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PharmII
Ch. 38 & 39
| Question | Answer |
|---|---|
| Community associated infections | Infection acquired by a person who has not been hospitalized or had medical procedure (dialysis, surgery, catheterization) within the past year |
| Healthcare associated infections | Contracted in a hospital or institutional setting. Were not present or incubating in the patient on admission. More difficult to treat due to causative microorganisms often being drug resistant and virulent |
| Healthcare associated infections (continued) | 1 of top 10 leading causes of death in US. MRSA (most common) |
| Disinfectant | Kills organisms. Used only on nonliving objects |
| Antiseptic | Inhibits microorganism growth, but doesn't kill. Apply to living tissue |
| Antibiotics | Medications used to treat bacterial infections. Try to identify causative agent before administration of medication. |
| Antibiotic therapy | Empiric: treatment of an infection before specific culture information has been reported. Definitive: tailored to treat organism identified with cultures. Prophylactic: to prevent infection |
| Antibiotic classes | Sulfonamides. Penicillins. Cephalosporins. Macrolides. Quinolines. Aminoglycosides. Tetracyclines. |
| Antibiotic therapy: Mechanisms of action | Interferes with cell wall synthesis. Interferes with protein synthesis. Interferes with DNA replication. Disrupts critical metabolic reactions inside bacterial cell wall. |
| Sulfonamides | Sulfadiazine. Sulfamethoxazole. Sulfisoxazole. Bactrim (Sulfamethoxazole + trimethoprim) |
| Sulfonamides: Mechanisms of action | Bacteriostatic. Inhibit sythesis of folic acid required for synthesis of purines and nucleic acid. Don't affect human cells or certain bacteria. Only affect organisms that synthesize their own folic acid. |
| Sulfonamides: Indications I | Effective against both Gram - and Gram + bacteria. |
| Sulfonamides: Indications II | Treatment of UTIs caused by susceptible strains of: Enterbacter spp,E. coli, Klebsiella spp, Proteus mirabilis, Proteus vulgaris, S. aureus, Pneumocystis jirovecii pneumonia, Co-trimoxazole, Upper respiratory infections |
| Penicillins | Natural penicillins; Penicillinase-resistant drugs; Aminopenicillins; Extended-spectrum drugs |
| Penicillins: Negative | Bacteria produce enzymes (beta-lactamases) capable of destroying penicillins. (Chemicals that inhibit these enzymes: Calvulanic acid, tazobactam, sulbactam) |
| Penicillins: Mechanism of Action | Bactericidal. Inhibit cell wall synthesis. Inside cell they bind to penicillin-binding protein. Normal cell wall synthesis is disrupted. Bacteria cells then die from cell lysis. *Do not kill other cells in the body. |
| Penicillins: Indications | Gram + bacteria, Streptococcus, Enterococcus, Staphylococcus |
| Penicillins: Adverse Effects | Urticaria, pruritus, angioedema, n/v, runs, abdominal pain, hives (rare). If patient is allergic to penicillin, may be allergic to cephalosporin as well. |
| Penicillins: Interactions | NSAIDs (ibuprofen) – compete with the drug for protein binding, more free penicillin may result (toxic risk). Oral contraceptives–Decreases efficacy of the contraceptive. Warfarin-Blood becomes thinner than expected |
| Cephalosporins | Semisynthetic derivatives. Structurally and pharmacologically related to penicillins. Bactericidal. Broad spectrum. Divided into groups according to antimicrobial activity |
| Cephalosporins: First Generation | Used for surgical prophylaxis. Good Gram + coverage. Poor Gram - coverage. Parenteral and PO forms (Examples: cefadroxil, cephradine, cefazolin, cephalexin); Cefazolin: IV or IM; Cephalexin: PO. |
| Cephalosporins: Second Generation I | Good Gram + coverage. Better Gram - coverage than first generation (Examples: cefaclor, cefprozil, cefoxitin) |
| Cephalosporins: Second Generation II | Cefoxitin (Mefoxin): IV or IM, Used for abdominal or colorectal surgeries. Also kills anaerobes; Cefuroxime, Surgical prophylaxis. Doesn't kill anaerobes |
