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Bacteriostatic
Stops of inhibits growth of bacteria
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Bacteriocidal
Kills Bacteria
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Antibacterial
Deals with bacterial infections
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Anti-infective define
Broad Term
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Gram + (aerobic or anaerobic?)
aerobic
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Iatrogenic
infection as a result of a procedure
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Nosocomial
implies that it's an infection developed in the hospital
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Gram - (aerobic or anaerobic?)
anaerobic
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Sepsis
infection were multiple organ are involved
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Bacteremia
bacteria in the blood
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inflammation
protective response to bacterial invasion
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Colonization
- localized microorganisms
- not necessarily an infection
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Infection
invasion and multiple recpilcations of bacteria
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Superinfection or Secondary infection
Assess for ____
- Vaginitis (because antibiotic will suppress flora)
- THRUSH (white patches in mouth/oralpharynx)
- Diarrhea (b/c antibiotic suppresses flora)
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Define Culture
determines identity of microbe
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Define Sensitivity
Determines which antimicrobial agent will be therapeutic
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Contributing factors to bacteria resistance
- Widespread use of anti-microbial drugs
- Interrupted treatment (Don't finish pills)
- Increase number of high risk pts (higher risk for developing infections)
- Location (ex. ICU, Lg hospital)
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How to treat an anaphylactic reaction
epinephrine and corticosteroids
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What are symptoms of a localized infection?
redness, heat, edema, pain, drainage
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What are some symptoms of systemic infection?
- fever, increase HR, increased RR
- Malaise
- Anorexia, N/V
- Palpable lymphnodes
- high WBC (5,000-10,000)
- Watch culture and sensitivity
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What is a high level of WBC?
5000-10000
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Which antibiotics interfere with cell wall synthesis?
- Penicillin
- Cephalosporins
- Vancomycin
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-
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What are some problems with penicillin (PCN)
- Risk for severe allergic reactions
- PCN resistant bacteria
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When does PCN (Penicillin) allergic reactions generally happen?
Not on the first dose
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Does PCN (Penicillin) cross the BBB? Placenta? Breast Milk?
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What category is penicillin?
Category B tetrogenicity
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What are the uses of Penicillin?
- Tx Gram+ organisms
- Bacterial endocarditis (infection of the inner layer of the heart)
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What is the prototype for PCN (Penicillin)
Penicillin G
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What does given on an empty stomach mean?
- 1 hour before your eat
- or
- 2 hours after you eat
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What are the ADE for PCN (Penicillin)?
- Common: N V D
- Severe: Allergic reaction
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What is the black box warning on PCN (Penicillin)
Aqueous is the only one that can be given IV
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Use PCN with caution when...
- Renal Disease
- Pregnancy and Lactation
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What is the prototype for Cephalosporin?
cefazolin
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How is Cephalosporin (cefazolin) given?
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What is cephalosporin used for?
- Surgical prophylaxis
- (Given 30 min-2hrs pre op/ complete 30 mins per op)
has to be given for at least 30 mins, and has to be done prior to 30 mins before surgery
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For cephalosporin:
Spectrum?
Excreted by?
Placenta, breast milk
BBB crossing?
- Broad spectrum
- Kindeys
- Crosses
- limited crossing
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How is Cephalosporin (cefazolin) given?
- PO- with food
- IM - into a lg muscle
- IV- pharmacist will usually mix it for you
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What are some ADEs of Cephalosporin (cefazolin)?
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What are some contraindications of Cephalosporin (cefazolin)?
- anaphylactic reaction to PCN
- allergy
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What is Vancomycin used for?
- Tx severe infections
- Tx C.Diff
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What is VRE?
Vancomycin resistant enterococci
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What is the mechanisms of action for vancomycin?
Inhibits cell wall synthesis
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What is the caution for giving Vancomycin IV?
- give SLOWLY
- 60-120 mins
- prevents red man syndrome: release of histamine that causes red rash from head to toe
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What are ADE of vancomycin?
Common: Rash, "red man syndrom"
Serious: Ototoxicity (effects hearing), Nephrotoxicity (watch Creatine levels)
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How do you administer Vancomycin?
IV
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What is the MoA of Aminoglycosides, Macrolides, tetracyclines?
- Inhibit protein synthesis of bacterial cell
- affect ribosomes of bacterial cells, not normal cells
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What is the prototype for aminoglycosides?
gentamicin
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What are the uses of aminoglycosides (gentamicin)
serious gram- infections
Bowel Prep- gets rid of all fecal activity in GIT, decreases flora (used for surgeries)
Tx of Hepatic Coma or Hepatic encephalopathy (decrease in consciousness assc with liver failure)
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Aminoglycosides:
absorbed by GIT?
