Antibacterial/Anti-Infective Agents Flashcards
actions of antibiotics (5)
- inhibition of cell wall synthesis
- alteration in membrane permeability
- inhibition of protein synthesis
- inhibition of RNA & DNA synthesis
- interference with cellular metabolism
examples of superinfection (2)
leukoplakia, candidiasis
what do you need to calculate before administering antibiotics?
GFR - normal should be 85-135 mL/min
what is the formula used to estimate GFR?
Cockcroft and Gault Formula: (140 – age) x weight in kg / 72 x serum creatinine
- multiply product by 0.85 for females
antibiotics that inhibit cell wall synthesis (3)
- penicillins
- cephalosporins
- glycopeptides
antibiotics that inhibit protein synthesis (4)
- macrolides
- tetracyclines
- aminoglycosides
- lipopeptides
antibiotics that inhibit DNA synthesis (2)
- fluoroquinolones
- lipopeptides
antibiotics that inhibit cell metabolism (1)
sulfonamides
examples of uricosuric drugs (2)
- Probenecid
- Sulfinpyrazone
uricosuric drugs action
decreases excretion of penicillin → increases serum penicillin levels → increases effectiveness
basic penicillin use
- narrow spectrum
- introduced to kill staphylococcus
broad-spectrum penicillins use
may treat both gram-positive and gram-negative bacteria - E. coli, Salmonella spp., Haemophilus influenzae
penicillinase-resistant penicillins use
treats penicillinase-producing S. aureus (enzyme that prevents antibiotic from going into cell)
extended-spectrum penicillins use
- against gram-negative organisms - Pseudomonas aeruginosa, Proteus spp., Klebsiella pneumoniae
- treat bone, joint, skin, soft tissue, respiratory tract, urinary tract infections
extended-spectrum penicillin example
Piperacillin (Pipracil)
beta-lactamase inhibitors use
given in combination with penicillinase-sensitive/broad-spectrum penicillin
beta-lactamase inhibitors action
inhibits bacterial beta-lactamase enzyme
beta-lactamase inhibitor example
clavulanic acid in Amoxicillin-Clavulanate (Augmentin)
broad-spectrum penicillin example
Amoxicillin-Clavulanate (Augmentin)
penicillin side effects (2)
- allergic reactions/hypersensitivity in 5-10% of people - rash, reaction leading to anaphylaxis
- N/V, diarrhea
treatment for penicillin allergic reaction/hypersensitivity
- stop medication
- for mild reaction: Diphenhydramine (Benadryl)
- for anaphylaxis: manage airway, administer epinephrine/corticosteroids, give saline/plasma expanders
penicillin contraindications
- history of hypersensitivity to penicillins
- avoid with severe renal insufficiency
food may _____ absorption of many oral penicillins
decrease
penicillins action
- interferes with cell wall synthesis
- bactericidal
cephalosporins action
- inhibit bacterial cell-wall synthesis
- bactericidal
penicillins and cephalosporins have a _______ structure
beta-lactam ring structure
first generation cephalosporins use
effective against gram-positive bacteria
first generation cephalosporin example
Cefazolin (Ancef)
fourth generation cephalosporins use
- more extended gram-negative activity including Pseudomonas
- broader gram-positive activity
fourth generation cephalosporins example
Cefepime (Maxipime)
cephalosporins general use
treats respiratory, urinary tract, skin, bone, joint, and genital infections
cephalosporins side effects (4)
- hypersensitivity
- N/V, diarrhea
- alterations in blood clotting, neutropenia, hemolytic anemia
- nephrotoxicity
cephalosporins + alcohol interaction
causes flushing, dizziness, headache, nausea/vomiting
macrolides action
- inhibits protein synthesis
- bacteriostatic, bactericidal in large doses
macrolides examples (3)
- Azithromycin (Zithromax)
- Clarithromycin (Biaxin)
- Erythromycin (E-Mycin)
macrolides uses (4)
- active against most gram-positive bacteria and some gram-negative bacteria
- treat moderate to severe infections of respiratory, GI tract, skin and soft tissue
- Mycoplasma pneumoniae
- Legionnaires’ disease
macrolides side effects
- GI distress
- tinnitus, ototoxicity
- superinfection
- hepatotoxicity
macrolides ______ serum levels of Carbamezapine (Tegretol), Theophyline, Warfarin (Coumadin)
increase
erythromycin + Fluconazole (Diflucan), Ketoconazole (Nizoral) interaction
increases erythromycin levels
azithromycin + antacids interaction
azithromycin levels may be reduced
glycopeptides action
inhibits bacterial cell wall synthesis
glycopeptide example
Vancomycin (Vancocin)
glycopeptides general use
primarily active against gram positive bacteria
IV glycopeptides use
