Monica - Week 3 - Exam 1 Flashcards
Stem cells from the bone marrow can differentiate further into which two categories of WBC?
Granulocytes and Agranulocytes
What WBC are considered granulocytes?
Basophils, Eosinophils, and Neutrophils
What WBCs are considered agranulocytes?
Monocytes and Lymphocytes
What type of cells are WBCs?
Disease fighting cells - protect from infections - bodies defense mechanism
What are the normal range for WBCs?
4,500 - 10,000 cell/mct
T/F: all WBC are the same
FALSE. Agranulocytes and Granulocytes
Characteristics of Granulocytes
contain granules within cytoplasm; multi-lobed nuclei - 2-5 segmented lobes connected by strands; appear in the initial stages of infection
What is the role of granulocytes?
To release their granules, which are anti microbial products, to help us kill off those pathogen
What is the most common type of granulocyte?
Neutrophils (50 - 70%), also known as “segs”; MATURE WBCs
What are “bands”?
Another type of neutrophil; horseshoe shape; IMMATURE neutrophils released into circulation during an acute infection
Range of “bands”
0-5%; could be greater if the acute infection is severe enough
What are the ranges of the eosinophil and basophils?
Eosinophils (2-4%)
Basophils (<2%)
What are eosinophils and basophils involved in?
Allergic reactions; they don’t respond to bacterial or viral infections
Characteristics of agranulocytes
contains no granules; mononuclear (one nucleus)
What are the two types of agranulocytes and their ranges?
Lymphocytes (30-40%) and Monocytes (4-8%)
what is the job of neutrophils?
they respond to bacterial infections through phagocytosis - because they have granules with anti-microbial properties
What stimulates neutrophil production?
Acute bacterial infections
T/F: Neutrophils have a short life span.
TRUE. once they engulf a pathogen, they die within 1-2 days.
In the presence of infection, if there is not enough neutrophils to fight infection d/t short life span, they will promote the release of ____?
Bands - immature neutrophils
Neutrophils stimulate the band cell production in acute bacterial infections - secondary force behind neutrophils
What is an increase in band cells called?
“a left shift”
What is the second line of defense in bacterial infections and foreign substances after neutrophils?
monocytes
characteristics of monocytes
slower to respond, but stronger than neutrophils; can transform into macrophages; assist in phagocytosis (ingest bacteria); clean up debris (help healing); longer lifespan
when do monocytes arrive on site?
3-7 days after the onset of inflammation
As macrophages, what do monocytes have the ability to do?
ingest large masses of matter and help clean up dead cells/tissue debri in order to help healing to commence
T/F Because they have a longer shelf life, monocytes are able to stay in places that need healing for weeks.
TRUE
what are the two different types of lymphocytes and which type of immunity are each?
B cells (humoral immunity) and T cells (cell mediated immunity)
what is the job of B cells?
humoral production and secretion of antibody bodies, specific to antigen; prevent the spread of infection; memory cells - remember our antigens and when they encounter again it remembers and sends specific antibodies to attach and destroy the antigen
what is the job of T cells?
recognize and attack foreign substances - upon recognition of something that doesn’t belong, they release
what do T cells release upon recognition of something that doesn’t belong?
they release large amounts of cytokines - cell signaling molecules - “cell to cell communication for immune response” - raise alarm to kill foreign organisms
Cytokines named _____ promote inflammatory response
Interleukins
What type of infections can lymphocytes fight against?
chronic bacterial infections and acute viral infections
C Reactive Protein is present with what?
produced by the liver in response to 0
tissue injury and acute inflammation (runny nose, feeling sick) - in the absence of inflammation, our levels are 0%
When does C Reactive Protein appear and when is the peak??
6 - 10 hr after inflammatory response; peak is 48 - 72 hours
Can C Reactive Protein tell us what kind of inflammation or infection?
No. It is a non-specific inflammatory marker; it tells us when there is an inflammatory response present.
T/F: CRP has also been used as a diagnostic for cardiac disease.
