Anti-infectives Flashcards
Sulfonamides - Name/Classification/Action
**Bactrim (sulfamethoxazole / trimethoprim) bacteriostatic antibiotics. They inhibit the growth of susceptible bacteria by preventing bacterial synthesis of folic acid.
Sulfonamides - Treatments
UTI, otitis media, chronic bronchitis, Pneumocystitic
Sulfonamides - Contraindications
Sulfa allergy (not same as sulfite allergy) Avoid sunlight Non-pregnant >2monthsage
Sulfonamides - Drug Interactions
Sulfonylurea, antidiabetic medications.
Sulfonamides - Adverse Effects
n/v, diarrhea, agranulocytosis, hepatoxicity, nephrotoxicity, skin (SJS, necrolysis)
Sulfonamides - Patient Education
-Avoid sunlight, Lots of fluids to avoid nephrotoxicity
Penicillins - Names, Classification, Action
Amoxicillin/Ampicillin, Nafcillin, **Pipercillin/Tazobactam (Zosyn)
Penicillins are bactericidal antibiotics, meaning they kill a wide variety of gram-positive and some gram-negative bacteria.
The mechanism of action of penicillins involves the inhibition of bacterial cell wall synthesis.
Penicillins - Treatments
Staphylococcus, enterococcus, streptococcus (hospital acquired infections—pneumonia, intraabdominal, sepsis
Penicillins - Contraindications
Allergy to penicillin! Watch cross-sensitivities to all beta lactams. Watch trade names (Zosyn, augmentin)
Penicillins - Drug Interactions
Oral contraceptives–??decrease efficacy
Penicillins - Adverse Effects
Urticarial, pruritis, angioedema Skin (SJS, etc)
Penicillins - Patient Education
General: rash, diarrhea Avoid taking w/ acid fluids
Cephalosporin 1st Gen - Name/Classification/Action
Cefazolin/Ancef IV; Cephalexin/Keflex PO semisynthetic antibiotics…structurally and pharmacologically related to the penicillins. cephalosporins are bactericidal and work by interfering with bacterial cell wall synthesis.
Cephalosporin 1st Gen - Treatments
Surgical prophylaxis/staph infections
Cephalosporin 2nd Gen - Name/Classification/Action
Cefoxitin/ IV; Cefuroxime/Ceftin PO Cephalosporins can destroy a broad spectrum of bacteria, and this ability is directly related to the chemical changes that have been made to their basic cephalosporin structure.
Cephalosporin 2nd Gen - Treatments
prophylactic abd. surgery
Cephalosporin 3rd Gen - Name/Classification/Action
Ceftriaxone/Rocephin IV/No PO
most potent of the first three gens of cephalosporins in fighting gram-neg bacteria, but generally have less activity than first- and second-gen drugs against gram-pos organisms
Cephalosporin 3rd Gen - Treatments
crosses blood brain barrier, once a day, MOST infections!
Cephalosporin 4th Gen - Name/Classification/Action
Cefepime/Maxipime IV
Cefepime is a broad-spectrum cephalosporin…it has increased activity against many Enterobacter spp. (gram-negative) as well as gram-positive organisms.
Cephalosporin 4th Gen - Treatments
enterobacter, UTIs, skin pnx
Cephalosporin 5th Gen - Name/Classification/Action
Ceftobiprole IV
It has a broader spectrum of activity than the current cephalosporins. It is effective against a wide variety of organisms, including methicillin-resistant S. aureus (MRSA)
Cephalosporin 5th Gen - Treatments
MRSA, pseudomonas
Cephalosporin All Gen - Contraindications
Cross sensitivity w/ penicillins. But not contraindicated.
Cephalosporin All Gen - Drug Interactions
Oral contraceptives = decrease efficacy No alcohol ingestions = accumulate acetaldehyde metabolite No antacids/iron = decrease absorption
Cephalosporin All Gen - Adverse Effects
Same as PCN
Cephalosporin All Gen - Patient Education
General: rash, diarrhea, skin, SJS
Monobactams: Name, Classification, Action
Aztreonam/Azactam It is a synthetic beta-lactam antibiotic that is primarily active against aerobic gram-negative bacteria, including E. coli, Klebsiella spp., and Pseudomonas spp. It destroys bacteria by inhibiting bacterial cell wall synthesis, which results in lysis.
