immunity Flashcards
(120 cards)
1
Q
classification of organsmims
A
bacteria, viruses, fungu, protozoa (parasitic worms), helminths (parasites)
2
Q
Bacteria cell walss
A
rigis
made of complecx macromolecules
high osmotic pressure inside of cell
relies on cell wall to keep water out
w/o cell wall, would take on water, swell, and burst
3
Q
difference between gram neg/pos bacteria
A
neg have a thinner peptidoglycan layer and additional outer membrane
4
Q
bacteriostatic drugs
A
inhibit bacteria
decrease growth/ production of the bacteria and thje immune system taked over
not great for immunocompromised
effect reversible wone drug is removed
does not kill bacteria
5
Q
bactericidal durgs
A
kills the organism
first choice of antibiotics
harder on kidneys
6
Q
narrow spectrum
A
affect only a few bacterial types
limits adverse effects like superinfections
7
Q
broad spectrum antibiotics
A
affect many bacteria
high pontential to cuase superinfections
altenative is combo therapy
8
Q
culture
A
the identitiy of the microbe
9
Q
sensitivity
A
the best therapeutic antibiotis
10
Q
when would a culture and sensitivity be taken
A
with signs of infection: fever, swelling, high WBCs, cloudy/sediment urine, green yellow sputum
11
Q
combo therapy advantages
A
trat an infection that is caused by more than one pathogen
used to prevent resistant microbes from developing
enhances antibacterial action
12
Q
combo therapy disadvantages
A
increased risk for toxic/ allergic reaction
for superinfection
for developing resistance
13
Q
prphylactic antibiotic use
A
when expose to a pathogen, immunocompromised, pre op
14
Q
empiric antibiotic use
A
when a diagnosis of infection is made, by pathogen is not identifies
15
Q
Misuse of antibiotics
A
attemtpted treatment of untreatable infections
treatment of fever of unknown origin
imporoper dosage
treatment in abscene of adequate bacteriologic information
16
Q
antibiotic resistance
A
when germs develop ability to defeat antibiotics desighned to kill them
17
Q
common antibiotic resistant infections
A
MRSA, VRE, Penmiccilin resistant streptococcus pneumoniiae, ESBL, C. Diff
18
Q
bacteria mechanisms of resistance
A
production of drug-inactivating enzymes
changes in receptor structure
changes in drug permeation and transport
production of efflux pump
decrease concentration of a drug at its sit of action
development off alternative metabolic pathways
transferring genetic material
inactivate a drug
19
Q
contributing factors if antibiotic resistance
A
overuse of antibiotics
underuse of antibiotis
interuppted or inadeqwuate treatment
type of baccteria
type of infection
use of antibiotics in cattle feed
public demand for antibiotics
20
Q
nosocomial infection
A
healthcare associated infections HAI
21
Q
superinfection
A
new infection that appears during the course of treatment for a primary infections
often cause d by drug resistant microbes, difficult to treat
22
Q
what tens to cause superinfections
A
broadspectrum antibiotica
23
Q
superinfection symptoms
A
diarrhea, bladder pain, painful urination, abnormal vaginal dischargee
24
Q
preventing resistant in hospitalized adults
A
vaccinate
get catheters out
target the pathogen
isolate the pathogen
stay home when sick
access the esperts
emphasize adherence to prescribed antibiotic regimens
HAND WASHING
25
antibiotic stewardship programs
trying to lower inappropriate antibiotic use
Gender, age, infection site, results, kidney function
increasing adherence to prescribed antibiotics
"time outs" withing 48 hrs after initiation
autmoactic stop orders
documentation of dose, dduration ,indication
26
general antibiotic adverse effects
GI irritation- nausea, vomiting, diarrhea
allergic reactions
toxicity like ototoxic or nephrotoxic
superinfections
27
beta lactam
4 atom ring found in some antibiotics essential for antibiotic activity
28
beta lactam antibiotics
PCN, cephalosporins, monobactams, carbapenems
29
beta lactamase