TRUE. CRP has been used to evaluate the risk for cardiac disease or cardiac event. plague formation causes inflammation.
what is a culture and sensitivity diagnostic test?
Culture: identifies the bacteria/pathogen that is making us sick
Sensitivity: identifies what antibiotic/treatment is gong to work on it (antibiotic sensitivity)
When would we want to identify the pathogen ideally?
We would want to identify the pathogen first, prior to antibiotic therapy
What would be the second best ideally?
to collect the specimen even before we started antibiotic therapy - if obtained after therapy has started, might harbor false positive results.
what types of specimens can be collected for C+S?
urine, blood, sputum, stool, wounds
how long does it take to identify the pathogen?
2 - 3 days
How does the lab test which antibiotics the pathogen is susceptible to?
the pathogen is exposed to antibiotic discs on an agar plate
what does the zone of inhibition indicate on a culture plate?
It means that the pathogen is susceptible to the antibiotic - that it will kill the pathogen - the wider the diameter, the more susceptible the antibiotic
What are the 3 different results?
susceptible, intermediate, resistant
what does intermediate mean?
it means it may work but it will require a higher dose in order for the antibiotic to be effective
C+S will also show a MIC. What is a MIC?
minimal inhibitory concentration - lowest concentration of drug that will inhibit the growth of the organism. lower MIC = lower dose; ideal; more effective and less cost to the patient
what is urinalysis used to diagnose?
UTI, kidney function, and metabolic diseases like diabetes
what are the characteristics of urine that indicate infection?
clarity, odor, nitrite, and leukocyte esterase
How does infection affect “clarity”?
infection causes urine to be cloudy, indicating presence bacteria or pus; if collected, quickly take it to lab → if sits, it will become cloudy.
how does infection affect “odor”?
bacteria causes an ammonia-like odor. a sweet syrup odor may indicate congenital metabolic disorder.
how does infection alter “nitrite” results?
Nitrite is used to test for bacteriuria. Increased presence of nitrite forming bacteria yields an abnormal, positive result.
how does infection alter “leukocyte esterase” results?
enzyme present in neutrophils; indicates an infection. leukocytes are increased in bacterial infection, calculus formation, fungal/parasitic infection, glomerulonephritis, interstitial nephritis, or tumor.
If any of these tests come back abnormal or there is RBCs in the urine, what occurs?
a microscopic urine culture. we want to find out what kind of bacteria is in the urine.
T/F: in the ER, they dip their own urine in order to identify it. If + for nitrite, leukocyte esterase, or RBC, it will be sent to the lab. They will also dip it for protein/glucose for DKA.
TRUE
what is gram staining used for?
it is used to categorize the bacteria that is potentially growing; in the lab, they will stain it.
what is gram positive bacteria?
they have a thick cell wall peptidoglycan layer; retains purple color; ex: staphlococcus, streptococcus, enterococcus
what is gram negative bacteria?
they have a THINNER, complex peptidoglycan layer; doesn’t retain purple, has a reddish, pink tone; structure of this bacteria’s cell wall makes it HARDER to treat; drugs → harder time penetrating through capsule
what are the 3 anti-infective principles?
empiric, definitive, and prophylactic
what is empiric therapy?
*aka broad spectrum therapy; is given when pathogen is unknown; when we’re not sure if its gram +/- or anaerobic (GI, Vaginal, cavity)
why do we give empiric therapy?
in an emergency, we don’t want our patient to die; prevent patient from getting more sick; can have more adverse effects ***IMPORTANT TO GET A SPECIMEN BEFORE START OF THERAPY TO ID PATHOGEN
once we find out the C+S results, what is it important that we do and why?
