HIST250 Exam4

Classified by shape and arrangement:

• - Spherical (Cocci)
• - Rod-like (Bacilli)
• - Curved Rods (Spirilla)
• - Pairs (Diplo)
• - Chains (Strepto)
• - Clusters (Staphylo)

• Sources:
• - Soil microorganisms (mold - Penicillin)
• - Chemical synthesis (Antimicrobials)

Bactericidal

Bacteriostatic

• - Antibiotics can lose their effect
• "Battle of the Bugs"

- Bacteria can acquire resistance genes through exchanging genes with other bacteria

Discovered as a byproduct of the dye industry in the 1930s but limited use since the discovery of Penicillin.

• Primarilary bacteriostatic
• Blocks synthesis of folic acid and thus bacteria cannot grow

• Used to control urinary tract infections
• Used in second- and third-degree burn treatments

• Sulfadiazine
• Sulfamethizole
• Sulfisoxazole

• Managing adverse reactions of Sulfonamides may require discontinuation of drug
• Stevens-Johnson Syndrome- serious and sometimes fatal hypersensitivity beginning with hive-like lesions on the face and head
• Loss of appetite, nausea, and vomiting
• Diarrhea, abdominal pain, chills, fever
• Fairly normal for skin and urin to be orange-yellow and crystals may form in the urine
• For burn victims, may note a stinging when medication is applied

Serious and sometimes fatal hypersensitivity to Sulfonamides beginning with hive-like lesions on the face and head.

• Narrow antibacterial spectrum
• - Mechanism of action involves interference with cell wall synthesis

• It can be administered IM
• Produces effects that last approximately 1 month

Hypersensitivity (allergic) reaction within the body

IV, IM, or PO

• Extended or broad spectrum
• Works on E. coli

• Ampicillin (Omnipen)
• Amoxicillin

All can be taken orally

Broader spectrum than the second generation Penicillin

• Carenicillin (Geocillin)
• Ticarcillin (Ticar)

Only used to treat UTI

Used to treat more serious respiratory, urinary, and bacteremic infections.

Even wider specturm than third generation Penicillin

Monosodium salts

Require parenteral administration (i.e. IV, IM, SC)

Often combination therapy of the generations will be used for an especially resistant bacteria.

• Nausea, vomiting
• Diarrhea
• Sore tongue or mouth
• Fever
• Pain at site of injection
• Superinfection

• Anaphylactic shock - severe form of hypersensitivity which occurs more often after IV administration than oral
• Once a patient is allergic to penicillin, it will always continue and patient may also be found to be allergic to Cephalosporin

cross-allergenicity

cross-sensitivity

• Contraindicated if allergic to Penicillin
• Used cautiously with:
• - Renal disease or gastrointestinal pain
• - Pregnancy or lactation
• - Patients with allergies
• - Asthma
• - Bleeding disorders

Affect the bacterial cell wall, making it defective and unstable.

• Used as a penicillin substitute in common Gram-positive infections
• Drug of choice for treating infections caused by Gram-negative Klebsiella pneumoniae

• Kefzol - most widely used
• Keflex
• Duracef
• Kantrex

• More potent than first generation Cephalosporins
• Often used to treat gonorrhea

• Mefoxin - good example
• Ceftin
• Ceclor

• More potent and longer duration
• Used to treat meningitis because able to cross the blood-brain barrier

Cefixime (Suprax)

• Gastrointestinal effects are most common
• Similar effects as penicillin allergies:
• - Fever
• - Diarrhea
• - Impaired skin integrity

Interfere with bacterial protein synthesis to produce bacteriostatic effect.

