Mechanism of action:decreases insulin resistance at peripheral sites and in liver (incrreases effects of insulin)
Adverse effects:
caution in patients with edema or heart failure due to fluid retention
- avoid in hepatic impairment (monitor fxn)
- can cause edema, weight gain, induce CHF, tooth disorders, headaches, myalgia (muscle sore) sinusitis, anemmia
Admin/PK: can contribute to hypoglycemia when combined with other agents that lower blood glucose
Mechanism of action: Stimulates release of insulin from functioning beta cells (only works with fxning beta cells!)
Adverse effects: Hepatic function impairment;
Can cause hypoglycemia and other adverse effects
(blood dyscrasias, bp changes, cardiac)
Admin/PK: Not used as monotherapy in pts inadequately controlled with other diabetic meds
Comments: Meds which increase blood glucose levels may lessen effects of nateglinide/repaglinideNateglinide - reduce 0.5% HbA1C, not common
Repaglinide - best effect is approx. 0.5-1.5%, decrease in alc, used in combo w/other drugs
Exenatide
Diabetes med
Use: type 2 diabetes
Mechanism of action: glucagon-like peptide to improve pancreatic beta cell response, secretion and slow gastric empying.
Adverse effects:
- avoided in patients with renal insufficiency- severe GI dz
- gastroparesis (contraindication)
- reports of pancreatitis - can cause dizziness, diarrhea, GI upset, headache, GERD, hypoglycemia
Admin/PK:adjunct in the treatment of patients who take metformin, a sultonylurea, or combination of these meds but who have not achieved adequate control; not an insulin substitute
Comments:not an insulin substitute
- best effect approx. 1%
- given subcutaneously
Pramlintide
Diabetic Medication
Use: Adjunct (A thing added to something else as a supplementary rather than an essential part.) in treatment of type-1and type-2 diabetes
Mechanism of action:
- slow rates of food absorption
- modulates gastric emptying
- helps prevent post-meal rise in bld glu and inc. satiety
Admin/PK: contraindicated in patients with gastroparesis (condition that reduces the ability of the stomach to empty its contents, but there is no blockage (obstruction))
Comments: doses of other drugs must be adjusted
- BE
(best effect) is approx 0.5%
- dec in alc
- given simutaneously
Sitagliptin
Diabetes med
Use: Adjunct in treatment of type-1and type-2 diabetes
Mechanism of action: blocks effects of dipeptidyl pepti-dase (DPP-4), enzyme that breaks down incretin hormones.. WANT more INCRETIN :) (increases in incretins leads to a rise in insulin levels and a corresponding decrease in blood glucose levels)
- Can contribute to hypoglycemia when used with other agents that lower blood glucose but is used as an adjunct with other medications
- Important to monitor blood glucose levels and A1C levels
Comments:
Other DPP-4 inhibitor drugs similar to sitagliptin now available but recent reports of pancreatitis associated with CLASS may affect new entrants and use
- 0.5-0.8%
- dec. in alc.
Saxagliptin
Use: adjunct in Tx of type-1 and type 2 diabetes
Mechanism of action: a DPP-4 inhibitor that is more commonly used. same as sitagliptin
GI, neuromuscular, respitary, flu-like symptoms, skin, heart problems, loss of taste/smell
Admin/PK: inhaled form only (increases risk of oral trush, so rinse mouth after to keep oral flora intact)
Flunisolide: if using INH and beta agonist (albuterol) use the beta agonist 1st bc it works faster and quicker to open up passages to allow corticosteroid to penetrate more.
beta agonist -> then corticosteroid --> then rinse mouth
Comments for both Flunisolide & Fluticasone** :
Other similar products: beclomethasone/QVAR®, mometasone/Asmanex ®, triamcinolone/Asmacort®
Blurred vision, change in IOP; caution in glaucoma, catracts
Bacteria are ____-celled microorganisms occuring in many forms, existing either as free-living organisms, or as parasites (as in the case of obligate intracellular parasite Chlamydiae)
single-celled
Properties of Bacteria
single-celled microorganisms
forms: free-living or parasites
range of biochemical and often pathogenic properties
small (size ranges 0.2-2 microns)
gram +
gram -
Choose the best answer:
Gram Positive
After the cell sample is fixed, stained, and washed, the bacterial cell walls:
A) Retain the crystal violet dye and have a purple cell wall under a microscope
adheres to peptidoglycan and remains stained
Choose the best answer:
Gram Negative
After the cell sample is fixed, stained, and washed, the bacterial cell walls:
A) Do not retain the cyrstal violet dye and have a light reddish cell wall under a microscope. They retain the reddish safarinin dye. These bacteria are decolorized and do not retain the crystal violet dye
Bacteria are not always able to be fully ID'd by Gram's stain alone, what other special methods can help give a preliminary or final ID of the bacteria? (3)
special stain and dye: Acid fast staining (ex: used for Mycobacteria)
basis of rising antibody titers, special immunofluorescence assays
morphological shape
What are some bacteria that do NOT possess a rigid cell wall so they must be ID'd on the basis of rising antibody titers, special immunofluorescence assays, etc ?
Legionella (in soil and dirty water)
Rickettsiae (extremely small, does possess a cell wal lbut no eptidoglycan)
Chlamydia (smaller than Rickettsiae, obligate intracellular parasite, possess cell wall but no peptidoglycan and robosomes)
What are the 5 commonly causes of community acquired pneumonia (in order)?