| Cephalosporins: Third Generation I | Most potent group against Gram - bacteria. Less active against Gram + bacteria (Examples: ceftibuten cefotaxime, ceftazidime, cefdinir, ceftizoxime, ceftriaxone, ceftazidime) |
| Cephalosporins: Third Generation II | Ceftriaxone (Rocephin): IV and IM, long half-life, once-a-day dosing. Elimination is primarily hepatic. Easily passes meninges and diffused into CSF to treat CNS infections |
| Cephalosporins: Third Generation III | Ceftazidime (Ceptaz): IV and IM forms. Excellent Gram - coverage. Used for hard to treat organisms (Pseudomonas spp.) Eliminated by renal route, not biliary. Resistance is limiting usefulness |
| Cephalosporins: Fourth Generation I | Broader spectrum third generation, especially against Gram + bacteria. UTI. Cefepime (Maxipime) |
| Cephalosporins: Fifth Generation | Not available yet. Broader spectrum. Effective against a wide variety of organisms (MRSA, Pseudomonas spp.) |
| Cephalosporins: Adverse affects | Similar to penicillins. Mild runs, abdominal cramps, rash, pruritus, redness, edema Potential cross-sensitivity with penicillins if allergies exist |
| Carbapenems I | Very broad-spectrum. Reserved for complicated body cavity and connective tissue infections. May cause drug-induced seizure activity. All given parenterally |
| Carbapenems II | Imipenem/Cilastatin (Primaxin). Used for treatment of bone, joint, skin, and soft-tissue infections |
| Monobactams | Aztreonam (Azactam). Synthetic beta-lactam antibiotic: Primarily active against aerobic Gram - bacteria (E. coli, Klebsiella spp., Pseudomonas spp.); Bactericidal. Parenteral use only. Used for moderately severe systemic infections and UTIs. |
| Macrolides | Erythromycin (E-mycin, E.E.S), azithromycin (Zithromax), clarithromycin (Biaxin), dirithromycin |
| Macrolides: Mechanism of Action | Bacteriostatic. Inhibit protein synthesis within bacterial cells. In high enough concentrations, may also be bactericidal |
| Macrolides: Indications | Strep infections, Streptococcus pyogenes, Mild to moderate URI and LRI, Haemophilus influenzae, Spirochetal infections, Syphilis and Lyme disease, Gonorrhea, Chlamydia, Mycoplasma |
| Ketolide I | Active against Gram +, including multi–drug-resistant strains of S. pneumoniae. Associated with severe liver disease. |
| Ketolide II | Telithromycin (Ketek), Only drug in this class. Community-acquired pneumonia, acute bacterial sinusitis, acterial exacerbations of chronic bronchitis |
| Ketolide: Adverse reactions: | Headache, dizziness, GI discomfort, altered potassium levels, prolonged QT intervals |
| Tetracyclines I | Bacteriostatic. Inhibit protein synthesis. Natural and semisynthetic. Obtained from cultures of Streptomyces. Dairy products, antacids, and iron salts reduce oral absorption |
| Tetracyclines II | Demeclocycline (Declomycin), oxytetracycline, tetracycline, doxycycline (Doryx, Vibramycin), minocycline, tigecycline (Tygacil) |
| Tetracyclines: Indications | Broad spectrum. Gram - and Gram + organisms (protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme disease, acne). Demeclocycline is also used to treat SIADH by inhibiting the action of ADH |
| Tetracyclines: Adverse Effects I | Strong affinity for calcium. Discoloration of permanent teeth and tooth enamel in fetuses and children, or nursing infants if taken by the mother. May retard fetal skeletal development. |
| Tetracyclines: Adverse Effects II | Alteration in intestinal flora may result in: Superinfection, Diarrhea, Pseudomembranous colitis, Vaginal candidiasis Gastric upset, Enterocolitis, Maculopapular rash |
| Nursing Implications I | Assess drug allergies; renal, liver, and cardiac function; obtain thorough patient health history; Assess for conditions that may be contraindications to antibiotic use; Assess for potential drug interactions |
| Nursing Implications II | obtain cultures from appropriate sites BEFORE beginning antibiotic therapy; Instruct patients to take antibiotics exactly as prescribed |
