pharm antimicrobial

Natural chemical produced by a microbe to inhibit or kill other microbes

includes any chemicals natural or syntheti which acts against microbes

inhibit bacterial growth and reproduction but don't kill bacteriol

directly kills bacteria at adequate concentration

causeses cell lyses

bacteriocidal

enzyme produced by bacteria to descroy structures of penicillins and cephalosporin and inactivate drug

acquired when bacteria survives to pass on genetic information.

• Methicillin resistant staph aureus
• vancomycin resistan
• enteroccoccus
• c-diff

• handwashing and equipment disinfection
• obtain specimin before therapy

• strep, pseudomonas, e.coli, c.diff
• answer-cdiff because it forms spores to kill c.dif hand washing and dilute bleach is needed.

• symptoms management and transmission
• when antibiotics are not needed
• how to take
• timing for absorption
• side effects
• preventing and reporting complications
• prebiotic and probiotic to prevent antibiotic associated diarrhea/thrush/candidiasis

penicillins, cephalosporins, imipenens

tetracyclines and macrolides

fluoroquinolones, inhibits DNA synthesis

mold has beta lactam structure

attach to proteins in bacterial cell wall and inhibit cell wass synthesis. kills bacteria by inhibiting cell wall synthesis

natural, amino, penicilinase resistant and extended spectrum penicillins

penicillin most effective agains gram positive aerobic bacteria

has added chemicals to keep them from being broken dow. (ticarcillin and piperacillin)

extended spectrum anti-pseudomonal penicillins to prevent bacterial inactivation

• wide therapeutic index, short half life 4-6 hours, renal excretion,
• hyperkalemia may occur

• allergic reaction-maculopapular rash to severe anaphylaxyser
• monitor client after 1st dose
• Gi upset, diarrhea
• headaches, seizures (high dose)
• blood dyscrasias
• overgorwth of fungus or resistant bacteria
• penicillin is not metabolized in liver it is renally excreted

gentamycin weakens cell wall, penicillin can howerver inactivate gentamycin and therefore they must be given in seperate tubing

Only available IV

• IM formulation
• Use for Gram positive cocci such as streptococcus pneumoniae and gram positive bacilli clostridium and anthrax; meningococcal meningitis; syphillis

Deep in muscle because it causes seizures and respiratory arrest in if given IV

• Oral formulation used for treating strep 25-50mg in children every 4 hours
• 500mg in adults

Gram positive bacteria

gram negative pacteria such as E. coli, salmonella, shigella, flue

can be given IV or PO. can be combine with sulabactam as IV (unasyn)

it must be diluted with 0.9% (normal) saline and given over 30 minutes

given to fast or too high a dose can cause cns toxicity and seizures

it causes less diarrhea and better blood control. and when combined with clavulanic acid it is called augmentin

• absorb on empty somach 1 hour before or 23 hours after meals.
• contact prescriber if symptoms dont resolve in 48-72 hours
• complete all drug therapy
• reduce risk of superinfection by takin with active bacterial/yeast cultures to prevent overgrowth of resitant organisms

• They are bacterialcidal, low toxicity and wide therapeutic index; and are renally excreted
• they have a beta lactam structure

1st generation (cefazolin (ancef), cephalexin)

Cefixime, cefotaxime, cetriaxoone (rocephin) they have a browad spectrum of activity and long halp life. anare are eliminated in bile

• 1% of those allergic to penicillin are allergic to cephalosporins
• if allergic to penicillin avoid cephalosporin
• vein wall erritation and thrombophlebitis are common with IV- can be prevented by slow administration and monitoring of iv site
• bleeding can occure with cefotetan (cefotan)
• if renal impaired need dose adjustment exception is ceftriaxone (rocephin) which is excreted through liver

given for surgical prophylaxis, it is used for gram positive bacteria. they are an alternative to penicillin

• Nausea, Canida growth
• Diarrhea -if severe or accompanied with abdominal bloatting or fever test for c dif.
• cefazolin (ancef) long acting

Gram + infection and surgical prophylaxi for skin organisms

• Active gram negative organism.
• Good CNS penetration

to treat gonorrhea (cefixime (supra))

via liver rather than kidneys. can bind calcium (not good)

• active agains gram - bacteria, good CNS penetration,
• can form fatal precipitate if given with calcium or IV solutions containing calcium (ringers or ringers lactate)

• Cefepime (maxipine)
• Good CNS activity
• reserve for serious infection to prevent resistance

Signs of AAPC and fungal overgrowth.

