Antibiotics, Antifungals, and Vaccines Flashcards
How do antibacterials kills bacteria?
Inhibit cell wall synthesis, alteration of membrane permeability, inhibition of protein synthesis, inhibition of synthesis of RNA/DNA, interference with metabolism within the cell.
Factors that aid in fighting infection.
age, immune system, nutrition, immunoglobulins, circulation
Organs involved in immune response
tonsils, bone marrow, spleen, lymph nodes
Superinfection
c. difficile, thrush, vaginal yeast infection, secondary fungal infection, on mouth, skin, respiratory tract, genitourinary tract, intestines
Organ toxicity with antibiotics
ear, liver, kidney
IGG
immunity
IGM
active disease
Active immunity
weakened (vaccine) antigen enters body triggering production of antibodies, develops slowly, long-lasting. Natural or acquired - develop a disease and develop an immunity to it.
Passive immunity
Receives antibodies from another source, lasts a few weeks to a few months. Happens quickly and goes quickly. Natural passive - breastfeeding - IGa antibodies are passed from the mother to the baby through the placenta and breastmilk. They last a few months and then go away.
Active passive immunity
Hepatitis A exposure - can be given an immunoglobulin which is short. Snake anti-venom as well.
Acquired immunity
Develop a disease and develop an immunity to it.
Community immunity
most of the community is immunized
Broad spectrum (Tetracycline, 3rd and 5th generation cephalosporins)
treats secondary infections, can cause organ toxicity - damage to liver, kidney, and ears.
Penicillins
Beta lactam ring structure, inhibit bacterial cell wall synthesis. Bacteriostatic and bactericidal depending upon drug and dosage. Low-moderate dose beta lactamases break down the structure of penicillin. Penicillinases or beta-lactamases attack penicillin enzymes.
Narrow spectrum Penicillin
G & V - often given with Procaine to decrease pain related to the injection - Penicillin G is bactericidal
Broad spectrum Penicillin
Amoxicillin - inhibits the enzyme in cell-wall synthesis and has a bactericidal effect. Used to treat both gram-positive and gram-negative bacteria. Not resistant to penicillin enzyme – penicillinase – used to treat ear infections and sinusitis.
Penicillinase-resistant
Dicloxiacillin, nafcillin, and oxacillin) penicillin are narrow spectrum. Used to treat staphylococcus aureus
Extended spectrum
piperacillin – broad-spectrum antibiotics effective against P. aeruginosa, a gram-negative bacillus that is difficult to eradicate.
Beta- lactamase Inhibitors
Clavulanic acid and amoxicillin = augmentin, sulbactam and ampicillin – unasyn, tazobactum and piperacillin= zosyn
inhibit enzymes and extend the spectrum of penicillin. Extends antimicrobial effect.
Adverse effects of penicillin
- 5-10% of pts have allergic reactions. s/e: laryngeal edema, hypersensitivity, superinfection, tongue discoloration, severe bronchial constriction, hypotension, stomatitis, GI distress, clostridium difficile associated diarrhea. Take it with food. Do not take it with acidic fruits or juices. Causes GI distress. Allergy to penicillin or cephalosporins = mild reaction may cause anaphylaxis. Cephalosporin 10% change of allergy with penicillin. Antibiotics interfere with birth control, monitor for infection – elevated temp, monitor for drug resistance.
Cephalosporins
Beta-lactum structure – inhibit synthesis of cell-wall. Each generation has an increased resistance to being destroyed, increased spectrum, and increased ability to cross the blood brain barrier. 1st generation does not treat beta-lactamase. 5th generation can cross the BBB.
Ceftriaxone
third-generation cephalosporin-effective against gram-negative bacteria and increased resistance to destruction by beta lactamases, treats ear infection, meningitis, appendicitis, gonorrhea, septicemia, and surgical infection prophylaxis. UTIs, intraabdominal, gynecologic, skin, respiratory, bone/joint. Side effect – nausea, dyspepsia, dysgeusia, stomatitis, glossitis, vomiting, diarrhea, abdominal cramps, flatulence, rash, flushing, diaphoresis, fever, pruritus, headaches, dizziness, edema, injection site reaction, epistaxis, chills, vaginitis.
5th generation cephalosporin
brain infection and MRSA
Cephalosporin anaphylaxis
dysgeusia, c. diff, nephrotoxicity, monitor BUN and creatinine, loop diuretics increase the risk of renal dysfunction, elevated liver enzymes and bilirubin levels, stevens johnson syndrome. Do not take with cephalosporin with alcohol – causes disulfirm-like reaction – headache/n/v dizziness, flushing and muscular cramps.
Uricosurics with cephalosporins
Probenecid – increase the excretion of uric acid and decrease the excretion of the antibiotic
Lincosamides
(Clindamycin and Lincomycin)- inhibit protein synthesis, absorbed through GI tract, GI irritation N/V, stoma – inflamed or sore mouth, glossitis – inflamed or sore tongue, altered taste
Glycopeptide
Vancomycin – inhibit cell wall synthesis – MRSA effective, C.diff treatments s/e= anaphylaxis, superinfection, red neck/red man syndrome – given too fast red blotching of face/neck/extremities. Hypotension, Toxic effect: disulfiram like reaction to alcohol. Nephrotoxicity, ototoxicity, tachycardia, Stevens-johnson syndrome. Tinnitus, dizziness, progressive hearing loss.
