Antibiotics- 38 Flashcards
Antiseptics
Inhibits growth of microorganisms
- applied to living tissue
Disinfectant
Kills microorganism
- used on non living objects
Empiric Therapy
Treatment of infection before specific culture information has been reported or obtained
Definitive Therapy
antibiotic therapy tailored to treat organisms identified with culture
Prophylactic Therapy
treatment with antibiotics to prevent an infection when there is a high possibility of microbial contamination
Therapeutic response
Decreased signs and symptoms of infection
Subtherapeutic response
Signs and symptoms of infection do not imporove
Superinfection
Occurs when antibiotics redue or completely eliminate normal flora (C diff, Vaginal yeast)
Symptoms of anaphylaxis (8)
- Itching
- Flushing
- Hives & Rash
- Wheezing bronchospasms
- Anxiety
- Hypotension
- Swelling of tongue/throat (respiratory arrest)
- Fast, irregular HR, Cardiac Arrest
Do not administer oral antibiotics with.. (5)
Antacids Calcium supplements Iron Products Laxative containing magnesium some antilipemic drugs
When can hypersensitivity occur?
- Up to 30 min after administration
- 1-72 Hours after administration
- > 72 hours after administration
Most common adverse effects
Nausea, Vomiting and Diarrhea
-Absorbed better if taken with at least 6-8 ounces of water
Examples of Sulfonamides
- Bactrim (sulfamethoxazole + trimethoprim)
- Septra (or co trimoxazole)
Sulfonamides mechanism of Action
Bacteriostatic
-Prevents synthesis of folic acid (DNA)
Sulfonamides: Indication
- Effective against both gram + and gram -
- Treatment of UTI
- Upper respiratory tract infections
- Opportunistic infections in patients with HIV (prophylaxis & treatment)
Sulfonamides: Contraindication
- Drug allergy (Sulfa allergy)
- (Chemically related drugs are generally considered safe in patients with an allergy)
- Typically cause a delayed cutaneous reactions–> 1. reactions begin w/ fever 2. Rash (mild to severe)
- *Do not use cyclo-oxygenase- 2 inhibitor celecoxib (celebrex)**
Sulfonamides: Adverse Effects (integumentary,Blood)
Integumentary- photosensitivity (severe sunburn), exfoliative dermatitis, Steven-Johnson Syndrome (SJS), epidermal necrolysis
Blood- Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia
Sulfonamides: Adverse Effects (GI, other)
GI: nausea, vomiting, diarhhea, pancreatitis, hepatotoxicity
Other: Convulsion, crystalluria*, headache, peripheral, neuritis, urticaria, cough
Sulfonamides: Interactions
- Reduces the efficacy of oral contraceptives
- Potentiates the anticoagulation effects of warfarin
- Potentiate the toxic effects of phenytoin
- Potentiate hypoglycemic effects of sulfonylureas in diabetic treatment
Sulfonamides: Implementation
-Take with 2-3 L of fluid/24hr
-Take oral dose with food
-Instruct patients to report:
worsening abdominal cramps/stomach pain
Diarrhea
Blood in the urine
Rash: severe or worsening
SOB
Fever
Penicillin combonations
Unasyn (Ampicillin +subactam)
Augmentin (Amoxicillin +ckavulanic acid)
Timentin (Ticarcillin + clavulanic acid)
Zosyn (Piperacillin +tazobactam)
Penicillin: Mechanism of Action
Interfere with normal cell wall synthesis
-Bacteria cells die from cell lysis (rupture)
Penicillin: Indication
- Prevention and treatment of infections caused by susceptible bacteria
- Most natural Pn have little effect on gram-negative bacteria
- Extended-spectrum penicillin have excellent g+,g- and anaerobic coverage
Penicillin: Contraindications
-Only contraindication is known allergy
Penicillin: Adverse Effects
-Cross reactivity between penicillin and cephalosproin is between 1% and 4%
-commonL N/V/D, taste alteration , Urticaria, pruritus & angioedema
Idiosyncratic:
-Maculopapular eruptions, eosinophilia, SJS, Exfoliative dermititis
Anaphylactic reaction
Penicillin: Interactions
NSAIDS: -increases free and active penicillin -May be beneficial Oral Contraceptives: -decrease efficacy of contraceptive Warfarin: -Enhanced anticoagulation effect
Penicillin: Implementation
-Take oral doses with 6 oz of water (not juices)
If anaphylactic reaction to penicillin:
-stop infusion
-Epinephrine & other emergency drugs used as ordered
-Supportive treatment (O2) at all times
