Anti-infectives
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| Define bacteriocidal: | antibiotics that kill bacteria
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| Define bacteriostatic: | antibiotics that do not actually kill bacteria but inhibit their growth.
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| Define colonization: | the establishment and growth of microorganisms on the skin, open wounds or mucous membranes or in secretions without causing adverse clinical signs or symptoms. (Instructor calls it "Pre-infection")
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| What is the administration of drugs based on known results of culture and sensitivity testing identifying the pathogen causing infection? | Definitive therapy
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| What is the administration of drug based on the practitioner’s judgment of the most likely causing pathogen? | Empiric therapy
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| What are antibiotics taken before anticipated exposure in an effort to prevent the development of an infection? | Prophylactic antibiotic therapy (prophylactics)
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| Define subtherapeutic: | An antibiotic treatment that is ineffective.
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| What test is a significant guiding choice for ant-biotic therapy | Gram positive/negative
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| What characterizes gram positive? | *Stain purple *Thick cell wall *Outer capsule
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| What characterizes gram negative? | *Stain red *complex cell wall structure *more difficult to treat
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| Define Antimetabolite action: | Drug that is similar enough to a natural chemical to participate in a normal biochemical reaction in cells but different enough to interfere with the normal division and functions of cells. Named because the drug inhibits metabolic process. (trojan horse)
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| What will obtaining a culture and sensitivity before starting antibiotic therapy achieve? | will reduce drug resistance strains and optimize drug selection
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| What should you monitor during antibiotic Tx? | BUN and Creatinine
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| What should you monitor for long term antibiotic Tx? | AST, ALT, CBC, HCT & Bilirubin labs.
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| What does it mean if the levels of creatinine and urea are high or rising? | that the kidneys are not functioning because they normally release these products from the body via urine.
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| What is aspartate aminotransferase (AST)? | test for liver damage. Low values are good, high values are bad.
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| What is alanine aminotransferase (ALT) | Test to see if the liver is damaged or diseased. Low levels of ALT are normally found in the blood. But when the liver is damaged or diseased, it releases ALT into the bloodstream, which makes ALT levels go up.
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| Why are billirubin levels checked? | to evaluate possible liver damage due to antibiotic usage.
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| Are sulfonomides bacteriostatic or bacteriocidal? | Bacteriostatic
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| Is sulfonomide broad or narrow spectrum? | Broad spectrum and effective against gram positive and negative bacteria
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| What are the contraindications of sulfonomides? | *Drug allergy to sulfonamides *Pregnant women at term *Infants less than 2 month old
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| What is steven-johnson syndrome? | Toxic epidermal necrolysis (appears as an extreme rash)
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| List three adverse effects of sulfonomides | *Rash *STEVEN-JOHNSONS SYNDROME *Photosensitivity reactions *GI upset, hepatotoxicity, pancreatitis *Aplastic anemia, hemolytic anemia, thrombocytopenia
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| What are two sulfonomide drug brand names? | *Bactrim *Septra
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| What three drugs do sulfonomides potentiate? | *Potentiate hypoglycemic effects of sulfonylureas in diabetic treatment *warfarin (leading to possible hemorrhage) *phenytoin
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| Is penicillin bacteriostatic or bacteriocidal? | Bacteriocidal. Kills the bacteria by inhibiting cell wall synthesis
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| Is penicillin a broad or narrow spectrum antibiotic? | Narrow. It has 4 subgroups which can be gram positive or gram negative.
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| Why is a med Hx even more important for penicillin in regards to allergies? | Because trade names do not end in “cillin”.
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| List 3 adverse effects of penicillins | *Rash, Pruritis, hives, Steven-Johnson syndrome *ANAPHYLACTIC REACTION *GI upset, abdominal pain, taste alterations, oral candidiasis *Anemia, granulocytopenia, increased bleeding times, bone marrow depression
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| Are Cephalosporins bacteriocidal or bacteriostatic? | Bacteriocidal. Kills the bacteria by interfering with cell wall synthesis
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| Are cephalosporins a broad or narrow spectrum antibiotic? | Broad spectrum. Effects on gram positive, gram negative and anaerobic bacteria will depend on the generation of Cephalosporins
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| True or False: A Pt with a penicillin allergy should take cephalosporins because they are a different type of antibiotic | False. Cephalosporins are chemically related to PCN
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| What is the REAL reason soldiers returning from deployment are afraid to have positive TB and be required to take cephalosporins? | Cephalosporins potentiate effects of alcohol, so they are not allowed to drink while on the medication.
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| What decreases the effect of cephalosporins? | Antacids & Iron
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| List 3 adverse effects of cephalosporins | *RASH, Pruritis, hives, STEVEN-JOHNSONS SYNDROME *ANAPHYLACTIC REACTION *GI upset, abdominal pain, taste alterations, oral candidiasis
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| Are macrolides bacteriostatic or bacteriocidal? | Bacteriostatic, it inhibits growth. HOWEVER, In high concentrations it will have bactericidal properties
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| Are macrolides broad or narrow spectrum? | Broad spectrum.
