Exam 2: Week 8 Wednesday- Antibacterials Flashcards
What are two ways nitroglycerin might be used?
Acute: for acute angina
Slow Release or Extended Release: long term lower dose to prevent Angina (prophetically)
In diabetic neuropathy: even if it is not specifically painful neuropathy, can a medication for neuralgia help?
Yes.
They are being increasingly used because they help some people with sensory issues.
For example, Gabapentin.
what is a good question to ask someone when you get their medication list?
Are you currently taking all of these medications?
What are some good goals for someone with a wound?
- reduce swelling
- decrease the size of the wound
- Eliminate infection
- Patient education (big!)
INR stands for
International Normalized Ratio From
WIkipedia: The INR is typically used to monitor patients on warfarin or related oral anticoagulant therapy. The normal range for a healthy person not using warfarin is 0.8–1.2, and for people on warfarin therapy an INR of 2.0–3.0 is usually targeted, although the target INR may be higher in particular situations, such as for those with a mechanical heart valve. If the INR is outside the target range, a high INR indicates a higher risk of bleeding, while a low INR suggests a higher risk of developing a clot. (https://en.wikipedia.org/wiki/Prothrombin_time#International_normalized_ratio)
How long do you have to communicate with an MD when you have a concern?
About 30 seconds
Give them concrete information (vitals and numbers around concern)
Precautions for someone whose blood is thin.
Be careful not to hurt yourself
Maybe just stay here until we find out what the MD wants you to do.
What is Selective Toxicity?
Selective toxicity – kill or attenuate the growth of the pathogen without excessive damage to the host
True/False: Bacteria are incapable of independent life. They must take over a cell structure to reproduce.
False
- ~Bacteria are structurally capable of independent life, but need a nourishing host
- ~Viruses must take over a cell for reproduction
What does broad spectrum refer to in antibiotics
Broad spectrum – how many different bacteria will the drug affect (broad spectrum would be many different bacteria)
What is the difference between the terms “Bactericidal” and “Bacteriostatic”?
Bactericidal – kills
bacteriostatic – limits growth and proliferation
What are the most common adverse effects of antibiotics?
Most common adverse effects of antibiotics – GI upsets (Nausea, Vomiting, Diarrhea)
Explain some points about human exposure to disease
- Humans are continually exposed to disease
- Infections are common and always evolving (Ebola)
- There is a continual struggle to keep antibiotics ahead of microbe mutations
- Some are becoming more common nosocomial (originatinating in the hospital) as well as community
- MRSA, VRE, multidrug resistant TB, Clostridium difficile (C-diff)
What were some of the first drugs to limit damage from bacterial infections in 1950s-1980s?
Sulfa drugs, penicillins, and antibiotics- 1950’s to 1980’s limited damage from bacterial infections
What are three diseases that were limited or eliminated by vaccinations?
Immunizations- limited or eliminated measles, mumps, rubella, poliomyelitis
What were some new infectious agengents that developed in the 1970s and 1980s?
New infectious agents- 1970’s and 1980’s- legionella, HIV, antibiotic-resistant organisms, Avian flu, Ebola
What are some microbes suspected as predisposing individuals to?
Some microbes are suspected as predisposing individuals to chronic disorders like heart disease, mental illness (Dementia, Alzheimer’s disease), autoimmune disorders
what are 4 resistant nosocromial infections?
- •MRSA,
- VRE,
- multidrug resistant TB,
- Clostridium difficile (C-diff)
What is an infection?
•Infection- Process in which an organism establishes a parasitic relationship with the host
What produces an immune response?
•Immune response- Produced by invasion and multiplication of an organism
what are three factors that must be present for the developement of an infection?
- Transmission
- Proper environment
- Susceptibility of the host
What is the 102 degree F Rule?
