infection drugs Flashcards
1
Q
what are the types of antibacterials
A
- penicillins
- cephalosporins
- beta lactams
- others
2
Q
penicillin uses
A
treats broad spectrum infections (ear and throat, urinary tract)
Amoxicillin: treats gonorrhea
3
Q
prototype penicillins
A
- amoxicillin
- amoxicillin and clavulanic acid (augmentin)
- piperacillin (zosyn)
4
Q
penicillin action
A
weaken and destroy cell wall by inhibiting enzyme necessary for cell wall formation (transpeptidase) and activates autolysin which opens cell wall during replication. Since human cells dont have cell walls it does not effect human cells therefore is very safe. Works mostly on gram positives
5
Q
penicillin SEs
A
GI: D/N/V
- pseudomembranous colitis due to suprainfection (overgrowth of opertunistic infection)
- can also cause yeast infection
6
Q
penicillin interventions
A
- monitor for GI symptoms
- monitor for pseudomembranous colitis
- bloody stools or watery diarrhea - watch for yeast infections (mouth/vagina)
7
Q
penicillin admin
A
- give at the beginning of meals to decrease GI symptoms and increase absorption
- give with probenecid, if prescribed, to increase therapeutic activity of amoxicillin
8
Q
penicillin teaching
A
- report bloody stools or water diarrhea
- take at the start of meals
- report mouth pain or vaginal burning
9
Q
penicillin contraindications
A
- infectious mononucleosis
2. severe liver disease
10
Q
penicillin interactions
A
- probenecid increases penicillin blood levels
2. tetracyclines may decrease therapeutic effects
11
Q
Cephalosporin uses
A
beta lactam, very similar to penicillin. 1.more active against gram negative
- more resistant to beta-lactamase bacteria
- more able to penetrate CSF to treat infections such as meningitis
12
Q
cephalosporin prototypes
A
1st generation: cephradine
2nd: cefaclor
3rd: ceftriaxone
4th: cefepime
13
Q
cephalosporin action
A
weaken and destroy cell wall by inhibiting the enzyme needed for cell wall formation (transpeptidase) and activates autolysin. Since human cells dont have cell walls it is very safe.
14
Q
cephalosporin SEs
A
- GI:D/N/V
- pseudomembranous colitis
- risk for hemorrhage (only cefotetan)
- risk for thrombophlebitis (IV cephalosporins only)
- can cause a disulfiram (antabuse) like reaction if taken with alcohol
15
Q
cephalosporin interventions
A
- monitor for bloody stools or watery diarrhea
- treat with vancomycin or metronidazole (flagyl) - ask if theyre allergic to a penicillin
- monitor PT, PTT, INR for cefotetan, give vit K if bleeding occurs
- monitor renal function tests
16
Q
cephalosporin teaching
A
- monitor for psuedomembranous colitis
- take right before a meal
- dont take alcohol
17
Q
cephalosporin contraindications
A
1.carnitine deficiency or milk allergy
18
Q
cephalosporin interaction
A
- probenecid increases blood levels
2. IV calcium and ceftriaxone causes a precipitate to form which can cause a PE
19
Q
Monobactams uses
A
a beta lactam that is narrow spectrum. kills gram negative aerobic bacteria
- lower respiratory infections
- UTIs
- abdominal and gynecological infections
20
Q
monobactam prototypes
A
1.aztreonam (azactam)
21
Q
monobactam action
A
inhibit transpeptidase and activates autolysin. Only effective against aerobic gram negative
22
Q
monobactam SEs
A
- thrombophlebitis at IV site
2. suprainfection
23
Q
monobactam interventions
A
- monitor for thrombophlebitis
2. monitor for suprainfections
24
Q
monobactams contraindications
A
1.lactation
25
monobactam interactions
1. incompatible in IV solution with many drugs
| 2. probenecid increases blood levels
26
Carbapenems uses
treats serious infections
27
carbapenem prototype
1. Imipenem with cilastatin (increases half life)
| 2. meropenem
28
carbapenem action
beta lactam antibiotics which inhibit transpeptidase and activates autolysin. Better then penicillin and cephalosporins
29
carbapenems SEs
