Infection (Pharm Made Easy 3.0)

Front 1

Antibacterials: Drugs that interfere with Cell wall synthesis

Back 1

•Penicillins

•Cephalosporin

•Beta lactams

•Others

Front 2

Penicillins

Back 2

•Treats: broad spectrum infections (ear and throat, UTI), amoxicillin treats gonorrhea and addition of clavulanic acid increases spectrum of disorder (allows amoxicillin to kill bacteria)

•Examples:

-Amoxicillin

-Methicillin

-Piperacillin

•Penicillin WEAKENS and DESTROYS cell wall, bactericidal (many aerobic gram positive and some aerobic gram negative) and penicillin G is active constituent

•Side effects:

-G.I symptoms (diarrhea, nausea and vomiting)

-Rare but may cause pseudomembranous colitis due to SUPERINFECTION

-Suprainfection with Candida albicans

•Allergy to penicillin (rash, hives) and cross sensitivity with cephalosporin

•Anaphylactic reaction (swelling of airway, wheezing and difficultly breathing)

•Report bloody stools or long periods of diarrhea (this INDICATES pseudomembranous infection)

•Monitor for Candida infections of mouth or vagina (SUPRAINFECTIONS)

•Monitor for allergy manifestations, withhold drug and notify provider

•Do NOT give to

-Patients allergic to penicillin or cephalosporin

-Infectious mononucleosis

-Severe liver disease (with AMOXICILLIN and CLAVULANIC acid) ☆

Front 3

Cephalosporin

Back 3

•Treats: Cephalexin (FIRST generation) treats infections caused by gram positive cocci, subsequent generations become more effective in

-Treating gram negative bacteria

-More resistant to beta lactamase (gram positive bacteria release this enzyme that breaks down penicillin and cephalosporin)

-More able to penetrate CSF to treat infections, such as meningitis

•Examples:

-Cephradine (FIRST generation)

-Cefaclor (SECOND generation)

-ceftriaxone (THIRD generation)

-cefepime (FOURTH generation)

•WEAKENS and DESTROYS cell wall and are bactericidal

•G.I symptoms (diarrhea, nausea and vomiting)

•RARE pseudomembranous colitis

•Possible CROSS SENSITIVITY to penicillin allergy

•Risk for HEMORRHAGE with cefotetan ONLY

•Thrombophlebitis (cephalosporin infused vía I.V ONLY) ☆

•Possible disulfiram like reaction (nausea, vomiting, severe headache and HYPOtension) if taken with ALCOHOL

•If the patient is taking cefotetan MONITOR prothrombin partial thromboplastin: INR; If bleeding occurs give vitamin K

•If watery or bloody diarrhea occurs report to provider

•Do NOT give to patients ALLERGY to penicillin or cephalosporin

•Do NOT give to patients with viral infections

•Do NOT give cefditoren to patients with carnitine deficiency or milk protein allergy

•Do NOT give Cefotetan to any ALCOHOL CONSUMER because the patient can develop disulfiram like reactions

Front 4

Monobactam

Back 4

•Treats: narrow spectrum antibiotic, fights infections caused by gram negative aerobic bacteria (lower respiratory infections, U.T.I, and abdominal & gynecological infections

•Example:

-Aztreonam (routes: I.M, powder and I.V)

•WEAKENS and DESTROYS cell wall and bactericidal (monobactams are not effective against anaerobes, gram positive bacteria)

•Side effects:

-Thrombophlebitis or inflammation at the I.V site

-SUPRAINFECTION with Candida albican

•Take AZTREONAM inhaled powder 3 times a day for 28 days

•Do NOT give to patients with viral infections

•Do NOT give to moms lactating

Front 5

Carbapenems

Back 5

•Treat: treat serious infections and those that multiple types of organisms cause

•Examples:

-Imipenem

-Cilastatin

-Meropenem

•Carbapenems are beta lactam antibiotics, WEAKEN cell wall, bactericidal and RESISTANT against beta lactamase and are better than penicillin and cephalosporin

•Side effects:

-G.I symptoms (nausea, vomiting if I.V infusion is too rapid)

