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47 Cards in this Set
- Front
- Back
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ANTIMICROBIAL-def?
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ANTIMICROBIAL- chemical substance which is capable in low concentrations of inhibiting the growth or killing micro-organisms. Mold is capable of producing penicillins that kill other micro-organisms.
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BROAD SPECTRUM
– Kills or inhibits the growth of many ?including ? and ? organisms – Alters ?- can lead to ?and ?– Uses: 3? |
BROAD SPECTRUM
– Kills or inhibits the growth of many different organisms including infecting and non-infecting organisms – Alters natural flora - can lead to super-infection and pseudomembranous colitis – Uses: Unidentified organism, mixed infections, no other alternatives |
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NARROW SPECTRUM
– Inhibits the growth or kills ?– Less potential for ? |
NARROW SPECTRUM
– Inhibits the growth or kills a limited number of different organisms – Less potential for super-infections |
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BACTERIOCIDAL
– At safe serum levels kills ?– Effective in ? individuals |
BACTERIOCIDAL
– At safe serum levels kills sensitive organisms – Effective in immuno-compromised individuals |
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BACTERIOSTATIC
– At safe serum levels, inhibits the growth of ?– Allows the body’s immune system to ? – Ineffective in ? |
BACTERIOSTATIC
– At safe serum levels, inhibits the growth of sensitive micro-organisms – Allows the body’s immune system to kill the micro-organisms – Ineffective in immuno-compromised individuals |
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MECHANISM OF ACTION
n Only effective in replicating organisms n 3 |
MECHANISM OF ACTION
n Only effective in replicating organisms n Interrupts cell wall synthesis, protein synthesis, vitamin utilization |
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RESISTANCE
2(1) |
RESISTANCE
n Inherent - organism never has been sensitive to a particular antimicrobial agent n Acquired - organism had previously been sensitive but has acquired an insensitivity – Associated with over use of antimicrobial agents |
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ANTIMICROBIAL SELECTION
6? |
ANTIMICROBIAL SELECTION
n Identify organism and its sensitivity n Identify source of infection n Select the most narrow spectrum agent possible n Avoid hypersensitivity n Cost n Use synergistic combination in immuno-compromise patients |
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CAUSES OF ANTIMICROBIAL FAILURE
5 |
CAUSES OF ANTIMICROBIAL FAILURE
n Fever not due to infection n Improper dose n Improper selection of antimicrobial n Improper duration of therapy n Failure to utilize ancillary measures – incision and drainage of white blood cells |
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PATIENT VARIABLES
3(2) |
PATIENT VARIABLES
n Genetic - metabolism of antimicrobial agents n Allergies - cross allergies n Age – Quinolones – Affects tendons in children – Tetracyclines not used in children due to adverse reactions of teeth mottling and effect on bone growth |
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PENICILLINS
4 |
n BACTERIOCIDAL
n Allergic to one - allergic to all penicillins n Narrow to Broad Spectrum n Crosses Blood Brain Barrier |
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PENICILLINASE RESISTANT PENICILLINS
3 (1) |
PENICILLINASE RESISTANT PENICILLINS
n Resistant to penicillinase enzyme produced by Staph Aureus n MRSA strains can still destroy this antimicrobial agent n Narrow Spectrum – Staph Aureus • Infections of skin, otitis, respiratory |
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PENCILLIN G’s
4 |
PENCILLIN G’s
n Spectrum – Strept pneumonia • Respiratory, skin, otitis – Anaerobic Strept • Respiratory – Neisseria • STD – Trepenema pallidum (syphilis) • STD |
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Wider Spectrum Penicillins
n Examples: 2n Spectrum – 4 |
Wider Spectrum Penicillins
n Examples: Ampicillin, amoxicillin n Spectrum – Same as penicillin G’s – E. Coli • GI, UTI – Hemophilus influenza • Respiratory, otitis – Enterococcus • GI, UTI |
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EXTENDED SPECTRUM PENICILLINS
3(2) 3 exs |
