Bacterial, Fungal & Viral Infections Flashcards Preview

Pharmocology > Bacterial, Fungal & Viral Infections > Flashcards

Flashcards in Bacterial, Fungal & Viral Infections Deck (47):
1

Gram-Negative

Contain endospores
Have "protection" against antibiotics

2

Bacterialcidal

Kill bacteria

3

Bacteriostatic

Low growth of bacteria, allowing body's natural defenses to eliminate the organism

4

Antibiotic resistance

Mutations the develop during bacterial cell growth may increase its ability to survive in harsher conditions (superbugs). Antibiotics used to cure the bacterial infection are ineffective.

*antibiotics kill good bacteria too which allow for resistant bacteria to grow, take over and give their resistance to other bacteria

5

MRSA

Methicillin resistant staphylococcus

6

VRE

Vancomycin resistant enterococcus

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CRE

Carbapenem resistant enterobacteriaceae

8

MDRO

Multi drug resistant organisms

9

Antibiograms

An antibiogram is generate by a hospital of healthcare system and summarizes antibiotic susceptibility of specific organisms. Think helps providers choose appropriate antibiotic therapy and monitor trends in resistance.

10

Use of antibiotics

Must have evidence of bacterial infection
OR
Prophylactically for immunocompromised clients

11

Broad spectrum antibiotics

Used if the organism is unknown as they are effective against a wide variety.
Once culture results come back, plectrum of antibiotics is narrowed

12

Pan culture

Culture everything! Sputum, stool, blood, urine, etc

13

Penicillins (PCN)C

Beta lactate ring is responsible for antibacterial activity
Certain bacteria produce an enzyme (betalactamase) that splits the ring, rendering the penicillin ineffective
Certain penicillin or drug combos inhibit the betalactamse enzyme, protecting them from destruction.
EXAMPLES: piperacillin/tazebactam (Zosyn), amoxicillin/clavulanate (Augmentin)
Other ex: amoxicillin, ampicillin, naficillin, oxacillin
END IN CILLIN

14

Penicillin G potassium

Thera: Anitbiotic
Pharm: cell wall inhibitor/penicillin
Indications: streptococcus, pneumococcus and staphylococcus; gonorrhea, syphilis, etc
MOA: inhibits cell wall synth having a bactericidial effect
Adverse: diarrhea, N/C, anaphylaxis, superinfection, pain at injection
Implications: Can be IM or IV (penicillin V is given PO), may decrease effectiveness or oral contraceptives. Observe client for 20 minutes of IM. Allergy to one penicillin increases risk of allergy to other penicillins (may have cross sensitivity to cephalosporins)

15

Cephalosporins

Largest class of antibiotics
Bactericidal
Contain beta lactate ring
5 generations that differ in susceptibility patterns and distance to beta lactamases
EX: cefazolin, cephalexin, cefuroxime, cefeime, ceftaroline, ceftriaxone
START WITH CEF

16

Cefotaxime

Thera: Antibiotic
Pharm: cephalosporin (3rd generation)
Indications: serious infection (resp, urinary, CNV, skin, bone, blood)
Adverse: diarrhea, N/V, anaphylaxis, superinfection, pain at injection site
Implications: Given IM or IV. Avoid alcohol, take entire course of meds

17

Tetracyclines

Bacteriostatic
Limited use - many resistant strains
Adverse: diarrhea, N/V, photosensitivity, superinfections (vaginal, oral, intestinal)
NUrsing Imp: decreases effectiveness of oral contraceptives, preg catergory D, do not take with milk, do not use with children (discolor teeth)
Examples: doxycycline, mini cyclone, tetracycline, tigecycline
ENDS CYCLINE

18

Macrolides

Bactericida or bacteriostatic - depends on dose or organism inhibit bacterial proving synth
Often used for infections resistant to penicillin
Examples: azithromycin, clarithromycin, erythromycin, NOT vanco

19

Azithromycin (Zithromax)