-Procain& Benzathine are thick (21 G needle)
-IM imipenem/cilastatin can be mixed with Plain lidocain (given in large muscle mass)
*Monitor patient taking penicillin for alergic reaction for at least 30 min after administration
Cephalosporins: Mechanism of Action
- Bactericidal action
- Broad Spectrum
- Not active against fungi and viruses
- injectable drugs produce higher serum concentraions
Cephalosporins: Indications (First Generation)
- Good Gram POSITIVE
- Poor Gram NEGATIVE
- Used for prohylaxis and susceptible infections
- parenteral and PO forms
Cephalosporins: Indications (Second Generation)
- Good gram POSITIVE
- Better gram NEGATIVE than 1st generation
- Anaerobic coverage found ONLY in 2nd generation
Cephalosporins: Indications (Third generation)
-Most potent group against gram- negative bacteria
- IV & IM only, long half life, once-a-day dosing
- Easily passes meninges and diffused into CSF
Ceftriaxone (Rocephin)
- Third generation cephalosporin
- IV & IM only, long half life, once-a-day dosing
- Easily passes meninges and diffused into CSF
- treats CNS infections (Meningitis)
- Drug is metabolized in the intestine after biliary excretion
- *do not give to patients with live function
Cephalosporin: Indications (Fourth generation)
-Broader spectrum of antibacterial activity than third generation, especially against g+
Cefepime (Maxipime)
- Fourth generation Cephalosporin
- Injectable form only
- UTI
- uncomplicated skin infections
- Pneumonia
Cephalosporin: Indications (Fifth generation)
- Newest
- Efective agianst wide variety
- MRSA, Community acquired pneumonia
Cephalosporins: Contradictions
- PAtients who have shown hypersensitivity to ceph
- Patient with serious anaphylactic reaction to PCN should NOT be given cephalosporins
Cephalosporins: Adverse Effects
- Simliar to PNC
- Mild diarrhea, cramps, rash, pruritus, redness, edema
Cephalosporins: Interactions
- *ETHANOL**
- Antiacids, iron (decreases absorption)
- Oral contraceptives
Cephalosporins: Assessment:
- Assess for PCN allergy:may have cross alergy
- GI disease (May predisose the patient to colitis)
Cephalosporins: IMplementaion
- Given orally with food to decrease GI upset
- ALCOHOL SHOULD BE AVOIDED
- avoid antacids
Carbapenems
- broadest antibiotic to date
- reserved for complicated body cavity and connective tissue infections
- *May cause drug-induced seizure activity (Risk reduced with proper dosage with impaired patients
- All given parenterally
- Risk of cross allergy with PCN
Carbapenems: Indications
-Used for treatment of bone, joint, skin and soft tissue infections
Carbapenems: Assessment
Assess for PCN allergy
-Presences of seizure disorder
Carbapenems: Implementation
MUST BE INFUSED OF 60 MINUTES
-monitor for seizure activity
Macrolides: MOA
- Prevents protien syntesis
- Bacteriostatic
Macrolides: Indications
- Strep infections
- Mild to moderated URI, LRI
- Spriochetal infections (shyphilis and lyme)
- Gonorrhea, Chlamydia, Mycoplasma
Macrolides: Contradictions
- Drug Allergy
* Alertnative drug for patient with allergies to beta-lactam antibiotics
Macrolides: Adverse Effects
GI effects (Primarily with erythromycin) -Most common V/D
Macrolides: Interactions
- Cyclosporines, digoxin, theophylline, warfarin (Enhanced effects and possible toxicity)
- Oral contraceptive failure
Tetracyclines: MOA
- Inhibits protein sythn
- Bacteriostatic
- strong affinity and ability to bind to calcium and magnesium to form insoluble complexes
Tetracyclines: Indications
- Wide spectrum
- alternative for patients with PCN allergy
Tetracyclines: Contraindications
- Allergy
- Pregnant women, nursing women, children under 8
Tetracyclines: Adverse Effects
- Strong affinity for clalcium
- discoloration of perm teeth
- abnormal tooth enamel in both fetus and children
- possible abnormal fetal skel development
- Photosensitivity, coagulation irregularities, exacerbation of lupus
Tetracyclines: Interactions
- Oral abosroption is decreased by ….
- Potentiates the affects of anticoagulates
- Antagonizes oral contraceptive
Tetracyclines: Implementation
- 6-8 oz of fluid
- no calcium, mg, iron
- avoid milk
- do not eat interacting food 2 hours before or 3 hours after
- photosensitive (sunscreen)
