Pharm Week 2: Comprehensive Study Guide on Anti-Infective Pharmacology and Immunotherapy

Vocabulary practice flashcards generated from the Immunity and Infection lecture notes, covering core anti-infective, antibiotic, antiviral, antifungal, vaccine, and immune sera terminology.

Anti-infective agents

Drugs that target foreign organisms that have invaded and infected the body of a human host, including antibiotics, antivirals, antifungals, and antiparasitics.

Bacteriostatic

Therapeutic action of anti-infective agents that inhibits or slows down the growth and reproduction of bacteria.

Bactericidal

Therapeutic action of anti-infective agents that directly kills the infectious bacterial organism.

Goal of Anti-infective Therapy

To decrease the population of the infectious organism to a point at which the human immune response can eliminate the infection.

Natural Resistance

Resistance that an organism has prior to exposure to an anti-infective drug, due to its physical structure or mechanism of action.

Acquired Resistance

Resistance that develops in an infectious organism after exposure to an anti-infective agent.

Culture (in Culture & Sensitivity)

The process of collecting data prior to starting antibiotics to identify the specific type of infection.

Sensitivity (in Culture & Sensitivity)

The process of searching for and determining the correct medication required to treat a specific infection.

Anti-infective Stewardship

The practice of using anti-infective medications only when clinically needed to prevent the development of drug resistance.

Combination Therapy

The administration of multiple anti-infective agents together to treat complex or systemic infections.

Prophylaxis

The use of anti-infective drugs to prevent an infection before it occurs in a high-risk individual or situation.

Gram-positive Bacteria

Bacteria identified via Gram staining that commonly infect the respiratory tract and soft tissues.

Gram-negative Bacteria

Bacteria identified via Gram staining that commonly infect the gastrointestinal (GI) and genitourinary (GU) tracts.

Aerobic Bacteria

Bacteria that require oxygen to survive.

Anaerobic Bacteria

Bacteria that do not use oxygen to survive.

Gentamicin

Prototype aminoglycoside antibiotic that acts as a 30S protein synthesis inhibitor (bactericidal) to treat aerobic Gram-negative bacteria such as E. coli.

Aminoglycoside Toxicity

Major toxic adverse effects associated with aminoglycoside antibiotics, specifically ototoxicity and nephrotoxicity.

Aminoglycoside Peak Level

The maximum drug level in serum, drawn $1\frac{1}{2}\text{ hours}$ after administration to ensure therapeutic levels and avoid toxicity.

Aminoglycoside Trough Level

The lowest drug level in serum, drawn $30\text{ minutes}$ prior to the next scheduled dose to determine proper clearance.

Gentamicin Toxicity in Older Adults

Age-related decline in renal function increases toxicity risk, requiring dosing strictly based on renal function and close drug level monitoring.

Carbapenems

Broad-spectrum bactericidal antibiotics indicated for serious or life-threatening infections such as sepsis, multidrug-resistant infections, complicated UTIs, and intra-abdominal infections.

Carbapenems Mechanism of Action

Bactericidal inhibition of bacterial cell wall synthesis.

Imipenem Neuro Risk

Central nervous system toxicity associated with imipenem that increases the risk for seizures, requiring pre-assessment of seizure history.

Carbapenems FINAL Mnemonic

Mnemonic summarizing key carbapenem points: F (For resistant infections), I (IV or IM route), N (Neuro risk for seizures), A (Allergy potential cross-reaction), L (Labs for kidney function).

Valproic Acid and Carbapenems Interaction

Co-administration decreases valproic acid levels, causing an increased risk for breakthrough seizures.

First-Generation Cephalosporins Identification Rule

Cephalosporin drugs whose names start with 'cefa' sounds (e.g., cefazolin, cephalexin, cefadroxil), with the exception of cefaclor.

Second-Generation Cephalosporins Mnemonic

'2 furry foxes tan faces like pros', standing for Cefuroxime, Cefoxitin, Cefotetan, Cefaclor, and Cefprozil.

