MODULE 2: PATIENTS WITH INFECTIONS Flashcards
Signs of chronic infection
- significant weight loss
- pallor associated with anemia of chronic disease
Signs of acute infection:
fever, chills, lymphademopathy, cough, SOB rash;
close to site = purulent drainage, pain, edema, redness
Risk factors for infection:
immunocompromised, age, nutritional status, medications
Clinical presentation of:
1) Inflammation
2) Infection
1) Redness, swelling, pain, warmth
2) All of above + exudate
Diagnostics r/t infection:
- WBC count
- Differential
- C-Reactive Protein
- Procalcitonin
- Gram stain
- C & S
Significance of Procalcitonin?
Indicator that bacterial infection has entered blood (sepsis)
(produced by C Cells in thyroid, peptide precursor of the hormone calcitonin, which is involved in calcium homeostasis)
How to determine if infection is localized or systemic?
Vital Signs
Check for sepsis - procalcitonin levels
Which population is prone to sepsis from UTI’s?
The elderly
Signs of pneumonia?
- productive cough (yellow/green sputum)
- decreased air entry (around area of infection)
- crackles + wheeze
- inc temp
- inc resps
What procalcitonin level indicates possible sepsis?
> 2 mg/ml
More common side effects of antibiotic therapy?
Nausea Vomiting Diarrhea Nephrotoxicity Hepatic toxicity
Lifespan considerations for antibiotic admin for:
1) Ped’s
2) Elderly
3) Pregnancy
1) Dosages are weight-based
2) Lower dosages
3) Potential to harm fetus/mother
Pregnancy Categories in Drug guide:
A) Can be ordered – no risk to fetus for abnormalities (has been tested with pregnant women with no adverse effects)
B) Yes (no adverse effects on animals in studies and no report of adverse from pregnant women)
C) ?? Not enough adequate controlled studies (unknown)
D) Risk to the fetus (definite) but benefit may outweigh the risks
X) DO NOT USE
3 important lab tests to perform with infection?
WBC Count/Differential
Procalcitonin
Culture + sensitivity (microbiology)
Three components shown by C & S
- the smear + stain
- the cultural and organisms identification
- the antimicrobial susceptibility (ie sensitivity)
2 Anti-inflammatory NSAIDS = ?
ASA (aspirin) + ibuprofen (advil)
What are NSAIDS?
large and chemically diverse group, are analgesic,
anti-inflammatory antiarthritic
antipyretics
- Generally less side effects than steroidal antiinflammatories
NSAIDS taken for?
Pain fever, inflammation (+ rheumatism)
Rheumatism =
general term for disorders characterized by inflm, degeneration, or metabolic derangement of connective tissue structures like joints
Acetaminophen
1) NSAID?
2) Common name?
3) Mechanism of action?
4) Why is it most commonly taken?
1) No
2) Tylenol
3) blocks prostaglandin synthesis; also acts on hypothalamus to lower set point
4) Has least side effects (not associated with bleeding or GI tract irritation, etc. like aspirin)
What is the antipyretic drug choice for children?
Acetaminophen (aspirin = Reye’s syndrom)
Potential side effects of acetaminophen?
rash, nausea, vomiting; blood disorders; hepatotoxicity if acute very high dose 150mg/kg; nephropathy if large amounts over long period of time
Max dose acetaminophen/day?
4000mg
- Note: may go over inadvertently if also on fixed ratio opioid that also includes acetaminophen
Antidote for acetaminophen?
acetylcysteine
– prevents hepatotoxic metabolites of acetaminophen from forming
Most serious interaction for acetaminophen?
Alcohol - inc risk for hepatotoxicity
Is ibuprofen anti-inflammatory?
Yes, unlike Tylenol.
- commonly used for rheumatoid arthritis, osteoarthritis, dental pain, MS disorders
Most common significant side effect of ibuprofen?
BI bleeding
Is ibuprofen suitable for children?
yes
Which drug is has daily dose recommended as prophylactic therapy for those at any risk of CAD or stroke *even with no hx
What dose?
ASA (Aspirin) b/c of anticoagulant properties
81mg = commonly called “children’s aspirin”
Can kids take Aspirin (ASA)?
No
children with flu-like symptoms = Reye’s syndrome; believed to be associated with salicylate therapy in presence of viral illness = neurological deficits + liver damage
Should antibiotics wait to be administered with regular meds?
No, need to be administered as soon as prescibed!
Once an antibioitic therapy has been prescribed, is it likely for it to be changed?
