Anti-infectives and Antipyretics NURM-102 Exam Review

Selective Toxicity

Ability to kill/suppress microbes without harming host

Cocci

Circle/Cluster

Bacillus

Rod

Beta-lactamase

Bacterial enzyme that destroys beta lactam antibiotics

ESBL

Extended spectrum beta lactamase

• Enzyme protects bacteria and can be shared with different bacteria

Antibiotic methods

• Disruption of bacterial cell wall

• Inhibition of enzyme activity

• Disruption of bacterial protein synthesis

• Inhibition of bacterial synthesis of nucleic acid

• Increased cell wall permeability

Elevated enzymes after antibiotics…

Come from damaged organs —> Know what organs the enzyme is from

Why is constant therapeutic level of antibiotic important?

Level dropping allows bacteria to grow again and gain resistance

What does the doctor do based on the peak and trough recorded?

Adjust dose

Natural drug resistance example

Pseudomonas inherently resists penicillin

Acquired Resistance Examples

VRE, ESBL, MRSA

Misuse of Antibiotic Examples

• Treatment of untreatable infection

• Treatment of FUO (Fever of Unknown Origin)

• Improper Dosage

• Treatment without culture and sensitivity test

Adverse Reactions to Antibiotics

• Side effects

• Allergic response

• Superinfection

• Organ toxicity

• Oral contraceptives reduced effectiveness

Superinfection

Some antibiotics attack normal flora —> Normally harmless bacteria becomes a threat

First-time antibiotic takers…

Can later develop antibodies as a reaction to a drug

Do not take tetracyclines or fluoroquinolone with…

MILK OR CALCIUM PRODUCTS

Tetracyclines and sulfonamides are…

Light sensitive —> Wear sunscreen

Which organs should be monitored?

Liver and kidney

Prophylactic Antibiotic Usage

• Pre-surgery

  • Stay safe from bacteria when opened up

• Bacterial endocarditis

• Neutropenia

  • Chemo/transplant patients with reduced neutrophils

Bacterial endocarditis

Bacteria on valves of the heart

Antipyretics

Lower set points by inhibiting prostaglandins

• ASA and Tylenol

Penicillin

AKA PCN

• Bacteriostatic/cidal

• Treats pneumonia, meningitis, STDs

• CAUSES CELL WALL DEFECT

Penicillin allergy is a risk for….

Cephalosporin allergy

Cephalosporins

Ceftraline (Teflaro) most recent and best generation

• Allergy to this —> Steven Johnson Syndrome

• Increases bleeding tendencies on blood thinners

• Taken WITH food

Cephalosporin drugs have…

CEF in the name

Macrolides

Prophylactic, static and cidal

• Erythromycin and clarithromycin

• TAKEN IF PCN ALLERGY

Macrolide EXAMPLES

ErythROMYCIN and ClarithROMYCIN

Vancomycin

Treats staph infections (MRSA + C diff)

• Must have peak and trough

• Causes nephro and ototoxicity

Ototoxicity comes from

Damage to CN VIII

• Deafness

How is vancomycin run?

500mg/hr

MUST be run slow, otherwise toxicity happens

Tetracyclines

For STIs, intestinal amoeba and acne

• PHOTOSENSITIVE —> Wear sunscreen and store away from light

• Bad for gregnant

• Taken on empty stomach

Fluoroquinolones

Interferes with enzyme DNA gyrase

• Treats bone/joint infection and UTI

• Has FLOXACIN in the name

Fluoroquinolones CONTRAINDICATIONS

• Under 18

• Nervous system disorders

• Risks Achilles tendon rupture

Fluoroquinolones EXAMPLES

Cipro
Levaquin

Sulfonamides

Inhibits folic acid synthesis

• Treats e coli, meningitis, UTI, upper respiratory infections

• NOT for pregnancy/breastfeeding

Silvadene/Sulfadiazine

Sulfonamide ointment for burn victims

Sulfonamides can cause…

Crystallization in urine —> Take fluids to flush

Aminoglycosides

Gram negative bactericidal

• BAD for renal disease and pregnancy

• Also can cause ototoxicity

Carbapenems

Bactericidal for serious infections

• BAD for pregnancy and CNS disorders

Carbapenem EXAMPLE

Etrapenem (Invanz)

Oxazolidinones

Treats VRE, MRSA, PCN resistance

• Linezolid (Zyvox)

• Adverse effects on CNS and GI

Patients should take antibiotics at _______ intervals

EVENLY SPACED

Contraindicated in pregnancy/breastfeeding

• Tetracycline

• Sulfonamides

• Aminoglycosides

• Carbapenems

Clients taking oral contraceptives…

Should use an alternative form of birth control if taking PCN