pharm class 8

exam 4

barriers to invasion

adaptive immunity, innate immunity, physical/chemical defenses

adaptive immunity (acquired)

cellular, humoral

cellular immunity (adaptive) is related to -

cytotoxic

humoral immunity (adaptive) is related to -

antibodies

innate immunity (natural)

macrophages, neutrophils, basophils, complement system

non specific physical and chemical defenses

skin, MMs, stomach acid, coughing, sneezing

what raises the risk for infection - age

older, babies

what raises the risk for infection - patient populations

uncontrolled diabetes, immunocompromised

what raises the risk for infection - sites of infection

bones, brain, heart

what raises the risk for infection - invasive medical procedures

iv, catheter, surgical site

how to reduce risk for infection?

handwashing, vaccines, limit exposure

contact precautions

gown, gloves, handwash

droplet precautions

mask, gloves, goggles, single room, no roomie

airborne precautions

n95, negative pressure, pt mask

types of airborne diseases

mycobacteria, tb, measles, varicella

which precautions are meant to be applied to all patients despite their infection status?

standard

transmission based precautions

known/suspected to be infected

example of an infection for contact precautions

c diff

example of an infection for droplet precautions

mumps

example of infections for aiborne precautions

rubella, varicella, tb

negative pressure

keeps air in pt room so it doesn’t go outside

positive pressure

keeps air from outside from entering room

example of disease that needs negative pressure

tb

blood culture

gram stain

gram stain is done immediately to determine -

what shape bacteria is

specificity of blood culture

accuracy of test to confirm positive culture

sensitivity of blood culture

bacteria is sensitive to antibiotic

cell envelope - gram negative

3 layers, thin cell wall and outer membrane hard to pass

cell envelope - gram positive

2 layers, thick cell wall easy to pass

do you wait for culture results in order to treat the patient?

no - use broad spectrum until results come

antibiotics work on synthesis of -

cell wall, cell membrane, protein, dna, antimetabolites, enzyme inhibitors

clinical indicators of success for antimicrobial therapy

reducing fever, s/s

types of antibiotic therapy

empiric, definitive, prophylactic

empiric therapy

tx before culture results

definitive therapy

tx after culture results

prophylactic therapy

tx to prevent

which patients need antibiotics before they go to surgery or dentist?

valve replacement, bacterial endocarditis, immunocompromised

types of antibiotics

broad, narrow, bacteriostatic, bacteriocidal

bacteriostatic antibiotics

slow growth

bacteriocidal antibiotics

kill bacteria

types of infections

bacterial, mycobacterial, viral, fungal, malarial, protozoan

why can’t you give antibiotics with the flu?

it’s viral, not bacterial

superinfection

antibiotic kills good bacteria along with bad, making you sicker

how to prevent superinfection

finish entire course

organisms with microbial drug resistance

staph aureus, c diff

antimicrobial/antibiotic stewardship

promote adherence to prescribing guidelines, reduce demand, emphasize adherence

microbial mechanisms of drug resistance - 4 actions

lower concentration, inactivate drug, alter structure, drug antagonist

antibiotics that promote resistance

broad spectrum

bacteria that have the _____ are resistant to almost all antibiotics

ndm 1

the more antibiotics are used, the faster -

drug resistant organisms emerge

s/s of c diff

watery diarrhea, cramps, abd pain, bloody stool, foul smelling

to have c diff you have to have watery diarrhea -

> 3 × 24 h

complications of c diff

bowel perforation, sepsis, dehydration

diagnosis and mgmt of c diff

culture, antibiotics

mild c diff antibiotic

metronidazole

severe c diff antibiotic

vancomycin

metronidazole moa

disrupts dna, kills anerobic bacteria

client teaching with metronidazole

avoid alcohol during and 3d after, causes disulfiram like reaction

cns issues caused by metronidazole

headache, seizure, neuropathy

metronidazole increases the effect of -

ccb, warfarin, benzos

expected/non concerning side effects of metronidazole

dark urine, metallic taste

vancomycin moa

inhibits cell wall synthesis, promotes bacteria lysis

what does vancomycin treat

mrsa, gram +

oral vancomycin is indicated for treatment of -

c diff, staph enterocolitis

vancomycin adverse effects

ototoxicity, nephrotoxicity, red man, thrombophlebitis, allergy

ototoxicity

vertigo, tinnitus

nephrotoxicity

cr > 1.3, bun > 20, < 30 mL/hr

red man syndrome

happens with vancomycin iv

red man syndrome interventions

bp check, slow infusion

vancomycin anaphylaxis

hives, angioedema, wheezing

what.to do if edema, pruritis, wheezing occurs with vanco?

epi pen

why does red man syndrome happen?

mast cells, basophils breaking open → histamine

vancomycin must be infused slowly over -

60 min

types of infections

community, hospital

community acquired infection

acquired by someone who has not been hospitalized or had a med procedure

health care associated infections

contracted in hospital, > 48h after admission, hard to treat

why are health care associated infections harder to treat?

causative microorganisms are drug resistant

which infection is most common within healthcare settings?

mrsa

risks of health care associated infections

older age, recent surgery, prolonged antibiotic use, indwelling

mrsa mechanism of resistance

produces pbps with low affinity for penicillins

treatment for mild mrsa

trimeth/sulfameth, doxy, clinda

treatment for severe mrsa

vanco, dapto, linezolid

intranasal and skin treatment for mrsa

mupirocin

how to reduce infection in hospitalized patient

prevent, diagnose and treat, antimicrobial drugs, no patient to patient

care bundles

clabsi, cauti

clabsi

central line associated bs infection

cauti

catheter associated uti

healthcare associated infection - prevention

handwashing, antiseptics, disinfectant, contact isolation

antiseptics

inhibit microorganisms but doesn’t kill them

disinfectants

kills organisms, used on objects

how much of the population has mrsa?

20-30%

risk groups for mrsa

athletes, gay, closed rooms, daycare, college

how does mrsa present?

abscess, boil, cellulitis, impetigo

how is mrsa transmitted?

skin to skin, contaminated objects

ways to prevent mrsa

shower after sports, clean equipment, wipe, no towel sharing

slow growing vs fast growing bacteria

slow growing hard to kill

reasons for using more than one antibiotic

severe, more than one organism, tb

therapeutic response of antibiotics

reduced s/s of infection

penicillin moa

enter bacteria via cell wall, bind to pencillin protein, cell wall synthesis disrupted, bacteria cells die

penicillin does NOT -

kill other cells