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infection pharm Flashcards

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1
Q

antimicrobials

A
  • used to treat infectious diseases
    -significantly reduced morbidity and mortality from infection
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2
Q

Antimicrobial agent

A

any agent that can kill or suppress microorganisms

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3
Q

antibiotic

A

chemical produced by one microbe that can harm other microbes

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4
Q

Selective toxicity

A

toxic to microbes but harmless to host
differences in the cellular chemistry of mammals and microbes

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5
Q

Two types of classification of antimicrobials

A
  1. classification by susceptible organism [narrow spectrum or broad spectrum]
  2. classification by mechanisms of action
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6
Q

Classification of antibiotics

A
  1. bactericidal
  2. bacteriostatic
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7
Q

bacteriocidal

A

drugs are directly lethal to bacteria at clinically achievable concentrations

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8
Q

bacteriostatic

A

drugs can slow bacterial growth but do not cause cell death

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9
Q

Classification of antibiotics

A

Drugs work on:
- cell wall synthesis
- cell membrane permeability
- protein synthesis (lethal)
- nonlethal inhibitors of protein synthesis
-synthesis of nucleic acids
-antimetabolites
- viral enzyme inhibitors

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10
Q

acquired resistance to antimicrobial drugs

A
  • over time, organisms develop resistance
    -may have been highly responsive and then become less susceptible to one or more drugs
    [enterococcus faecium, staphylococcus aureus, enterobacter species, klebsiella species, pseudomonas aeruginosa, acinetobacter baumannii, clostridium difficile
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11
Q

Nosocomial infections

A

HAIs

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12
Q

superinfection

A

new infection that appears during the course of treatment for a primary infection
often difficult to treat
Why do they avoid giving antibiotics unless for sure bacterial

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13
Q

How do you delay emergence of drug resistance

A

-promote adherence to appropriate prescribing guidelines
- emphasize adherence to prescribed antibiotic regimens (TAKE WHOLE DOSE)`

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14
Q

Steps in selection of antibiotics

A
  1. identify organism
  2. drug sensitivity of organism
  3. host factors: allergy, inability to penetrate the site of infection, if the patient cannot tolerate
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15
Q

Empiric therapy

A

antibiotic therapy for patients before the causative organism is positively identified [based on clinical evaluation, knowledge of microbes most likely to have caused infection]

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16
Q

Identifying the infectious organism

A
  • match the drug with the bug
  • gram-stained preparation (culture)
  • determining drug susceptibility
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17
Q

Antibiotics must be present:

A

at the site of infection
for a sufficient length of time

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18
Q

prophylactic use of antimicrobials

A

agents given to prevent infection rather than to treat an established infection:
- surgery
- bacterial endocarditis
- neutropenia
- other indications

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19
Q

Misuses of antimicrobial drugs

A

-attempted treatment of viral infections
- treatment of fever of unknown origin
-improper dosage
-omission of surgical drainage
- treatment in the absence of adequate bacteriologic information

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20
Q

Penicillins

A

common allergic reaction drug
active against a variety of bacteria-> structure includes beta-lactam ring-> beta-lactam family [cephalosporins, aztreonam, imipenem, meropenem, and etrapenem]

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21
Q

Penicillin MOA

A

-weaken cell wall, causing bacteria to take up excessive water and rupture
-active ONLY against bacteria undergoing growth and division
-bactericidal (kills cells)
-least toxic of all antibiotics

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22
Q

Examples of broad-spectrum penicillins (aminopenicillins)

A

ampicillin
amoxicillin

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23
Q

extended-spectrum penicillins

A

Antipseudomonal penicillins:
piperacillin
- broad spectrum but penicillinase sensitive
-effective against organisms susceptible to aminopenicillins
& pseudomonas aeruginosa, enterobacter species, proteus (indole +), bacteroides fragilis, many klebsiella

