Pharmacology - Exam 2 Blueprint

Superinfection

a type of resistance that results when an antibiotic kills normal/natural flora, thus favoring the emergence of a new infection that is difficult to eliminate
EX: thrush, diarrhea caused by C. diff (can be deadly), and vaginal yeast infections
- antimicrobial therapy

narrow-spectrum antibiotics

effective against a narrow range(specific) of bacteria
- used when the CAUSE of the bacterial infection is KNOWN

broad-spectrum antibiotics

effective against a broad range of bacteria
- can cause superinfection

bactericidal

kills bacteria directly
- weakens the cell wall (lysis)
- interferes with enzymes
- DISINFECTANT

Bacteriostatic

kills bacteria indirectly, by slowing down the growth of bacteria and allowing the immune system to finish the job!
- ANTISEPTIC

used in pts. w/ penicillin allergies

Macrolides: Erythromycin + Azithromycin

minimum inhibitory concentration (MIC)

the lowest concentration of antibiotic that inhibits bacterial growth, but does not kill the bacteria

minimum bactericidal concentration (MBC)

the lowest concentration of an antibiotic that kills the bacteria

sites that are difficult for Antimicrobials to reach

places with poor blood flow
- spinal fluid
- brain (because of the BBB; meningitis)
- an abcess
- the heart (endocarditis)

What do you ALWAYS do prior to administering an antibiotic?

CULTURE! CULTURE! CULTUREEEE!!!!!

Patients taking Antibiotics must always...

...TAKE THE FULL COURSE OF MEDICATIONS PRESCRIBED!!!!
- and take an additional form of contraceptive (BABY!)

community-associated infection

an infection acquired by a person who is not recently hospitalized
EX: sinus infection

health care associated infection

infections the patient acquires during the course of receiving treatment during their hospital stay

Types of Antibiotics

- Antibiotics affecting the Bacterial cell wall
- Antibiotics affecting Protein Synthesis
- Antibiotics treating UTIs

Antibiotics affecting the Bacterial Cell Wall

Penicillins
Cephalosporins
Vancomycin
- nephrotoxic

Penicillins

Group of antibiotics that are often used to treat infections by gram-positive bacteria
- typically ends in "-cillin"
- ALLERGICCCC; cross-sensitivity with cephalosporins
- renal impairment & hyperkalemia are complications
- take with meals
Includes: Penicillin G, Amoxicillin

each subsequent generation of cephalosporins is...

...more likely to reach cerebrospinal fluid and more effective against gram-negative organisms and anaerobes

Cephalosporins

broad-spectrum; structurally and functionally similar to penicillins; comprised of 5 generations
- start with "cef-" or "ceph-"
- have a cross-sensitivity with penicillins
- Thrombophlebitis w/ IV is a complication (rotate sites and dilute)
- have a disulfiram reaction with alcohol

First Generation Cephalosporins

cefazolin, cephalexin
- F,Z

Second Generation Cephalosporins

Cefaclor and Cefotetan

Third Generation Cephalosporins

Ceftriaxone and Cefotaxime
- F,T,X

Fourth Generation Cephalosporins

Cefepime
- F,P

Vancomycin

an additional antibiotic that inhibits cell wall synthesis (including Aztreonam and Fosfomycin); saved for severe infections and bacteria that are resistant to other antibacterials (treatment of choice for C. diff)
- BIG EARS (ototoxicity) and KIDNEYS (monitor vancomycin trough and peak levels)
- Red Man Syndrome (due to rapid infusions; rashes, flushing, tachycardia, etc; give vancomycin slowly over 60 mins)
- dilute IM/IV
- corn allergies!!!

