Drugs to treat bacterial infections – Flashcards
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Pathogens
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Organisms that can cause disease
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What are some examples of pathogens?
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Bacteria, viruses Fungi, unicellular organisms (protozoans) Multicellular animals (flees, mites, or worms)
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What two ways do pathogens cause disease?
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Invasiveness because they multiply rapidly and cause direct damage, also by toxins that disrupt normal cell function in even very small amounts
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What is pathogenicity?
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Ability of organism to cause infection, and some pathogens are better at this than others
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What is virulence?
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The ability of a microbe to produce disease when present in minute numbers?
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What are bacillus shaped bacteria?
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Rod shaped
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What are cocci shaped bacteria?
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Spherical
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What are spirilla?
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Spiral shaped
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What does aerobic mean?
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That the bacteria use O2
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What does anaerobic mean?
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That the bacteria do not use O2wgat
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What does a gram-positive result mean?
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That the bacteria have thick walls
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What does a gram-negative result mean?
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That the bacteria have thin walls
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What does an anti-infective drug affect?
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The target organism's structure, metabolism, or life cycle.
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What are antibiotics?
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Natural substances produced by bacteria that kills other bacteria
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What do bacteriocidal agents do?
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Kill bacteria and these are for more serious infections
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What do bacteriostatic agents do?
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Slow the growth of bacteria
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When does aquired resistance occur?
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When the pathogen aquires a gene for bacterial resistance
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What does long term use do for resistance?
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Increases resistant strains
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How do you choose the correct antibiotic?
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Need a culture and sensitivity test, also for effective pharmacotherapy and to limit adverse effects
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What are broa-soectrum antibiotics used for?
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For a wide variety of bacteria, they are often used initially, before the organism is known
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What is a narrow spectrum anti-biotic used for?
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For a specific pathogen that we are targeting specifically.
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What is culture and sensitivity used for?
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Tested for sensitivity to antibiotics, bacteria take several days to identify, viruses take several weeks
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What are superinfections?
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Secondary infections that occur when to many host flea are killed by an antibiotic
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How do these superinfections happen?
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Host flora prevent the growth of pathogenic organisms, but when they are gone pathogenic organisms have a chance to multiply and they are opportunistic
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What are the signs and symptoms of superinfections ?
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Diarrhea, bladder passion, painful urination, or abnormal vaginal discharge
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What are some host factors that influence selection of antibiotic?
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Immune system status, local condition at infection site, allergic reactions, age, pregnancy, and genetics
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Classes of antibiotics
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Penicillins, cephalosporins, tetracyclines, macrolides, aminoglycosides, fluoroquinolones, sulfonamides
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What are penicillins mechanism of actions?
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Kill bacteria by weakening their cell walls, allowing water to enter, and thus killing the organism
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What are some penicillins?
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PNC, dicloxacillin, nafcillin, amoxicillin, ampicillin, piperacillin
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What are some indications for penicillins?
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Primary use: drug of choice against streptococci, pneumococci, & staph organisms that do not produce penicillinase; also a medication of choice for gonorrhea and syphilis
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What are some adverse effects of penicillins?
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The safest class of antibiotics; bacteria can become resistant; allergy is possible; lowered red/white blood cell count can occur, rash, pruritis, diarrhea, nausea, fever, nephrotoxicity
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What are nursing implications for penicillans?
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Report allergy, rash, hives, fever, anaphylaxis. Allergy to PCN increases risk of allergy of meds in the same class, PCN increases risk of hyperkalemia if taken with a K sparing diuretic, give cautiously if severe renal disease, Do not administer with aminoglycosides
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What is the mechanism of action for cephalosporins?
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Bind to the bacterial cell wall, inhibit cell wall synthesis, Act with broad-spectrum activity against gram-negative organisms
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What are some drugs that are in the cephalosporins class?
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Cephalexin, cefazolin, cefdinir, ceftriaxome
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What are some indications for cephalosporins?
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Primary use: for serious infections of the lower respiratory tract, central nervous system, genitourinary system, bones, blood, and joints, skin structure infections
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What are some adverse effects of cephalosporins?
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Also safe drugs like PCN'S, allergy to drug, rash, diarrhea, nausea, superinfections, abdominal cramping, pruritis, fatigue. Anaphylaxis, nephrotoxicity, colitis
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What are some nursing implications for cephalosporins?
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Take all meds as prescribed, report allergy and side effects to provider. Pregnancy category B, 5-10% of patients with allergy to PCN will exhibit hypersensitivity to cephalosporins (if history of severe allergy to PCN do not use)
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What is the mechanism of action for tetracyclines?
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Inhibit bacterial protein synthesis, affective against a broad range of gram negative and gram positive organisms
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What are some examples of tetracyclines?
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Doxycycline, minocycline, and tetracycline
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What are some indications of tetracyclines?
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Primary use: the drugs of choice for only a few diseases because of resistant bacterial strains (Rocky Mountain Fever, typhus, cholera, Lyme disease, peptic ulcers, and chlamidia) Also used for acne (p.o. and topical)
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What are the adverse effects of tetracyclines?
