pharm 2

shapes of bacteria

coccus, vibrio, soirillium, bacillus, coccobacillus, fusiform bacillus, spirochete

gram neg stains

red

gram positive stains

purple

gram negative is

harder to treat g

gram negative bacteria

more complex

gram negative bacteria has

2 membranes

community associated infection

infection that is acquired by a person who has not been hospitalized or had a medical procedure within last year

health care associated infection

contracted in a hospital or institutional setting

health care associated infections occur

more than 48 hours after admission

2 days

health care acquired infections are _____ to treat

more difficult

causative microorganisms are drug resistance

most microorganisms that cause HCAI are

gram neg bacteria

most common HCAI

MRSA

prevention of HCAI

handwashing, antiseptics, disinfectants

most important prevention step in HCAI

handwashing

antiseptic

inhibit growth of microorganism, does not necessarily kill them

antiseptic are applied to

living tissue

ex. bedadine

antiseptics are used to clean

wounds or an abscess

antiseptics are a ___ agent

static

disinfectants

kill organisms

disinfectants are used on

non living objects

clorox wipes, lysol

disinfectants are ___ agents

cidal

antibiotics

meds used to treat bacterial infection

before beginning antibiotic therapy, you should obtain a

culture to identify causative organism and antibiotic susceptibilities

start antibiotic ___ culture is obtained

after

empiric therapy

treatment of an infection before specific culture information has been reported or obtained

definitive therapy

antibiotic therapy tailored to treat organism identified with cultures

prophylactic therapy

treatment with antibiotics to prevent infection, as in intraabdominal surgery or after trauma

normal wbc

5000-10000

therapeutic response

assess after patient been on antibiotic

decrease in specific signs and symptoms of infection are noted

subtherapeutic response

signs and symptoms of infection do not improve

reason why signs and symptoms may not improve

route of med admin

inadequate drainage of abscess

bacterial resistance

superinfection

decrease in normal bacteria flora

example of superinfection

c diff

c diff causes

foul smell, diarrhea or watery stool

secondary infection example

upper respiratory symptoms, come back to doctor with ear pain from bacteria after URI

resistance can occur from

not taking full dose of antibiotics

what percent of antibiotic prescriptions are unnecessary

30%

example of food drug interaction

tetracycline and dairy

decreases absorption

host factors include

age, organ function, genetics

allergic reactions are most common to

penicillins and sulfonamides

most common severe reactions

difficulty breathing, significant rash, hives, or other skin reaction, GI intolerance

pregnancy related host factors

some antibiotics may pass through placenta to the fetus

genetic host factors

glucose 6 phosphate dehydrogenase deficiency

slow acetylation

g6pd deficiency

blood cells break down when body exposed to certain meds

hemolytic anemia

classes of antibiotics

sulfonamides, penicillins, cephalosporins, macrolides, quinolones, aminoglycosides, tetracyclines

antibiotic mechanism of action

interfere with cell wall and protein synthesis

interfere with DNA replication

disrupt critical metabolic reactions in cell

site of antibiotic activity

cell wall synthesis, DNA and RNA replication, antimetabolies, protein synthesis of 30S and 50S ribosomes

bactericidal

kill bacteria

bacteriostatic

inhibit growth of susceptible bacteria rather than killing them immediately, leads to bacteria death

sulfonamides are often ___ with antoher antibiotic

combined

synergistic

sulfamethoxazole is combined with ___

trimethoprim

creates SMX-TMP

sulfonamides are

bacteriostatic

sulfonamides prevent

synthesis of folic acid required for synthesis of purines and nucleic acid

sulfonamides do nto affect

human cells or certain bacteia

sulfonamides only affect organisms that

synthesis their own folic acid

sulfonamides are effective against

gram positive and gram negative bacteria

sulfonamides teat

UTIs caused by snterobacter spp, e coli, klebsiella spp, proteus mirabilis, proteus vulgaris, s aureus

bactrim achieves main concentration in

kidney

bactrim treats

UTI, upper resp, pneumonia, and MRSA

SMX-TMP is used for

outpatient staph infections because of high reate of MRSA

sulfonamide blood adverse effects

hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia (reduction in platelet)

normal count of platelets

150,000-400,000

sulfonamides integumentary adverse effects

stephen johnson syndrome

if allergic to sulfonamides, probably allergic to

sulfonuria, thyozide, loop diuretics

sulfonamide GI adverse effects

nausea, vomiting, diarrhea, pancreatitis

sulfonamdide other adverse effects

crystalluria

sulfonamides may increase effects of

warfarin

increase chances of bleeding

beta lactam antibiotics include

penicillins, cephalosporins, carbapenems, monobactams

betalactamase

breaks down bond between carbon and nitrogen in beta lactam ring

decrease effectiveness of drug

types of penicillins

natural penicillin

penicillinase resistant drugs

aminopenicillins

extended spectrum drugs

natural penicillins

penicillin G

penicillin V

penicillinase resistant drugs include

nafcillin

cloxacillin

oxacillin

dicloxacillin

aminopenicillins include

amoxicillin

ampicillin

extended spectrum penicillin includes

carbenicillin

piperacillin

ticarcillin

beta-lactamase inhibitors

bind with beta lactamase enzyme to prevent break down of penicillin molecule

examples of beta-lactamase inhibitor drugs

clavulacin acid

tazobactam

sulbactam

clavulanic acid combines with ___ to make augmentin

amoxicillin

examples of combo drugs

ampicillin/sulbactam (unasyn)

amoxicillin/clavulanic acid (augmentin)

ticarcillin/clavulanic acid (timentin)

piperacillin/tazobactam (zosyn)

penicillins are

bacteriocidal

strep and staph

penicillin mechanism of action

enter the bacteria via cell wall

bind to penicillin binding protein

normal cell wall synthesis is disrupted

result from penicillin entering bacteria

bacteria cells die from cell lysis

indicators for penicillins

prevention and treatment of infections caused by bacteria such as

gram positive bacteria, strep spp, enterococcus spp, staph spp

contraindications for penicillins

known drug allergy

errors are made with penicillin meds because

penicillin drug called by its trade name is given to patient with penicillin allergy

not all penicillin meds end with “cillin”

allergies occur in ___ of people taking penicillin

.7-4%

patient with history of throat swelling or hives from penicillin should not recieve

cephalosporins

penicillins interact with

NSAIDs, oral contraceptives, warfarin

A patient is receiving Augmentin (amoxicillin and clavulanic acid) liquid solution through a percutaneous endoscopic gastrostomy tube. What is the purpose of the clavulanic acid?

it inhibits the production of enzymes produced by beta lactamise producing bacteria

cephalosproins are

semisynthetic antibiotics

cephalosporins are ____ related to penicillins

structurally and pharmacologically

cepahlosporins are

bacteriocidal and broad spectrum

generations of cephalosporins

first

second

third

fourth

fifth

first gen cephalosporins

good gram positive coverage

first gen cephalosporins are available in ___ forms

parenteral and oral forms

examples of first gen cephalosporins

cefadroxil (duricef, ultracef)

cephradine (velosef)

cefazolin (ancef)

cephalexin (keflex)

cefazolin (ancef)

available IV, IM

given pre-op for staph

cephalexin (keflex)

PO

For mild skin infection NOT MRSA

cephalosporin second gen

good gram positive, a little gram neg

examples of cephalospoin second gen

cefaclor (ceclor)

cefprozil (cefzil)

cefoxitin (mefoxin)

cefuroxime (zinacef)

cefotetan (cefotan)

cefoxitin (mefoxin)

IV and IM

used prophylactically for abdominal or colorectal surgeries

kills anaerobes