Antibiotics Affecting Protein Synthesis

Tetracyclines
Macrolides
Aminoglycosides

Tetracyclines

broad spectrum, bacteriostatic antibiotics that prevent protein synthesis; treats Rickettsial infections, Chlamydia, H.pylori, and lyme disease
- end in "-cycline"
- cause GI discomfort, teeth discoloration (children under 8) and suprainfection of the bowel
- LIVER!!!
- No milk, calcium, or iron
- take on an empty stomach (1 hr before, or 2hrs after)

Macrolides

bacteriostatic antibiotics that prevent protein synthesis; given if patients have a penicillin allergy, Cardiac dysrhythmia
- BIG EARS (ototoxicity) and KIDNEYS
- causes prolonged QT intervals
Includes: Erythromycin and Azithromycin medications

Aminoglycosides

bactericidal antibiotics that prevent protein synthesis and mainly treat aerobic gram-negative bacilli
- for tapeworms & amoebas
- paraesthesia of hands and feet
- BIG EARS (ototoxicity) and KIDNEYS (nephrotoxicity)
- peak levels: 30 mins after giving IM
Includes: Gentamicin and Streptomycin

Antibiotics typically used to treat UTIs

Sulfonamides and Trimethoprim
Urinary Tract Antiseptics
Fluoroquinolones
Urinary Tract Analgesics

Sulfonamides and Trimethoprim

inhibit bacterial growth by preventing the synthesis of a folic acid derivative
- the FIRST CHOICE for UTIs caused by E. coli
- also used for otitis media, chancroid, pertussis
- Complications: hypersensitivity (Stevens-Johnson Syndrome), Blood dyscrasias, Crystalluria (increase fluid intake), and liver issues, Kernicterus (Jaundice)
- Pregnancy Risk Category D
Includes: Trimethoprim-Sulfamethoxazole

Urinary Tract Antiseptics

broad spectrum urinary antiseptic used for ACUTE UTI and prophylaxis for recurrent UTIs
- turns urine brown
- take with milk or food
- avoid crushing bc it'll stain teeth
- Complications: GI discomfort, blood dyscrasia (AST, ALT), peripheral neuropathy
- do not give if creatinine clearance levels are low
Includes: Nitrofurantoin

Fluoroquinolones

broad-spectrum, bactericidal antibiotics that inhibit an enzyme necessary for DNA replication
- ends in "-floxacin"
- can be used to prevent anthrax
- NO DAIRY, yes food
- Complications: Achilles tendon rupture (do not give if <18), Suprainfection, Phototoxicity
- abstain from sex until fully treated
- Worst enemies are Theophylline and Coumadin
- IV: dilute and give over 60 mins slow in large vein
Includes: Ciprofloxacin (floxacins)

Urinary Tract Analgesic

decreases pain and burning, urgency, and other symptoms of an UTI
- DOES NOT eliminate bacteria
- changes urine an orange-red color which can stain clothes
- take with or after meals
-Includes: Phenazopyridine, AZO

Antimycobacterial (anti-TB) meds

Rifampin and Isoniazid
- given together to help fight resistance and decrease doses
- mycobacterium organisms are waxy and tough to kill
- very long-term treatment

Isoniazid

an anti-TB that inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the cell wall
- given in the latent phase (9mo) and the active phase (6 mo, with Rifampin)
- LIVER!!!!! (hepatoxicity)(ASL/ALT)
- given IM or PO
- it can cause a B6 (pyridoxine) deficiency which is to be given to decrease the risk of peripheral neuropathy
- direct observation therapy

Pregnancy Risk C

Rifampin

a braod-spectrum, bactericidal anti-TB that is usually administered with Isoniazid in the active stage of TB
- turns bodily fluids (pee, sweat, etc) orange
- give 1 hr before meals or 2 hr after

No Alcohol

Hepatoxicity (AST/ALT)

anti-TB effectiveness

3 negative sputum cultures for TB, usually taking 3-6 months to achieve

Antiprotozoals

broad-spectrum, bactericidal meds that work against anaerobic microorganisms (parasitic/protozoal infections)
- darkens urine
- causes neurotoxicity (numb extremities) and pseudomembranous colitis (fever, diarrhea, bloody stool)
- disulfiram-like reaction with alcohol
Includes: Metronidazole (Flagyl)

Antifungals

Amphotericin B
Ketoconazole
Nystatin (powder)
Fluconazole

Antifungals: Amphotericin B

for SEVERE, SYSTEMIC, LIFE-THREATENING FUNGAL INFECTIONS
- nicknamed "The Tear" because it's SOOOO HARD on yo body
- infuse slowly over 2-4 hr IV with 1 L NS
- Can cause infusion reactions (symptoms 1-3 hr after infections), thrombophlebitis, nephrotoxicity, electrolyte imbalances (K+), and bone marrow suppression