It’s important to start the patient on a narrow spectrum (definitive) antibiotic that is for sure susceptible to the drug. It reduces cost, resistance of antibiotics, and toxicity d/t adverse effects.
what is definitive therapy?
narrow spectrum agent once pathogen has been ID’d
what is prophylactic therapy?
preventative therapy against possible pathogens; narrow spectrum (tissue infection, bone infection) given when infective organism likely to occur in the OR before first incision and surgeries longer than 3 hrs (2nd dose) ex q8hrs for 3 doses
what are the 4 mechanisms that anti-infective fight bacteria?
cell wall synthesis interference, disruption of metabolic reactions, interference of nucleic acid replication, and protein synthesis interference.
how does cell wall interference work? which drugs use this mechanism?
antibiotic will interfere with the creation of the cell wall; it doesn’t allow it to form or become mature and contents leak out; drugs include beta lactams, vancomycin
how does disruption of metabolic reactions work? which drug uses this mechanism?
disruption of metabolic process inside the bacteria - example is folate synthesis, needed for protein synthesis (NA, DNA, amino acids); drug includes sulfonamides
how does interference of nucleic acid replication occur? which drugs use this mechanism?
DNA/RNA inhibition - prevents the replication process of pathogen; drugs include quinolones and Rifampin; Rifampin - tx of TB
how does protein synthesis interference work? what drugs use this mechanism?
affects/interrupts process of RNA transfer, changes the shape of ribosome (protein builders), and interferes with pathogen’s ability to be effective; drugs include macrolides, tetracycline, and aminoglycosides
what is the structure of beta lactams?
beta-lactam RING structure
what do beta-lactams do?
inhibit the peptidoglycan cell wall; ability to stop construction of antigen cell wall, doesn’t allow it to become effective
which two drugs fall into the beta-lactams category?
penicillin and cephalosporins → bactericidal
d/t antibiotic resistance, bacteria can now secrete an enzyme called __________ which ______________
beta-lactamase; hydrolyzes the B-lactam ring in penicillins and celphalosporins → inhibits the anti-infective qualities of the drug
d/t resistance, beta-lactamase inhibitors were created. what are the 3 beta lactamase inhibitors? type of penicillin + a B-L inhibitor
amoxicillin + clavulanic acid (Augmentin), piperacillin + tazobactuam (Zosen), and ampicillin + sulbactam (Unicem)
three characteristics of penicillin
bactericidal;
narrow-spectrum against GRAM + (streptococcal and staphylococcal infections);
can be given prophylactically
what are the indications of penicillin?
pneumonia, gonorrhea, and syphilis strains
what are the adverse effects of penicillin?
CAUTION in patients with hypersensitivity to cephalosporins (same beta lactam ring structure)
should we know what type of reaction the patient had to a penicillin?
YES; if it was severe, like anaphylaxis - dont give
if it was a small rash, etc, we could give and watch for effects.
What is the drug to drug interaction of penicillin
may ↓ effectiveness of oral contraceptives.
how many generations of celphalosporins are there?
5 generations
Celphalosporins have a cross-sensitivity with _____. What does this mean?
Penicillin. This means that it is not recommended for patients with a history of penicillin anaphylaxis. `
3 characteristics of celphalosporins
bactericidal; broad spectrum coverage including gram +/- AND anaerobic; perioperative prophylaxis (3 doses after surgery)
T/F: level of gram negative coverage increases with each successive generation.
TRUE
which generation is effective against MRSA?
the 5th generation
what are the adverse effects of cephalosporins?
Steven-Johnson syndrome, C. Diff associated diarrhea.
what is the sulfonamides combination drug?
trimethoprim/sulfamethoxazole
what spectrum drug is it and what is it’s mechanism? (sulfonamide)
it is a broad spectrum drug (gram+/-) and it works by inhibiting folic acid synthesis within the antigen
what is the sulfamethoxazole part of the combo drug?
a bacteriostatic - stops growth → immune system can take over
what is the trimethoprim part of the combo drug?
bactericidal - kills the pathogen
what are the indications of sulfonamides (trimethoprim/sulfamethoxazole)?
UTI prophylaxis, UTI, bronchitis, otitis media
when is trimethoprim/sulfamethoxazole contraindicated?
pt with megaloblastic anemia because it inhibits folic acid synthesis; contraindicated in pregnancy
what are the adverse effects of trimethoprim/sulfamethoxazole?
