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Abx Flashcards

1
Q

Indirect pathogen spread

A

pathogen spread to person from a contaminated object

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2
Q

Exotoxins

A

proteins released by bacteria that inactivate or kill host cells

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3
Q

Endotoxins

A

– non-protein released from cell wall of Gram-negative bacteria that elicit immune responses
Cause macrophages to release cytokines

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4
Q

Pathogen Ability to evade host defenses

A

Capsules to prevent phagocytosis
Antigenic shift and drift to avoid detection by immune system
- changing how they look

Inducing endocytosis to hide certain bacteria in host cells
Resistance to anti-infective medications

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5
Q

Resistance to anti-infective meds occurs by

A

Pathogen modifies drug target site
Pathogen modifies uptake of drug by altering its capsule, cell wall or membrane
Pathogen inactivates drug

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6
Q

If bacteria stain purple they are

A

Gram positive

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7
Q

If the stain is red or pink the bacteria is

A

Gram negative

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8
Q

Bacteria classed by

A

Staining property
Shape
Ability to use O2

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9
Q

Which bacteria are easier to klil based on O2 requiredments

A

Anearobic

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10
Q

Promotion of resistance occurs by

A

Bacteria change physiology to become resistant by:
Replicating rapidly
Mutating spontaneously and randomly
Acquiring resistance and promoting resistance to other bacteria via conjugation
Transfer of small pieces of DNA called plasmids that contain resistance promoting gene

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11
Q

Mechanism of anti-infectives are

A

Bacteriocidal
Bacteriostatic

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12
Q

Four main sources for spreading of HAIs

A

Patient flora in skin, lungs, urinary tract

Invasive devices such as catheters and endoscopes

Medical personnel – pathogens are spread by healthcare workers

Medical environment – pathogens can survive outside of host environment; spread on clothing

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13
Q

Vancomycin-resistant enterococci (VRE)

A

Found in wounds and pressure ulcers in hospitals and nursing homes
Patients with weakened immune systems at most risk

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13
Q

Methicillin-resistant Staphylococcus aureus (MRSA)

A

Resistant to certain antibiotics
At least 60% of MRSA infections resistant to penicillin
Most often acquired in hospital
Usually occurs in patients with weakened immune systems
Therapy options are limited.

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14
Q

Guidelines for Antibiotic Therapy (1 of 2)

A

Where possible, use (C&S) testing to identify the organism, and then the appropriate antibiotic

If not possible to do C&S, begin with a broad spectrum antibiotic then use a narrow-spectrum antibiotic

Broad spectrum are effective against many types of bacteria but affect host flora

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15
Q

If infection caused by one microbe, treat-ment with _______ is usually best

A

a single drug

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16
Q

Combining antibiotics can _________

A

decrease their effectiveness and promote resistant strains

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17
Q

Patient factors affect choice of anti-infective.

A

Host defenses and immune system status
Local tissue conditions – for some infections, it is difficult to get a therapeutic concentration to site of infection
Allergy history and drug hypersensitivity
Pregnancy, age, genetics

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18
Q

Superinfections

A

(secondary infections) develop when host flora is damaged by antibiotic as nutrients and space become available for pathogens to grow

Host flora being in competition with each other for space and nutrients is called microbial antagonism

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19
Q

Broad spectrum abx are more likely to cause

A

Broad spectrum antibiotics are more likely to cause superinfections

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20
Q

B Lactam Abx

A

Breaks down peptogylyvan molecules in cell walls of bacteria, allowing fluid to enter causing cell lysis and death.

  • Penicillin, cephalosporins, carapenems
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21
Q