Doxyxyxline (Vibramycin)

• Stains teeth if given to children 9 or younger
• Fanconi Syndrome - Kidneys
• - Polyuria
• - Proteinuria
• - Acidosis
• - Leads to failure to thrive, stunted growth, and bone disorders, such as rickets

• Isolated from soil fungus
• Used particularly for infections of the respiratory and genital tract

• Erythromycin and Tylosin
• Sithromax
• Biaxin
• Dynabac

• Generally related to the gastrointestinal system:
• - Nausea, vomiting, and abdominal pain
• - Pseudomembranous colitis may range in severity from mild to life-threatening

Cipro - "resurrected" by anthrax scare

• Fluoroquinolones
• Aminoglycosides

• Extensively studied and documented in more than 37,000 publications
• More than 100,000 patients enrolled in double blind trials around the world
• Prescribed for more than 340 million patients worldwide
• Extensive and unprecedented safety profile

• Contraindicated for long-term use because of potential for ototoxicity and nephrotoxicity (exception is when used for tuberculosis)
• Used cautiously in patients with kidney failure
• Increased risk for ototoxicity when used in diuretics
• Risks for respiratory paralysis when used with anesthetic

Tuberculosis

• Most are bacteriostatic(slow or retard the growth of bacteria) against the M. tuberculosis.
• Usually act to inhibit bacterial cell wall synthesis, which slows multiplication rate of the bacteria.

• Isoniazid
• Rifampin
• Ethambutol
• Pyrazinamide

• Used with caution during pregnancy and lactation or for patients with kidney or liver problems
• Decreases effect of digoxin
• When used with isoniazid, may increase risk of damage to liver
• May decrease effect of anticoagulant or hypoglycemic drug
• Decrease effect of birth control pills, chloramphenicol, phenytoin, and verapamil

• Kidney damage
• Damage to the organs of hearing
• Ringing in the ears
• Nausea, vomiting, dizziness
• Paresthesia around the mouth

• Can cause fetal harm if used in pregnancy
• Used cautiously in patients with hearing difficulties
• Ototoxic effect increased with taken with ethacrynic acid, furosemide, or mannitol

Leprosy

• Used cautiously in patients with gastrointestinal disorders, diarrhea, and during pregnancy and lactation
• If used during pregnancy, infant may be born with pigmented skin
• No known drug-drug interactions

• Trobicin is chemically related to but different from the aminoglycosides
• Exerts its action by interfering with bacterial protein synthesis

Used to treat gonorrhea

Hives, dizziness, rash, chills, and fever

• Contraindicated for use in infants
• Additional anti-infectives may be needed in conjunction if other sexually transmitted diseases are present
• Not yet determined if safe during pregnancy or lactation
• No known food or drug interactions

Mainly used for C. difficile

• "Red man syndrome" from histamine reaction
• - chills and/or fever
• - Fainting
• - Tachycardia
• - Hives and itching
• - Hypotension
• - Nausea or vomiting
• - Rash or redness of the face, base of neck, upper body, back, and arms

• Bactericidals and antivirals cannot kill all viruses
• Drugs potent enough to kill viruses also damage host cells

• Initial and recurrent herpes
• AIDS
• Inflammation of the retina of the eye
• Influenza A respiratory tract illness
• RSV - severe lower respiratory tract illness

Inhibit viral DNA and RNA replication in the virus, causing viral death

• Treatment of cytomegalovirus
• Use of ribavirin for influenza A and B
• Used for chronic hepatitis
• Used for genital herpes
• Used for measles

• Rapid IV administration can cause crystals in the urin
• When administered systemically, can cause GI disturbances
• When administered topically, can cause burning, stinging, and pruritus at the application site

• Contraindicated in patients with CHF, seizures, kidney disease, or during lactation
• Given with caution to children or during pregnancy
• Ribavirin is NOT to be used during pregnancy or lactation
• Numerous interactions have been noted

• Used to treat herpes infections of the skin, lips, and genitals; herpes zoster (shingles); and chickenpox
• It does NOT cure herpes infections but decreases pain and itching and promotes healing
• Given as soon as the symptoms first appear

• Used to treat the first episode of genital herpes and recurrent severe genital herpes
• Reduces the pain and the number of sores with the first episode and decreases the frequency and severity of episodes
• In treatment of shingles, reduces pain, shortens the time in which sores heal, and limits the spread of virus and the formation of new sores
• Can be used to treat chickenpox to reduce healing time, limit the number of sores (pox), and reduce fever if used within the first 24 hours after the onset of the disease.

