AFAMS

Anti-infective Drugs for Systemic Use(Insert Dari)

EO 003.01 Part 23

AFAMS

Lesson Overview(Insert Dari)

Antibacterials for Systemic Use• Bacteria

- characteristics- what is a pathogen?

• Classes of antibiotics: - Tetracyclines- Amphenicols- Beta-lactams- Sufonamides- Macrolides- Aminoglycosides- Fluoroquinolones- Other antibiotics

Antimycotics for Systemic Use• Fungi

-characteristics• Antimycotics

Insert Dari

AFAMS

Lesson Overview(Insert Dari)

Antivirals for Systemic Use• Viruses • Types of antivirals

Immune Sera and Immunoglobulins

Insert Dari

AFAMS

What I need to know as a pharmacy technician(Insert Dari)

In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under

(J) Anti-infectives for Systemic Use

For each of these medications/classes students must obtain an understanding of:

(1) Mechanism of Action

(2) Indications (Uses)

(3) Efficacy

(4) Side Effects

Insert Dari

AFAMS

Infections (Insert Dari)

An infection is the invasion of the human body by a disease causing organism such as:

(1)Bacteria(2)Virus(3)Fungi(4)Parasite

Note: Antiparasitics will be covered in another lecture.

Insert Dari

AFAMS

Anti-bacterials for Systemic Use(Insert Dari)

AFAMS

What are bacteria?(Insert Dari)

• Single celled organisms

• Very small

• Need a microscope to see

• Can be found on most materials and surfaces

• Billions on and in your body right now- can be harmful (cause infection)- can be helpful

Streptococcus can cause strep throat.

This E. coli helps you digest food.

Insert Dari

AFAMS

What do they look like?(Insert Dari)

Three basic shapes

(1) Rod shaped called bacilli

(2) Round shaped called cocci

(3) Spiral shaped

Some exist as single cells, others cluster together

Bacilli SpiralCocciCluster of cocci

Insert Dari

AFAMS

Bacteria are ALIVE!

• They reproduce (make more of themselves).

• They have some of the same components as human cells:

(1) Nucleoid (similar to nucleus)

(2) Ribosomes to produce protein

(3) Cytoplasm

• And some unique components:

(1) Cell wall

(2) Capsule

(3) Flagella

(4) Pili

Insert Dari

AFAMS

(Insert Dari) Insert Dari

Insert Dari

Insert DariInsert Dari

Insert Dari

Insert Dari

Insert Dari

Insert Dari

Insert Dari

AFAMS

Characteristics of Bacteria(Insert Dari)

Cell Wall

A rigid layer made up of peptidoglycan.

Cells can be gram positive or negative.

Gram negative cells have an outer layer which protects the cell wall.

Insert Dari

Insert Dari

Insert Dari Insert Dari

Insert Dari

Insert Dari

Insert Dari

Insert Dari

AFAMS

Characteristics of Bacteria Continued(Insert Dari)

Anaerobic vs. Aerobic

Aerobic – require oxygen

Anaerobic – can function without oxygen

Cell secretions

Many bacteria secrete enzymes that make their living environment more favorable.

Insert Dari

AFAMS

How do bacteria reproduce?(Insert Dari)

• Grow in number not in size

• Make copies of themselves by dividing in half

Insert Dari

AFAMS

How do bacteria obtain nutrients?(Insert Dari)

• Some make their own food from sunlight—like plants.

• Some are scavengers and share the environment around them.Example: The bacteria in your stomach are now eating what you ate for breakfast.

•Some are warriors (pathogens), they attack other living things in order to obtain nutrients. Example: The bacteria on your face can attack the skin causing infection.

Photosynthetic bacteria

(Insert Dari)

Harmless bacteria on the stomach lining(Insert Dari)

A pathogen(Insert Dari)

Insert Dari

AFAMS

How does a pathogen enter the body? (Insert Dari)

Contact with people who are sick:

• Direct (physical contact)

• Indirect

- airborne (through coughing/aspirating).

