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Ati flash cards 02, antiinfectives

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Ati flash cards 02, antiinfectives

  1. 1. Antiinfectives Key Points N203 ATI (Unit 2) Antiinfectives -
  2. 2. · Broad-spectrum vs. narrow-spectrum antibiotics · Antimicrobials treat bacterial, viral, and fungal infections · Culture and sensitivity specimens should be collected prior to initiation of therapy. · Adverse reactions include: · Hypersensitivity & anaphylaxis · Superinfection · Organ toxicity (ototoxic, nephrotoxic) ·  warfarin activity ·  efficacy of oral contraceptives ·
  3. 3. Penicillins N203 ATI (Unit 2) Antiinfectives -
  4. 4. Expected Action: · β-lactam – destroys bacteria by weakening cell wall Therapeutic Uses: · Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes) · Med of choice for syphilis · First choice for meningitis · Prophylaxis against bacterial endocarditis · · Extended spectrum against Pseudomonas, Proteus, Klebsiella Adverse Effects: · Anaphylaxis / Renal Impairment / Hyperkalemia (w  doses) Contraindications: · Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction Interactions: · Aminoglycosides / η Oral Contraceptives Education: · Take orals ĉ H2O, ŝ food (some may be taken ĉ food)
  5. 5. Cephalosporins N203 ATI (Unit 2) Antiinfectives -
  6. 6. Expected Action: · β-lactam – destroy bacteria by destroying cell wall · Four generations, each is:η against G- and anaerobes –more resistant to lactamase – more able to reach CSF Therapeutic Uses: · Broad spectrum with TI for postop infections, meningitis, pelvic infections Adverse Effects: · Anaphylaxis / Bleeding / Thrombophlebitis / Pain ĉ IM / cross allergies to penicillins / AA-pseudomembranous colitis Contraindications: · Allergies to Penicillin / Kidney Dysfunction · Caution with anticoagulants, antiplatelets, and thrombolytics Interactions: · EtOH intolerance (disulfiram reaction) / Probenecid  renal excretion Education: · Take ĉ food
  7. 7. Carbapenems N203 ATI (Unit 2) Antiinfectives -
  8. 8. Expected Action: · β-lactam – destroy bacteria by destroying cell wall Therapeutic Uses: · Broad spectrum effective for serious infections such as pneumonia, peritonitis, and UTIs. P. aeruginosa develops resistance (use combo) – [broadest spectrum available] Adverse Effects: · Allergy / GI symptoms / Superinfection Contraindications: · Caution with renal impairment Interactions: · Education: ·
  9. 9. Monobactams N203 ATI (Unit 2) Antiinfectives -
  10. 10. Expected Action: · β-lactam – destroy bacteria by destroying cell wall Therapeutic Uses: · MRSA / Antibiotic-associated pseudomembranous colitis by C. difficile Adverse Effects: · Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis Contraindications/Precautions: · Caution with renal impairment · Infuse over 60 minutes · Very low therapeutic index Interactions: · Education: ·
  11. 11. Tetracyclines N203 ATI (Unit 2) Antiinfectives -
  12. 12. Expected Action: · Bacteriostatic by preventing protein synthesis Therapeutic Uses: · Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus fever / Rocky Mountain spotted fever / Lyme disease / UTI & VI Adverse Effects: · GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity / superinfection of bowel Contraindications/Precautions: · Renal disease (except doxycycline) / Use during pregnancy will stain deciduous teeth but not permanent teeth Interactions: · Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to η) · η of oral contraceptives Education: · Give with water on an empty stomach (except doxycycline & minocycline)
  13. 13. Bacteriostatic Inhibitors (Macrolides / Ketolides) N203 ATI (Unit 2) Antiinfectives -