• Influenza
• It is used to prevent or treat certain influenza (flu) infections (type A)
• It may be given alone or along with flu shots
• Will NOT work for colds, other types of flu, or other virus infections

Fungus

• Molds
• Yeasts

• Destroy fungi or slow their growth
• Drugs have an effect on the cell memebrane of the fungus

Amphocin, Fungizone

Diflucan

Fulvicin P/G, Grifulvin V, Gris-PEG

Nizoral

Mycostatin

Lamisil

Terazol

• Few adverse effects
• Irritation or burning may occur with topical use
• Redness, stinging, or abdominal pain possible with vulvovaginal antifungal drugs

• Fungal infections respond slowly and patient and family need to be reminded to be patient with therapy
• Kidney function may need monitoring
• Lesions may be present which will be at risk for infection

Amphotericin B

• Serious reactions such as fever, shaking, chills, headache, malaise, joint and muscle pain, abnormal kidney function or damage, nausea, vomiting, and anemia
• Aspirin, antihistamines, or antiemetics may help the symptoms

Given mainly for serious and potentially life-threatening fungal infections

Parasite

Helminthiasis

• Albendazole
• Mebendazole
• Pyrantel
• Thiabendazole

• Pinworms are common everywhere
• Other helminth infections can be found where sanitary conditions are substandard

To kill the parasite (i.e. worms)

• Interferes with life cycle of the plasmodium developing and reproducing in the mosquito
• Used to treat Malaria

• Chloroquine
• Doxycycline
• Quinine sulfate

• Preventing the diesease (prophylaxis)
• Eliminating protozoa from all tissues (radical cure)
• Interfering with protozoal metabolism

Hypotension, electrocardiographic changes, visual disturbances, headache, nausea, vomiting, anorexia, diarrhea, and abdominal cramps

• Destroys Plasmodia that invade the human red blood cells
• Can be used to prevent malaria
• Sometimes is ineffective against Plasmodia falciparum

• Effects during pregnancy unknown
• Increase risk of hepatotoxicity
• Certain foods may decrease its effect: cranberries, plums, prunes, meat, cheese, eggs, fish, cheese

• Fanconi Syndrome - Kidneys
• - Polyuria
• - Proteinuria
• - Acidosis
• - Leads to failure to thrive, stunted growth, bone disorders, such as rickets

• Contraindicated during pregnancy
• Cautiously used in patients with kidney or liver impairment and during lactation
• Absorption is decreased with taken with antacids or iron
• Decreased effect when taken with barbiturates, phenytoins, and carbamazepins
• Increases risk of digoxin toxicity

Has a selective action against parasites that invade red blood cells

Contraindicated for use during pregnancy

• CNS stimulation
• Ringing in the ears
• - Cinchonism
• Headache

• Kills amebas
• Used to treat infections caused by these susceptible microorganisms

Amebas

Various types of skin eruptions, nausea, vomiting, fever, chills, abdominal cramps, vertigo, and diarrhea

Caution is used during pregnancy or for patients with thyroid disease

• Few adverse reactions but the most common are nausea, vomiting, and diarrhea
• Nephrotoxicity and ototoxicity have also occurred

Given with caution during pregnancy or for patients with bowel disease

Immunity

• Cell-mediated defenses (cellular immunity)
• Antibody-mediated defenses (humoral immunity)

• Helper T4 Cells
• Helper T1 Cells
• Helper T2 Cells
• Suppressor T Cells
• Memory T Cells

Helper T4 Cells

Helper T1 Cells

Helper T2 Cells

Suppressor T Cells

Memory T Cells

Antigen

Antibody

Naturally Acquired Active Immunity

Artificially Acquired Active Immunity

• Cholera
• Diphtheria
• Haemophilus influenzae type B
• Hepatitis A
• Hepatitis B
• Influenza
• Japanese encephalitis
• Lyme disease

Passive Immunity

Provides immediate immunity but lasts for only a short time

Hepatitis B immune globulin which is used in an attempt to prevent Hepatitis B after the indvidual has been exposed to the virus

They cause antibody-producing tissue to react to an antigen, even a dead or weakend one.

They are capable of stimulating bacteria to produce toxins.

Both are used to stimulate bacteria to produce toxins.