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Nausea, vomiting, abdominal cramping, flatulence, diarrhea, phototoxicity, dizziness, rash, stinging/burning with topical. Causes anaphalaxis, hepatotoxicity, secondary infections, exfoliate dermatitis, permanent teeth discoloration
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What are the nursing implications of tetracyclines?
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Administer po drugs with a full glass of water, administer antacids and tetracyclines 1-3 hours apart. Do not take with milk or iron (can decrease absorbtion by 50%). Do not give to children under 8. Pregnancy category D (affect fetal bone and teeth growth)
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What is the mechanism of action for macrolides?
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Inhibits protein synthesis by binding to the bacterial ribosome Effective against most gram-positive and many gram-negative bacteria
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What are some examples of macrolides?
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Azithromycin (Z-pak) clarithromycin, erythromycin, fidaxomicin (used for C. dif)
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What are some indications for macrolidesm
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For whooping cough; Legionnaire's disease; infections by streptococcus, H. Influenza, and mycoplasma pneumonia N. Gonorrhea (single dose of Zithro) H. Pylori (clarithromycin)
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What are some adverse effects of macrolides?
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Nausea, vomiting, abdominal cramping, diarrhea, dry skin, and burning with topical. Anaphalaxis, ototoxicity, superinfections, colitis, hepatotoxicity, anemia, dysrhythmias
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What are nursing implications for macrolides?
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Do not use erythromycin with statinsmay increase risk for muscle toxicity, anesthesia azole antifungals, anticonvulsants, may increase serum levels of erythromycin resulting in toxicity Hearing loss, dizziness, and vertigo may occur with high doses. May increase the effects of Warfarin
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What is the mechanism of action for aminoglycocides?
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Inhibit bacterial protein synthesis
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What are some examples of aminoglycosides?
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Amikacin, gentamicin, neomycin, streptomycin, ramycin
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What are the indications for aminoglycosides?
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Treatment of serious systemic infections caused by aerobic gram-negative bacteria, mycobacteria, and some protozoans. (E. Coli, serratia, proteus, klebsiella, pseudomonas)
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What are some side effects of aminoglycosides?
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Pain or inflammation at injection site, rash, fever, diarrhea, dizziness, tinnitus, anaphalaxis, nephrotoxocity, irreversible ototoxicity, superinfections
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What are some nursing implications for aminoglycosides?
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More toxic than other antibacterial classes, with serious systemic adverse effects. Be aware of potential for serious effects on inner ears and kidneys. Loss of hearing, vertigo, dizziness, lots of balance, persistent HA, ringing in ears, signs of ototoxicity, permanent deafness can result. Monitor BUN, creatinine, closely. Neomycin used as topical for infections of ears, eyes, skin
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What is the mechanism of action for Fluoroquinolones?
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Affect DNA synthesis
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What are some examples of fluoroquinolones?
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Levofloxins, ciprofloxacin, ofloxacin, moxifloxcin
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What are some indications for Fluoroquinolones?
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For respiratory infections, GI and genitourinay. Tract infections, and some skin and soft tissue infections, UTI'S. It is indicated for prophylaxis of anthrax infection
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What are some adverse infections of Fluoroquinolones?
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Nausea, vomiting, diarrhea, sleep disturbances, HA dizziness, must serious adverse effects are dysrhythmias, hepatotoxicity, tendon rupture, superinfections, photosensitivity, colitis, seizure, peripheral neuropathy
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What are some nursing implications for Fluoroquinolones?
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Well absorbed from GI tract, not indicated for children less than 18 and avoid use in elderly because of increased risk for tendonitis, or tendon rupture esp. If on steroids. Do not use in pregnancy or lactating women due to effects on cartilage development. Can be taken with food, but avoid taking with multivitamins decreases absorbtion of some fluoroquinolones by as much as 90%
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What is the mechanism of action for Sulfonomides?
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Inhibit the synthesis of folic acid or folate (folate acid inhibitors)
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What are some examples of Sulfonomides?
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Sulfadiazine, sulfadoxine-pyrimethamine, trimethoprim-sulfamethoxazole
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What are some indications for Sulfonomides?
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For UTI's Pneumocystosis carinii pneumonia, shigella infections of small bowel
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What are some adverse effects of Sulfonemides?
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Formulation of crystals in the urine, hypersensitivity reactions, nausea, Vomiting, anorexia, rash, photosensitivity, agranulocystosis, acute hemolytic anemia, and aplastic anaphalaxsis, thrombocytopenia, anaphalaxis, superinfections, Steven-Johnson syndrome, hyperkalemia, hepatic necrosis
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What are some nursing implications for Sulfonamides?
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Notify provider of adverse effects/allergic reaction, use sunscreen, notify PCP of rash, diarrhea (esp with blood, pus, or mucus), sores in mouth, fever, sore throat, or unusual bleeding. Monitor I&O encourage po fluids to prevent crystals in urine
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What is the mechanism action for Urinary antiseptics? (other antibacterials)
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Inhibits DNA, RNA, protein and cell wall synthesis
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What are some examples of Urinary antiseptics?