| Nursing Implications III | Assess for signs and symptoms of superinfection; check the name of the medication carefully because there are many drugs that sound alike or have similar spellings |
| Nursing Implications: Sulfonamides | Take with 2000 to 3000 mL of fluid/24 hr; Assess RBCs prior to beginning therapy; Take oral doses with food; Take oral doses with water, not juices; Monitor patients at least 30 minutes after administration |
| Nursing Implications: Cephalosporins | Assess for penicillin allergy; may have cross allergy. Give orally administered forms with food, even though this will delay absorption; Some of these drugs may cause a disulfiram (Antabuse)-like reaction when taken with alcohol |
| Nursing Implications: Macrolides | Highly protein-bound and will cause severe interactions with other protein-bound drugs. Take erythromycin on empty stomach, but because of the high incidence of GI upset, many drugs are taken after a meal or snack |
| Nursing Implications: Tetracyclines | Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug-binding that occurs. Take all medications with 6 to 8 ounces of fluid; avoid sunlight and tanning beds |
| Antibiotic Therapy: Concepts I | Multidrug resistance; Therapeutic drug monitoring; Minimum inhibitory concentration (MIC); Time-dependent killing; |
| Antibiotic Therapy: Concepts II | Concentration-dependent killing; Once-daily dosing vs. multi-daily dosing; Peak and trough blood levels; Synergistic effects Post-antibiotic effect (PAE) |
| Antibiotic Therapy: Toxicities I | Ototoxicity: Temporary or permanent hearing loss, balance problems. Nephrotoxicity: Varying degrees of reduced renal function. Rising serum creatinine may indicate reduced creatinine clearance; |
| Antibiotic Therapy: Toxicities II | Monitor trough levels every 5 to 7 days; Monitor serum creatinine levels every 3 days |
| Aminoglycosides I | Gentamicin (Garamycin); kanamycin; neomycin (Neo-Fradin); streptomycin; tobramycin (Nebcin); amikacin (Amikin) |
| Aminoglycosides I | Natural and semisynthetic. Produced from Streptomyces. Poor oral absorption; no PO forms. Very potent antibiotics with serious toxicities. Bactericidal; prevents protein synthesis. Kill mostly gram-negative; some gram-positive also |
| Aminoglycosides: Indications | Gram -. Poorly absorbed through the GI tract. Given parenterally. (Exception: Neomycin. Given orally to decontaminate the GI tract before surgical procedures) |
| Aminoglycosides: Adverse Effects I | Cause serious toxicities. Nephrotoxicity: renal damage. Ototoxicity: auditory impairment and vestibular impairment. Must monitor drug levels to prevent toxicities |
| Aminoglycosides: Adverse Effects II | Ototoxicity and nephrotoxicity are the most significant. Headache, Paresthesia, Fever, Superinfections, Vertigo, Skin rash, Dizziness |
| Fluoroquinolones I | ciprofloxacin (Cipro), norfloxacin (Noroxin), levofloxacin (Levaquin), gatifloxacin (Tequin), moxifloxacin (Avelox), gemifloxacin (Factive) |
| Fluoroquinolones II | Excellent oral absorption Absorption reduced by antacids Effective against Gram - organisms and some Gram + organisms |
| Fluoroquinolones: Mechanism of Action | Bactericidal. Alter bacterial DNA, causing death. Do not affect human DNA |
| Fluoroquinolones: Indications | Gram - bacteria such as pseudomonas. Respiratory infections. Bone and joint infections. GI infections. Skin infections. STDs. Anthrax |
| Fluoroquinolones: Adverse Effects I | Headache, dizziness, fatigue, depression, restlessness, insomnia. n/v, runs, constipation, thrush, increased liver function. Prolonged QT interval |
| Fluoroquinolones: Adverse Effects II | Rash, pruritus, urticaria, flushing, photosensitivity. Fever, chills, blurred vision, tinnitus. Black box warning: increased risk of tendonitis and tendon rupture |