Usually mild and include chills, fever, muscular aches and pains, rash, and lethargy

Toxoids

Anyone allergic to gelatin, neomycin, or to a previous injection of the vaccine, and during pregnancy

• During acute fevrile illnesses, leukemia, lymphoma, immunosuppressive illness or drug therapy, and nonlocalized cancer
• Used with extreme caution in individuals with a history of allergies

Varicella Vaccine

Globulins

Immune Globulins

Antivenin

• Provide passive immunization
• Working rapidly but for a short duration

Used for passive, transient protection from bites of spiders and snakes

Rare and, if they occur, only last several hours.

• Usually in the form of hypersensitivity
• If patient is allergic to horse serum, serious reaction and death may occur

• Contraindicated in patients with a history of a prior allergic reaction to the drug
• Caution is used with patients who are pregnant or lactating

• Contraindicated in patients allergic to horse serum
• Caution is used with patients who are pregnant or lactating

• Parents are encouraged to have their children vaccinated
• Those traveling to a foreign country are urged to have immunizations well in advance of their departure date
• All are encouraged to report any adverse reactions

• Used in the treatment of cnacer for cure, control, or palliative therapy
• May affect normal and malignant cells

Chemotherapy

In a series of cycles to allow for recovery of normal cells

• Interfere with the process of cell division of malignant and normal cells
• Drug binds with DNA, causing breaks and preventing DNA replication
• Malignant cells appear more susceptible to alkylating drugs

• Do not have anti-infective (against infection) abilities
• Actions are similar to the alkylating drugs, interferes with the process of cell division of malignant and normal cells
• Interferes with reproductions of DNA and RNA

• Bleomycin (Blenoxane)
• Doxorubicin (Adriamycin)
• Plicamycin (Mithracin)

• Exact mechanism is unclear
• Appear to counteract the effect of male or female hormones in hormone-dependent tumors
• Appear to alter the hormonal enviroment of the cell

• Testolactone (Teslac)
• Conjugate Estrogens
• Megestrol (Megace)
• Goserelin (Zoladex)

Interfere with or stop cell division

• Paclitaxel (Taxol)
• Vincristine (Oncovin)

Mechanisms of action not clear.

• Cisplatin (Platinol)
• Hydroxyurea (Hydrea)

• Given alone or in combination
• May share similar activities but have different uses

• Wide variety of adverse reactions, most of which are dose dependent
• Bone marrow suppression, nausea, vomiting, stomatitis, diarrhea, and hair loss, tissue integrity, anxiety, alopecia, anorexia

• Vary for individual drug although generally contraindicated in patients with leukopenia, thrombocytopenia, anemia, serious infections, serious renal disease or during pregnancy
• Use cautionsly with kidney or liver disease, active infections, or other debilitating illnesses

• May antagonize effects of antigout drugs by increasing serum uric acid levels
• May increase risk for nephrotoxicity and ototoxicity when used with aminoglycoside
• Increased risk of ototoxicity when used with loop diuretics
• May decrease antibody response of live viral vaccines

• Digoxin levels may decrase when used with bleomycin
• Increased risk of bleomycin toxicity when used with cisplatin
• Pulmonary toxicity may occur with bleomycin and other antineoplastic drugs
• Increased risk of bleeding when plicamycin given with aspirin, warfarin, heparin, or NSAID

• Plicamycin, Mitomycin, Mitoxantrone, and Dactinomycin have an additive bone marrow depressant effect
• Mitomycin, Mitoxantrone, and Dactinomycin decrease antibody response to live virus vaccines
• Dactinomycin can reactivate skin or gastrointestinal reactions of radiation therapy

• Can antagonize effects of antigout drugs
• Methotrexate toxicity can be increased by oher nephrotoxic drugs
• When given with antineoplastics, can suppress bone marrow

• Vitamins containing folic acid may decrease the effects of methotrexate
• Live viral vaccines may be ineffective with fluorouracil
• Severe cardiomyopathy with left ventricular failure can occur with the use of fluorouracil and cisplatin together

• Bicalutamide may increase the effect of oral anticoagulants
• Flutamide enhances the action of leuprolide
• Additive effects noted when leuprolide used with megestrol or flutamide
• Estrogens decrease the effectiveness of tamoxifen

