Anti Infective Drugs I Flashcards
Medication that are used to treat bacterial infection
Antibiotic
Gram negative bacteria are much harder to destroy than gram positive
True
Antibiotic drugs depend on what the causative organism is, the severity of infection, age and host factors
True
Broad spectrum can
eradicate a large number of organisms
Narrow spectrum
kills only a certain type of organism
Bactericidal is preferred in what? What do they do?
preferred in more serious infection
kill the bacteria by targeting the cell membrane
Bacteriostatic
prevents bacteria from replicating targeting DNA/RNA inside the cell
General MOA of Anti Invectives
Interfere with bacterial cell wall synthesis, portion synthesis
Interfere with DNA/RNA replication
Interfere with cellular fx
General Adverse effects of anti infective
N&V, diarrhea Allergic reaction Serum sickness- delayed "allergy" starting a week after Superinfection Immune suppression
what is a superinfection & what has happened
antibiotic reduce/ eliminate normal flora bacteria- without normal flora new infections can emerge such as thrush, yeast infection
Immune suppression is what happens
a primary infection leads to a new infection- common cold or cold sores can develop
Empiric Therapy
Based on experience
Physician prescribes antibiotic based Upton presenting info
Prophylactic Therapy
Prevention of transmission
Administered prior to invasive procedures
For immunocompromised pt
Definitive Therapy
Drug is selected upon C&S results
Combination Therapy
Indicated for infections that can be caused by multiple organisms
Microbes that are difficult to treat
Immunocompromised pt
When does antibiotic resistance occur
when microorganisms defeat the drugs designed to kill them
what are factors that cause Antibiotic resistance
Misuse & overprescribing of antibiotic
Pt failure to adhere to drug- not taking full course
Bacterial mutation
Sharing medications
What are some ways we can eliminate AR
Vaccinations
Not treating Viral infections with antibiotics
Obtain cultures
How to tell if Antibiotic therapy has worked
WBC normalized
Decreased fever
Less pain
Sulfonamides MOA
bacteriostatic- inhibits folic acid responsible for bacterial cellular biosynthese
Sulphonamides are effective against
Gram negative and Gram positive
Indication for Sulphonamide
UTI
Opportunistic infections
Community acquired staph aureus
Example meds of Sulphonamide
Bactrim
Septra
Adverse effects of Sulphonamide
Immune related b/c drug is a antimetabolite Allergic reaction- fever, rash photo sensitivity GI, liver, renal dysfunction Thrombocytopenia- low platelet
Why wouldn’t we give Sulphonamides
Allergy
3rd trimester pregnancy
Cross allergenicity- is used with other sulpha drugs can cause allergic reaction
Other Drug interactions with Sulphonamides
Sulfonylurea- can cause hypoglycaemia
Phenytoin- toxicity
Warfarin- haemorrhage
Reduce efficiency of oral contraceptive
Beta Lactamas
aka penicillinase are what
enzymes secreted by some bacteria
what does beta lactamase enzyme do
the enzyme splits the beta lactic ring of the antibiotic destroying its antibacterial properties - bacterial resistance
ESBL stand for
Extended spectrum beta lactamas
what do we do with positive ESBL pt and why?
Isolate them so the enzyme cannot be transmitted
Beta Lactamase inhibitors are
drugs that inhibit the enzyme, therefore allowing the drug to still work.
What are some examples of Beta Lactamase inhibitors
Clavulanic acid/ Amoxicillin trihydrate
Piperancillin/ Tazobactam
Clavulanic acid and Tazobactam does what to prevent what?
binds with beta lactamase to prevent the enzyme from destroying penicillin
combining these drugs with penicillin reduce the resistance
Penicillin are generally____and well ___ group of medication
safe and tolerated
Those allergic to penicillin are very likely to be allergic to other beta lactams
True
Adverse effect of Penicillin
Allergy- urticaria, pruritus, angioedema, anaphylaxis
Rash
Gi upset
Adverse effect =
unexpected effect
Drug interactions of penicillin
unexpected side effect
NSAIDS
Oral contraceptive
Warfarin
Beta Lactam Antibiotic include
Penicillin, cephalosporins, carbapenems, monobactams
Beta Lactam Antibiotic General MOA
inhibits synthesis of bacterial cell wall- cells will lyse(breakdown)= kill bacteria cella
Beta Lactam Antibiotic
what is responsible for antibacterial activity
Beta Lactamamase ring
Narrow Spectrum- Natural Penicillin includes _______routes
IV
IM
Oral
Why would we use Narrow Spectrum- Natural Penicillin
Gram + bacteria
Gonorrhea and Syphilis
why is narrow spectrum the drug of choice for staph, strep, pneumococci
Drug of choice of streptococci, pneumococci, staphylococci bacteria that do NOT produce penicillinase
Narrow Spectrum- Penicillinase Resistant Drugs
Indication for drug & examples
Gram + cocci bacteria
Effective against bacteria that release penicillinase
Cloxacillin & Oxacillin
Broad spectrum- Aminopenicillians Indication
Ampicillin & Amoxicillin
gram - or + bacteria
skin infection, soft tissue, rest, GU
Prevention of bacterial endocarditis
Extended Spectrum- penicillin
examples?
