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176 Cards in this Set
- Front
- Back
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bacterial species that stain purple with gram staining |
gram postitive |
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bacterial species that stain red with gram staining |
gram negative |
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what is the cell wall of a gram positive orgranism made of |
peptidoglycan |
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gram negative or gram positive harder to treat? |
gram negative |
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signs and symptoms of infection |
fever chills sweats redness pain swelling fatigue weight loss increased white blood cell count |
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what is a community acquired infection |
infection acquired by a person that has not recently been hospitalized or had a medical procedure |
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disinfectant |
able to kill organisms only on non living objects
called cidal agents |
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antiseptic |
inhibits the growth of microorganisms but does not necessarily kill them and is applied to living tissue
static agents |
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three general uses of antibiotics |
empiric therapy definitive therapy preventative therapy |
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empiric therapy |
given immed.
antibiotic therapy chosen by the one that can kill the microoganisms most known to cause infection |
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definitive therapy |
antibiotic therapy is tailored to treat an identified specimen from culture |
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prophylactic therapy |
used to prevent therapy |
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how long before incision should prophylactic therapy be given |
30 minutes before incision |
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subtherapeutic |
signs and symtoms do not improve |
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superinfection |
antibiotics eliminate normal flora and other bacteria can take over |
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pseudomembraneous colitis |
antibiotics disrupt the normal cut flora and c difficile takes over |
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food drug interaction between milk and tetracycline |
results in decreased GI absorption of tetracycline |
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what are host factors |
factors that pertain to a specific patient and have a part in the success of failure of antibiotic therapy
ex. age, allergy, kidney and liver function, pregnancy, site of infection ,host defenses |
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what antibiotic effects developing teeth and bones |
tetracyclines |
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what antibiotics effect bone or cartilage development in children |
quinolones |
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what antibiotic can displace bilirubin from albumin and precipitate kernicterus in neonates |
sulfonamides |
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acetylation |
person has make up that cause drugs to be metabolized slowly and can lead to toxicity from accumulation |
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use of sulfasalazine |
treat ulcerative colitis and rheumatoid arthritis |
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mechanism of action of sulfonamides |
bacteriostatic inhibit growth of susceptible bacteria by preventing synthesis of folic acid |
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what are sulfonamides effective against |
gram negative and gram positive broad spectrum |
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cyclooxygenase 2 inhibitor celecoxib or Celebrex should not be used in patients with |
a known sulfonamide allergy |
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sulfites are used for... |
preservatives in wine and food |
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Adverse effects of sulfonamides |
sulfa allergy photosensitivity GI hepatic renal hematologic reactions |
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what interacts with sulfonamides |
hypoglycemic effects in diabetic patients
may potentiate anticoaagulent effects of warfarin and lead to hemmorage
increase likihood of cyclosporine induced nephrotoxicity
reduce efficiency of oral contraceptives |
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sulfamethoxazole/ trimethoprim (co-trimoxazole)
Bactrim |
sulfonamide
fixed combination drug
interferes with the bacterial synthesis of the folic acid
antibiotic |
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beta lactam are so named due to the |
beta lactam ring that is part of their chemical structure |
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beta lactams function by |
inhibiting synthesis of the bacterial peptidoglycan cell wall |
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why are beta lactam inhibitors added to penicillin antibiotics |
make the drug more powerful against beta lactamase producing bacterial strains |
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penicillins are chemically related to what |
mold (fungus) |
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penicillins are_____________ antibiotics and they kill______________________- |
bactericidal antibiotics
kill a wide range of gram positive and gram negative bacteria |
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beta lactamases that specifically inactivate penicillin molecules are |
pencillinases |
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currently available combinations of penicillin and beta lactamase inhibitors (4) |
ampicillin/ sulbactam (Unasyn) amoxicillin/ clavulanic acid ( Augmentin) ticarcillin/ clavilanic acid ( Timentin) piperacillin/ tazobactam ( Zosyn) |
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mechanism of action of penicillins |
inhibition of bacterial wall synthesis
gain entry and then bind to the appropriate binding sites known as penicillin binding proteins |
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what does bacterial death occur with the use of penicillins |
lysis of the bacterial cells due to drug induced disruption of cell wall structure |
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natural penicillins have limited ability to kill what bacteria |
gram negative |
