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Pharmacology > Infection and Sepsis > Flashcards

Infection and Sepsis Flashcards

1
Q

First Step of Infection Assessment.

A

Locate the point of origin/ affected area.

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2
Q

What is the Sequalae of Assessment?

A
  • Assess Signs and Symptoms
  • Identify ports of entry for pathogen
  • Assess current immunity
  • Assess exposure risk
  • Assess health history
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3
Q

Second Step of Infection Assessment?

A

Attain a pathogenic culture from the source!
uring a bacteria culture test, a sample will be taken from the blood, urine, skin, or another part of the body. The culture will be tested to identify the pathogen.

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4
Q

What are the two classifications of bacteria?

A

Gram-negative and Gram-positive

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5
Q

What is the difference between Gram-negative and Gram-positive bacteria?

A

Gram-positive bacteria have a thick peptidoglycan layer and no outer lipid membrane whilst Gram-negative bacteria have a thin peptidoglycan layer and have an outer lipid membrane.

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6
Q

Third Step of Infection Assessment?

A

Treatment! There are two types of treatment to limit further bacterial growth. Empirical and Focal treatment!

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7
Q

Empirical Treatment.

A

Empirical treatment is administered by using medical judgement. There are signs of infection but the specific pathogen is unknown. Empiric treatment is started as soon as possible in order to control the bacterial growth and infection progression.

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8
Q

Focal Treatment.

A

This kind of treatment is initiated when the pathogen is known. When the culture results come back with a definitive diagnosis then a treatment plan to focus on that specific pathogen is initiated.
Empiric treatment may be switched to focal treatment when the pathogen is identified.

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9
Q

Narrow Spectrum Antibiotics.

A

These antibiotics are able to kill or inhibit a limited species of bacteria.

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10
Q

Types of Narrow Spectrum Antibiotics.

A
  • Azithromycin.
  • Clarithromycin.
  • Erythromycin.
  • Clindamycin.
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11
Q

Broad Spectrum Antibiotics.

A

These antibiotics are able to kill or inhibit a large species of bacteria.

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12
Q

Types of Broad Spectrum Antibiotics.

A
  • Doxycycline.
  • Ampicillin.
  • Amoxicillin/clavulanic acid
  • Carbapenems
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13
Q

How do Antibiotics work?

A

Antibiotics inhibit bacterial cell wall synthesis. This inhibition will interfere in the bacteria cell function and stop them from multiplying.
These kinds of medications are classified under carbapenems

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14
Q

Carbapenems.

A

carbapenems are bactericidal beta-lactam antibiotics that bind to penicillin-binding proteins (PBPs). By binding and inactivating these proteins, carbapenems inhibit the synthesis of the bacterial cell wall, which leads to cell death.

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15
Q

Side Effects of Carbapenems.

A
  • Diarrhea
  • Abdominal Pain
  • Nausea
  • Allergic reactions
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16
Q

Immunotherapy.

A

An alternative treatment is used to prevent or treat disease by stimulating the immune response.

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17
Q

Immune Globulines (IG) therpay.

A

The IG therapy provides extra antibodies that the body cannot make on its own. The antibodies from a donor are collected and administered by IV to immediately boost immunity

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18
Q

Cytokine Therapy.

A

Cytokine therapy is an alternative treatment when interferons and interleukins are administered in order to stimulate the immune system. Synthetic immune mediators stimulate WBC synthesis and T-cell stimulation and phagocytosis.

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19
Q

Innate Immunity.

A

Innate immunity is the defence system with which you were born.

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20
Q

Adapative Immunity.

A

The acquired immune system is a subsystem of the immune system that is composed of specialized, systemic cells and processes that eliminate pathogens or prevent their growth.

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21
Q

Role of T-cells.

A

Their roles include directly killing infected host cells, activating other immune cells, producing cytokines and regulating the immune response.

22
Q

Role of B-cells.

A

Produce antibodies to fight bacteria and viruses. These antibodies are Y-shaped proteins that are specific to each pathogen and are able to lock onto the surface of an invading cell and mark it for destruction by other immune cells.

23
Q

What populations are most at risk for immunty difeincies?

A

-Newborns and elderly.

24
Q

How do newborns gain immunity?

A

Newborns gain passive immunity. Unborn babies gain antibodies from mothers that are passed through the placeneta. When the baby is born, there are more antibodies being passed through breastmilk!

25
Q

How does age affect immunity?

A

With age, the thymus gland begins to atrophy. Therefore the degeneration of the gland will cause decreased overall function. There is also a decrease in WBC synthesis which decreases the number of T-cells as well as B-cells.

26
Q

Infection Prevention.

A

The best way to prevent pathogenic infection is immunization! Administration of an antigen (either dead or weakened).
- Once these pathogens are introduced into the body the B-cell antibodies increase in synthesis and fight off the pathogenic infection.

27
Q

Sequalea of Infection Treatement.

A

1, Prevention:

  • Immunizations
    2. Anti-Infective Therapy:
  • Antibiotics and antifungal
    3. Immunomodulation:
  • Supplemental immune agents (Immune Globulin, Cytokines: interferons and interleukins)
    4. Surgery
  • Removal of infected tissue
  • Wound debridement and drainage
28
Q

Sepsis.