• they have a beta lactam structure. and are very broad spectrum bacteriocidal
• resistant to beta lactamase enzymes. when combine with cilastatin it prevents its distruction by renal enzymes and improves efficacy
• they have good CNS penetration
• cross sensitivity with penicillin

infections with mixed organisms and anearobes

• Gi upset
• diarrhea
• alergic reactio n may occur
• suprainfection.

• Active agains MRSA and G+bacteria.
• it is a glycopetide
• Poorly absorbed in GI but useful PO for treatment of C.Diff

• can cause histamine release with hypotension
• tachycardia
• flushing and hives
• thrombophlebitis-monitor iv site

at serum blood levels >30 ototoxicity can occur . therefore serum blood levels must be monitored 1.5 -2.5 hours after dose completed.

• Po 125-500mg
• Iv- 1gm over 60-90 minutes every 12-24 hours.

tetracylines, macrolides, aminoglycosides

• broad spectrum antibiotic which inhibits protein synthesis
• has a transport system that allows tetracycline to enter bacterial cell but not human

• rickettsial diseases (rocky mt. spotted fever, typhus)
• chlamydia infections
• cholera
• mycoplasma pneumonia
• lyme disease
• anthrax
• H. Pylori treatment
• topical for acne and peiodontal rinses

• poorly lipid soluble, forms insoluble complex with calcium, iron, magnesium aluminum and zyinc
• Ca, Mg, Fe, Al, Zn

• absorption is reduced by food. must be taken 1 hour before or 2 hours after meals.
• avoid taking with calcium or iron supplement or antacids

kidney and bile

• doxycycline; minocycline
• they have increased liid solubility

through bile they are lipid soluble. fewer problems with concurrent renal disease

• Gi upset,
• esophagitis
• they bind to bones and teeth and cause discoloration. should not be used in children younger than 8 or during pregnancy
• photosensitivity
• hepatoxicity at high does >2gm/day
• thrombophelbitis with IV admin and muscle irritation with IM admin

• given slowly cause it causes thrombophlebitis
• give slowly over 1-4 hours diluted in >100ml 0.9% saline

• avoid sunlight,
• take with a full glass of water to prevent esophagitis and sit up
• take with food. take 2 hours apart from anacids and mineral supplements
• report rash, yellow skin/jaundice, easy bruising or bleeding, fever chills or mouth sores

• big bacteria protein inhibitors
• alternative for those with penicillin alergy.
• bacteriostatic at low dose bacteriocidal at high dose

• respiratory illness; legionnairs disesease,
• perstussis
• diphtheria
• chlamydia
• mycoplasmial
• pneumonia
• strep infection

• metabilized by liver and excreted in bile
• has poor CNS penetration

• gi upset - nausea; because it increases gi motility
• diarrhea - may be severe
• life threathning arrhythmias
• thrombophelibitis with IV administration
• inhibits metabolism of other drugs---inceased risk for drug toxicity

• Bacteriocidal against respiratory infections
• long half life. daily dosing
• loading dose given initially
• poor absorption when given with food

• influenza
• N. Gonorrhea
• Mycoplasma pneumonia
• chlamydia
• legionelle pneumonia

• does not inhibit metabolism of other drugs
• less gi upset and diarrhea than other macrolides and
• does not prolong cardiac conduction or contribute to arrhythmia

• Gi upset, diarrhea,
• abdominal pain
• jaundice
• increased liver enzymes
• photosensitivity; rash
• blood dyscrasia ; rare
• dizziness
• superinfection - candida, c. diff

1 hour before and 2-3 hours after meals avoid taking with antacids

• yellow skin or eyes
• abdominal pain
• diarrhea
• palpitations

• 1 hour before or 2-3 hours after meals (except azithromycin);
• avoid giving with antacids

• liver function
• CBC and electrolytes
• bruising
• bleedings

ihibits liver enzymes by erythromycin can raise the blood level of other durgs.

