) Endocarditis Septicemia Community Acquired Pneumonia Bacterial Meningitis
Examples of Carbapenems (2) ertapenem (Invanz) imipenem-cilastatin (Primaxin)
Carbapenems are Contraindicated in (4) Pt's with allergies to cephalosporins and PCN Pt's with Renal Failure Pregnancy Children under 3 months
Vancomycin Most effective treatment for MRSA
AE's of Vancomycin (3) Chills/Fever Pseudomembranous Colitis Redman Syndrome
Redman Syndrome Vanco given IV Sudden profound decrease in BP, fever, chills, paresthesias, and erythema of neck and back
Monitor these religiously with Vancomycin BP and infusion rate
metronidazole (Flagyl) is a miscellaneous Anti-Infective
AE's of Flagyl Metallic taste Seizures Extremity numbness
Flagyl may increase the effects of Warfarin/Coumadin
If GI effects to severe, Flagyl can be given with Meals
Do not consume this when taking Flagyl ETOH
Created by: Wakingupto42