Tetracycline, macrolides

A

Bacteriostatic, inhibit protein synthesis

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22
Q

Flourquinolones, macrolides,

A

Prevent DNA replication of pathogens

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23
Q

Sulphonamides action

A

Inhibit DNA replication due to inhibition of folate

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24
Vancomyocin action
Inhibit cell wall synth damaging cell wall allowing fluid to enter and cause lysis of cell
25
For acute infections choosing the wrong antibiotic for just a few days even hours can lead to
a poor prognosis or death.
26
For the correct antibiotic to be chosen you need to know the ________ ________.
Causative agent
27
How do we find the causative agent?
Specimens
28
How do we then determine the most effective antibiotic?
Culture and sensitivity test
29
If infection is severe treatment is usually started with a ________ ________ antibiotic.
Broad spectrum
30
B-lactam abx most effective against what kind of pathogens
G+
31
How do bacteria become resistant against peniciliin
They mutate so they lack the penicillin-binding proteins that are the target of penicillin's They secrete an enzyme (penicillinase or beta-lactamase) that splits penicillin's beta-lactam ring, often in response to penicillin
32
Penicillins
Mostly effect G+ Narrow spectrum Wide distribution except CNS (CSF) Short half life Extended Spectrum have an additional advantage (Pseudomonas Aeruginosa) next slide
33
Adverse effects of Penicillin
N/V/D Most serious Anaphylaxis
34
Piperacillin/Tazobaxtam (Piptaz)
 Antibiotic piperacillin and the β-lactamase inhibitor tazobactam. The combination has activity against many Gram-positive and Gram-negative bacteria. Those who are allergic to another β-lactam are more likely to be allergic to piperacillin/tazobactam.
35
Abx associated pseudomembranous colitis
A serious super infection caused by c-difficile secreting a toxin that causes severe inflammation of the bowel followed by necrosis. Can be life threatenin
36
Cephalosporins
Largest abx classs Primaryly for G+ and some G- Broad spectrum Can be toxic to kidneys Beta lactam
37
Ceftriaxone
Broad spectrum Beta lactam abx Mainly used to treat harder to treat infections
38
Ceftriaxone used for
Bacterial endocarditis (an infection of the heart) Bacterial meningitis (inflammation of tissues surrounding the brain and spinal cord) Bacterial otitis media (middle ear infection) Bacterial sepsis (a severe immune overreaction to infection) Bacterial skin infection Bacterial urinary tract infections Bone and joint infections Community-acquired pneumonia
39
SJS
Life threatening rash that can progress into toxic epidermal necrolysis which causes skin to slough off
40
Cephalosporin Prototype Drug Cefotaxime
Broad spectrum activity against G- Can cause rash, diarreah, pain at injection sites, anaphylaxis, and seizure
41
Carbapenems
Broad-spectrum antibiotics with similar properties to other beta-lactam antibiotics (they are resistant to beta lactamase) Better activiity against seriious G- multidrgu resist infections The Big Guns Must be given IV Ex. Meropenem
42
Tetracyclines
One of the broadest spectrum of any class of abx Bacteriostatic Decrease effectiveness of Birth control
43
Tetracyclines adversities
SHould be taken on empty stomach Often remain in GI tract killing normal flora producing diarrhea Can be hepatotoxic Do not take with Ca and Iron products Discolouration of teeth N/V/D, epigastric burning Phtosenesitivy
44
Macrolides
Most effective against Gram-positive bacteria Alternative drugs for patients allergic to penicillin Generally well tolerated and safe Bacteriostatic in low doses, can bacteriocidal in high doses Most adverse effects are GI related
45
Mech of Erythromycin
Inhibits protein synthesis Considered bacteriostatic, but may be bacteriocidal in high doses
46
Adverse effects of macrolide
Hepatotoxicity Anaphylaxis Otoxicity (hearing loss, vertigo, dizziness) Cardiotoxicity
47
Azithromycin
Newer macrolide Causes less GI irritation Longer half life so? More expensive but brief duration of therapy thought to increase client adherence
48
Aminoglycosides
Only given IV Bactericidal VERY poorly absorbed PO
49
Certain tissues bind Aminoglycosides tightly, renal excretion may be prolonged for up to 20 days after discontinuation, serum drug levels may fall but they still may exhibit minimal antibiotic activity. This is called the
Post abx effect
50
Aminoglycoside waht spectrum
Broad Can be used in meningitis
51
Aminoglycoside adverse effects
NVD Serious adverse effects Ototoxicity Nephrotoxicity Neuromuscular blockage Neurotoxicity
52
Fluoroquinolones
Fluoroquinolones work by preventing DNA replication, bactericidal G- action with some G+ Favorable safety profile NVD common side effect Can also affect CNS (Dizziness, headache,s and sleep disturbances)
53
Ciprofloxacin (Fluroquinolone)
Prevents DNA replication Rapidly absorbed after oral administration Caffiene to be avoided May increase effect of Warfarin
54
Ciprofloxacin most often used for
UTIs
55
Sulfonamides
Broad spectrum Adverse effects include formation of crystals in urine, hypersensitivitys rxns etc
56
Sulfonamides use for
UTI prophylaxis and UTI
57
Vancomycin
Adverse effects: Red man syndrome (Flushing, HOTN, tachycardia, rash) in upper body
58
What causes red man syndrome
Vancomycin administered IV too quickly, treated with Benydril
59
Nursing consideration when administer abx IV
Monitor for 30 minutes closely for rxn
60
Monitoring for clients on abx therapy
Monitor for severe diarrhea (indicating possible superinfection, or pseudomembranous colitis) Monitor intake of OTC drugs that may affect absorption of antibiotics (antacids, Ca and Mg supplements, Fe supplements) Determine possible drug interactions Monitor for adverse effects specific to each antibiotic drug class Monitor for signs of photosensitivity, ototoxicity, nephrotoxicity associated with specific antibiotic drug classes Monitor IV sites for……… Monitor compliance of patient with drug administration schedule
61
Pharmacotherapy for UTIs
Sulfonamides Fluoroquinolones Given PO, only reach effective conc in kidneys
62
Nitrofurantoin adverse effects
Adverse effects Hypersense rxn N/V, Diarrhea Headache Rash Serious adverse effects Hepatotoxicity Acute and chronic pulmonary toxicity
63
TB
Tuberculosis caused by Mycobacterium tuberculosis, spread via airborne droplets Immune system response leads to formation of tubercles in lungs that surround mycobacteria (visible on x-ray) In healthy person, mycobacteria remain dormant, person is asymptomatic If immunocomprimised infection becomes active
64
Two major goals of therapy of TB
Eliminate all tubercle mycobacteria Avoid emergence of resistant strains
65
DOT
Directly observed therapuy - must watch pt take meds
66
It is ESSENTIAL to obtain cultures from appropriate sites _____ beginning antibiotic therapy:
BEFORE
67

NURS200 (30 decks)

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