Azithromycin
macrolides – exacerbation of myasthenia gravis: s/e = GI disturbances, superinfection. Hepatotoxicity when taken in high doses - do not take with acetaminophen.
Tetracyclines
Minocycline and doxycycline – take with food, inhibits bacterial protein synthesis, treats H. pylori, peptic ulcers, and acne. Given orally. Binds with minerals and forms clumps that prevent absorption such as Al, Mg, Ca. Take 1-2 hours after meals on an empty stomach. s/e= GI distress, photosensitivity, teratogenic, adolescent females – birth control and risk, causes permanent discoloration of teeth. Do not give to children 8 years old or younger or to pregnant women. Can cause ototoxicity, hepatotoxicity, nephrotoxicity. Drug and food interactions with milk products, antacids, oral contraceptives, penicillins, aminoglycosides increase nephrotoxicity. Take antacids, iron, and calcium at least two hours a part. Nursing process= baseline function of renal or liver function, use backup birth control, avoid sun exposure, do not give to anyone that is pregnant or children under 8.
Glycycline
Tigecycline- blocks protein synthesis in bacterial cells, resulting in bacteriostatic action. Given for pneumonia, skin infections, and intraabdominal infections. man made tetracycline – same side effects and adverse effects –GI distress, photo sensitivity, hyperglycemia – not the tooth staining.
Synthetic analogue of tetracyline.
Aminoglycosides
ototoxicity and nephrotoxicity - serious infections only, Gentamicin and neomycin – not absorbed through GI, given IM or IV, Neomycin given orally before bowel surgery. Stays in the GI tract and kills the bacteria in the gut before surgery.
Gentamicin peak and trough
Peak 5-8, trough less than 1-2
Gentamicin
Side effects: Ototoxicity-tinnitus, dizziness, progressive hearing loss, nephrotoxicity- look at kidney function CHECK THE SERUM DRUG LEVELS – bun, creatinine, urine output, baseline urine function.
IV not in GI tract – kills the bacteria in the gut
Effectiveness decreased with penicillin – separate doses within a few hours
Increases effects with warfarin, epicrynic acid increases ototoxicity. Risk increased when taken with cephalosporins, vancomyacins, and diuretics
Fluoroquinolones
Ciprofloxacin, levofloxacin
Monitor BGL – increased risk of hypoglycemia. Increased effects of caffeine.
NSAIDS and steroids increase risk of toxicity and adverse effects, do not take it with antacids, iron, and calcium– slow absorption
Can cause GI effects and GI distress – decrease that by taking it with food. Can slow the absorption.
Causes crystal urea – increased fluid intake. Increased risk of tissue damage and rupture – generally in Achilles tendon. Black Box!
Highly nephrotoxic and hepatotoxic, photosensitivity-avoid sun exposure. Be aware of s/sx of super infection
Sulfonamides
first antibacterial developed, prevent bacteria from making folic acid – can’t grow and reproduce. Bacteriostatic.
We get folic acid from diet, no impact on human or normal body cells.
Treats UTI and ear infection.
Anaphylaxis can happen. S/Sx= crystal urea, nephrotoxic. Increase fluid intake, minimum is 2 Liters per day.
Secondary Infection/Superinfection – vaginal itching, sore throat, diarrhea, thrush, fungal infection in the mouth, blood in stool, c. difficile, vaginal discharge, yeast infection, oral candidiasis, sore throat.
Trimethoprim-sulfamethoxazole
synergistic-work better-less bacterial resistance – increases crystal urea – used for UTI and ear infection
Oral hypoglycemics and oral anticoagulants – monitor blood glucose and bleeding, monitor CBC
Trimethoprim and TMP-SMZ block steps in the bacterial synthesis of protein and nucleic acid, producing a bactericidal effect.
Renal function and CBC. 2000 mL a day. Drink with a full glass of water, food doesn’t affect absorption- take it without regard to meals. Avoid antacids and report signs of superinfection.
Nitromidazoles
Metronidazole – flagyl and Tinidazole
Used to treat H. Pylori – peptic ulcers/gastric ulcers & treats C.Difficile. Take with food. Metronidazole can be taken without food.
Do not take it with alcohol – disulfiram-like reaction. Nausea, vomiting, confusion, breathing difficulty.
Tongue and urine color discoloration.
Tuberculosis
causes by mycobacterium tuberculosis – spread by droplets - latent TB = not contagious – inhaled, the organisms will be present in the body and it will be latent – positive for a skin test. PPD skin test tells you if you have TB – initial baseline test, 8-10 weeks later ppd skin test to see if you contracted TB through exposure. Chest x-ray if that one comes back positive.
TB symptoms
cough, fever, weight loss, night sweats, positive TB culture, chest x-ray
