ati flash cards 02, antiinfectives

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  • 1. AntiinfectivesKey PointsN203ATI (Unit 2)Antiinfectives -

2. Broad-spectrum vs. narrow-spectrum antibiotics Antimicrobials treat bacterial, viral, and fungal infections Culture and sensitivity specimens should be collected prior toinitiation of therapy. Adverse reactions include: Hypersensitivity & anaphylaxis Superinfection Organ toxicity (ototoxic,nephrotoxic) warfarin activity efficacy of oral contraceptives 3. PenicillinsN203ATI (Unit 2)Antiinfectives - 4. Expected Action: -lactam destroys bacteria by weakening cell wallTherapeutic Uses: Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes) Med of choice forsyphilis First choice for meningitis Prophylaxis against bacterial endocarditis Extended spectrum against Pseudomonas, Proteus, KlebsiellaAdverse Effects: Anaphylaxis / Renal Impairment / Hyperkalemia (w doses)Contraindications: Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney DysfunctionInteractions: Aminoglycosides / Oral ContraceptivesEducation: Take orals H2O, food (some may be taken food) 5. CephalosporinsN203ATI (Unit 2)Antiinfectives - 6. Expected Action: -lactam destroy bacteria by destroying cell wall Four generations, each is: against G- and anaerobes more resistant tolactamase more able to reach CSFTherapeutic Uses: Broad spectrum with TI for postop infections, meningitis, pelvic infectionsAdverse Effects: Anaphylaxis / Bleeding / Thrombophlebitis / Pain IM / cross allergies topenicillins / AA-pseudomembranous colitisContraindications: Allergies to Penicillin / Kidney Dysfunction Caution with anticoagulants, antiplatelets, and thrombolyticsInteractions: EtOH intolerance (disulfiram reaction) / Probenecid renal excretionEducation: Take food 7. CarbapenemsN203ATI (Unit 2)Antiinfectives - 8. Expected Action: -lactam destroy bacteria by destroying cell wallTherapeutic Uses: Broad spectrum effective for serious infections such as pneumonia, peritonitis,and UTIs. P. aeruginosa develops resistance (use combo) [broadestspectrum available]Adverse Effects: Allergy / GI symptoms / SuperinfectionContraindications: Caution with renal impairmentInteractions:Education: 9. MonobactamsN203ATI (Unit 2)Antiinfectives - 10. Expected Action: -lactam destroy bacteria by destroying cell wallTherapeutic Uses: MRSA / Antibiotic-associated pseudomembranous colitis by C. difficileAdverse Effects: Ototoxicity / Infusion Rxn (red man syndrome) / ThrombophlebitisContraindications/Precautions: Caution with renal impairment Infuse over 60 minutes Very low therapeutic indexInteractions:Education: 11. TetracyclinesN203ATI (Unit 2)Antiinfectives - 12. Expected Action: Bacteriostatic by preventing protein synthesisTherapeutic Uses: Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhusfever / Rocky Mountain spotted fever / Lyme disease / UTI & VIAdverse Effects: GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity /superinfection of bowelContraindications/Precautions: Renal disease (except doxycycline) / Use during pregnancy will stain deciduousteeth but not permanent teethInteractions: Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to ) of oral contraceptivesEducation: Give with water on an empty stomach (except doxycycline & minocycline) 13. Bacteriostatic Inhibitors(Macrolides / Ketolides)N203ATI (Unit 2)Antiinfectives - 14. Expected Action: Bacteriostatic by inhibiting protein synthesis Bactericidal at high dosesTherapeutic Uses: Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires Chlamydia, Mycoplasma pneumoniae, Streptococcus pyogenesAdverse Effects: GI discomfort / thrombophlebitisContraindications/Precautions: Pre-existing liver diseaseInteractions: Toxic with: antihistamines, theophylline (asthma med), carbamazepine(anticonvulsant), warfarinEducation: Administer on empty stomach with water IV is rarely used 15. Aminoglycosides(Medication List)N203ATI (Unit 2)Antiinfectives - 16. gentamicin amikacin kanamycin