1. GI: N/V (usually occur with an IV infusion that is too rapid)
2. thrombophelebitis
3. suprainfections
30
carbapenems interventions
1. check for cross alergies with other beta lactams
2. monitor for GI side effects
3. monitor for infiltration
31
Carbapenem teaching
1. report nausea
2. report pain, swelling at redness site
3. report mouth pain, difficulty chewing or swallowing or vaginal pain
32
Carbapenem contraindications
allergy to penicillin. Be cautious if theyre allergic to cephalosporins
33
carbapenem interactions
the other beta lactam antibiotics decrease effect of imipenem
34
Vancomycin uses
does not have a beta lactam ring. Used for
1. MRSA
2. CDIF
3. infection with penicillin allergy
35
vancomycin action
inhibits transpeptidase and activates autolysin
36
vancomycin SEs
1. hypotension and flushing of the face and trunk (red-person syndrome)
- caused by rapid IV infusion due to release of histamine
2. Ototoxicity
- tinnitis
3. nephrotoxicity
4. thrombophlebitis
37
vancomycin interventions
1. watch for red man syndrome
2. monitor hearing
3. monitor kidney
4. monitor for phlebitis
38
Vancomycin admin
give orally only for colitis
| 1.vanco is extremely incompatible with many other drugs
39
vancomycin teaching
1.report flushing, feeling of faintness, hearing loss, or pain/swelling at the IV site
40
vancomycin contraindications
1.allergy to corn products
41
vancomycin interactions
1.metformin may increase risk for lactic acidosis
42
what are the 3 types of antibiotics that inhibit protein synthesis
1. tetracyclines
2. macrolides
3. aminoglycosides
43
tetracycline uses
```
first choice for
1.chlamydia
2.myoplasmal infections
3.rickettsial (typhus and rocky mountain fever)
4.syphilis
5.tetanus
also treats
1.cholera
2.anthrax
3.acne vulgaris (topical form)
4.prevents malaria in quinine resistant parasites
5.promotes growth in cattle
```
44
tetracycline prototype
1. tetracycline
2. doxycycline
3. minocycline
45
tetracycline action
1. inhibit protein synthesis by inhibits tRNA from binding with mRNA at the ribosomal acceptor site
2. bacteriostatic (prevents bacteria from growing)
46
tetracyclines SEs
GI: N/V/D and abdominal pain
1. Liver toxicity (especially if patient is pregnant)
2. suprainfections
3. photosensitivity
4. can discolor the developing teeth of a fetus, infants over 4 months and children under 8 years. (yellow brown stain, sometimes in a stripe pattern, that are not effected by whiteners)
47
tetracyclines interventions
1. give nondairy foods if GI symptoms occur and decrease dose
2. ask if patient is pregnant
3. watch for sun burns
4. liver tests
5. suprainfection
48
tetracyclines admin
1. work best on empty stomach. 1 hr before or 2 hours after meal
2. do not give right before bed
3. give with nondiary food if you cannot give on empty stomach
4. doxycycline can be given with dairy
49
tetracycline teaching
1. avoid calcium containing foods to avoid GI upset and ideally take it on empty stomach
2. avoid giving to children under 8
3. protective clothing
4. keep drug away from light
5. suprainfections
6. liver damage
50
tetracycline contraindications
1. pregnant
2. children under 8
3. serious renal or liver failure
51
tetracyclines interactions
1. decrease effectiveness of oral contraceptives
2. antacids containing calcium, magnesium, aluminum deactivate the drug
3. antidiarrheals containing kaolin, dairy products, iron, zinc decrease absorption
52
macrolides uses
first line for
1. legionnaires
2. whooping cough
3. acute diphtheria
4. some chlamydia infections
5. certain pneumonias
6. ophthalmic ointment used to prevent eye infections in neonates
53
macrolides prototypes
1. erythromycin
| 2. azithromycin
54
macrolides action
1. inhibits rTRNA from binding with mRNA
| 2. bacteriostatic
55
macrolides SEs
1. GI: N/V/D abdominal pain
2. ventricular dysrhythmias caused by prolonged QT
3. ototoxicity
4. suprainfections
56
macrolides interventions
