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classes of anti-infective agents
What are antibiotics?
medications used to treat bacterial infections
What is one of the most important things that should be done before the administration of antibiotics?
culture and sensitivity before therapy
Why should you obtain a culture and sensitivity?
to identify exactly what is needed to treat the bacteria
what is going to be given before the results of the C&S comes back from the lab?
a broad spectrum antibiotic
What are some ideal characteristics that should be in the antibiotics
- selective toxicity with minimal side effects - easy to tolerate
- bactericidal rather that bacteristatic
- narrow spectrum rather than broad
- low cost for the consumer
- adequate bioavailablity
What are the antibacterial target areas?
- cell wall
- nucleic acid
- cell membrane
which antibiotics inhibit cell wall synthesis?
which antibiotics inhibit protein synthesis?
which antibiotics inhibit nucleic acids and replication and transcription?
Which antibiotics inhibit synthesis of metabolites?
Which antibiotics cause injury to the plasma membrane?
- Polymyxin B
- amphotericin B
2 mechanisms that work against the bacteria
- bactericidal - kills quickly
- bacteriostatic - slow death
What is a nosocomial infection?
hospital acquired infects
How do clients acquire nosocomial infections?
- clients have decreased resistance
- immunocompromised before they come in
- staff not using good universal protection
What are some nosocomial infections?
- Staph (skin & lungs)
- Pseudomonas (lung & wounds)
- Proteus (wound and UTI)
What are some things that need to be know about the bacteria to be treated?
- type of pathogen (C&S)
- site of infection
- defense mechanism of host
What are the defense mechanisms of the host?
- nutritional status
- organ function
How does age have to do with defense mechanism of the host?
Very young and elderly are most effected. Elderly usually have decreased renal and hepatic function
How does nutritional status effect the defense mechanism of the host?
vit c and protein necessary for health cells
How does immunoglobulin effect the defense mechanism of the host?
if in renal or liver failure, not producing immunoglobulin
How does the organ function effect the defense mechanism of the host?
liver produces immunoglobulin
How does ciruclation effect the defense mechanism of the host?
- heart is not working enough
- inside arteries are clogged with cholesterol
- years of hypertension and the body stops sending blood to the toes and other non-essential parts.
What are some ways to solve the problem with bacterial resistance?
- increase research
- appropriate drug use
- HAND WASHING by healthcare
- quick id and isolation of pt
What are some antibiotic resistant microorganism?
- Methicillin Resistant Strephylococcus Aureus MRSA
- Penicillin resistant Streptococcus (PRSP)
- Vancomycin Resistant Enterococci (VRE)
- Vancomycin Resistant Staph Aureus (VRSA)
Adverse reactions of antibacterials
- Allergic reactions
- organ toxicity
Pharmacokinetics of antibacterial?
- excreted via kidneys
- absorbed through the GI tract
- must penetrate the bacterial cell wall in sufficient amounts
- be able to bind to the bacterial cell
- half life
4 classes of Penicillins
- Broad spectrum
- Penicillinase Resistant Pencillins
- Extended-spectrum Penicillins
What are basic penicillins?
- Penicillin G (protype)
- Penicillin V
- also called beta-lactams
- Natural penicillins
What are broad spectrum penicillins?
- amoxicillin-clavulanate (Augmentin)
What is the most prescribed penicillin?
What do broad spectrum penicillins treat?
both gram - & gram + & bacteria
Is broad spectrum penicillins Penicillinase resistant?
what problems are broad spectrum penillins used for?
What are Penicillinase Resistant Penicillins?
- Cloxapin (cloxicillin)
- Dynapin (dicloxacillin)
- Unipen (nafcillin)
Are the penicillinase resistant penicillins used from Gram - or Gram +?
What are Extended-spectrum Penicillins?
Characteristics of Extended-spectrum Penicillins are?
- broad spectrum antibiotic +
What is added to Extended-Spectrum Penicillins to prevent breakdown and to extend coverage?
Beta Lactamase Inhibitor
What labs are used to monitor Extended-spectrum Penicillins, especially with geriatric clients?
What is the mechanism of action of penicillin?
- Alter membrane permeability
- Inhibit protein synthesis
- Inhibit syntheses of RNA and DNA
- Interference with metabolism of cell
how do bacteria work against antibacterials?
- bacteria produce enzymes capable of destroying penicilins
What causes antibacterials to not work?
What are scientist using to fight beta-lactamases?
clavulanic acid, bind with beta-lactamases and prevent the enzyme from breaking down the penicillin
What are side effects of Penicillins?
- abdominal pain
- anaphylactic reaction
- birth control less effective
what are the anaphylactic reactions?
- laryngeal edema
- bronchoconstruction with stridor
What is the combination that makes Augmentin?
amoxicillin & clavulanic acids
- Penicillin-beta-lactamase inhibator
- Inactivates beta-lactamase enzymes
- protects PCN and extends spectrum
- Available PO