Pharm(antibiotic/viral/ fungal/ emergency)

Antibiotic basics

Narrow spectrum is classified as

Gram pos & gram neg

Antibiotics basics

Broad spectrum is classified as

both gram pos & gram neg

antibiotics basics

_____ bacteria that must have oxygen to live

Aerobes

Antibiotics basics

______ bacteria that do NOT require oxygen

-Hardy & difficult to eradicate

Anaerobes

Antibiotics basics

_____ kills microorganisms

Bactericidal

Antibiotics basics

________ inhibits replication

bacteriostatic

-inappropriate use

-subtherapeutic dosing

-compliance

Antimicrobial resistance

-Disk susceptibility aka kirby-bauer

-broth dilution

-minimum inhibitory concentration: degree of susceptibility of an organism

Culture & Sensitivities

-lowest does possible above MIC(minimum inhibitory concertation)

-Effective as long as concentration is above the MIC(minimum inhibitory concertation)

Time dependent antibiotics

-width of the peak is important

-height of the peak is not important

Time dependent antibiotics

-NO residual effect

-Given BID or TIB

Time dependent antibiotics

-Beta lactams

-Peniceillins & Cephalosporins

-macrolides

-tetracyclines

-lincosamides

-sulfonamides

Time dependent antibiotics

-Concentration independent

-bacterial killing unaffected by increasing drug concentration

time dependent

__________Optimize duration of exposure

pharmacodynamic goal

-highest does above MIC that is safe

Concentration dependent antibiotics

-Height of the peak is important

-width of the peak is not important

Concentration dependent antibiotics

-residual effect

-often given only SID

concentration dependent antibiotics

-aminoglycosides

-fluoroquinolones

-metronidazole

concentration dependent antibiotics

Modes of Action- Antibiotics

-only work when the bacteria are growing/dividing

-penicillins, cephalosporins

Inhibition of cell wall synthesis

Modes of Action- Antibiotics

-bind to ribosomes & disrupt bacteria's metabolism

-Aminoglycosides, Tetracyclines, Macrolides, Lincosamides, Chloramphenicol

inhibition of protein synthesis

Modes of Action- Antibiotics

-bind to components involved with DNA & RNA synthesis

-flurooquinolones, metronidazole, rifampin

Inhibition of nucleic acid synthesis

Modes of Action- Antibiotics

-Bind or block bacterial enzymes

-sulfonamides

Inhibition of folic acid synthesis

Inhibition of Cell Wall Synthesis

-most commonly used antibiotics

penicillins

Inhibition of Cell Wall Synthesis

-Bactericidal

-Gram pos bacteria

-Does NOT cross into CSF, joints, or milk

penicillins

Inhibition of Cell Wall Synthesis

-Deactivated by beta lactamase

-produced by the bacteria for antibiotic resistant

-combine with clavulanic acid

-binds to beta lactamase to prevent destruction of the antibiotic

-beta lactamase inhibitor

penicillins

Inhibition of Cell Wall Synthesis

-narrow spectrum of activity

-staph & Strep

-injectable, IM only

-patient aversion

penicillin G

-cat abscesses

-combined with clavulanic acid(potentiated aminopenicillin)

-urinary tract, skin, & soft tissue infections

SE: is GI upset

Amoxicillin

Inhibition of Cell Wall Synthesis

-broad spectrum and bactericidal

-UTI's, skin including pyoderma, & pneumonia

SE: Tachypnea, nephrotoxicity

Cephalosporins

-First generation treats gram pos only

-Second generation treats gram Pos. & neg

-Third generation treats gram neg & Pseudomonas

-Fourth generation treats gram pos, gram neg, & Enterobacter

-Resistant to beta lactamases

4 Generations of cephalosporins

Inhibition of Protein Synthesis

-ONLY effective against gram neg aerobic bacteria

-often given with beta lactam (gram pos coverage)

-Distributed in ECF & accumulate in inner ear & kidneys

-Not approved for use in food animals

Aminoglycosides

SE: Ototoxic & Nephrotoxic

-Contraindicated in patients with renal disease

-Greater potential for nephrotoxicity in patients receiving furosemide

Aminoglycosides

Inhibition of Protein Synthesis

Aminoglycosides

-Treats serious gram neg infections

-septic arthritis in horses, intrauterine infectious in mare

-cats are very susceptible to vestibular effects(CN 8)

