Infections Pharm/info

  1. First line of defense to infecton
    • Skin (acidity), Lysozymes from tears, sweat, mucous.
    • Respiratory system: cillia sweep pathogens out of airway, coughing/sneezing another mechanism of defense.
    • GI system: acidity of stomach and alkalinity of intestines.
  2. Second Line of defense to infection
    Immune system: Macrophages, WBCs.
  3. Modes of transmission
    • Direct contact
    • airborne 
    • droplet 
    • Vectors
    • fomites
  4. Pathogenicity (Virulence)
    the ability of an organism to cause disease
  5. Approx. times for immune response
    • up to a week in some cases
    • Some pathogens proliferate faster than immune response=Hantavirus causes hemorrhagic fever incubation period 24-48 hours.
  6. Toxins?
    • Endotoxins: integral part of cell wall in gram-negative bacteria
    • Exotoxins: released by the cell.
    • causes host macrophages to release large amounts of cytokines causing inflammation, fever and chills. Results in serious adverse effects of clotting, bleeding, inflammation, shock. 
    • Septic shock is a possibility, gram (-) must be treated slowly for this reason. (endotoxins) release upon death
  7. Course of Infection
    • Incubation
    • Prodromal Period- feel a cold coming on
    • Period of illness-acute phase with S&S
    • Convalescent period-Containment of infection-antibodies/ antibiotics. Sometimes permanent damage depending on pathogen.
  8. Biofilms
    bacteria release extracellular matrix to attach to each other and objects-they can be beneficial or cause trouble
  9. Broad vs narrow spectrum
    • Culture and sensitivity (C&S) to help etermine if narrow or broad spectrum atibiotics are best. 
    • Broad spectrum: attacks all bacteria negative and positive.
    • Narrow spectrum: depending on antibiotics-it will target only negative or positive bacteria.
  10. Penicillins
    contains beta-lactam ring that is substituted into the peptoglycan chain preventing cell wall construction. Allows water to enter the cell. 

    • Used for gram positive bacteria: strep, staph. 
    • treats: –Pneumonia; meningitis; skin, bone and joint infections; stomach infections; blood and heart valve infections; gas gangrene; tetanus; and anthrax.
  11. aminopenicillins (principen)
    • affects gram positive and some negative
    • observe for hypersensitivity reaction that occurs 5-10 days after treatment initiated.
  12. Penicillins adverse effects:
    Rash, pruritus, diarrhea, nausea, fever–Anaphylaxis: angioedema, circulatory collapse, cardiac arrest, nephrotoxicity
  13. Penicillin resistance
    • –Beta lactamase/penicillinase
    • Bacterial enzyme that splits the penicillin’s beta lactam ring
  14. Penicillin G
    Narrow spectrum-gram positive bactericidal
    Any gram positive infections-Strep, staph most common.
  15. Penicillins
    penicilinase resistant
    naficilin (Unipen)
    used for pencilinase producing staph. administer slowly 500mg-1g every 4 hours.
  16. Extended spectrum penicillins 
    Pipercillins 2-4g every 6-8 hours
    • Broad spectrum and additional activity against pseudomonas aeruginosa
    • neutralize bacteria secreting enzyme- beta lactamase
  17. Cephalosporin
    • largest antibiotic class
    • do not administer within 2 hours of an aminoglycoside
    • rash may develop/ signs of allergic reaction up to 7 days after treatment
    • Contraindicated for pt. with a severe allergy to penicillin. 5-10% of pt. will have an allergic reaction if they're allergic to penicillin
  18. 1st Gen-cefazolin sodium (Ancef)
    • used for gram positive bacteria
    • Diseases: Strep and staph
  19. 2nd generation Cephalosporin
    cefotetan (cefotan)
    • has broader spectrum than 1st gen however these have been replaced by 3rd generation.
    • Diseases: –S. Aureus–Streptococci–Haemophilus influenza–E. Coli–Klebsiella pneumoniae
  20. 3rd generation cefotaxime (Claforan)
    • Even broader than 2nd gen or 1st gen. Targets more gram negative-resistant to beta lactamase
    • disease: –Enterobacter, Neisseria gonorrhea, citrobacter
  21. 4th and 5th Gen Cephalosporin
    Can enter CSF to fight infections. Broader range than previous generations.