- Someone who has infection with fever below 102 will look quite different from those with fever above 102
- Older people may be an exception
Some Details and rationale:
Some people with serious infection may not develop fever initially, but may become tachypneic, confused, or hypotensive
In aging adults – impaired thermoregulatory system may mask fever; temp or 99-100°F may be sufficient to cause alarm
True or False: microorganisms colonization is present in many people’s tissue but it does not create necessarily have signs and symptoms of systemic disease
True
Person is therefore carrier and transmitter
True or False: Colonization and infection are the same thing
False.
They are very different.
Time frames for Infection (3)
- Incubation period- time from invasion to signs and symptoms (Ebola 2 to 21 days)
- Latent period- microorganism has replicated but lay dormant (TB, herpes zoster)
- Period of communicability- time after latency when symptoms or transmission can occur (Ebola after symptoms occur in humans)
What is communicable disease?
any disease where the causative agent can be passed directly or indirectly
Signs/Symptoms of Infectious Disease (6)
- Abscess – leukocytes wall off the invader – if necrosis progresses, abscess deepens (we may not be able to see or palpate it)
- If not obvious (i.e., internal), may present as pain, limp, lump – abdominal abscess, pelvic inflammatory disease, tuberculosis of the spine may form abscess between posterior peritoneum and psoas/iliac fascia, presenting as hip pain
- Rash, macropapuler eruptions (measles, mumps), vesicubullous eruptions (herpes zoster p. 405), petechial or purpuric eruptions (Epstein-Barr)
- Red streaks (blood poisoning)- person may be marked up to see if line is moving n positive or negative direction
- Inflamed lymph nodes
- Joint effusion
Most common early symptoms of infectious disease
- fever
- chills
- malaise
Symptoms of infectious disease in integumentary system
- purulent drainage from abscess, wound, or lesion
- skin, rash, red streaks
- bleeding from gums or into joints; joint effusion or erythema
Symptoms of infectious disease in cardiovascular system
- petechial lesions
- tachycardia
- hypotension
- change in pulse rate
Symptoms of infectious disease in CNS
- altered level of consciousness, confusion, and seizures
- headache
- photophobia
- memory loss
- stiff neck, myalgia
Symptoms of infectious disease in GI system
- nausea
- vomitting
- diarrhea
Symptoms of infectious disease in Genitourinary system
- dysuria or flank pain
- hematuria
- oliguria
- urgency, frequency
Symptoms of infectious disease in upper respiratory system
- tachypnea
- cough
- dyspnea
- hoarseness
- sore throat
- nasal drainage
- sputum production
- oxygen desaturation
- decreased exercise tolerance
- prolonged ventilatory support
The Anatomy Lesson of Dr. Nicolaes Tulp
Rembrandt
1632
Common lymph node sites
- left and right supraclavicular nodes
- left and right axillary nodes
- left and right inguinal nodes
- retroperitoneal nodes
Types of organisms that can invade our bodies and make us feel like crap (8)
- Viruses
- Mycoplasmas
- Bacteria
- Rickettsiae
- Chlamydia
- Protozoa
- Fungi
- Prions
Points to note about bacteria
- do not require host
- single-cell microorganism of many variations - rod, spherical, spiral, gram positive/negative (staining)
- motility
- tendency toward capsulation
- capacity to form spores
- aerobic, anaerobic
- specific antibiotic for type
Modes and causes of nosocomial infections
Modes
- UTI- catheter
- Bloodstream infection- IV, wounds
- Pneumonia- intubation, lack of mobility
- GI and genitourinary- lack of motility
Causes: Surgical procedures, immunosuppressed, antibiotics, sicker/older patient, caregivers hygiene and amount of exposure, displacement of normal flor