Amikacin

Inhibition of Protein Synthesis

Aminoglycosides

-Use extreme caution in patients w/ CRF

-do NOT use in rabbits

Gentamicin

Inhibition of Protein Synthesis

Aminoglycosides

-Most nephrotoxic of the aminoglycosides

-often used topically

-skin, eyes, ears

Neomycin

Inhibition of Protein Synthesis

Aminoglycosides

-effective against Mycoplasma & gram neg bacteria

-least ototoxic & nephrotoxic of the aminoglycosides

Spectinomycin

Inhibition of Protein Synthesis

-Time dependent, bacteriostatic

-mycoplasma, spirochetes, chlamydia, & rickettsia

-oral absorption & immunomodulating effects

-readily cross the placenta & milk

-not well tolerated in cats

-causes esophageal strictures

-follow oral dosing w/ syringed water

SE: Vomiting, diarrhea, sunburn

tetracyclines

Inhibition of Protein Synthesis

-readily cross the placenta & milk

tetracyclines

Inhibition of Protein Synthesis

-tick diseases & heartworm

Doxycycline

Inhibition of Protein Synthesis

-Water & feed treatments

-Aureomycin

chlortetracyline

Inhibition of Protein Synthesis

-commonly used in cattle

-pink eye, wounds

Oxytetracycline

Inhibition of Protein Synthesis

-broad spectrum, bacteriostatic

-treat respiratory disease esp. gram pos bacteria

-excreted in bile

Macrolides

Inhibition of Protein Synthesis

-Treat Mycoplasma & Rhodococcus equi

-hyperthermia is the most common side effect

Azithromycin, clarithromycin, erythromycin

Inhibition of Protein Synthesis

-Bovine & ovine respiratory disease

-Mannheima(Pasteurella) Haemolytica

-Fatal in humans, swine & horses

Tilmicosin

Inhibition of Protein Synthesis

-bocine respiratory disease, foot rot, & infectious bovine keratoconjunctivitis

-draxxin, increxxa

Tulathromycin

Inhibition of Protein Synthesis

-promotes growth in cattle, swine & chickens

-treats swine diarrhea & poultry disease

-often added to feed or water

Tylosin

Inhibition of Protein Synthesis

-anaerobes, gram pos aerobic cocci, toxoplasma

-distributed in milk & cross the placenta

-excreted mostly by the liver

-do NOT give to horses, rabbits, or rodents

Lincosamides

Inhibition of Protein Synthesis

-bite wounds, abscesses, osteomyelitis

-Staph & toxoplasma

-Causes GI upset & esophageal stricture in cats

Clindamycin

Inhibition of Protein Synthesis

-Approved for use in swine & chickens

Lincomycin

Inhibition of Protein Synthesis

-small animals & Horses

-broad spectrum, bacteriostatic

-anaerobic bacteria

-Prohibited in food animals

Chloramphenicol

Inhibition of Nucleic Acid Synthesis

-bactericidal

-gram neg bacteria

-Lipophilic, well distributed

-absorption decreased by gastric contents

Fluoroquinolones

SE: cartilage damage, GI upset, retinal detachment(cats)

-enrofloxacin has greater bioavailability than ciprofloxacin

-Ciprofloxacin is metabolite of enrofloxacin

fluoroquinolones

Inhibition of Nucleic Acid Synthesis

-Giardia, anaerobic infections

-Prohibited in food animals

-gut friendly antibiotics

Adverse effects: Neurologic disorders

Metronidazole

Inhibition of Nucleic Acid Synthesis

-Rhodoccoccus equi when combined w/ erythromycin

-combined with antigungals to treat histoplamosis

-Causes red/orange discoloration of urine, trears, & sweat

Adverse effects: Hyperthermia

Rifampin

Inhibition of Folic Acid Synthesis

-Bacteriostatic if used alone

-readily absorbed for the GI tract of nonruminants

-renal excretion

-often combined w/ trimethoprim

-Treatment of prostatic disorders & Methicillin resistant Staph.

SE: Diarrhea, hemolytic anemia & keratoconjunctivitis

Sulfonamides

Inhibition of Folic Acid Synthesis

-treatment of coccidiosis in dogs(Extra label)

-Fowl cholera, infectious coryza, & coccidiosis in poultry

Sulfadimethoxine

Modes of Action- Antibiotics

-Only work when the bacteria are growing/dividing

-Penicillins, Cephalosporins

Inhibition of Cell Wall Synthesis

Modes of Action- Antibiotics

-Bind to ribosomes & disrupt bacteria's metabolism

-Aminoglycosides, Tetracyclines, Macrolides, Lincosamides, Chloramphenicol

Inhibition of Protein Synthesis

Modes of Action- Antibiotics

-Bind to components involved with DNA & RNA synthesis

-Fluoroquinolones, Metronidazole, Rifampin

Inhibition of Nucleic Acid Synthesis

Modes of Action- Antibiotics

-Bind or block bacterial enzymes

-Sulfonamides

Inhibition of Folic Acid Synthesis

-increase cellular membrane permeability

-inhibit growth

-disrupt metabolism

Antifungals

-topical, oral, or IV formulations

SE: nephrotoxicity & bone marrow suppression

-pancytopenia

-contraindicated in prego animals

-teratogen

antifungals

Teratogen

A chemical that interferes with the normal development of embryos or fetuses.

