Chemotherapy of infectious diseases
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What are pyrogens agents? Septicemia agents? What is selective toxicity? What is TI?
- Pyrogens: fever inducers.
- Septicemia: infection that has spread to the blood.
- Selectie toxicity: The ability to suppress or kill an infectious microbe w/o injury to the host. It is the way antibiotics work.
- TI: The way to evealuating the degree of selective toxicity.
What are the 3 most common ways for selective toxicity to work in bacteria? explain each.
- Disruption of the bacterial wall: Osmotic pressure is high inside the bacteria, but the cell wall prevents water from coming in and burst the bacteria. Several family of drugs (penicillins, cephalosporins) weaken the cell wall allow for water to penetrate and burst the bacteria. It does not cause damage to mammalian cells bc of the lack of cell wall.
- Inhibition of an enzyme unique to bacteria: sulfonamides inhibit an enzyme needed to make folic acid, a compound needed for B mammals and bacteria. However, bacteria cannot absorb folic acid from dietary sources, they can only synthesize it (Para-AmiboBenzoic Acid (PABA) --> Folic acid). Sulfonamides block this conversation and don't injure mammalian's cells.
- Disruption of bacterial protein synthesis: drugs can inhibit the synthesis of proteins in bacteria since ribosomes (proteins are done by ribosomes) are different in mammals and bacteria.
What is bacteriostatic? examples? Bactericidal? examples? antimicrobial spectrum?
- Bacteriostatic: inhibits the growth of microorganisms w/o directly killing the bacteria.
- Examples: icebox, operating room, etc.
- bactericidal: directly kill bacteria/microorganism.
- Examples: bleach, alcohol, steam for sterilization, etc.
- Antimicrobial spectrum: range of microbes against which the drug is effective. EX, broad spectrum.
What are nosocomial infections?
Infections acquired in hospitals and other healthcare facilities. Usually the pt was accepted for a reason other than the infection.
What is a superinfection? When do risk increases?
- Also called yeast infection.
- Occurs during the course of therapeutic/prophylactic microbial therapy- when the anti-infective kills the host flora.
- Risk increases when: Large doses of antimicrobial are used. More than one antimicrobial drug is used concurrently. Broad-spectrum drugs are used.
What are the Multi Drug Resistant Organism (MDRO's) examples?
- MRSA: Methicillin-Resistant Staphylococcus Aureus.
- VRE: Vancomycin-Resistant Enterococci.
- Drug Resistant TB (noncompliant pts)
- C-diff: Clostridum difficile.
What are drugs that weaken the bacterial cell wall?
- Cephalosporins, Carbapenems, vancomycin, aztreonam, and fosfomycin.
Penicillins MOA? Classification? AE?
- MOA: Weakens the cell wall which causes permeability. Bc of the high osmotic pressure, water goes inside the cell causing it to swell and burst. (bactericidal).
- * Most effective only against bacteria that is undergoing growth and division.
- Classifications: Narrow-spectrum pencillinase-sensitive (penicillin G and V).
- Narrow-spectrum: penicillinase resistant (Methicillin, Nafcillin, Oxacillin, Cloxacillin, dicloxacillin).
- Broad-spectrum penicillins (aminopenipenicillins): ampicillin, amoxicillin, bacampicillin.
- Extended-spectrum penicillins (antipseudomonal penicillins) : Carbenicillin infanyl, Ticarcillin, Mezlocillin, piperacillin.
- AE: Principal is allergic rxn, 3 major side effect of all antibiotics: Nausea, vomiting, and Diarrhea.
Where is Penicillin G (benzulpenicillin) most commonly used? what infection? AE?
- It is a broad spectrum, therefore, work for gram-positive and some gram-negative.
- Usually used in syphillis.
- AE: It is the least toxic and could cause the 3 major side effects.
What other antibiotic could be considered when there is a mild allergic rxn in the pt? what abt when there is a history of anaphylaxis?
- Is there a Hx of anaphylaxis, then neither penicillin nor cephalosporin should be consider for the treatment.
Cephalosporins MOA? Clasification? AE? TU?
- Cephalosporins: Similar to PCN, Bactericidal, usually given parentally in hospitals, Beta-lactam antibiotic.
- MOA: Disrupt cell wall synthesis, and causes cell lysis. Most effective against cells undergoing active growth and division.
- Classification: 1st to 4th generation. 3th and 4th generation most used.
- AE: Allergy, bleeding. Thrombophlebitis when given IV.
- TU: Most widely used group of antibiotics. Broad spectrum.
- 1st and 2th generation: rarely used for active infections.
- 3th gen: (cefotaxime) preferred therapy for several infections. Highly active against gram-negative. Able to penetrate to CSF.
