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