1. monitor GI
2. watch for QT prolongation
3. suprainfection and ototoxicity
57
macrolides admin
1.give on empty stomach
58
macrolides teaching
1. give GI symptoms occur take it with food
2. report heart palpitations
3. suprainfections and hearing loss
59
macrolides contraindications
history of prolonged QT
60
macrolides interactions
1. decreases blood levels of chloramphenicol and clindamycin
2. increases blood levels of digoxin, warfarin, and theophylline
3. grapefruit juice may increase adverse effects
4. drugs that inhibit the enzyme CYP3A4 increase blood levels (verapamil, azole antifungals, protease inhibitors, diltiazem)
61
aminoglycosides uses
1. gram negative
| 2. topically for skin and eye infections
62
aminoglycosides prototypes
gentamicin
2. amikacin (amikin)
3. tobramycin
4. neomycin
63
aminoglycoside action
inhibit tRNA from binding with mRNA.
64
aminoglycosides SEs
1.elevation of trough levels can lead to ototoxicity
-tinnitus, headache, vertigo
(after a dose drug levels rise then fall to trough)
2.nephrotoxicity
-polyuria, protein and casts in urine
65
aminoglycosides interventions
1. ototoxicity
2. monitor peak and trough levels
3. monitor kidney function
66
aminoglycosides admin
1.for ophthalmic drops instruct to hold pressure at inner canthus for 1-2 mins to prevent systemic absorption and keep eyes shut for 1-2 mins to maximize absorption
67
aminoglycosides teaching
1. report tinnitus, headache, vertigo or hearing loss
| 2. report increase output of dilute urine
68
aminoglycoside contrainidcations
1.pregnancy or lactating
69
aminoglycosides interactions
1.vancomycin, ethacrynic acid, furosemide increase risk for ototoxicity
70
drugs that inhibit DNA replication or cell division
Fluoroquinolones
71
Fluoroquinolones uses
1. treat wide range of bacterial infections including severe UTIs
2. prevent anthrax
72
Fluoroquinolones prototypes
1. ciprofloxacin
| 2. floxin
73
Fluoroquinolones action
inhibits DNA replication and cell division by inhibting DNA gyrase and topoisomerase IV(4). They also have a bactericidal effect
74
Fluoroquinolones SEs
1. CNS
- dizziness, headache, confusion in older adults
2. GI N/V/D
3. rupture of achillies tendon (more common if patient is on glucocorticoids)
4. photosensitivity
75
Fluoroquinolones interventions
1. monitor for CNS and GI symptoms
| 2. report tendon pain
76
Fluoroquinolones admin
give antacids, iron or calcium supplements and sucralfate 2 hours after or 6 hours before cipro
77
Fluoroquinolones teaching
1. decrease caffeine intake b/c it can increase CNS symptoms
2. avoid sunlight which can cause a phototoxic reaction which manifests as a severe sunburn. Use SPF 30 which contain zinc oxide. If reaction does occur treat with cold compresses and topical steroids
78
Fluoroquinolones contraindications
tendon pain
79
Fluoroquinolones interactions
1. antacids, iron, calcium, sucralfate decrease oral absorption
2. increases theophylline levels
3. increases warfarin levels
80
what drugs inhibit folic acid synthesis
1. sulfonamides
| 2. urinary tract antiseptics
81
sulfonamides uses
1. UTIs
2. pneumocystis pneumonia
3. shigellosis enteritis (travelers diarrhea)
4. chronic bronchitis (acute phase)
5. acute otitis media in children
82
sulfonamide prototype
1. sulfamethoxazole and trimethoprim (bactrim, septra)
| 2. tripmethoprim (proloprim)
83
sulfonamide action
inhibits folic acid synthesis which is needed for synthesis of DNA, RNA, and cellular proteins. It is also bacteriostatic
84
sulfonamides SEs
1. GI N/V/ anorexia
2. allergic skin reaction
3. thrombocytopenia, leukopenia, anemia
4. suprainfections
5. steven johnson syndrome
85
sulfonamide interventions
1. monitor for GI symptoms
2. monitor CBC
3. suprainfections
86
inital onset of steven johnson syndrome
fever and sore throat. Then painful red to purple skin rash that spreads rapidly. can cause blisters on the skin and inside the mouth.
