Biodefense & Cancer Flashcards
Leukocytosis
WBC count > 10,000
Neutrophils will have L shift:
high # bands/immature cells
Low # segmented/mature cells
Antibacterial: bacteriocidal
Kills bacteria
Antibacterial: bacteriostatic
Disrupts replication
Antibacterial resistance
Bacterial cell divides and one mutates
Mutant cell resistant to antibiotic
Only new resistant cell survives
New resistant bacterium cont to divide
Common antibiotic ADRs
Superinfection
Allergy/hypersensitivity (anaphylaxis)
Diarrhea
(Resistance is not ADR)
Clostridium difficile (C. diff)
Common superinfection
Pathogen thrives when normal GI flora is destroyed by antibiotics
Worse with high doses, >1 antimicrobial, and broad-spectrum
Leads to pseudomembranous colitis
Can occur days or weeks after start of antibiotics
Client education for antibiotics
Take full course of pills (most pts feel better w/in few days)
Don’t stop if sx improve (at this point most susceptible bx have been killed - still many present)
Don’t share, don’t save, don’t take antibx if you don’t need them
Cephalosporins
Cephalexin 1st gen
Cefoxitin 2nd gen
Cephtrixone 3rd gen
Cefapime 4th gen
Beta lactam antibiotics
All similar structure and fx: Penicillins, cephalosporins, mononbactams, carbapenems
Effective against gram+ and -, affect cell wall (peptidoglycan)
D/t similar structure/function if there’s hypersensitivity reaction to one, incr chance will have reaction to all
Vancomycin (Vancodon)
Monobactam Bacteriocidal (destroys cell walls) AND bacteriostatic (alters RNA synthesis) = very effective antibiotic
nephrotoxic and ototoxic @ high doses
Active against gram+, incld MRSA
Tx serious UTI, skin infection, lower resp. infection
Penicillin
Inhibit cell wall synthesis - bactericidal
Most common antbx used for strep throat so it doesn’t develop into of rheumatic fever, or cause worse complications
high dose causes hyperkalemia
type 1 hypersensitivity immediate onset (w/in 2 mins), anaphylaxis - tx w/ epi pen
If pt allergic to this antbx, 5-10% chance will be allergic to cephalosporins
Cephalosporins
Destroy cell wall - bacterialcidal
Nephrotoxic
Gen 1 active against skin and soft tissue infections, gram+ coverage —-cephalexin (Keflex)
Gen 2 active against 1st gen and klebsiella, E. coli, gram+ AND gram- coverage, broad-spectrum —– cefoxitin (Mefoxin)
Gen 3 adds broader coverage for gram- bacteria —— ceftriaxone (Rocephin)
Gen 4 best gram- coverage but only used for serious HAIs (resistant to beta-lactamases) and has fewer ADRs ——cefapime (Maxipime)
Empiric therapy
Broad-spectrum antibx prescribed until results from culture sensitivity come back
HCP may prescribe new narrow-spectrum antibx to target specific bacterium
Vancomycin ADRs and interactions
ADRs: infusion reaction, thrombophlebitis, chills, fever, hearing loss, nephrotoxicity
Don’t use w/ loop diuretics, digoxin, aminoglycosides (also nephrotoxic)»_space; nephrotoxicity
Rapid IV infusion = “Red man syndrome” red neck, intense itching, upper body rash d/t rapid release of histamine
infusion should be > 1 hr
infusion reaction not allergic reaction
Pre-dose w/ benadryl
Ciprofloxacin (Cipro)
Fluoroquinolones: Synthetic broad-spectrum
MOA: alter DNA via DNAgyrase. Active against pseudomonas, gram+, cocci
Tx pneumonia, UTI, gonorrhea, bone, joint, eye, ear infx
ADR: N/V, spontaneous achilles tendon rupture (more common peds)
Cipro only fluoroquinolone approved in peds
Cancer cells break the rules
avoids apoptosis
no contact inhibition (grows where ever)
neoplasm (abnormal cell growth/tumor)
malignant: cells can invade and kill nearby tissue; able to metastasize
metastasis: malignant cells spread to other part of body
Why are tumors surgically removed
Cancer cells don’t die so they are removed
Cells still have enough normal markers that immune sys doesn’t destroy them
Why cancer wins
self-sufficiency in growth signals
insensitivity to antigrowth signals
evading apoptosis
limitless replication potential
sustained angiogenesis
tissue invasion/metastasis
Causes of cancer
tobacco asbestos UV light carcinogens viruses (HPV) meds oncogenes damaged tumor supressor gene diet
Dysplasia
abnormal cells, look abnormal under a microscope but are not cancer; can develop into cx
Occurs in HPV
Metastasis
Malignant cx cells spread via lymph sys and vascular sys
Common sites are brain, lungs, liver, bones, adrenal glands
TNM staging
T = size of tumor N = # of nearby lymph nodes that have cx M = whether cx has metastasized
BRCA
BRCA is a tumor suppressor gene that all humans have
BRCA mutation causes cx
BRCA 1 and BRCA 2
15% of breast cx pts have gene mutation
15% w/ BRCA mutation will get ovarian cx
BRCA 1 = 55-65% will get cx
BRCA 2 = 45% will get cx
Tamoxifen
Anti-estrogen
Many ADRs
Prevents relapse in estrogen receptor cx
Antiemetics
Zofran (ondansetron) prevents N/V caused by chemo
Compazine (prochlorperazine) is an antipsychotic used to control severe N/V
Beta lactamase
Enzymes that are produced by bacteria which provide resistance to beta lactam antibiotics
If bacteria is resistant to one beta lactam, will likely be resistant to others
Desensitization
Expose pt to small amt of antibiotic over and over to decrease their hypersensitivity
Penicillin route and dose
Route: IM
Mod - severe infx: 600k - 1.2 mil units/day
Pneumonia: 600K units q12hr
Gonorrhea: 4.8 mil units divided 1x
Cipro route and dose
Route: PO, IV
UTI: 250-500 mg q12hr x3-7d
URI: 500-750 mg q12hr x7-14d
Pneumonia: 400 mg q8-12 hr IV x10-14d
Vancomycin route and dose
Route: PO, IV
Systemic infx: 500 mg q6hr