EXTENDED SPECTRUM PENICILLINS
n Examples: Piperacillin, Ticarcillin, Mezlocillin n Synergistic with aminoglycosides n Spectrum – Same as Wider Spectrum – Pseudomonas aeruginosa • UTI, Respiratory |
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PENICILLIN POTENTIATORS
3 3exs |
PENICILLIN POTENTIATORS
n Examples: clavulanate, tazobactam, sulbactam n Overcomes resistant organisms n Overcomes enzymes that would destroy the penicillin antimicrobial agent |
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CEPHALOSPORINS
5 |
CEPHALOSPORINS
n Bacteriocidal n 10% cross allergenicity with penicillins n First generation does not cross blood brain barrier (BBB) n Only cefuroxime of second generation crosses BBB n All 3rd generation cross BBB |
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FIRST GENERATION Cephalosporons
n Spectrum 4 |
FIRST GENERATION
n Spectrum – E. Coli – Staph – Hemophilus influenza – Klebsiella • respiratory |
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SECOND GENERATION CEPHALOSPORINS
2*(1) |
SECOND GENERATION CEPHALOSPORINS
n May be effective in first generation resistance n Spectrum – Bacteroides (anaerobe) • GI, respiratory, skin |
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THIRD GENERATION CEPHALOSPORINS
3(2) |
THIRD GENERATION CEPHALOSPORINS
n May be effective against organisms resistant to 1st and 2nd generation n Synergistic with aminoglycosides n Spectrum – Similar to second generation – Pseudomonas |
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ERYTHROMYCIN
2(4) |
ERYTHROMYCIN
n Bacteriostatic n Forms – Base - oral, poorly absorbed, useful for bowel sterilization prior to surgery – Stearate - well absorbed, causes GI upset – Estolate - well absorbed, little GI upset, but associated with cholestatic hepatitis – Gluceptate, Lactobionate - IV use, cannot give IM |
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ERYTHROMYCIN
n USE 3 n SIDE EFFECT ? |
ERYTHROMYCIN
n USE – Penicillin allergy to gram positive cocci for treating respiratory, otitis and syphlis – Topical use for acne – Legionnaire's Disease n SIDE EFFECT – Significant GI Upset |
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MACROLIDES
2 |
MACROLIDES
n Azithromycin (Zithromax®) - Respiratory infection, mycobacterium avium n Clarithromycin (Biaxin®) - Respiratory infection, mycobacterium avium, helicobacter pylori |
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CLINDAMYCIN
n Bacteriostatic n Use 2 Adverse Reactions 2 |
CLINDAMYCIN
n Bacteriostatic n Use – Anaerobic Infections - GI, respiratory n Adverse Reactions – Diarrhea – Pseudomembranous colitis - therefore limit therapy to no more than 7 days |
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METRONIDAZOLE
n BACTERIOSTATIC/BACTERIOCIDAL n USE –3 n ADVERSE REACTION – 1? |
METRONIDAZOLE
n BACTERIOSTATIC/BACTERIOCIDAL n USE – Trichomonas – Anaerobic Infections – Helicobacter pylori n ADVERSE REACTION – Disulfiram like reaction with alcohol |
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VANCOMYCIN
n BACTERIOCIDAL n No ?absorption, but given orally to treat pseudomembranous colitis n Use 3 |
VANCOMYCIN
n BACTERIOCIDAL n No oral absorption, but given orally to treat pseudomembranous colitis n Use – Penicillin allergy for gram positive cocci – MRSA – Pseudomembranous colitis |
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VANCOMYCIN
n Monitor 1Levels n Adverse Reactions 2 |
VANCOMYCIN
n Monitor – Peak and Trough Blood Levels n Adverse Reactions – Ototoxic – Nephrotoxic |
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TETRACYCLINES
3 |
TETRACYCLINES
n Bacteriostatic n Extremely Broad Spectrum - risk of super-infection n FOOD/DRUG INTERACTION – Minerals: Mg, Ca, Fe, Al (antacids) |
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TETRACYCLINES
4 |
TETRACYCLINES
n Avoid in Children - affects teeth and long bone n Side Effects – Photosensitivity, GI upset n Do not use expired medication – Fanconi Syndrome n Use – Chlamydia, acne, COPD, cholera |
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CHLORAMPHENICOL
3 n Adverse Reaction - ? n Use 2? |
CHLORAMPHENICOL
n Hepatic elimination n Poor elimination in infants n Crosses Blood Brain Barrier n Adverse Reaction - Aplastic anemia n Use – Meningitis – Anaerobic Infections |
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AMINOGLYCOSIDES
5 |
AMINOGLYCOSIDES