Antibiotic therapy frequently complex and modifications necessary b/c of sensitive test results + disease progression
- Will change as gain more understanding of cause of infection
What is one main factor that guides the choice of antibiotic therapy
Whether bacteria are gram positive or gram negative
What is empirical antibiotic therapy
- admin of antibiotics based on practitioner’s judgment of the pathogens most likely to be causing an apparent infection; involves presumptive treatment of infection to avoid treatment belay, before specific cultural information has been obtained
Prophylactic antibiotic treatment
used to prevent infection; given when likelihood of infect high (such as when entering procedure)
What do you see with therapeutic efficacy?
decrease in signs + symptoms
When and why are pt’s on antibiotics assessed?
-prior to therapy, during + after to evaluate effectiveness, monitor adverse effects, and ensure infection does not recur
What condition would be less likely to show signs + symptoms of infection?
Immunocompromised
If a condition (such as bacterial infection) is “Subtherapeutic”, what does that mean?
- signs and symptoms do not improve
- can result from use of incorrect route of admin, inadequate drainage of an abscess, poor drug penetration to infected area, insufficient serum levels of drug, or bacterial resistance
Antibiotic therapy considered toxic when?
serum levels too high if pt has adverse rxn
Adverse reactions seen with antibiotics?
Rash, iching, hives, fever, chills, joint pain, difficulty breathing, wheezing
GI discomfort and diarrhea common
Do you usually terminate antibiotic use if it is causing GI discomfort and/or diarrhea?
No
What is a superinfection?
Ex?
1) infection occurring during antimicrobial treatment for another infection, resulting from overgrowth of organism not susceptible to antibiotic used OR
2) secondary microbial infection occurs in addition to primary, often because of weakening of pt’s IR by 1st infection
•Can occur when antibiotics reduce or eliminate normal bacterial flora
Ex) yeast infection
Why is “clinical finesse” required when dealing with a superinfection that is bacterial?
What is a sign of bacterial infection developing secondary to a viral infection?
Sometimes primary inf is viral, then sec is bacterial (need to prescribe antibiotics for sec w/o needlessly doing so for first…
→ yellow or green sputum common sign for bacterial inf secondary to viral resp infect
What sort of host factors can have impact on success of antibiotics?
- age
- allergy history
- kidney and liver fx
- pregnancy
- genetic characteristics
- site of infection
- host defenses
4 ways that antibiotics work?
1) Interference with bacterial wall synthesis
2) Interference with protein synthesis
3) Interference with replication of nucleic acids
4) Antimetabolite action that disrupts critical metabolic rxns inside bacterial cell wall
4 ways that viruses enter a host?
1) Inhalation through resp tract
2) Ingestion through GI
3) Transplacentally from mother to infant
4) Inoculation via skin or mucous membranes (sexual contact, blood transfusion, sharing of needles, transplants, animal bites, etc.)
How do antiviral drugs work?
Kills or suppress viruses through either destroying virions (mature viruses) or inhibiting their ability to replicate
Current drugs typically synthetic compounds that work indirectly by inhibiting viral replication – enter host cell and prevent viral nucleic acid formation; or prevent fusion of virus to host cell
What are immunoglobulins?
[ ]’d antibodies that attach + destroy viruses – can be thought of as antivirals but more often are vaccines
Are there many antivirals available?
-Drug Tx available for small amount of viruses, and don’t typically kill the virus completely
Goal for effective treatment of viruses?
Early diagnosis - before virus has had time to take over and mutate (and therefore be less responsive to treatment
Why is treating viruses difficult?
- Drugs must first enter host cell to prevent replication → very difficult w/o destroying much of host cells
- Replicate thousands to millions of times before symptoms appear → early detection key!
Who typically responds best to antivirals?
Those with an intact immune system –> own immune system works in conjunction with antivirals
Are antibiotics typically taken on a empty stomach?
- Some ideally taken empty stomach but can allow small amount of food to help patient tolerate it
Antiretroviral drugs vs viral drugs?
Antiretrovirals = specifically for treatment of infections caused by HIV - fall under broader category of antivirals but mechanisms of action specific to HIV
Lifespan consideration for antibiotic use in children?
Children cannot take certain antibiotics because affects development
- Tetracycline b/c affect developing teeth + bones in infants; cartilage + bones in children
- Fluoroquinolones – bone + cartilage in children
- Sulfonamides – displace bilirubin from albumin and precipitate hyperbilirubinemia in neonates
Lifespan consideration for elderly in antibiotics
Dosage adjustments for reduced kidney + liver fx in older adults
2 common allergies for antibiotics?
Penecillins + sulfonamides
Most common severe allergic reactions to antibiotics?
difficulty breathing, significant rash, hives or other skin rx; sever GI intolerance