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extended spectrum penicillins have coverage against |
gram positive gram negative anaerobic |
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adverse effects of penicillin |
urticaria pruritus angioedema maculopapular eruptions eosinophilia steven johnsons syndrome exfoliative dermatitis |
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methotrexate reaction with penicillin |
decreased renal elimination of methotrexate
increased methotrexate levels |
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NSAIDS reaction with penicillin |
compete for protein binding
more free and active penicillin |
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interaction of rifambin with penicillin |
inhibition
may inhibit the killing activity of penicillin |
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interaction of warfarin with penicillin |
reduced vitamin k from gut flora
enhanced anticoagulant effect of warfarin |
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benzathine and procaine salts are used as |
long acting IM injections especially helpful for treating the STD syphilis |
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nafcillin |
penicillinase resistant penicillin
others in same class are: cloxacillin, dicloxacillin and oxacillin
able to resist breakdown from penicillinase
large bulky side chain near beta lactam ring
S aureus are resistant |
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amoxicillin |
free amino acid in chemical structure
enhanced activity against gram negative also effective against some gram positive
treat infections of the ears, nose , throat, GI, skin and skin structures |
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ampicillin |
free amino acid in chemical structure
enhanced activity against gram negative and also effective against some gram positive
available in 3 salt forms
anhydrous and trihydrate given orally
ampicillin sodium given parenterally |
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extended spectrum penicillins currently available |
benicillin piperacillin ticarcillin |
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because of the broad spectrum of activity extended spectrum penicillins are commonly used as |
empiric therapy |
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cephalosporins |
semisynthetic antibiotics
bactericidal
work by inhibiting cell wall synthesis
bind to same penicillin binding receptors as penicillins |
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cephalosporins are effective against |
broad spectrum of bacteria dependent on the generation
not effective against fungi or viruses |
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most commonly reported adverse effects of cephalosporins |
mild diarrhea abdominal cramps rash pruritus redness edema |
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first generation cephalosporins |
active against gram positive bacteria
cefadroxil, cefazolin, cephalexin, cephradine |
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cefazolin (Ancef) |
first generation cephalosporin
excellent coverage over gram positive bacteria
commonly used for surgical prophylaxis and for susceptible staphylococcal infections |
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cephalexin ( Keflex) |
first generation cephalosporin
excellent coverage for gram positive bacteria |
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second generation cephalosporins |
coverage against gram negative organisms and enhanced coverage against gram positive organisms
available drugs include: cefaclor, cefoxitin, cefuroxime, cefotetan, cefpreozil, loracarbef |
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cephamycins |
cefoxitin and cefotetan
better coverage against various anaerobic bacteria such as streptococcus spp and clostridium spp |
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cefoxitin ( Mefoxin) |
parental second generation cephalosporin
excellent gram negative coverage and better gram positive coverage
used prophylactically in patients undergoing abdominal surgery because can kill intestinal bacteria including anaerobes |
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cefuroxime (Zinacef) |
parental form of second generation of cephalosporin
does not kill anaerobic bacteria
prodrug
little antibacterial activity until it is hydrolyzed in the liver to its active cefuroxime form |
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third generation cephalosporins |
most potent of first three generations in fighting gram negative bacteria but generally less activity than the first two when fighting gram positive bacteria
drugs include: cefotaxime, cefpodoxime, ceftibuten, cefdinir, ceftizoxime and ceftriaxone |
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ceftriaxone ( Rocephin) |
extremely long acting third generation drug
given once a day
pass easily through the blood brain barrier
indicated for the treatment of meningitis
metabolized in the intestine after biliary excretion
**not given to hyperbilirubinemic neonates or patients with sever liver disfuntion
** should not be given with calcium infusions |
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ceftazidime( Ceptazm Fortazm Tazidime) |
parentally administered third gen. cephalosporin
activity against hard to treat gram negative bacteria like pseudomonas spp
generally given in combination with aminoglycoside |
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cefepime ( Maxipime) |
fourth generation cephalosporin
broad spectrum
increased activity against many gram negative and gram positive organisms
indicated for treatment of UTIs, uncomplicated skin and skin structure infectiosn and pneumonia |
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fifth generation cephalosporins |
Cefaroline (Teflaro)
broader spectrum of activity
only cephalosporin that treats MRSA
indicated for acute skin and skin structure infections and community acquired pneumonia
**needs to be adjusted for decreased renal function |
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carbapenems |
broadest antibacterial action of any antibiotics up to date
bactericidal and inhibit cell wall synthesis
often reserved for body cavity and connective tissue infections
*possible drug induced seizure activity
*do not given to patients with penicillin allergy
**infuse over 60 minutes** |
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imipenem / cilastatin ( Primaxin) |
exerts its antibacterial effect by binding to penicillin binding proteins inside bacteria
inhibits bacterial wall synthesis
most serious adverse effect is seizures