Thera: antibiotic
Pharm: protein synth inhibitor/macrolide
Indications: resp infection, gonorrhea, otitis media, sinusitis
MOA: Interferes with protein synth
Adverse: Diarrhea, N/V, prolonged QT interval on ECG, increased liver enzymes
IMplications: may receive loading doses on day 1, long half life (short duration if therapy) May improve compliance

20

Aminoglycosides

Bactericidal
Indicated in serious aerobic gram negative infections
Often used in combo with other antibiotics
Toxicity if a concern! (Ototoxicity and nephrotoxicity) - MONITOR DRUG LEVELS. Nephrotoxicity is usually reversible
Ex: amikacin, gentamicin, neomycin, tobramycin

21

Fluoroquinolones

Bactericidal
Broad spectrum
4 generations of Fluor (newer less toxic)

22

Tiprofloxacin (Cipro)

Thera: Antibiotic
Pharm: fluoroqinolone
Indications:
MOA; inhibits bacterial DNA synth, more effective against gram neg
Adverse: Diarrhea, N/V, headache, tendonisitis/tendon rupture
Implications: DO NOT take with antacids, vitamins or minierals, increases anticoagulant effect of warfrin

23

Sulfa Drugs

Bacteriostatic
Broad spectrum
EX: silver sulfadiazine, trimethoprim sulfamethoxazole (Bactrim)

24

Trimethoprim-sulfamethoxazole
Bactrim

Thera: antibiotic
Pharm: folic acid inhibitor, sulfonamide
Indications: UTI, bronchitis, otitis media, pneumocystis carinii pneumonia (PCP/PJP)
MOA: Inhibits bacterial DNA synth, more effective against gram neg
Adverse: N/V, hypersensitivity/allergy, Stevens JOhnson syndrome, hyperkalemia
Implications: Use caution with preexisting renal disease, maintain adequate hydration to prevent crystalluria, increases anticoagulant effect with warfrin, when giving IV only infuse through D5W

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Other Antibiotics

Vancomycin: effective against gram positive organisms (staph, strep, MRSA). C.diff infection. Nephrotoxicity, ototoxic, red man syndrome. Patients may be on two different routes
Linezolid: MRSA
Daptomycin: serious skin and soft tissue infections
Imipenem, meropenem (carbapenems)

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Red man syndrome

Upper chest rash but not a true allergic reaction
Need to slow down infusion rate of vancomycin
Sometimes need to administer Benadryl
NEED TO TELL NEXT NURSE

27

Tuberculosis

Mycobacterium tuberculosis
25% of the worlds population has latent TB (infected but not ill)
Worldwide leading cause of death for HIV+
Typically affect lungs but can be found in other tissues (tubercles found in apex)

28

Tuberculosis treatment

First line: ethambutol (N/V), isoniazid (paresthesias, neurotoxicity, hepatotoxicity), pyrazinamide (gout/Uris acid), rifampin (N/V, gastric pain, orange discoloration of body fluids)

Typically on all these drugs for 6-12 months

29

2 phases of tuberculosis treatment

Initial phase: 2 months of all four drugs

Continuous phase: 4 months of isoniazid and rifampin

Multi drug resistant infections are common

30

Tuberculosis Factors to poor compliance

- Money and resources
- Drug administration
-

31

Fungi Types

Mushrooms
Yeast - Candida albicans is responsible for majority of human fungal infections. Histoplasma capsulatum
Molds - Aspergillus, Penumocytis jiroveci

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Fungal infections

Most common route of exposure are inhalation and comtaminged soil.
Infection can be:
Superficial: scalp skin nail mucous mem
Systemic: Spread throughout systems of the body
The immunocompromised are most at risk for serious consequences related to fungal incearions
Opportunist infection occurs because the immune system is weakened

33

Superficial infections

May. Occurs in anyone
Most often treated with topical medications (torches are sucked on)
Occasionally oral medication may be required for deep skin or nail infections

34

Nystatin

Thera topical antifungal
Pharm: Polyene
Indication: vagina, skin or mouth candida infection
MOA; break down fungal cell membrane
Adverse: minor skin irritation, given orally (swish and swallow) may cause N/V diarrhea
Implications: Do not easy or drink for 30 min after using "swish and swallow" Nystatin powder is best for moist areas. WIth vaginal infection abstain from intercourse until treatment if complete.