Types of Precautions for infection control
- Standard Precautions (All patients)- Bloodborne Pathogen, Gloves and hand washing with body fluid contact, alcohol based products if hands are not visibly soiled
- Airborne Precautions (TB)- Private negative airflow room, Door to room closed, Respiratory precautions (respirator mask fit tested), Restrict entry to most susceptible, Limit transport and use surgical mask for patient when transport is necessary
- Droplet precautions (Influenza)- Private room or with like infection, Door can be open, Mask within 3 feet, Limit transport and use surgical mask for patient when transport is necessary
- Contact precautions (C-diff, MRSA, VRE)- Private room, gown and gloves, dedicate equipment to patient for full stay (single use stethoscope/BP cuff, limit patient transport)
Points to note about Clostridium difficile AKA C-diff (5)
- becoming more prevalent due to high rate of antibiotic use in hospitals, est. 228/100,000 persons
- Fecal-oral transmission, contaminated environment (alcohol-based hand sanitizers not effective)
- Age and use of H2 reception blockers and proton-pump inhibitors for GERD may increase risk
- Overgrowth of C. diff occurs when other intestinal flora are destroyed (such as by Clindimycin)
- Fecal transplants showing great promise; Flagyl (effective against anaerobic bacteria)
Staphylococcal Infections (S. aureus, S. epidermis)- 6 points to know
- Hygiene issue
- Spread by direct contact, multiple predisposing factors (Table 8-6, p. 317in Goodman and Fuller)
- Infection, suppuration, abscess, infective syndromes
- Antibiotic effectiveness is problematic
- Vancomycin for MRSA, VISA (vancomycin intermediate S. aureus), VRSA
- Daptomycin, Linezolid- new meds for VRSA
Group A Streptococci (GAS, S. pyogenes)
- Spread by direct contact or droplets (Table 8-67 p. 319)
- Includes multiple common diseases- Scarlet fever, some neonatal infections, and necrotizing fascitis
Group B Strep (S. agalactiae)
- leading cause of neonatal pneumonia, meningitis, sepsis
- group B strep is part of normal vaginal flora, found in 30% of women.
- Pregnant women are checked to see if they are Step B positive.
3 treatment options for Gas gangrene (Clostridial Myonecrosis)
- Debridement and excision of necrotic tissue
- IV antibiotics
- possible hyperbaric oxygen (HBO) therapy
Pseudomonas aeruginosa
- One of the most common hospital and nursing home-acquired pathogens
- Pathogens found in moist areas, like sinks – also in healthcare workers’ hands, nails (a reason why artificial nails are prohibited)
- Seen in pneumonias, wounds, UTI, sepsis, chronic lung diseases
- Contact spread
- Local infections managed fairly easily; septicemia has a high mortality rate
- grayish green and smells like dirty gym socks
2 specialty MDs who may work together and have advanced training with infectious diseases
an infectious disease physician
immunologist/allergist physcian
A common side effect of penicilln
skin reactions, including Steven Johnson syndrome where skin sloughs off
Most Common Causes of Prolnged Fever (Goodman & Snyder Table 8-1; pg 300):
14 Examples of Conditions in which fever generally does not exceed 102* F
(Dr. T did not say to memorize these, I just found this chart that helped me understand the 102* F rule that she mentioned)
- Catheter-accociated Bacteriuria
- Atelectasis
- Phlebitis
- Pulmonary emboli
- Deyhydration
- Pancriatitis
- Myocardial infarction
- Uncoplicated wound infections
- Any malignancy
- CMV infection (cytomegalovirus)
- Hepetitis
- EBV infection (Epstein-Barr Virus)
- Subacute bacterial endocarditis
- Tuberculosis
What are Cephalosporins?
What are they used for?