- body secretions

- insect bites

Food, water, or other surfaces that are contaminated

Insert Dari

AFAMS

Common Pathogens(Insert Dari)

Insert Dari

Insert Dari

Insert DariInsert Dari

Insert Dari

AFAMS

What is an Antibacterial? (Insert Dari)

Antibacterial drugs are substances that inhibit the growth of bacteria or kill bacteria.

Bacteriostatic = inhibits growth

Bactericidal = kills bacteria

Insert Dari

AFAMS

ANA Formulary (Insert Dari)

AFAMS

AFAMS

AFAMS

Why are there so many different types of Antibacterials?(Insert Dari)

When a doctor is wanting to treat a patient with an antibiotic there are many factors that they must consider, which affect their choice of antibiotic

What are the characteristics of the pathogen?

(1)Gram positive/negative – antibiotics that destroy the cell wall do not work well against gram negative bacteria. (2)Anaerobic/aerobic – antibiotics that target the use of oxygen will be ineffective again anaerobic bacteria.

Insert Dari

AFAMS

Why are there so many different types of Antibacterials?(Insert Dari)

(3) Patient characteristics

Certain antibiotics cannot be used in children or pregnant women.

Some patients may have allergies to certain classes of antibiotics.

* These are just a few examples of factors to be taken into account, there are many more.

Insert Dari

AFAMS

AFAMS

Tetracyclinesتيتراسيكلين

Mechanism of Action• Act at the ribosome to inhibit

bacterial protein synthesis.

Indications (Uses)• Used to treat skin infections

(i.e. bad acne). • Can be used to treat

bronchitis. • Can be used to treat H.Pylori

infection in the stomach which causes ulcers.

تاثيرات:نهي • سبب

پروتين وسنتيزميشود بكتري

Insert Dari

AFAMS

Tetracyclinesتيتراسيكلين

Side Effects

– Photosensitivity

– Yellow-gray-brown discoloration of teeth.

– May cause diarrhea and upset stomach.

Important points

– Not recommended for children under 9 due to teeth discoloration.

– Not recommended for women who are pregnant (can cause damage to the unborn baby).

– Do not take antacids, laxatives or products containing mineral (i.e. iron and calcium) within 2 hours of taking Tetracycline

جانبي عوارضدرمقابل- حساسيت

شعاع - خاكستري- – د زر

شدن رنگ بي خرمائيدندان

Insert Dari -

Insert Dariزير - اطفال براي نبايد

وجنين 9سنين سالهتوصيه رشد درحال

گردد-Insert Dari

AFAMS

AFAMS

Mechanism of Action

• Act at the ribosome to inhibit bacterial protein synthesis.

Indication

• This is an old antibiotic that is rarely used anymore due to concerns with toxicity.

• Can be used to treat typhus.

Chloramphenicol کلورامفینیکول

تاثيرات:نهي • سبب

پروتين وسنتيزميشود بكتري

Insert Dari

AFAMS

Side Effects

• Bone marrow suppression which can =anemia.

• Diarrhea

• Feeling lightheaded (low blood pressure).

Important Points

• Many drug interactions exist with this medication.

• Should not be used in very young babies.

Chloramphenicol کلورامفینیکول

Insert Dari

AFAMS

AFAMS

Penicillins

ها پینیسیلینMechanism of ActionInhibit bacterial cell wall synthesis exposing

the less stable membrane which can lead to cell lysis.

Depends on ability to cross bacterial cell wall:

Gram positive bacteria have a cell wall that penicillin can cross. Gram negative bacteria have a membrane that acts as a barrier.

Resistance to pennicillin –due to inactivation of the antibiotic by β-lactamase, an enzyme secreted by the bacteria.

Sometimes these antibiotics will be combined with a β-lactamase inhibitor such as tazobactam to increase activity of the antibiotic.

Insert Dari

AFAMS

Penicillins

ها پینیسیلینIndications

Common infections:

- pharyngitis- otitis media- minor skin infections.

Serious infections: - infective endocarditis- meningitis - syphillis

Insert Dari

AFAMS

Penicillins

ها پینیسیلینSide Effects• may cause stomach upset • diarrhea• rash (if severe (hives) patient should see doctor right away as it may be anaphylaxis).