87
sulfonamide admin
give with 8 oz of water
88
sulfonamide teaching
1. drink atleast 2500 ml of water
2. take with food if you have GI symptoms
3. report rash or hives (frequently cause allergic reactions)
4. report fatigue, pallor, easy bruising, new infections such as sore throat
5. suprainfections
6. warn patients that oral contraceptives will have decrease effectiveness during therapy
89
sulfonamide contraindications
1. decreased kidney or liver function
2. hypersensitivity to sulfites that are preservatives (wines)
3. bone marrow supression
4. patients at risk for megaloblastic anemia (alcoholics, pregnant women, debilitation)
90
sulfonamides interactions
1. may cause a disulfiram type reaction if mixed with alcohol
2. may increase effects of warfarin, phenytoin, tolbutamide
3. increased immunosuppression for patients taking methtrexate
4. reduces effectiveness of oral contraceptives
91
Urinary tract antiseptics uses
1.treat and prevent UTIs
92
urinary tract antiseptics prototypes
1. nitrofurantoin (macrodantin)
| 2. methenamine (Hiprex)
93
urinary tract antiseptics action
intereferes with RNA and DNA producing enzymes. they are bacteriostatic or bactericidal depending on the dose. acidic pH enhances bactericidal effect
94
urinary tract antiseptics SEs
1. GI: N/V/D
2. permanent peripheral neuropathy (common in patients with renal impairment)
3. anemia, macrolytic anemia, thrombocytopenia, neutropenia
4. liquid suspension can cause tooth staining
5. brownish appearance of urine (harmless)
6. respiratory issues
- watch for chills, fever, cough
95
urinary tract antiseptics interventions
1. monitor fo GI symptoms. Give with food to minimize
2. monitor respiratory (d/c if they occur)
3. neuropathy
4. CBC
5. rinse mouth after
96
urinary tract antiseptics admin
rinse mouth after
97
urinary tract antiseptics teaching
1. take with food or milk
2. report numbness, tingling, weakness of extremities
3. report cough
4. report fatigue, easy brusing, reoccuring infections
5. rinse mouth after
98
urinary tract antiseptics contraindications
1. impaired kidney function
2. jaundice from gallbladder disease
3. greater then 38 months of gestation
4. infants less then 1 month old
99
urinary tract antiseptics interactions
1. antacids decrease absorption
| 2. probenecid increases chance of toxicity
100
drugs for TB (antimycobacterials)
1. isoniazid
2. rifampin
3. ethambutol
4. pyrazinamide
101
isoniazid uses
active and latent TB (positive skin test)
102
isoniazid action
interferes with lipid, RNA, and DNA syntehsis in tubercle bacilli. It is bactericidal in higher doses
103
isoniazid SEs
1. GI: N/V/C
2. liver damage including hepatitis and liver failure
3. peripheral neuropathy
- numbness, tingling and pain in hands or feet (Due to b6 deficiency)
4. CNS symptoms
- dizziness, ataxia, seizures, psychotic symptoms
104
isoniazid interventions
1.give with empty stomach
2.monitor GI and CNS
3.monitor liver
4give pyridoxine (B6) for neuropathy
105
isoniazid admin
1. give on empty stomach
| 2. contains crystals therefore warm it to room temperature before using
106
isoniazid teaching
1. take on empty stomach unless you have severe GI symptoms
2. increase fiber and fludis to prevent constipation
3. report jaundice, abdominal pain and unusual fatigue
4. report numbness and tingling and pain in hands or feet
107
isoniazid contraindications
1.liver damage
108
isoniazid interactions
1. alcohol will increase risk for toxicity and adverse reactions and also cause a disulfiram like reaction
2. may cause phenytoin toxicity