One more thing
- Type of antibiotic (acts on cell membrane synthesis)
- may be used low dose prophylactically, ex: kids with recurrent ear infections or SCI with recurrent UTIs
- cross sensitivity with penicillin, but works on same bugs
Most Common Causes of Prolnged Fever (Goodman & Snyder Table 8-1; pg 300):
16 Examples of Conditions in which fever regularly exceeds 102* F
(Dr. T did not say to memorize these, I just found this chart that helped me understand the 102* F rule that she mentioned)
- Malignant hyperthermia (secondary to anestehsia)*
- Transfusion reactions
- Urosepsis
- IV line sepsis
- Prosthetic valve endocarditis
- Intra-abdominal or pelvic peritonitis or abscess
- C. difficile colitis (C-diff)
- Procedure-related bacteremia
- Nosocomial pneumonia (hospital aquired pneumonia)
- Drug fever
- HIV infection
- Heat stroke
- Acute bacerial endocarditis
- Tuberculosis (usually disseminated or extrapulmonary)
- Lymphoma
- Metastasising carcinoma to liver or CNS
*Malignant hyperthermia is disease passed down through families that causes a fast rise in body temperature (fever) and severe muscle contractions when the affected person gets general anesthesia. (Wikipedia)
What are Carbapenems?
Negative effects?
- type of antibiotic (act on Cell Membrane Synthesis)
- CNS abnormalities, especially for patients with pre-existing seizure disorder or if drug dosage is too high
- can cause dizziness, confusion
Antibiotics that work on bactierial cell wall synthesis (2)
Side effects
- topicals- ex: bacitracin. may cause local hypersensitivty
- Vancomycin- side effects: bitter taste in mouth, hypersensitivity, nephro and ototoxic med (need blood draws to monitor kidney function)
What does Nosocomial mean?
hospital aquired
Points to remember about antibiotics that inhibit bacterial protein synthesis
- Spectrum?
- Three negative effects?
- When is it chosen?
- Very broad spectrum
- nephrontoxic- liver and kidney failure
- ototoxic
- Choice may be chosen due to routine protocol, what is available, cost, physician preference
Names of antibiotic that inhibit bacterial protein synthesis and some key points about them.
- Erythromycin – may be useful in airway infections; must monitor liver function
- Tetracycline - good: may have anti-inflammatory, neuroprotective, and immunomodulation effects; bad- photosensitivity, interference with osteoblasts/clasts in bone remodeling, discoloration of teeth, bone, and skin
- Chloromycetin – may lead to aplastic anemia, reserved for non-responsive resistant infections
- Clindamycin – has a black box warning for C. diff
- Ketek – first of new class: ketolide antibacterials – erythromycin derivative. May be useful in bacterial resistance but hepatotoxic
drugs in class that inhibit RNA/DNA synthesis include:
- anti-TB
- anti-leprosy drugs
- Fluoroquinolones – for resistant strains. Adverse effects: CNS toxicity, photosensitivity, risk of causing tendinopathy, especially for folks who are older or in renal failure – monitor for pain complaints, back off of exercise loading
- Sulfonamides – photosensitivity
Thompson’s wrap up point regarding use of antibiotics
- use judiciously
- follow the MD directions and follow the whole course when it is prescribed
- be mindful of effects of poly-pharmacy
Erythromycin –
- What class is it from?
- What is it useful for?
- Negative effects?
Erythromycin –
- Antibacterial that inhibits bacterial protein synthesis (erythromycins)
- may be useful in airway infections;
- must monitor liver function
Tetracycline -
- What class is it from?
- Positive effects? (3)
- Negative effects? (3)
Tetracycline -
- Antibiotic that inhibits bacterial protein synthesis (tetracyclines)
- Positive effects: may have
- anti-inflammatory,
- neuroprotective, and
- immunomodulation effects;
- Negative effects:
- photosensitivity,
- interference with osteoblasts/clasts in bone remodeling,
- discoloration of teeth, bone, and skin
Chloromycetin –
- What class is it from?
- When is it used?
- Negative effects?
Chloromycetin –
- Antibiotics that inhibit bacterial protein synthesis (other agents)
- reserved for non-responsive resistant infections
- may lead to aplastic anemia
Clindamycin –
- What class is it from?
- Negative effects? (2)
Clindamycin –
- Antibacterial that inhibits bacterial protein synthesis (other agents)
- has a black box warning for C. diff
- Pretty sure it is ototoxic
Ketek –
- What class is it from?
- What is unique about it?
- When is it used?
- Negative effects?