indicated for treatment of bone , joint, skin and soft tissue infections , bacterial endocarditis , intraabdominal bacterial infections , pneumonia , uti's, pelvic infections |
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aztreonam ( Azactam) |
only monobactum antibiotic developed
primarily effective against aerobic gram negative bacteria
inhibits cell wal synthesis
combined with other antibiotics for the treatment of intraabdominal and gynecologic infections
adverse effects of : rash , nausea, vomiting and diarrhea |
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macroglides |
bacteriostatic
available drugs: azithromycin, clarithromycin, erythromycin
adverse effects: nausea, vomiting, GI bleed |
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indications of macroglides |
mild to moderate upper and lower respiratory tract infections
lyme disease
*often used as alternative drugs for patients with allergies to beta lactam antibiotics
interactions caused by being highly protein bound and metabolized in the liver
**drugs that compete for protein binding include carbamazepine, cyclosporine and warfarin |
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erythromycin |
macroglide antibiotic
protein bound
metabolized in the liver
absorption enhanced if taken on empty stomach , but can be taken with meal or snack because of high incidence of stomach irritation |
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azithromycin (Zithromax)
clarithromycin (biaxin) |
macrolide antibiotics
used for the treatment of both upper and lower respiratory tract infections
used for skin infections |
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Telithromycin (Ketek) |
ketolides
derived from erythromycin A
better acid stability and antibacterial coverage than macroglide
** been associated with sever liver damage** |
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tetracyclines |
inhibit bacterial protein synthesis
not for use in peds under 8 because of affinity for calcium resulting in tooth discoloration
not for use in pregnant women |
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tetracycline inhibits the action of _____________ making it useful in the treatment of |
antidiuretic hormone
SIADH |
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interactions of tetracyclines |
antacids, dairy , calcium, enteral feedings, iron preps absorption of tetracyclines are reduced
can cause blood urea nitrogen levels to be increased
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adverse effects of tetracycline |
discoloration of permanent teeth
enamel hypoplasia
retard fetal skeletal development
photosensitivity
alteration of intestinal and vaginal floram reversible bulging fontenels, coagulation irregularities, hemolytic anemia |
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demeclocycline ( Declomycin) |
tetracycline
used for antibacterial action and ability to inhibit action of antidiuretic hormone in SIADH |
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doxycycline ( Doryx) |
semisynthetic tetracycline antibiotic
useful in rickettsial infection like rocky mountain spotted fever, chlamydial infections, prevention and treatment of anthrax and malaria
treatment of acne |
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tigecycline ( Tygacil) |
referred to as glyclycycline
indicated for treatment of skin and skin structure infections caused by susceptible organisms including MRSA
nausea and vomiting most common side effects |
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antibiotics are not to be given at the same time as |
antacids, calcium, iron products, laxatives, magnesium,antilipemic drugs |
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monitoring for hypersensitivity with antibiotics |
immediate reactions may not happen for 30 minutes
accelerated reactions may take 1-72 hours
delayed responses may happen after 72 hours |
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macroglides are not to be given with |
fruit juices |
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sulfonamides should be taken with |
plenty of fluids 2000-3000ml per 24 hours
food to decrease gi adverse effects |
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the following beverages should be avoided with penicillin |
caffeine, citrus fruit, cola, fruit juices and tomato juice |
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with cephalosporins __________ must be avoided |
alcohol |
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with tetracyclines what should be avoided |
tanning beds, sunlight |
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aminoglycosides are |
bactericidal drugs
treatment of virulent infections
once daily
therapeutic trough concentration on or below 1 mcg/ml
trough about 2 is associated with ototoxicity and nephrotoxicity |
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mechanism of action of aminoglycosides |
bind to the ribosomes and prevent the protein synthesis of the bacteria
when in combination with beta lactam the beta lactam is always given first because they break down the cell wall and allow the aminoglycosides to gain access |
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aminoglycosides are not to be given to |
pregnant or lactating women |
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concurrent use of aminoglycosides with loop diuretics increases |
the risk of ototoxicity |
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effect on vitamin k from aminoglycosides |
reduces the amount of vitamin k
can potentiate warfarin toxicity |
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gentamicin |
aminoglycoside
treatment of gram positive and negative bacteria |
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tobramycin |
aminoglyoside
treat recurrent pulmonary infections with patients with cystic fibrosis
for inhalation goes by the name TOBI |
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neomycin |
aminoglyoside
commonly used for bacterial decontamination of the GI tract before surgical procedures
helps reduce the amount of ammonia producing bacteria in the GI tract |
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quinolones |
bacteriacidal broad spectrum
norfloxacin, ciprofloxacin, levofloxacin and moxifloxacin
**must be infused over 1-1.5 hours** |
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mechanism of action for quinolones |
destroy bacterial by altering their dna |
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why are quinolones not recommended in prepubescent children |
affect cartilage development |
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cardiac effect of quinolones |
prolongation of the QT interval |