• digoxin
• tehophylline
• phenytoin
• carbamazepine
• warfarin
• ***blood levels of these drugs will increase with erythromycin or

• new drug for used against multidrug resitance vancomycin resistant enterococci (VRE and MRSA)ein
• ribosomal prot ein inhibitor- bacteriostatic against Gram + aerobic bacteria

• PO
• IV- potential for hypertensive crisis if combined with sympathomimetics like ephedrine or food containing large amounts of tyramine

peripheral neuropathy

• vasoconstriction.
• it is found in aged products.

• Is a narrow spetrum bacteriocidal antibiotics
• active against aerobic Gram - bacteria

• e.coli
• klebsiella
• proteus,
• pseudomonas

• poorly absorbed in GI
• Polar molecules
• parenteral admin for serious infection

renal and ototoxicity requires blood levels to be obtained dosing need adjustment to prevent renal damage and hearing loss

gentamycin

• broad specturm antibiotics which inhibits folic acid synthesis in bacterial cells.
• Folic acid is necessary for DNA, RNA and protein synthesis

metabolized in liver and renally excreted

• Sulfamethoxazole/trimethorpim/SMX-TMP (bactrim/septra)
• combines to folic acid ihibitors in one drug preparation

• Urinary tract infection
• Chlamydia
• listeria
• pneumocystis pneumonia
• toxoplasmosis and malaria

• IV or PO
• Po given with food

• nausea/vomitting; rash
• Photosynsitivity

hemolytic anemia with G-6pd deficiency and megaloblastic anemia with folate deficientcy

may cause kirnicterus.

• encourage adequate fluids and folic acid
• sun protection

billirubin get into CNS and stains brain tissue

• severe skin reaction, rash
• gi upset
• diarhea
• hepatitis
• jaudice
• blood dyscrasias
• phlebitis at IV site
• crystaluria

• assess allergy
• monitor CBCor Iv
• urinalysis and liver function tests
• increase fluid intake to 2-3 liters daily
• teach food sources of folic acid
• monitor iv for phlebitis
• give drug over 60-90 min diluted in dextrose

broad spectrum antibiotics which disrupts bacterial DNA by ihibiting enzymes needed for replication; bacteriocidal activity

metabolized by liver and excreted by kineys

• UTI, gynecological infections
• bone and join infections
• intra abdominal
• respiratory and skin infections

• effects cartilage formation so it is not used in pregnancy of kids.
• floixins for infection reign..but watch out for the muscle pain

• UTIs
• gonorrhea
• traverles diarhea
• pseudomonas
• antrhax

do not give with dairy. it causes decreased absorption, antacids, or mineral supplements. give supplement 2 hours afer. can bound cations.

• abdominal pain,
• nausea
• diarhea
• CNs- dizziness, drowsiness confusion especially elderly
• achilles tendon or tendon rupture
• photosensitivity
• hypo or hyperglycemia in diabetics
• phlebitis with iv- given slowly because of vein wall irritation.

• use sunscreen
• avoid taking with vitamin/mineral supplements or antacids
• avoid excessive sun exposure
• report new muscle pain/tenderness

diarrhea, vaginitis or other signs of superinfection

• assess pregnancy
• assess for new muslce or tendon pain
• monitor liver and renal function
• oral forms binds cat ion avoid giving with vitamin/mineral supplements or antacids
• assess for dizziness or confusion esp elderly
• monitor for superinfection

• causes DNA breakage and interferes with nucleic acid synthesis in anaerobic organisms only
• bacteriocydal for anaerobic bacteria and protozoa

• given for variety of intra abdominal , CNS, genitoruinary, soft tissue and bone/joint infections often with other aerobact bacteria drugs
• c.dif overgrowth and AAPC

• po or IV
• IV loading dose is given at least 1 hour then every 6hrs.

• nausea, metallic taste, darkening urine
• Headaches , dizziness,seizures, neuropathy, metallic taste, gi upset, dairrhea
• Antabuse like reaction (sweating, flushing, nausea) when taken with alcohol---bad bad bad reaction.

• assess for pregnancy
• monitor CBC
• assess for neurologic problems or changes
• monitor GI effects
• evaluate response to therapy

• take with meals to avoid nausea
• may cause metallic taste chewing gum may help
• urine will turn reddish brwon during treatment
• avoid alcohol while taking and 48 hours after
• report numbness and tinglin in extremities, extreme weakness, fer/vhills, mouth sores and call provider if symptoms do not improve

against bacterial organisms (not viral)