ImportantBest to take on an empty stomach (if possible) – meaning 1 hr before or 2hrs after a meal. Some patients are allergic to penicillins (important to check allergies with the patient.

Insert Dari

AFAMS

AFAMS

Cephalosporinsها سیفالوسپورین

Mechanism of ActionSame as penicillins - inhibit

bacterial cell wall synthesis exposing the less stable membrane which can lead to cell lysis.

Indications Used in many different types of

infections: • Sinusitis• Pharyngitis• Otitis media • Skin infections• Urinary tract infections

Insert Dari

AFAMS

Cephalosporinsها سیفالوسپورین

Side Effects

• Diarrhea

• Upset stomach

• Increased sensitivity to sun.

Includes

• Cephalexin

• Cefazolin

• Ceftriaxone

• Cefixime

Insert Dari

AFAMS

Carbapenems ها کارباپینم

Imipenem/Cilastin

Mechanism of Action

Imipenem – same as beta lactams.

Cilastin – prevents imipenem from being broken down in the body.

Indications

Many infections (generally of a more serious nature)• lower respiratory tract• urinary tract, • intra-abdominal, • gynecologic, • bone and joint, • skin • endocarditis

Insert Dari

AFAMS

Carbapenems ها کارباپینم

Side Effects

• Diarrhea

• Upset stomach

• Rare: Severe rash, seizures

Insert Dari

AFAMS

AFAMS

Sulfonamidesسلفامیدها

Mechanism of Action Interferes with synthesis of folate

which is essential for the production of amino acids which form proteins.

Trimethoprim – interferes with the production of folate.

IndicationsUsed to treat many different types

of infections• urinary tract infections• respiratory infections (in

patients with HIV)• prostatitis

Insert Dari

AFAMS

Sulfonamidesسلفامیدها

Side Effects

• Diarrhea

• Upset stomach

• Rash, can be minor or in rare cases very severe.

Important PointPatients may be allergic to

sulfonamides, it is important to check allergies with the patient.

Insert Dari

AFAMS

AFAMS

Mechanism of ActionInterferes with protein

synthesis in the bacteria.

Indications• sinusitis• pneumonia• chlamydia

Side Effects• diarrhea• upset stomach

Macrolides

ها ماکرولیدInsert Dari

AFAMS

AFAMS

Aminoglycosides ها امینوگالیکوزید

Mechanism of Action Interferes with protein synthesis in the

bacteria.

Synergistic effect with beta-lactams, because beta-lactams break down the cell wall allowing the aminoglycosides to enter the cell.

IndicationsUsed for more severe infections:• septicemia,• respiratory tract infections,

complicated urinary tract infections

• complicated intra-abdominal infections

• osteomyelitis (bone infection)

Insert Dari

AFAMS

Aminoglycosides ها امینوگالیکوزید

Side Effects• problems with hearing (deafness). • kidney problems. • rash

Important Points• Administered by IV

Insert Dari

AFAMS

AFAMS

Fluoroquinolonesها فولروکینولون

Mechanism of Action Interfere with the replication of

bacterial DNA, thus preventing cell replication.

Indications• Respiratory tract infections• Urinary tract infections• Prostatitis• Infectious diarrhea

Side Effects• Diarrhea• Nausea/upset stomach• Tendon ruptures have been

reported.

Insert Dari

AFAMS

Fluoroquinolonesها فولروکینولون

Important Points

• Not for use in pregnant women or children.

Insert Dari

AFAMS

AFAMS

Vancomycin

وانکومایسینMechanism of ActionInhibits bacterial cell wall synthesis.

Indications (Use) • For methicillin resistant infections• For life threatening C.Diff

infections.

Side Effects • red-man syndrome if infused too

fast• Ringing in the ears. • Can cause kidney problems

Important PointsAdministered intravenouslyRequires laboratory monitoring of drug

levels to achieve effect.