- 4th gen: yet to be stablished.
Carbapenems? MOA? TU? AE? Examples?
- Beta-lactam antibiotic. Has an extremely broad antimicrobial spectrum with low toxicity. Not active against MRSA.
- MOA: weakening of the bacterial cell wall, causing leakage and burst.
- TU: Generally given parentally. Extremely broad spectrum and low toxicity. Therefore, it is used for a wide range of gram + and - infections.
- AE: Common 3 side effects.
- Examples: -PENEMS suffix. Imipenem (primaxin). Meropenem (merremIV), etc.
Vancomycin (vancocin, cancoled) MOA? TU? AE?
- Not a beta-lactam ring.
- MOA: Prevents bacterial cell wall synthesis, causing the cells to burst and die.
- TU: (IV and oral) Most widely ised antibiotic in US hospitals. Specially for C. Diff, MRSA, and serious infection in pts allergic to PCN.
- AE: Ototoxicity reversible or permanent, Red Man Syndrome, Thrombophlebitis (common), Thrombocytopenia (rare), allergy.
What the inhibitors of protein synthesis antibiotics?
Tetracyclines, Macrolides, and others.
Tetracuclines? members? MOA? TU? AE? Drugs and food interaction?
- Increasing bacterial resistant had emerged, that's why they are not being used as much)
- Names: -Cycline suffix. Tetracycline, Demeclocycline, Doxycycline, Minocycline.
- MOA: Inhibits protein synthesis.
- TU: Broad-spectrum antibiotic. Many uses: Rickettsial disease, chlamydia trachomatis, Lyme disease, Anthrax, acne, etc.
- AE: The 3 common ones, effect on the bones and teeth, superinfection, hepatotoxicity, etc.
- * Drugs and food interactions: Absorption of tetracyclines decreased if given with, Milk products, Calcium supplements, Iron supplements, magnesium-containing laxatives, Most antacids.
Tetracyclines nursing implications:
- avoid in pregnancy and children under 8.
- Contraceptive effectiveness reduces.
- Take on empty stomach with full glass of water.
- Do not take with milk products.
- Avoid strong sunlight and use sunscreen to avoid photosensitivity rxns.
Macrolides (erythromycin)? MOA? TU? AE? Names
- Usually bacteriostatic but can be bactericidal.
- MOA: inhibition of protein synthesis.
- TU: Broad-spectrum antibiotic. Active against most gram-positive and some gram-negative. Use if allergic to penicillin. Pneumonia, whooping cough, some chlamydial.
- AE: GI, QT prolongation and sudden cardiac death, Superinfection.
- Names: -Mycin suffix. Clarithromycin (biaxin), Azithromycin (zithromax- z-pack) Dirithromycin (Dynabac).
What are Linezolid (zyvox)? TU? MOA? AE?
- First member of a new class of antibiotics- OXAZOLIDINONES.
- TU: Active against multidrug-resistant gram-positive pathogens (VRE and MRSA).
- MOA: Bacteriostatic inhibitor of protein synthesis.
- AE: Diarrhea, Nausea and vomiting, Headache.
- May also cause myelosuppression (decrease in leukocytes, erythrocytes, and thrombocytes).
Telithromycin? TU? AE?
- First representative of Ketolides class of antibiotics.
- TU: effective against strains of Streptococcus pneumonia.
- AE: GI effects, gray syndrome, visual disturbances.
Dalfopristin/quinupristin or synercid? MOA? TU? AE?
- First member of streptogramins.
- MOA: Inhibit bacterial protein synthesis.
- TU: VRE and agricultural use.
- AE: hepatotoxicity.
Chloramphenicol (chloromycetin)? MOA? TU? AE?
- MOA: inhibits protein synthesis, but it targets all the cells.
- TU: only in life-threatening infections for which safer drugs are ineffective or contraindicated.
- AE: Reversible bone marrow depression, fatal aplastic anemia, gray syndrome, GI effects, peripheral neuropathy.
What are aminoglycosides? names? MOA? TU? AE? important about dosing?
- Names: -CIN suffix. gentamicin, tobramycin, Neomycin. amikacin.
- MOA: Disrupts bacterial protein synthesis.
- TU: narrow-spectrum antibiotics, Bactericidal, use against aerobic gram-negative bacilli. Use parentally.
- AE: Nephrotoxicity, ototoxicity, etc.
- Monitoring of serum levels is common bc the same dose can cause different rxn in different pts. The levels should be high enough to kill the bacteria, but low enough to minimize toxicity. (narrow TR, all weight based)
Nurse implications with aminoglycosides?
- Discuss toxicity before giving to the pt.
- Monitor BUN, CBC, LFTs, creatinine - and serum drug.
- get cultures and sensitivity prior to initiating therapy.