BBB
Excreted
Tetraogenicity category?
Placenta
- poorly absorbed
- Does not cross
- Excreted unchanged by kidneys
- Category D
- Crosses placenta
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When does serum aminoglycoside (gentamicin) peak and trough?
- Peak: 30-60 min after IV dose
- Trough: 30 min before next dose
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What are the black box warning about aminoglycosides (gentamicin)
- Ototoxicity (ear)
- Nephrotoxicity (alt in urinary elimination)
- Potentiates anesthetic neuromuscular blockers (may take longer for paralysis due to surgery to wear off)
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What are some nursing assessments for aminoglycosides (gentamicin)
- C&S
- hearing function
- renal function (BUN 5-25, Creatine .5-1.5)
- Post-op: RR
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What are normal levels for BUN?
5-25
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What are normal Creatine levels?
0.5-1.5
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What are some contraindication for aminoglycosides (gentamicin)
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What are the Black Box warnings for Aminoglycosides (gentamicin)
- Ototoxicity
- Nephrotoxicity
- Neuromuscular blockade
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What is the prototype for Macrolides?
erythromycin
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What are some uses for Macrolides (erythromycin)
- Tx resp tract infections
- Skin infection
- Tx gram and infection
- Substitue for PCN allergies
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What are some contraindications to Macrolides (erythromycin)
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What are some ADE to Macrolides (erythromycin)
- Common: N/V/D
- Serious: Hepatotoxicity
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What is the prototype for tetracycline?
Tetracycline
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What is tetracycline used for?
Tx of infection for: RT, GU, lyme, skin, acne
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What are some contraindications of tetracycline?
- Renal Failure
- Pregnancy: mom-hepatic necrosis, fetus-effects bones and teeth
- Children < 8y/o
- Lactating Women
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What are the MoA of Fluoroquinolones?
Antibiotic that inhibit nucleic acid synthesis
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What is the prototype for Fluoroquinalones?
ciprofloxacin (cipro)
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What are some contraindications of Fluoroquinalones (ciprofloxacin)
- Children <18 y.o
- Adults > 60 y.o - causes arthropathy
- hypersensitivity
- Category C
- Pregnant or lactating
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How is Fluoroquinalones (ciprofloxacin) taken?
PO
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What is the black box warning for Fluoroquinalones (ciprofloxacin)
avoid high impact exercise and strenuous wt lifting due to possibility of tendon rupture
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What are some ADE of fluoroquinalones (ciprofloxacin)
- N/V/D
- headache
- dizziness
- photosensititivy
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What is the MoA of Sulfonamides?
- Antibiotis that inhibit metabolic pathways- antimetabolites
- inhibits nucleic acids
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What is the prototype of Sulfonamides
sulfamethoxazole-trimethoprim
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What are the uses for Sulfonamides (sulfamethoxazole-trimethoprim)?
- UTI
- Ulcerative Colitis
- Topically: Vaginal infection, Dermititis, Burns
- NOT for systemic infections
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What are some contraindications of sulfonamides (sulfamethoxazole-trimethoprim)?
- Late pregnancy or to newborns > kernicterus: will displace the bilirubin and will rise and get to toxic levels
- lactating women
- < than 2 months old
- Hx of allergies to sulfa meds
- Renal or hepatic failure
- Category D
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What are some ADE for sulfonamides (sulfamethoxazole-trimethoprim)?
- Common: N/V/D
- Serious: Rash, hives, itch, crystals in urine
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What is stevens johnson syndrome?
JUST BE AWARE OF IT
- hypersensitivity syndrome r/t:
- Sulfonamides
- PCN
- Tetracycline
- Barbiturates
- Thiazides
- NSAIDS
Viral Infections
Malignancies
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What antibiotic is associated with C. Diff?
- PCN
- Cephalosporins
- Fluoroquinolones
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What are the symptoms of C.Diff?
Mild: water diarrhea 3x or more per day, abd cramping and tenderness
- Severe: Watery diarrhea 10-15x a day
- fever
- blood, pus in stool
- dehydration, Wt Loss
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What is treatment for C Diff
- Stop ABX
- Vancomycin
- Fidaxomicin
- Fluids
- Fecal Transplants?
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What are the 6 steps to prevent C Diff?
- Question whether antibiotics are needed
- Test for C Diff right away
- Disinfect EVERYTHING with bleach
- Protect- PPE
- Isolate pt
- Alert- all health care providers involved
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