1. Strep Pneumoniae
2. Hemophlius influenza
3. Mycoplasma pneumoniae
4. Chlamydia pneumoniae
5. Legionella pneumoniae
What are the prinicpal groups of true bacteria are distinguished by their morphological shapes when viewed under the microscope?
Cocci
Bacilli
Spirillum
Spirochetes
Fungus-like
Decribe the characteristics of the bacteria: Cocci
spherical
ex: Streptococci, Staphylococci, and Neisseria
Decribe the characteristics of the bacteria: Bacilli
rod-shaped
Ex: E.coli, Bacillus, and Clostridia
Decribe the characteristics of the bacteria: Spirillum
short, rigid spirals
ex: Vibrio (present in raw crab eggs and roe and other seafood and shellfish), Cholera
Decribe the characteristics of the bacteria: Spirochetes
protozoa-like bacteria that are thin, flexible, motile, and spiral-shaped
ex: Borrelia (lyme dz) and Treponema (syphilis)
Decribe the characteristics of the bacteria: Fungus-like
bacteria that possess branching filamentous elements resembling fungal hyphae.
ex: Mycobacteria, Nocardia, and Actinomyces
Pick the best answer:
Rickettsiae is:
C) Extremely small bacteria thought to be viruses because their growth takes place within a host cell and has cell wall. Ex: Coxiella, Typhus, Rickettsiae. Not seen on gram stain
Pick the best answer:
Mycoplasma is:
D) Very small, lacks cell wall and bound by membranes, IDd with antibody titers. Ex: Mycoplasma pneumnoiae
Pick the best answer:
Chlamydia is:
D) Obligate intracellular parasites which possesses cell walls and ribosomes but must rely on host cell for metabolic E. Smaller than Rickettsiae and also thought to be a virus at one point. Dx: using titers. Ex: Chlamydia pneumoniae, C. trachomatis, and C. psittaci
Viruses are the _____ microorganisms known to have non-pathogenic/pathogenic (circle one) properties in humans.
smallest
pathogenic
Viruses size:
C) Nanomicrons. SUPER small
What are the properties of a VIRUS?
smallest microorganism
pathogenic properties in humans
size: nanomicrons
contains nucleic acid fragments (DNA or RNA), a capsid, and lipoprotein coat
uses structures and systems in host cells to recplicate themselves
most often causes eye infections: Herpes virus and adenovirus
List the properties of: Specimen colletion
colleted with care to prevent inadvertent contaminationcollection sites should represent suspected location of infection
specimen amt shld be sufficient size and numbers
need to be placed in appropriate containers and labelled
delivery should occur promptly
Culture and Sensitivity is a test in which patient specimens are cultured on approp. media and incubated. Bacteria grown on the media must be directly ______, _______, and ______ for susceptibility to different Ab.
isolated, identified, and tested
Sensitivity testing may be done by using 3 types of methods which are:
disc method
automated disc method
serial dilution method
Cultures:
Colonies surrounded by greenish zones means:
C) partially hemolytic bacteria.
= Alpha hemolytic Streptocci such as S. viridans or S. pneumoniae.
in chains and pairs
Cultures:
Colonies surrounded by clear zones means:
A) fully hemolytic bacteria
= beta hemolytic Streptococci such as Group A Streptococci
S.pyogen in eye
Cultures:
Colonies NOT surrounded by zones means:
A) non-hemolytic bacteria
= Gamma hemolytic such as Streptococci like Enterococci
Sensitivity:
Wide zones of inhibited (no) growth indicate antibiotic ____.
C) sensitivity
Sensitivity:
Areas with minimal growth inhibition indicate antibiotic ____.
C) minimal sensitivity
Sensitivity:
Areas with no growth inhibition indicate antibiotic ____.
A) antibiotic resistance
Define: Minimum inhibitory concetration (MIC)
The LOWEST in-vitro concentration of antibiotic in solution with a bacterial suspension that prevents/inhibits growth of the bacteria after an incubation period.
Note: look at minimum MIC breakpoint
if >8 not acceptable
if <4 good!
MIC:
If the concentration of the Ab represented by the MIC can be achieved in the patient's serum by normal routes of delivery, the bacteria is said to be ________ to the Ab
sensitive
MIC:
If the MIC is above the achievable level, or is within range that would be toxic to a patient, then the bacteria is said to be ______ to the Ab.
resistant
Define: Broad Spectrum
Ab which halt the growth of, or eradicate many differnt bacteria
Define: Narrow Spectrum
Ab whcih are effective for a specific bacteria only
Define: Bacteriocidal
Ab whose mechanisms of action (MOA) usually result in bacterial cell death
Define: Bacteriostatic
Ab whose MOA results in inhibiting or arresting growth, development, or multiplication of the infecting bacteria
static = still, lack of movement
List the 6 anti-infective MOA:
1. inhibition of cell wall synthesis, cause cell wall lysis. ex: Penicillins, cephalosporin, vancomycin
2. alteration of cell mb permeability, inhibition of active transport across the cell mb (most antifungal)
3. inhibition of protein synthesis via inhibition of ribosomal subunit transcription/translation (macrolides/ketolides, tetracyclines, glycylcycline, quinu/dalfo, aminoglycosides, clindamycin, linezolid)