-Thrombophlebitis at I.V site

-Possible cross sensitivity with other antibiotics with the beta lactam ring (PENICILLIN and CEPHALOSPORIN)

•Suprainfection

•Assess for and monitor antibiotic allergy PRIOR to infusing imipenem (assess for PENICILLIN, CEPHALOSPORIN and CARBAPENEM allergy)

•Do NOT give carbapenem to patients allergic to carbapenem, penicillin and cephalosporin ☆

Front 6

Vancomycin

Back 6

•Treats: severe infections (MRSA, pseudomembranous colitis and infections in patients allergic to penicillin)

•WEAKENS and DESTROYS cell wall, bactericidal (effective against gram positive bacteria, MRSA, and C.diff)

•Side effects:

-Hypotension and flushing of face and trunk (RED PERSON SYNDROME) with rapid infusion

-Ototoxicity (hearing loss can be permanent) ☆

-Nephrotoxicity (kidney damage) ☆

-Thrombophlebitis at I.V site and tissue damage with I.V infiltration ☆

•Monitor vancomycin blood levels (trough levels every 4 days, depends)

•Do NOT give to patients with allergy to vancomycin

•Do NOT give to patients allergic to corn products

Front 7

Antibiotics: antibiotics that inhibit protein synthesis

Back 7

•Tetracycline

•Macrolides

•Aminoglycosides

Front 8

Tetracycline

Back 8

•Treat: first choice antibiotic for: chlamydia, mycoplasmal, rickettsia infections, syphilis and gram negative in patients allergic to penicillin and gram positive infections (tetanus), cholera, anthrax, and acne vulgaris

•Examples:

-Doxycycline

-Minocycline

•Tetracycline INHIBITS protein synthesis, bacteriostatic, prevent malaria in quinine-resistant parasites and promote growth in cattle

•Side effects:

-G.I symptoms nausea, vomiting and abdominal pain

-Liver toxicity ☆

-Suprainfection

-Photosensitivity

-Stains and damages teeth ☆

•Monitor liver function (AST, ALT and bilirubin)

•Determine if woman is pregnant before giving this drug, hold if pregnant

•Give tetracycline 1 hour before a meal or 2 hours after a meal (best on an empty stomach)

•Do not give right before bed time

•Give with nondairy foods (foods that do not contain milk)

•Do NOT give tetracycline to children UNDER 8 years old or PREGNANT women

•Monitor for Suprainfections (vaginal discharge with yeast infection, difficultly swallowing with thrust, watery stools with pseudomembranous colitis)

•Do NOT give to those exposed to U.V light

•Do NOT give to patients with severe renal or liver disorders

•Do NOT give to patients allergic to tetracycline

Front 9

Macrolides

Back 9

•Treats: first line treatment for: legionnaires’ disease, whooping cough, acute diphtheria, some chlamydia and certain pneumonias, treats common infections in patients allergic to penicillin and use eye ointment to prevent eye infection in neonates

•Examples:

-Erythromycin

-Azithromycin

•Macrolides INHIBIT protein synthesis and are bacteriostatic (effective against gram positive bacteria and some gram negative bacteria)

•Side effects:

-G.I symptoms

-Cardiac symptoms (V.dysrhythmia caused by prolonged Q.T on EKG)

-Ototoxicity (hearing loss, vertigo and tinnitus; reversible once therapy ends) ☆

-Suprainfection (pseudomembranous colitis and Candida)

•Monitor for and report signs of ototoxicity

•Question patient of any history of prolonged Q.T

•Monitor and report suprainfections

•Do not give if allergic to macrolide antibiotics

•Do NOT give to patients with history of Q.T prolongation on E.K.G

Front 10

Aminoglycosides

Back 10

•Treats: gram negative aerobic bacilli which causes severe infections, gentamicin (combined with other antibiotic) treats severe infections caused by gram positive bacteria and used topically for skin and eye infections

•Examples:

-Amikacin

-Tobramycin

-Neomycin

-Gentamicin

•INHIBIT protein synthesis and are bactericidal (effective at killing gram NEGATIVE aerobic bacilli)

•Side effects:

-Ototoxicity (hearing loss, vertigo and tinnitus) ☆

-Nephrotoxicity (damages kidneys) ☆

•Monitor peak and trough blood levels

•Monitor lab values (BUN, urine for protein, creatinine)

•Report increase in dilute urine

•Do not give to patients allergic to aminoglycosides

•Do not give if patient has vertigo or any other ear problem

•Do NOT give gentamicin to pregnant women because it is a category D drug

Front 11

Fluoroquinolones

Back 11

•Treat a wide range of bactericidal infections, including severe U.T.I and prevents anthrax (following inhalation of anthrax pores)

•Examples:

-Ciprofloxacin

-Ofloxacin

•Fluoroquinolones INHIBIT DNA replication and cell division and are bactericidal (destroy many gram negative bacteria and some gram positive bacteria and very few anaerobes)

•Side effects:

-Mild CNS symptoms (dizziness, headache and confusion in older adults)

-G.I symptoms

-Achilles tendinitis rupture (rare) ☆

-Photosensitivity

-Apply sunscreen to protect against sun exposure

•REPORT tendon pain to provider while taking fluroquinolone

•Do not give to patients allergic to fluoroquinolone antibiotic

•Do NOT give to patients with tendon pain

Front 12

Antibacterials: Drugs that inhibit Folic Acid Synthesis

Back 12

•Sulfonamides

•Urinary tract antiseptics

Front 13

Sulfonamides

Back 13

•Treats: Trimethoprim and sulfamethoxazole work together to treat: U.T.I, pneumocystis pneumonia, shigellosis enteritis, chronic bronchitis and acute otitis media in children

•Examples:

-Trimethoprim and sulfamethoxazole this combination is called Bactrim or Septra

-Trimethoprim (by it self is called Proloprim)

•Sulfonamides INHIBIT folic acid synthesis and are bacteriostatic (effective against gram positive cocci, gram negative bacilli, and some protozoa and fungi)

•Side effects:

-G.I symptoms

-Allergic skin reactions

-Blood cell deficiencies (thrombocytopenia, leukopenia, and anemia) ☆

-Suprainfections

-Severe rash, including Steven Johnson syndrome (life threatening) ☆

•Monitor for rash and hives (stop/withhold the drug; give epinephrine) and report to provider

•Monitor and report blood deficiencies

•Monitor and report severe diarrhea or Candida infection

•Give oral dose with 8 oz of water (drink 2,500 to 3,000 mL of water a day)

•Sulfonamides DECREASE the effectiveness of oral contraceptives; use alternate form

•Do NOT give to patients who are pregnant and nursing

•Do NOT give if ALLERGIC to sulfonamides or cyclooxygenase-2 inhibitor (celecoxib)

•Do NOT give to patients with megaloblastic anemia from a folic acid deficiency

•Do NOT give to children less than 2 months

•Do NOT give to patients with pharyngitis caused by group A beta hemolytic strep

•Do NOT give to patients with HYPERkalemia, severe impairment in urine creatinine clearance (renal insufficiency)

Front 14

Urinary Tract Antiseptics

Back 14

•Treat: treatment and prevention of lower U.T.I, no action on infections outside urinary tract and excretion of drug happens through urine

•Examples:

-Nitrofurantoin

-Methenamine

•Urinary tract antiseptic INTERFERES with RNA and DNA producing enzymes, can be bactericidal or bacteriostatic (depends on dose), acidic pH enhances antibacterial activity, effective against both gram negative and positive bacteria

•Side effects:

-G.I symptoms

-Permanent peripheral neuropathy ☆

-Blood deficiencies (thrombocytopenia, leukopenia and neutropenia) ☆

-Tooth staining caused if given in SUSPENDED LIQUID (give with milk or juice)

-Brownish appearance to urine (harmless side effect)

-Allergic respiratory reactions (chills, fever, cough that lasts 2 to 4 days)

•Monitor for respiratory symptoms and withhold drug

•Monitor lab for blood components (C.B.C)

•Dilute med suspension in milk or juice to prevent staining or have the patient rinse mouth immediately after administration

•Do NOT give to patients if they have these conditions:

-Allergic to nitrofurantoin

-Have an impaired kidney (low creatinine clearance) ☆

-Have jaundice caused by gallbladder disease

-Are pregnant greater than 38 months of gestation

-Are in labor, lactating moms

-Are infants less than 1 months old

Front 15

Antimycobacterials: Drugs Therapy for Tuberculosis

Back 15

•Isoniazid

•Rifampin

Front 16

Isoniazid

Back 16

•Treat: active tuberculosis (TB) and treat of latent tuberculosis (positive TB skin test, disease not yet active)

•Examples:

-Isoniazid

-Pyrazinamide

-Ethambutol

•INTERFERES with lipid, RNA, and DNA synthesis, bacteriostatic and to tubercle bacilli and bactericidal in higher doses

•Side effects:

-G.I symptoms

-Liver damage ☆

-Peripheral neuropathy ☆

-Orange-red urine and bodily fluids ☆

-CNS symptoms: dizziness, ataxia, seizures

•Contraindications:

-History of allergy to isoniazid

-History of liver damage from isoniazid

-Severe liver damage from any cause

Front 17

Rifampin

Back 17

•Treat: Adjunct therapy to treat tuberculosis, prevention therapy for carrier of Neisseria meningitis, may help treat leprosy and prevents Haemophilus influenzae infection)

•Example:

-Rifampin

•SUPPRESSES protein synthesis and is bacteriostatic (effective against gram positive, gram negative and the organism responsible for leprosy and meningitis)

•Side effects:

-Liver toxicity ☆

-Red orange color of body fluids ☆

-G.I symptoms

•Monitor liver function (ALT, AST)

•Give Rifampin 1 hour before a meal or 2 hours after a meal for better absorption; but if G.I symptoms worsen, give with food (try to take it on empty stomach)

•Do NOT give to patients allergic to Rifampin

•Do NOT give to patients with obstructive gallbladder disease

•Do NOT give to patients with current meningococcal disease

Front 18

Antiparasitics: Drug therapy for parasites

Back 18

•Metronidazole

•Chloroquine

Front 19

Metronidazole

Back 19

•Treat: pseudomembranous colitis and bacterial vaginal infections, giardiasis, trichomoniasis and intestinal and systemic amebiasis, I.V form prevents anaerobic bacterial infections (for these surgeries: colorectal, abdominal and vaginal) and metronidazole is used with tetracycline and bismuth subsalicylate for H. pylori caused by peptic ulcer disease

•Examples:

-Metronidazole

-Iodoquinol

-Tinidazole

•Metronidazole DAMAGES the DNA and is bactericidal (anaerobes gram NEGATIVE bacteria and Protozoa)

•Side effects:

-G.I symptoms

-CNS symptoms (mild to moderate: headache, vertigo, ataxia; severe: seizures, peripheral neuropathy) ☆

-Darkening of urine (harmless effect)

-Suprainfection with Candida

•Monitor for CNS symptoms; stop metronidazole if patient experiences seizures and neuropathy

•Monitor for and report candida infections (thrust in the mouth and yeast infection in the vagina)

•Give oral metronidazole 1 hour before a meal or 2 hours after a meal for best absorption but if G.I symptoms worsen give with food (try to give it on an empty stomach)

•Do NOT give to patients with active CNS diseases

•Do NOT give to patients with severe blood disorders (a patient with a damaged liver is an example)

Front 20

Chloroquine

Back 20

•Treat: chloroquine sensitive malaria (all form of parasitic causing types) prophylaxis for malaria and SECOND LINE therapy for rheumatoid arthritis and systemic lupus erythematosus (S.L.E)

•Examples:

-Chloroquine

-Primaquine

-Quinine

•Chloroquine works by INHIBITING heme polymerase, this PREVENTS the conversion of toxic heme to non-toxic heme in the protozoa, which leads to ACCUMULATION of toxic heme in the protozoa which eventually kills it

•Side effects:

-G.I symptoms (nausea, diarrhea; high dose)

-Visual symptoms (photophobia, blurred vision; high dose) ☆

•For patients traveling take 500 mg of chloroquine tablets once weekly for 1 to 2 weeks before traveling and continue 4 weeks after leaving the region