3. aluminum antacids decrease absorption
109
Rifampin uses
1. TB
2. preventive therapy for carriers of Neisseria meningitides (causes menigitis) (first line therapy)
3. leprosy
4. Haemophilius influenzae
110
Rifampin action
suppresses protein synthesis by inhibiting action of RNA polymerase
111
rifampin SEs
1. liver toxicity leading to hepatitis
2. red-orange body fluids (harmless)
3. GI: N/V/D/ cramping and abdominal pain
112
rifampin interventions
1. monitor liver enzymes
2. hepatitis
- abdominal pain, fatigue, nausea
3. GI symptoms
113
rifampin admin
give on empty stomach unless GI symptoms are to much
114
rifampin teaching
1. report abdominal pain, nausea, unusual fatigue, jaundice
2. red-orange body fluids
3. may stain contact lenses
4. can decrease the effectiveness of oral contraceptives
115
rifampin contraindications
1. obstructive gallbladder disease
| 2. current meningococcal disease
116
rifampin interactions
1.decreases blood levels of oral contraceptives, and warfarin
117
what drugs are used for parasites
1. metronidazole
| 2. chloroquine
118
metronidazole uses
```
can be used for some bacterial infections
1.Cdif
2.bacterial vaginal infections
Mainly used for protozoal infection
1.intestinal and systemic amebiasis
2.Giardiasis
3.Trichomoniasis
Used with tetracycline and bismuth subsalicylate for H.pylori infections
```
119
metronidazole prototypes
1. metronidazole (flagyl)
2. iodoquinol (yodoxin)
3. Tinidazole (Tindamax)
120
metronidazole action
damages DNA once it is INSIDE the organism interfering with its ability to replicate and also has a bactericidal effect against anaerobic gram negative bacteria and protozoa
121
metronidazole SEs
1. GI: N/V/D metallatic taste
2. CNS: headache, vertigo, ataxia, seizures, peripheral neuropathy
3. darkening of urine (harmless)
4. suprainfection
122
metronidazole interventions
1. monitor for GI and CNS symptoms
- give with food to minimize GI
2. suprainfections
3. stop the drug if patient experiences seizures or neuropathy
123
metronidazole admin
1. give 1-2 hours before meals for best absorption
| 2. slow IV infusion
124
metronidazole teaching
1. take with meal if GI symptoms are really bad
2. dont worry if urine gets dark
3. report mouth or vaginal pain
4. Report cns symptoms
125
metronidazole contraindications
1. Active CNS disease
| 2. severe blood disorder
126
metronidazole interactions
1. disulfiram may cause psychotic reaction
2. phenobarbital decreases blood levels
3. increases lithium levels
127
Chloroquine uses
1. Malaria
2. amebiasis
3. second line for RA and SLE
128
Chloroquine prototypes
1. Chloroquine (aralen)
| 2. Primaquine, quinine (qualaquin)
129
chloroquine action
kills the erythrocytic form of plasmodium.
When bitten by a misquito the parasite travels to the liver and lies dormant until it activates as erythrocytic plasmodium. These invade erythrocytes where they reproduce then cause lysis to the cell.
130
Chloroquine SE
1. Visual problems
| 2. GI : N/V
131
Chloroquine interventions
1. monitor for visual symptoms
| 2. monitor for GI symptoms
132
chloroquine admin
can use prophylatically 1-2 weeks prior to traveling and 4 weeks after leaving
133
chloroquine teaching
1. take with meal to minimize GI
| 2. wear sunglasses to minimize visual effects and report any vision changes immedietly
134
chloroquine contraindications
1.prophyria - a disorder in the production of Hemoglobin
135
chloroquine interactions
1. antacids and laxatives that contain magnesium or aluminium decrease absorption
2. lemon juice decreases effectiveness