| Other Antibiotics I | clindamycin (Cleocin); linezolid (Zyvox); metronidazole (Flagyl); nitrofurantoin (Macrodantin); quinupristin and Dalfopristin (Synercid); daptomycin (Cubicin); vancomycin (Vancocin); colistimethate (Coly-mycin) |
| Other Antibiotics: Clindamycin | Used for chronic bone infections, GU infections, intraabdominal infections. May cause pseudomembranous colitis. |
| Other Antibiotics: Linezolid | New class: oxazolidinones. Used to treat vancomycin-resistant Enterococcus faecium (VREF), hospital-acquired skin and skin structure infections (MRSA). May cause hypotension, serotonin syndrome if taken with SSRIs |
| Other Antibiotics: Metronidazole | Used for anaerobic organisms. Intraabdominal and gynecologic infections. Protozoal infections. |
| Other Antibiotics: Nitrofurantoin | Primarily used for UTIs. Use carefully if renal function is impaired. Drug concentrates in the urine. May cause fatal hepatotoxicity Usually well-tolerated if patient is kept well-hydrated |
| Other Antibiotics: Quinupristin & Dalfopristin | Used for bacteremia and infections caused by vancomycin-resistant Enterococcus (VRE) and other skin infections. May cause arthralgias, myalgias |
| Other Antibiotics: Daptomycin | New class: lipopeptide. Used to treat complicated skin and soft-tissue infections |
| Other Antibiotics: Vancomycin I | Bactericidal. Gram +. Destroys cell wall. Treats MRSA. May cause ototoxicity and nephrotoxicity. Should be infused over 60 minutes. Rapid infusions may cause hypotension |
| Other Antibiotics: Vancomycin II | Monitor IV site closely. Red man syndrome may occur. Flushing/itching of head, neck, face, upper trunk. Ensure adequate hydration, 2 L fluids per 24 hr if not contraindicated to prevent nephrotoxicity. Monitor trough levels carefully. |
| Therapeutic | Decrease in specific signs and symptoms of infection are noted |
| Subtherapeutic | Signs and symptoms do not improve |
| Bactericidal | Kill bacteria |
| Bacteriostatic | Inhibit growth of susceptible bacteria (eventually leads to bacterial death) |
| Sulfonamides: Adverse affects I | Blood Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia, photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis, |
| Sulfonamides: Adverse affects II | n/v, runs, pancreatitis, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria |
| Beta-Lactam Antibiotics | Gram -. (Penicillins, cephalosporins, carbapenems, monobactams, beta-latam ring) |
| Sulfonamides | Sulfadiazine |
| Sulfonamides | Sulfamethoxazole |
| Sulfonamides | Sulfisoxazole |
| Sulfonamides | Bactrim (Sulfamethoxazole + trimethoprim) |
| Cephalosporins | cefadroxil |
| Cephalosporins | cephradine |
| Cephalosporins | cefazolin |
| Cephalosporins | cephalexin |
| Cephalosporins | Cefazolin |
| Cephalosporins | Cephalexin |
| Cephalosporins | Cefoxitin (Mefoxin |
| Cephalosporins | Cefuroxime |
| Cephalosporins | Ceftriaxone (Rocephin) |
| Cephalosporins | Ceftazidime (Ceptaz) |
| Cephalosporins | Cefepime (Maxipime) |
| Carbapenems | Imipenem/Cilastatin (Primaxin) |
| Monobactams | Aztreonam (Azactam) |
| Macrolides | Erythromycin (E-mycin, E.E.S) |
| Macrolides | azithromycin (Zithromax) |
| Macrolides | clarithromycin (Biaxin) |
| Macrolides | dirithromycin |
| Ketolide | Telithromycin (Ketek) |
| Tetracyclines | Demeclocycline (Declomycin) |
| Tetracyclines | oxytetracycline |
| Tetracyclines | tetracycline |
| Tetracyclines | doxycycline (Doryx, Vibramycin) |
| Tetracyclines | minocycline |
| Tetracyclines | tigecycline (Tygacil) |
| Aminoglycosides | Gentamicin (Garamycin) |
| Aminoglycosides | kanamycin |
| Aminoglycosides | neomycin (Neo-Fradin) |
| Aminoglycosides | streptomycin |
| Aminoglycosides | tobramycin (Nebcin) |
| Aminoglycosides | amikacin (Amikin) |
| Fluoroquinolones | ciprofloxacin (Cipro) |
| Fluoroquinolones | norfloxacin (Noroxin) |
| Fluoroquinolones | levofloxacin (Levaquin) |
| Fluoroquinolones | gatifloxacin (Tequin) |
| Fluoroquinolones | moxifloxacin (Avelox) |
| Fluoroquinolones | gemifloxacin (Factive) |
Created by:
maggardba
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