n No oral absorption n Nephrotoxic and Ototoxic n Monitor therapy with peak and trough levels n Good gram negative coverage n Synergistic with penicillins |
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AMINOGLYCOSIDES
n Tobramycin and amikacin reserved for resistance to gentamicin n Neomycin used orally for bowel sterilization n USE 3 |
AMINOGLYCOSIDES
n Tobramycin and amikacin reserved for resistance to gentamicin n Neomycin used orally for bowel sterilization n USE – Intravenous for systemic gram negatives – Topical – Ophthalmic and otic |
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QUINOLONES
5 n Use 2 |
QUINOLONES
n Broad spectrum n Minerals block absorption n Affects tendon growth in children n Increasing rate of resistance n Use – UTI – Respiratory Infection |
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URINARY TRACT INFECTION
n Increasing resistance? and ?acquired infections n ?not very useful any more |
URINARY TRACT INFECTION
n Increasing resistance in hospital and community acquired infections n Sulfonamides (Sulfa) not very useful any more |
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SULFONAMIDES
3 |
SULFONAMIDES
n High acquired resistance n Use in combination with trimethoprim to overcome resistance n Trimethoprim/sulfamethoxazole (co-trimoxazole) inhibits bacteria ability to activate folic acid to tetrahydrofolate |
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CO-TRIMOXAZOLE
n Use 3 n Adverse Reactions –3 |
CO-TRIMOXAZOLE
n Use – UTI – Respiratory Infection – Pneumocystis Carinii (high dose therapy) n Adverse Reactions – Anemia associated with high dose therapy – Serious Skin Rashes – Diarrhea |
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METHENAMINE
4 |
METHENAMINE
n Breaks down to formaldehyde in acidic environment n Enteric coated to avoid breakdown in the stomach n Cranberry juice and Vitamin C help acidify urine n Not useful with indwelling foley catheters |
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FUNGAL INFECTIONS
n SYSTEMIC 3 n DERMATOLOGIC 1 |
FUNGAL INFECTIONS
n SYSTEMIC – Respiratory (coccidioidomycosis) – Urinary – Meningitis n DERMATOLOGIC – Athlete’s Foot |
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AMPHOTERICIN B
5 |
AMPHOTERICIN B
n Intravenous and Bladder Irrigation n Precipitates in Saline, therefore intravenous admixtures in Dextrose and bladder irrigation in water n Protect from light n Test dose is administered n Dose is gradually increased |
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n Amphocorin B
Adverse Reactions 4 |
n Adverse Reactions
– Headache, chills, fever • premedicate with antipyretic, steroids, and/or antihistamines – Thrombophlebitis • Premedicate with an anticoagulant – Hypokalemia – Nephrotoxicity - reversible |
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FLUCONAZOLE
4 |
FLUCONAZOLE
n Oral and Intravenous Therapy n Less effective than amphotericin n Less side effects n Advantage: oral agent for systemic infections |
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Nystatin
3 |
Nystatin
n Oral and Topical n Oral use for candida (thrush) n Topical use for skin and vaginal infections |
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Flucytosine
2 |
Flucytosine
n Oral Use n Adjunct therapy for meningitis |
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Miscellaneous- anti fungal
4 |
Miscellaneous
n Miconazole - topical and vaginal use n Griseofulvin - oral for dermatologic and nail infections - duration of therapy can be 6 months to a year n Ketoconazole - dermatologic and oral infections n Terbinafine - Nail infections |
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Mycobacterium
3 |
Mycobacterium
n Slow growing organism n Difficult to eradicate n Mycobacterium tuberculi can be cured |
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TUBERCULOSIS THERAPY
5 |
TUBERCULOSIS THERAPY
n Non-compliance leads to resistance n Minimal to Moderate disease requires two drugs for two years n Advanced (disseminated) disease requires three drugs for three years n Prophylactic therapy for healthy positive converters for 9 to 12 months n Most medications are hepatotoxic |
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VIRAL THERAPY
3 |
VIRAL THERAPY
n Some viral infections cannot be cured – HIV, Herpes n Some agents may stop flare ups – Acyclovir n Some agents may hasten recovery – Amantadine - Influenza type A |