Monobactams: Treatments, Contraindications, Drug Interaction, Adverse Effects, Patient Education
Possible w/ Penicillin Seizures no know drug interactions Rash, n/v, diarrhea, seizures General: diarrhea, rash, superinfection
Carbapenems - Name/Classification/Action
imipenem/cilastatin
imipenem, which is a semisynthetic carbapenem antibiotic similar to beta-lactam antibiotics
cilastatin, an inhibitor of an enzyme that breaks down imipenem.
Imipenem has a wide spectrum of activity against gram-positive and gram-negative aerobic and anaerobic bacteria.Cilastatin is a unique drug in that it inhibits an enzyme in the kidneys called dehydropeptidase, which would otherwise quickly break down the imipenem.
Carbapenems - Treatments, Contraindications, Drug Interaction, Adverse Effects, Patient Education
- Ecoli, UTI, Complicated body cavity/ connective tissue infections
- Possible w/ Penicillin Seizures
- no know drug interactions
- Rash, n/v, diarrhea, seizures
- General: diarrhea, rash, superinfection
Macrolide - Name/Classification/Action
Erythromycin, **azithromycin
Macrolides are considered bacteriostatic; however, in high enough concentrations they may be bactericidal to some susceptible bacteria.
Macrolide antibiotics are bacteriostatic drugs that inhibit protein synthesis by binding reversibly to the 50S ribosomal subunits of susceptible microorganisms.
Macrolide - Treatments, Contraindications, Drug Interaction, Adverse Effects, Patient Education
- Upper/lower resp tract, Skin, soft tissue + bacteria that reproduce in host cell.
- Known drug allergy. Used for pts w/ pcn/beta-lactam allergies
- Oral contraceptives, Compete w/ other drugs for hepatic metabolism
- GI tract; Rash; hepatoxicity; Tinnitus; SJS, necrolysis
- May be 1, 3 or 5 day intense pack. Take as directed. Take w/o no food
Tetracyclines - Name, Classification, Action
- doxycycline
- bacteriostatic drugs
- inhibit bacterial protein synthesis by binding to the 30S bacterial ribosome.
Tetracyclines - Treatments, Contraindications, Drug Interaction, Adverse Effects, Patient Education
- Spirochetal bacteria- syphilis, lyme disease, PID, Chlamydia, gonorrhea
- Strong affinity for Ca—avoid in pregnant, nursing, <8 tooth discoloration
- Oral contraceptives. Reduced oral absorption w/ any calcium/oral products; Oral anticoagulants
- Photosensitivity, alteration in intestinal/vaginal flora, coagulation irregularities
- Avoid sun; Do not take w/ Ca
Aminoglycosides - Name, Classification, Action
- **Gentamicin, Tobramycin, Neomycin (PO)
- a group of natural and semisynthetic antibiotics that are classified as bactericidal drugs
- they bind to ribosomes, specifically the 30S ribosome, and thereby prevent protein synthesis in bacteria
Aminoglycosides - Treatments, Contraindications, Drug Interaction, Adverse Effects, Patient Education
- Neomycin—decontaminate GI prior to surgery; E coli
- Pregnancy C/D class; breast milk
- Risk for nephrotoxicity can be ↑ with concurrent use of other nephrotoxic drugs
- Nephrotoxicity;Ototoxicity—permanent hear loss. Check blood levels
- Oral give w/ fluids. Report hearing changes, tinnitus
Quinolone/Fluoroquinolone - Name/Classification/Action
- **Ciprofloxacin, Levofloxacin, Moxifloxacin
- very potent bactericidal broad-spectrum antibiotics
- destroy bacteria by altering their deoxyribonucleic acid (DNA) (see Figure 38-3). They accomplish this by interfering with the bacterial enzymes DNA gyrase and topo-isomerase IV.
QuinoloneFluoroquinolone - Treatments, Contraindications, Drug Interaction, Adverse Effects, Patient Education
- Ciprofloxacin–anthrax Urinary tract infections, procedures, STDs
- Avoid pregnant women/children. Avoid oral w/ anatacids, iron, zinc, Carafate 1 hour. True drug allergy rare
- Prolonged QT w/ amiodarone/Disopyramide, theophylline
- seizures
- Avoid sun,General, diarrhea
Miscellaneous - Clindamycin:
- Name
- Class
- Action
- Tx
- Contraindication
- Pt Ed.