tobramycin sulfate neomycin paromomycin streptomycin 17. AminoglycosidesN203ATI (Unit 2)Antiinfectives - 18. Expected Action: Kill bacteria by disrupting protein synthesisTherapeutic Uses: Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P.aeruginosa) Oral paromomycin use for amebiasis and tapewormAdverse Effects: Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitivity Streptomycin: Neurologic disordersContraindications/Precautions: Renal impairment reduced dosesInteractions: Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (neph-tox) /tubocurarine / penicillins ( AG)Education: 19. Penicillins(Medication List)N203ATI (Unit 2)Antiinfectives - 20. Penicillin G Augmentin (amoxicillin-clavulanate) - Broad spectrum Nafcillin - Carbenicillin -AntistaphylococcalAntipseudomonas 21. Cephalosporins(Medication List)N203ATI (Unit 2)Antiinfectives - 22. 1 Cephalexin (Keflex) Cephapirin (Cefadyl)2 Cefaclor (Ceclor) Cefotetan (Cefotan)3 Cefatriaxone (Rocephin) Cefotaxime (Claforan)4 Cefepime (Maxipime) 23. Carbapenems(Medication List)N203ATI (Unit 2)Antiinfectives - 24. Imipenem (Primaxin) Meropenem (Merrem IV) 25. Monobactams(Medication List)N203ATI (Unit 2)Antiinfectives - 26. Vancomycin (Vancocin) Aztreonam (Azactam) Fosfomycin (Monurol) 27. Tetracyclines(Medication List)N203ATI (Unit 2)Antiinfectives - 28. Tetracycline hydrochloride (Sumycin) Doxycycline (Vibramycin) Minocycline 29. Macrolides / Ketolides(Medication List)N203ATI (Unit 2)Antiinfectives - 30. Azithromycin (Zithromax) Clarithromycin (Biaxin) Dirithromycin Erythromycin Clindamycin (Cleocin) 31. Sulfonamides & Trimethoprim(Medication List)N203ATI (Unit 2)Antiinfectives - 32. SulfamethoxazoleTrimethoprim (TMP-SMZ, Bactrim) Cotrim Septra Sulfadiazine Sulfamethoxazole Sulfisoxazole 33. Sulfonadmides-TrimethoprimN203ATI (Unit 2)Antiinfectives - 34. Expected Action: Bacteriostatic by inhibiting folate synthesisTherapeutic 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) / photosensitivityContraindications/Precautions: Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min Reduce dosages with renal dysfunctionInteractions: Warfarin / phenytoin / tolbutamide ( effects of these)Education: Empty stomach with full glass of water 35. Urinary Tract AsepticsN203ATI (Unit 2)Antiinfectives - 36. Expected Action: Damages DNA Prototype: Nitrofurantoin Static a@ doses, Cidal @ dosesTherapeutic Uses: Acute UTIs / Prophylaxis for recurrent lower UTIAdverse Effects: GI / hypersensitivity / blood dyscrasias / peripheral neuropathyContraindications/Precautions: Renal dysfunction creatinine clearance < 40Interactions:Education: Urine will be brown 37. AntimycobacterialN203ATI (Unit 2)Antiinfectives - 38. Expected Action:Prototypes: isoniazid (INH), streptomycin, ethambutol,pyrazinamide Prevents synthesis of mycolic acidTherapeutic Uses: Active and latent tuberculosisAdverse Effects: Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily) HepatotoxicityContraindications/Precautions: Liver diseaseInteractions: Phenytoin (accumulates) INH with EtOH, rifampin, pyrazinamide hepatotoxicityEducation: Empty stomach but food if needed 39. Anti-Hansens DiseaseN203ATI (Unit 2)Antiinfectives - 40. Expected Action: Prototype: Dapsone Others: Clofazimine, Rifampin Prevents synthesis of folate which inhibits M. leprae.Therapeutic Uses: Used in combination therapy to treat leprosyAdverse Effects: Rifampin: Discoloration of body fluids / Hepatotoxicity GI discomfortContraindications/Precautions: Use caution with liver dysfunctionInteractions: Rifampin warfarin / OC / protease inhibitors / NNRTIs (HIV)Education: 41. AntiviralN203ATI (Unit 2)Antiinfectives - 42. Expected Action:Prototype: AcyclovirOthers: ganciclovir, interferon, ribavirin, amantadine Prevents reproduction of viral DNATherapeutic Uses:Adverse Effects: Acyclovir: Phlebitis, nephrotoxicity, nausea & headache Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity /teratogenicContraindications/Precautions: Pregnancy / neutrophil count (