ATI (Antiinfectives)

Question 1

Antiinfectives Key Points

Answer 1

• Broad spectrum vs. narrow-spectrum antibiotics
• Antimicrobials treat bacterial, viral, and fungal infections
• Culture and sensitivity specimens should be collected prior to initiation of therapy
• Adverse reactions:
- Hypersensitivity and anaphylaxis
- Organ toxicity (ototoxic, nephrotoxic)
- ⬇️ efficacy of oral contraceptives
- Superinfection
- ⬆️ warfarin activity

Question 2

Penicillins

Answer 2

• Expected Action:
- B-lactam - destroys bacteria by weakening cell wall
• Therapeutic Use:
- Med of choice for G+ cocci (strep pneumonia, S. viridans, S. pyogenes)
- Med of choice for Syphilis
- Med of choice for Meningitis
- Prophylaxis against bacterial endocarditis
- Extended spectrum against Pseudomonas
- Proteus
- Klebsiella
• Adverse Effects:
- Anaphylaxis / Renal Impairment / Hyperkalemia ( w ⬆️ dose)
• Contraindications:
- Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction
• Interactions:
- Aminoglycosides / ⬇️ n Oral Contraceptives
• Education:
- Take orals c H2O, s food (some may be taken c food)

Question 3

Cephalosporins

Answer 3

• Expected Action:
- B-lactam- destroy bacteria by destroying cell wall
- Four generations, each is: ⬆️ n against G and anaerobes- more resistant to lactamase- more able to reach CSF
• Therapeutic Uses:
- Broad spectrum with ⬆️ TI for postop infections, meningitis, pelvic infections
• Adverse Effects:
- Anaphylaxis / Bleeding / Thrombophlebitis / Pain c IM / cross allergies to penicillins / AA- psuedomembranous colitis
• Contraindications:
- Allergies to Penicillin / Kidney Dysfunction
- Caution with anticoagulants, anti-platelets, and thrombolytics
• Interactions:
- EtOH intolerance (disulfiram reaction) / Probenecid ⬇️ renal excretion
• Education:
- Take c food

Question 4

Carbapenems

Answer 4

• Expected Action:
- B- lactam- destroy bacteria by destroying cell wall
• Therapeutic Uses:
- Broad spectrum effective for serious infections such as pneumonia, peritonitis, and UTIs. P. aeruginosa develops resistance (use combo)- [broadest spectrum available]
• Adverse Effects:
- Allergy / GI symptoms / Superinfection
• Contraindications:
- Caution with renal impairment

Question 5

Monobactams

Answer 5

• Expected Action:
- B-lactam- destroy bacteria by destroying cell wall
• Therapeutic Uses:
- MRSA / Antibiotics- associated pseudomembranous colitis by C. difficile
• Adverse Effects:
- Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis
• Contraindications/Precautions:
- Caution with renal impairment
- Infuse over 60 minutes
- Very low therapeutic index