35

Systemic Infections

More common in immunocompromised
Often life threatening
Requires more prolonged course of treatment
Common systemic antifungals
-anole drugs
-amphotericin B
-capsofungin
-micafungin

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Fluconazole (Diflucan)

Thera: Systemic antifungal
Pharm: Triazole
Indications: Candida infection, crytoccal infection
MOA: inhibits fungal sterol synthesis
Adverse:N/V, headache, rash
Implications: IV or PO, Fluconazloe and other anoles are tetragenoic

37

Amphotericin B (ambisome)

Thera: Systemic anti fungal (big guns)
Pharm: Polyene
Indications: effective against must fungi, for sever infections
MOA: breakdown of fungal cell membrane
Adverse: Fever and chills (common), nephrotoxicity, hypokalemia, N/V, diarrhea
Implications: Given IV (not absorbed from GI tract). Irritating to veins. Topical formulation for superficial infections. Liposomal formulations avail to decrease toxicity, Avoid concurrent use with other meds which can impair renal function (aminoglycosides, vancomycin, furosemide). START WITH TEST DOSE. May require premedication to decrease adverse effects (Tylenol, Benadryl, corticosteroids, fluid bolus)

38

Viral Infections

Difficult to treat: rapid mutation of viruses renders drugs ineffective. Symptoms often appear after most of the virus particles have replicated

Antiviral are often specific to the treatment of specific viruses.

39

Goals of therapy for viral infections

Prevent viral infections
Treat active infection
Boost immune system to keep viruses in latent state

40

Influenza

Flue season Oct-May
70-85% of influenza deaths are in those >65 yo
Effects very young too
Influenza vaccine causes body to produce antibodies again certain strains of the virus
Influenza antiviral drugs are an important adjunct to the vaccine and can be used to treat old prevent the disease
Early treatment with antiviral drugs can shorten duration of illness and reduce death in hospitalized

41

Oseltamivir (Tamiflu)

Thera: antiviral
Pharm: Neuraminidase Inhibitor
Indications: Flu A and B and prophylaxis
MOA; Inhibits flu virus neuraminidase which affect viral particle release
Adverse: N/V, diarrhea. Young people get neurological effects (confusion and seizure)
Implications: best if given within 48 hours of symptom onset. May prevent infection if given prior to exposure. Decrease nausea if given with food.

42

Herpesvirus Infections

HSV 1: eye mouth lips
HSV 2: genital
Cytomegalovirus (CMV): multiple body systems, usually seen in immunocompromised
Varicella Zosters: chickenpox (varicella) and shingles (zoster)
Epstein-Barr: mono and Burkitts lymphoma

43

Acyclovir (Zovirax)

Thera: antiviral
Pharmacy: nucleoside analog
Indications: HSV 1,2, prophylaxis treatment of acute infections
MOA; decreased durations and severity of episode by hibiting viral DNA synthesis. DOES NOT cure and no effect on virus in latent phase
Adverse: N/V,diarrhea, headache, irritation of blood vessels
Implications: topical, IV or PO

44

HIV/AIDS Goals

Cellular immune deficiency chara by the depletion of helper T cells (CD4). The loss of DC4 cells results in the development of opportunistic infections and neoplastic processes (cancer)
Goals Phram:
Prolong survival
Improve quality of life
Preserve immune function
Suppress viral load
Prevent maternal-child transmission

45

HIV/AIDS Infno

Typicall starts when CD4 count is <350 or when AIDS related illness is identified
Once antiretroviral therapy for HIV is started it continues for life

46

HIV/AIDS
HAART Therapy

Standard Treatment (combo 3-4 drugs)
Antiretroviral drug classes
1. Nucleoside and Nucleotide Reverse Transcriptase Inhibitors
2. Non-nucleosides Reverse Transcriptase Inhibitors
3. Entry inhibitors
4. Integrate Inhibitors
5. Fusion Inhibitors

47

Adverse effects to HAART Therapy

Lipid abnormalities
Hepatotoxicity
Neuropathy
Osteoporosis
Cardiovascular disease