anti-infectives Flashcards by Mellow Green

what indicates response to anti-infective therapy?

reduced fever
normal white blood count
improved appetite
absence of symptoms such as cough

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how are anti-infective drugs known as commonly?

antibacterial
antimicrobial
antibiotic
antifungal

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what are the ways anti-infective drugs are classified?

chemical structures

mechanism of action

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actions of anti-infective drugs

affect target organism’s structure, metabolism, or life cycle

goal is to eliminate pathogens.

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what is the difference between bactericidal and bacteriostatic?

bactericidal = kill bacteria
bacteriostatic = slow growth of bacteria

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drug classes for treating bacterial infections

penicillins
cephalosporins
tetracyclines
macrolides
aminoglycosides
fluoroquinolones
sulfonamides
miscelaneous antibacterials

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penacilins

end in icillin….and there are a ton.

the “A”s are all BROAD and are aminopenicillins

the various penacilins are narrow and pencillinase sensitive …the penicillinase resistant narrow sepctrum are cloxacillin and didoxacillin.

extended spectrum are piperalcillins, carbenicillin and ticarcillin

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therapeutic action of penicillin

most effective against gram-positive bacteria

kill bacteria by disrupting cell wall with betalactam ring

beta-lactamase or penicillinase is an enzyme allowing bacteria to be resistant

newer drugs are penicillinase resistant

combination drugs with beta-lactamase inhibitors!

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penicillin G potassium

kills bacteria by disrupting their cell walls

primary use is streptococci, pneumococci, staphylococci, gonorrhea and syphilis treatment

adverse effects include anaphylaxis, diarrhea, nausea, vomitting, pain at injection site, superinfections, drug interactions

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Cephalosporins

all are ceph or cef

there are four generations

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therapeutic action of cephalosporins

similar in structure and function to penicillins

have beta-lactam ring; are bactericidal

widely prescribed anti-infective class

more than 20 cephalosporins are availableg

cross sensitivity with penicillins

classified by generations

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what is the difference between the generations of cephalosporins?

first generation is oldest. bacteria producing beta-lactamase are resistant

second are more portent, broader spectrum, more resistant to beta-lactamase

third are longer in duration of action with an even broader spectrum. they are resistant to beta-lactamase

fourth generation is effective on organisms resistant to earlier generations

third and fourth capable of entering CSF

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cefotaxime

cephalosporin prototype.
3rd generation

inhibits cell wall synthesis

primarily used for broad spectrum activity against gram-negative organisms; for serious infections of the lower respiratory tract, CNS, genitourinary system, bones, blood and joints

adverse effects are hypersensitivity, rash, itching, anaphylaxis, diarrhea, vomitting, nausea, pain at injection site, drug interactions

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Do cephalosporince affect prothrombin

yes, they may

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tetracyclines

demeclocycline
doxycycline
minocycline
tetracycline

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therapeutic action of tetracyclines

some of broadest spectrums of any antibiotic class

large number of resistant bacterial strains

drug of choice for only a few diseases: rocky mountain spotted fever, typhus, cholera, lyme disease, peptic ulcers, chlamydial infections

inhibit bacterial protein synthesis with bacteriostatic effect

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tetracycline

prototype of tetracycline

is broad-spectrum, effective against a broad range of gram positive and negative bacteria

primarily used for chlamydiae, rickettsiae, and mycoplasma

adverse effects are superinfections, nausea, vomitting, epigastric burning, diarrhea, discoloration of teeth, photosensitivity, drug interactions

not for pregnant or lactating women…damages linear skeletal growth of tiny person…not for kids under 8 either

decrease effectiveness of oral contraceptives

don’t take with milk products, iron supps, magnesium containing laxatives or antacids.

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macrolides

azithromycin
clarithromycin
erythromycin

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therapeutic action of macrolides

safe alternatives to penicillin

effective against most gram positve and negative bacteria

inhibit protein synthesis by binding to bacterial ribosome

bacteriostatic at low doses and bacterocidal at high doses

drug of choice for whooping cough and legionnaire’s disease. used for infections caused by mycoplasma pneumoniae, streptococcus, h.influenz, chlamydia

broad spectrum, no superinfections may occur

erythromycin

prototype macrolide anti-infective

acts as spectrum similar to penicillins

effective against gram positive bacteria

preferred drug for whooping cough (bordetella pertussis)
cornebacterium diphtheria

adverse effects are hepatotoxicity, nausea, abdominal cramping, and vomitting

aminoglycosides

gentamicin
neomycin
streptomycin
tobramycin

therapeutic action of aminoglycosides

narrow spectrum

bactericidal, inhibit bacterial protein synthesis

reserved for serious systemic infections caused by aerobic gram negative bacteria (e.coli, serratia, proteus, klebsiella, and pseudomonas)

why are aminoglycosides used under careful monitoring?