- Cleocin
- a semisynthetic antibiotic
- It inhibits protein synthesis in bacteria
- Anaerobic properties
- Avoid <1 mo, ulcerative colitis
- Diarrhea: pseudomembraneous colitis
Miscellaneous - Linezolid:
- Name
- Class
- Action
- Tx
- Contraindication
- Drug Interaction
- Adverse Effects
- Pt Ed.
- Zyvox
- New class of antibiotics known as oxazolidinones
- works by inhibiting bacterial protein synthesis
- VRE, hospital acquired pneumonia, MRSA
- Uncontrolled HTN
- SSRI’s, TCA’s MAO
- n/v diarrhea, headache, ↓ platelet count
Miscellaneous - Metronidazole:
- Name
- Class
- Action
- Tx
- Contraindication
- Drug Interaction
- Adverse Effects
- Pt Ed.
- Flagyl
- an antimicrobial drug of the class nitroimidazole
- It works by interfering with microbial DNA synthesis, and in this regard is similar to the quinolines
- Anaerobic—abdominal cavity, GU; antibiotic colitis
- Dizziness, headache, neutropenia, thrombocytopenia
- NO ETOH. Check meds!
- seizures
- No alcohol, nor alcohol meds
Miscellaneous - Nitrofurantoin:
- Name
- Class
- Action
- Tx
- Contraindication
- Drug Interaction
- Adverse Effects
- Pt Ed.
- Macrodantin
- an antibiotic drug of the class nitrofuran
- It works by interfering with the activity of enzymes that regulate bacterial carbohydrate metabolism and also by disrupting bacterial cell wall formation
- UTI caused by Ecoli, Staph, Klebsiella
- contraindicated in cases of known drug allergy and also in cases of significant renal function impairment
- Oral only!
- GI discomfort, dizziness, headache, skin reactions
- GI upset—give w/ food
Miscellaneous - Vancomycin:
- Name
- Class
- Action
- Tx
- Contraindication
- Drug Interaction
- Adverse Effects
- Vancomycin
- a natural bactericidal antibiotic that is structurally unrelated to any other commercially available antibiotics.
- It destroys bacteria by binding to the bacterial cell wall, producing immediate inhibition of cell wall synthesis and death
- Severe staph, MRSA, Oral for clostridium difficile
- Peak/trough levels,Nephrotoxicity
- nephrotoxicity exp. w/ other nephro meds
- red man syndrome!Ototoxcitity
Adrenergic/Therapeutic Classes: name and ID effected recptor
- Bronchodilators
- Stimulate β-adrenergic receptors
- Ophthalmic—vasoconstriction
- α adrenergic located in small arterioles in the eye
- Nasal decongestants—vasoconstriction
- both α and β-adrenergic
- Vasoactive-
- selective & vasoconstrictive
Bronchodilators (2)
Albuterol (Proventil)
β2 adrenergic
Acts on airway smooth muscle
USE: Bronchospasm 2 to COPD, asthma,
ROUTE: MDI, inh
Salmeterol (Serevent)
β2 adrenergic
Acts on airway smooth muscle
USE: prevent bronchospasm, COPD, asthma, exercise-induced
Name the following:
NASAL DECONGESTANTS
OPTHALMIC
NASAL
Pseudophedrine (sudafed/afrin) OTC
Both α and β-adrenergic
Uses: nasal decongestant
oral/nasal spray
OPTHALMIC
Tetrahydrozoline (murine/visine) OTC
relieves itching and minor irritation caused by eye congestion (redness)
Vasoactive adrenergics:
Epinephrine
Epinephrine
- α & β adrenergic properties
- Directly acts on tissues innervated by SNS
- dose related physiologic response
- low dose β1 for heart rate & force of contraction
- moderate dose for brochodilation of the lungs
- high dose/IV drip vasoconstriction for severe hypotension
- Use–Anaphylactic reaction, Severe hypotension, Cardiac arrest
Name CardioSelective Beta blockers (two)
- Use?
- Adverse Effects?
- Side Effects?