• Additive bone marrow depressive effects
• Vincristine and digoxin result in decreased effect of digoxin
• Decreased in serum concentration of phenytoin when given with vinblastine

• Increased risk for bone marrow suppression when levamisole or hydroxyurea are given with another antineoplastic drug
• Levemisole used with phenytoin increases risk of phenytoin toxicity
• Procarbazine may potentiate hypoglycemia if given with insulin or oral antidiabetic drugs
• Pegaspargase may alter response of anticoagulant

• Asparaginase increases the risk for hyperglycemia in patients with diabetes
• Glucocorticoids decrease the effect of aldesleukin
• Aldesleukin given with antihypertensive will result in additive hypotension
• Etoposide may decrase immune response to live viral vaccine
• Additive CNS response when procarbazine given with depressants

• Orally or parenterally (most common)
• Zoladex given subcutaneously with a dry pellet implanted in the soft tissue of belly

• Compliance can be an issue because the patient may wish to skip a dose in an effort to feel better
• Anxiety issues always surround chemotherapy and family counseling will be imperative

• Green Tea
• - Polyphenols or flavonoids have antioxidant properties
• - Benefits include cancer prevention and maintenance of heart and liver health
• - Does contain caffeine so should be avoided during pregnancy and used with caution in those with hypertension, anxiety, insomnia, diabetes or ulcers

• Suppresses or prevents but does not cure arthrititis and synovitis
• Exact mechanism is unknown
• Therapeutic effects occur slowly

Used to treat active juvenile or adult rheumatoid arthritis not controlled by other anti-inflammatories

• Dermatitis and stomatitis
• Photosensitivity
• Chrysiasis pigmentation of skin

• Parenterally contraindicated in patients with uncontrolled diabetes, liver disease, uncontrolled hypertension, uncontrolled CHF, SLE< or blood dyscrasias, or who have had recent radiation therapy
• Orally contraindicated in patients with necrotizing enterocolitis, pulmonary fibrosis, or hematological disorders
• Contraindicated during pregnancy or lactation

• Allopurinol (Zyloprim) - reduces uric acid and thus reduces deposits of urate crystals in joints
• Probenecid (Benemid) works in a similar manner and may be combined with colchicine as combination therapy

• Skin rash followed by hypersensitivity
• - Exfoliative dermatitis
• - Stevens-Johnson Syndrome: nausea and vomiting, diarrhea, abdominal pain, hematological changes

Used cautiously in patients with kidney or liver disease, during pregnancy and lactation, and in older adults

• Increased risk of skin rash when allopurinol and ampicillin used together
• Allopurinol and theophylline increase risk of theophylline toxicity
• ACE inhibitors or thiazide diuretics given with allopurinol increase the risk of hypersensitivity reactions
• Aluminum salts decrease the action of allopurinol

• Mode of action not clearly understood as they relieve muscle spasm and pain
• Used in various acute, painful musculoskeletal conditions such as a muscle strains and back pain

Drowsiness is the most common reaction

• Various contraindications by specific drug
• Caution for patients with history of stroke, cerebral palsy, parkinsonism, or seizure disorder
• Caution during pregnancy and lactation

• Increased CNS depressant effect when used with alcohol, antihistamines, opiates, and sedatives
• Additive anticholinergic effect when used with another drug with anticholinergic effect

• Used to treat osteoporosis in postmenopausal women and Paget's disease as well as postop total hip replacement
• Inhibits normal and abnormal bone resorption which increases bone mineral density

• Alendronate and risedronate contraindicated in patients with hypocalcemia
• contraindicated during pregnancy
• Use with hormone replacement therapy is NOT recommended

• Hormones secreted from the adrenal cortex
• Used to treat rheumatic disorders such as ankylosing spondylitis, rheumatoid arthritis, gout, bursitis, and osteoarthritis

Given in high doses for some arthritic disorders, and steroid effects are generally noted

• Penicilliamine
• Methotrexate
• Hydroxychloroquine

Exact mechanisms of these drugs are unknown

• They are all similar
• - Methotrexate is reserved for severe, disabling disease that is not responsive to other treatment because it is a potentially toxic drug
• - Penicillamine may also cause a severe toxic reaction

