Drugs for Bacterial Infections (PT LPN Ch 6)
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| An organism that causes disease in humans | Pathogen
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| Ways Pathogens enter a host | broken skin, ingestion, inhalation, mucus membranes
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| Anaerobic | Without Oxygen
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| Aerobic | With Oxygen
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| Pathogenicity | the ability of an organism to cause infection
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| Virulence | the degree of pathogenicity.
the higher the virulence the easier to produce disease even in small numbers
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| Anti-Infectives | General term given to a drug that is effective against pathogens
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| Anti-Infectives are classified by | chemical structure or by mechanism of action
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| How an Anti-Infective works | selectively targeting pathogen metabolism OR life cycle.
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| Antibiotic | a natural substance made by a bacteria that kills other bacteria
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| Bacteriocidal | Drugs kill bacteria
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| Bacteriostatic | slows growth of bacteria allowing for natural defenses to eliminate organism
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| Acquired Resistance | Ability of microorganism to resist activity of antimicrobial agents.
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| Wide spread or unwarranted use of antibiotics can cause | Acquired Resistance by an organism
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| Nosocomial Infection | Hospital Acquired Infection
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| Nosocomial Infections are often | resistant to common antibiotics
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| Two common resistant infections | methicillin-resistant Staphylococcus aureus (MRSA)
vancomycin-resistant enterococci (VRE)
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| Ways to prevent infections | - immunizations
- proper infection control procedures (wash hands)
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| Ways to prevent Acquired Resistance | - Restrict use of antibiotics to conditions necessary
- Advise pt to take for full length of therapy
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| Culture and Sensitivity | Organism grown and then tested for effective antibiotics
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| Broad-spectrum Antibiotics | One that is effective against a wide variety of different microbial species
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| Narrow-spectrum Antibiotics | One that is effective against a smaller group of microbes or only an isolated species.
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| Broad-spectrum are more likely to cause | Secondary or Super Infections
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| Super (Secondary) Infections | Common side effect to anti-infective therapy
- when microorganisms normally present are killed or allowed to overgrow
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| Examples of Super Infections | pseudomembranous colitis (C-Diff)
Yeast Infections (Thrush, vaginal)
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| Penicillins kill bacteria by | disrupting their cell walls
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| S/Sx of allergy to Penicillins (4) | Skin rash, Urticaria, Pruritis, wheezing
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| Penicillins given to this pt group for prevention of infection | Pre-op patients
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| The 4 groups of Penicillins | - Natural
- Penicillinase-resistant
- Aminopenicillins
- Extended-spectrum penicillins
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| Natural Penicillin is what spectrum antibiotic | Narrow Spectrum
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| Is Natural Penicillin commonly used? | No
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| Examples of Natural Penicillins (2) | PCN G and PCN V
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| Abbreviation for Penicillin | PCN
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| Penicillinase Resistant PCN (what is it effective against and what spectrum) | effective against penicillinase producing bacteria
and is a narrow spectrum antibiotic
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| Penicillinase | enzyme made by certain bacteria that inactivates PCN
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| Penicillinase Resistant PCN examples | dicloxacillin (Dynapen)
Oxacillin
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| Aminopenicillins (what spectrum antibiotic) | Broad Spectrum
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| What is frequently possible with Aminopenicillins | Super/Secondary Infections
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| Examples of Aminopenicillins (2) *hint: AM.... | Amoxicillin
Ampicillin
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| Extended Spectrum PCN's | Effective against more microbial species than broad spectrum
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| Examples of Extended Spectrum PCN's (2) | piperacillin
carbenicillin (Geocillin)
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| What are PCN - beta-lactamase Inhibitor Combinations | PCN combined with drugs that inhibit bacterial enzyme beta-lactamase
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| What is beta-lactamase | Enzyme that can destroy part of PCN called beta lactam ring
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| Examples of PCN-beta-lactamase Inhibitor Combinations | amoxicillin/clavulanate potassium (Augmentin)
piperacillin/tazobactam (Zosyn)
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| If using anticoagulants, what can PCN increase | Large doses of PCN may increase bleeding risk
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| PCN and Birth Control | Alternatives to the BC pill may be necessary
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| You should take PCN's with what | A full glass of water
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| How to take PCN's with Meals | give 1 hour before meals or 2 hours after meals
(exceptions of PCN V and Amoxicillin)
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| 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
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| 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)
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| Cephalosporins | Similar to PCN.