Atenolol (Tenormin) and Metropolol (Lopressor) PO, IV
- hypertension, MI
- Atrioventricular block, bradycardia, heart failure, peripheral vascular insufficiency
- Impotence, rash, alopecia, bronchospasms, dry mouth
Vasoactive adrenergics:
Dobutamine
β1 receptors on heart muscle, + (positive) inotropy = increase contractility of heart
Vasoactive adrenergics:
Dopamine
- natural occurring catecholamine neurotransmitter in the SNS, potent α1 and β1-adrenergic receptor activity
- low dose—(dopaminergic receptor) dilate blood vessels in brain, kidneys, heart,
- high dose—acts on β1-adrenergic treats low BP, thus increase contractility and cardiac output
Vasoactive adrenergics:
Midodrine
α1 adrenergic stimulation of both arterioles & veins
leads to peripheral vasoconstriction
USE: symptomatic/refractory orthostatic hypotension
ROUTE: oralContraindications: supine hypertension, urinary urge /frequency
Adrenergic blockers:
α-blockers effect
vasodilation, BP, miosis or constriction of pupil, suppressed ejaculation
Adrenergic blockers:
β-blockers
Cardioselective –β1 (receptors primary in heart) only
Nonselective β1 and β2 Blockers—bronchioles and blood vessels.
Alpha adrenergic blocker:
Tamsulosin/Flomax
α blocker
relaxing and dilating the vasculature and smooth muscle near prostate,
USE: BPH
Side effect: dizziness, headache
**first dose orthostatic hypotension
Cardioselective β-Blockers:
what are efx on heart?
All medications have a profound effect on conduction system of the heart
conduction in the SA node and through the AV node is slowed down, decreasing heart rate.
Unique attributes of some drugs:
treatment of angina—decreases myocardial energy and oxygen consumption of heart.
cardioprotective—inhibit stimulation of the mycoardium by circulating catecholamines (after MI or heart attack)
Topical great glaucoma
treating hypertension by reducing heart rate, force of myocardial contraction,
Nonselective Beta Blockers:
name 3
_Propranolol (Inderal)-_lipophilicity (attraction to lipid or fat) thus can gain entry into CNS, treat migraine Carvedilol/Coreg-alpha & beta1 & beta2 blocker,USE: primarily used for heart failure, angina, hypertension, Oral only
_Labetalol _ (blocks both α and β adrenergic. treats severe hypertension/hypertensive emergencies. BP 250/130!!
Name 2 Cholinergic Direct-Acting Drugs
Pilocarpine-Action: increase salivary gland secretion, miosis
Bethanechol (Urocholine)-Action: smooth muscle of the bladder, to increase tone, motility, and relax sphincter.
Indirect Acting Cholinergic Drug
Donepezil (Aricept)
Action: works centrally in brain to inhibit break down of ACH (anticholinsterase)
USE: Alzheimers
Some Adverse Effects of Cholinergic Drugs
Contraindications: concurrent use of cholinergic drugs concurrent use of anticholinergic blockers.
Medical conditions: GI or GU obstruction, bradycardia, hyperthyroidism, epilepsy, hypotension, COPD, Parkinson’s disease
Caused by “overstimulation” of the PSNS; Bradycardia, ConvulsionsAbdominal cramps, increased secretions, nausea, vomiting. Increased bronchial secretions, bronchospasms. Lacrimation, sweating, salivation, loss of ocular accommodation, miosis
S/S of Toxicity in Cholinergic Medications
Seen with longer-acting given repeatedly over long period.
Overstimulation of PSNS
Looks like SLUDGE:
salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, & emesis.
Treatment:
Atropine - anticholinergic
Cholinergic Blocking Drugs
- anticholinergics, parasympatholytic, antimuscarinic
- blocks the action of the ACh at the muscarinic receptors in the PSNS
- Allows the SNS (adrenergic) to dominate.
- oldest drugs, naturally occurring, belladonna alkaloid from plants.
Anticholinergics: Name 5
Atropine
Dicyclomine (Bentyl)
Scopolamine
Tolterodine (Detrol)
Benztropine (Cogentin)
Anticholinergics: Atropine
USE:
unstable bradycardia
Preoperative—reduce saliva & GI secretions
ophthalmic: dilates pupils for exams
Anticholinergics:
Scopolamine
USE: prevention of motion sickness
Anticholinergics:
Tolterodine (Detrol)
USE: bladder (detrusor) overactivity
Anticholinergics: Benztropine (Cogentin)
muscle rigidity 2 to Parkinson’s disease
medications with side effect of Extrapyramidal reactions (EPS) (Haldol