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box warning for quinolones |
increase risk of tendonitis and tendon rupture |
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concurrent use of these things with quinolones causes reduction in oral absorption |
antacids, calcium, magnesium, iron, zinc |
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ciprofloxacin (cipro) |
drug of choice for treatment of anthrax
quinolone
**same class is levaquin |
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clindamycin (cleocin) |
bactericidal or bacteristatic
inhibits protein synthesis in bacteria
indicated for treatment of chronic bone infections, intrabdominal infections, anaerobic pneumonia, septicemia
some neuromuscular blockade action- vent support as needed
*all enterobacteriaceae are resistant |
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clindamycin is contraindicated |
those with ulcerative colitis or enteritis
infants younger than one month of age
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zolid ( zyvox) - what should be avoided while on this medication |
tyramine containing food can raise blood pressure
SSRI's because of serotonin syndrome |
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metronidazole ( flagyl) |
good activity against anaerobic organisms
* avoid alcohol 24 hours before therapy and 36 after the last dose
phenytoin and phenobarbital may reduce effects of this drug |
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quinupristin and dalfopristin (synercid) should only be infused with what |
5% dextrose in water (d5w) |
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vancomycin |
choice of treatment for MRSA
poorly GI absorbed
use with caution In patients with renal dysfunction and hearing loss
therapeutic range of 5-50
red man syndrome when infused to fast |
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considerations of gentamicin |
intramuscular: give deeply and slowly ventrogluteal
IV give only clear or yellow solutions
difuse with normal saline or d5w |
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clindamycin should be taken with |
8 ounces of water |
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to rapid infusion of clindamycin can cause |
severe hypotension and possible cardiac arrest |
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oral forms of linezolid must be used |
within 21 days of reconstitution |
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quinupristin/ dalfopristin should be mixed by_____, this bag is good for _____ or ______ if refrigerated |
rolling 6 hours 54 hours |
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what is a viral capsid |
protein coat surrounding the genome |
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antiviral drugs are |
chemicals that kill or suppress viruses by either destroying virions or inhibiting their ability to replicate |
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antiretroviral drugs are |
indicated specifically for the treatment of infections caused by HIV |
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HSV 1 is associated with |
oral herpes |
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HSV 2 is associated with |
blisters on genitalia |
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how do antivirals work |
work by blocking the activity of a polymerase enzyme that normally stimulates synthesis of new viral genomes |
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Amantadine is contraindicated |
in lactating women, children under 12 months of age and patients with a eczematous rash |
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cidofovir is contraindicated in patients |
that already have a highly compromised renal function
those receiving therapy with other highly nephrotoxic drugs |
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ribavirin is contraindicated in |
pregnant women and their sexual partners |
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amantadine ( Symmetrel) |
active against influenza A virus
recommendations change yearly |
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acyclovir (zovirax) |
suppress replication of HSV1 HSV2 and VZV
considered drug of choice |
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ganciclovir (Cytovene) |
synthetic nucleoside analogue of guanosine
indicated for infections caused by CMV
dose limiting toxicity is bone marrow suppression |
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oseltamivir (Tamiflu) zanamivir(Relenza) |
active against influenza type A and B
indicated for uncomplicated acute illness caused by influenza in adults
reduce infection by several days
zanamivir only for inhalation
treatment needs to begin within 2 days of onset |
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ribavirin ( Virazole) |
interferes with both DNA and RNA synthesis
primarily used in hospitalized infants for treatment of severe lower respiratory tract infections caused by respiratory syncytial virus |
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HIV 2 primarily in
HIV 1 primarily in |
western africa
rest of the world |
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retroviruses use |
reverse transcriptase in replication |
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chemically seperates the new viral RNA from the viral protein molecules |
protease |
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rate of HIV infection rising rapidely in what populations |
African americans hispanics |
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WHO model of HIV infection
stage1 stage2 stage3 stage4 |
asymptomatic infection
early general symptoms
moderate symtoms
severe symptoms often leading to death |
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persistent generalized lymphadenopathy |
inflammation of the lymph nodes in at least 2 sites outside the inguinal area that lasts for some months |
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prophylactic treatment for opportunistic infections is common when the patients CD4 count falls below |
200 cells/mm3 |
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primary goal of antiretroviral therapy |
viral load below 50 copies/ml |
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what is the most common cause of chronic liver disease in the US |
hepatitis c |
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major adverse effect of protease inhibitors |
lipid abnormalities or redistribution of fat stores under the skin |
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enfuvirtide ( Fuzeon) |
fusion inhibitor