Antifungals: Ketoconazole

for non-life threatening fungal infections
- liver (build up of bilirubin) + sex hormones

Antivirals

alter viral replication
- end in "-vir" or have "vir" in them
- Acyclovir: give IV slowly over 1 hr, relief of symptoms NOT A CURE, put on gloves for topical admin, nephrotoxicity (Kidneys)(BUN & Creatinine)

Wash lesions 3-4 times with soap and water

Epinephrine

the antidote for ALL anaphylactic reactions

Adjuvants

medications for pain that are given with a primary pain medication (opioid agonist) to increase pain relief which reducing the dosage of the opioid agonist
- adjuvants are not given alone
- some are an off-label use
EX: NSAIDs (Ibuprofen) given to treat inflammation

Subcutaneous Injections

- small volume of medication
- slower absorption
- volume: 0.5 to 1.5mL (1.5mL MAX)
- needle length: 3/8 to 5/8 inch
- large needle gauge (small)
- 45 to 90 degree angle

IM Injections: Ventrogluteal

- SAFEST
- iliac crest
- inject in gluteus medius
- volume: 0.5 to 3mL (3mL MAX)
- small needle gauge (large)
- needle length: 1 to 1 1/2 inch
- aspirate

IM Injections: Deltoid

- acromion process
- volume: 0.5 to 1mL (1mL MAX)
- needle length: 5/8 to 1 1/2 inch
- aspirate

Z Track Method for IM Injections

pull skin taut, insert at 90 degrees, aspirate, inject, pull out, let go

Infiltration

occurs when IV fluid leaks into the surrounding tissue
- non harmful

Extravasation

occurs when IV medication leaks into the surrounding tissue
- harmful

Necrosis

tissue death

Disease-Modifying Antirheumatic Drugs (DMARDs 1)

treats RA and acute lymphoblastic leukemia
- nonbiologic = treats the whole immune system
- Pregnancy Category X!!!!
- Complications: increased risk of infection, bone marrow suppression, and retinal damage (H; don't give if patient has Glaucoma)
Includes: Methotrexate and

Effects of Disease-Modifying Antirheumatic Drugs (DMARDS

delayed and can take 3 to 6 weeks, with full therapeutic effect taking several months
- for long-term therapy

Disease-Modifying Antirheumatic Drugs (DMARDS 2)

blocks tumor necrosis which slows RA progression
- biologic = specific part of the immune system
- Complications: Stevens-Johnson syndrome (stop med), IV infusion rxns (I), risk of infeciton, and heart failure
- NO LIVE VACCINES (E)
Includes: Etanercept and Infliximab

NSAIDs for RA

rapid pain and inflammation relief; does NOT delay disease progression

Erythromycin (Macrolides)

slows the growth of mirco-organisms by inhibiting protein synthesis (bacteriostatic) but it can be bactericidalmicro at high doses

Nitrofurantoin (UTI antiseptics)

is a broad-spectrum urinary antiseptic with bacteriostatic and bactericidal action. It injures bacteria by damaging DNA

-Acute UTIs

Peripheral Neuropathy

Rust-Yellow

Phenazopyridine

functions as a local anesthetic on the mucosa of the urinary tract

-relieves burning, polyuria, fluid imbalance

Fluoroquinolones

Ciprofloxacin

bactericidal due to inhibition of an enzyme necessary for DNA replication

Isoniazid + Rifampin =

increase the risk of liver toxicity (AST/ALT)(hepatoxicity)

Antifungals: Nystatin

Treat systemic fungal infections

Treat superficial fungal infections

Infusion reactions: pretreat with acetaminophen

Nephrotoxicity(kidneys)(BUN & Creatinine)

