antibiotics part 1 Flashcards
health care associated infections
contracted in a health care facility. ex- hospital or LTC
community-acquired infection
infection acquired by a person who has not been hospitalized or had a medical procedure within the past year
when do health care associated infections occur
more than 48 hours after admission
why are health care-associated infections hard to treat
MOs are often drug resistant and the most virulent
what is the first indication of infection
confusion
health care-associated infections
MRSA and VRE (vancomycin-resistant enterococcus)
health care-associated prevention
handwashing, antiseptics, disinfections
what do disinfectants do
kill organisms, used only on non living objects, cidal agent
what do antiseptics do
generally only inhibits the growth of MOs, applied to living tissue, static agents
what are antibiotics
meds used to treat bacterial infections
before beginning antibiotic therapy
area of infection should be cultured to identify causative organisms
empiric therapy
treatment of infection before specific culture info has been reported
definitive therapy
antibiotic therapy tailored to treat organism identified with cultures
prophylactic therapy
treatment with antibiotics to prevent infection as in intra abd surgery or after trauma
therapeutic response
decrease in specific signs and symptoms of infection are noted
subtherapeutic response
signs and symptoms of infection do not improve
superinfection
reduces or eliminates normal body flora
what is an example antibiotic acquired diarrhea super infection
pseudomembranous colitis: clostridium difficile
what is a secondary infection?
follows the initial infection and comes from an external source
host factors
factors that pertain specifically to a given pt and can have an impact on the success or failure of antibiotic therapy. ex- allergy history, age, pregnancy status
what are 2 classes of antibiotics that many ppl have allergies to
penicillins and sulfonamides
most common severe reactions to antibiotic therapy
difficulty breathing, rash, hives, other skin reactions, sever GI intolerance
glucose 6 phosphate dehydrogenase deficiency
genetic abnormality that results in enzyme deficiency. administration with antibiotics can result in hemolysis.
slow acetylation
drugs metabolized slower than usual. can result in drug toxicity or accumulation.
antibiotic MOA
interference with cell synthesis or DNA replication or disrupts metabolism
actions of antibiotics
bactericidal or bacteriostatic
sulfonamides example
sulfamethoxazole combined with trimethoprim (septra) SMX TMP
sulfonamides MOA
-bacteriostatic
-prevents synthesis of folic acid (which makes up DNA and RNA)
-don’t affect human cells, only affects organisms that synthesize their own folic acid
sulfonamides indications
- effective against gram + and -
- treats UTIs
sulfonamides indications
- pneumocystis jiroveci pneumonia
- upper resp tract infections
- staphylococcus infections
sulfonamides contraindications
- celebrex
- pregnant and <2 months
- stops action of birth control
sulfonamides and sulfonylureas
increased hypoglycemic effect
sulfonamide and phenytoin
toxicity of phenytoin
sulf and warfarin
increased bleeding
sulf and cyclosporine
nephrotoxicity
take sulfonamides with plenty of fluid to avoid
crystalluria or precipitation in the kidneys
what are the B lactam antibiotics
penicillins, cephalosporins, carbapenems, monobactams
examples of natural penicillins
penicillin G and penicillin V
work against gram pos only
example of a penicillinase-resistant drug
cloxacillin sodium.
resists breakdown of enzyme penicillinase
ex of aminopenicillins
amoxicillin and ampicillin
B lactamase inhibitors
clavulanic acid (clavulante) and tazobactam
extended-spectrum drug examples
piperacillin sodium/ tazobactam sodium (Tazocin)
penicillin indications
prevention and treatment of infections caused by bacteria
penicillin adverse effects
0.7-4% of treatment courses
- urticaria, pruritus, angioedema
- increased risk to other B lactam antibiotics
- nausea, vomiting, diarrhea, abd pain
what pts should not receive cephalosporins
history of throat swelling and hives from penicillin
penicillin interactions
NSAIDS, birth control, potassium supplements, probenecid, rifampin, warfarin
avoid taking oral penicillin with
caffine, citrus, fruit/juice, tomato juice, colas
cephalosporins
semisynthetic antibiotic, related to penicillin, bactericidal, broad spectrum
1st gen cephalosporins
- gram pos coverage
- poor gram neg coverage
- parenteral and enteral
- used for surgical prophylaxis
1st gen cephalosporin example
cephalexin PO (Keflex) and cefazolin (IV or IM)
2nd gen cephalosporins
- good gram + coverage
- better gram - than first gen
2nd gen cephalosporin examples
- cefoxitin (IV and IM, kills anaerobes, surgical prophylaxis)
- cefuroxime (PO, surgical prophylaxis, doesn’t kill anaerobes)
3rd gen cephalosporins
- most potent against gram -
- less active against gram +
3rd gen cephalosporin examples
-ceftazidime (good for gram -, IV and IM)
- ceftriaxone (IV and IM, long half life, treats meningitis)
4th gen cephalosporins
- broader spectrum than 3rd gen especially against gram pos
-treats UTIs
ex of 4th gen cephalosporins
cefepime hydrochloride (Maxipime)
cephalosporin adverse effects
GI symtoms, rash, pruritus, redness, edema
which has the broadest antibacterial action of any of the antibiotics
carbapenems
what are carbapenems used for
complicated body cavity and connective tissue infections in acutely ill hospitalized pts
carbapenems may cause
drug induced seizure activity. can be reduced with proper dosage
example of a carbapenem
imipenem/cilastatin (Primaxin)
- treats bone, joint, skin and tissue infection
ex of macrolides
erythromycin, azithromycin, clarithromycin
macrolides MOA
- prevents protein synthesis
- bacteriostatic
macrolide indications
strep infections, upper and lower resp infections, spirochetal infect, gonorrhea, chlamydia, mycoplasma
macrolides adverse effects
GI with erythromycin
azithromycin and clarithromyin- less GI, longer duration of action, better efficacy
tetracyclines examples
doxycycline hyclate (Doxycin, VIbramycin)
tigecycline (Tygacil)
tetracyclines
natural and semisynthetic
bacteriostatic
inhibits protein synthesis
tetracycline binds to
Ca Mg and Al to form insoluble complexes
what reduces the oral absorption of tetracyclines
dairy products, antacids, iron salts
dont use tetracyclines with
kids <8, pregnant, lactating because of tooth discoloration
tetracycline indications
wide spectrum (gram pos and gram neg)
tetracycline adverse effects
vaginal candidiasis, GI upset, enterocolitis, maculopapular rash
assessments before antibiotics
- allergies
-CULTURE - renal, liver cardiac function
- immune status
- possible contraindications
- drug interactions
symptoms of superinfection
fever, perineal itching, cough, lethargy, unusual discharge
all oral antibiotics are absorbed better when taken with
180mL of water
sulfonamides should be taken with how much water
2000-3000ml per 24 hrs
dont take penicillins with
juice because it can nullify the antibacterial action
monitor for allergic reaction to penecillin
30 mins after admin
what to allergy to assess for before giving cephalosporins
penicillin
do u give cephalosporins with food
yes to decrease GI upset
disulfiram reaction
cephalosporins and alcohol
avoid sunlight with what drug
tetracycline
