pharm class 9

exam 4

aminoglycosides

gentamicin

gentamicin moa

abnormal proteins in bacterial cell membrane cause leak

gentamicin is a ____ antibiotic

narrow spectrum, bactericidal

what is gentamicin used for?

aerobic gram negative (e coli)

gentamicin must be given iv because it’s not -

absorbed from gi

the higher the dose of aminoglycosides like gentamicin, the more -

cells get killed

dosing of gentamicin

single large dose or 2-3 small ones

the same aminoglycoside can produce ____ in every patient?

different plasma levels

peak levels of gentamicin must be high enough to ____ and trough must be low enough to ____

kill bacteria, lower toxicity

what type of dosing schedule for gentamicin is the best?

once a day

why is a large dose of gentamicin once a day better than divided doses throughout the day?

big dose kills right away, postantibiotic effect allows it to keep working even when dose gets lower

gentamicin is more dangerous the longer it -

stays in the body

gentamicin should not be given for more than -

10 days

gentamicin adverse effects

nephrotoxicity, ototoxicity, resp dep/paralysis d/t nm block

in order to avoid resp dep and paralysis with gentamicin -

don’t give with neuromuscular block

peak levels of iv gentamicin should be taken after -

30 min

when giving divided doses, trough levels of gentamicin should be taken -

before next dose

when giving one-daily dose, trough levels of gentamicin should be taken -

1 hour before next dose, value should be close to 0

interactions with gentamicin

nephrotoxic drugs - amphotericin, nsaids, vanco

what is often given with gentamicin?

penicillin

if penicillin dose is too high, what can it do to gentamicin?

inactivate

to prevent ototoxicity, what is most important to monitor with gentamicin?

trough levels

before giving gentamicin, it’s important to assess the patient for a history of?

myasthenia gravis

utis are the -

second most common infection

utis risk factors

sexually active women, older women in nursing homes

utis are less frequent in -

males

upper uti

pyelonephritis, bacterial prostatitis

lower uti

acute cystitis, urethral syndrome

complicated uti associated with -

calculi, prostatic hypertrophy, catheter, urine flow block

uncomplicated uti associated with

women of childbearing age

organisms that cause community utis

e coli

organisms that cause hospital utis

staph, e coli, pseudomonas

tx of choice for utis

trimeth/sulfameth, nitrofurantoin

acute cystitis symptoms

dysuria, urinary urgency, polyuria, pyuria, bacteriuria

what type of therapy is preferred for acute cystitis?

short course over 3 days

three types of oral therapy for community associated infections

single dose, short course, conventional

acute uncomplicated pyelonephritis is common in -

kids, older adults, childbearing women

acute uncomplicated pyelonephritis s/s

fever, chills, flank pain, dysuria, urinary urgency, polyuria, pyuria, bacteriuria

mild pyelonephritis can be treated at -

home

severe pyelonephritis requires patient to be at -

hospital, iv antibiotics

complicated uti

functional abnormality of urinary

examples of complicated utis

prostatic hyperplasia, calculi, renal/bladder tumor, catheter

s/s of complicated uti

fever, bacteremia, septic shock

recurrent uti - relapse

structural abnormality of urinary, kidneys, chronic prostatitis

recurrent uti - reinfection

lower tract, r/t sex

when reinfections are frequent (3x+ a year) -

long term prophylaxis needed

acute bacterial prostatitis

inflammation of prostate caused by bacterial infection

acute bacterial prostatitis s/s

fever, chills, malaise, dysuria, nocturia, polyuria, retention

most cases of acute bacterial prostatitis caused by -

e coli

acute bacterial prostatitis is associated with -

catheter, urethral instruments, prostatic resection

acute bacterial prostatitis responds well to -

antimicrobials

urinary tract antiseptics - lower uti

nitrofurantoin, methenamine

nitrofurantoin - low concentrations

stops bacterial growth

nitrofurantoin - high concentrations

bactericidal

uses of nitrofurantoin

lower uti, prophylaxis

nitrofurantoin adverse effects

gi, pulmonary, hematologic, neuropathy, hepatotoxicity, birth defects

what is irreversible with peripheral neuropathy related to nitrofurantoin?

demyelination, nerve degen

pulmonary reactions with nitrofurantoin resolve as soon as the drug is-

discontinued

acute pulmonary reactions with nitrofurantoin

dyspnea, chills, cp, fever, cough

what patient needs trimeth/sulfameth the most?

female with recurrent uti

which patient most likely needs iv antibiotics to treat uti?

uncomplicated uti caused by e coli

first drugs available for systemic treatment of bacterial infection

sulfonamides

sulfonamides moa

inhibit folate

primary use of sulfonamides

uti

other uses of sulfonamides

nocardiosis, chlamydia, ulcerative colitis, malaria

trimeth/sulfameth inhibits -

bacterial folic acid

therapeutic uses of trimeth/sulfameth

uti, otitis media, bronchitis, shigella, pneumonia, gi

adverse effects of trimeth/sulfameth

gi, rash, photosensitivity, sjs, blood dyscrasias, kernicterus, renal damage

gi effects of trimeth/sulfameth

nv

trimeth/sulfameth can lower ____

wbc, rbc, platelets

sjs

lesions on skin and mouth, fever, malaise

because of the risk of kernicterus, sulfonamides should not be given to -

babies < 2 months

sulfonamides and pregnancy

don’t give after 32 weeks

patient education with trimeth/sulfameth

hemolytic anemia, fluids to avoid renal failure, s/s of low blood, rash

signs of low blood count

fatigue, weak, easy bruising, sob

signs of rash

pruritis, redness

silver sulfadiazine

antimicrobial, burn patients

do not use silver sulfadiazine if the patient has

sulfa allergy

phenazopyridine is NOT an -

antibiotic

phenazopyridine use

uti burning relief

patient education with phenazopyridine

turns body fluids orange, report s/s of liver problems

do not use phenazopyridine -

long term

patient education with sulfadiazine

avoid sunlight, sunscreen

a patient complains of burning pain when they urinate. what tests should be obtained?

urinalysis, urine culture, blood culture, creatinine

what are other signs of uti?

delirium, burning, polyuria

when patient has uti and is being treated with antibiotic, what should be encouraged?

fluids, hygiene

complex infections like tb, leprosy, mycobacterium avium are caused by which species of mycobacteria?

mycobacterium tb

mycobacterial infections have ______ microbes

slow growing

mycobacterial infections require _____ treatment

prolonged

mycobacterial infections promote emergence of -

drug resistant mycobacteria

tb pathogenesis

may stay in lungs or spread, no obvious s/s

how is tb transmitted?

person to person, coughing, sneezing

immunity of tb develops within -

few weeks

latent tb

asymptomatic, no spread

5-10% of latent tb patients will develop -

active tb

how does tb develop when it comes to your immune system?

immune system can’t control primary infection

what happens to your lungs with tb?

necrosis, cavitization

always treat tb with -

2 or more drugs

with tb drugs, what type of drug administration is considered standard care?

direct observation - watch them take it

treatment of tb is considered effective when -

no mycobacteria, colonies