2ATI Flash Cards 02, Antiinfectives

7/30/2019 2ATI Flash Cards 02, Antiinfectives

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Antiinfectives

Key Points

N203

ATI (UnitAntiinfectiv


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Broad-spectrum vs. narrow-spectrum antibiotics

Antimicrobials treat bacterial, viral, and fungal infection

Culture and sensitivity specimens should be collected p

initiation of therapy.

Adverse reactions include:

Hypersensitivity & anaphylaxis Superinfectio

Organ toxicity (ototoxic,

nephrotoxic) warfarin a

efficacy of oral contraceptives


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Penicillins

N203

ATI (Unit Antiinfectiv


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Expected Action:

-lactam destroys bacteria by weakening cell wall

Therapeutic Uses:

Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogene

Med of choice for

syphilis First choice for meningitis

Prophylaxis against bacterial endocarditis

Extended spectrum againstPseudomonas, Proteus, Klebsiella

Adverse Effects:

Anaphylaxis / Renal Impairment / Hyperkalemia (w

doses)Contraindications:

Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunct

Interactions:

Aminoglycosides / Oral Contraceptives

Education:

Take orals H2O, food (some may be taken food)


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Cephalosporins

N203



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Expected Action:

-lactam destroy bacteria by destroying cell wall

Four generations, each is: against G- and anaerobes more resistant

lactamase more able to reach CSF

Therapeutic Uses:

Broad spectrum withTI for postop infections, meningitis, pelvic inf

Adverse Effects:

Anaphylaxis / Bleeding / Thrombophlebitis / Pain IM / cross allergie

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 food


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Carbapenems

N203



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Expected Action:


Therapeutic Uses: Broad spectrum effective for serious infections such as pneumonia, per

and UTIs.P. aeruginosa develops resistance (use combo) [broades

spectrum available]

Adverse Effects:

Allergy / GI symptoms / Superinfection

Contraindications: Caution with renal impairment

Interactions:

Education:


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Monobactams

N203



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Expected Action:


Therapeutic Uses:

MRSA / Antibiotic-associated pseudomembranous colitis by C. difficil

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:


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Tetracyclines

N203



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Expected Action:

Bacteriostatic by preventing protein synthesis

Therapeutic Uses:

Acne / rickettsia / Chlamydia /Helicobacter pylori / periodontal diseas

fever / Rocky Mountain spotted fever / Lyme disease / UTI & VI

Adverse Effects:

GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity /

superinfection of bowel


Renal disease (except doxycycline) / Use during pregnancy will stain d

teeth but not permanent teeth

Interactions:

Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to

of oral contraceptives

Education:

Give with water on an empty stomach (except doxycycline & minocyc


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Bacteriostatic Inhibitors(Macrolides / Ketolides)

N203



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Expected Action:

Bacteriostatic by inhibiting protein synthesis Bactericidal at high dos

Therapeutic Uses:

Use for pts with penicillin allergies / pertussis / diphtheria / Legionnair

Chlamydia,Mycoplasma pneumoniae, Streptococcus pyogenes

Adverse Effects:

GI discomfort / thrombophlebitis


Pre-existing liver diseaseInteractions:

Toxic with: antihistamines, theophylline (asthma med), carbamazepine

(anticonvulsant), warfarin

Education:

Administer on empty stomach with water IV is rarely used


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Aminoglycosides(Medication List)

N203



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gentamicin amikacin kanamy

tobramycin sulfate neomycin paromom

streptomycin


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Aminoglycosides

N203



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Expected Action:

Kill bacteria by disrupting protein synthesis

Therapeutic Uses:

Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mira

aeruginosa) Oral paromomycin use for amebiasis and tapeworm

Adverse Effects:

Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitiv

Streptomycin: Neurologic disorders


Renal impairment reduced doses

Interactions:

Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (nep

tubocurarine / penicillins ( AG)

Education:


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Penicillins(Medication List)

N203



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Penicillin G

Augmentin (amoxicillin-clavulanate) - Broad spec

Nafcillin -

Antistaphylococcal

Carbenici

Antipseudomonas


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Cephalosporins(Medication List)

N203ATI (Unit

Antiinfectiv


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1

Cephalexin (Keflex) Cephapirin (Cefadyl)

2

Cefaclor (Ceclor) Cefotetan (Cefotan)

3

Cefatriaxone (Rocephin) Cefotaxime (Claforan)

4

Cefepime (Maxipime)


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Carbapenems(Medication List)

N203ATI (Unit

Antiinfectiv


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Imipenem (Primaxin)

Meropenem (Merrem IV)


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Monobactams(Medication List)

N203ATI (Unit

Antiinfectiv


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Vancomycin (Vancocin)