Piperacillin & piperacilllin
Tazobactum
Extended Spectrum -penicillin
Indications
Gram - bacteria
treat pseudomonas but requires combination of drugs
Carapenems
Imepenum/ Cilastin / Meropenem
What are these
broadest antibacterial action of all groups
These re for complicated infections in acutely ill
Carapenems risk is
they can cause seizures
Cephalosporins have how many generation of meds
5 but only 4 are offered in Canada
What are Fisrt gen Cephalosporins used for
Gram +
Staphylococcal infection
Prevent surgical site infections
Treat upper rest infection
example of Cephalosporins first gen medications
Cephalexin
Cefazolin
What are 2nd gen Cephalosporins used for
Gram + and some Gram - UTI soft tissue Lower resp infection bone and joint infection
example of Cephalosporins 2nd gen medications
Cefoxitin, Cefuroxime
these drugs are effective against drug resistant strains
What are 3rd gen Cephalosporins used for
Potent against gram -
3rd gen Cephalosporin drug used for
Ceftriaxone – able to pass the BBB so used to treat meningitis
Ceftazidime – used for hard to treat infections such as pseudomonas
4th gen Cephalosporin use
ex. Cefepime
Enterobacter gram + and -
Treatment of UTI, skin infection & pneumonia
Maceolides
MOA
Bacteriostatic- prevents portion synthesis within bacterial cells
Maceolides Indication
streptococcus pyrogens
Resp infection
Spirochetal infection- Lyme disease
why are maceolides unique
they are effective against bacterial that reproduces inside of cells
examples of macrolides
Azithromycin
Clarithromycin
Tetracyclines drug ex
doxycycline
Tetracycline MOA
Bacteriostatic- inhibtit portion Synthese
Broad spectrum activity- gram +&-
why would we use a tetracycline
Acne Chlamydia Mycoplasma pneumonia Lyme disease Syphilis
Adverse effects of Tetracycline
Vaginal candidiasis
GI upset
Photosensitivity
What does Tetracycline have a strong affinity to & why could this be a issue in certain pt
Calcium; bone development children and fetal
discolouration of teeth
What are we going to Assess prior to giving antibiotic
Med history Allergies Lab results Immune status Hydration Physical assessment
Antibiotics should be giving _____.
on time
sulphonamides are to be taken with
with food
2-3 L while on therapy
Penicillin is to be taken with
only water-
avoid juices due to acidity
Cephalosporin; we need to watch for ____ and need to take with what?
penicillin allergy and take with food
Macrolides are _____ protein bound and oral meds are absorbed better when?
highly protein bound - will cause interactions with other protein bound drugs - only so may sites
On a empty stomach
Tetracyclines; we need to avoid and why
milk, iron preparations and antacids because of drug binding
Take with 180 ml of water
Teach: all oral antibiotics are best absorbed when taken with ____-_____ml of ____
180-240ml of water
cephalosporins may cause serious reaction when taken with ____
alcohol
most common side effect of antibiotic is
N&V
Diarrhea
Cefazolin or Ancef
admin 1-2 g 30-60 mins prior
drug of choice for surg
Cefazolin common side effects
rash, diarrhea
Cdiff
Antibiotic for heart to treat infections
Aminoglycosides Ouinolones Vancomyocin Clindamycin Metronidazole
Aminoglycosides drugs
gentamicin, tobramycin, neomycin, amikacin, strepomycin
Aminoglycosides MOA
bactericidal- preventing bacterial protein synthesis
Aminoglycosides provide a synergist effect when combined with other antibiotics
true
Why would we give Aminoglycosides
Serious gram - infections (pseudomonas, enterobacter)
some gram positive infections(staph)
clinical use for Aminoglycosides
bacterial endocarditis resistant to other antibiotic
prophylaxis(prevent disease) to GI & GU
Aminoglycosides
toxicity
nephron
ototoxicity- toxic to the ear
what to do before aminoglycoside admin
creatinine clearance
monitor renal fx
therapeutic drug serum levels
Contraindication for Aminoglycosides
Allergy, pregnancy, treat feeding
Adverse effects of Aminoglycosides
headache, fever, vertigo, rash, paresthesia
Drug interactions
Aminoglycosides & vacomiyocin, cyclosporine
Nephron toxicity when used
Aminoglycoside and loop diruetic
increased risk of ototoxicity
Quinolone drugs include
ciprofloxacin, levofloxacin, maxifloxacin
Why would we use Quinolone’s
Active against Gram - and Gram + resp infection UTi prostate Bone/joint infection infection diarrhea Gonorrhea
Adverse effects of Qunolones
CNS, GI, Skin
tendonitis
fever, chills
blurred vision
Quinolones interactions
antacid, Ca, Mg, iron, Zinc
take interacting drug 1hr before or after taking quinolone
Dairy products, Enteral tube feed, and oral anticoags are interacting drugs of Quinolones
true
Clindamycin
misc classification
–
Clindamycin MOA
bactericidal or bacteriostatic
what is bactericidal and bateriostsic
Bactericidal - kill the bacteria (preferred in more serious infections), mostly target the cell membrane
Bacteriostatic -prevent bacteria from replicating, target the DNA and RNA inside the cell
why would we use clindamycin drug
it is active against gram + or - Chronic bone infection UTI Intra ABD infection Anerobic Pneumonia serious skin infection
Adverse effect of Clindamycin
Cdiff
Vancomycin
is a misc class oral forms are poorly absorbed and distributed
Vancomycin MOA
Binds to bacterial cell wall and inhibits cell wall synthesis= cell death
drug of choice for MRSA
Indications of vancomycin
Oral: antibiotic induced colitis -cdiff
Given to prevent SSI(surgical site infection) in those allergic to cefazolin
Adverse effects vancomycin
Ototoxicity Nephrotoxicity HTN with rapid Iv admin Muscle spasm Dyspnea
Nursing Care for vancomycin
monitor serum levels to ensure therapeutic level
Draw immediately before admin of next dose- optimal trough levels 15-20mcg
Metronidazole MOA
Bactericidal
Metronidazole Indication
Active against anaerobic microorganism
protozoal infection
intra ABD infection