Patients are closely observed for any adverse reactions such as skin rash, fever, cough, easy bruising or unusual bleeding, or complaints of sore throat, visual changes, mood change, loss of hair, tinnitus, or hearing loss

• Methotrexate is contraindicated during pregnancy because it may cause birth defects in a developing fetus
• Patients should be aware that penicillamine is contraindicated if they are allegic to penicillin

• Glucosamine - from marine invertebrates and other lower animals and memebers of the plant family
• Chondroitin - derived from shark cartilage

• Blood Plasma
• Plasma Protein Fractions
• Protein Substrates
• Energy Substrates
• Plasma Expanders
• Intravenous Replacement Solutions

Blood Plasma

• Water
• Sugar
• Electrolytes
• Fats
• Gases
• Proteins
• Bile Pigment

• Critical in regulating volume of circulating blood
• Used to treat shock from low blood volume

• Human Plasma Protein
• Normal Serum Albumin

• Maintains plasma colloid osmotic pressure
• Carries metabolites

Caution used if patient is allergic to albumin

• Amino acid preparations that promote production of proteins
• Enhance tissue repair and wound healing
• Reduce the rate of protein breakdown
• Used in total parenteral nutrition solutions

• Dextrose solutions:
• - Available with electrolytes
• - Available with alcohol
• Fat emulsions of soybean or safflower oil (not given if allergic to eggs)

Provides source of nonprotein calories and fluid

Mainly caused by administration equipment or vein irritation

• To expand plasma volume as an emergency measure only
• - Hetastarch (Hespan)
• - Dextran
• Prophylaxis of venous thrombosis or thromboembolism

• Allergic reactions possible
• Cautiously used during pregnancy and lactation

• Used for hydration
• Used to facilitate amino acid utilizations
• Used to maintain electrolyte balance

• Source of electrolytes and water
• Source of calories in parenteral nutrition

• Requires close monitoring
• Fluid overload is a concern, especially in an older patient
• Patient and family member must be cautioned not to tamper with or adjust the rate of flow of the IV set

Electrolytes

• Bicarbonate (HCO3)
• Calcium (CA++)
• Magnesium (Mg++)
• Potassium (K+)
• Sodium (Na+)

• Plays a vital role in the acid-base balance in the body
• Used in IV treatment of metabolic acidosis secondary to shock, diabetes, severe diarrhea, kidney disease, or heart attack
• Used orally as a gastric and urinary alkalinizer
• - ingredient in baking soda as sodium bicarbonate NaHCO3

• Necessary for the functioning of nerves and muscles
• Needed for clotting of blood
• Needed for building of bones and teeth

• Used to reduce muscle cramping from black widow spider bite
• Given for CPR if epinephrine fails

• Transmission of nerve impulses
• Controls seizures in obstetric patients
• Used in carbohydrate metabolism

• Needed for transmission of impulses
• Needed for contraction of smooth, cardiac, and skeletal muscles

• Essential for maintence of normal heart action and in osmotic pressure in body cells
• Available with dextrose also

Caution used when water retention is a problem

Normal Saline

Half-Normal Saline

• Used to replace fluid and electrolytes
• Used to provide calories

Combined Electrolyte Solutions

• Oral Solutions
• - Pedialyte
• - Rehydralyte
• IV

Hypocalcemia

Hypokalemia

Hyponatremia

Hypernatremia

• Needed until normal eating can be resumed
• Used to prevent nitrogen and weight loss
• Used to treat negative nitrogen balance

• Rate of administration is slowly decreased when discontinued
• Dose depends on patient's condition

For lower respiratory infections, skin infections, and urinary tract or sexually transmitted disease

Leprosy

• Staphylococci
• Streptococci
• Pneumococci

You should not drive a car until the effect of the drug is apparent

Ringworm

• Vaccines
• Toxoids
• Immunoglobulins

Passive immunity against disease

Bone Marrow

To allow for recovery of the normal cells

• Bleeding gums and easy bruising
• Tarry stools
• Bloody urine
• Coffee-ground emesis

True

False

Sepsis caused by administration equipment

Hypocalcemia

To prevent nitrogen and weight loss

• Nausea
• Vomiting
• Diarrhea