treat drug resistant staph. infections
oral glycopeptides use
treat staph. enterocolitis and antibiotic-associated pseudomembranous colitis due to C. difficile
IV vancomycin adverse reactions (5)
- red neck/red man syndrome
- nephrotoxicity
- ototoxicity
- blood dysrasias
- Stevens-Johnson syndrome
red neck/red man syndrome prevention
dilute vancomycin (500 mg in 100 mL, 1000 mg in 250 mL) and infuse slowly (over 60-120 minutes)
tetracyclines action
- inhibits bacterial protein synthesis
- bacteriostatic
tetracyclines uses (4)
- first broad-spectrum antibiotic effective against gram positive and negative bacteria + many other organisms
- Mycoplasma pneumoniae
- treat H. Pylori in combination with metronidazole and bismuth subsalicylate
- oral and topical used for severe acne vulgaris
tetracyclines side effects (6)
- very irritating to gastric mucosa: nausea/vomiting, diarrhea, flatulence, epigastric distress, abdominal discomfort, heartburn
- rash, pruritus
- photosensitivity
- headache
- teratogenic
- teeth discoloration (esp. if younger than 8 y/o)
do not give tetracycline with _____ or _____
dairy products or antacids
aminoglycosides action
- inhibits bacterial protein synthesis
- bactericidal
aminoglycoside example
Gentamicin (Garamycin)
aminoglycosides use
- narrow spectrum
- for “serious” infections
aminoglycosides side effects (8)
- rash
- numbness
- tremors
- muscle cramps or weakness
- visual disturbances
- photosensitivity
- skin sensitivity
- tinnitus
aminoglycosides adverse reactions (9)
- oliguria
- urticaria
- palpitations
- superinfection
- ototoxicity
- nephrotoxicity
- thrombocytopenia, agranulocytosis
- neuromuscular blockade
- liver damage
aminoglycosides + loop diuretics interaction
increases risk for ototoxicity
aminoglycosides + amphotericin B, polymyxin, cisplatin, furosemide, vancomycin interaction
increased risk for nephrotoxicity
fluoroquinolones action
- interrupts DNA synthesis
- bactericidal
fluoroquinolone example
Levofloxacin (Levaquin)
fluoroquinolones use
- broad-spectrum
- UTI, bone and joint infections, bronchitis, pneumonia, gonorrhea
fluoroquinolones side effects (7)
- nausea/vomiting, diarrhea, abdominal pain/cramps, flatulence
- headache, dizziness
- fatigue, restlessness, insomnia
- rash
- flushing
- photosensitivity
- tinnitus
fluoroquinolones adverse reactions (5)
- Stevens-Johnson syndrome
- encephalopathy
- seizures
- Pseudomemrabous colitis - C. Diff, inflammation of bowel wall
- dysrhythmia
fluoroquinolones + oral hypoglycemics and theophylline interaction
increased effects of fluoroquinolones
fluoroquinolones + antacids and iron interaction
decreased absorption of fluoroquinolones
lipopeptides action
- inhibits protein, DNA, and RNA synthesis
- bactericidal
lipopeptide example
Daptomycin (Cubicin)
lipopeptides uses
- complicated skin infections
- septicemia due to staph. A infections
- infective endocarditis due to MRSA
daptomycin side effects (7)
- hypo/hypertension
- anemia
- numbness
- tingling
- dizziness
- insomnia
- pain/burning in urination
daptomycin adverse reactions (4)
- elevated creatine kinase (rhabdomyolysis) especially when given with statins
- unexplained mypopathy, neuropathy
- hypo/hyperkalemia, hyperglycemia
- pleural effusion
daptomycin + tobramycin interaction
risk for toxicity
daptomycin + Coumadin interaction
increased bleeding
sulfonamides action
- inhibits cell metabolism - interferes with formation of folic acid in bacterial cells which is essential for bacterial growth
- bacteriostatic
sulfonamides uses
gram-negative infections, UTI, prostatitis, respiratory infections, burn wounds (topical), meningococcal meningitis, newborn eye prophylaxis, chlamydia, toxoplasmosis
antiviral drugs action
interfere with viral nucleic acid synthesis in cell
antiviral drugs uses (4)
herpes simplex virus, influenza, viral hepatitis, CMV
antiviral example
Acyclovir Sodium (Zovirax)
acyclovir side effects (5)
- nausea/vomiting, diarrhea
- headache, lethargy, tremors
- rash, pruritus
- increased bleeding time
- phlebitis at IV site
acyclovir adverse reactions (6)
- urticaria
- anemia
- nephrotoxicity
- bone marrow depression
- thrombocytopenia, leukopenia, granulocytopenia
- acute renal failure
acyclovir contraindications (2)
- hypersensitivity
- caution with several renal or hepatic disease
metronidazole action
interferes with DNA function of bacteria
metronidazole use
treats anaerobic infections
metronidazole side effects (7)
dizziness, headache, confusion, depression, irritability, weakness, insomnia
