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77 Cards in this Set
- Front
- Back
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What do antimicrobial agents treat?
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Bacterial, viral and fungal infections
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How are antimicrobials classified
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According to the microorganism that they treat
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Empiric therapy -
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Treatment of an infection before specific culture information has been reported
- based on experience |
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Prophylactic therapy
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Treatment to prevent infection before it occurs
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Therapeutic response
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Decrease in specific signs and symptoms of infection
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Subtherapeutic response
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Signs and symptoms do not improve
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Superinfections
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-treatment eliminates immune response and secondary infection incurs
- Yeast infections |
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Antibiotic resistance
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Over prescription, under use
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Host factors to superinfection
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Age
Allergy Kidney and liver function Pregnancy Genetics Site of infection Host defenses |
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Genetic host factors
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- G6PD deficiency: destruction of RBCs with sulfonamides
- Slow acetylation: peripheral neuropathy with isoniazid |
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Antibiotic classes
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Sulfonamides
Penicillins Cephalosporins Tetracyclines Aminoglycosides Quinolones Macrolides |
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4 Antibiotic mechanism of actions
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Interference with cell wall synthesis
Interference with protein synthesis Interference with DNA replication Disrupt critical metabolic reactions inside cell |
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Bactericidal
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Kills bacteria
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Bacteriostatic
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Inhibits growth of susceptible bacteria
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Sulfonamides -
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One of the first antibiotic groups
-often combined with trimethoprim |
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Trimethoprim
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An antibiotic that blocks the action of an enzyme needed for folic acid production
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Sulfonamides: Mechanism of action
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- Bacteriostatic action
-Inhibit B-lactamase which disrupts bacteria reproduction - prevents the synthesis of folic acid - does not affect human cells, which can use preformed folic acid |
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dairy , antacids and iron and anti-biotics
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Decrease absorption
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Sulfonamides indications -
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Treatment of UTIs, PFP, Upper Respiratory infections, Otis Media
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Sulfonamides: Adverse effects - Blood:
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Hemolytic, aplastic anemia, agranulocytosis, thrombocytopenia
-Integumentary – photosensitivity, exfoliative demititis, epidermal necrolysis -GI – nausea, vomiting, diarrhea, pancreatitis |
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Sulfonamides: interactions -
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Warfarin, phenytion, oral hypoglycemics, oral contraceptives
-Avoid in pregnancy and laction - Take with lots of water/food/milk to avoid GI upset |
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Beta Lactam antibiotics
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Penicillins
Cephalosporins Carbapenems Monobactams |
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Natural penicillins
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- introduced in 1940s
-penicillin G Penicillin V potassium |
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Penicillinase-resistant drugs
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Cloxacillin
Dicloxacillin -Nafcillin Oxcillin |
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Aminopenicillins
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- More effect against gram negative bacteria
amoxicillin ampicillin bacamicillin |
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Extended-spectrum drugs
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-Wider spectrum activity
piperacillin ticarcillin carbenicillin |
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Penicillins _ Mechanism of action
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-Inhibit Cell wall synthesis
- Cells die from lysis |
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Penicillins : Indications
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Prevention and treatment of infections caused by susceptible gram positive bacteria
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Penicillins: Adverse effects -
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Allergic reactions
-nausea, vomiting, diarrhea and abd pain |
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Penicillin allergic reactions
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.7% - 4% of pts
-those allergic have a four-six fold increased risk of allerg to other B lactam antibiotics -Cross reactivity between penicillins and cephalosporins (1-18%) |
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Penicillin : Interactions
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NSAID
Oral contraceptives Warfarin : increased anticoagulant effect Probenecid : prolongs effects of PCN Rifampin: inhibits the killing effect of PCM |
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Cephalosporins
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- Four generations
- semisynthetic deriviatives of fungus - interfere with cell wall synthesis - broad spectrum depending upon generation |
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Cephalosporins: adverse effects
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Similar to penecillins
- mild diarrhea, abdominal cramps, rash, pruritis |
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Administration of cephalosporins
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Administer with food even though it delays absorption
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Macrolides
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Erythromycin
Azithromyicim Clindamycin Clarithromycin |
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Macrolides : mechanism of action
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- Prevent protein synthesis
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Macrolides, Bacteriostatic or bactericidal
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Bacteriostatic, althou in high concentrations bactericidal
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Macrolides : Indications
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Strep infections
Mild to moderate URI, or LRI Syphillis and lyme disease Gonorrhea, chlamydia, mycoplasma |
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Macroides : Adverse effects -
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GI effects primarily with erythromycin
- highly protein bound and will cause severe interactions with other protein bound drugs |
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Tetracyclines
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- 3 natural and 2 semisynthetic
- bacteriostatic - inhibit protein synthesis - bind to Ca and Mg and Al to form insoluable compounds |