  14. 14. Expected Action: · Bacteriostatic by inhibiting protein synthesis – Bactericidal at high doses Therapeutic Uses: · Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires’ · Chlamydia, Mycoplasma pneumoniae, Streptococcus pyogenes Adverse Effects: · GI discomfort / thrombophlebitis Contraindications/Precautions: · Pre-existing liver disease Interactions: · Toxic with: antihistamines, theophylline (asthma med), carbamazepine (anticonvulsant), warfarin Education: · Administer on empty stomach with water – IV is rarely used
  15. 15. Aminoglycosides (Medication List) N203 ATI (Unit 2) Antiinfectives -
  16. 16. · gentamicin · amikacin · kanamycin · tobramycin sulfate · neomycin · paromomycin · streptomycin
  17. 17. Aminoglycosides N203 ATI (Unit 2) Antiinfectives -
  18. 18. Expected Action: · Kill bacteria by disrupting protein synthesis Therapeutic Uses: · Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa) · Oral paromomycin use for amebiasis and tapeworm Adverse Effects: · Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitivity · Streptomycin: Neurologic disorders Contraindications/Precautions: · Renal impairment  reduced doses Interactions: · Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (neph-tox) / tubocurarine / penicillins ( AG) Education: ·
  19. 19. Penicillins (Medication List) N203 ATI (Unit 2) Antiinfectives -
  20. 20. · Penicillin G · Augmentin (amoxicillin-clavulanate) - Broad spectrum · Nafcillin - · Carbenicillin - Antistaphylococcal Antipseudomonas ·
  21. 21. Cephalosporins (Medication List) N203 ATI (Unit 2) Antiinfectives -
  22. 22. 1º · Cephalexin (Keflex) · Cephapirin (Cefadyl) 2º · Cefaclor (Ceclor) · Cefotetan (Cefotan) 3º · Cefatriaxone (Rocephin) · Cefotaxime (Claforan) 4º · Cefepime (Maxipime)
  23. 23. Carbapenems (Medication List) N203 ATI (Unit 2) Antiinfectives -
  24. 24. · Imipenem (Primaxin) · · Meropenem (Merrem IV) · · · ·
  25. 25. Monobactams (Medication List) N203 ATI (Unit 2) Antiinfectives -
  26. 26. · Vancomycin (Vancocin) · · Aztreonam (Azactam) · · Fosfomycin (Monurol) · ·
  27. 27. Tetracyclines (Medication List) N203 ATI (Unit 2) Antiinfectives -
  28. 28. · Tetracycline hydrochloride (Sumycin) · · Doxycycline (Vibramycin) · · Minocycline · ·
  29. 29. Macrolides / Ketolides (Medication List) N203 ATI (Unit 2) Antiinfectives -
  30. 30. · Azithromycin (Zithromax) · · Clarithromycin (Biaxin) · · Dirithromycin · · Erythromycin · · Clindamycin (Cleocin) ·
  31. 31. Sulfonamides & Trimethoprim (Medication List) N203 ATI (Unit 2) Antiinfectives -
  32. 32. · Sulfamethoxazole–Trimethoprim (TMP-SMZ, Bactrim) · Cotrim · Septra · Sulfadiazine · Sulfamethoxazole · Sulfisoxazole
  33. 33. Sulfonadmides-Trimethoprim N203 ATI (Unit 2) Antiinfectives -
  34. 34. Expected Action: · Bacteriostatic by inhibiting folate synthesis Therapeutic Uses: · Med of choice for UTI by E. coli and Pneumocystis carinii. Adverse Effects: · Hypersensitivity (sulfonamides, thiazide diuretics, tolbutamide, loop diuretics) · Blood dyscrasias / crystalluria / kernicterus ( bilirubin) / photosensitivity Contraindications/Precautions: · Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min · Reduce dosages with renal dysfunction Interactions: · Warfarin / phenytoin / tolbutamide ( effects of these) Education: · Empty stomach with full glass of water
  35. 35. Urinary Tract Aseptics N203 ATI (Unit 2) Antiinfectives -
  36. 36. Expected Action: Damages DNA Prototype: Nitrofurantoin · Static a@ doses, Cidal @ doses Therapeutic Uses: · Acute UTIs / Prophylaxis for recurrent lower UTI Adverse Effects: · GI / hypersensitivity / blood dyscrasias / peripheral neuropathy Contraindications/Precautions: · Renal dysfunction ĉ creatinine clearance < 40 Interactions: · Education: · Urine will be brown