  22. Tetracyclines
    (Sumycin, Doxycycline, Vibramycin)
    protein synthesis inhibition
    • Therapeutic class:Antibacterial
    • Preg Cat: D
    • MOA: PO/topical  Broad spectrum Positive and negative bacteria-protein synthesis inhibition
    • Indications: Rocky Mountain, Spotted Fever, Typhus, Cholera, Lyme disease, Peptic ulcer disease
    • Contraindications:<8 y/o, and hypersensitivity 
    • Adverse: photo-sensitivity, tooth discoloration, potential for C-Diff. 
    • Interactions:Milk will decrease the efficacy
    • Lab Values:
  23. Aminoglycosides 
    gentamicin (Garamycin)
    Protein synthesis inhibition
    • Therapeutic class:Antibacterial
    • Preg cat: D
    • MOA: IV/IM
    • Indications: Serious infections caused by aerobic, gram-negative bacilli. (Enterobacter, E. Coli, Klebsiella, Pseudomonas, Serratia)
    • Contraindications: renal failure, hepatic failure, hypersensitivity 
    • Adverse: Nephrotoxicity, Ototoxicity
    • Interactions:–Give IV aminoglycosides and extended spectrum penicillins at least two hours apart.
    • Lab Values: BUN
  24. fluoroquinolones
    ciprofloxacin (Cipro) levofloxacin, Levaquin.
    • Therapeutic class: Antibacterial
    • Preg Cat: C
    • MOA: IV/PO/Ophthalmic Widely used broad spectrum-Infuse over an hour.
    • Indications: Enterobacter, E. Coli, Haemophilus, Klebsiella, Proteus, Staphylococcus, Shigella, Salmonella
    • Contraindications: hypersensitivity
    • Adverse: rash, diarrhea, nausea, vomiting, headache, irritability-High does can cause neurotoxicity.
    • Interactions: concomitant tizanidine (muscle relaxant) (zanaflex) administration with
    • Lab values:
  25. Misc anti-infective
    Metronidazole (Flagyl)
    • Therapeutic class: Antibacterial, Antiprotozal
    • Preg cat: B
    • MOA: nitroimidazole, diffusion into cytoplasm of anaerobic bacteria-results in inhibition of DNA synthesis resulting in bacterial death. 
    • Indications: anerobes and serious infections, abscess, deep wound infections, pre-op colorectal surgery. 
    • Contraindications: alcohol at least 3 days after, concomitant use of disulfiram, hypersensitivity
    • Adverse: GI discomfort, abnormal taste, diarrhea, nausea, dizziness, headache, candida infection of genital region, vaginal discharge, vaginitis.
    • Interactions: 
    • Lab values:
  26. Sulfonamides
    Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
    inhibition of metabolic pathways
    • Therapeutic effect: Antibacterial
    • Preg Cat: D
    • MOA: Infuse over 60-90 mins, 
    • Indications: Commonly used for UTI prophylaxis and treatment; and pneumoncystitis carinii pneumonia
    • Contraindications: Hypersensitivity, hepatic damage/impairment, infants younger than 2 months, severe renal insufficiency.
    • Adverse: Rash, urticaria, nausea, vomiting, hyponatremia, C-diff, neutropenia (blood dyscrasia)
    • Interactions: 
    • Lab Values:
  27. Antimalarials-Plasmodium flaciparum
    artemether and lumefantrine
    • Therapeutic class: antimalarias
    • Preg Cat: C/D
    • MOA: Inhibit nucleic acid and protein synthesis
    • Indications: Prevention and treatment of malaria
    • Contraindications: Take with food and avoid grapefruit juice. Many adverse effects.
    • Adverse: Palpitations, abdominal pain, diarrhea, loss of appetite, nausea, vomiting, arthalagia, many adverse effects with high occurrence. 
    • Interactions: Mefloquine is possible. many possibilities.
    • Lab values: unk
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Infections Pharm/info
nursing infectious disease pharm