Ketek –
- Antibacterial that inhibits bacterial protein synthesis (other)
- first of new class: ketolide antibacterials – erythromycin derivative.
- May be useful in bacterial resistance but
- hepatotoxic
penicillin –
- What class is it from?
- Negative effects? (6)
penicillin –
- Antibiotic that acts on Cell Membrane Synthesis
- Negative effects:
- Always
- skin reactions,
- Stevens - Johnson syndrome (sloughing of the skin),
- toxic epidermal necrosis;
- skin reactions,
- with prolonged use,
- may cause CNS issues (hallucinations, confusion),
- hemolytic anemia,
- thrombocytopenia
- Always
Cephalosporins –
- What class is it from?
- Unique characteristics?
- Used for? (3)
Cephalosporins –
- Antibiotic that acts on cell mambrane synthesis
- Unique characteristics: cross-sensitivity with penicillin
- Best uses:
- works on the same bugs as penacilin;
- may be better than penacillin for UTI
- often used as Low dose, “prophylactic” antibiotics –
- SCI patient, or ear infection prone
Carbapenems -
- What class are they from?
- Negative affects?
Carbapenems -
- Antibacterial that acts on bacterial cell membrane synthesis (Meropenem is listed in book as a Carbapenem, but Carbapenem itself is not listed in the chart)
- Negative affects:
- CNS abnormalities, especially for patients with pre-existing seizure disorder or if drug dosage is too high
Topical Antibacterials
- What class are they from?
- Negative effects?
Topical Antibacterials
- Dr. T listed them under Antibacterials that act on bacterial cell membrane synthesis, but others were topicals too I believe. (in the book there is Polymyxin B that is an Antibacterial that acts on bacterial cell mebrane and is so nephrotoxic that it is used almost exclusively in topical-like ways. Maybe she meant that?)
- Negative effects: local hypersensitivity (true for topicals no matter what class)
Vancomycin –
- What class is it from?
- Negative effects? (4)
Vancomycin –
- Antibacterial that works on bacterial cell membrane synthesis
- Negative effects?
- hypersensitivity,
- bitter taste in mouth,
- nephrotoxicity (kidney issues)
- ototoxicity (ringing in ears)
Drugs that Inhibit bacterial protein syntheis
In General
- Unique characteristics?
- Negative effects? (3)
Drugs that Inhibit bacterial protein syntheis
In General
- Unique characteristics: Very broad spectrum
- Negative effects?
- problems with toxicity –
- nephrotoxicity and kidney failure
- ototoxicity,
- liver failure
- problems with toxicity –
Drugs that inhibit DNA/RNA synthesis
- Four types of drugs in the class
Drugs that inhibit DNA/RNA synthesis
- Types of drugs in the class
- anti-TB
- anti-leporosy
- Fluoroquinolones
- Sulfonamides
Fluoroquinolones –
- What class are they in?
- Negative effects? (3)
Fluoroquinolones –
- Antibacterial that inhibits DNA/RNA synthesis
- Negative effects?
- CNS toxicity,
- photosensitivity,
- tendinopathy,
- especially for folks who are older or in renal failure – monitor for pain complaints, back off on exercise loading
Sulfonamides –
- What class are they in?
- Negative effects?
Sulfonamides –
- Antibacterials that inhibit DNA/RNA synthesis
- Negative effects: photosensitivity
List the Antibacterials Dr. T listed that act on bacterial cell wall synthesis (5?)
- Pencillin
- Cephalosporins
- Carbapenems (meropenem?)
- Topicals?
- Vancomycin
List the Antibacterials Dr. T listed that act on bacterial protein synthesis (5-6)
- Erythromycin
- Tetracycline
- Chloromycetin
- Clindamycin
- Ketek
- (Book also listed Aminoglycosides)
List the Antibacterials Dr. T listed that inhibit bacterial DNA/RNA synthesis (5)
- Anti-TB
- Anti-leprosy
- Fluoroquinolones
- Sulfonamides
