Mod Iv Pharm- Anti Infectives

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Gram positive bacterial walls are composed of

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monolayer of peptidoglycans

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Gram neg bacterial walls are composed

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multiple layers including an outer layer of lipopolysaccharide membrane.

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empiric

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antibiotics are often started before the results of that lab test are available.

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Antibacterial classification
Broad vs Narrow Spectrum

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Broad: effective against a wide range of bacteria in comparison to the narrow spectrum.

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Beta lactams (name 5)

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Penicillins, cephalosporins, monobactams, carbacephems, and penems

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Beta lactams

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Inhibit cell wall synthesis.

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penicillinase

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Bacteria have the ability to develop resistance by producing enzymes

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Quinolones

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Bactericidal
blocks the enzyme responsible for DNA growth.

hazards: no antacids, increase thorphylline toxicity, phototoxic

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ciprofloxacin (Cipro) levofloxacin (Levoquin)

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Quinolones

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Aminoglycoside

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used in serious infections
gram -
w/ ampicillin for gram +
bactericidal
aerosol route because of toxicity
Ototoxic, nephrotoxic

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Amikacin (Amikin)
gentamicin (Garamycin)tobramycin (Nebcin)

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Aminoglycoside

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Vancomycin

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bactericidal
used life threating infections
gram + cocci
used for MRSA
S.E.: nypotension, nephrotoxicity, ototoxicity.

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alternative drug for vancomycin?

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Teicoplanin (Targocid)

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Protein synthesis Inhibitors

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used for pulmonary infection

Erythromycin decreases theophylline metabolism so monitor theophylline levels.

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Erythromycin (E-mycin), clarithromycin (Biaxin), azithromycin (Zithromax)

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Protein synthesis Inhibitors

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Tetracyclines

(it kills it all!!!)

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broad spectrum
gram + and -
aerobes, anaerobes,mycoplasms,mycobacteria, chlamydia,spirochetes

hazards:antacids, iron, or dairy products, decrease absorption.

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Folate inhibitors

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sulfoamides used for easy UTI's

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Bactrim, Septra, Gantanol, Gantrisin.

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Folate inhibitors

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Antitubercular Agents 1st line

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1st line primary are bactericidal

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Antitubercular Agents

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2nd line secondary which are bacteriostatic and only used in combination with 1st line drugs when others have become resistant.

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Isoniazid, rifampin, pyrazinamide, ethambutol.

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1st line Antitubercular Agents

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streptomycin, cycloserine, ethionamide.

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2nd line Antitubercular Agents

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Factors affecting drug therapy in kids.

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Size: body weight, there is a direct relationship between body weight and mass of drug.

Age: neonates and children are not simply little adults.

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age definitions

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Definitions:
Premie: < 36 weeks.
Neonate: 1st month of postnatal life.
Infant: 1 – 12 months.
Child: 1 – 12 years.
Adolescent: 12 – 18 years.
Adult: > 18 years.

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Factors to consider when adminster rx to little ones

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Infants can not take pills

Parenteral dosages must be closely watched.

more Total body water in kids will effect the distribution of water soluble drugs.
Liver enzymes have not matured in the neonate & infant.
Renal clearance mechanisms have also not fully developed in the infant.

pharmocokinetic:Some drug effects are opposite of what they become in adults.

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gram negative bacteria (7)

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pseudomonas
bacteroides
campylobacter
haemophilus
klebsiella
legionella
mycoplasma

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gram positive (4)

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clostridia
listeria
streptococci
staphylococci

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gram + cocci normal flora sputum samples

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a-hemolytic streptococci
pneumococci
staphylococcus epidermidis

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gram - bacilli normal flora sputm samples

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haemophilus influenzae

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gram - cocci

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neisseria catarrhais

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bactericidal anti infectives (3)

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penicillins
cephalosporins
vancomycins

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bacteriostatic anti infectives (2)

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erythromycin
tetracyclines

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broad spectrum anti infectives (3)

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tetracyclines
ampicillin
cephalosporins

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narrow spectrum anti infectives (3)

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penicillin
erythromycin
vancomycin

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how does beta lactamase work??

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destroys beta lactam ring rendering the drug inactive

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cehalosporins

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same moa as penicillin
but resistant to beta lactamase and have a longer half life

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what does ribavirin treat?

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respiratory syncytial virus

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ribavirin adminstered how??

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SPAG II
12-18HRS A DAY FOR 3-7 DAYS
TERATOGENICTY

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ACYCLOVIR (ZOVIRAX)
FAMCICLOVIR (FAMVIR)

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ANTIVIRAL

TREATS HERPES

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ZANAMIVIR (RELENZA)
OSELTAMIVIR (TAMIFLU)
AMANTADINE (SYMMETREL)
RIMANTIDINE (FLUMADINE)

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ANTIVIRAL

TREATS INFLUENZA

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RIBAVIRIN (VIRAZOLE)

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ANTIVIRAL

TREATS REPIRATORY SYNCYTIAL VIRUS

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NYSTATIN (MYCOSTATIN)

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ANTI FUNGALS

LOCAL SKIN CANDIDIASIS ORAL THRUSH

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AMPHOTERICIN B (FUNGIZONE)
FLUCONAZOLE (DIFLUCAN)

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ANTI FUNGALS

HIGHLY TOXIC NEEDS MONITORING

IV SYSTEMIC ORAL THRUSH