Aztreonam (Azactam)

Fosfomycin (Monurol)


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Tetracyclines(Medication List)

N203ATI (Unit

Antiinfectiv


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Tetracycline hydrochloride (Sumycin)

Doxycycline (Vibramycin)

Minocycline


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Macrolides / Ketolides(Medication List)

N203ATI (Unit

Antiinfectiv


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Azithromycin (Zithromax)

Clarithromycin (Biaxin)

Dirithromycin

Erythromycin

Clindamycin (Cleocin)


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Sulfonamides & Trimethoprim(Medication List)

N203ATI (Unit

Antiinfectiv


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SulfamethoxazoleTrimethoprim (TMP-SMZ, Bactrim

Cotrim

Septra

Sulfadiazine

Sulfamethoxazole

Sulfisoxazole


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Sulfonadmides-Trimethoprim

N203ATI (Unit

Antiinfectiv


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Expected Action:

Bacteriostatic by inhibiting folate synthesis

Therapeutic Uses:

Med of choice for UTI byE. coli andPneumocystis carinii.Adverse Effects:

Hypersensitivity (sulfonamides, thiazide diuretics, tolbutamide, loop diur

Blood dyscrasias / crystalluria / kernicterus ( bilirubin) / photosensitivi


Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/mi

Reduce dosages with renal dysfunction

Interactions:

Warfarin / phenytoin / tolbutamide ( effects of these)

Education:

Empty stomach with full glass of water


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Urinary Tract Aseptics

N203ATI (Unit

Antiinfectiv


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Expected Action: Damages DNA Prototype: Nitro

Static a@doses, Cidal @doses

Therapeutic Uses: Acute UTIs / Prophylaxis for recurrent lower UTI

Adverse Effects:

GI / hypersensitivity / blood dyscrasias / peripheral neuropathy


Renal dysfunction creatinine clearance < 40

Interactions:

Education:

Urine will be brown


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Antimycobacterial

N203ATI (Unit

Antiinfectiv


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Expected Action:

Prototypes: isoniazid (INH), streptomycin, eth

pyra

Prevents synthesis of mycolic acid

Therapeutic Uses: Active and latent tuberculosis

Adverse Effects:

Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily)

Hepatotoxicity


Liver diseaseInteractions:

Phenytoin (accumulates)

INH with EtOH, rifampin, pyrazinamide hepatotoxicity

Education:

Empty stomach but food if needed


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Anti-Hansens Disease

N203ATI (Unit

Antiinfectiv


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Expected Action: Prototype: Dapsone Others: Clofazimine,

Prevents synthesis of folate which inhibitsM. leprae.

Therapeutic Uses: Used in combination therapy to treat leprosy

Adverse Effects:

Rifampin: Discoloration of body fluids / Hepatotoxicity

GI discomfort


Use caution with liver dysfunctionInteractions:

Rifampin warfarin / OC / protease inhibitors / NNRTIs (HIV)

Education:


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Antiviral

N203ATI (Unit

Antiinfectiv


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Expected Action:

Prototype: A

Others: ganciclovir, interferon, ribavirin, am

Prevents reproduction of viral DNA

Therapeutic Uses:

Adverse Effects:

Acyclovir: Phlebitis, nephrotoxicity, nausea & headache

Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity

teratogenic


Pregnancy / neutrophil count (


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Fluoroquinolones(Medication List)

N203ATI (Unit

Antiinfectiv


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Expected Action: Prototype: Cipr

Bactericidal by inhibition of enzyme needed for DNA

Therapeutic Uses: Broad spectrum / prevention of inhaled anthrax

Adverse Effects:

GI discomfort / Achilles tendon rupture / superinfection


Avoid use in children


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Antiprotozoals

N203ATI (Unit

Antiinfectiv

Expected Proto: Amp


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Expected

Action:

p

Others: flucytosine, miconazole, nystatin, griseofulvin, keto

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 infusio


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Antiprotozoals

N203ATI (Unit

Antiinfectiv

Expected Action: Proto: metronidazole


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Expected Action: Proto: metronidazole

Broad spectrum with anaerobic activity

Therapeutic Uses:

Protozoal infections / Bacterial infections against obligate anaerobes

Prophylaxis for surgical procedures at high risk for anaerobic infections abdominal, colorectal)

H. pylori with tetracycline and bismuth salicylate

Adverse Effects:

GI discomfort / metallic taste / darkening of urine / CNS symptoms


Caution with renal dysfunction / avoid during 1st trimester of pregnancy

Interactions:

Disulfiram-like reaction EtOH

Warfarin Flagyl inhibits inactivation of warfarin

Education:

Documents

2ATI Flash Cards 02, Antiinfectives