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24
Q

Penicillin combinations

A

beta-lactamase inhibitors
- clavulanic acid, tazobactam, sulbactam

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25
What do penicillin combinations do?
extend antimicrobial spectrum when combined with penicillinase-sensitive antibiotics
26
Examples of penicillin combinations
- ampicillin/ sulbactam [unasyn] - amoxicillin/ clavulanic acid [augmentin] - piperacillin/ tazobactam [zosyn]
27
Drugs that weaken the bacterial cell wall
cephalosporins, carbapenems, vancomycin
28
Cephalosporins
injection/infusion -most widely used group of antibiotics - bata-lactam antibiotics -similar to penicillin structures -bactericidal - given parenterally (poorly absorbed through the GI tract) -low toxicity
29
Cephalosporin MOA
-bind to penicillin-binding proteins (PBPs), disrupt cell wall synthesis, cause cell lysis - most effective against cells undergoing active growth and division
30
Therapeutic uses for cephalosporins
-widely used for prophylaxis against infection in surgical patients -Second generation : gram + - ; rarely used for active infection - Third generation: gram - ; preferred therapy for several infections -able to penetrate cerebrospinal fluid (CSF)
31
Vancomycin
Action: inhibits cell wall synthesis Uses: severe infections ONLY [MRSA, staphylococcus, epidermidis, clostridium difficile IV administration
32
Vancomycin {vancocin, vancoled} Adverse effects
- ototoxicity (reversible or permanent) - "Red man" syndrome- too rapid infusion leads to: - flushing, rashing, itching, hives, tachycardia, hypotension - infuse slow -Thrombophlebitis (common) - inflammation of vein - Thrombocytopenia (rare) - decrease in platelets - allergy
33
Examples of bacteriostatic inhibitors of protein synthesis
tetracyclines, macrolides, and others
34
Tetracyclines given for:
Treatment of infectious disease - acne - peptic ulcer disease -periodontal disease - rheumatoid arthritis - mycoplasma pneumonia - lyme disease - anthrax - helicobacter pylori
35
Tetracyclines adverse effects
- GI irritation - yellow discoloration on bones and teeth [NOT given to children under 8] - superinfection - hepatotoxicity - renal toxicity - photosensitivity and other effects
36
Macrolides [erythromycin]
Broad-spectrum antibiotic
37
Macrolides [erythromycin] MOA
inhibition of protein synthesis - usually bacteriostatic but can be bactericidal -used if patient is allergic to penicillin - active against most gram + and some gram - bacteria [whooping cough, chlamydia]
38
Macrolides [erythromycin] therapeutic uses
- Whooping cough, acute diptheria, corynebacterium, diptheriae, chlamydial infactions, M. pneumoniae, group A streptococus pyogenes * may be used as an alternative to penicillin G in patients with penicillin allergy*
39
Macrolides [erythromycin] adverse effects
- GI - QT prolongation and sudden cardiac death - sueprinfections, thrombophlebitis, transient hearing loss
40
Clindamycin [cleocin]
- inhibits protein synthesis -can promote severe C. diff associated diarrhea (CDAD - can be fatal_ - active against most anaerobic bacteria (gram + -) - used as an alternative to penicillin
41
Examples of aminoglycosides
bactericidal inhibitors of protein synthesis
42
Aminoglycosides
- most commonly used agents: gentamicin, tobramycin, amikacin -narrow-spectrum antibiotics - bactericidal
43
Uses of Aminoglycosides
aerobic gram - bacilli
44
Adverse effects of Aminoglycosides
can cause serious injury to inner ear and kidney NOT absorbed from GI tract
45
Gentamicin [Garamycin] uses
To treat serious infections caused by aerobic gram - bacilli [pseudomonas aeruginosa, escherichia coli, klbsiella, proteus mirabilis]
46
Adverse effects of Gentamicin
nephrotoxicity -> kidneys ototoxicity-> hearing
47
Sulfonamides
-first drugs available for systemic treatment of bacterial infection -> NOW more effective and less toxic drugs are now available - High allergy rate [UTIs] - ALWAYS assess for hives, rash, edema
48
Sulfonamides MOA
inhibit synthesis of folic acid (folate)
49
Fluoroquinolones
broad-spectrum agents with multiple applications - disrupt DNA replication and cell division - Orally or IV
50
Fluoroquinolones side effects
generally mild but can cause tendon rupture (low risk) - Achilles tendon - not in patients under 18 Risk to ALL patients: older than 60, those taking glucocorticoids, undergone kidney, heart, or lung transplant
51
Fluroquinolines: ciprofloxacin
broad-spectrum antibiotic (gram - some gram +)
52
Uses of Fluroquinolines: ciprofloxacin
drug of choice-> anthrax ( taken 60 days) Infections: respiratory, UTI, GI, bones, joints, skin, soft tissue
53
Fluroquinolines: ciprofloxacin adverse effects
Mild: - GI: N/V, diarrhea, abdominal pain -CNS: dizziness, headache, restlessness, confusion, rarely seizures - Tendon rupture - photoxicity -Candida infections: pharynx and vagina (yeast infections) -Increased risk of C. Diff Older Adutls: -confusion, somnolence, psychosis, visual disturbances - myasthenia gravis (DO NOT GIVE)
54
Fluroquinolines: ciprofloxacin Drug/food interactions
Absorption reduced by: - aluminum antacids - magnesium antacids - iron salts - zinc salts - sucralfate - milk and dairy Elevation of drug levels (increase in plasma levels of several drugs): - theophylline (asthma) - warfarin (an anticoagulant) - tinidazole (antifungal)
55
Other examples of Fluroquinolines
Ofloxacin, moxifloxacin, norfloxacin, levofloxacin, gemifloxacin
56
Metronidazole [flagyl]
bactericidal
57
Uses for Metronidazole [flagyl]
protozoal infections infections caused by obligate anaerobes bacteria helicobacter pylori CDI
58
Adverse effects of Metronidazole [flagyl]
neurotixicity allergy (strong) superinfections
59
Rifampin
broad-spectrum antibacterial used primarily for TB (4-6mo), and for meningitis
60
Adverse effects Rifampin
color urine, feces, saliva, sputum, swear, tears bright red-orange prophylaxis of meningitis due to haemophilus influenzae
61
Rifaximin
non-absorbable PO form used for travelers diarrhea Adverse effects: nausea, flatulence, and defecation urgency - prevention of encephalopathy in patients with chronic liver disease

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