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| What bacteria are macrolides are MOST effective against? | Bacterial species that reproduce INSIDE host cells instead of in bloodstream or interstitial spaces
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| How are Penicillin, sulfonomides, and cephalosporins eliminated from the body? | Through the kidneys
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| How are macrolides eliminated? | Metabolized in the liver
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| List 3 adverse effects of macrolides | *Rash, pruritus, urticaria, thrombophlebitis at IV site *Chest pain, palpitations, prolonged QT interval (rare) *GI upset, hepatotoxicity, pancreatitis *Headache, vertigo, tinnitus, hearing loss
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| name a macrolide | *Erythromycin *Clarithromycin *Azithromycin
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| Are quinolones bacteriostatic or bacteriocidal? | Bacteriocidal. They kill the bacteria by altering its DNA
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| Are quinolones broad or narrow spectrum? | Broad spectrum. acts on gram negative & select gram positive
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| How are quinolones elimitated from the body? | Through the kidneys
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| What are the contraindications of quinalone? | Known drug allergy and prepubescent children (affects cartilage development in laboratory animals)
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| What is the black box warning of quinolones? | Tendonitis
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| List 3 adverse effects of quinolones | *Rash, pruritus, urticaria, photosensitivity, flushing *GI upset, dysphagia, constipation, increase AST & ALT *Aplastic anemia, hemolytic anemia, thrombocytopenia *Fever, chills, blurred vision, tinnitus
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| Why should quinolones be taken with care while the PT is being TX with Class Ia and III antidysrhythmic drugs? | Can cause a prolongued QT interval
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| True or False. Give quinolones with milk, antacids, iron or zinc salts to reduce the effects of indegestion while on the drug. | False. DO NOT give with the said products for oral absorption of the drug is reduced.
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| When the PT is on quinolones, when should the C++ and MG++ preperations be taken. | One hour before or one hour after taking Quinolones
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| What are two examples of quinalones? | *Ciprofloxacin *Levofloxacin
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| Are aminoglycosides bacteriostatic or bacteriocidal? | Bacteriocidal. They kill the bacteria by interfering with protein synthesis.
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| What are aminoglycosides indicated for? | Serious gram negative infections & specific gram positive cocci bacteria
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| How are aminoglycosides eliminated? | Through the kidneys
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| What is the biggest danger of aminoglycosides? | They are highly nephrotoxic and ototoxic
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| What are the contraindications of aminoglycosides? | *PRE-EXISTING RENAL IMPAIRMENT *known drug allergy *lactating women (can cross the placental barrier and cause fetal harm)
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| List 3 adverse effects of aminoglycosides | *Highly nephrotoxic (proteinuria, increased BUN & serum creatinine) *Ototoxic (hearing loss) *dizziness, tinnitus *Rash, fever, headache, paresthesia
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| True or False Depending on the dosage of aminoglycosides, hearing loss will recover with time. | False. Though the damage to hearing IS dose dependant, the hearing loss itself is PERMANENT.
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| What is a serious sign of nephrotoxicity from aminoglycosides? | Proteinuria
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| What drug when taken with aminoglycosides increases the risk of ototoxixity and the hearing loss associated with it? | Loop diuretics (like lasix)
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| Name an aminoglycoside (or for imaginary bonus points name 3) | *Amikacin *Gentamicin *Tobramycin
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| Are tetracyclines bacteriostatic or bacteriocidal? | Bactriostatic. They inhibit growth by interfering with protein synthesis
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| Where are tetracyclines eliminated? | Kidneys and liver
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| What is the common drug interaction shared by the antibiotics is this lesson? | They potentiate the anticoagulant effects of warfarin
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| Are tetracyclines broad or narrow spectrum? | Broad spectrum. They are effective against a wide variety of resistant bacteria.
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| What are the contraindications of tetracycline? | *known drug allergy *pregnant and nursing women *pediatric patients under 8 due to tooth discoloration
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| List 3 adverse effects of tetracyclines | DISCOLORATION & HYPOPLASIA of teeth in children & fetus *RETARDED FETAL SKELETAL DEVELOPEMENT if taken during pregnancy *Rash *Photosensitivity *GI upset, hepatotoxicity, pancreatitis *Aplastic anemia, hemolytic anemia, thrombocytopenia
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| True or False. Do not give tetracyclines with milk, antacids, iron or zinc salts. | True. It reduces the oral absorbtion of the drug.
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| Define mycosis: | Infections caused by a fungus
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| What are the routes a fungal infection can be obtained? | inhaling, ingesting, or cutaneous contact
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| What are the categories of fungal infections? | *Superficial *Topical *Systemic
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| How does Terbinafine/Lamisil work | It interferes with fungal cell wall synthesis
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| List 3 things Terbinafine/Lamisil is used to treat | *tinea pedia, tinea cruris, tinea corporis *onychomycoses of the fingernails or toenails
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| What are the contraindications of Terbinafine/Lamisil | hypersensitivity to drug or liver disease
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| What is the choice drug for many major systemic fungal infections? | Amphotericin B-drug
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| What is the oldest of antifungal drugs and has major adverse effects | Amphotericin B-drug
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| What are the contraindications of amphotericin B? | patients with renal impairment or bone marrow suppression
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| How can the adverse effects of amphotericin B be reduced? | By pre-treating with antiemetics, antihistamines, antipyretics, corticosteroids and slowing the infusion rate.
