DATE:

Imipenem (Primaxin)Meropenem (Merrem IV)

Carbapenems

(Medication List)

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 12

1Cephalexin (Keflex)Cephapirin (Cefadyl)2Cefaclor (Ceclor)Cefotetan (Cefotan)3Cefatriaxone (Rocephin)Cefotaxime (Claforan)4Cefepime (Maxipime)

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 & anaphylaxisSuperinfectionOrgan toxicity (ototoxic, nephrotoxic)( warfarin activity( efficacy of oral contraceptives

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 1

Antiinfectives

Key Points

Cephalosporins

(Medication List)

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 11

gentamicinamikacinkanamycintobramycin sulfateneomycinparomomycinstreptomycin

Aminoglycosides

(Medication List)

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 8

Penicillin GAugmentin (amoxicillin-clavulanate) - Broad spectrumNafcillin - AntistaphylococcalCarbenicillin - Antipseudomonas

Penicillins

(Medication List)

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 10

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:

Aminoglycosides

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 9

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

Bacteriostatic Inhibitors

(Macrolides / Ketolides)

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 7

Expected Action:Bacteriostatic by preventing protein synthesisTherapeutic Uses:Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus fever / 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 deciduous teeth 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)

Tetracyclines

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 6

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) / Thrombophlebitis Contraindications/Precautions:Caution with renal impairment

Infuse over 60 minutes

Very low therapeutic indexInteractions:Education:

Monobactams

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) [broadest spectrum available]Adverse Effects:Allergy / GI symptoms / Superinfection Contraindications:Caution with renal impairmentInteractions:Education:

Carbapenems

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 4

Expected Action:-lactam destroy bacteria by destroying cell wall

Four generations, each is:( against G- and anaerobes more resistant to lactamase more able to reach CSFTherapeutic Uses:Broad spectrum with (TI for postop infections, meningitis, pelvic infectionsAdverse Effects:Anaphylaxis / Bleeding / Thrombophlebitis / Pain IM / cross allergies to penicillins / AA-pseudomembranous colitisContraindications:Allergies to Penicillin / Kidney Dysfunction

Caution with anticoagulants, antiplatelets, and thrombolyticsInteractions:EtOH intolerance (disulfiram reaction) / Probenecid ( renal excretionEducation:Take food

Cephalosporins

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 3

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 5

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 for syphilisFirst choice for meningitisProphylaxis against bacterial endocarditisExtended 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)

Penicillins

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 2

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 13

Monobactams

(Medication List)

Vancomycin (Vancocin)Aztreonam (Azactam)Fosfomycin (Monurol)

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 14

Tetracyclines

(Medication List)

Tetracycline hydrochloride (Sumycin)Doxycycline (Vibramycin)Minocycline

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 15

Macrolides / Ketolides

(Medication List)

Azithromycin (Zithromax)Clarithromycin (Biaxin)DirithromycinErythromycinClindamycin (Cleocin)

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 16

Sulfonamides & Trimethoprim

(Medication List)

SulfamethoxazoleTrimethoprim (TMP-SMZ, Bactrim)

Cotrim

Septra

Sulfadiazine

Sulfamethoxazole

Sulfisoxazole

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 17

Sulfonadmides-Trimethoprim

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

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 18

Urinary Tract Aseptics

Expected Action: Damages DNAPrototype: NitrofurantoinStatic 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

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 19

Antimycobacterial

Expected Action:Prototypes: isoniazid (INH), streptomycin, ethambutol, pyrazinamidePrevents 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

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 20

Anti-Hansens Disease

Expected Action:Prototype: Dapsone Others: Clofazimine, RifampinPrevents 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:

N203

ATI (Unit 2)

Antiinfectives - SEQ Card/n \* MERGEFORMAT 21

Antiviral

Expected Action:Prototype: Acyclovir

Others: ganciclovir, interferon, ribavirin, amantadinePrevents reproduction of viral DNATherapeutic Uses:Adverse Effects:Acyclovir: Phlebitis, nephrotoxicity, nausea & headache

Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity / teratogenicContraindications/Precautions:Pregnancy / ( neutrophil count (