Insert Dari

AFAMS

Fosfomycin(Insert Dari)

Mechanism of Action

Prevents the synthesis of the bacterial cell wall.

Indications (Uses)

Used in complicated urinary tract infections.

Side Effects• Upset stomach• Diarrhea

Important Points

Administered orally

Insert Dari

AFAMS

Linezolid(Insert Dari)

Mechanism of Action

Prevents bacterial protein synthesis.

Indications (Use)

Generally used to treat infections which are resistant to vancomycin.

Side Effects• Diarrhea• Upset stomach• Signs of low blood sugar

Insert Dari

AFAMS

Antimycotics for Systemic Use(Insert Dari)

AFAMS

AFAMS

Mycosis(Insert Dari)

Mycosis – a fungal infection.

Inhalation of fungal spores or localized colonization of the skin may initiate persistent infections; therefore, mycoses often start in the lungs or on the skin.

Fungus - any of a group of unicellular, multicellular, or spore-producing organisms feeding on organic matter. This includes mold and yeast.

Insert Dari

AFAMS

Fungal infection of the nails (tinea pedis)(Insert Dari)

Severe fungal infection of the skin(Insert Dari)

AFAMS

AFAMS

Fluconazole(Insert Dari) Mechanism of Action

Interferes with the formation of the cell membrane.

Indications (Use)

Used to treat yeast infections.

Side Effects

Generally well tolerated

Mild side effects include: • headache• diarrhea• upset stomach

Important Points

Many drug interactions exist.

Insert Dari

AFAMS

Nystatin (Insert Dari)

Mechanism of Action

Degrades the cell wall.

Indications (Use)

Also used to treat yeast infections, generally of the mouth.

Side Effects• Upset stomach• Diarrhea

Important Points

Patients should swish the solution around in their mouth for at least 60 seconds before swallowing.

Insert Dari

AFAMS

Anti-virals for Systemic Use(Insert Dari)

AFAMS

Viruses(Insert Dari)

A virus is a small infectious agent that replicates only inside the living cells of other organisms. Viruses can infect all types of life forms, from animals and plants to bacteria.

Viruses are responsible for causing a wide variety of illnesses from the ‘common cold’ to the human immunodeficiency virus (HIV).

Insert Dari

AFAMS

Viral Replication(Insert Dari)

Viral populations do not grow through cell division.

Instead, they use the machinery and metabolism of a host cell to produce multiple copies of themselves.

They do this by having viral genetic material copied in the host cell.

Insert Dari

AFAMS

AFAMS

Antiviral Drugs: Acyclovir(Insert Dari)

Mechanism of Action

Prevents replication of the Herpes Simplex Virus by disrupting the replication of genetic material.

Indications (Uses)

Used to treat Herpes Simplex infections

• shingles

• cold sores

• genital herpes

Insert Dari

AFAMS

Antiviral Drugs: (Insert Dari)

Side Effects

Generally well tolerated in patients.

Rare but severe side effects include:

- kidney problems

- neurotoxicity

Insert Dari

AFAMS

Other Antiviral Drugsويروس ضد ادويه

Mechanism of Action

Inhibit viral DNA replication.

Indications (Use)

Lamivudine and Entecavir– HIV and Hepatitis B

Ritinavir – Respiratory Simplex Virus (RSV) and Hepatitis C

Insert Dari

AFAMS

Other Antiviral Drugsويروس ضد ادويه

Side Effects

Lamivudine – headache, diarrhea, low energy levels, dizziness, muscle pain and disruption of sleep.

Entecavir – liver problems, blood in the urine, upset stomach and dizziness.

Ritinavir – skin irritation, hair loss, diarrhea, disruption of sleep and loss of appetite.

Insert Dari

AFAMS

Immune Sera and Immunoglobulins(Insert Dari)

AFAMS

AFAMS

These are blood products that are usually not controlled by the pharmacy department.

Hepatitis B Immune globulin

Given to patients who have been exposed to contaminated blood or blood products (i.e. needle prick injury) to prevent them from getting hepatitis B.

Anti-tetanus Immune globulin

Given to patients who have possibly been exposed to tetanus and have not been previously vaccinated.