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| True or False: fluconazole (Diflucan) is effective against a broad range of fungi, but has serious side effects. | False. it provides excellent coverage against many fungi, but with LESS adverse effects
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| What may indicate renal toxicity in a PT on antifungals? | *Increased BUN (>40mg/dL) *creatinine (>3mg/dL)
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| What may indicate hepatic toxicity in a PT on antifungals? | Increased AST, ALT, alk phos, bilirubin
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| What may indicate renal involvement in a PT on antifungals? | *a weight gain of 2 pounds or more in 24 hours *a weight gain of 5 pounds or more in one week
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| How often should vitals be monitored on a PT on antifungals | Initially every 15 minutes, then as needed.
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| A client with a fungal infection is taking fluconazole (Diflucan). The nurse explains that possible adverse effects include? (Select all that apply) *A Gastrointestinal upset *B Constipation *C Dizziness *D inging in the ears | A & C (Fluconazole is well tolerated. Adverse effects include headache, gastrointestinal upset, and elevated liver ezymes)
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| List 3 innoculation routes that a virus can take | sexual contact, blood transfusion, use of shared needles, organ transplantation or bites
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| How do antivirals kill virus's? | destroying or inhibiting ability to replicate (Act by blocking the synthesis of new viral genomes)
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| Define immunoglobins: | concentrated antibodies that attach and destroy viruses
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| How do interferons destroy viruses? | simulate the body’s immune system to kill the virus
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| Ribavirin will have increased risk of hepatotoxicity and lactic acidosis when given with what? | Another antiviral drug.
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| What may have additive CNS and nephrotoxicity with drugs causing similar adverse reactions? | Acyclovir
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| List 4 signs of nephrotoxicity | hematuria, oliguria, fatigue, weakness
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| What should be done when antivirals are administered via IV to prevent crystaluria? | increase fluid to 3L (3,000mL) per day to decrease crystalluria
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| When should systemic antivirals be administered to maintain therapeutic serum drug levels? | Around the clock.
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| What Hx MUST be obtained before administering antivirals? | A complete nutritional, medical and pharmaceutical history must be obtained before administering antiviral medications.
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| Define Helminthiasis: | Invasion of the body by worms (Helminthes)
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| What is malaria? | infectious disease caused by a protozoan and transmitted to humans through the bite of an infected mosquito.
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| Define Amebiasis: | Invasion of the body by an amoeba
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| What is the worldwide death rate of malaria? | 1-2 million per year
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| What is the causative organism of malaria? | Plasmodium protozoa
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| What are the two stages of the lifestyle of malaria? | sexual inside mosquito asexual inside host liver & erythrocytes.
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| When is malaria sexual? | Inside the mosquito
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| When is malaria asexual? | Inside the host liver and erythrocytes
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| True or False: Antimalarial drugs are effective against all stages of malaria | False. They are only effective during the asexual lifestyle.
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| When is malaria TX started? | only AFTER a laboratory confirmation of the disease
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| What are the mechanisms of action for antimalaria drugs? | *Interfere with parasite protein synthesis *Interferes with parasite’s ability to use erythrocyte hemoglobin
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| What antimalarial drug if given with anti-seizure drugs will result in the loss of seizure control? | Chloroquine
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| What antimalarial drug if given with Beta-blockers, calcium channel blockers or quinidine will increase the risk of dysrhythmias, seizures and cardiac arrest? | Mefloquine
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| What antimalarial drug if given with other hemolytic drugs will increase risk for myelotoxic effects (muscle weakness)? | Primaquine
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| List 3 adverse effects of antimalarial drugs. | *GI upset, diarrhea, abdominal distress *Dizziness, headache, pruritus
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| What are the adverse effects specific to mefloquine | insomnia, visual disturbances, depression, psychosis
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| For malaria prophylaxis, when should treatment be taken? | two weeks prior to exposure and continue for 4-6 weeks after leaving malarious area
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| How can GI distress be reduced while taking antimalarial medication? | Take with milk and/or meals
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| True or False: Worms reside in intestines of the host but can migrate to other tissue | True
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| True or False: Antihelmintic drugs are potent and effective against all worms. | False. Antihelmintic drugs are specific in their action and require that the causative worm be IDENTIFIED BEFORE TREATMENT is begun
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| What should be done with the feces while the PT is on antihelmintic drugs? | specimen must be sent to lab while warm & 1-3 weeks post tx
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| True or False: Antihelmintic drugs can be mixed with food. | True. They may be crushed, chewed, swallowed whole, or mixed with food
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| How many negative stool cultures after completion of treatment are required to verify effectiveness? | Three
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