an enzyme produced by bacteria that can break the beta lactam ring and deactivate the antibiotic
30
narrow spectrum (natural) penicillins
gram positive
penicillin G (injection)
penicillin V (oral)
31
aminopenicillins
gram negative
ampicillin
amoxicillin
32
extended spectrum (antipseudomonal pcn)
piperacillin
ticarcillin
33
penicillinase-resistant
methicillin (no longer avialbale
nafcillin
oxacillin
34
PCN beta-lactamase inhibitor combinations
block enzyme from destroying antibiotic
used in conjunction with penecilling
ampicillin + sublactam- unasyn
amoxicillin+ clavulanicacid- augmentin
ticarcilllin + clavulanic acid- Timentin
piperacillin + tazobactam- zosyn
35
penicillinase
resistance developed within 10 years
an enzyme produced by staphylococcus aureuas bacteria that inactivates pencillin
for staph infection must used penmicillinase reseistant PCN
36
penicillin MOa
inhibit cell wall synthesis
binds to PBP inside cell wall and eventually makes cell wall weak
cell wall swells and burst from osmotic pressue
37
penicillin spectrum of action
gram positive
limited gram negative coverage
38
PCN kinetics
som eunstable in acid and cannot begiven orally (PCN G)
widely distibuted in body water
excretes mostly unchanged in urine- need good renal function
rapidly cleared- difficult to maintain therapeutic levels
39
PCN Adverse effects
hypersensitivity
neutopenia
rash
Gi upset due to loss of normal flora: N/V , diarrhea, abdominal pain, gastritis, sore mouth
yeast infectiong (super infections)
pain/ inflammation at injection site
40
PCN caution/ contraindications
contraindicated with allergy
caution with renal, elderly pts
41
PCN drug interactions
aminglycosides: administer 2 hrs apart, inactivate each other
anticoagulants: may prolong bleeding times
Oral contraceptives
tertracyclines
probenecid: prolong PCN levels, sometimes given with PCN G to slow excretiong through kidneys
42
PCN education
allergy, not taking anything that ends with -cillin
wear allergy ID
importance of taking full course of entibiotics
use othe rforms of brith control besides the pill
43
True allergic PCN reactions
antigen/ antibody reactions- rash, itching, hives, periorbital swelling, shortness of breath
44
PCN allergy (general)
with mild reaction: cephalsporin
anaphylaxis- avoid PCN or cephalosporin
45
type of PCN reactions
immedieate- 2-30 min
accelerated- 1-72 hrs
delayed rxn tkakers days to weeks
46
PCN anaphylaxis
larygneal edema
brochoconstriction
severhypotension
47
treating PCN anaphylaxis
stop IV
epinephrine, antihistamine, steroids
respiratory support
maintain BP
48
preventing PCN allergic reaction
Skin testing
49
Monobatams ex.
azetreonam
50
Monobactams
inhibits cell wall synthesis, but only work on gram negatie bacteria
give to PCN allergy pts bc structure is different
IV or Im, checking IV for thrombophlebitis
eliminated by kidney, prolonged half life w/ renal failure
51
carpabenems
imipeenem + cilastatin= primaxin
dirpenem (doribax)
ertapenem (invanz)
meropenem (merrem)
52
carbapenems MOA
inhibit cell wall synthesis
53
carbapenems targets
gram positive
gram negative
anaerobic
resistnat to beta lactamases
54
imipenem kinetics
metabolized by enzyme found in kidneys
always given with cilastatin which inihibits this enzyme and promotes half life on imipenem
55
ertapenem kinitects
high protein boung
no livee metabolims
excreted by kidney
56
meropenem kinetics
little protein binding
no metabolism
renally excreted
57
Carbapenems adverse effects
cross reactivity with PCNs
rash
seizures
diarrhea
N/V
Edema
58
First gen Cephalasporins
cefazolin
cephalexin
59
second gen cephalasporins
cefaclor
cefuoxime
cefoxitin
60
thirs gen cephalasporin
ceftriaxone
ceftazidime
61
fourth gen cephalasporans
cefepime
62
fith gen cephalasporans
ceftaroline
ceftoboprole
63
first gen ceph SOA
gram positive
some gram neg, anaerobic
little resistance to beta lactamase
rarely used
64
second gen ceph SOA
increased gram neg
more beta resistance
rarely used
65
thirs gen ceph SOA
extended gram neg