A

Sepsis occurs when your body’s immune system starts to send infection-fighting chemicals throughout the body rather than just to the infection itself. These chemicals cause inflammation and start to attack the healthy tissues. The body is no longer fighting the infection, it’s fighting itself.

29
Q

Effects of Sepsis.

A

-lowered blood pressure
-Decreased perfusion
_Decreased oxygenation
-Organ failure

30
Q

Signs of Sepsis.

A

When it comes to sepsis remember it’s all bout TIME!
T: temperature- high or low?
I: Infection
M: mental decline- confused, sleepy?
E: extremely Ill: severe pain, discomfort, shortness of breath, parlour

31
Q

Septic Shock.

A

Presence of hypotension & organ hypoperfusion’ in a septic patient. If you develop septic shock, this means your blood pressure has gotten dangerously low, also making it hard for your blood to reach throughout your body.

32
Q

Pathological Sequelae of septic shock.

A

Hypotension- Hypoxemia- Hypoxia- Overall Ischemia

33
Q

Distributive Shock.

A

Distributive shock as a result of sepsis occurs due to a dysregulated immune response to infection that leads to systemic cytokine release and results in vasodilation and fluid leak from capillaries.
- In distributive shock, systemic vasodilation leads to decreased blood flow to the brain, heart, and kidneys damaging vital organs.

34
Q

Side Effects of Excess Inflammation.

A
  • Overwhelming inflammatory response
  • Vasodilation
  • Fluid Shift
35
Q

3 Types of Distributive Shock.

A
  1. Septic (response to a pathogen)
  2. Anaphylactic (response to an allergen)
  3. Neurogenic (response to an injury)
36
Q

Treatment for Septic Shock.

A

EMPIRIC ANTIMICROBIAL THERAPY!

37
Q

Treatment Sequeleae for Septic Shock.

A
  • Antimicrobial Therapy (empiric or Focal)
  • Fluid Resuscitation: 500ml bolus
  • Adrenergics (norepinephrine, dopamine, dobutamine)
  • O2 therapy
  • Surgery (if necessary)
  • PRN analgesics
38
Q

What complications are Associated with Sepsis?

A
  1. Renal failure
  2. Metabolic Acidosis
  3. GI Ischemia
  4. Hyperglycemia
  5. Disseminated Intravascular Coagulation (DIC)
  6. Fever
39
Q

How deos Sepsis Cause Renal failure?

A

The hypotension (low blood pressure) caused by sepsis will also result in a decrease of perfusion to important organs such as the kidney. The lack of perfusion will result in renal ischemia.

40
Q

Signs and Symptoms of Renal Failure.

A

Oliguria. (urine output less than 400mL a day)

41
Q

Treatment for renal Failure.

A

Catecholamines (in low doses), and fluid resuscitation

42
Q

How does Sepsis Cause Metabolic Acidosis?

A

The inadequate perfusion caused by sepsis causes inadequate oxygenation. Allowing the body to switch to anaerobic respiration which allows an increase of lactic acid (the byproduct of the respiration without oxygen). The increased level of lactic acid cause cellular acidosis

43
Q

Treatment for metabolic acidosis.

A
  • Tx of the underlying cause (e.g. infection)
  • Optimize oxygenation & ventilation (increase ventilation to decrease CO2)
  • Check electrolytes (Hyperkalemia d/t potassium shift from cells)
  • Sodium bicarbonate
44
Q

How does Sepsis Cause GI Ichemia?

A

The lack of blood flow further impacts other organs such as the stomach and small intestines! The inadequate blood flow inhibits the function which causes mucosal vasoconstriction

45
Q

How to Treat GI ischemia.

A
  • NG tube in order to preserve the function of the stomach and intestines and provide nutrients
  • PPIs, H2 receptor antagonists to decrease acidity
  • Antiemetics
46
Q

How does Sepsis Cause Hyperglycemia?

A

Caused by tissue hypoxia which leads to decreased cellular metabolism and transport of nutrients and glucose to cells. Therefore there is an elevated amount of glucose within the bloodstream
- Stress due to the infection will also induce hyperglycemia due to the release of catecholamines and cortisol! (These stimulate hepatic glucose production)

47
Q

How to treat Hyperglycemia.

A

Insulin via IV, enteral nutrition

48
Q

Why is parenteral not used as treatment for hyperglycemia caused by sepsis?

A

parenteral causes further fluid shift!

49
Q

How does sepsis cause DIC?

A

DIC= Acute coagulation followed by bleeding!!!! there is over coagulation! The tissue injury triggers the coagulation cascade and promotes inflammation! The inflammatory mediators will increase and cause an overwhelming trigger to coagulation paired with other complications (such a decreased organ function)!

1st: there is widespread coagulation, Many inflammatory mediators will be used and ultimately cause a depletion in these mediators after a period of time!
2nd: The depletion of platelets and clotting factors increase the risk of bleeding and increased vascular fibrin deposits which can lead to ischemia and organ hypoperfusion!

50
Q

How to treat DIC?

A

Anticoagulants (to inhibit thrombin) and administering blood and blood products (such as, whole blood, platelets and vitamin K)

Pharmacology (27 decks)

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