Pharm Antibiotics part 1

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cswett
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134981
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Pharm Antibiotics part 1
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2012-02-13 15:05:51
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Pharm Antibiotics part 1
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  1. Drugs that effect bacterial cell wall:
    • beta lactams - cell wall lysis by damage to peptide chains
    • -penicillins
    • -cephalosporins

    • glycopeptides- cell wall lysis by damage to peptide chains
    • -vancomycon
  2. Antibiotics that effect ribosomes
    Antibiotics that effect ribosomes - stop protein synthesis-

    • -Aminoglycosides
    • -Macrolides
  3. Antibiotics that effect bacterial DNA
    • Antibiotics that effect bacterial DNA
    • - Sulfa's
    • -Quinalones
  4. Gram + bacteria (types)
    Gram -
    • Gram + - accept gram stain
    • Staph
    • Strep
    • MRSA

    • Gram - do not accept gram stain
    • e. coli
    • pseudomonas aurogenosa
  5. Empiric Therapy
    Empiric therapy (1st) - "best guess" therapy - based on knowledge that certain types of bacteria causes certain signs & symptoms

    • Skin & soft tissue infections tend to be gram (+)
    • UTI's tend to be gram (-)

    Broad spectrum anitbiotics - kills most gram (+) OR gram (-) bacteria
  6. Streamlined Therapy
    • 4 reasons why we streamline:
    • 1. Antibiotic that cost less - broad spectrums tend to cost more
    • 2. Less toxic -
    • 3. decreases resistance
    • 4. decreases super infection - secondary infection on top of original infection
    • - - community: candida vaginitis
    • - - hospital: c. Diff leads to speudomembranous colitis
  7. Resistance
    Natural Selection
    • Resistance - loss of an antibiotics ability to achieve a therapeutic outcome
    • antibiotic resistance was always there - antibiotics comes from natural sources so the bacteria have some innate ability to overcome
    • Natural selection - wimpy strains killed off first - leaves strong ones to reproduce-selection pressure: Antibiotics
  8. How to minimize resistance
    • 1) timing - dont miss doses - allows bacterial regrowth
    • 1 x day - take same time each day
    • 2 x day - q 12 hours
    • 3 x day - q 8 hours
    • 4 x day - q 6 hours - get up in middle of night to take dose

    • 2) Finish Antibiotic
    • 3) DON'T SHARE
    • 4) Don't save for later - reconstitution only good for 10 days -left overs are not enough to kill all bacteria- old antibiotics can become toxic (nephrotoxic)

    5) Documented need - many people want to take antibiotics for viruses
  9. PCN - Penicillins
    Generations
    • penicillins
    • - P.D. lyse cell walls -
    • - P.K. go straight to renal secretion - check BUN and Creatinine
    • - - Allergic - anaphalactic - document allergy and reaction

    • 1) First Gen - Natural penicillins - Pen V, Pen VK, cover G (+) > G (-)
    • 2) Sec Gen - Antistaphylococcal - methicillin, oxicillin G (+) > G (-)
    • 3) Thir Gen - Aminopenicillins - Amoxicillin G (+) = G (-) - - Amoxicillin used frequently
    • 4) For Gen - Antipseudomonal - pipracillin G (-) > G (+)
  10. PCN resistance & how to overcome
    PCN Resistance = Beta lactamase - common form of resistance - lytic enzyme that is produced by bacteria

    • Beta lactamase inhibitors - able to overcome enzyme based resistance- gives new life to old antibiotics-clavolanic acid
    • Amoxicillin + clavulanic acid = Augmentin
  11. Caphalosporins
    Generations
    • - Prefix - cef- or ceph
    • -PD: lyse cell walls
    • -PK: straight to renal excretion
    • Allergy: Cross allergy : , 2% to about 14% (beta lactam - so if Ax to PCN may have Ceph also

    • Generations:
    • 1st - Gram (+) > G (-)
    • 2nd- G (+) = G (-) - CYA - most often prescribed
    • 3rd- G (-) > G (+)
    • 4th - Maxipine (cephapine) drug of last resort - only used on really nasty bugs

    Prophalaxis - before surgery - easier to keep out than get out after its moved in

    Cephs have some inherant resistance to beta lactamase
  12. Vancolmycin
    • Glycopeotide antibiotics (cell wall lysis) most are IV route only (PO forms affect C. Diff only)
    • - Vancomycin - not absorbed by PO route
    • -PD: lyses cell walls, Covers G (+) only - kills MRSA-Vanc works slower than PCN & Ceph
    • -PK: Renal excretion - check BUN/CR - therapeutic window -


    MRSA = Vancomycin is the only drug that works
  13. Vancomycin SE/ADV
    • toxicity
    • oto & nephrotoxicity - nephro = BUN/CR
    • oto = hearing - is hearing affected?

    • Redman/ Redneck syndrome - vancomycin toxicity infustion rate related systemic histamine release Pseudoallergy - fake - looks like allergy but not an allergy
    • give hives on face, neck & torso - not life threatening watch for systemic drop in blood pressure

    -Remedy - slow down infusion rate (lengthen the infusion time) - most institution run vanco over 90 minutes so run it up to over 2 hours

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