more beta resistance
penetrate CSF
66
fourth gen ceph SOA
most gram neg coverage
most resistance to beta lactamase
penetrate CSF
67
fith gen ceph SOa
made to target resistant strains
68
Cephalaospirns MOa
similar to penicillins in structure
inhibition of cell wall synthesis, causing weakened wall that will swell and burst
beta lactgam antibiotics
bactericidal
69
cephalasprin kinetics
widely distributed in body water
3rd/4th have good CSf penetration
most excreted uynchanged by kdiney
ceftriaxone excreted hepatically
short helf live
70
cephalasporin adverse effects
hypersensitivity- cross reactivity with PCN 15% of pts
thrombocytopenia
bleeding
thrombephlebitis
rash
GI upset
superinfection due to destruction of normal flora
71
cephalasporuin drug interactions
aminoglycosidea- risk for nephrotoxicity
oral anticoagulents- increased risk of bleeding
probenecid (for gout)- may prolong effects
alcohol w/ first gen- flusshing, SOB, N/V, chest pains, confusion, dizziness,m seizures, headache, tachycardia
72
tricyclic glycopeptide
c- vancomycin
p- vancomycin
73
Vanco MOa
inhibit cell wall synthesis
Bactericidal
74
vanco SOA
for sever infections only
gram positive
Good for MRSA
75
vanco kinetics
not absorbed orally well
renally excreted, but po vanco is excreted in feces
some protein binding
half life 4-6hr, but in elderly/ renal impairment 146hr
give over 1 hr
76
vanco adverse effects
nephrotoxicity
ototoxicity (ears)
red man syndrome
thrombophlebitis
throbocytopenia
allergy
extravasation
used with aminoglycoside to treat methicilliun resistant which increases nephrotocity
77
Vanco cautions
renal pts
pts receiving aminoglycosdie- increases nephrotoxicity
IBD pts w/ Po vanco- increases absorption of vanco, increasing toxicity risk
Elderly: may need monitoring bc decreases renal function may put them ato risk for toxicity
78
vancomycin resistant enterococcus
in wounds anpressure ulcers in hospital sna nursing homes
immunocomprimised at most risk
therapy options limited
enterococcus usually treated with a cobmo like aminoglycoside with a PCN or with a cephalosporin
strains have developen resisitnace to PCN, gentamicin and vanco
79
Tetracyclines
p- tetracycline
doxycycline
minocycline
demeclocycline
80
tetracycline MOa
inhibitions of protein synthesis
bacteriostatic
broad specturm- slow down/ suppresses growth by blocking protein production
81
tetracycline SOA
some gram pos/neg,anaerobes
broad spectrum
82
tetracylcine kinetics
variable live metabolism
renal excretions
given PO on emtoy tomach 75% absdorbed
tends to accumualt in bone (teeth), salivary glands, liver tissues
can be irritating if given IV
83
tetracyclines Adevrse effects
GI upset
tooth discoloration
photosensitivity
decrease effects of oral contraceptivews
superinfections
hepatotoxicity
renal toxicity
84
tetracyline contraindications
allergies
during pregancny and lactation
85
tetracycline caution
children younger than 8 to prevent teeth damage
hepatic/ renal pts
86
tetracycline drug/food interactions
PCN G- decrease effectiveness of PCN G, may need to be increased if on combo
oral contraceptives
antacids and vitamin supplements- forms insulble chelate with aluminum, calcium, iron, magnesium, zinc
calcium
warfarin- increase bleeding time
dont take antacid with other meds
87
tetracycline education
do not give and keep out of reach of children
take on empty stomach and without dairy
take antacids/ OTS that contain miniarl salt at least 2-3 hr post tetracycline
use back up contraceptive if on pill
sunsscreen for increassed photosensitivity
when expired turn into toxic byproducts
88
aminoglycosides
p- gentamicin
amikacin
neomycin
tobramycin
streptomycin
89
aminoglycoside MOA
bind to ribosome and inhibit protein synthesis
bactericidal
90
aminoglycoside SOA
gram neg aerobes only
need oxygen to survie
91
aminogllycoside kinetics
excreted unchanged in kidney
concentrated in kidney (levels can reach 50 times higher than in serum
concentrates in ear
poor oral absorption
