Pharm Exam 3

Gram positive

purple and thick peptidoglycan layer

Gram negative

pink and thin peptidoglycan layer

Anti-infectives are used to treat infections caused by

bacteria, viruses, fungi, and protozoan

What percent of antibiotics prescribed are unnecessary?

30%

Common issue with antibiotics- pseudomembranous colitis

Too much C. difficile grows in the intestine and they give off a strong toxin that causes inflammation and bleeding in the lining of the colon

common issues with antibiotics- Stomatitis

C. albicans can overgrow in people who have taken antibiotics

Common issues with antibiotics- stomach upset

Antibiotics upset the bacterial balance and harm the good bacteria and cause a disturbance in the ecosystem to make you sick

cross-sensitivity

allergy to drugs in the same or related group

Hypersensitivity reaction caution

take caution in clients with a history of allergies to many substances

hypersensitivity reaction signs and symptoms

skin rash, urticaria, pruritus, sneezing, wheezing, bronchospasm, laryngospasm, angioedema, hypotension, anaphylactic reactions

__ and _ decrease the effectiveness of oral contraceptives

tetracyclines and some penicillin

issues with antibiotoics- superinfection

When taking any antibacterial drug, overgrowth of other bacteria or elimination of normal flora can result in superinfection

bacteriostatic

slows the multiplication of bacteria

bactericidal

destroy the bacteria

DNA/RNA synthesis disruptors- antibacterial drugs

fluroquinoles, metronidazole

protein synthesis disruptors

tetracyclines, aminoglycosides, macrolides

cell wall disruptors

penicillin, cephalosporins, carbapenems, vancomycin

Folic acid (cell metabolism inhibitors) examples

sulfonamides

DNA/RNA synthesis disruptions action

When DNA and RNA synthesis is interrupted, the bacterial cell cannot cannot reproduce and die

Protein synthesis disruptors action

interfere with the development of protein in the bacterial cell. mRNA tells cells how to build amino acids. Drugs act here by preventing the amino acids from linking together to make protein. Bactericidal.

Cell wall disruptor action

Disrupt and inhibit the growth and repair of the bacterial cell wall. When the drug attaches to the cell, a portion of the drug molecule (beta-lactam ring) breaks the cell wall and the cell dies.

DNA/RNA synthesis disruption drug examples

fluoroquinoles, metronidazole

Protein synthesis disruptor drug examples

tetracyclines, aminoglycosides, macrolides

Cell wall disruptors drug examples

penicillin, cephalosporins, carbapenems, vancomycin

Folic acid (cell metabolism inhibitors) drug examples

sulfonamides

Antibiotic stewardship

Antimicrobial resistance, health facility-associated infections, culture and sensitivity

Antimicrobial resistance

ability of bacteria to produce substances that inactivates or destroy the antibiotic

What is an example of antimicrobial resistance?

MRSA

Health-facility infections

staph infections (MRSA), occur most frequently in people in hospitals or skilled nursing facilities

1 in __ clients have at least 1 FAI

30

Culture and sensitivity

swab the infected area, strain of microbe is identified, determines which antibiotic will or will not kill the microbe

sulfonamides action

inhibits the activity of folic acid in bacterial cell metabolism

Are sulfonamides bacteriostatic or bactericidal?

bacteriostatic

bacteria affected by sulfonamides

E. coli, staph aureus, kelbisella, enterobacter

Uses of sulfonamides

UTI, otitis media, ulcerative colitis, bacterial skin and eye infections, topically for burn treatment and prevention of infection

sulfonamide ADR

stomatitis, crystalluria, N/V/D, anorexia, abdominal pain, photosensitivity

Major adverse reaction of sulfonamides

Topic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS)

What occurs in TEN and SJS

widespread sloughing of skin and mucous membranes; if intestinal organs are involved, death may occur

TEN or SJS signs and symtpoms

fever, cough, muscular aches and pains, headache, lesions appear as red wheals/blisters starting in face, mouth, lips, neck, and extremities

Prolonged sulfonamide use

leukopenia, thrombocytopenia, aplastic anemia

sulfadiazine is the prototype for

sulfonamides

sulfonamide common prefex

“sulfa”

Penicillin types

natural, penicillinase-resistant penicillin, aminopenicillins

penicillin action

disrupt and inhibit the growth and repair of the bacterial cell wall

penicillin uses

UTI, septicemia, meningits, intra-abdominal infections, syphilis, pneumonia and other respiratory infections, soft tissue injections and injuries

penicillin ADR

stomatitis, N/V/D, glossitis, gastritis, blood cell changes (thrombocytopenia, leukopenia, anemia, bone marrow depression)

Penicillin common suffix

“cillin”

Cephalosporins action

disrupt and inhibit the growth and repair of the bacterial cell wall

Cephalosporin common prefix

“cef” or “ceph”

How many generations of cephalosporins are there?