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Fosfomycin, methenamine, nalidixis acid, nitrofurantoin
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What were the indications for urinary antiseptics?
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UTI prevention, actions specific to urinary system. Used to treat local infections, in bladder kidneys without reaching high levels in the blood that might produce systemic toxicity. Not considered first line.
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What are some adverse effects of Urinary antiseptics?
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N/V, diarrhea, anorexia, back pain, HA, dark urine, anaphalaxis, superinfections, Stevens-Johsons syndrome, interstitial pneumonitis
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What are some nursing implication for Urinary antiseptics?
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Monitor I&O for diarrhea, esp with blood, pus, mucus), with nitrofuratoin assess lung sounds,for cough fever, CP, altered PFT's malaise, DOE if prolonged use
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What are some broad spectrum IV only drugs for specific infections?
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Carbapenems: Invanz (ertapenem, Primaxin (imipenem-cilastatin), and they contain a beta-lactam ring and inhibit th e construction of cell wall
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Which one is the most perscribed?
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Imipenand combined with cilastatin increases serum levels
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What is imipenum approved for?
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bacterial meningitis and peritonitis
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What is so special about ertapenum?
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It has a narrower coverage but a longer half life. It is used for serious abdominal infections, pelvic, and skin infections, CAP, and complicated UTI
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What are the adverse effects of these?
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diarrhea, rash, nausea, thrombophlebitis at the IV site
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Clindamycin (Cleocin) IV or PO
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Effective against both gram positive and gram negative. Used when a less toxic drug is not effective. Used to treat fusobacterium, clostridium and for abdominal infections caused by bacertoides. Contraindicated in patients with hypersenitivity, history of regional enteritis (Crohns), ulceritive colitis.
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What are some adverse effects of Clindamycin?
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Can cause pseudomembranous colitis, rash, difficulty breathing, diarrhea, N/V, anaphylaxis, cardiac arrest, blood dyscrasias
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Flaryl (metronidazle) IV or PO
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Older anti infective. Effective against anaerobes that cause abscesses, gangerne, diabetic skin ulcers, and deep wound infections. Used for H. pylori. Has both antibacterial and antiprotozoal activity.
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What are some side effects?
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Common: nausea, abdominal pain, anorexia, dry mouth, HA, dizziness, candida infections Serious: seizures, peripheral neuropathy, leokopenia
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Quinuprisin/dalfopristin (Synercid)
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Combo drug, IV. Class called streptogramins
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What are the indications for Quinuprisin/dalfopristin (Synercid)?
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for vancomycin resistant enterococcus infections, Use very cautiously if patient has renal or liver impairment.
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What are the side effects of Quinuprisin/dalfopristin (Synercid)?
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Common:pain at IV site, myalgia, arhtralgia, diarrhea Serious: Hepatotoxicity, superinfections, pseudomembranous colitis
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What is linezolid (Zyvox)?
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Oxazolidiones, and as effective as Vanco against MRSA. Contraindicated if allergic and in pregnancy. Use with caution in HTN or taking SSRI's because can cause hypertensive crisis.
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What are some side effects of linezolid?
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thrombocytopenia. bleeding, diarrhea, HA, N/V, rash, dizziness, fever, anaphylaxis, superinfections, PMC, blood dyscrasias
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Vancomycin IV or PO
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Reserved for serious gram positive infections, S. aureus & strep pneumonia; Used after bacteria have become resistant to other safer antibiotics. Most effective drug against MRSA, Peak and trough levels are monitored
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What are some side effects of Vancomycin?
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Ototoxic and we need to check this often, Nephrotoxic monitors renal funtions. With rapid IV administrationcan develop red man syndrome from large amount of histamine released into body: signs and symptoms include hypotension flushing rash on face, neck, trunk, upper body. Other signs and symptoms also include, N/V, anaphalaxis, superinfections
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Daptomycin (Cubicin)
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Used IV. Cyclid lipopeptides
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What are the indications for Daptomycin (Cubicin)?
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Indicated for treatment of serious skin/skin suture infections (major abscesses, post surgical wound infections, infected ulcers with staph/strep
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What are the adverse reactions from Daptomycin (Cubicin)?
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GI distress, nausea, constipation, HA, anaphylaxis, colitis, superinfections, myopathy
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Telithromycin (Ketek)
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It is a ketolide. perscribed for respiratory infections. It is an oral drug
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What are the indications for Telithromycin (Ketek)?
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bacterial exacerbation of chronic bronchitis, acute bacterial sinitis, CAP from S. pneumoniae
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What are the side effects of Telithromycin (Ketek)?
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N/V, diarrhea, visual disturbances, hepatotoxicity, dysrthymias
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What are some nursing diagnoses for bacterial infections?
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Infection, pain, hyperthermia, deficit knowledge, risk for injury, risk for deficit fluid volume (r/t fever, diarrhea, vomiting)