92
aminoglycoside adverse effects
renal toxitcity
ototoxicity
neurotoxicity
neuromuscular blockade
93
aminoglycosdie cautions
in pregnancy/ lactation- ototoxic to fetus as well as issues with bones/ teeth
known allergy
renal/hepatic disease
dehydration
myasthesis gravis
pts receiving nephrotoxic and ototoxic drugs
pre-exisitng hearing loss
94
aminglycoside serum levels
dosing: singl elarge dose daily or 2-3 smaller doseas
same dose can createdifferent levels in different pts
peak levels high enough to kill bacteria
trough levels low enough to minimize toxicity
95
aminoglycosides drug interactions
interact with other drugs that are ototoxic, nephrotoxic, and neurotoxic
NSAIDS
Loop diuretics
Cephalasporins
Extended PCNs
96
aminoglycosdies Education
take on empty stomach 1 hr before, 2 hrs post meal
S/S ototoxicity and nephrotoxicity
know how to give eye drops
97
macrolides
p-erythromycin
azithromycin
clarithromycin
98
Macrolides MOA
bind to ribosomes and interfers with protein synthesis
bactericidal or static
99
macrolide SOA
gram po/neg, some anaerobes
100
macrolides kinetics
well absorbed
highly protein bound
azithromycin/ clarithomycin had increased efficacy and duration and are administered once daily
take on empty stoamach
good with pts allergic to PCN
101
macrolides adverse effects
GI upset (c. diff)
hepatotoxicity
QT prolongation and sudden cardiac death
102
Lincosamides
p-clindamycin
lincomycin
103
clincamycin MOA
inhibition of protein synthesis by binding to the ribosome
bacteristatic or cidal depending on concentration or dosage
104
clindamycin SOA
aerobic gram positive
some anaerobic gram negfative
105
clindamycin kinetics
oral absorption varies depening on if food is in stomach
IM: rapid absorption
IV: weithin minutes
highly protein bound
liver metabolism
106
clindamycin adverse effects
rash
GI upset
C.diff diarhhea (black box warning)
decrease some forms of contraception
Dry skin
107
clindamycin contraindicators
pregnancy
allergies to lincosamides
histroy of asthma
hepatic or renal dysfunction
108
fluoroquinolones
p- ciproflaxacin
levofloxacin
moxifloxacin
gemifloxacin
109
quinolones MOa
inhibition of DNA supercoiling
Bactericidal
110
quinolones SOA
gram pos/neg
some anaerobews
111
quinolones Kinetics
extensive liver metabolism
renal excretion
112
quinolones adverse effects
gi upset (small frequent meals to thelp)
rahs
not to be given with children/ pregnancy
joint disease
tendon rupture
photoxicity
113
Quinolones drug interactions
antacids, ceffeine, foo (especially dairy)
procainamide
warfarin
therophylline
sulfonylureas
many others
114
sulfonamides
p-trimethoprim-sulfamethoxaxole
sulfadiazine
silve sulfadiazine for burns
classified by absorption and excretion qualities, ie oral agents readily/ not absdorbed, topicasl agents
115
Sulfonamides MOA
active aginst broad spectrum of microorgansims
suppress bacterial groweth by inhibiting folic acid made by bacteria
will interact with a specfic enzyme needed to make folic acid
bacteriostatic
116
sulfonamides adverse effects
renal damage from crystalluria (drink lots of water/ IV saline)
kernicterus
hypersensitivity reactions
BLood abnormalities
N/V, anorexia
hyperkalemia
117
sulfonamidess drug interactions
enhance effects of oral anticoagulant and increase risk of toxicity
diuretic may cause hyperkalemia and can lower BP
may increase hypoglycemic response
don't use potassium supplements
118
antibiotics lab monitoring
culture an sensitivy
Drug levels: peak/trough
REnal and hepatic function
CBC
119
antibiotci education
take full course
call provider if symptoms dont improve with a few days
S/S allergic reactions
s/s superinfections: discoloration of toungem, fatigue, vaginal discharge
120
probiotics
live bacteria and yeats that are good for the body
available in some foods and supplements
often prescribes with antibiotics
take 2-3 hrs apart from antibiotics
lactobacillus: most common, found in yogurt
bifidobacterium
saccharomyces boulardii