they have much more serious side effects than other antiinfectives/antibiotics

can cause ototoxicity(toxic to ear), nephrotoxicity (poisonus to kidney), neuromuscular blockade

gentamicin

aminoglycoside, anti-infective

broad-spectrum, bactericidal

primarily used for serious urinary ,respirator, nervous or GI infections

often used parenterally or in eyedrops and used in combination with antibiotics

adverse effects are ototoxicity and nephrotoxicity

fluoroquinolones

they are anti-infectives first gen: cinoxacin second gen: ciprofloxacin norofloxacinth ofloxacin third gen: levofloxacin fourth gen: gemifloxacin moxifloxacin

therapeutic action of fluoroquinolones

are bactericidal and affect dna synthesis by inhibiting two bacterial enzymes all have activity against gram-negative pathogents newer drug classes have activity against gram-positive microbes

ciprofloxacin

an anti-infective; a fluoroquinolone inhibits bacterial dna gyrase; effects bacterial replication and dna repair primarily used for respiratory infections, bone and joint infections, GI infections, ophthalmic infections, sinusitis, prostatitis adverse effects in GI system, headaches, dizziness, and drug interactions need to monitor white blood count

what may norfloxacin, a fluoroquinolone anti-infective, cause?

photophobia

what can fluoroquinolone, an anti-infective drug class, affect, especially in children?

tendons

Sulfonamides

sulfacetamide sulfamethoxazole sulfsoxazole trimethoprim

therapeutic action of sulfonamides

are bacteriostatic and act by inhibiting folic acid are broad spectrum widspread use leads to resistance use in combination to treat UTIs used to treat pneumocytis carinii and shigella anti-inflammatory properties can help with rheumatoid arthritis and ulcerative colitis

trimethoprim-sulfamethoxazole

a sulfonamide, anti-infective kills bacteria by inhibiting bacterial metabolism of folic acid primarily used to treat UTIs, pneumocytis carinii pneumondia, shigella, and bronchitis adverse effects are skin rashes, nausea, vomiting, agranulocytosis or thrombocytopenia, causes photosensitvity can induce steven-johnson syndrome, a skin abnormality

Vancomycin

is a miscellaneous anti-infective bactericidal, inhibits cell wall synthesis primarily used for and reserved for severe or resistant gram positive infections EFFECTIVE FOR MRSA INFECTIONS! adverse effects are ototoxicity, nephrotoxicity, red man syndrome and anaphylaxis

which anti-infectives inhibit rna synthesis?

rifampin

which anti-infectives inhibit cell wall synthesis

penicillins cephalosporins vancomycin isoniazide

which anti-infectives inhibit dna synthesis

fluoroquinolones

which anti-infectives inhibit metabolites?

sulfonamides

which anti-infectives are protein synthesis inhibitors

``` macrolides aminoglycosides tetracyclines clindamycin chloramphenicol ```

what are super infections?

are secondary infections that occur when too many host flora are killed by an antibiotic host flora prevented growth of pathogenic organisms by out competing it and producing antibacterial substances signs and symptoms include diarrhea, bladder pain, painful urination, abnormal vaginal discharge

Antituberculosis drugs

``` first line: ethambutol isoniazid pyrazinamide ciprofloxacin rifampin rifater streptomycin ``` ``` second line agents amikacin ciprofloxacin kanamycin ofloxacin ```

what is TB caused by?

mycobacterium tuberculosis usually invades the lung, may enter other systems immune response attempts to isolate TB by walling it off and so TB can be dormant for a life time in walled-off areas called tubercles OR can reactivate when immune system is suppressed

how is TB different from other infections?

mycobacteria have a cell wall resistant to penetration by anti-infective drugs at least two and up to four antibiotics are given concurrently the drugs prevent and treat TB

pharmacotherapy of TB

multidrug therapy, 2-4 administered concurrently different combinations during course of therapy. this is required because mycobacterium grows slowly and is commonly resistant

what is chemoprophylaxis and when is it used?

an antituberculosis drug used to prevent TB in high-risk populations (those close to someone with TB, those with AIDS, HIV or receiving immunosuppresent drugs

For whom is antituberculosis therapy contraindicated?

those with AIDS, liver disease, kidney disease used with caution in those with renal failure, pregnant or lactating or a history of convulsive disorders

isoniazid

an antituberculosis drug bactericidal for active organisms, bacteriostatic for dormant mycobacteria drug of choice for TB adverse effects are numbness of hands and feet, rash, fever and rarely hepatotoxicity