5

Uses of cephalosporins

respiratory infections, otitis media, bone/joint infections, complicated intra-abdominal or GU tract infections, prophylaxis (sexual assault and peri-operative)

Cephalosporins ADR

N/V/D, nephrotoxicity, SJS, positive direct coombs test

What does a positive direct coombs test mean

antibodies stick to RBC and cause RBC to die too early

Cephalosporin prototype

cefepime

Are cephalosporins bacteriostatic or bactericidal

bactericidal

Are penicillins bacteriostatic or bactericidal

bactericidal

penicillin bacterial resistance

some bacteria can produce penicillinase and some can produce beta-lactamases, which destroy the beta-lactam ring. Some penicillins are combined with beta-lactamase inhibitors.

What is augmentin made of

Amoxicillin + clavulanic acid

What is augmentin?

A penicillin mixed with a beta-lactamase inhibitor

Vancomycin action

disrupt and inhibit the growth and repair of the bacterial cell wall

Vancomycin uses

used in treatment of serious gram + infections that dont respond to treatment with other anti-infectives, anti-infective associated pseudomembranous colitis caused by C. difficile

Vancomycin ADR

nausea, chills, fever, urticaria, sudden BP fall, redness of face, arms, neck, and back, neprotoxicity, otoxicity

Precautions of vancomycin

can damage kidneys and organs of hearing

Is vancomycin bacteriostatic or bactericidal

bactericidal

Tetracycline bacteriostatic or bacericidal

bactericidal

tetracyclines common suffix

“cycline”

Tetracycline action

Interfere with the development of protein in bacterial cell

tetracycline uses

E. coli, respiratory infections, RMSF, uncomplicated infections with chlamydia trachomatis, severe acne as an adjunctive, H. pylori

Tetracyclines ADR

stomatitis, N/V/D, epigastric distress, skin rashes, photosensitivity

tetracyclines contraindications

<9, can cause permanent yellow-grey-brown discoloration of teeth

tetracycline precautions

nephrotoxicity, hepatotoxicity, may reduce insulin requirements in clients with diabetes

Aminoglycosides suffix

“micin” or “mycin”

aminoglycoside action

block the ribosome from reading the mRNA, preventing protein synthesis and bacterial reproduction

Client monitoring aminoglycoside

must monitor clients closely because they easily produce toxic reaction

aminoglycoside uses

bowel preparation, hepatic coma, infections caused by gram - microbes

Aminoglycosides ADR

N/V, anorexia, rash, urticaria, nephrotoxicity (usually reversible), ototoxicity (permanent), neurotoxicity

Aminoglycoside bacteriostatic or bactericidal

bactericidal

Aminoglycoside prototype

gentamicin

Macrolide common suffix

“thromcyin”

Macrolides bactericidal or bacteriostatic

both

high rate of bacterial resistance to this class

macrolides

Macrolides uses

wide - and gram + infections, acne vulgaris, skin infection, URI caused by Haemophiles influenzae (with sulfonamides)

Fluroquinolones common suffix

“floxacin”

Fluoroquinolones action

prevents the making of bacterial DNA and prevents cell reproduction

Fluroquinolones uses

lower RTI, bone and joint infection, UTI, skin infections, STI

Floroquinolones bactericidal or bacteriostatic

bactericidal

Fluroroquinolones ADR

photosensitivity

Fluoroquinolones precautions

Risk for aoritc dissection or rupture, tendonitis risk and rupture risk

Who are most at risk for a tenon rupture and tendonitis

clients > 60 who take corticosteriods

In what patient’s should Fluroquinolones NOT be prescribed

If diagnosed with an existing aortic aneurysm, HTN, peripheral atherosclerosis, or genetic blood vessel disorder

Fluoroquinolones prototype

ciprofloxacin

Metronidazole/Flagyl action

prevents the making of DNA and cell production

Metronidazole/Flagyl bacteriostatic or bactericidal

Bactericidal

Metronidazole/Flagyl uses

used to treat anaerobic microbes in bone, skin, CNS, internal body cavity, respiratory system

Metronidazole/Flagyl ADR

headache, nausea, peripheral neuropathy, disulfiram (like interaction with alcohol)

Tuberculosis is an infectious disease caused by

mycobacterium tuberculosis

Tuberculosis is transmitted by

droplets

how many kinds of tuberculosis are there

3

What are the different kinds of tuberculosis

latent, active, extrapulmonary

What is the leading cause of death in clients with HIV

TB