suppresses the fusion process whereby a virion is attached to the outer membrane of a host T cell before entry into the cell
treatment of HIV
reduced viral loads |
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indinavir(Crixivan) |
protease inhibitor
best absorbed in gastric environment
high protein and high fat foods reduces absoption, so recommended to be giving in fasting state
produces increases in CD4 count and decreased viral load
take with 48 ounces of liquids daily
can cause kidney stones |
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maraviroc ( Selzentry) |
CCR5 antagonist
used in treatment experienced patients with evidence of viral replication
phenytoin, carbamazepine, rifampin may decreases effects
hepatotoxicity has been reported with allergic type features |
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raltegravir (Isentress) |
integrase inhibitors
myopathy and rhabdomyolysis have been reported
immune reconstitution syndrome may result in an inflammatory response to residual opportunistic infection |
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tenofovir (Viread) |
NRTI
latic acidodis and sever hepatomegaly have been reported
indicated for use in HIV infection in combination with other antiretroviral drugs |
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zidovudine (retrovir) |
very first anti hiv med
given to pregnant women and newborn babies to prevent transmission
major dose limiting effect of bone marrow suppression |
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amantadine can not be used in who |
children under 12 years |
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intravenous acyclovir is stable for how many hours at room temp |
12 hours |
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given IV ganciclovir is to be mixed with |
5% dextrose or normal saline |
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drugd given with SPAG equipment are usually administered when |
12-18 hours daily for up to 7 days beginning within 3 days of symptom onset |
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antitubercular drugs are used to treat infections from what |
myocobacterium |
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before the results of TB susceptabiity tests are done the patient is started on |
isoniazid rifampin pyrazinamide ethambutol or streptomycin |
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contrainidication of antitubercular drugs |
major renal or liver disfunction |
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relative contrainindication of ethambutol is |
optic neuritis |
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what tb drug can cause falso positive readings on a urine glucose test |
isoniazid |
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ethambutol (myanbutol) |
first line bacteriostatic drug for the treatment of TB
inhibits protein syntheis
contrain. patients with optic and children under 13 |
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isoniazid |
mainstay in the treatment of TB
used as a single drug for prophylaxis or combination
metabolized in the liver through process called acetylation
when taken by slow accelerator drug accumulates
contrain. previous isoniazid hepatic acute liver disease |
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rifabutin |
considered 1st line for TB but more commonly used for infections caused by mavium intracellular complex
can turn urine feces saliva skin sputum sweat and tears a red orange brown color |
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rifampin |
bacterialcidal drug inhibiting protein syntheis
urine saliva tears sweat to be red orange colored |
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streptomycin |
aminoglycoside
first drug to effectively treat TB
most commonly used in combination regimens for MDR-Tb infections |
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drug therapy for TB can last how long |
24 months |
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what can be given for isoniazid induced peripheral neuropathy |
pyridoxine ( vitamin b6) |
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what becomes ineffective when taken with rifampin |
oral contraceptives |
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fungi that cause integumentary infections are known as |
dermatophytes |
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main sterol in fungal membranes |
ergosterol |
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contrainidications of antifungals |
liver failure , kidney failure, porphyria |
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amphotericin B ( fungizone) |
treatment of choice for severe systemic mycoses
almost all patients experience fever, chills, hypotension, tachycardia, malaise, joint pain , anorexia, vomiting, headache
contrain. patients with severe bone marrow suppression and renal impairments
used as a local irrigant |
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nystatin ( mycostatin) |
applied topically for treatment of candida diaper rash
treatment of oral and vaginal canididasis |
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terbinafine (Lamisil) |
treating tinea pedis, tinea cruris and tinea corposis
primarily used for onychomycoses of the fingernails and toenails |
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IV amphotericin |
don't give if cloudy or has precipitates
pump recommended
monitor vitals every 15 minutes |
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oral voriconazole should be given |
one hour before or after meals |
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where does the sexual life cycle of plasmodium take place |
inside the mosquito |
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treatment of malaria is determined by what 2 factors |
infecting plasmodium species
clinical status of patient
drug susceptibility of infecting parasites determined by geographic area infection aquired |
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antimalarial drugs work against the parasite during which cycle |
asexual |
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antimalarial drugs are ineffective during what tissue phase of infection |
exoerythrocytic phase |
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contrain. for antimalarial drugs |
tinnitus pregnancy (quinine) severe renal, hepatic or hematologic dysfunction |
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why is dosing for antimalarials confusing |
tablet strength listed is often the strength of the entire salt form not just the active ingredient which is referred to as the base ingredient |