Bacteriocidal. Inhibit bacterial cell wall synthesis
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| Primary Uses for Cephalosporins | Gram-Negative Infections
UTI, Bone/Joint, Resp, Otitis media
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| Special Use for Cephalosporins | Sexual Assaults
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| What can Cephalosporins have a cross allergy with | PCN
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| Cephalosporins are classified by | Generations
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| First Generation Cephalosporins | PCNase producing bacteria will be resistant to these
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| Examples of First Generation Cephalosporins | Ancef, Kefzol (only given IV/IM
cephalexin (Keflex) PO *Michelle is allergic to this
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| Second Generation Cephalosporins | More potent and more resistant to PCNase
Broader spectrum than 1st Gen
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| Examples of 2nd Gen Cephalosporins | Ceclor
Ceftin, Zinacef
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| Third Generation Cephalosporins | Even broader spectrum and are PCNase resistant
Longer duration of action
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| Examples of 3rd Gen Cephalosporins | Omnicef PO
Rocephin IM/IV
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| Fourth Generation Cephalosporins | Effective against organisms that have developed resistance to earlier cephalosporins
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| Example of 4th Gen Cephalosporins | Maxipime IV/IM
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| AE of Cephalosporins | N/V/D
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| Special allergic reaction of Cephalosporins | Stevens-Johnson Syndrome
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| Cephalosporins are contraindicated in pt's with an allergy to | PCN
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| Use caution with Cephalosporins in pt's that take | Loop diuretics and anticoagulants
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| Should ETOH be consumed within 72 hours of taking a Cephalosporin? | No.
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| abbreviation for alcohol | ETOH
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| Tetracyclines | Broad Spectrum
Bacteriostatic
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| Common uses of Tetracyclines | GI amebiasis
Skin and soft tissue infections
urethral infections
endocervical infection
rectal infection
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| Examples of Tetracyclines (2) | Tetracycline
Doxycycline (Vibramycin)
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| AE's of Tetracyclines (3) | N/V/D
Epigastric distress
Photosensitivity!!
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| What to take Tetracyclines with | Full glass of water
Empty Stomach
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| What NOT to take with Tetracyclines | Dairy, antacids, laxatives, iron
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| Contraindications of Tetracyclines | Pregnancy and Lactation and children under 9 years old
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| Avoid this with use of Tetracyclines | Direct exposure to sunlight
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| Children under 9yrs may develop this when taking Tetracyclines | permanent yellow-brown teeth
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| 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
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| Macrolide Antibiotics | Used against wide range of infections
Inhibit bacterial protein synthesis
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| Common uses of Macrolide Antibiotics | UTI, Respiratory, Acne and Skin Infections
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| Macrolide Antibiotics are often a safe alternative to | PCN
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| Examples of Macrolide Antibiotics (2) | azithromycin (Zithromax)
erythromycin (E-mycin)
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| AE's of Macrolide Antibiotics (3) | N/V/D
Abdomen Pain
Super Infections
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| Use of Macrolide Antibiotics may increase these 2 things | - Serum levels of Digoxin
- Effects of anticoagulants
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| If GI upset occurs, Macrolide's can be given with | Food
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| Aminoglycosides | Broad Spectrum
Bacteriocidal - inhibit protein synthesis
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| Aminoglycosides have serious potential for | toxicity
Levels must be monitored
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| Aminoglycosides used for | Gram Negatve, mycobactera and some protozoan infections.
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| Aminoglycosides sometimes used as a prep for what and why | Bowel prep because it cleans you right out!
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| Examples of Aminoglycosides (3) | gentamicin (Garamicin)
neomycin
streptomycin
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| 3 toxic areas of Aminoglycosides to watch for | Nephrotoxicity
Ototoxicity
Neurotoxicity
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| S/Sx of Ototoxicity | tinnitus, dizziness, vertigo, mild to severe hearing loss
Hearing loss could be permanent
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| S/Sx of Nephrotoxicity | proteinuria, hematuria, elevated BUN, decreased urine, increased serum creatinine
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| S/Sx of Neurotoxicity | numbness, tingling, circumoral paresthesia, peripheral paresthesia, tremors, convulsions, weakness
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| Aminoglycosides are a long-term drug? | No. Nein. Negative.