•Give chloroquine 4 hours before or after antacids or laxatives for adequate absorption

•REPORT visual changes immediately to the provider to prevent permanent loss of vision

•Do NOT give if allergic to chloroquine

•Do NOT give if patient has a history of taking drugs related to chloroquine that caused visual changes

•Do NOT give to patient with prophyria

Front 21

Antifungals: Drug therapy for fungal infections

Back 21

•Polyene antibiotics (treat superficial and systemic fungal infections, candida or yeast infection and yeast like fungi)

•Azole (treat systemic fungal infections and have fewer adverse/toxic effects than polyene antibiotic)

Front 22

Polyene antibiotic

Back 22

•Topical cream and oral suspension

-Used for candida infections of the skin and mucus membrane

•I.V

-Used for severe fungal infections (amphotericin B)

•Urinary irrigation

-Candida infections of bladder or lower urinary tract

•Examples:

-Amphotericin B

-Nystatin

•INTERRUPT integrity of cell wall of fungi and are fungistatic or fungicidal

•Side effects (these first 6 side effects occur 1 to 2 hours after infusion begins, and subside within 4 hours of infusion)

-Chills (give BENADRYL prior to infusion)

-Fever ☆ (give acetaminophen prior to infusion)

-Tachycardia

-HYPOtension

-Headache

-Nausea

-Thrombophlebitis

-Anemia

-Renal toxicity ☆

•To REDUCE the common 6 side effects give BENADRYL and ACETAMINOPHEN prior to infusion of amphotericin B

•Monitor kidney function (creatinine and BUN)

•Monitor C.B.C (for anemia, low RBCs)

•Monitor vitals signs (especially the blood pressure)

•For nystatin oral suspension to treat thrust candida infection ask the patient to swish before swallowing the suspension)

•Do NOT give to patients allergic to amphotericin B

•Do NOT give to moms lactating

Front 23

Azole

Back 23

•Treats: severe systemic fungal infections (less toxic than amphotericin B), candida infections, tinea (fungal) infections, Coccidioidomycosis (found in desert soil) and histoplasmosis (soil contaminated with bird or bat droppings)

•Examples:

-Ketoconazole

-Itraconazole

-Miconazole

-Clotrimazole

•Azole antifungal meds INTERRUPT cell wall integrity of fungi and are fungistatic and fungicidal

•Side Effects:

-Liver toxicity (check liver function test: ALT and AST) ☆

-G.I symptoms

-Nausea, vomiting, constipation

-Drowsiness

-Temporary decrease in sexual hormone synthesis which causes:

gynecomastia

︎︎decreased libido

low sperm count

menstrual irregularities

•P.O azole requires acid medium for good absorption (coffee, water, tea, juice)

•Avoid taking azole meds with antacids

•Do NOT give azole to meningitis caused by fungi

•Do NOT give azole to patient with onychomycosis (fungal infection of the nail)

•Do NOT give azole to patients with ocular (eye) fungal infections

Front 24

Acyclovir

Back 24

•Treats: herpes simplex and herpes zoster, topical acyclovir is used to treat herpes labialis and herpetic infections in immune-compromised patients

•Examples:

-Acyclovir

-Valacyclovir

-Famciclovir

•INHIBITS replication of D.N.A (inactivates D.N.A polymerase) and it is bacteriostatic (herpes simplex & herpes zoster)

•Side effects:

-Burning & Itching with topical form

-G.I symptoms (P.O)

-Headache

-Vertigo

-Renal toxicity (I.V; check B.U.N & creatinine) ☆

-C.N.S toxicity (RARE and patients with renal problems are more susceptible to this side effect; watch for CNS effects restlessness, tremors, seizures)

-Thrombophlebitis at I.V site; I.V infiltration causes tissue damage (necrosis)

•HYDRATE patient 2 hours AFTER I.V infusion

•Do NOT give to patients allergic to acyclovir or valacyclovir

•Precaution must be taken with patients with

-Renal insufficiency

-Neurologic disorders

-Dehydration