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| 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 |