- Assess for burning and numbness with streptomycin.
- Monitor I&O, and hearing.
Whats common b/t sulfonamides and trimethoprim?
- Broad-spectrum antibiotics.
- B have closely related mechanisms
- Suppress bacterial growth.
- Used for UTI.
Sulfonamides? MOA? TU? AE? Drug interaction?
- First drugs available for systemic treatment of bacterial infections. (more effective and less toxic drugs now available)
- MOA: Inhibition of synthesis of Folic acid.
- TU: UTI. other uses chlamydia trachomatis, Conjuction therapy for toxoplasmosis/malaria, ulcerative colitis.
- AE: Hypersensitivity rxn -steven-Johnson syndrome (itching and pain, histamine release, kind of common with the red-men syndrome)
- hematologic effects (response of blood cells to radiation)
- DI: Metabolism-related interactions and allergy-inducing drugs.
Trimetroprim (proloprim and trimpex) TU? AE?
- TU: acute and uncomplicated UTI.
- AE: hematologic effects and could be use in pregnancy and lactation.
Trimethoprim-sulfamethoxazole (TMP-SMZ) MOA? TU? AE?
- MOA: Inhibits better the sequential steps in bacterial folic acid synthesis. More powerful that each drug by itself.
- TU: UTI, otiti media, bronchitis, GI infections, others.
- AE: GI (nausea and vomiting), rash, Stevens-johnson syndrome.
What are the most common nurse implications when using sulfamethoxazole?
- Assess for side effects.
- Monitor I & O.
- Take with full glass of water and food to prevent GI side effects.
- Monitor glucose in diabetic pts.
what is Pyelonephritis? Cystitis? what is the primary cause?
- Pyelonephritis: Inflammation of the substance of the kidney as a result of bacterial infection (upper UTI)
- Cystitis: Inflammation of the urinary bladder. It is often cause by infection and is usually accompanied by frequent, painful urination.
- Cause: Usually bacterial, E. Coli.
Urinary tract antiseptics? MOA? TU? AE?
- Nitrofurantoin (furadantin, macrodantin, macrobid)
- MOA: Bacteriostatic (low concentration) bactericidal (high concentration)
- TU: lower UTIs, prophylaxis, recurrent lower UTIs.
- AE: GI effects, pulmonary rxns, hematologic effects, peripheral neuropathy.
Treatment for TB? What are the first line of drugs?
- The only treatment for TB is long-term (6 to 24 months) frug therapy.
- Most TB drugs work by inhibiting growth rather than killing the organism.
- Always treat with 2 or more drugs.
- Direct observation therapy (DOT)
- 1st line of drugs: Isoniazid, rifampin.
Isoniazid? MOA? AE? TU?
- Primary agent.
- MOA: Bactericidal.
- AE: Peripheral neuropathy, Hepatotoxicity (get LFTs)
- TU: TB treatment.
Rifampin (rifadin) MOA? TU? AE? DI?
- MOA: Broad-spectrum antibiotic.
- TU: TB, leprosy, etc.
- AE: It causes yellow color. Hepatotoxic/hepatitis.
- DI: oral contraceptives, Warfarin, drugs for HIV infection.
Nurse implications for Rifampin?
- Take on empty stomach with full glass of water.
- Warn pt abt change in color of body fluids.
- Stress importance on taking medication on time and completing entire course of drug therapy.
- Oral contraceptive may not be effective.
What are the miscellaneous antibacterial drugs?
Fluoroquinolones, metronidazole, bacitracin, and polymyxins.
Fluoroquinolones name? TU? MOA? AE?
- Name: Ciprofloxacin (cipro)
- MOA: Broad-spectrum agents (gram - and some +) with multiple applications. Disrupt DNA replication and cell division.
- TU: Orally or IV. multiple systems: Anthrax, respiratory infections, UTI, GI, bones, joints, skin, and soft tissue.
- AE: Could cause tendon rupture (low risk) usually affects the achilles tendon, avoid in pts younger than 18 yrs.
- Mild: GI 3 common, CNS (dizziness, headaches, restlessness, confusion, rarely seizures) Candida infections-pharynx and vagina.
- Elderly pt: they get a little bit more confused and psychosis.
Metronidazole (flagyl) MOA? TU? AE:
- MOA: Bactericidal.
- TU: protozoal infections mainly.
- AE: Neurotoxicity (neuropathy, difficult concentrating, etc) Sun exposure, Allergy, superinfection.
Bacitracin? Polymyxin B?
- Almost always used topically for bacterial infections.
- Systemic can cause serious toxicity.
- Polymyxin B: topical treatment for ears, eyes, and skin. Skin treatment usually in combination. Not used for systemic infections (toxicity risks)
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