  37. 37. Antimycobacterial N203 ATI (Unit 2) Antiinfectives -
  38. 38. Expected Action: Prototypes: isoniazid (INH), streptomycin, ethambutol, pyrazinamide · Prevents synthesis of mycolic acid Therapeutic Uses: · Active and latent tuberculosis Adverse Effects: · Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily) · Hepatotoxicity Contraindications/Precautions: · Liver disease Interactions: · Phenytoin (accumulates) · INH with EtOH, rifampin, pyrazinamide  hepatotoxicity Education: · Empty stomach but ĉ food if needed
  39. 39. Anti-Hansen’s Disease N203 ATI (Unit 2) Antiinfectives -
  40. 40. Expected Action: Prototype: Dapsone Others: Clofazimine, Rifampin · Prevents synthesis of folate which inhibits M. leprae. Therapeutic Uses: · Used in combination therapy to treat leprosy Adverse Effects: · Rifampin: Discoloration of body fluids / Hepatotoxicity · GI discomfort Contraindications/Precautions: · Use caution with liver dysfunction Interactions: · Rifampin η ĉ warfarin / OC / protease inhibitors / NNRTIs (HIV) Education: ·
  41. 41. Antiviral N203 ATI (Unit 2) Antiinfectives -
  42. 42. Expected Action: Prototype: Acyclovir Others: ganciclovir, interferon, ribavirin, amantadine · Prevents reproduction of viral DNA Therapeutic Uses: · Adverse Effects: · Acyclovir: Phlebitis, nephrotoxicity, nausea & headache · Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity / teratogenic Contraindications/Precautions: · Pregnancy /  neutrophil count (<500/cc) Interactions: · Nursing Info: · Acyclovir: Never give IV bolus, Infuse over 1 hour min. ·
  43. 43. Fluoroquinolones (Medication List) N203 ATI (Unit 2) Antiinfectives -
  44. 44. Expected Action: Prototype: Ciprofloxacin · Bactericidal by inhibition of enzyme needed for DNA Therapeutic Uses: · Broad spectrum / prevention of inhaled anthrax Adverse Effects: · GI discomfort / Achilles tendon rupture / superinfection Contraindications/Precautions: · Avoid use in children <18 d/t risk for tendon rupture Interactions: · Cations ( Cipro absorption) / Theophylline & warfarin ( med plasma levels) Education: · Infuse slowly over 60 minutes
  45. 45. Antiprotozoals N203 ATI (Unit 2) Antiinfectives -
  46. 46. Expected Action: Proto: Amphotericin Others: flucytosine, miconazole, nystatin, griseofulvin, ketoconazole ·  permeability  leakage of intracellular cations (static or cidal) Therapeutic Uses: · Systemic or cutaneous fungal infections Adverse Effects: · Amphotericin: Infusion rxn (1-3 hrs) / thrombophlebitis / nephrotoxicity / hypokalemia / marrow suppression · Ketoconazole: Hepatotoxicity / Sex hormone effects Contraindications/Precautions: Renal dysfunction Interactions: · Aminoglycosides (streptomycin, cyclosporine) – additive nephrotoxicity · Flucytosine – antifungal effects are potentiated with amphotericin Education: Highly toxic, infuse slowly (2-4 hr) · Renal damage limited by infusing 1 L NS on day of amphotericin infusion
  47. 47. Antiprotozoals N203 ATI (Unit 2) Antiinfectives -
  48. 48. Expected Action: Proto: metronidazole (Flagyl) · Broad spectrum with anaerobic activity Therapeutic Uses: · Protozoal infections / Bacterial infections against obligate anaerobes · Prophylaxis for surgical procedures at high risk for anaerobic infections (vaginal, abdominal, colorectal) · H. pylori with tetracycline and bismuth salicylate Adverse Effects: · GI discomfort / metallic taste / darkening of urine / CNS symptoms Contraindications/Precautions: · Caution with renal dysfunction / avoid during 1st trimester of pregnancy Interactions: · Disulfiram-like reaction ĉ EtOH · Warfarin – Flagyl inhibits inactivation of warfarin Education: ·

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