S-J syndrome, crystaluria (crystals in urine) → drink lots of water ( 1L -1.5L /day)
what are the drug to drug interactions of trimethoprim/sulfamethoxazole?
may ↑ hypoglycemic and anticoagulant effects, hyperkalemia with concurrent K+ sparing drugs, like spironolactone
what are the 3 characteristics of tetracycline?
broad spectrum (gram +/-) including anaerobic, bacterostatic - stops growth; inhibits protein synthesis prevents the addition of amino acids
what are the indications of tetracycline?
gonorrhea and syphilis treatment for PCN allergic pts; prevent chronic bronchitis exacerbations; acne
what are the adverse effects of tetracycline?
SJ syndrome; photosensitivity - more susceptible to sunburns
what are the drug-food-drug interactions of tetracycline?
dairy, calcium products, and iron supplements reduce absorption by 50% or more; recommended to wait 1-2 hrs b/t to take drug.
what are the two macrolides?
erythromycin and azithromycin
what are the indications of erythromycin?
resp. infections, skin/skin structure infections, pertussis, syphilis or gonorrhea (hypersensitivity to PCN)
how does erythromycin work?
inhibits bacterial protein synthesis; works against strept/staph strains like penicillin
what are the 2 characteristics of azithromycin?
longer half life; short duration of therapy (3-5 days); compared to 10 day tx
what are the indications of azithromycin?
lower and upper respiratory infections like bronchitis and pneumonia
what is the name of the older generation fluroquinolones?
ciprofloxacin (gram - pathogens)
what are the names of the two newer generation fluroquinolones?
levofloxacin and moxifloxacin (gram + pathogens)
what are the indications of fluroquinolones?
UTI, gynecologic infections, respiratory tract infections, skin/skin structure infections, bone/joint infections
- can be given to pt with hypersensitivity to penicillin and cephalosporins
what is the name of the aminoglycoside drug?
gentamicin
what principle does gentamicin fall into? (spectrum)
narrow spectrum reserved for serious systemic infections for patients allergic to penicillin
what are characteristics of vancomycin?
bactericidal; mechanism - disrupt bact. cell wall; active against gram + pathogens; seen for MRSA and septicemia
IV form is given for: _____? what happens if it infiltrates?
septicemia and MRSA - can cause necrosis and extravasation if infiltrates
What is PO Vancomycin used for?
Clostridium difficile - goes to GI tract unlike IV
what are adverse effects of vancomycin only?
red-man syndrome and hypotension if IV quickly infused
what are the adverse effects of both vancomycin and gentamicin?
assess kidney function (renal pt, CKF pt doses ↓) 90% excreted by kidneys (except PO vancomycin - stool) - can cause toxicity;
can cause nephrotoxicity (assess BUN, Creatinine, I+O, GFR; urine pink/cloudy, foster hydration and kidney function) or ototoxicity (hearing loss, ringing ears, can be irreversible00000000000000000000000000)
**if any pain caused by IV, a new IV should be started - midline = ↓ risk of necrosis
Red man syndrome is a result of what ?
massive histamine release when vancomycin given too fast - benedryl as tx
what is a trough?
our way of monitoring how well kidneys are clearing the drug (renal clearance); it is lowest concentration of the drug in the blood stream.
what are 3 ways to prevent infections?
immunizations, hygiene care of catheters, and hand hygiene
what are 3 ways to identify and treat infection?
culturing organisms, limiting use of broad spectrum agents, and patient teaching (finish antibiotics, dont share, dont save for later)
what are 3 ways to prevent nosocomial infections?
hand hygiene, PPE practices (isolation) and prevention of recurrent infections
when should a trough be taken and why?
prior to administering the next dose because it lets us know renal clearance and how therapeutic the drug is (assures therapeutic levels between doses)
what occurs when the trough level is low?
↑ in dose and/or dosing frequency
what occurs when the trough level is high?
↓ in dosage or hold dose until next trough
what are the “ok” trough levels for gentamicin?
trough NTE 2 mcg/ml
what are the “ok” trough levels for vancomycin?
trough NTE 10 mcg/ml mild to moderate infection
sever infections: 15 - 20 mcg/ml