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| Aminoglycoside Contraindications (there's a few here....) | previous hearing loss, myasthenia gravis, parkinsonism, pregnancy and lactation.
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| Loop diuretics may effect Aminoglycosides | Increase risk of toxicity
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| Aminoglycosides may be taken with | Meals
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| Trough | Minimum drug concentration PRIOR to a dose.
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| When is a trough drawn | Prior to next dose
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| Peak | Maximum drug concentration following a dose
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| when is a peak drawn | Drawn 30 minutes after IV dose
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| Fluoroquinolones | Inhibit bacterial DNA synthesis
Prevent cell reproduction
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| Common uses for Fluoroquinolones | UTI, bone/joint, repsiratory, skin, and STI's
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| Examples of Fluoroquinolones (3) | ciprofloxacin (Cipro)
levofloxacin (Levaquin)
moxifloxacin (Avelox)
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| AE's of Fluoroquinolones (4) | Headache
ABD pain
Photosensitivity
Superinfections
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| Fluoroquinolones are contraindicated in | Children under 18
Pregnancy
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| Fluoroquinolones may increase effects of | Oral coagulants
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| You may take Fluoro's with this but not these | taken with food but not antacids
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| Increase this while on Fluoro's | Increase fluid intake
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| Sulfonamides | Broad Spectrum
Bacteriostatic - inhibits folic acid in cell metabolism
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| Another name for Sulfonamides | Sulfa Drugs
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| 2 special uses for Sulfa Drugs | Second and Third Degree Burns
Choice drug to treat UTI
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| Examples of Sulfa Drugs (1) | trimethoprim-sulfamethoxazole (Bactrim, Septra)
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| AE's of Sulfa Drugs (3) | Anorexia
Crystalluria
Hematological Changes
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| Fluid Intake mL/day when on Sulfa Drugs | 2000mL/day
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| Avoid this when on Sulfa Drugs | prolonged sun exposure
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| Monitor pt's for this when on Sulfa Drugs | fever
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| Monitor pt's with DM for this when on Sulfa Drugs | Hypoglycemic Reaction
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| Sulfa Drug Contraindications (4) | Allergy
Lactation
End of pregnancy
Children under 2 years
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| Lincosamides | Inhibit protein synthesis
High potential for toxicity
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| Lincosamides are used when | PCN or erythromycin is not effective against a serious infection
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| Example of Lincosamides (1) | clindamycin (Cleocin)
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| AE's of Lincosamides (3) | ABD Pain
esophagitis
Pseudomembranous Colitis 0_0!!!
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| clyndamycin may be taken with | food
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| lincomycin may not be taken with | food
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| Take Lincosamides with | A Full glass of agua
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| Lincosamides are used cautiously with | GI, renal, or liver impairment
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| Carbapenems | Inhibit synthesis of bacterial cell wall
Used to treat serious bacterial infections
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| Serious Bacterial Infections when Carbapenems are used (4) | Endocarditis
Septicemia
Community Acquired Pneumonia
Bacterial Meningitis
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| Examples of Carbapenems (2) | ertapenem (Invanz)
imipenem-cilastatin (Primaxin)
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| Carbapenems are Contraindicated in (4) | Pt's with allergies to cephalosporins and PCN
Pt's with Renal Failure
Pregnancy
Children under 3 months
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| Vancomycin | Most effective treatment for MRSA
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| AE's of Vancomycin (3) | Chills/Fever
Pseudomembranous Colitis
Redman Syndrome
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| Redman Syndrome | Vanco given IV
Sudden profound decrease in BP, fever, chills, paresthesias, and erythema of neck and back
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| Monitor these religiously with Vancomycin | BP and infusion rate
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| metronidazole (Flagyl) | is a miscellaneous Anti-Infective
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| AE's of Flagyl | Metallic taste
Seizures
Extremity numbness
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| Flagyl may increase the effects of | Warfarin/Coumadin
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| If GI effects to severe, Flagyl can be given with | Meals
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| Do not consume this when taking Flagyl | ETOH
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