Potassium imbalance

Bone marrow suppression: CBC

Bleeding

Thrombophlebitis

Bactericidal medication

directly kills the bacteria, great for pts. that are amino comprimised

Bacteriostatic medications

slows the growth of micro-organism

allows immune system to kill bacteria

Factors when selecting Antibiotics

Identity of causative agents

Sensitivity of the infection organism to an antimicrobial

Other factors location, age, allergies, & immune status of host

Anti-microbial Therapy

is the use of medications to treat infections due to bacteria viruses or fungi

Antibiotic Resistance

not as effective as before

produce resistance

protect this by taking the whole course & use as directed

Selection of Antimicrobials

Culture: samples of the biological material

these are used to find what antibiotic to use

Nurses should draw cultures before initiating antibiotic treatment

Nurses must collect fluid for cultures to prevent contamination

Oral Contraceptives

makes them less effective

many anti-microbial interact with hormonal contraceptives

educate female pts about other forms of contraceptives

Site of infection

anti-infectives bloodstream must travel through the blood stream to reach the site of infection

cerebrospinal fluid (meningitis)

bacterial infiltration within the heart (endocarditis)

purulent abscesses anywhere within the body due to poor blood supply

Lifespan considerations

Geriatrics: higher risk toxicity reduced excretion & metabolism

Pediatrics: underdeveloped slow excretion & metabolism risk for toxicity

Disease Processes: renal or liver disease failure

Pregnancy and Breast Feeding: safe before administering

Previous Allergies: assess allergy

Cytotoxic Agent: Methotrexate

Increased risk of infection

Hepatic fibrosis and toxicity: dosing with folic acid & monitor liver & kidney function

Bone marrow suppression: CBC (repeat 3-6 moths)

Ulcerative Stomatitis/ GI ulcerations: early finding with toxicity

Fetal Death: avoid use during pregnancy

Penicillin: Antibiotic

"Penny the Prostitute"

Who takes out any bacteria that come her way. She doesn’t let any bad bugs mess with her business.

Cephalosporins= Antibiotic

"Chef’s Orgy" (three C’s)

Cefazolin, Cephalexin, Ceftriaxone

kitchen party where the chef (Cephalosporins) uses his cooking skills to annihilate bacteria

Tetracyclines: Antibiotic

"Tetra the Temptress"

Aminoglycosides: Antibiotics

Vancomycin: Antibiotic

"Van the Voyeur"

Erythromycin: Antibiotic

"Erotic Red"

Azithromycin: Antibiotic

"Azzy the Escort"

Gentamicin: Antibiotic

"Gentle Giant"

Rifampin: Anti-TB

Rifa the Red-Hot

Isoniazid: Anti-TB

Izzy the Tuberculosis Terminator

Acyclovir: Antiviral

Ava the Viral

Nitrofurantoin: anti-infective

" Nitro's Bacterial Blitz"

Sulfamethoxazole/Trimethoprim (TMP): anti-infective

"Sulfur and Trimmed Treats”

Ciprofloxacin: Anti-infective

Cindy's Pathogen Purge

Nystatin: Antifungal

"Natalie the Fungal Nemesis

Phenazopyridine: Analgesic

Pamela the Passionate Pain

Methotrexate: Chemotherapy & DMARDS

Morgan the Chemotherapy Conqueror

NSAIDs: DMARDS

Nicole Silly Attempts to Ignore Discomfort

Gentamicin

Treats E. Coli

Aminoglycoside

Anti-Biotics Affecting Protein Synthesis

Anti-Biotics Affecting Protein Synthesis

Gentamicin

Erythromycin

Azithromycin

Tetracyclines

Tamoxifen: Chemotherapy

Dysrhythmia

Estrogen Receptors

Thromboembolic events (DVT & PE, Stroke)

Increase Calcium & Vitamin D

Hot Flashes

Alopecia (hair loss)

Bone Marrow Suppression

Mucositis

Gastric Ulcers

Immunizations

Nasal FLu= Live

IM shot = Not Live

Who cannot receive immunizations

Chemo pts

Immunocompromised

Steriods

Prego people

people over the age of 50+

Who can receive immunizations

people from the ages 2-49 years old

Healthy people within this age range

How to give a child Immunization

Ventrogluteal

Vastuslateralis (thigh)

How to give an adult immunization

Deltoid

Prego - NOs

DMARDs

Chemotherapy

Live- Vaccines

Gentamicin

Azithromycin

Bacterium (TMP)

Embolism

sudden blocking of an artery

Pulmonary Edema

one or more arteries in the lungs become blocked by a clot

Deep Vein Thrombosis

blood clot in a deep vein (usually legs)

Thrombophlebitis

blood clot in the vein causing inflammation and pain