-fungistatic, fungicidal at higher doses

-used for Malassezia dermatitis, histoplasmosis

-alternative treatment for hyperadrenocorticism

-reversable suppression of gonadal & adrenal steroid synthesis

-use with caution in cats

SE: liver damage, thrombocytopenia, GI upset

Ketoconazole

used for malassezia dermatitis, and histoplasmosis

ketoconazole

alternative treatment for hyperadrenocorticism

-reversible suppression of gonadal & adrenal steroids synthesis

ketoconazole

-fungistatic

-drug of choice for systemic mycoses w/out CNS involvement

-effective against yeast and dermatophytes

-absorption & bioavailability INCREASE w/ food

-lipophilic & well distributed throughout the body

Itraconazole

-drug of choice for systemic mycoses w/out CNS involvement

-effective against yeast & dermatophytes

itraconazole

-absorption &bioavailabiltiy INCREASE with food

-lipophilic

itraconazole

-fungistatic

-excellent oral absorption that is not affected by food

-penetrates well into the CSF, eye, & peritoneal fluid

-drug of choice for CNS fungal infections

-Cryptococcal meningitis, blastomycosis, & histoplasmosis

SE: GI related

Fluconazole

drug of choice for CNS fungal infection

-Cryptococcal meningitis, blastomycosis, & histoplasmosis

fluconazole

-fungicidal against dermatophytes, fungalstatic against yeast

-do NOT use in patients with liver or kidney disease

terbinafine

-fungaistatic

-primarily used for ringworm & dermatophyte infections

-absorption enhanced by a fatty meal

-panocytopenia

teratogen in cats

Griseofulvin

-primarily used for ringworm & dermatophytes infections

-enhanced by fatty meal

Griseofulvin

-Fungistatic or fungicidal depending on dose

-used for life threatening systemic mycotic infections ONLY

-must be given IV, poorly absorbed when given orally

-high plasma protein binding(albumin)

-nephrotoxic

amphotericin B

-Used for life threatening systemic mycotic infections ONLY

-IV

-High plasma protein binding(albumin)

-nephrotoxic

amphotericin B

-topical antifungal

-can be used for fungal overgrowth in mouth & GI tract

-treats candida infection

-very poorly absorbed & excreted mostly unchanged

Nystatin

• Quickly & systematically evaluate an animal

• Determine order of attention

• DOCUMENT to avoid repeating treatments

• Anticipate & Prepare

EMERGENCY BASICS

CPR Meds

-beta 2 adrenergic agonist

-positive inotrope

-increases blood pressure & HR

-bronchodilation

-Causes significant tachycardia

Epinephrine

CPR Meds

-Positive inotrope

-increases HR & blood pressure

-increases renal perfusion

Dopamine

CPR Meds

-positive inotrope

-Does NOT increase heart rate

Dobutamine

CPR Meds

-positive inotrope

-decreases HR

-contraindicated in cats w/ HCM

SE: gi upset

Digoxin

CRP Meds

-cholinergic block

-prevents bradycardia

-causes bronchodilation

-antidote for organophosphate poisoning

SE: are dose related

-tachycardia, ileus, constipation

Atropine

Antiarrhythmics

-prevent & treat bradycardia

-atropine

Anticholinergics

Antiarrhythmics

-Depressing cardiac muscle excitability

-Prolongs action potential

-Treats VPCs & Ventricular tachycardia

-Procainamide & Lidocaine

Sodium channel blocker

Antiarrhythmics

-propranolol & Atenolol

-Treats APCs & VPCs

SE: hypotension, hypoglycemia, & bradycardia

Beta Blockers

Anaphylactic Meds

-sympathetic NS activates

-Bronchodilators

-Stabilizes mast cell & reduces release of histamine

epinephrine

Anaphylactic Meds

-blocks the effects of histamine

-also used as antiemetics

SE: CNS depression, urinary retention

-diphenhydramine(Benadryl) & Hydroxyzine

Antihistamines

Anaphylactic Meds

-high dosage & short term use only

-causes vasoconstriction, increases preload & afterload on the heart

Corticosteroids

Bronchodilators

-block acetylcholine, which causes bronchoconstriction

-atropine

Anticholinergics

Bronchodilators

-Potent bronchodilators by smooth muscle relaxation

SE: are significant tachycardia & hypertension

-Epinephrine, Albuterol, Terbutaline

-Albuterol is used in inhalers

Beta 2 Agonist

Bronchodilators

-Relax smooth muscles of the airway & pulmonary vasculature

-treats asthma, collapsing trachea, & bronchitis

SE: severe hypertension, CNS stimulation, Vomiting

-Aminophylline & Theophylline

Methylxanthines

Anticonvulsants

-CNS depressant

-Drug of choice for status epilepticus

-not used for long term control because of short duration of action

-valium

Diazepam

Anticonvulsants

-CNS depressant

-often used when drug reaction is suspected

Midazolam

Anticonvulsants

-used for long term control of seizures

-NOT during emergency convulsions

Phenobarbital

-Indicated for toxins

-Do NOT use when acidic or caustic chemicals are ingested

-Must be given within 2-6 hours of toxic ingestion

Emetic

Emetics must be given with in ____ hours

2-6 hours

Emetics

-opioid side effects

-dissolve tablets in saline for use in conjunctival sac

-Emetic of choice for dogs

Apomorphine

Emetics

-contraindicated in cats

-esophageal irritation & Stricture

Hydrogen peroxide

Emetics

-Emetic of choice for cats

-CRTZ stimulants

Xylazine

Antidotes

-absorbs toxins/drugs

-reduces systemic absorption

-Do NOT give oral meds w/in 3 hrs of substance

SE: constipation, diarrhea, black stool

Activated charcoal