pharm 5 set 3

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kbryant86
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249348
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pharm 5 set 3
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2013-11-27 17:31:17
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pharm 5
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  1. 3 ways that anitmicrobials work
    • disrupt cell wall (mammals have no cell wall)
    • inhibit of unique microbial enzymes
    • disrupt bacterial protein synthesis
  2. bacteriostatic
    vs
    bacteriocidal
    static= slow microbial growth but do not cause cell death

    cidal= directly lethal to bacteria at clinically achievable concentrations
  3. 4 types of antimicrobial resistance
    • dec [ ] of drug at the site (dec intake, inc export)
    • Inactivate drug (enzyme- beta lactamase)
    • Alter drug target receptor (change own structure)
    • Produce antagonist (block receptors)
  4. misuses of antimicrobials
    • untreatable infections - virus
    • incomplete Tx
    • idiopathic fever
    • improper dosage
    • lack of id of microbe
    • omission of surgical drainage
  5. supra/superinfection
    show up during treatment for of primary infection
  6. what drugs weaken the bacterial cell wall?
    • penicillins
    • cephalosporins
    • carbapenems
    • monobactums
  7. penicillins
    • weaken cell wall, causing fluid intake and rupture
    • bactericidal
    • bacterial resistance
    •  - Gram neg wall is impervious to peni
    •  - beta-lactamase inactivates peni
  8. classifications of penicillins
    • narrow spectrum penicillinase sensitive
    • narrow spectrum penicillinase resistant
    • broad spectrum
    • extended release
  9. Beta-lactamase inhibitors
    • Not given alone
    • Must be prepared in combo with peni's
    • Boost peni action
  10. MRSA
    methicillin resistant staph aureus
  11. penicillin allergy
    • type 1 hypersens
    • mild to life threating

    Use Cephalosporin for pt. with allergy
  12. Tx of penicillin allergic rxn?
    Epi and resp. support
  13. Cephalosporin
    • weaken cell wall
    • most widely used group
    • Beta-lactamase resistant
    • similar to peni in structure
    • bactericidal like peni
    • eliminated by kidney

    se= allergy, bleeding (interfre with Vit. K), thrombophlebitis, ETOH
  14. classifications of cephalosporins

    (generations)
    • next gen cephlo's attempt to be more:
    • -beta-lactamase resistant
    • -effective against gram negs
    • -able to reach CSF
  15. carbapenams
    • cell wall weakener
    • not effective against MRSA
  16. Monobactams
    • cell wall weakener
    • narrow spectrum gram neg
  17. Vancomycin / Lyphocin
    inhibits cell wall synthesis

    • used for severe infections 
    •  - MRSA, C-Diff

    • SE= ototoxicity
    •  = thrombophlebitis
    •  = allergy
    •  = RED-MAN SYNDROME

    best to give slow in central line if possible
  18. list of Bacteriostatic inhibitors of protein synthesis

    (1-5)
    • tetracyclines
    • macrolides
    • clindamyacin
    • Chloramphenicol
    • Newer drugs
  19. Tetracyclines

    -absorption
    -side effects
    • inhibit protein synthesis
    • Broad-spectrum antibiotic
    • bacterial entry system w/o getting into mammal cells

    absorption - cut out dairy while using

    SE= GI, discolored teeth, superinfect, photosensitivity, hepatotoxicity, renal toxic
  20. Macrolides / Erythromycin
    • protein synth inhib
    • broad spectrum antibiotic
    • Use these and cephalo's if allergic to peni

    SE= sudden cardiac death, GI, cholestatic hepatitis, superinfect
  21. Clindamycin / Cleocin
    protein synth inhib

    can cause super infect w/ C-Diff and bloody mucous stool

    Indicated only for certain anaerobic infections located outside the CNS
  22. Linezolid / Zyvox
    • new protein synth inhib
    • Oxazolidinone classification

    • acts against mutli-drug resistant microbes
    •  - VRE and MRSA
  23. Tigecycline / Tygacil
    • new protein synth inhib
    • Glycylycline classification

    acts against broad spectrum of resistant microbes
  24. Aminoglycosides
    • narrow spectrum antibiotic
    • create abnormal cell wall protein

    resistance is growing

    watch peak and trough very closely with this drug
  25. Aminoglycosides adverse effects
    • nephrotoxicity
    • otoxicity
    • hypersens rxns
    • nueromuscular blockade (Ca+ salts)
    • drug interactions (w/ penicillin in particular)
  26. Gentamicin / Garamycin
    Aminoglycoside

    used for serious infections caused by aerobic gram-neg bacilli

    Has toxic SE's
  27. Sulfonamides / Sulfamethoxazol
    • 1st antibiotic
    • Inhib bacterial folic acid production

    used for UTI's

    • se= hypersense rxns
    •  = hematologic effects
    •  = kernicterus (bilirubin deposits in fetal brain
    •   --> Prego category X drug
    •  = Crystalluria
  28. Trimethoprim / Proloprim
    2nd gen sulfonamide

    UTI only

    still has Hematalogic effects
  29. Sulfamethoxazol-Trimethoprim / SMZ/TMP
    combo to dec dose and SE's

    Bactrim or Septra

    for uncomplicated UTI's
  30. two or more drug types are recommended for simultaneous use for TB b/c of resistance
    two or more drug types are recommended for simultaneous use for TB b/c of resistance
  31. two phases of TB Tx regimen
    • induction phase - 2 months
    • Continuation phase
  32. induction phase

    continuation phase
    • I= eliminate active TB
    •  = Isoniazid (INH)

    • C= eliminate intracellular "persisters"
    •  = still using INH
  33. DOT for TB
    • Direct Observation Therapy
    • can dose 2-3 times a week
  34. TB drugs will interact with HIV drugs
    TB drugs will interact with HIV drugs
  35. Isoniazid / Laniazid / INH
    • breaks down cell wall
    • introduce with other, continue by it self

    • se= peripheral neuropathy
    •  = vit B deficiency
    •  = Hepatotaoxicity
    •  = anemia
  36. Rifampin / Rifadin
    • broad spectrum antibiotic
    •  -TB, leprosy, H Flu, staph, legionella

    P450 enzymes increase, decreasing level of other drugs

    se= hepatits, discolor of body fluids
  37. Pyrazinamide
    • unknown mech of bacterial kill
    • will replace INH for TB

    se= hepatotoxicity, hyperuricemia, arthralgia
  38. Ethambutol / Myambutol
    • bacteriostatic --> prevents reproduction
    • Stops cell wall formation
    • used for TB multi drug regimens

    se= optic neurtits, allergy, hyperuricemia

    Active against all strands of MT
  39. Hansens disease
    Leprosy

    skin lesions, neuropathy, resp tract
  40. Rifampin, Dapasone, Clofazimine
    used together for leprosy
  41. Mycobacterium Avuim complex
    seen in chicken farmers

    resp lesions that can spread to any organ
  42. Azithromycin
    Clarithromycin
    preventative drugs used for myobac avium
  43. what else is added to the Azith. and Calrith. for breakout of an acute infection?
    Ethambutol
  44. Ciprofloxacin / Cipro
    • "floxin"
    • broad spectrum antibiotic
    • inhibits bacterial DNA

    DOC for Anthrax and GI infections

    SE= GI, HA, Candida of pharynx and vagina
  45. Metronidazole / Flagyl
    bactericidal

    • used for many GI infectious agents
    • DOC for protozoa infections

    SE= neurotoxicity, allergy, superinfections

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