Third-Generation Cephalosporins Mnemonic

'3 po'docs fixing dinner got tazed for late taxes', representing Ceftriaxone, Cefpodoxime, Cefixime, Cefdinir, Ceftazidime, and Cefotaxime.

Fourth-Generation Cephalosporins Root Word

Class identified by the root word 'pi', such as Cefepime.

Fifth-Generation Cephalosporins Root Word

Class identified by the root word 'ol', such as Ceftolozane and Ceftaroline.

Cephalosporin Generational Trends

As cephalosporin generation increases, there is increased Gram-negative coverage, increased ability to cross the blood-brain barrier, and increased resistance to beta-lactamases.

Cefotetan Unique Adverse Effects

Risk of hemorrhage due to lowered prothrombin and a severe disulfiram-like reaction when combined with alcohol.

Cephalosporins CEPHAL Mnemonic

Mnemonic for monitoring: C (Creatinine/BUN), E (ETOH intolerance), P (Pseudomembranous colitis), H (Hypersensitivity), A (Administration IV/IM), L (Lower prothrombin).

Cephalexin

A 1st generation cephalosporin given primarily PO for skin/soft tissue infections and otitis media in children, focusing mainly on Gram-positive coverage.

Cefuroxime

A 2nd generation cephalosporin given PO or IV/IM for respiratory infections and otitis media, offering broader Gram-negative coverage than 1st generation drugs.

Ceftriaxone

A 3rd generation cephalosporin given IV/IM only, characterized by once-daily dosing, strong CNS penetration, and biliary excretion.

Ceftriaxone Calcium Interaction

Mixing or co-infusing IV ceftriaxone with calcium solutions can cause fatal precipitate organ damage in neonates.

Ceftriaxone Neonatal Contraindication

Contraindicated in neonates with hyperbilirubinemia due to the risk of biliary sludging.

Levofloxacin

Prototype fluoroquinolone that interferes with bacterial DNA enzymes, indicated for severe UTIs, general bacterial infections, and post-exposure anthrax prevention.

Levofloxacin IV Administration Rate

Must be infused slowly over $60\text{ minutes}$ and is incompatible with other medications in IV solutions and tubing.

Achilles Tendon Rupture

A high-risk adverse reaction to fluoroquinolones (levofloxacin), particularly in older adults and patients concurrent on glucocorticoids.

Levofloxacin Drug Interactions

Sucralfate and antacids decrease absorption; warfarin increases bleeding risk; corticosteroids increase tendon rupture risk; antidiabetics increase hypoglycemia risk.

Levofloxacin Pediatric Contraindication

Avoided in children under $18\text{ years}$ of age due to the risk of arthropathy.

Amoxicillin

Broad-spectrum bactericidal penicillin prototype that inhibits cell wall synthesis, used for common ear, throat, and urinary tract infections.

Amoxicillin Food Administration Timing

Oral amoxicillin should be administered at the beginning of meals to minimize GI side effects.

Probenecid Interaction with Penicillin

Blocks renal excretion of penicillin, leading to increased and prolonged penicillin blood levels.

Oral Contraceptives Interaction with Antibiotics

Antibiotics such as amoxicillin, piperacillin, TMP-SMX, and tetracycline decrease the therapeutic effectiveness of oral contraceptive pills.

Piperacillin

Bactericidal penicillin prototype that inhibits cell wall synthesis, indicated for moderate-to-severe infections like sepsis, hospital-acquired pneumonia, and Pseudomonas.

Piperacillin Route of Administration

Administered exclusively via the intravenous (IV) route.

Piperacillin Adverse Effects

Key adverse effects include nephrotoxicity, electrolyte abnormalities (sodium and potassium), and thrombocytopenia.

Penicillinase

An enzyme synthesized by bacteria upon prolonged penicillin exposure that inactivates penicillin molecules, conferring resistance.

Trimethoprim-Sulfamethoxazole (TMP-SMX)

Combination sulfonamide drug used to treat UTIs, pneumonia, bronchitis, and otitis media in pediatric patients.

Trimethoprim-Sulfamethoxazole Mechanism of Action

Inhibits bacterial synthesis of folic acid required for nucleic acid production.