Insert Dari

AFAMS

Questions? (Insert Dari)

AFAMS

In-class Assignment(Insert Dari)

This assignment will consist of 7 questions which are to be completed individually. Once complete the instructor will review the answers with the class.

Insert Dari

AFAMS

1. A human cell has all of the following components in common with bacterial cells EXCEPT for?

(Insert Dari)

A) Ribosomes

B) Cytoplasm

C) Cell wall

D) Cell membrane

Insert Dari

AFAMS

1. Answer: A human cell has all of the following components in common with bacterial cells EXCEPT for?

(Insert Dari)

A) Ribosomes

B) Cytoplasm

C) Cell wall

D) Cell membrane

Insert Dari

AFAMS

2.Which of the following are key characteristics of bacteria?

(Insert Dari)

A) Gram positive/negative

B) Aerobic/anaerobic

C) Secrete enzymes and other substances

D) All of the above

Insert Dari

AFAMS

2.Which of the following are key characteristics of bacteria?

(Insert Dari)

A) Gram positive/negative

B) Aerobic/anaerobic

C) Secrete enzymes and other substances

D) All of the above

Insert Dari

AFAMS

3. True of False: A physician can just pick any antibiotic at random to treat an infection.

(Insert Dari)

AFAMS

3. Answer: True of False: A physician can just pick any antibiotic at random to treat an infection.

(Insert Dari)

Answer: False, a doctor must consider various factors regarding the pathogen such as: gram postive/negative,

aerobic anaerobic etc.

(Insert Dari)

AFAMS

4. Match the following antibiotics with their correct class?(Insert Dari)

A) Amoxicillin

B) Sulfamethoxazole/Trimethoprim

C) Azithromycin

D) Gentamicin

1) Aminoglycoside

2) Sulfonamide

3) Macrolide

4) Pennicillin

Insert Dari

AFAMS

4. Answer: Match the following antibiotics with their correct class?(Insert Dari)

A) Amoxicillin – (4) Pennicillin

B) Sulfamethoxazole/Trimethoprim (2) Sulfonamide

C) Azithromycin (3) Macrolide

D) Gentamicin (1) Aminglycoside

Insert Dari

AFAMS

5. Match the following antibiotics with their mechanism of action (each mechanism can be used

more than once). (Insert Dari)

A) Pennicillin

B) Gentamicin

C) Vancomycin

D) Ciprofloxacin

1) Interfere with protein synthesis

2) Interfere with cell wall synthesis

3) Interfere with DNA replication

Insert Dari

AFAMS

5. Answer: Match the following antibiotics with their mechanism of action (each mechanism can be used

more than once). (Insert Dari)

A) Pennicillin (2) interferes with cell wall synthesis

B) Gentamicin (1) interfere with protein synthesis

C) Vancomycin (2) interferes with cell wall synthesis

D) Ciprofloxacin (3) interferes with DNA replication

Insert Dari

AFAMS

6. Which of the following statements are NOT true? (Insert Dari)

A) A virus is a small infectious agent.

B) A virus can cause a variety of illnesses from the common cold to HIV.

C) A virus can multiply on its own, outside of a host cell.

D) Acyclovir is an antiviral used to treat shingles and other herpes infections.

Insert Dari

AFAMS

6. Answer: Which of the following statements are NOT true?

(Insert Dari)A) A virus is a small infectious

agent.

B) A virus can cause a variety of illnesses from the common cold to HIV.

C) A virus can multiply on its own, outside of a host cell.

D) Acyclovir is an antiviral used to treat shingles and other herpes infections.

Insert Dari

AFAMS

7. Which of the following drugs are used to treat yeast infections?

(Insert Dari)

A) Ciprofloxacin

B) Fluconazole

C) Acyclovir

D) Amoxicillin

Insert Dari

AFAMS

7. Which of the following drugs are used to treat yeast infections?

(Insert Dari)

A) Ciprofloxacin

B) Fluconazole

C) Acyclovir

D) Amoxicillin

Insert Dari