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Tetracycline contraindications -
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Pregnant lactating women
-Children under age 8 - dairy, antacids and iron salts reduce absorption Avoid sunlight |
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Tetracycline: indications
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Wide spectrum : Gram + & -
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Tetracyclines: adverse effects
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Superinfections (overgrowth of nonsuspectible organisms
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Antibiotic nursing guidelines
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-Pt should be instructed to take exactly as prescribed
- assess for signs of super infection - double check the name of medication monitor for adverse effects and therapeutic effects |
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MIC
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Minimum inhibitory concentration
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PAE
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Post antibiotic effect
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Ototoxicity
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Temporary or permanent hearing loss, balance problems
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Nephrotoxicity
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-varying degrees of renal function
-rising serum creatinine may indicate reduces creatinine clearance -monitor trough levels every three days |
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Aminoglycoside drugs
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Gentamicin
Kanamycin Neomycin Streptomycin Tobramycin Amikacin Netilmicin Paromomycin |
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Aminoglycosides
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-Natural and semi-synthetic
-produced from streptomyces - poor oral absorption; no PO forms -bactericidal - prevent protein synthesis - kill mostly gram negative - primarily given IV -must monitor serum concentration levels -must monitor minimum inhibitory concentration |
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Aminoglycosides: indications -
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Gram negative bacteria
- Often used in combination with other antibiotics for synergistic effects - Certain gram-positive infections that are resistant to other antibiotics -Given perenterally except neomycin used to decontiminate GI tract before surgical procedures |
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minimum inhibitory concentration
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How much drug concentration needed to kill standard amount of bacteria
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Aminoglycosides : toxicity
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Nephrotoxicity
Ototoxicity |
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Aminoglycosides adverse effects
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Headache
Paresthesia (tingling) Fever Superinfections Vertigo Skin rash |
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Fluoroquinolones
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Ciprofloxacin
Norfloxacin Levofloxacin Gatifloxacin Moxifloxacin Gemifloxacin |
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Fluoroquinolones -aka qinolones
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-excellent oral absorption
- absorption reduced by antacids -effective against gram negative and some gram positives - alter bacterial DNA - can be given orally |
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Fluoroquinolones: Mechanism of action
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bactericidal
alters DNA of bacteria does not affect human DNA |
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Fluoroquinolones: Indications
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Lower respiratory tract infections
Bone and joint infections Infectious diarrhea UTI Skin infections Sexually transmitted diseases Anthrax |
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Fluoroquinolones: Adverse effecs CNS:
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Headache dizziness, fatigue, depression, insomnia
GI: nausea, vomiting, diarrhea, constipation, thrush, increased liver function Integumentary: Rash, pruritus (itching), urticaria (hives), flushing, photosensitivity Other: fever, chills, blurred vision, tinnitus |
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Clindamycin (Cleocin)
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Used for chronic bone infections, GU infections, intrabdominal infections
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Dapsone
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Used for lerosy (hansen’s disease, PJP, pneumnia associates with HIV
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Linezolid (Zyvox)
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- New class : oxazolidones
- used to treat vancomycin-resistant enterococcus (VREF, VRE) and hospital acquired skin infections, including those with MRSA - may cause hypotension, seratonin syndrome if taken with SSRIs and reactions if taken with tyramine-containing foods |
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Metronidazole
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- used for anaerobic organisms
- intraabdominal and gynecologic infecions - protozoal infections - several drug interactions |
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Metronidazole:
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-interaction with alcohol: flushing, vomiting, headache
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Metronidazole: Side effects
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Nausea, anorexia, bloating, cramping, dizziness
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Nitrofurantoin
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- Primarily used for UTIs
- Well tolerated if well hydrated - Concentrates in urine, use carefully with renal function impairment |
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Quinupristin and Dalfoprisin (Synercid)
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- 30:70 combination works synergistically
- used for complicated skin conditions and those caused by VRE - may cause arthralgias, myalgias |
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myalgias
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Muscle pain
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Arthralgias
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Joint pain
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Daptomycin
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- New class: Lipopetide
- used to treat complicated skin and soft tissue infections |
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Vanomycin
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- Natural bactericidal antibiotic
- destroys cell wall - treatment of choice for MRSA and other gram + infections - must monitor blood levels to ensure therapeutic levels and avoid toxicity |
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Vanomycin: adverse effects
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May cause ototoxicity and nephrotoxicity
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Vanomycin: administration
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Infused over 60 minutes
Monitor IV site closely Ensure adequate hydration |
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Vanomycin: side effect
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Red man syndrome
- flushing/itching -antihistamines may reduce side effects |
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Symptoms of nephrotoxicity
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Urinary casts, proteinuria, increased BUN and serum creatinine levels
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Assessment
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Allergy
Metabolism (liver function) Excretion (Kidney function) GI upset (particularly diarrhea) |
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Antibiotic Teaching vels)
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- Take complete course to prevent bacterial resistant growth and reinfection
-Take with/without food dependant upon drug -Take at same time everyday (to maintain peak le |