Trimethoprim-Sulfamethoxazole Adverse Effects

GI manifestations, blood cell deficiencies, superinfections, Stevens-Johnson syndrome, and kernicterus.

Trimethoprim-Sulfamethoxazole Pediatric Contraindication

Strictly contraindicated in infants younger than $2\text{ months}$ of age due to the risk of kernicterus.

Trimethoprim-Sulfamethoxazole Fluid Requirement

Patients should maintain an increased oral fluid intake of $1200-1500\text{ mL/day}$ to prevent crystalluria and renal issues.

Tetracycline Indications

First-choice antibiotic for chlamydia, Mycoplasma infections, syphilis, tetanus, cholera, anthrax, and acne vulgaris.

Tetracycline Mechanism of Action

Bacteriostatic inhibition of bacterial protein synthesis.

Tetracycline Effects on Teeth and Bones

Causes permanent tooth discoloration in fetuses/children and suppresses long-bone growth in infants.

Tetracycline Age Contraindication

Contraindicated in children under $8\text{ years}$ of age due to adverse effects on dental enamel and bone growth.

Tetracycline Food and Binding Interactions

Absorption is significantly decreased when taken with dairy products, iron, zinc, antacids, or antidiarrheals.

Tetracycline Administration Timing

Should be taken on an empty stomach $1\text{ hour}$ before or $2\text{ hours}$ after meals, and never immediately before bedtime.

Azithromycin Indications

First-choice macrolide for Legionnaires' disease, whooping cough, acute diphtheria, PCN-allergic patients, and newborn ophthalmic infections.

Azithromycin Mechanism of Action

Alters bacterial protein synthesis, exerting bacteriostatic or bactericidal action depending on dose.

Azithromycin Adverse Effects

GI distress (N/V, diarrhea, abdominal pain), cardiac dysrhythmias, ototoxicity, and C. difficile superinfection.

Azithromycin Cardiac Contraindications

Contraindicated in patients with history of prolonged QT syndrome, hypokalemia, or hypomagnesemia.

Acyclovir

Antiviral prototype that inhibits viral DNA replication, indicated for herpes simplex, cytomegalovirus (CMV), varicella-zoster, and immunocompromised viral infections.

Acyclovir IV Adverse Effects

Intravenous administration can lead to renal toxicity, CNS toxicity, and thrombophlebitis at the injection site.

Acyclovir Drug Interactions

Probenecid increases blood levels; zidovudine increases CNS toxicity risk; concurrent nephrotoxic agents increase renal toxicity risk.

Nystatin

Fungicidal agent that alters fungal cell walls, indicated for local and mucosal Candida infections (candidiasis).

Nystatin Oral Administration Technique

Shake liquid prior to use; swish solution in the mouth as long as possible before swallowing or spitting out as prescribed; withhold eating/drinking for $30\text{ minutes}$ post-dose.

Immunity

A state of relative resistance to a disease that develops after exposure to a disease-causing agent.

Active Immunity

Long-lasting immune resistance produced by the host's own immune system, consisting of humoral (B cell antibody) and cell-mediated (T cell) responses.

Passive Immunity

Temporary immunity acquired by receiving antibodies produced outside the host, such as maternal antibodies or monoclonal antibody injections.

Vaccine

An immunization preparation containing weakened or altered protein antigens that stimulate antibody formation against specific pathogens.

Live Attenuated Vaccine

A type of vaccine created using a weakened version of a live germ (e.g., LAIV, MMR, Varicella).

Inactivated Vaccine

A type of vaccine containing a killed version of the germ (e.g., IIV influenza vaccine).

Vaccine Adjuvant

A chemical ingredient added to a vaccine that boosts the overall immune response to the antigen.

Herd Immunity

Community-level protection created when a high percentage of a population is vaccinated, blocking virus spread to protect vulnerable, unvaccinated individuals.

Rabies Immune Globulin Dosing and Administration Rule

Administered at $20\text{ IU/kg}$ once (infiltrated around wound, excess IM); must never be given in the same syringe or anatomical site as the rabies vaccine.